RunnerRN

But was it necessary to push the patient through the hallway without at least covering him up? I was literally shoved out of the way by the bed being pushed by the RT. It isn't about having more room, it is about the attitude that the staff had that we *couldn't* intubate in that room. And again, I dont' WANT to deliver a high risk infant in my trauma room, but you have to at least check the kid to make sure he can tolerate the extra 10 minute trip upstairs. What would happen if we let them breeze through the department and got upstairs and the baby wasn't survivable? All because the ER wasn't the ideal place to deliver. No one would be able to prove that kid was alive or dead when they came through the ER. I'm sure the ER would get slammed on that one. The attitude that we simply can't do something because it isn't the ideal situation isn't an excuse, and it is becoming all too pervasive in the department. It isn't about me having a casual attitude about RSI or any other aspect of my job. If you can't intubate an ideal patient in a less than ideal situation, then what happens when you HAVE to intubate an anterior patient in a less than ideal situation?

It seems that I've heard this more and more in the last few weeks. Ex 1: unk amount of OD comes into a psych room (smaller, has all the appropriate equipment, but kind of tight). Pt will open eyes to pain or strong verbal. Decision made to intubate....that's fine, this patient obviously can't maintain his airway. ER MD, tech, and RT freak out, "We can't do this in here!" and decide patient has to be moved to a bigger room before tubing. They proceed to move patient out IN HIS UNDERWEAR and go past several hallway patients. Sats were 100%, it was a prophylactic intubation - not due to any emergent medical issue. Ex 2: Mom w preterm labor coming in via EMS with known placenta previa. OB notified, ER physician insists patient be directly taken to L&D because "We can't deliver a baby in here." Um, we're the ER. We can handle it if the right people come down. Finally convinced MD we at least needed to check the baby first to ensure FHR still up. No, the ER isn't the best place to deliver a baby, but you can't take a mom upstairs (L&D is a 10 min walk) if the baby's HR is 70. Ex 3: I'll spare the story, but it pretty much encompassed "We can't code this patient in here." Seriously. Would you like me to tell her to wait until we get a trauma room open? What are people thinking? I'm an ER nurse, you're an ER MD. Give me the right equipment and we can tube in the bathroom if we need to. What drives me nuts is medics tube upside down in the rain, but my pampered docs can't handle it in a psych room.

They don't get ruined. Seriously. I've worked in this position (in a level I) for over 3 years and have worn the same white tops for almost that long. You just wash in hot water and use a little bleach. If you get them spotted with blood just grab some hydrogen peroxide and dab it on. Do people not have better things to do than whine about stuff like this? This is so small in the grand scheme of things....maybe we should worry more about staffing ratios and pay.

I'm guessing you're coming to work with me at John's. Don't even bother going against the dress code. It has been in place for over 4 years and really isn't that big of a deal. Charcoal stains anything, and of course you're going to change your scrubs if someone pees on them. Management has no problem with us calling the OR and getting the hospital scrubs if you get even a spot of blood on your top or bottoms. I actually like the dress code because everyone looks professional and you can really tell who everyone is....techs wear green, housekeeping royal blue, RT dark green, and transport maroon. Seriously, it isn't such a big deal that you should get your panties in a wad about it. If you don't want to wear white/navy then you shouldn't work here. Do you really think this hasn't been brought up? But with over 100 RNs in the ED, and more than 1000 in the hospital, one PRN person isn't going to "rock the boat". You're just going to get fired. Our department management is awesome, so just go with the dress code and enjoy working with us. We have a really great group of nurses, and everyone (for the most part) works as a team.

We do not xray to confirm placement, just confirm through blood return.

Wow, old thread. MSO4 is morphine, MgSO4 is mag sulfate. You can see why neither are approved abbreviations now.

In what other profession would it be considered "okay" to be abused in such a manner by a client/customer for any period of time? None, of course. Talk to your charge nurse or manager immediately, and tell her that you are tired of being beat up by this patient on a daily basis, and that you will not accept that tx from him anymore. IMO, it is better to say something up front so they have the opportunity to assign him to another nurse in the first place. Good luck!

A loud ipod, very dark sunglasses, and book titled "Nursing for Dummies" usually do the trick to keep people from talking to me :) Being serious about the ipod and sunglasses though. Then just pretend you can't see, feel, or hear them.

I find it very hard to go with all the people who are responding "she has had some hard times, let her vent, listen to her, and maybe it will get better." I really don't care how hard someone's life has been, no one has the right to light into me for no good reason. I fully believe that people behave during stressful times the same way they behave during the easy times. The correct response in this situation, for me, would have been one raised eyebrow, respond "I'll be back in a moment" and a walk out of the room directly into my supervisor's office to let her deal with this hateful person.

Thanks for the replies so far. Like I said, I've never run across any legit pt who would say that, but I didn't want to judge without hearing opinions of others who weren't involved in the situation. Every cell in my body was screaming "seeker" and she hit all of my top 5 seeker cues....complimented my earrings, addressed me by my first name before I introduced myself, told me where the good veins usually were, stated "I've had people ask me if I'm a IV drug user since I have no veins", and said "I haven't had an IV in months" when she very obviously had multiple new track marks. And on top of that, she did a little commentary as I was vein searching..."she thinks she found one she likes, can she get it to pop at all, reaching for the needle...inserting, inserting, nothing....hee hee hee." So very odd.

Had a patient last week who presented with multiple track marks and NO veins. I'm a pretty good stick, and couldn't even find a spider vein to get a 24 in. She claimed migraine, and also stated that "IM phenergan doesn't work for me." Said only thing that worked was IV Dilaudid and Phenergan. I've never run across a true instance of an IM med not working well when the IV form does...maybe takes longer, but still usually works. What is your experience?

Besides having vertical nametags with our info displayed on them, my hospital went to a classified scrub color system a few years ago. Nursing wears navy bottoms with a white top, top has the name of the hospital and "RN" embroidered on it (LPN embroidered for LPNs). Techs wear another color, housekeeping another color, transport techs another, etc. Patients have found it to be very informative - even if you have terrible eyesight, you can still tell who just walked into your room. I also love it. You can always tell who is in your department, and I think it just looks more professional.

I orient new grads, and my newest orientee called me freaking out last week because she also took the full number of questions. When she tried to look up her pass/fail 2 days later, it gave her a number to call. She passed, but was told she was in a sample group of test takers who were selected to take the entire 265, and then take a survey about it. So I guess NCLEX is having some people take the full 265, without informing them if could be a possibility. BTW, they also told her how many she would have taken if she hadn't been in the sample group.....75 How frustrating!

I'd be less worried about the HR and more so regarding the decreased SpO2 and fever. Sounds like a raging pneumonia. Not knowing the pt's age and med hx, I can't really pass judgment on the HR and RR. Those would be pretty acceptable numbers for a 1 yr old, but not for a 9 year old. And yes, I think you should have recognized the severity of a low sat, even excepting the HR. Good luck.