russ11

I will be very interested to see the results...I have been a nurse for 27 years...was part-time 3 eights...last month our ER went to mandatory 12 hour shifts because they say it we are way over budget. There were only eight people in a >100 person department doing eights or a combination of 2 12's and 2 8's. so I don't think we were the budget problem. Of the eight one left immediately and 5 others are currently looking. These were some of our most experienced nurses. I think it will back fire. I had 18 years in the ER and another nurse had 21 years in theER. The other six had between 5-15 years. Our turnover is very high...even interns we have supported through nursing school rarely stay after their 2 year committment is up. We need experienced nurses because we are the 2nd busiest trauma center in our state. I think expences for recruitment and orientation will eat up any money they might save by eliminating 8 hour shifts as an option. In addition many older nurses don't want 12's and even younger nurses starting families find 12 hours is too long away from their children...not having the option of eight's may make our ER less attractive as almost everyone will face a situation at some time where thay cannot do 12 hour shifts(caring for parents, children, after surgery,etc. ) If forced to do 12's, I am planning to find another job but before I leave willo talk with our VP of Nursing, VP of Human resources and our CEO to see if some compromise can be found.

I have been a nurse for 27 years...I have never not been able to get to work because of weather. I rarely call in for any reason. In the last 17 years have only been out only 5 days usually with sick kids. That said here are a few of my experiences. Once I was at the hospital when the snow hit...policy said they could hold us for until next shift arrived. I worked 16 hours ...hospital refused to feed us because the patient cafeteria couldn't figure out how to charge us...patients were giving us food off their trays...worked 24 hours like this until staff revolted and someone called a local radio station that shamed the hospital into feeding us. Worked 16 hours/day for 3 days...we were allowed 8 hour off to sleep and shower ...after 3 days when I was told I could leave the floor I went to my car, put on boots and walked 4.5 miles home. Once EMS brought us into the hospital ...stayed 2 days working 16 hours/day...hospital refused to get us home ...had to pay a cab. Hospital required those who didn't have enough money to sign IOU"s for meals from cafeteria. Once I went in on Friday ahead of the storm and got a hotel room with 3 other nurses (150.00 for 2 days split between 4 of us) Worked 16 hours for 2 days. All Administrators and physicians were reimbursed for the hotel but not nurses. 4 nurses for 2 days for $150.00 seemed like a bargin to me...won't do that again. Once was involved in a wreck with a new car when someone slid into me while coming to work to help out (on my day off ) because people further away couldn't make it in ...car badly damaged...2 weeks in the body shop ...$500.00 deductible...won't do that again either . Ever notice that nurses are expected to be on the job but ...all "non essential personnel" are not expected to come ie, laundry, housekeeping, secretaries, operators... are exempt. Often Administrators are not even required to come...they should be required to come and pick up the slack for all the non-essential people they have allowed to stay home...answering phones , getting laundry , passing meal trays.....after all if we don't need them then why do we hire them... For me these are all lessons learned...I will probably still continue to come but I expect the hospital not taking good care of me while I am there... Our administration learned the hard way that if you need to treat staff well because it snows every year and if you don't take care of your staff they won't make the effort to come in ....lkast year administration was in cooking breakfast and putting pizza on the corporate credit card (they struck a deal with local Papa Johns). I have learned "you get what you settle for" They expect me to come.I expect to have plenty of food, supplies, and someone besides me to answer the phone...I also expect the folks that make the big decisions and the big bucks to be on the sinking ship with me. My plan: I keep blankets, boots, bottled water and plenty of snack food in my car. I pack an overnight bag with shampoo, hairdryer, clothes as well as extra scrubs. If they pick me up I get the name of the administrator who is going to see that I get home. I work in the ER...there is nothing I can't or won't do. I let them know I am always available for staffing issues but if it is not safe to drive, they have to get me there , feed me and get me home...this is non negotiable. And for the record, you can not be fired for abandonment if you have not assumed the care of the patient.

18 month old raped by bf...had a tear from her lady parts to her rectum that her mother had sewn up with a needle and thread at home... bilateral above knee amputations while pushing stalled car off road ...happened twice this year 12 month baby drowned while in hot tub with intoxicated parents divorced dad had to work late, ex-wife called and said if he was late picking up 6 year old son wouldn't get to see him .. instead of going home to get his car picked up child in work van with no passenger seat only had to drive a mile home ...hit by drunk and son killed 28 y o groom pushed into pool by his brother/best man 2 hours after his wedding...c3 vent dep quad. 2 brothers 18 & 21... 21 y o getting married...went out drinking...21 y o too drunk to drive, gives keys to 18 yo drunk brother...hit a power pole which falls on car and sets it on fire..21 yo legs pinned burns to death while screaming for help...18 yo comes in with arm burns and singed hair after trying to pull brother from car...parents drive by accident on way to hospital...see 21 yo still in car...arrive at hospital and mother asks "what do i say to my son who just killed his brother" went to jail for vehicular homicide its in the memory of those we cannot save that we save the ones we can. 21 yo shot in head on christmas eve while drinking and parents out of town ..last thing he says before he goes unconscious is "tell my folks i love them and it was an accident"... in the or the surgeon literally scoops out a handful of brain and closes him up...3 days later he wakes up, extubated ...gives me a big hug when i visit and says "you did a great job" some movement problems with one arm ...talks to kids about drinking and gun safety. 16 yo drowns at ny eve party at local ymca...resus for an hour...no deficits... going to college this year 20 y o gsw to left ventricle trying to stop a car jacking ...open chest within 6 min of arriving by car at back door...thoracic surgeon between cases drinking coffee at trauma desk when he arrived ..sewed up heart in er and off to icu stable 8 y o drowns at church picnic...resus for 2 hours ...no deficit 13 yo on vacation at beach impaled by glass from coffee table...8 in shard goes in though buttocks, into pelvis and severs gluteal artery...loses liter of blood in the first minute ...bleeding controlled by mother /er nurse at scene...survives 25 min wait for ems. trauma surgeon said would have bled to death in another 2 minutes ...c on christmas i'm walking back from l & d pushing a w/c ..i see a visitor with a group of family members walking to the icu who looks like he's not feeling well. i say are you ok?? "i'm fine just a little dizzy"...he looks gray...i put him in w/c and say i'm taking you with me ...amid protesting from him and family i whip him into a cardiac room where he arrests before i get him on the bed. resus 45 min...shock 9 times...that was 15 years ago...every year on christmas day he calls the er and tells whoever answers the phone..."15 years ago your staff saved my life and i want them to know i appreciate it, i've had another great year with my family...i believe in miracles and so should you...you can make miracles happen...god bless you and have a merry christmas" it's hard work. bad things happen to good people. and one person can make a difference.

my new years resolution many years ago was that i was no longer going to put up with anyone being nasty to me or my co-workers...doctors, other co-workers, patients...i'm not talking about people being snappy during stressful situations i'm referring to people who bully and belittle others on purpose. my new motto is from the movie thelma and louise "you get what you settle for" . these personality types are bullies and they single out people least likely to defend themselves. i often function as the trauma/float nurse and am expected to help everyone .if i am present when any type of verbal abuse occurs i make it my business...i am polite but very firm. recently a doctor who has a reputation for being difficult (especially to new nurses) was nasty on the phone was being verbally abusive to a new nurse (near tears). she was trying repeatedly to tell this doctor that his patient was not doing well and i could tell he was being hateful...i interupted the nurse, took the phone and explained that "liz" was going on break and i would be taking care of her patients. i said i understand liz has explained her concerns to you and i need to know what you want me to do...when he started berating me i said "we have called you because we have concerns and there has been a change in your patients condition, i will be glad to take additional orders from you but i will not be yelled at because i am trying to do what is best for your patient...if you continue i am going to hang up," he continued , i again stated that i was going to hang up , when he started in again i hung up. he called back furious and demanded to speak with liz... i said "liz was very upset about the way you were treating her earlier, she will no longer be taking your calls concerning this patient...my name is 'mary' and i will be the nurse taking care of this patient now ...what can i do for you?..." he gave me new orders and told me he was coming in...after some discussion about his interaction with liz i pointed out that he had a reputaion of being difficult ...he then asked me to appologize to liz for him...i said "i think that is something you need to do personally...if there is nothing else you need from me now i will get started on these orders." he had previously treated liz rudely but after this day he was a totally different person to her. when co-workers say things to newcomers in in front of others whoever is present should say "i think ya'll need to discuss this in private" and then walk off...no audience... with patients i usually say "i know you don't feel well but i am not going to be talked to in this manner...i will be back in a few minutes" and i leave ...usually the most obnoxious patients are the least sick and a few minutes of "wait therapy" gives them time to ponder the wisdom of being rude to the person that gives the pain meds, gets the pillow/blanket and coordinates their care. i find that addressing the issue immediately usually alters the behavior. avoiding the issue almost guarantees the behavior will escalate. some infamous bad behavior divas need a more direct approach... once 'god's right hand man' (a neurosurgeon) was "off the chain" about something and began screaming at me about a hospital policy. (i wasn't even involved with his patient just happened to be there) i said "you may talk to your wife and children like this or maybe your office staff but not me ...i'm not the cause of your problems and i am not going to be blamed for them and i certainly don't have to put up with your bad behavior." and i walked off. much to his dismay a short time later he realized i was the only person in our whole departmant who was trained to monitor the icp monitor he wanted to insert in the er...our hospital has a policy that prohibits inserting icp monitors in the er but allows exceptions when the patient is critical and there is a nurse available who is certified to monitor it. on this day the patient was not critical but he did not want to wait(had dinner plans) while the patient was transferred to the or or neuro icu. my cn left it up to me and then made him ask me if i would be willing to assist him and monitor his patient even though it did not fall into the exception clause of the policy...i agreed, i was polite but avoided his attempts to "chat" and only gave short answers to direct questions during the procedure . to this day he goes out of his way to be nice to me .... and usually looks for me anytime he has a patient in our department... the longer you tolerate bad behavior the worse it will become. i'm a firm believer that in all aspects of your life "you get what you settle for"

in our er you are almost never waiting on the nurse. most people are triaged by a nurse with in 20 minutes even during the busiest times. then you wait for a room to open up. when a room is available you are taken to the room by your primary nurse and reassessed. this nurse starts your iv, and can order labs , xrays, ekg's and in some cases ultrasounds or cat scans before you are seen by the doctor. now you are waiting to be seen by the doctor and for everything to result. during this time the staff may not appear to be doing anything from a patients perspective. often we give pain meds and antibiotics during this time (after consulting with md). the nurse is also monitoring results as they come back and is caring for 2-4 other patients. if you are waiting your nurse should be updating you on exactly what you are waiting on. we have 63 beds in all departments with 6 md's , 6 pa/np's , and 21 rn's working most of time so its not a staffing issue. often in a trauma center critical patients take up a lot of resources and time and patients who are not in that part of the er are not exposed to the flurry of activity that is going on in that area. nurses in the less critical areas of the er are often less busy and may have "down time" while waiting for their patients to be seen. from 3am to 7am the minor er is closed so if you have a minor complaint during these hours you are at the bottom of the "see next list" and you will wait. best advice in any er. come early on the day shift for minor complaints... most hospitals have a minor er during these hours and more resources in all departments. don't wait until you are at "the end of your rope" before you do come...just because you "can't take it anymore" doesn't mean you have a true emergency in the big picture of the er. sundays and mondays are always bad because a lot of people try to "wait it out" so they can see their md on monday and either can't take it anymore or find out they can't be worked in. and finally, during flu season remember in most cases you should stay in bed, drink lots of water, gatorade and juice. take tylenol every 4 hours (if you have a fever )around the clock. if you are not having nausea, vomiting or diarrhea also take advil for the aches...most er doctors do not prescribe antivirals for the flu unless you have underlying medical problems. if you have fever in spite of an aggressive tylenol/advil routine or can't keep even water down, or are old, young, or have complicating medical problems we need to see you ...otherwise there is not much we can do for you in the er that can't be done at home. last but not least: be nice...i know it is hard when you don't feel well. being sick is no excuse for bad manners. right or wrong it's human nature... grumpy demanding people are often avoided. no one will go out of their way for you...you will still be cared for according to good nursing practice but there is a huge difference between what ena requires and what will be done to expedite your treatment and make you less miserable during your stay.

I do not. Now I work in an ER in a smoke free facility. But I didn't take them out to smoke even before the ban. It is a huge liability/safety issue for staff and patients. We have had staff members assaulted in our department by MH and other patients. Last year a 72 year old man (cute little grampy with alzheimers) nearly strangled a staff member who was in a charting room that was in the back of the departmant... she was saved when he knocked over a chair and a tech heard the ruckus. I certainly would not go outside into the parking lot...after all patients are basically strangers, some more than others. Legally I would be very surprised if the hospital could make you do it as part of a care plan.... And as for "it calms them down" what if they had rather have a beer??? They are both legal addictions... Years ago in a VA hospital on a long term unit we occassionally provided patients with alcohol which I thought was odd as so many were alcoholic but the doctors actually wrote orders for " 1 beer @ bedtime" Now I might be more tempted to take them out for a margarita and some chips and salsa.

Yes...if CN phone is busy the Trauma nurse or SS can place patients.

We are computerized and everyone has a timer that started when they signed in to the ER so when I am in triage I usually look at the timers and will say "if we don't have another life threatening emergency come in the next person that will be taken to a room has been in the waiting room 2 hours and 51 minutes (or whatever the times says). I then tell them how many other people are also waiting to be seen. I then say "We will get to you as soon as we can but it is going to be a while. Let me know it you develop any new symptoms. "Then when they tell me they don't feel good I explain that everyone who is in the ER is here because they aren't feeling well . I also tell them I understand but after taking their history and assessing them in triage I don't see anything that makes me think they need to be seen ahead of someone who has been waiting longer than them." We often have LONG waits this time of year (2-10 hours) so I do try to seem helpful and always, always tell them to let me know if they develop new sx or are getting worse. If they aren't sick and they want to leave I sign them out AMA. If they are sick I tell them when I triage them "It is going to be a long wait...but no matter how long it is you have to have medical treatment today. Do not leave without talking to me." I write myself a note with their name and my Dx and I retriage them every 2 hours. I also make sure if I leave triage that the next person is aware of my concerns. This usually works well on most sober reasonable patients. When they get obnoxious I just say "I don't know" and move on.

Every staff person in all our departments carry a phone... doctor, nurse, tech, patient rep, translater, admissions staff because our department is huge and busiest in the state. We have a monitor tech who takes all EMS calls, watches the monitors and runs the EKG's. The CN is very mobile...monitors department,expedites bed assignments, flexes staff, assigns rooms, and handles problems. Pts. primary nurse takes orders or if tied up any any available nurse can do it as charts are computerized and all info (meds, allergies, hx, treatment) is available to everyone. Over the CN we have a shift supervisor that coordinates all 4 areas of Emergency Medicine ..we have an adult ER and trauma area , Fastrack, Peds ER, and and observation unit.