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Emergency RN

Emergency RN


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  1. Emergency RN

    8 hour days or 12 hours days?

    You're right in that eights seem a bit rushed. As soon as you get everything settled and "in the groove" so to speak; it's time to leave, LOL... Working 3 days a week versus 5 allows you to pay only 66% commuting costs both in money for gas and time spent going to and from work. Twelves are harder on the body, but if you're young, then usually that's not an issue. You have a lot more time on your hands to work a second job if you so desired, continue education, or for family life or socializing. After 26 years, I couldn't ever work eights. Welcome to nursing and good luck!
  2. Emergency RN

    Is it legal to rewrite nursing notes 3 months later?

    In terms of my opinion, I would be disinclined to change anything and would tell the employer so. I would apologize for the charting error and let the chips fall where they may. My rationale is, losing a job is still better than losing a license. That said, the OP's question instantly recalled something really humorous that had happened when I was in nursing school. We had just been subjected to a long lecture about the legal responsibilities of nurses and how each of our notes may one day be a part of a court record, and what the proper procedure was to legally adjudicate charting errors (the aforementioned single line strike out with annotated initials). So of course, the very next day, we were doing our psych clinical rotation and we all sat there looking at a Certified Social Worker on the locked unit, using the commercial paper correction product "White Out" to paint out entire passages of notes and then rewrite over them. The real kicker to this, was the institution we were doing clinical in, just so happened to use green tinted paper for their progress notes. This woman somehow had obtained the White Out product in a green colored formulation, allowing her to perfectly match the exact same green color of the paper. All of us silently looked on in dumbfounded amazement at such a glaring example of how not to do it, stunned at the lengths that some people would go to, in order to cover up their errors.
  3. Emergency RN

    reamed out for using soft wrist restraints

    one of the worst things that the phrase "dee en are" has become over the years is it has mutated itself into a anti-nursing anti-patient phenomenon. like power sapping, destructive kryptonite to superman, once a nurse hears that phrase, he or she automatically shut off their brain and their mind already begins measuring coffin size for the "soon to be deceased." stop!!! dnr never, ever, ever means to withhold care; our nursing degree did not suddenly change to imply mortuary sciences. in essence, dnr simply means that after a patient has died, we are then supposed to do nothing extraordinary to try to bring then back from death. but, up until that point, we are still obligated to pull out all the stops, intubate, fluids, transfusions, whatever... anything and everything to keep that person alive. granted, there are some things that, given a patient's condition, may be deemed medically or clinically futile. however, that's a medical decision, and not a nursing judgment. over the years, dnr has somehow morphed itself in some nurses minds to imply carte blanche for them to deny care based on their nursing judgment; that couldn't be farther from the truth. the op in this case did the absolute right thing in calling the md, using non behavioral restraints with an md order, to facilitate airway and line protection. op, as for your colleague's belittling comment of, "...hoping that she never gets a nurse like you" i would tell her to be really careful what she wishes for. as for her suggestion to you to perform a necessary life saving function, record the positive results of that action, and then clandestinely, deliberately withdraw and withhold that life saving function knowing full well that the patient will die as a result? that is called conspiracy to commit murder. :eek: you did absolutely the right thing in ignoring her. further, if i were you, i would report her not just to your employer but to the state.
  4. Emergency RN

    How much do you get paid for being on call?

    our on call rate is 75% of our hourly rate, and if called in, we're guaranteed a minimum of 4 hours at 150% hourly rate. at my hourly rate, that would be about $37 and $75 dollars per hour respectively. of course, this is in unionized new york; home of the "tax and spend" liberals where they still have some respect for the working man and woman. support your nursing unions!
  5. Emergency RN

    Demerol 75 mg was given IV instead of IM. Fired!!!

    I beg your pardon, but don't you see? This is exactly what everyone here is talking about. Just look at the statement you made above; do you think perhaps you can puff your chest out any more? Now, I don't know you, your boss, or your hospital, but just listening to your tone bespeaks volumes. As respondent MjMoon stated, it's all about attitude and I would bet that that was what irritated your boss more than anything else. Whether the med error was serious or not is moot; what is clear here is that they wanted to get rid of you. It probably wasn't any one particular thing, but a culmination of all your daily interactions and minor but cumulative transgressions over your entire length of employ that lost favor with your employer. But, they probably didn't have anything worth firing you for, that is, until now; that is, you making a "serious" medication administration error. No offense, but sometimes, taking a serious hard look into a mirror is one of the most difficult things for a person to do. As you're just starting out in this field and likely have many more good productive years in the profession, my suggestion is that you first take care of your own human failings or else they may severely handicap any future employment. Good luck. I otherwise wish you a long and successful career.
  6. Emergency RN

    Documenting Report from EMS Contact

    The question that immediately comes to my mind is, what ever happened to the Ambulance Call Report (ACR, or document which every EMS crew is supposed to file and leave a copy of upon arrival at the ED)? As a matter of protocol it has all info regarding their patient contact; including time of call, what they found, what they did, and who they turned the patient over to in the ED. It's all a part of their continuity of care. I really don't see why you need to duplicate any of that onto your ED paperwork as it would be a needless and time costly redundancy. In our ED, the EMS crews who use electronics will fax their report, which is then printed out from our printers upon their arrival. Those that are still using Fred Flintstone tech, will hand over a paper copy of their report. We then immediately scan either into our computer charting so that any RN or MD can then call up the image immediately from anywhere where they can access the hospital network, even from home.
  7. Emergency RN

    Man gives wife STD from Mosquito Bite

    you can catch std's and never even have sex; hiv is considered an std and can be passed on by blood products or needle sharing, or from childbirth (infection from maternal source). thus, you can catch an std just by being born. imho, the health care arena needs to start losing the term "sexually" from "transmitted diseases" as it erroneously preconditions thinking that there needs to be sex involved; it doesn't.
  8. Emergency RN

    Mistakes Common in U.S. Hospitals

    Many hospital errors are due to issues with staffing, failing equipment, mismanagement, or antiquated systems. What compounds these problems is that there is also an longstanding culture that thinks it's cheaper to fire an individual nurse for what are, in reality, institutional failures. They don't want to face the costs of having to revamp entire hospital systems. When "mistakes" are reviewed with a punitive eye, the people who "make" them will endeavor to hide or cover up. Only when the health care industry adopts the same methodologies of NASA and or the Federal Aviation Administration (where mishaps are investigated non punitively), will people not feel threatened in coming forward honestly; only then can systems solutions be found to prevent recurrence of mistakes. This is something too, that sadly, Nursing Unions have yet to universally pick up on...
  9. Emergency RN

    Abducted Nursing Student - Tennessee

    sad story, i hope they find her alive and well soon... word of advice to every woman before ever walking off with any man to go anywhere: pull out your cell phone, take their picture (with their knowledge), and send it to someone you trust with the text message, "i'm going with (name) to (wherever)..." this does several things; time stamp, identifies the man, and lets him know that others already know who he is. it may not stop him from killing a woman, but it would certainly give him a bit more hesitation from acting rashly. please stay safe...
  10. Emergency RN

    Do you use your pda/smartphone at work?

    I was like... HUH? Why feel weird? Frankly, in this day and age, IMHO it is considered almost de rigueur to have a pocket device with answers at your fingertips at the bedside. Sure, the device can have multiple purposes (eg. a stethoscope can be used for safe cracking too); but at the bedside, it's usage is understood to be for professional reasons. That is, you're pulling out the Blackberry to obtain clinical knowledge, and presumably not to gossip text or violate HIPAA by taking photos of the patient. So it should not be a problem at all.
  11. Emergency RN

    Man gives wife STD from Mosquito Bite

    excellent story on an otherwise obscure illness. the zika virus (an illness that clinically closely resembles dengue, yellow fever, west nile and japanese encephalitis) is considered an emerging pathogen that was first seen outside africa and asia for the first time in 2007. the article points to how the virus, normally being mosquito borne, is suspected nonetheless of also being capable of sexual transmission. this highlights the fact that there are probably many other as yet undiscovered pathogens in the wild. as man aggressively urbanizes the bush, he is bound to encounter and be affected by some of them. i thank the op for bringing this story to our attention. sadly, i suspect that we will eventually hear a lot more of this virus as the genie is out of the bottle, so to speak.
  12. Emergency RN

    Tufts nurses vote 70% to authorize strike

    Excuse me, but even us brothers are proud of the sisterhood; I get the sentiment so no offense taken
  13. Emergency RN

    Tufts nurses vote 70% to authorize strike

    no, i would not cross a picket and here's why: knowing nothing at all about tuft's nor the union involved, nor anything even about boston, my sentiment is thus based solely on what i understand about nurses and the economy. the economy is stinking bad; any nurse willing to walk off a job must have some damned good reason. nurses don't leave patients in a lurch; it just goes contrary to their nature both as professionals and as people. any nurse willing to walk away from a patient in need must have some damned good reason. given that tuft's (according to the op) has 1100 nurses, and the vote was over 70%, that means that 770 plus rn's are willing to walk out. there must be a damned good reason. support your nursing unions!
  14. Emergency RN

    Why no air bubbles in IV lines for cardiac patients?

    Air emboli injected into a large pool of mixing churning blood (such as that going from the Vena Cava into the Right Atrium or Right Ventricle) is not a big deal. The air bubble is usually diluted by and then rapidly diffuses into the comparatively larger body of blood. However, if an air bubble is allowed to go from the right atrium into the left atrium (as through an Atrial Septal Defect) or from right ventricle into the left ventricle (as through a Ventricular Septal Defect), then there exists a good possibility that the air bubble is then ejected from the left heart into systemic arterial circulation. An air bubble coming out from the heart can follow the path of systemic arterial blood flow to anywhere that arterial blood can go. It can go directly into the coronary arteries where the air emboli would likely cause a Myocardial Infarct; or it may go into the cerebral circulation where it would cause a Stroke. The problem is with the nature of arterial circulation itself; the amount of blood relative to the amount of air bubble is rapidly diminished as it travels along arterial anatomy, which is the exact opposite of that seen with venous circulation. Thus, the air bubble is much more dangerous to the point that it is potentially lethal as there is less chance for it to mix and become dilute. It would stay intact and its surface tension would block blood flow, the classic definition of embolic event. In this case, it would be referred to as (like respondent GreyGull alluded out) a Paradoxical Air Embolus. (Note: A Paradoxical Embolus is when a venous blood clot enters arterial circulation, usually via some right to left shunt like an ASD/VSD.) Sources: http://ccforum.com/inpress/CC2362 http://bja.oxfordjournals.org/content/84/1/112.full.pdf In Hollywood movies, when the killer injects an air bubble into the victim's IV line, and the victim suddenly grabs at his chest and dies; you laugh at the artistic license. But, if the plot has it that the victim had a known Atrial Septal Defect, and the killer who was aware of this, injected air and kills him; you say, "damn... but that's some excellent script writing." LOL...
  15. Emergency RN

    Nursing insturctor terrifying students

    IMHO, instead of writing this here, I would suggest that by informing or complaining to the program that employs her, it would be a lot more productive. As the parent of a high school student, you should have a hell of a LOT of say over the quality of education that your child receives, and most schools usually bend over backwards to investigate parental complaints. I suggest you also write a letter to your local board of education, too. As for the instructor, this kind of belittling drill sergeant attitude may have been the way that she herself received training back in the boot camp styled nursing schools of the 1930's. But thankfully we've come a long way; we've learn to communicate effectively not only with our patients, but also with our peers, subordinates and the public at large. Unfortunately, there are some people in the world who can't feel good about themselves unless they make others feel bad. It has nothing to do with nursing, but rather is a character issue with some people and can be in any field or calling. If this is the instructor's style of teaching, then perhaps this retired "nurse" needs to be put out to pasture too. Tell your daughter good luck, and I wish her a long successful nursing career