Mr. Grumpy

I have an idea. Give yourself the ativan and relax. You didn't kill or hurt anybody that we know of. Just go to your preceptor or charge nurse upon return to work and waste the med. Use this experience as a learning tool. Always waste your meds immediately. Just think. The one day that you forget and some cop pulls you over for swerving or tailight out. You may end up in jail or worse, without a career. Don't care to waste time. This is your career!!

Sounds like the pt. is gonna die. Cut-downs should be like very last resort. Should be history like last resort. The doctor was probably concerned about infection (systemic). Now, he just gave another link to the infection chain. Wasn't there. I feel that the nurse should have advocated for a ID consult and new central line (in OR). Since the doctor probably didn't use sterile technique on the first one, he is probably worried about introducing more bugs on his second try. Now, he has introduced the outside to the inside.

Sunshine, Your burning my parade up. If you have never worked in ED, you may need more orientation than 2 weeks (especially a Level I). Your previous experience in nursing school is not going to help you as much as you think. Mostly, your orientation will be the standard JCAHO, Haz-Mat, paperwork stuff that will become an old file cabinet for that 0.5% of crap that you don't use. The rest is the stuff that will "make or break" you working in the ED. These are the task oriented skills. Be prepared to grow some tough skin and work hard. It is not always peaches and cream. Finally, good luck.

If you are indeed taking a charge position, then don't go to forums and ask what to do. Each ED has it's own weaknesses and strengths. Therefore, each unit is going to have different methods to building morale. However, Danny boy does have some good starters. But, the key is not to bull**** yourself or others.

My policy is to see the whites of eyes of person that is giving the ride. Of course people do ask to go smoke, sneak out, etc. Those are the ones that I call the po-po and advise of. You can't adult-sit these people. However, you can inform them of their illegal activities and endangerment of others. Most people that have a vehicle will wait for a ride when you remind them that you worry more about the "others" that they could harm. Especially, when you mention children.

Grow some balls and go to your local ED. After explaining your situation, ask the charge nurse or nurse manager if you can observe the ED in action. If you have to make up some story about having to write a paper for nursing school, then do so. After gaining some trust, help make stretchers or wipe down porta-potties. Then after about 4 hours of doing this, ask about jobs. If the ED is hiring, put in an app. and wait for a response. Do this about 2-3 times and you should be making stretchers and wiping potties for cash. Once you graduate, you might get a raise for doing these things.

I work at one of the wealthier ED's in the nation a.k.a. (spa). I really can't stand all of the pt. satisfaction B.S. that occurs. I tend to treat people as I want to be treated until.... they start acting, become dramatic, or whine for things like pillow fluffing,etc. Then, I throw the crap they dish out right back at them. Usually, they stop very quickly. I really love it when they threaten me with harm or give verbal assaults. I just become one big walking smile. This really enrages people. Then, they do something stupid and can't retract. A good example is when a pt. complained about taking 30 seconds longer to get a CT. When I went to assist him out of the tube and back to the stretcher, he swung a fist at me witnessed by about three others. Preventing a fall, I grabbed him by the neck and gently placed him on the stretcher. I smiled and reminded him that I was only trying to help him and that he needed to try to help himself to prevent worsening of his problems. Upon return to the trauma bay, he snapped and took another swing. This time he was intubated in about 2 minutes, preventing yet another fall and aspiration (BAC was 387). He spent the next eight hours sobering up in the ICU. Never got a complaint, actually got a thank you letter from his spouse. However, my curiosity is: Would admin care about satisfaction if the ED was full of non-paying, freq. flyers, or homeless folks? I would have to say that it would be weighted as much as nurse satisfaction at my ED.

Just wear an N-95 mask.

Besides all of these comments, review your vessel anatomy. If your working in trauma, especially level I, don't worry to much. There are so many people willing to stab a pt. that you don't need to. This will free you up for other more important tasks such as assisting with advanced airway placement, or applying oxygen. Finally, remember there are more ways to access than from elbow down. You could ask for central line placement or take a stab in the neck. If you miss those, then you may want to go into telephone triage or comm.

1st Edition, I have bilat. hearing loss, as well. I have been working in critical care environments for 13 years. The last 5 have been spent in the ED. Nowadays, I generally do not use a stethescope at all. There are several reasons for this. First, listening to sounds (breath or bowel) is just one tool or sign of an overall condition. It is similar to watching a nurse fuss with pulse ox cables to get the perfect waveform. You can usually see that somebody is SOB and needing treatment before you actually listen to their lungs. Basically, what I'm saying is that you have to rely on other things like your eyesite and listening to patient history. Some nurses would argue that this is unacceptable. However, I can't claim disability and become one of those ED pt's that abuse the system. Besides, when was the last time you placed an NGT and asked a pt. to speak. Can't speak if the tube is in your trachea. One would surely be gagging and SOB otherwise. Pulse ox would drop. Etc. Another reason for lack of stethescope use is the cost to replace hearing aids. Each time I would use a stethescope, I would remove my hearing aids. Where would one set them down. In a pool of vomit, or blood, or urine. What if they were steped on? Do you think the hospital is gonna fork over $4800? The safest place for my hearing aids are in my ears. Finally, I don't use a stethescope due to cost to obtain one that is compatable with my hearing aids. Besides, I don't like carrying all that crap with me. The only things I carry are trauma shears, tape, and pen. So, that is how I survive non-stethescope practice. Next time you are involve with an intubation or code, just glance around and notice all of the stethescopes in the area. Then, ask someone to listen to breathe sounds. Watch how many people step up, willing to listen. Usually, I get a minimum of three. Back to your question. The only thing preventing you from working in the ED is yourself.