Heather56

Were I work, Victoria bc, we have well written P & P for use of subcu butterflies. A differrent one is used for each med and they are primed with the particular med so no flushing. as the med is sitting in the subcutaneous tissue and slowly being absorbed by the body I would imagine use of more than one substance at the site would cause irritation. Also flushing with saline would actually be adding saline to the medication in the tissues and could change the effectiveness of the medication.

Vancouver Island Health Authority has 164 registered nurse and psych nurse positions posted this week on it's public postings, that's not counting internal postings. VIHA covers vancouver island and some areas on the mainland.

I'm sorry Fiona59 has had such bad experiences with ESNs. We have had them in the er I work in and, although there can be exceptions, generally they are very helpful. I would certainly recommend going for your RN and forgetting the LPN route. Good Luck and maybe our paths will cross at some point!

I've been almost relieved to see a familiar face when waking in PAR or on the floor. I have also looked after co-workers and others I know. I've looked after family members of friends and they seem to be happy to see someone they know. I think it would depend alot on what they are there for and the kind of care needed.

This is a hard issue to answer as we don't know the circunstances. I know, though, that in the job qualifications for nursing jobs at my place of work is that the applicant have the "physical ability to perform the duties of the position"

In BC canada the only one who can give instruction to the paramedic is the er doctor at the receiving hospital. Certainly no other health professional including drs have any say at the scene. I have to say that having been the one stuck in the car after hitting a tree on a dark stretch of highway I appreciated everyone who stopped to help.

best of luck to you minmi, just don't get ahead of yourself, I'm sure you know all the sayings!

I know we've all had the pt who's allergic to most pain meds. I am one of those who is actually allergic to all nsaids, I have severe asthmatic reactions to them. It's fairly common with people who have asthma and nasal polyps. I certainly have gotten the "look" from nurses and docs when I tell them though. It does make me get a bit more history when pts tell me they are allergic.

First I would just like to say I am not under any circumstances advocating alcohol or drug abuse. However, that said, we see alot of young people in the ER who are experimenting. There are some times of year where it's particularly bad such as the first week of University/College. The ambulance arrives transporting a drunk, puking young lady and her almost as drunk but, thankfully, not puking boyfriend/date. He didn't know what to do with her. Or it's transporting a very drunk fellow and is closly followed by a group of friends who, again, are almost as drunk. He was having trouble walking so they called and ambulance. The other classic vists are the "I just smoked some marijuana and now I feel weird, I just did some cocaine/crystal meth and my heart's racing, I just did some heroin/sedation and I feel like passing out." My response "and what did you expect to happen?"

Managing my time was the most difficult thing for me. No amount of school training can prepare you for all the things that crop up during a shift. One thing I took from my training was med checks. With frequent news artlicles about med errors it's taking the time to go threw the checks that make the difference between an error and an almost error.

I'm bad with remembering names so use "Dear" alot with patients. Being 51 I can get away with it with both young and old. I have never had a negative reaction to using dear however numerous times I have been corrected when I've used Mrs with an elderly woman who is a Miss!

Last night had a patient come in with a rash. brought him in out of the wr to a chair right away as I was concerned about scabies. Pt proceeded to make rude comments to me everytime I walked by him. After he had been in the dept for 20 min heard a loud voice in the wr and turned in time to see my pt, pants down and rash covered bottom displayed saying we were all idiots as he toddled out the door. hmmm The issue of pt behavoiur and duty to treat was addressed by our nursing association recently in their magazine. They said that, although we did have a duty to provide treatment/care, we also had to consider the safety of others in the wr and of staff. In our er if a pt becomes loud and verbally aggressive or bothers other pts we call security. They will read the pt the riot act and if the pt refuses to behave he/she will be escorted off the property. This is actually quite rare as these pts do have enough sense to realize that they won't get anything if they don't behave. It's after they've been seen and d/c (after getting some ibuprofen) that they really start to scream at us but security just arrange for them to get a personal ride with the local police.

See this frequently here. I believe, though, that once retired they lose all their seniority so are at the bottom of the casual list. Mind you with the shortage of nurses that still means they can work lots if they want.

I have a hard time with calling 911 to avoid an er wait. If I had been triaging this patient I would have looked at all the factors, no sob, easy resps etc and triaged her accordingly regardless of how she arrived. It's a common misconception in our et dept that pts in ambulances get seen first. Heather

-Family Doctor or specialist calls in saying, "sending so & so to emerg for x reason". Patient arrives and is upset that they aren't immediately rushed to front of line, their Dr made an appointment! -Pt calls ambulance from pay phone downtown with c/o pain somewhere (I have a good suggestion!) is triaged, downloaded into the waiting room or on a stretcher then disappears. Check of pt information finds pt lives 2 blocks from ER. Of course they don't pay for the ambulance as they are on assistance or are destitute. Some even make sure they get as much food as they can get out of us before they disappear. -Pt who keeps asking when he'll be seen (every 5 minutes), when finally gets a stretcher (after having to be called numerous times as outside for smoke, gone for coffee, etc.) again asks when Dr is coming. Asks to use phone then 1 minute after he hangs up Grandma calls and reams out nurse for Grandson not being seen immediately and that he is in soooo much pain. (He has a tooth abscess, never went to a dentist, and didn't take own morphine before coming in as figured he'd just get it from us.) -Pts who closely watch for your reactions when they give details at triage, my pain is a 6/10, no an 8/10, no a 10/10! I have pain in my stomach, well no across my whole front, well no in my chest, well no chest and down arms! -And, finally, how often the horrible symptoms the patient has had for days, vomiting, diarrhoea, bloody stools, etc, disappear as soon as they arrive in the ER and never are seen again even though they are there for 8 hours. It's amazing the cure one gets just walking (or being carried) through those ER doors.

I just read your thread and am wondering which province you are working in. I know in BC the BCNU addresses many of the issues you describe quite clearly in our contract. You should talk to a union rep, after all dealing with issues like these is what we pay union dues for!

The classics we get are the males (I can't call them men) between 20 and 40 who come in with: vomitted x 1 - 8 hrs ago, nausea (as they sit there with their coke and chips), rash, and various aches and pains. The one thing they all have in common is that they are single, have recently moved here to work or go to school and Mommy is back home in what ever town they came from. It's also very hard to "encourage" these guys to go to a clinic instead, they would rather sit in the ER waiting room for 8 hrs with lots of complaints of course. Rain at night brings the regulars that normally sleep in doorways, it's amazing how knowledgable they are about how triage works, they know which complaints will get them a stretcher right away. On the opposite end of the list are the people who are dragged into the ER by wives or husbands in the midst of an MI or stroke, "Oh come on dear it's just a little indigestion!"

About a year ago I got my first tattoo and since then have gotten several more. I have alot of work on my left forearm, celtic knots and shading. I have not had any problems at work and have only recieved positive comments from patients (maybe the tats discourage negative remarks!) I work in ER so have contact with all kinds of people. During one recent shift I had 3 different patients with chest pain, all well-dressed women in their 70's. Each of them grabbed my arm and asked about my tattoos with great interest. I generally tell people the tats are my midlife crisis and, at 49, I don't have to go through the hassle of my parents telling me I was ruining my life!

I agree that male nurses can be just as catty as female. The last place I worked had a group of nurses who were the ultimate of catty ie "mean girls". The problem was that they also jumped at the chance to have preceptor nursing students and would train their students in their art! I think there are many reasons why nurses are catty. I have found however that the cats are usually in packs (prouds?) and this can destroy the moral on a unit. I have to say the area I presently work in is much better.

I agree that some patients and their families act angerly when they are just terribly stressed however it's usually easy to separate them from the just plan ornery types. I've worked in neuro med-surg and am now in the ER and have been called everything in the book, usually be family members. Do you notice how the "big manly" fellow who is willing to get right up in your face with threats backs right down to mr congenilality as soon as security arrives? I've even had patients do the old "hey I'm a good old guy that nurse just couldn't take a joke" to security after he'd just finished explaining to me what was going to happen to me if I persisted in telling him he was discharged. I am not good at handling rude obnoxious people. I just state I don't need to listen to that kind of talk and will return with security, luckily our security are excellent men and women and very supportive.

I would like to know what type of RN/Pt ratios nurses are working with in ER depts in Canada. In the department I work in out of aprox 25 beds it is not unusual to have 15 admitted pts. As well pt's are lined up in halls, on benches and any spare spot. And these are the pts that have been admitted into the er. It's not unusual to have 6 or 7 pts, some waiting for hospital beds (as long as a week) and some ER pts with bleeds, chest pain, etc. Everyone in our department seems to be burning out fast with no solutions in sight. thanks for any info.

jellybean1 you wrote "Just wondering what your thoughts are on what is happening with the government/health authority plans to replace/displace RN's." HMMM would that be what is happening this week, last week or next week. Things seem to change as fast as the names and areas in each health authority! My concern in the area I work is the serious lack of direction in job descriptions. We work with the Most Responsible Nurse designation but also have LPNs on the ward. They are being encouraged to expand their scope of practice although to what extent no one really seems to know. I was an LPN before continuing on to be a RN and am not trying to put anyone down. Realistically, though, as the LPNs are encouraged to do more it's my job I see going out the window and I am not about to just passively let that happen. The government and health authorities are, on one hand, looking at more ways to get new nurses into the field with various programs. On the other hand they seem to be decreasing the number of RN positions by bringing in LPNs. Interestingly no-one seems to be working on more ways to get new LPNs in the field. On our unit we often work short because no-one is available to replace a LPN off on sick leave or vacation and we are discouraged from calling in an RN because it's an LPN position. Anyway, that's my rant and, that said, I still wouldn't live anywhere else so I guess I'll just deal with it. Also past experience has shown me that alot of the problems we have are pretty much found right across Canada.

Joeknee, I too like the Deauville scrubs. I was at Marks Wearhouse today and they are carrying them (at least in Victoria).

Dennie, it's called a Dermoid cyst or a teratoma. One theory is that it is a twin ovum that is absorbed by the first and just stays inside slowly growing. You know how every once in a while a tabloid boasts about some man being pregnant? It's probably just a large Dermoid cyst growing in his abdomen!

Kelly, if ICU is where you want to be hang in there. In a similar situation I allowed the nurses involved to intimidate me into leaving ICU and returning to the ward I had been on before. Unfortunately I didn't realize how much support I had there from the majority of nurse until after I'd gone. About 3 months after I had left one of my patients on the ward coded. The ICU nurse who came to the code took me aside after and told me I had done well and why didn't I come back to ICU. Even 6 years later ICU nurses I worked with back then still tell me I should come back! I think what often happens is that the "difficult to work with" nurses end up all together as most others try to move to other shifts. This also means new staff often end up working with this "select" group. Hang in there and good luck.