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.

That is because, in the ER, the time constraints of patients isn't important. Not to sound evil or witchy, but my job is simply to facilitate treatment and keep people from dying. Not to be worked into someone's busy schedule (Burger King medicine....Have it your way). The simple reasons that ERs have such long wait times are lack of staff, increase in patients needing to be seen, increase in EDs that are closing, lack of inpatient beds, and increase in pt acuity. In my ED, we never have problems with staffing in my department, but lack of staff directly contributes to the lack of inpt bed problem - we have days when we have lots of beds open, but blocked due to lack of floor RN staff.

Tons of both A&B, and also some people who are dx symptomatically who don't swab +. We give ILNS bolus, IV Toradol, po Tylenol, swab for flu, and send home w Tamiflu Rx if relatively new sxs. Occasionally get a CXR if productive cough to r/o pneumonia. This nurse is tired of the flu cases....most of them are aged 18-45 with no other comorbidities, and are big whiners. Gaahhhhh!

Like I said, I'm happy to help talk you through this, but please don't expect to post a question and get it answered from A-Z. Part of the process of knowing this stuff is figuring it out for yourself. PM me if you want some help, or feel free to keep posting on the board. There are a lot of very experienced and smart people here who are happy to help.

Is this for a school assignment? Just think of your ABCs - can't do anything until airway secured. Then you can't do anything until the pt can breathe adequately. Sometimes it just takes a neb tx, sometimes some Lasix, sometimes you have to intubate. We won't do your homework for you, but we will certainly help to point you in the right direction or critique you if you're moving the wrong way.

Allow this ER nurse to give you a bit of insight here. I carried a load of 4-5 patients during my shift yesterday. Even with 5 patients, there were several times when I had drawn all my labs, given all my meds, obtained my UAs, given food/water, etc. In a nutshell, I had worked my orifice off for hours keeping these patients happy and alive, and keeping their care moving forward. At that point I am either waiting for an inpt bed to become available, for labs to come back to determine a dispo, or for the ER MD to discharge the patient. The doc may not be able to d/c a completed patient for any number of reasons (suturing a lac, intubating a pt, finishing up a more ill pt, etc). Too many people forget that the ER RN is NOT the end all be all of patient care in the dept. I start the IV and draw the labs, but I don't run the labs - it moves on to another dept that is also probably inundated and doing its best to get work done. I order the CT, but can't help it if a CVA or trauma pt takes precedence. Generalizing that "no ER RNs I've ever seen seem to be in a hurry" is a pretty stupid thing. This is my JOB not my life. If my work is caught up and no one needs help, there is no reason I can't ask my friend/coworker what she is doing this weekend. There is also no reason I can't ask my friend what she wants for lunch as I chart (I can do two things at once). For the OP, I have no idea what might have been going on to make your parents wait for 7 hours. If it was a cardiac cath, it may have just been bad luck and the hospital got multiple AMIs during that time period yesterday. Either way, someone should have been up front with your family to tell them what was going on.

Take a look through the last few pages of ED threads. I know we've discussed this several times. The Cliff notes version -- find an ED that has a new grad/transition program consisting of at least 10 weeks precepted time. My hospital offers a 5 month program; it starts with 1 month of 40 hrs/week classroom, then 2 months with 16 hrs/week classroom and 24 hrs/week in the department, then another 2 months of 40 hrs/week in the department. I wouldn't trust a new grad to be hired into a department without a FORMAL orientation program. Good luck! PS-My personal feeling is that as long as you have a formal program, there is no need to spend time in an ICU or medsurg. When ICU nurses come to the ER they have to unlearn a lot of time management issues, although their assessment and other skills are usually impeccable. Medsurg also helps with the time management and assessment, but a lot of people can't tolerate the atmosphere on the floor.

I have to comment on this reply. My ED's (level I, 55 beds) pain management protocol is Tylenol, then Vicodin, then attempt to obtain MD order for narcotic management. Nursing can give Tylenol, Motrin, or Vicodin without an order. While it is a nice thought to tell this pt "we'll start with tylenol and move on from there until we get your pain under control" it isn't realistic in an ER setting. You cannot po medicate an MVC pt who hasn't been scanned/through Xray because you can't rule out possible surgical injuries. Also, I assume this pt was c-collared/BB/immobilized, and po pain meds are an aspiration risk at that point. Not to mention if that pt becomes nauseated and pukes, and can't clear his airway. If the MD is not going to order IV pain meds or narcotics then my hands are tied. I can do my best to verbally reassure the pt, but it sounds like this guy wanted narcotics....as evidenced by the fact that he grew wings and flew away when it was made known his only option was Toradol. Additionally, if our trauma patients don't have obvious ortho injuries, we typically don't medicate right away. Would hate for someone to develop an acute abdomen that was blunted by narcotics. I'm not against medicating trauma/MVC patients, and I'm not against medicating the people that you may get a gut feeling on. But there are some very valid medical reasons for not medicating this pt off the bat. I also would rather give a drug seeker a fix than send someone home in pain without medication. I told myself I wasn't going to get involved in the drug seeker debate aspect of this thread. :::going back to making dinner now:::

Don't confront this bully. It will get you nowhere. I would talk to my CN (the one who informed you of the incident) and find out if it was passed up the line to management. If not, ask that s/he tell your NM what happened. I also don't see where writing a letter to your NM is going to help. You didn't hear her say anything, you just heard from other people that she was talking about you. What would a letter say? "Annie was saying mean things about me behind my back." If this person has been there for 17 years, I guarantee they know what the deal is with her attitude and either don't care or don't want to rock the boat. I hope your attitude towards this nurse has changed - no fake niceties or anything, just be professional and end it there. If you want something done, request a meeting with your NM to talk about this. You seem quite well-spoken and I'm sure would be able to conduct yourself accordingly.

MVCs, esp those going to CT, need to be undressed and any metal taken off that could cause artifact or show up on the scan. Any pt that comes in w a weapon to my ED must either voluntarily or involuntarily give it to security. This thread is not about medication of drug seekers, it was about how to disarm an unruly pt who happens to have the traits of a drug seeker. There are multiple threads in the ED forum regarding drug seekers and the medication of them.

Ok, so I'm sure you know that these meds are used to correct K+ imbalance as well as fluid retention. Here is my order: -Calcium first, over 5-10 minutes...for the same reason as the PP. Plus, it is the one most likely to cause problems so you will still be in the room for close to 5-10 more minutes after it to watch the monitor. -Insulin-I always dilute my insulin in 1 cc of NS (draw up your insulin with an insulin syringe, have it verified, then draw up 1 cc of NS in a different syringe and add your insulin - this just makes it easier to give) No real rate for insulin, just give it. D50-your big limitation on the rate for D50 is how fast you can actually push the med. It is thicker than NS and more difficult to push in the amp. I've found that if I push it at a rate comfortable for my hand, it is not too fast or too slow, and goes in over a little more than a minute. -NaHCO3-Same as D50. -Lasix-I push each 20mg over 2-3 minutes, so 60mg would go over about 5 minutes. Monitor your BP. Obviously flush in between each med. Then you have Kayexalate.....one of the meaner drugs to give. I think it is super mean to give it just before a patient goes home (if you're sending this patient home....we've done just Kayexalate for mild K+ increases and sent them home) So if we do have to do that, I tell them it will cause the runs and tell them they can make the choice between staying in the WR for a while or heading home. In giving to an admit pt, it is bad karma to give it just before going up, but I will admit that I've done it too. Hope this helps!