KKERRN

Arwen U: Thanks so much!! I will send for this book and put it to good use!! I appreciate such quick reply. I haven't used this site for awhile, but I have returned to Mother/Baby nursing this past year...where my heart of nursing was born!! Our unit needs improvements and I intend on pursuing one issue at a time. Positive research will really help this transition in smoothly. Thanks again for your reply! Karen

Our hospital in Southwest Ohio is now urging nightshift to have parents Room in-but don't seem concerned about having policy with guidelines to be followed! What about the nurses liability??? I'm researching to see if policies exist in other hospitals that we could refer to???? I hope to be able to present research to begin a written policy for our unit. Thanks!! Karen

I don't like it either. It seems only the unhappy ones reply. Our scores for the ER are low again this year! I don't feel it should be used in the ER's.

We use it for conscious sedation to reduce dislocations mostly. We have policy and procedure to follow. We also use versed and sucs. Patient arouse better with the etomidate and seem to be discharged sooner than when we give versed.

stevemartin, We all suffer through low times. You say things will get better. How do ya know it will get better?? I worked at a hospital that told us that for 3 years and then they closed!!

stevemartin, I'll have to ask how the administration determines our FTE's. I only know they use a 1 nurse to 4 patient ratio which include our charge nurse and triage nurse. Again, how can they count your hours, the nurse manager and clerk??? When it comes to patient care they should only count the actual number of nurses giving patients care! That is just common sense to me. By the way, how are the Press Ganey scores doing for your ER's??? Ours weren't so good. No matter how hard we work, how fast we go or how good the care we give...it's not good enough when those scores come in!!! Thanks,Karen

luv2nurseinER, Thanks for responding to my question. It seems the 1/4 ratio is a standard for ER's, but the charge and triage RN resposibilities differ. Glad to hear your have some Quiet time...we seldom do anymore! I work weekend 1900-0700 only, but they say the numbers show that Mondays and Thursdays are the busiest.

We had a security officer spray someone unnecessarily...had to evacuate the ER and fire dept hooked up fans to blow the bad air out the doors!! What a night that was.

Thanks everyone for your responses! I can see staffing is terrible in ER's all over. This will help give me information to help fight the staffing battle and to stop counting our triage and charge RN's in the ratio for actual pt care. I need all the information that I can gather to present the best battle that I can give them! Thanks again, Karen

I work in ER and we must take on call 8hrs for our 6 week work schedule. We are given 4 hr slots to sign up our choice. We are paid $3/hr for being on call and paid premium pay if we are called in to work.

Your poem is beautiful and so true! I copied and posted at my break area also. You need to publish it. Thanks.

renerian, Please tell me more about your ER. How many beds,rooms/zones, how many patients does one nurse usually care for? Our charge is called CTF, meaning charge to float. The other nurses depend on charge to assist in codes, get the IV on hard sticks, help them in anyway to keep pt care flowing. This is the first ER that I've worked in. I've been there 3 1/2 years. I don't know how other ER's operate, but I now that this one could be much better. Rena, I'm also clueless when it comes to how they staff ratio's/grids, but I'm now on a mission to learn and to improve my ER before I'm totally burn out. I love ER nursing, but something has to change.

Thanks for sharing your food for thought! This has happened in our ER...yet. How long did it take for bronchospasms to resolve?

If you carry your own malpractice insurance....you need to contact them also. They may provide a lawyer for you.

Thanks for your replies. When we speak to upper management about what can be done to decrease the burn out/stressed out nurses and staff they appear to be truly concerned. The nurse director of ER explains the nurse/pt ratio as one nurse caring for 4 patients. I told her to me it is common sense that the charge and triage nurses are not giving patient care to 4 patients...except when the charge nurse is force to take a zone! She agreed with me during our conversation, but still asked, "Karen tell me what we can do to make changes?" she also said there are studies being done on nationwide ER's about the charge/triage nurses counting in the patient care grid ratio. I just want to have any information I can find to help make a change. "We will get exactly as much crap as we will take." This is so true and I'm tired of taking the crap!!! Thanks sjoe! May I use your comment? Rena RN how many beds in your ER??

Our charge and triage nurse is counted in the nurse/patient ratio. Ours is 1 nurse/4 patients. We have approx 40 beds and see approx 100 per day plus. Most nights 0300-0700 and 0700-0900 our charge has to take a zone due to lack of staff/increase patients/increase acuity. Many times we use a NA to watch triage during those times for a nurse can give pt care and calls for RN when patient arrives! All of charge nurses are basically burned out! Press Ganey scores are low...mostly due to increase wait times in triage and for MD to eval or f/u on busy nights. We are asking for charge and triage nurses not to be counted because they are not giving patient care in a zone, but they are being counted in the nurse/patient ratio. We have 3 zones with 4 telemetry bed, 2 zones with 5 minor medical and 1 MH bed and fast track with 14 beds. Only our fast track gets 2 nurse/emt assigned. I'm preparing to write up suggestions and need back up of how other ER's are staffed. Any advice or suggestions will be much appreciated. Thanks, Karen

Just used Stadol 2 mg IV, Reglan 10 mg IV and Benadryl 25 mg IV this weekend and it also seemed to work quickly for this patient. Each of our docs seem to have their own remedy to try. KKERRN

JBudd, That was really fresh brew you removed!! We are using just charcoal on those they feel are over the 60 minute timeframe. I still haven't had the opportunity to use code blue. Thanks for sharing your experience with me. KKERRN

gmx4dh, Thanks for your response. Our code blue tube is for oral use only. I like the garbage bag idea...we could just use a red hazmat bag and just tie it up and toss it in the haz mat box! Thanks, Karen

We also recovery ours for one hour with VS q15minutes and then discharge from ER. We use conscious sedation alot for bone reductions and recovery is until pt awake and VS stable-usually 1-2 hours depending on meds given. Rn staysat bedside during procedure and we have form for VS q5 minutes and rate pt by a recovery scale totalling 10 points. Pt must be 8-10 to be discharged and have a driver.

traumaRUs, That makes sense not to lavage if over 60 minutes has passed. I will try to make that part of our protocol! We still haven't had another chance to use code blue on nights yet. Thanks, Karen

This code blue tube system is passed orally and comes with a special tube that has 2 syringes attached. One is for input,the other for output directly in it's own attached drainage bag. It is easier to pass than a NG tube and faster to lavage/gavage by use of the syringe system(once you learn how to use it!). I wish I had a packet insert from this to send you. It has pictures and troubleshooting techniques.

nurseeverycare, The code blue is a brand name of a lavage oral gastric tube to use for patients that have over dosed. When our patient arrest/need immediate attention we also have our ER doctor's to assist us immediately or the hospital units/ward call for "code team" to respond and assist. When a patient "arrests", we call this a "code". What do you use for clients that have over dosed on pills? Do you lavage/gavage or just give activated charcoal?

Bob, Thanks for the web site info. I printed info to take to work to share. We rarely get patients within 60 minutes of the overdose. It's amazing how many we get in for their repeat performance and they beg to "Just drink the black stuff" Karen

seastir, I like your way better! We still have to use nasal or gastric lavage first. Why did you get to change? thanks, Karen