jimminy

OBHEATHERNurse "You guys in ER & L&D are the only one's (I think) that have pt's that walk in off the street. You guys don't really have anywhere to steer your frustration of another new patient. But unfortunately, you get the brunt of it. " Thank you - not nurses think of this and it is really nice to hear our frustrations verbalized by someone else upstairs - thanks

Ours is called SAMA (Satori Alternatives to Manage Aggression). Satori stands for "clear understanding". It is a four day program that has been condensed into one 8 hour session. It involves all aspects of aggression, including recognizing, de-escalating, and defensive techniques. It was developed by Larry Hampton and it copyrighted by Satori Learning Designs, Inc. I quess you could find out about them on the net, but I'm not sure. We had employees from our district go to a conference on it, then they taught us. Hope it helps

Sounds good. The reason we don't always stand up and be counted is because we are too **** tired after shifts from hell. Our poor bodys would have to be held up by sticks and someone would have to open and shut our mouths for us to talk.:chuckle

no, you do not sound crazy! We were so bad the other night. The house supervisor came down and said the same thing about the floor being just as crazy. She said they did not have enough staff upstairs. I'm afraid I lost it a little. All trauma rooms were full, trauma in the halls and tele had just let us know we were have multiple GSWs coming in!! I screamed at her to find me some beds now, and "send me some help by God or get out your stethoscope and grab a patient in this hall, because until you have them overflowing in your halls upstairs, then you're not as busy as us!!!!" She looked stunned, turned and left. She sent me one nurse and one nursing assistant, who of course did not know a thing about emergency medicine! I'm surprised I still have my job

CEN35 Oops, I forgot to mention that we heard the unofficial scuttlebutt after one of the "administrators" spent three hours with us....................they are going to leave the EC alone for now!!ROTGLOL! Of course they haven't offered to approve MORE staff, but we can go a long way on that one day (satisfaction way)

CEN35 Wouldn't they just die, probably after just three hours also!!! We have all (all er nurses) gotten used to working so short staffed at such a high acuity level, that even if they staffed us a little better it would be short staffed according to standards and we would think it was better!! Does that make any sense at all?? I'm also so tired of hearing about that "damned EC" I could scream. Upstairs they refuse to work greater that 1:7 on regular floors! I'd give my first born and my right arm to have1:15 of higher acuity!

michelle, At our hospital, the one that finds the problem fills out the incident report, informs the head nurse and the doctor. The doctor has to fill out a portion that states what he did, then the head nurse fills out an investigation report and sends it to qa. If the head nurse is able to determine who made the error, she fills out a medication error the same day. If not, QA sends a form for the director to investigate by getting the chart and reviewing it. Always call the MD on any error and chart it, facts only. He/she may have wanted an acetaminophen level in for hours, and again four hours later and/or given her a dose of mucomyst since it was an elderly lady. Of course, it may have not been needed at all, but the md needs to make that decision, not the head nurse. Always CYA, don't assume that the other nurse or department will do the right thing. It is NOT tatteling (sp), tell them it is hospital policy and best for the patient. Who knows, this nurse may have made many med errors in the past and needs counseling. You did good, dont let other nurses intimidate you.

Wow, I think this applies to every hospital around. I'm hoping a situation last week will help. We have been "reorganized" by a consultant company and things could not be worse. We have been telling administration and the consultants to come spend a night with us, then tell us we have too many staff. Last Friday one administrator came down at three pm. We were holding 32 patients, including four ICU, seven telementry, and the regular admits. We were balls to the wall with new ones coming in and people waiting to be seen that had already been triaged in. The truama hall were full and overflowing. It was awfu, but was not an "exception". We are always like this. She was supposed to stay the night with me, but only made it until seven pm!!!! She said she was going home, she could not take anymore and did not know how we did it. We only had four nurses in holding, a close obs nurse, a hall nurse and three shock nurses. She had that deer in the head light look. We were running strecthers to the front of the hospital for a patient actively seizing, and another code three was coming in. Heh heh....I'm still waiting to hear her report of the need to decrease staffing!!!!!

OOOOH, makes my hair stand on end. Sometimes our nights are so bad, freaky codes coming in,, patients more irate than usual. We open the viewing room to "air out the spirits". Believe it or not, things actually calm down ( or a least they appear to). Have never actually seen a ghost, but will whirl around quickly thinking someone has just blown on my neck. How about near - death experiences? It may already be a thread.

We work 12hour shifts. We get one unpaid lunch break and two 15 min. breaks when there is time. For the most part we try to relieve each other without interruptions. We seldom get the full lunch. Our fifteen min. breaks we take in little four to five min. breaks. There is always the same few that push it. They take frequent smokes breaks (15 min), then go to the caf. to get food, then count their break starting when they get back. It is a very busy er, so the rest of us get a little peeved. They have been approached, reprimanded by management, etc. but the one thing that has worked the best is this.... If you are the one covering for their frequent breaks, dont say anything. Wait till they get back, then leave for as long as they were gone,, each time. I KNOW this sounds petty, but it only takes a few times for them to get the pix and they will not do it when they work with you. THEY dont like to do all the work. No, the patients are covered, the other nurses are in on it and cover incognito. heh. My one question about breaks is this ..... If your break is unpaid, should you be able to snooze? We are not allowed to in case some other dept sees us and it looks bad. However, days can leave the premises to eat breakfast and lunch ..two lunch breaks?I think we should be able to take a quick refresher snooze on our unpaid break, it really helps

I work at a level one trauma center that is also a teaching hospital so we have many different levels of experience there. I can tell you honestly, having experienced paramedics to help out is WONDERFUL! We have so many new nurses that are still learning the ropes, so many new docs that are still learning. It is a welcome relief to have an experienced person in the EC that recognizes a crumping patient. We have some great ones. Just like and job, including nurses or docs, we also have some not so great ones - that's normal in a job situation. Our paramedics do not pass meds, but they start pivs, ng tubes, foleys, v/s etc. They are told before hire that they are not working like they would on their boxes, there are restrictions. If they cant accept that, then they dont work there. We all work well as a team, and that's the secret. they work under the doctor's license. We never ask them to do something we wouldn't do ourselves if we could. This is a new program we are trying - so far so good.

Its good you can cry! Everyone handles it differently, IE: Black humor, crying, laughing, smoking, quiet time. My hardest one was coding a 13 yr old boy GSW victim. He looked just like my 13yr old son. Putting him in a body bag was the hardest thing I've everdone. I went home later, woke up my son a gave him a hug and kiss and thanked him for being where he was supposed to be. This boy that died had snuck out of the house in the middle of the nite. His family got a call to come to the hospital and they didn't even realize he was gone. It was soooooo sad! I agree, get your ACLS. It will help. Also be the one to record for a while. It gives you a chance to see the flow of the room versus being focused on just one activity such as IV insertion.

Any suggestions for tar removal on a severly burned patient, without doing further damage?

You can press charges on any aggressive patient that causes harm to you. However, getting the DA to accept the case is another matter. According to them, if the patient has a true psyc. history, they will not accept the case because that person is unable to decide right or wrong!!!!!!!!!!!!! Well, we have citizens that have a true psyc history that function in everday society. We just had a nurse that was able to put an HIV patient , that intentionally bit her drawing blood, in prison for one year. The DA originally did not want to take the case because the patient had a history of schizo. What helped this case was the documentation (that word again). During the original assessment, the nurse had noted the history but wrote in her notes that patient denied AVH, no SI, no HI. C/O left arm pain only after a minor MVA. The patient was angry because of the type of pain meds given. He wanted demerol, not toradol. The DA finally agreed, but wanted to agree to ten days only in jail on a plea bargain. This nurse held her grounds and won. I do not know the laws regarding this. It seems to be just the DA's opinion.