Psqrd

I am an ED nurse as well and see only a couple of issues, yes that is a high dose of morphine but the flip side is that if you go over it is easily rectified with narcan..however your patient being alert, oriented and ambulatory tells me that he has a high tolerance to morphine and thus I would have been looking for something else..the other issue to consider is that if his pain was that extreme..this would have been a huge red flag and I would have been pullng a doc in and calling the OR to expedite as this is an indication that something is turning real bad for this patient. A two hour wait for a ruptured appy is WAY too long and I certainly hope you were dumping antibiotics in this guy fast. I think of q10 minute pain meds and I know i have at least 2 or 3 other patients that wont be getting any care at all as all I would be doing is running from the pyxis to this guy and back again.

I have to smile at your post as I recently was grilled by a patients' family member about why I didn't want to be a physician and appeared bewildered when I explained that I loved being a nurse! P2

Darknights, I admire nurses like yourself that everyday despite poor conditions continue to do the best they can every day for their patients. To second guess what you could have done different in this situation is very tough indeed, as you were only thinking of what was best for the patient. In my own experiences I have learned to move or disturb a patient as minimally as possible at end of life. Faced with your situation I believe you did the best thing possible which was to cover the blood on the linens and wipe the patient as best you could...the only other thing if possible would have been maybe move the patient to clean room if available. You did the best you could for your patient to move from this life to the next as easy and respectfully as possible and no fault can be found in that. Keep up the good work your doing down under, and know for what it's worth, I would be proud to work with you any day! Psqrd.

I would remind the family member that the injury is of the brain not the arm itself. I have seen some edema in the affected arm but this is usually after a long time following the stroke. Not all strokes are the same...with my grandmother she feels pain/sensation in her weak arm but has no muscle control. If the family insists that they don't want the BP or blood draws on the weak arm then I guess you will have to comply.

I was a phlebotomist before I was an RN...I have one word for this practice..LAZY! As I know that most of these sticks are brachial or femoral..if they clot off or damage the artery do they have a plan for re-vascularizing the limb...if this was my child trust me that heads would roll if I found out about it. P2

I have taken care of several individuals with stroke symptoms and I can see no reason why you can't draw blood or start IV's on the weak side. In fact, a good argument could be made that starting the IV on the weak side would be the better choice as that would keep the strong side free as that is the arm they will be using for everything from eating to personal hygiene. The stroke is a brain injury not an injury of the body... I hope this helps. P2

Anytime a medication is held, document observations and notify physician. Not notifying the physician of a held medication can get you in trouble. P2

Well I would certainly list the job or you will have trouble explaining the gap in employment and as most employers are doing credit checks it would most certainly pop up there. As far as how to talk about the job I would just say that you left seeking opportunities that better fit your career goals and leave it at that. Its truthful and sounds professional and people leave jobs all the time trying to find a better fit for themselves. It used to be that the someone seeking reference could ask if you were eligible for rehire and that the former employer would give that information but now most wont even give that. If they do say your not eligible I would say that you fell short of a full two week notice because of vacation plans or something. Don't stress about it..I would be more worried about them reporting it to your license that you delayed care. P2

I too will be starting in the ED here in Sacramento in January and similar to you have 1 and half years of experience on a cardiac unit. I don't have any advice but wanted to let you know that you are not alone in starting this ED adventure and wanted to wish you luck on your endeavor. P2

I had a patient that wanted to go AMA, I pushed the elevator button for him and asked him while he was waiting if he would sign this little form I had entitled "AMA". When the elevator came I said see ya later.. and we was back before I came back on shift. I agree with everyone in regards to having a sense of humor with your patients so as to not let them get to you. Once they get to you then they have won, plain and simple and thus have power over you. The one thing that I always suggest is that they don't have to leave...they are allowed to refuse parts of the treatment regimen...I think in your situation I would have asked if he wanted t refuse the vent...got the AMA form signed with at least 2 witnesses to the AMA advisement and signature. Called the MD left a message that the patient was refusing the vent as he wouldn't call back and call RT to remove it. At least your clear as being able to monitor him and if he got bad again you can say "told you so". I think nurses often forget that patients are allowed to refuse a medication but accept other meds or they can refuse certain treatments and I will even remind the patient thay they have the right to refusal. I had a patient refuse a med then continued to apologize for refusing it...I reminded her that it was her body and thus she was still the boss of it. No skin off my nose!

It's not good enough just to have the license as the competition is heating up for the few new grad jobs that become available. My manager speaks with the clinical instructors and asks who is the best and that is who she is recruiting. The other issue at hand when I graduated a year and a half ago is that new grad positions are seasonal...what I mean by that is the people in my class that started applying about a month from graduation got jobs..the ones that decided to wait didn't. So my advice is try and do the best that you can...while working floors make those contacts with managers and get your name and face known to them. Try and work as many floors as you can, even if it's not the floor you want to work on... you can do it for a year and then move on to what you want. Good luck, P2

I took ACLS as a fourth semester student about 2 months before graduation and because of it ended up on a Cardiovascular intervention floor. You are correct that it gives you a bit more confidence and increases your marketability if you ever want to move to tele or higher acuity floor. My advice is don't wait...go for it! Do your pre-reading before the course and you should have no problem as they teach you all that you need to know to pass. P2 my

I am sure I am not the originator of the term "Jenny Craig" assignment of one patient at one end and another patient at the opposit end of the unit but I love the term.

On my unit we do the assignments for our shift. I having worked with the nurses on a regular basis take into account whether the nurse had a bad assignment the night before as to not give them heavy patients again..I also consider isolation as I try an spread them out so one nurse does not have all the isolation patients. I also consider the nurses ability...I try not to dog out floats as it can be tough enough on a floor that you don't know where everything is and I don't want our nurses to get dogged when they go to their floor... I'm not sure but maybe your charge did not know how heavy those patients were and if that is the case I would bring it up with them to make sure they don't pass that assignment on. The other thing that needs to be addressed is the lack of teamwork on your floor...no one should be sitting on their duffs while you run crazy...if this is going on then I would definately bring that up with charge and if nothing happens then take it up with your manager. The other thing to consider is of course is your perception that you are the only one with a bad assignment. I have had nurses come to me and ask why they got such a bad assignment...In one situation I explained that everyone had bad assignments as it was just a heavy floor that night...it was quickly confirmed by another nurse walking/running by who asked if she would like to trade assignments...she got the picture. Alot goes into it...in fact I consider it to be the biggest challenge of being charge and always feel guilty when someone gets the "bad" assignment. I had to the day shift assignment once (i work nights) as the charge was going to be late and I have to tell you I don't envy them with all the discharges and admits from surgery or cath lab...that one is a total crap shoot sometimes. P2

I have heard that cover up makeup works really well...use that for the interview then when you are hired..it's to late. I work with nurses that have tattoos that show piercings too...no problem that I have seen. Just my 2 cents. P2