ecat81

We have unit based educators but they more fill the role of policy making and meetings than actually holding classes and providing up to date information. I think it is a wonderful idea if educators are getting the new information and refresher courses to the staff.

Anyone heard anything about Samford University in Birmingham, Alabama? I know their program is fairly new but wondering if anyone out there has heard good/bad/in-different? Thanks, Ben

715:banghead: is the highest I have ever come across. Many times you have to check the anion gap because the etoh will be through the roof due to the patient drinking rubbing alcohol:yeah:!

In the ED we have patients that undergo procedures in the ED and of course many that go to surgery. Many times the patients going to surgery do not see the physician until they arrive in pre-op. Surgery always complains that the ED didn't get the consent signed:angryfire. I never get the patient to sign the consent unless its informed consent. (Emergency surgeries are different of course-then you dont need a consent) I was reading an article and came across something that I hope to get some feedback:yeah:. Informed consent is an agreement by a client to accept a course of treatment or a procedure after complete information including the risks and facts have been presented by the physician. The nurse is just a witness to the giving of informed consent. Then, the (of course) nurse gets the consent signed by the patient after the following has been met: 1. The consent is voluntary 2. Consent must be given by an individual with the capacity and competency to understand. 3. The patient must be given enough information to be the sole decision maker. BUT:D...also in this article it states if the nurse only witnesses the client's signature and not the exchange of informed consent between the patient and physician then the nurse shoud write "witnessing signature only" beside their signature. My question is by writing "witnessing signature only" and documenting in the nurses notes does this cover the nurse legally? Also, can this been done without the patient actually having informed consent? In other words the paper is signed and the nurse "witnessed signature only" be used legally? Thanks! :twocents:My opinion still stands that I will not get it signed myself and will back any of my nurses that don't have the consent signed before surgery, without the patient being informed.

I love Brooks shoes. They are expensive but well worth it walking all shift and hold up very well.

One thing I do want to ask everyone. Do you have locum tenems doctors or full time? Are they board certified in ED med? Luckily we have 8 board cert. ed docs and recently added 1 board cert. locum due to a doc leaving until they get someone else hired. I think it makes a big difference to have full time board cert ed docs. You get to know them, what they order, and have consistency among them.

I work in a not-for-profit 32 bed Level II ED. 8 of those are express beds but we have up to 8 other patients in the hall. We start at 4:1 but sometimes it goes 5:1 very rarely is it 6:1. In express 8:1-2 varies during the day. We see about 58,000 a year and recieve trauma's from a 35 mile radius from 3 states. Pay is low due to 4 nursing schools in that 35 mile radius. I believe starting pay is $19.50:chuckle plus $1.00:cry: ED diff.; 8-16% second and third diff. Our staffing has really come up in the last few months we will see if they hang on through the winter season. We have 42 FTE's (6 short of being "fully staffed" financial difficulties-yeah another subject:devil:), 3 clinical managers, quality nurse, educator, case manager, study site nurse, 8 per diem's, and director. And many techs/sec's.

Check out this site for some great laughs! I would love to wear some of these to work! Maybe when I decide to leave:rolleyes:. http://shop.cafepress.com/emergency-nurse

I work in a non-profit community hospital seeing 58,000 ED patients a year. This year the hospital has been hit hard by the "charitable care" given to the community. The hospital has for years let the community get away with coming in and not paying their bills and now it is hurting the hospital. Don't get me wrong the hospital is still making money, but only half what they wanted to make and the hiring freeze has only hurt the employees. The ED is in the early stages of hiring NP/PA to see our wound rechecks/re-evaluations in a clinic and eventually to start seeing medically screened patients by appointment. This is to curtail the abuse of our ED and the loss of capital. There is no quick solution. You're right if we try to educate the public then they cry to adminstration and then they talk with us. And I wonder why there is so much burnout and turnover in the ED:banghead:?

This recently happened to one of our patients on a night I was in charge. Except the patient was intoxicated when brought in and was about an hour away from his home. We exhausted every relative and friend he was willing to give numbers for. We do have cab vouchers but have stopped using them because of abuse. The patient was told to find a ride by using the phone in the lobby and didnt get home for about 14 hours. He was fed and given a blanket. I hope someone can give a good answer to your question. I was approached by someone as to why I let him sit in the lobby and I gave my explanation of abuse of EMS-vouchers. If he was able to come with friends an hour away to go drinking then he had money and friends to take him back. Not being uncompassionate but not allowing patients to take advantage of the hospital. Also I believe an employee going home in the direction he lived carried him home. To me this is a huge liablity also for the hospital. What if they got in a wreck and the patient dies? Thanks

Was wondering if anyone else had an Emergency differential and what it is? We saw 57000 last year in a 32 bed ed. We have just found out we got a raise but administration decide to take away .50 of our diff down to 1.00. How can they justify this when we cant keep staff and why work your a$$ off when you can do half the work making only a dollar less on the floor! Makes great sense!

Medical Center in Dothan finally went up to 18.50 with still 8%/16% diff. ACLS is .50, Certification in area 1.50, Charge 1.50. Only unit diff in hospital is ED took .50 away down to 1.00.

Just remember Cerebyx can be given 150/min but slower for women b/c it will cause outrageous lady partsl itching. And also on anyone if going to fast can cause vomiting;).

If There Is Any One On 10 Hour Shift In Their Ed Please Reply And Let Me Know What Your Rotation And Shift Times Are. We Are Looking At These Shifts But It Has Been A Struggle Trying To Get The Shift Times And Coverages To Work. Thanks

We Are Looking At 10 Hour Shift In Our Ed. Is There Anyone On This Schedule? Please Reply With Your Shift Times. Thanks

I Love another one bites the dust!

In our ED only RN's with atleast a year experience in our ED can triage out front. But EMS that comes in usually whoever has the room triages the pt.

In the southeast region the base for new grads is a dysmal 16.50 and hour and hasnt budged in 3 years. This is a ridiculous wage considering that there is a definite shortage in our area now. We have had many nurses walkout of our hospital. Its tough. Something has to be done about the low wages with gas 2.80 and milk 4.50 a gallon.

We get $1.50/h for charging and only selected nurses get to charge. We normally dont take pt's but at times on nights we have to take pt's.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc, We have a Chest pain with meds listed, Fever with meds, Pneumonia with beeper alerts to charge nurse if infiltrate shown on CXR, Extremity(Ortho), SOB almost complete, and a few others i cant remember can check at work tom. 2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example) All mostly are for orders of labs, x rays, etc. Chest pain protocol goes more in depth with meds it actually is a 2 page in depth set of orders. We have biosite meters so we can have CKMB,Myoglobin,Trop I, and BNP readouts in 15 minutes. The fever protocol calls for tylenol motrin of course. 3. Does it make a difference in how fast patients can be seen, treated and released. Makes for quicker dispos thats for sure. 4. Do they empower you as a nurse or make you life harder Empower us. We really did these things before but now its "signed off on" 5. How often do the powers that be check to make sure your following protocols. All the time. 6. How often do your Doc's disagree or stray from the protocol All our board cert er docs have signed off on the protocols and helped develop them. 7. What are your thoughts on protocols? Pos, neg etc. I think they are great. Allow us to use our nursing judgement and help move things along in an er that sees 170 - 200 a day.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc, We have a Chest pain with meds listed, Fever with meds, Pneumonia with beeper alerts to charge nurse if infiltrate shown on CXR, Extremity(Ortho), SOB almost complete, and a few others i cant remember can check at work tom. 2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example) All mostly are for orders of labs, x rays, etc. Chest pain protocol goes more in depth with meds it actually is a 2 page in depth set of orders. We have biosite meters so we can have CKMB,Myoglobin,Trop I, and BNP readouts in 15 minutes. The fever protocol calls for tylenol motrin of course. 3. Does it make a difference in how fast patients can be seen, treated and released. Makes for quicker dispos thats for sure. 4. Do they empower you as a nurse or make you life harder 5. How often do the powers that be check to make sure your following protocols. 6. How often do your Doc's disagree or stray from the protocol 7. What are your thoughts on protocols? Pos, neg etc.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc, 2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example) 3. Does it make a difference in how fast patients can be seen, treated and released. 4. Do they empower you as a nurse or make you life harder 5. How often do the powers that be check to make sure your following protocols. 6. How often do your Doc's disagree or stray from the protocol 7. What are your thoughts on protocols? Pos, neg etc.

Unfortunately making wireless monitors would be great except we had to quit buying remotes and phones (we now have the old huge phones in the rooms that have buttons but used to have the round dials) because the pts walk off with them and there is a huge market on ebay for this type stuff. Also never lay down your stethoscope or it will go too. We have all brand new monitors in our er dragers that monitor everything you could imagine. The only problem is that we have some nurses that lose the leads and o2 cables.

We are very autonomous in our ED. As soon as a pt is brought to a room we do draw a rainbow, send urine, get an ekg, start our bedside cardiacs, etc etc. We cant afford to wait til the doc sees the pt due to the fact that we are so busy. But we also on the other hand have great docs. We have 9 board cert. ed docs not family physicians or other docs. right now and have 4 physician coverage everyday, plus a pa in the express from 10a-10p. and 3-4 days a wekk we have a pa that sees pts in the main ed from 5p-5a. Im talking about the fact that the pt has orders to go upstairs and the nurses on the floor want everything done so they can put them to sleep and not do anything else. to include nightly meds, etc. We do all the orders our ed docs order plus even some he admitting docs want done. I have had pts go to the med surg floor and 1.5 hrs later they call stating we cant find the orders on pt so and so. Hmmm you mean that you havent seen the pt in 1.5 hours and they are under your care. It would be different if you went to the floor and there wasnt 4-5 nurses and 2-3 techs sitting at the nurses station when you walk by and you still have to ring the bell to get them to come receive the pt.

We fax our reports up to the floor and it works well for us. We call to confirm that the report was recieved and then the pt goes to the floor. Jacho stated to us that report was a courtesy. We fax then the pt goes up. We only go to the floor with pt's on cardiac gtts or to the unit. About the "let me get the room setup" ...never happens. We repeatedly go up and nothing is in the room except the tele monitor. We have to pull sheets back, move chairs out of the rooms, move bed side trays, poles, to be able to even get in the room. We try to get all pts to the floor in 30 mins due to the fact of our high mumbers in the ED. We average 165 a day right now and increase every year by double percentages. The floors seem to delay the inevitable. We have no control over our influx and most floor nurses dont understand or care about that. On the floor they pitch a fit wanting all meds, labs, etc done before the pt gets up to the floor and a full report. Sorry not going to spend 10 minutes going over the pt for your assessment. Do your own. During that 10 minutes we had 5 ems arrive with 3 traumas and a code and still have 28 pts in the lobby waiting for over 4 hours now. What really gets me is when we do get a chance to run to the cafeteria to get food to eat cold a few hours later the nurse I just took a pt to is sitting in the cafeteria eating with a tech and another nurse off the same floor-How nice. Sorry for the rant but thought I'd give my thoughts.