azhiker96

Highly recommend you purchase your own copy of the ASPAN standards. It is too easy for managers to try to bend the standards when they are being pressured by OR to just take a patient. The standards are the minimum safe standards, not a target or average of care. Excerpt from the ASPAN 2023-2024 Standards Study the standards and when you are ready, put in a Midas report when you or another nurse is given an unsafe assignment. Be sure to quote the ASPAN standard as well as the page, paragraph, date, etc. Be sure the tone is a desire to provide safe care within the recommended guidelines of our National organization. It can also help if you prepare and give an inservice to your department so that everyone is aware of the safe standards of care. Be aware that you may not change anything and only end up getting a target on your back. Some managers hate it when staff nurses push back. Be ready to find a better, safer PACU if needed.

Young women out earning young men in some major cities

My daughter is a college professor at a fairly liberal university. She has told me of a few instances where males were paid more than her even though she has better qualifications, teaches more classes, obtains more grants, and oversees more graduate students. However, her husband has not worked since they got married. Based on how the government reports the wage gap, in this case a woman is making more than a man. Add in my two step daughters who are both doctors and make more than their husbands, men are definitely paid less than women. Equal pay for equal work has been the law of the land for decades. I think the government needs to make sure their reporting represents gender based pay for equal positions instead of claiming overall gross earnings are a fair representation. I have seen an article or two that say for some younger cohorts women are paid more than men, largely due to young men not entering the workforce.

And a new guy moved into first place for ridiculous. Chief complaint was "I missed work today and need an excuse that I was at the ED. I thought about saying I had a cold but then you'd have to swab my now and I don't like that. So I told them I hurt my hand.” Me: Does your hand hurt? Him: " No, but I need a note that I was seen here for hand pain because that is what I told work.” Thanks to EMTALA we have to let him check in but with appropriate and accurate notes of his complaint. Good luck buddy.

I’ve also sometimes called it Status Dramaticus. It can be addressed with the appropriate IM med depending on pt Hx.

Hyperdraumademia is evident on inspection. I treat room temperature BP until it’s BP compatible with life. Most of our drunks and ODs end up MTF, metabolize to freedom.

Healthy 30 something male came in complaining that he had felt light headed at work 8 hours prior to entering our doors. He also had his discharge paperwork from the ED he had visited before coming to us. They had given him a liter of NS and a full work up but didn’t find a reason for his transitory experience. Since they didn’t have an answer for him, he came to us. I imagine that guy could still be on a lifelong mission to find out why he had that one particular episode.

I think all ERs should have a triage RN. When I work triage we occasionally have bypassed registration or sent a family member there while taking a pt to critical care. Most times we get an initial set of vitals but if they look sick enough we even bypass that step.

The shutdown is not without long term negative effects. Rural hospitals are hurting. This one in southern Arizona is the only hospital between Tucson and Nogales and might shut down. https://www.azcentral.com/story/news/local/arizona-health/2020/04/04/hospital-southern-arizona-says-may-have-close-due-covid-19/5119264002/ I also just read that Threadgills in Austin has decided they will not reopen. Other small businesses and restaurants are hurting.

I have refused a new admit in PACU three times because it would create an unsafe staffing. I could have been fired but taking the patient would have put the patient and my license at risk. It also would have violated national standards by ASPAN. We need national safe staffing laws. I hope she is able to get a tidy settlement.

Good experience. I've seen patients go apneic from 2 mg of Morphine and had pt's ask for Benadryl after a 6mg Dilaudid push. Individual patients respond differently. I would second the comment about a lower dose of Narcan. In the field or ED with an overdose pt it makes sense to give the full 0.4 mg amp. In PACU I usually titrate in 40 mcg doses or 20 mcg if peds. I want the patient breathing, not screaming. With my docs I can ask for a lower dose, and generally get it, based on my assessment and judgement. Narcotics should be titrated to effect but I know the Joint Commission don't seem to want or respect nursing judgement. Glad I work at a facility that uses DNV instead. In PACU I have several PRN meds for pain and give them based on patient history and response.

Depending on how hard your supervisor pushes this issue I'd also consider calling the compliance hotline or filing a Midas report. You should never be asked to document medications or treatments you did not give or perform.

I don't think disability discrimination comes into it. People with chronic pain can legally take narcotics with a prescription. However, BONs and employers don't allow nurses to work while under the influence of narcotics.

We give the meds the patient needs. I know pharmacy reviews the orders as quickly as they can but for the good of the patient I don't wait for that to occur. We have an EMR but also the ability to pull any medication for our patients. As a critical care area I think that is vital. I understand the hospital wanting the pharmacy check on whether the med, dose, route, etc is appropriate but when my pt has room temperature BP, stridor, severe bradycardia or any other life threatening condition I am not going to wait for a pharmacy sign off.

I think metal detectors and armed security is a good evidence based solution. That has been in use for several decades at many inner city schools. It was implemented in the US in response to gang violence. Israel implemented school security in the 1960s in response to a terror attack. I've heard the argument against saying the kids will feel like they are in prison. Please, the kids are smarter than that. They see metal detectors and armed security when they go to concerts and sports venues. If it is explained well the kids will accept it.