ERNurse03

this is taken from the osha website regarding the eating and drinking. 1910.1030(d)(2)(ix) eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.1910.1030(d)(2)(x) food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or benchtops where blood or other potentially infectious materials are present. as far as the breaks, why aren't you getting them, or taking them? you say you are a new nurse and i guess i have to ask, are the other nurses who aren't new are getting their breaks? i'm just wondering if it's a time management issue you may be having as a newer nurse that maybe someone could observe and help you work on.

I wouldn't investigate anything. It sounds like she's had a battery of tests already and the doctor's aren't finding anything. The only thing you really need to do as a nurse asside from the doctor's orders is give this lady emotional support and alert the doctor if you see changes in her condition that may indicate something is wrong.

You're right Maisy, it would be nice once in awhile to just be able to say, sorry, we're full we can't take any more admissions. It's a good thing our ER patients aren't sick and demanding...it's a good thing ER patients don't require out of control paper work.

I don't blame you for not liking ignorant remarks because I don't like them either, but I didn't throw out any remarks about floor nursing and I did not say that ER nursing was any harder than any other floor or ICU.

I don't know what kind of ER you've worked in, but this is the typical mis-conception. You are right about one thing the patients are transferred out of the ER because once they are either treated and sent home or stabalized, the ER is not a place to hold patients because there is a continuous influx of patients of various acuities. However, I disagree with the first statement that "ER Nursing is quite simple."...please refer to my very first sentence. The way I understand it is that you think ER patients are not in "pretty bad shape." Apparently you've never had a victim of a house fire who was pronounced dead at the scene and placed in a body bag. Then when the paramedic seen the bag move on the way to the morgue they turn around and roll the patient out of a body bag and onto your ER cot. You realize that the chared body of this living human who is actually not dead but in "pretty bad shape" is attempting to speak to you. The rest of your "quite simple" 1,2,3 ER explanation sounds like it is spoken by someone who doesn't really know what happens in the ER.

Well, we work on a small ward and the RN's take turns being in charge. When anyone else is in charge they assign the RN's work equally and include themselves. He doesn't. He assigns everyone else all the work and he does hardley anything. We work on an acute psych ward where the length of stay is supposed to be only 3-5 days. So needless to say we do a lot of admission data bases and a lot of discharges and transfers off of acute. One day, neither of us was in charge and the assignments were made out that I did discharge #1 and then he did #2 the charge nurse did #3 then it was back to me for #4 etc down the line. He spent all morning in treatment team and knew we had tons of discharges to do, and knew they all had a bus to catch at 1pm, so right before all the discharge orders came through, he waltzes by the desk and says "I'm going to lunch now." While he was gone the other nurse and I did 7 discharges in a row. He came back from lunch just after all the work was done, and when I asked him to do a referral assessment note to extended care on another patient for me he replied "That pt is not on my treatment team." I ended up doing that too. I argued with him a little bit, but realized there was no point. He did agreed to do but insisted that he had to get on the internet first and check out what was playing at the cinema, then he acted like he was doing me some kind of huge favor and he was the only one working and speaking sarcastically and acting like I wasn't capable of handling all my work or something. The very next day, I was in charge and assigned the discharges the same. I was #1 and he was #2. I did the first discharge while he was still in treatment team, and when he came out of treatment team, I went to lunch. I had just sat down to eat and the phone in the breakroom rang and it was the LPN who stated "He wanted me to call and tell you to come out here and do this discharge because you have assigned yourself to the first one." This time, I simply replied, "Tell him to do it, because I've already done one." The next day after that, he brought me lunch that he'd made at home. It's really weird. Last weekend, he was in charge and just refused to do the charge nurse duties and made me do everything. I don't know if this is all making any sense to you, but It's just really hard to explain.

I loved the ER. It's always something new and exciting with the exception of the regulars and the drug seekers. It gets busy, but it's a great feeling knowing that you've helped stabalize a critical patient. Then you can just hand them off and stabalize the next one. You have to be be mentally prepared for seeing the worst. You have to be compassionate yet somewhat emotionally detached. It's not easy, but it can be very fulfilling.

Nasty I could deal with, but right now I'm trying to deal with a passive-aggressive co-worker. It's not a female either. It's a 40 yr old single homosexual male. He's worse than any woman I've ever met. He sets people up for failure, back-stabs, instigates and worms his way out of doing anything while he makes the comments that he's the only one doing any work. He does all this and at the same time he makes himself appear completely innocent. He can be extremely nice to you at the same time he's screwing you over. He doesn't take responsibility for anything. It's so bad that I searched the internet trying to teach myself how to deal with it, the bad news it...you can't change them...you just have to make the best of it.

lucky1RN listed a lot of the same ones that drive me nuts. I'd like to add that a BUN is B.U.N not Bun as if it were the bread you'd eat with your hamburger. Also I think MRSA should be spelled out as well. When I hear everyone call it "Mersa" it is irritating to me. I work in psych at a VA facility, so I can be forgiving of the risperdal mispronunciation because the generic name risperidone does have the "I" in it, but in the VA system everything us called by it's generic name so no one says Zyprexa, it's Olanzapine to us. I used to work ER and all the drug seekers were looking for "Dilauda." One of an ER nurses biggest pet peeves has to be when people say "defibulate" instead of defibrillate. The best one I've personally heard was when a paramedic told me that the patient she was handing off to me had "psoriasis" of the liver. I made her repeat it just for kicks and laughed about it later, but I didn't say anything to her, sometimes you just have to over look other peoples ignorance.

I don't think that she would lose her license for a medicaion error unless is was just plain negligence which caused harm. She would probably not lose her job for a medication error unless negligence. However, If it is a chronic problem with her making multiple errors, or if she has falsefied legal documents and lied to cover up her error she could be in big trouble and probably lose her job and possibly even her license. You should make your instructors aware but not worry about your own future license. If she signed the med off on the MAR and the documentation shows that she gave it, then she's responsible. Even if you did do it, she is still responsible because she is supposed to be watching and teaching you and you don't have a license. That is what preceptors do. They take responsibility for the student they are precepting. In my experience, the preceptor has to have a contract with the school in order to even be a preceptor. The school needs to know to stop utilizing this particular nurse as one of their preceptors.

I am also sorry for what you are going through. I also agree with everyone else who says that you should see if you can get records and see what the nurses documented. I do not want to say anything to make you feel any worse, However, you did ask the question and having worked several trauma codes with similar brain injuries from GSW's and also MVA's my hunch is that she was unconsious and never regained consiousness and 3 hours is how long it took for her heart to stop so that she could officially be pronounced. I took care of a lady one time who had severe brain trauma from an MVA. She had some brain matter outside her skull. We made her comfortable and just waited for her heart to stop...which took awhile. I can't remember for sure, but it was at least an hour after she arrived to the ER. She was unconsious the entire time. It was agonizing for the staff, but I'm certain that the lady felt nothing. She was pronounced before her son arrived from out of town. The doctor explained to him that she had presented with "non-survivable" injuries and there was nothing we could do except wait for her heart to stop. The young man thanked us for not doing anything that would cause her to live in a vegetative state and prolong the inevetable. Again, I am so sorry for what you are going through.

I agree with all of the above, but to answer the first question, it's called "elopement."

It is a long process. I can't imagine it taking a full year though. It took me about 4 months, but I think that was quicker than most. I already knew a few people who worked there who were pulling for me.

I'm not sure exactly what you are asking, but when charting such procedures you need to remember to include not only the details of the procedure but how the patient tolerated the procedure. Example for NG insertion. 16 F NGT placed with ease through the right nares using clean technique after prep with cetacaine spray and xylocaine jelly for pt comfort. Placement checked per auscultation and return of gastric contents. 100 ml yellow liquid gastric contents returned immediately. NG connected to LIWS per order. Pt tolerated the procedure well and vital signs remain within normal limits. The clean technique, cetacaine spray or xylocaine jelly may be PRN protocol, if so, you can just document "per protocol" instead of giving all those details. For an ET I will usually chart this: 8.5 ET tube placed successfully after two attempts per respiratory or MD (whichever). Placement initially checked by positive breath sounds bi-lat and positive end tidal Co2. Stat x-ray ordered to confirm placement. Tube placed 22 at the lip and tube secured. Pt's SpO2 now 98% and pt's color is pink, patient is warm and dry. Then you would chart either the patient is being bagged per RT or pt placed on a vent and be sure to document the vent settings. If there is anything suctioned from the lungs you would need to document the consistancy, the color and the amount. Prior to documenting the placement procedure, of course you would also need to document what the patient looked like ie: why they needed intubated, then any medications that were given to relax or sedate the patient. Don't forget the soft restraint documentation if you are using those. Most places require separate papers for soft restraints or safety devices. This probably isn't perfect, but it's worked for me for 11 yrs in the ER.

I am also working at the VA in Ohio. I know a BSN is not required. I work with ADN's LPN's and BSN's. I have recently completed my BSN, but I was an ADN when I got hired. My husband was also recently hired at the VA and he is a new grad RN. The thing I recommend when trying to get a job at VA is persistance and patience. Call once a week and check the status of the application. Once you are called for an interview be persistant and call them back often again about once a week. If they sound a bit aggrivated with you calling, just give it 2 weeks then call again. It took me and also my husband several months to get a hire date even after the interview and pre-employment physical. The people you put on your application as refrences will be mailed a form to fill out, and until they fill them out and send them back they will not hire you, so make sure you contact your refrences and they return their forms in a timely manner. This will help speed up the process.