NewEDRN

I work in a small community hospital, emergency room. The hospital is very involved in this big push for customer service right now. Though many of the changes are patient based and generally well accepted, many of them are very insensitive and border on legal and ethical issues with staff. For instance, many workers have been forced to change uniforms with a week's notice, being measured for and getting one to two uniforms given to them, having to pay exorbitant prices if they want more (obviously having one uniform when you work 6 or 7 days in a row will be an issue). In the beginning of the year, nurses will be required to change to white uniforms, with no clothing allowance or uniforms given (i as well as most nurses spend several hundred dollars a year on the navy uniforms we have worn for years and now will have absolutely no use for). Starting today, we are no longer allowed to have any food or drinks anywhere on the unit, which i totally understand the food, but our break room is very out of the way from the rest of the unit, and anyone working 12 hr shifts in a busy er knows you are lucky if you get 10 mins to eat a lunch let alone get breaks where you can get something to drink. I don't see how i can be made to run like crazy all those hours and not be allowed to have a bottle of water in the nursing station, which is high enough to be totally out of view of any patients. Imagine telling someone in a desk job that they are allowed to drink only on their breaks, that's ludicrous. Also, and yes, i am a smoker, and beginning in jan 1, we are no longer allowed to smoke anywhere on hospital property, including outside, parking lots, etc, there will be no designated smoking area. The kicker is, leaving the hospital grounds is considered patient abandonment even if on a break or at lunch, and punishable by immediate termination. Can a job legally say what i can or can't do on a break?? any input from others going through something similar would be great.

I made a stupid mistake the other day. I've been a nurse for a little over 2 years, recently moved from the icu to er. We had a pt the other night who was a terrible stick- 3 nurses, 2 lab personnel, and iv therapy were unable to draw her labs. Finally, the doc and i go in to do central sticks, atleast 7 or 8 jugular, and more than 10 groin sticks before we finally got some labs. Her coag tube was the tiniest bit short, and before we could draw another one, coud'nt get anymore blood. The pt had been there 10 hrs and was on coumadin, the only thing she needed was labs resulted and she could go. I dont' know what i was thinking, i had a bunch of tubes that were half full, and half kidding to another nurse, i said i wish i could just add a little to the short tube, she states, i've done that a million times and never had any problems. So, i proceed to pull some blood with a syringe out of a tube i thought had no preservatives or anything in it, add it to the coag tube, and send them out, without even considering the conseuquences at this point, the doc says to me, i really hope those coags get resulted, cause i'm not sticking her again, and i say to him, they should, i filled the tube the rest of the way with a discard. Needless to say, labs come back all messed up, and when called into the dr, (who knows very little about how the lab works), states, could it be because the nurse put a little extra in the short tube?? at this point, it becomes crystal clear what i have done, the tube i added from did have a thinner in it, and hindsight what it is, it's now so very clear why you're not supposed to mix tubes. I don't know what the heck i was thinking when i did that, i've never done it before, and certaintly won't again. I told my supervisor, who laughed about ti and told me not to worry about it, but i know the incident reports go to the department heads, who are not so nice and understanding. I'm feeling so sick right now and hope i'm not going to lose my job over this. luckily we just cancelled the labs, and the pt went home with instructions to follow up with her family doc. As much as i cringe over my series of mistakes, i am glad i admitted to it, if it had'nt been detected, the pt could have wound up admitted getting FFP and several more lab sticks.

i worked for bayada on and off for the last year or so. Some of the cases are really nice, great people. For me, it just was'nt a good fit. Many of the cases they offer are long term care type, i worked with many adults with brain injuries. Acute cases are hard to get, and few and far between. Working in critical care, i was bored feeding, walking, bathing, cleaning, etc for one patient. I also had some problems with family- keep in mind, many of the family members have been dealing with their family members illness for many years and are very very particular about how they want things done. The rates in my area are from $22-28 an hr, 22 for long term care, little nursing skill needs, around $25 an hr for vent/trach/kids, and have "nursing skill visits" at rates of $35-60 per 1-2 hr visit. For me, many of the cases they offered were 20-30 miles from me, and i made more than twice the money they offer doing overtime at my hospital. I know several people who love homecare though, so maybe you will.

My ED is currently 23 actual beds, but when add in halls can take 32 pts at a time in the back. We have one triage nurse, one tech to do vitals, and admission people are all in same place in triage. They decide if pt goes to fastrack, waits, or comes right to the back. If fastrack, the LPN calls their own pts to there, if goes to the back, charge nurse will assign bed, and will get charts of waiting people by order to call. Fast track closes at 2, and we don't have a triage nurse after 3. So at 3, charge nurse does all triage, bed and nurse assignments, and will take pts if we are still really busy. We see 150-250 pts per day, and are expanding our ED to 40 beds, 11 fast track next month, so don't know how triage will work then.

As a relatively new ED nurse, and working in a small hospital that happens to have the only psych screening and inpatient facility in the county, we see a lot of frequent fliers, psych pts, od's, and like all ED's, tons of people with trivial problems who just can't understand why they are not seen within 5 mins. We've had a brutal week, sometimes with waits of 7 to 8 hrs to be seen, and in the middle of the night last sat, we get a coding pt, K of 1.9, going back and forth between wide complex brady and pulseless vt, we did every med imaginable, shocked him 36 times, did central line, temp pacer, the whole nine in the er. with only 5 nurses on, one in triage, one in charge, and 2 helping in the code, only the charge nurse and one other nurse were trying to manage the other 50 pts currently in the ED. I was in the code, but frequently switched with another nurse outside to help with pt flow, and a pt of mine, who was in plain view of everyone coming in and out of the critical care room, is literally waiting at the door everytime i came out, demanding i pull the dr from the code to read her CT report. She had been there only 1 and 1/2 hrs, and came in with n/v x2 earlier at home, totally uncaring for anything else going on in the ED, i could'nt believe that people could be so uncaring. I go out to discharge one of my pts, who i got report on at 11pm, had been there 10 hrs, and who i had never even looked in on in almost 4 hrs, we were in the code for over 3 hrs. Her room was across from the code room, and as the doors opened and closed, she could see staff rushing in and out. She tells me she can wait if i need to go, that she knows there is someone there who needs my help a lot more than she does, and she has been in her room for the last 2 hrs, praying for the pt we were coding. I was truly touched, though i know most people do not have this type of patience and compassion, i sure wish more of my pts had some of these characteristics.

Had a frequent flier come in the other day, unfortunately, only having been in the er for 2 months, i did not know he was a frequent flier, ugg. He comes in swearing he is having a stroke, and playing quite the part- not moving R side at all, only moving L side of face, had the expressive dysphagia going and all, i thought it was a little odd that he had no medical history or vision changes at all, no HTN, nothing, but being a small community hospital, we don't see a lot of strokes, so i was buying it, right until the doc came in and asked him if he could'nt move, how did he walk through the triage area, sign all the papers out front, etc. His story quickly fell apart from there, he became beliggerant, screaming that he was having a stroke and needed immedient treatment with dilaudid. After about an hour, bloodwork and ct done and still no dilaudid, he abruptly got up, told us all to go F ourselves, that we neglected him by not giving him the "proper treatment for his distress with dilaudid" and stormed out. Apparently, someone must have told him that stroke pts are seen immediently, unfortunately he was not aware that dilaudid is not the treatment for it, i'm sure he'll be in with a new story soon

We also have both CNA's and techs in my ED. The CNA's do stuff like vitals, can do pt transports, unfortunately for our CNA's, the majority of their time is spent doing 1 on 1's, we are the only psych screening and inpatient unit in the county, so we get tons of intoxicated, od's and psych pts. Our techs can do transports, vitals, 12 leads, direct stick labs, all the ortho splinting and teaching, dressings, suture set ups, take out iv's, can do discharge instructions for non complicated pts, they do not do any iv's, foleys, anything considered a skilled nursing duty.

Never heard of T-sheets. i work in a small hospital, we use ibex in the ed, very good system, docs put in charting and orders, nurses can do complete assessment, vs, chart all meds, procedures, etc, and fairly easy to use, all current results and recent visits are also accessible. We have another system that the rest of the hospital is using, not up and running as well but has the capability to, can only get results, no doc orders or nurse charting. we have another in house system to put stuff like lab, diet and supply orders in. Otherwise, all in house stuff, dr orders, nurse charting is still all paper. Eventually all systems will be integrated into one, but will take several years, so for now, it can be a bit overwhelming.

Thanks for all the replies everyone. Last night, i finally got a different assignment, thank god, though i still had 5 or 6 pts at a time, the turnover was not as bad, and for the first time in weeks, i actually got a lunch. And just to clarify a little, i did mention to one charge nurse tonight how relieved i was to get something different, and luckily she already knew how many days i was in the other area and how busy i was. We had a staff meeting yesturday, and many collegues brought up the suggestion of limitting nurses time to 4 to 8 hrs on that assignment. It's not that the pts are less critical in that area, it is generally an 8 bed assignment, 2 "surg" beds, almost always full work ups, 2 gyn beds, always full work ups with foley and fills, plus have to be in the room with doc for all procedures, do fetal heart tones, etc, 2 ent beds, usually children with full work ups, and 2 hall pts, usually the only ones without full work ups. The problem is, when you have so many pts, all of who need line, labs, procedures, etc, even when they're not overly acute, they're busy as hell, and its' easy to come out of one room and find 3 pts waiting who all need full work up's too, ugg, just thinking about it gets me overwhelmed. I do really like acute care, mostly because i'm so used to it, but love fastrack too, love to get pts in and out in 15 to 20 mins, don['t care how many of them there are. Anyway, still loving being there so far, and am learning a lot, just hope the assignments find some kind of balance.

Hi everyone, pretty new here, and to the ER. I had 2 yrs experience in ICU and am in school to get my bachelors. I recently switched to the ER because i needed a change and new challenges. I finished my 4 week orientation last week, and am finally on my own. While in orientation, because of my critical care experience, i was almost exclusively assigned critical rooms and rooms where only experienced nurses would work, i worked pretty much on my own, and asked for help or questions to my preceptor. Now that i'm on my own, for 4 days in a row, i have been assigned the same, and probably most difficult and frustrating area of the ed. It is an area with less critical pts, very high turnover, and can have up to 7 or 8 pts at a time, because it is also in an isolated area, most of the other staff forget you are even there, it's so crazy, even the experienced ER nurses who work this assignment are used to getting at the most a 15 min break on a 12 hr shift (where other areas its almost guaranteed 2 (15 min) and 1 40 min lunch break. i'm exhausted and feel taken advantage of. Though i know i'm the new guy, it's not fair to be in the area everyone hates to be in most every day. One of the reasons i left the ICU is because i work in a small community hospital, where most nurses have been there from 10 to 30 years, so even after being there a few years, you still got dumped on- worked every holiday, and you better believe if there was a psych pt jumping out of bed, or a 600 lb vented pt, they were the newest person on the units pt. I know i'm new, but i was specifically sought out and recruited to the ER because they have so many new grads and so little people with critical care experience, and the assignments i'm getting don't use my skills. I'm feeling dumped on already. Should i just bear it and hope i won't always be at the bottom of the totem pole, is it too early to speak up about my assignments (which in the area i'm in, it's usually standard to only keep someone there 4 to 8 hrs, and never 2 days in a row, but i've done 4 (12) hr shifts in a row there? Anyone else have this kind of experience when new?

First of all, hello everyone, this is my first post, and i'm new to the site. I'm in the process of orienting to the ED following 2 years of ICU experience (where i started as a new grad). Had a weird situation happen last night, and wondered what other people may think of it. I was at lunch last night when my preceptor picked up a pt, and when i came back, i immediently began my assessment on a pt coming in, so my preceptor had been taking care of this other pt. As things got busy, he handed me d/c papers for the pt he had cared for and told me to give the pt a motrin on the way out. So i go in the room, say to the pt in the bed-are you miss so and so, she says yes, and i tell her i'm going to d/c her and give her a motrin. Because there are a ton of family members in the room and no where to put things down, i hand her the cup with the motrin in it, and tell her let me see your id band. As i compare it to my d/c papers, i notice it is the same last name, but different first name. I tell the pt her name bracelet is different than my papers, and she says yep, thats my moms name, i tell her not to take the motrin, but she pops it in her mouth, i went as far as to ask her to spit it out, but she swallowed it, saying sorry it tasted bad, i wanted to get rid of it. I immediently tell the dr that the name on her paperwork is her mothers and ask if there was a mistake in the admission, he tells me no, the mother is also a pt, and is also in the room. This is a one bed curtained area, and i would'nt imagine in a million years we would have 2 pts in the same one person room. My preceptor the pt or her mother never stated there was a mother and daughter in the room, and the mother was sitting on the floor with a bunch of other family members, was'nt even in a bed or chair. Turns out, the one who got the motrin was there for abd pain and doc wanted her NPO. I know i made a med error, and have accepted the write up, but i'm mortified that this happened. The patient was not harmed, but the mother complained, and i'm written up, i'm afraid of extending my orientation or putting my job on the line becuase of this. Even the dr was upset that 2 pts had been put in the same room, and no one had told me there were 2 pts, but at that point there was not much he could do except reassure the mom the daughter would be ok (daughter was a minor-16). The daughter was still in testing when i left this am, so if she really did have something wrong (they were thinking appy surgery), i coudl really be in troulbe. What do you guys think? or ever had a similar situation?