New2ER

I'm so annoyed at myself. I did a tummy prep today and paid extra attention to the belly button, used 4 swabs to clean it out. The last one appeared to come out clean. When the surgeon got to the field he used another swap to pull out MORE gunk. It looked clean to me. The only thing I can think of is that the betadine sat in there an loosened up more gunk that didn't come out the first 4 times I swabbed it. How many times do you swab the button before you're 100% certain that it's clean? Do you soak it before hand to loosen the dirt up? I feel like such an idiot.

I posted earlier this year about my diagnosis. Since then I have move from the warm and sunny south to the northeast in search of cooler weather that will make my MS symptoms more bearable. I started working in the OR of a large hospital several months ago. Things were going just peachy until I relapsed last week, complete with balance and gait issues. I'm still having spastic gait issues with my left leg and feeling horribly guilty that I'm not at work right now. Logically, I know that if I saw someone near my sterile field walking the way I am I would shoo them away and would not let them carry or open anything sterile. The other part of me feels guilty that I've had to take 2 weeks off from work because my legs don't work right. I have this underlying fear that the OR environment is going to result in repeated exacerbations because of the stress. (Even though I love it, over all). Not to mention how my orientation process is going to work out since I'm missing 2 full weeks. (I'm hoping my gait will get better and I can go back to work in 2 weeks). I hate these unexpected surprises. My plan was to go on and finish my bachelor's and obtain a Masters so I can eventually teach, but the future seems so uncertain that I'm playing with the idea of getting an accounting degree. At least I know that I'd be able to sit at a desk and type all day.

So today is my last day at my current job. In a few weeks I'll be starting a periOp course that involves studying and passing tests and didactics. I'm terrified. Now, I understand that I have taken tests to get my RN license and that obviously with a few years of experience, I'm not a total idiot. The OR though, as much as I want to be there, excited me and scares me at the same time. It's a totally new place and so much unlike any other nursing I've done up until now. I'm ready to give it my all but all I can do is worry about "what if I fail the tests" "what if they don't think I can cut it". I'll have moved us over a 1000 miles and it'll be my fault that we're financially in the red. Any hints to get through this trying time?

So I have this boss who apparently thinks that showing up to work is pretty much all she has to do. She delegates EVERYTHING, even paperwork that she's supposed to complete, to the staff. When she does do things, like the schedule, she completely screws it up (as in forgetting to schedule already approved days off and scheduling staff for days when they aren't able to work). I work nights, I haven't seen her face in 8 months. When I put in my resignation I didn't even get an acknowledgement that she had received it. She didn't put in my PTO requests and is cold and condescending when she does talk to you. In the past she has walked into our nursing station, sat in a chair clicking on the the computer and walked out. All the while never acknowledging that there was even another warm body present and making no eye contact. In fact, she kept her back to us the entire time! (This has happened in multiple settings.) Don't go to her for help with anything because she'll somehow turn it into your fault. You're not efficient enough, you're not using your time wisely, etc. Once, when she was playing at being house sup, I passed her in the hallway and started to update her on staffing issues I was having. She stopped me mid sentence and said, "Who are you supposed to talk to about this?". Well if she had let me finish I would have told her that I'd already talked to that person and as the house sup I thought she might want to be informed on what was going on, silly me. She shows no interest in actually doing her job whatsoever. She sneaks in the back door (literally) and then hidesout in her office. When she sups at night she doesn't do rounds and spends most of her time hanging out in her office. I don't get it. Stupid me always thought managers were supposed to manage

I'm rather appalled at this. I have had offered contingent on passing background screens and visa or work permits but never on passing a physical. I have MS, obviously I will tell my job this at my physical. Right now I have no symptoms and can do my job perfectly. Might it affect my job later, possibly - but it would be illegal, not to mention immoral, for an employer not to provide the offered job based on the fact that I "might" be affected by my physical condition later. There is nothing to prevent healthy staff from developing medical conditions, chronic or otherwise, in the future. At my last job I disclosed a previous back injury, I was required to obtain a note from a doctor that I would be able to work. That's fine. But the offer wasn't rescinded due to that. I was under the impression that the physical is mainly for the insurance companies.

I wonder if we changed this to: "Anyone who goes into medicine for the money probably isn't doctor material." Does that change anything?

I grit my teeth when I hear my current boss say, "I'll take care of it". Here I sit tonight with no tech for a 5 bed locked psych ER because even though the hole in the schedule was there 3 weeks ago when the schedule was printed, he was going to "take care of it". Oh, and there's another hole on the same day in two weeks. I think I'll be sick that day. If they can't be bothered to provide staff, I guess I can't be bothered to come to work. Although, technically, I haven't seen or spoken to my boss in over 6 months now. Not even to acknowledge my resignation letter (which I gave him over a month in advance so they could fill my position). I should have just given it 2 weeks notice. *sigh*

we actually had one psychiatrist attempt to baker act (involuntarily commitment) another at our facility. apparently they got into a fairily heated arguement. i didn't see it, but most of the other staff still recounts the story several years later. :chuckle

At my current job we generally use Haldol 5, Ativan 2, and Benadryl 50. The benadryl is given both as a sedative and to counteract possible EPS side effects from the Haldol. It does total 3ml. On occassion the doc will order Haldol 10 which would made the injection 4mls and I split it into two syringes, Haldol in one and ativan/benadryl in the other. We don't use Geodon at all and have only recently added zyprexa as an emergency medication. It's still not routinely given. Geodon can't be given to the patient here until there is an EKG on file that shows no QT abnornmality. I have discussed this topic with several other nurses and a doc and they all were suprised that haldol and benadryl are not supposed to be mixed. Only one nurse knew about the restriction but stated that it was assumed that those instances are a "one shot deal".

I was just thinking last night that the staff I work with needs medication more than some of our patients. I have had my flirtations (figuratively speaking of course) with therapists in the past and I like to think that I've worked through most of my major issues. I think I'm most keenly aware of co-workers with "issues" when it affects staff interactions and patient care. One co-worker in particular is very elitist and makes comments along those lines. Often tries to cover up by calling them "jokes", but really they're just mean spirited and meant to put staff and patients down. There is a hystronic nurse on one floor who throws a fit over EVERYTHING. Sounds like chicken little for any little thing. And another who is hostile and passive aggressive no matter how nice you try to be. At this point, I just identify the behavior and manage them very much like a manage my patients. More amusing anecdotes for my memoirs :) I forgot to mention, the only psych staff I've met who appear to be relatively well adjusted seem to be the staff that enter psych after being in the regular medical world, or plan on transitioning out of psych.

Example: Alert and oriented adult woman comes to the ER for treatment of a fever. During the course of treatment, it is noted that she has multiple bruises in various stages of healing. She does eventually tell the ER RN that she is frequently beaten by her boyfriend but refuses to allow police to be called and does not want to file a report. Is the ER RN required to report the case to the abuse hotline?

You haven't taken your antipsychotic/antidepressant for 3 days because you couldn't afford the copay but AMAZINGLY you coughed up the copay for your valium/oxycodon TODAY? Even though the bottles are dated 3 days ago? And you've already taken more then 50% of the medication (over 70mg of oxycodone and 8 valiums). Of course we'll admit you, you obviously are getting "ripped off by everyone" and need "a few days to sleep". Sheesh! 19 year old with chief c/o of N/V with active vomitting, I ended saying something very similar to this. "Why are you drinking water? You've been vomitting for 2 days. I told you the last time I cleaned up your vomit that you should NOT be drinking anything. (He snuck water from his bag twice before). You're thirsty? Yes, you've been vomitting for 2 days. You need IV fluids. Have you noticed that everytime you drink something you vomit? See a pattern? That's because your stomach is senstive right now and can't handle it. If you stop drinking, I won't have to clean up your vomit and I will have time to put in an IV so you have stop feeling thirsty" His answer to this speech was, I swear, "but I'm thirsty!" "You haven't been seen by the doctor for over an hour for your chest pain that hurts when you move and upon palpation, normal labs, and no other symptoms? Now you want to leave because you don't like the service? Well, as it turns out that ER doctor has spent the last hour or so coding people whose chest pain turned out rather badly. You are not a priority case right now." "You've spent 8 hours in the ER waiting for a tele bed for your loved one and now you want to take her home because you've been waiting too long? You brought her to the hospital because you thought it was an emergency. The ER doctor agreed and the attending admitted her. She's being monitored by nursing staff and receiving her inpatient meds, but for some reason you think she'd be better off at home? You're an idiot." (I actually did say that, except the idiot part.) A woman, who told every sole in the ER that she was an RN harrassed the ER MD into admitted her mother for R/O MI. Mom had no complaints unless her daughter was in the room. Daughter wanted to WALK her mother out to the waiting area to get water, I repeatedly told her no. I finally gave up and told her she could pick out something from the vending machine and come right about, about a 50 ft walk. The patient disappeared for almost an hour. Turns out the daughter had then taken mother OUT TO THE CAR to call relatives and enjoy her drink. I was sitting at the nurses station venting to a coworker when the daughter overheard and huffed about being a nurse. I said "If you're really an RN and truly worried about your mother's cardiac condition you would know not to ambulate out of the hospital away from monitoring and medical assitance. If you mother had arrested somewhere out there we'd never know. Frankly, I think your decision was a bad one and you lied to me. I'm trying to take care of you mother but your behavior is not helping her at all". She had no response and walked away. I had another pt in his mid 30s that acted very sick, refused to answer his mother/brother when talked to, in general very attention seeking. The family kept calling me into the room because he appeared unresponsive. After the third time, I asked the family to step out of the room. I told the patient, "you've being immature and unnessarily worrying your family when you didn't answer or even open your eyes. Your lab work is perfect, your vitals signs are normal and your oriented. I understand you don't feel well but you're being overdramatic". I didn't have to go in there again for an "unresponsive" pt all night.

"Ma'am, I understand that you're worried about your son and I assure that the he is receiving the best care we can provide. That includes getting his pain medication when necessary and as prescribed. Please calm down and refrain from insulting either myself or our profession or I will have to ask security to remove you from the premises until such time that you feel you are in control of your behavior enough to return."

I work in psychiatric ER the entire staff consists of myself (an RN) and a tech. My psychiatric experience includes working on the acute inpatient unit for 6 months before working down here fulltime. (I've been here for A year and a half). We have an ER doctor who likes to order "assessments" by the psych ER staff for his patients in the medical ER. Keep in mind that our assessments are rudimentary and include psychosocial information and questions about S/I, H/I and A/V hallucinations. I DON'T have an advanced degree in psychology or license to diagnose these patients. This physician will admit/discharge based on the information that is typed into the psychosocial on our computer system by the assessing RN. My problem is that he will then chart that he is discharging because the PSYCH RN did not find s/s of psychosis etc. No where in my charting do I make mention of discharging the patient, and what concerns me is that his charting appears to imply that he is discharging the patient based on my word RATHER THAN HIS OWN ASSESSMENT. What exactly can/should I chart to protect myself against problems that might creep up due to HIS charting?

the NCLEX is actually the same test in every state. You could graduate in Hawaii and take the test in Florida for a license in California. What matters is that the score gets sent to the BON for the state you're applying to. As a matter of fact, I graduated from a school in NJ, applied for licensure in FL and took my NCLEX in New York City. And now I just applied for licensure by endorsement to PA!