RNintheER

I agree canoehead!!! We had considered this but risk mgmt said we had to implement the same interventions as on the floor.....which means a bed alarm/bed chirper on rooms out of direct (sight) observation. This is not practical in our ED. I think everyone who comes in the ED is a fall risk because they are placed on gurneys which are less stable and more narrow than beds!!! As well as the narcotics, and the reasons they came in....syncope, ALOC, pain, etc!!! Thanks!

I am a new nurse manager in the ER......a new nurse at that!!! I am on our fall risk committee in the hospital. The risk management person at our facility tends to make blanket statements about new regulations without really understanding what the regulation means. After I got a copy of the fall risk regulation I noticed there are some options for us. ****Up to this point we were doomed to do the fall risk and interventions just like on the floors but it wasn't practicle in our ED so I was very concerned**** One suggestion was to contact other hospitals and find out what they are using and how it is working. So being that we transfer a lot of our patients out, I am comfortable calling other facilities. I called several yesterday starting with the ones closest to us and branching out. I am in California so I even called Stanford and UCLA. I left messages for all except UCLA. The woman was extremely rude to me. She said she didn't have time for this and I asked if there was someone else that I could discuss this with, perhaps the Education department since I know the ED managers are busy! She said no. She was just very abrupt and negative. So that is fine. I expect some people to be like that! My question is how do I network and meet people from other organizations where I can pull from when trying to improve our organization???

We have computerized charting as well. I am curious to know if your screening tool and interventions are the same as on the floor? And do you reassess after every pain medication???

Do any of you give motrin PR??? We have in the past drawn up the liquid motrin in a syringe placed the IV cathter (minus needle!!!) on the top and inserted it into the rectum. We held the buttocks closed for a minute after inserting the medicine. We used this on febrile seizure babies who had already had max dose of tylenol but were seizing and we didn't want to give it orally for risk of aspiration. Our new peds hospitalist says no but will not tell us why. We are trying to find evidence based information to see if we can or cannot continue doing this. Any ideas?

We have been told by our risk dept that due to a JC guideline we have to now screen every person who comes to the ED for a fall risk and reassess as needed......i.e. after giving narcotics, etc. This seems like it is going to be difficult to do. We can't do it in triage because we have to send a lot of people back to the lobby even though they might be categorized as a fall risk simply because we have no rooms avail. We are jam packed constantly. We are not a trauma center but a small 18 bed ED. Anyone care to share how their facility is doing this? Also, they said that the fall risk screening tool and interventions need to be the same throughout the facility. I don't get why ER has to implement the same things as medsurg.....its two different areas!

We use agency for day to day needs. We use travelers for positions that are consistently left unfilled. Unfortunately, they are both very expensive and agency can cancel at the last minute and have no ties to the organization. Our CFO will not allow us to fill more positions for new grads but did just ok us to extend our 2 travelers!!! Whatever was he thinking!

I posted recently on interview advice and ended up getting the clinical supervisor position in my ER. Now I start in a week or two and am nervous about what to do. The job description is very vague and the schedule is one of the main things that I will be doing. Also, meetings, bulletin board maintenance, community outreach, and whatever else the director delegates me to do. Here is my issue.....I know that JCAHO and DHS have "rules" and our hospital follows them.....I think! Where can I find this information? Is there something listed on a website? Examples of issues are having an RN at the triage window (our hospital employs LVN's in ER as well) and having hallway beds for patients. Where can I find this information? Also, any advice or recommendations on what to read, websites to visit, etc, regarding anything that you think might help me in my new position, would be greatly appreciated. I have absolutely no experience in management of any kind. During the winter months there are always patients boarding in the ER and I know this issue causes problems between the supervisors of the ER and other floors. I just know there is so much to learn and I would like to know something before I start! Also, the person who was previously in this position has since quit and I will basically be learning as I go. She will come in and help train me when she can but I will have a lot to learn on my own. Thanks for any advice/guidance/recommendations!

Also just to add, I know I don't have a lot of experience to be considered for a clinical supervisor position but where I work there aren't many more experienced people. I know the other night shift charge nurse didn't go to nursing school, became a nurse in the army and has only worked 3yrs as an rn. Anyway, just wanted to add that piece of info. Thanks again for any replies!

I have been an ER nurse for almost 3 yrs with 4 months off for maternity leave. Also, I have been a charge nurse for a year. I work in a small hospital where we are always hurting for staff. I currently and always have worked nights. It is taking a toll on me not spending the evenings with my family. I have my BSN as well which not many people have at my hospital, including the director. My hospital mgmt is such that there is the director and 2 clinical supervisors. There is an opening for a clinical supervisor job. I have talked to my director and told her this is what I have always wanted to do and that I think I would learn fast and do a good job. Also, the outgoing clinical supervisor who is the director's best friend, also recommended me for the job. Of course there is a huge interview process with the director and the other clinical sup as well as a panel interview with other clinical supervisors. My concern is that the director has stated to other staff members that she doesn't think I would be happy in that position. Also, she is concerned because we are always extremely short on night shift and especially for charge nurses. One is going on maternity leave and both myself and the other are applying for the job! I am upset because I feel that even if I do awesome in the interview process, I will not be hired. Staff have "talked me up" to my director as a wonderful resource, etc and I don't think she wants me to leave the noc shift as charge. So even though I am furious that these concerns are coming into the decision making process, that I feel are irrelevant, I want to do well on the interview. Any advice? What should I practice on? What should I focus on? I have been told to talk about utilizing the experience of other clinical supervisors to learn the position and also to focus on networking with departments in the hospital. And throughput was up there as well??? Any other suggestions??? Thanks for reading my long post!

Our facility allows us to draw labs when we initiate IV access. I usually just draw with a 12 or 20cc syringe screwed into the angiocath. When I am done I attach a hub and secure the site. If there is a re-draw or an add on hrs later that the lab cannot use the blood I have previously drawn, the lab tech comes and does a straight stick. In other words, if the IVL has been flushed we are not allowed to draw from it! This is ok of course on the patient's that have been given the TNKase after an MI where not IV sticks are allowed. Seems like if it works then fine, why not spare everyone else the extra pokes! Renee

The issue is that we are understaffed for break coverage as well as other hospitals having the no nurse at the triage window. Just wondering how other hospitals are doing it! Our director keeps saying how we are budgeted for 6 nurses each shift but we work with 9-10 and that is still not enough. I have to sign no lunch slips almost every other night! Thanks for the replies!

OK. Well we used to have one RN doing triage. Now we have two....sometimes 2 RN's sometimes an RN and an LVN. Technically, the RN at the window takes basic data, name, dob, pmd, allergies, and Chief Complaint. Then assigns a triage priority (1-5) puts a chart together and gives it to the nurse in the back. The nurse in the back is called a data collector to get past the sometimes LVN in that assignment. So the back nurse does vitals, asks PMH, surgical history, ht/wt/smoking history, etc. Then either rooms the patient or puts them in the lobby to wait for a room. Our thing is that an RN and only an RN must remain at that window 24/7. We are busy and understaffed and sometimes we hardly get pee breaks!!! I have seen other ER's where a registration clerk is at the window and you sign in with your complaint. No RN? Does anyone know about this? It is frustrating me to no end! I believe they said its a DHS thing? Our management is not so great though so who knows! Thanks for any info!

I am currently an ER nurse and am 26 weeks pregnant. I work in an understaffed hospital with very high turnover. There are only 2 staff RN's on the nightshift. The rest are travelers or registry. I have been having a frustrating pregnancy from the beginning. I had hyperemesis until 19 weeks. I had a thrombosed hemmorrhoid removed last week and I have had sciatic nerve pain and ligament pain throughout. I am usually not a complainer but I am frustrated! Last week I was taking care of a guy high on cocaine who flipped out and hit me in the stomach/chest area with his right arm that had a cast on it. Because I couldn't leave immediately and check on myself or by baby, I finished assisting with the cath UA and then left. I stopped with the tech and got FHT's with the doppler which made me feel a little better. Then my shift was over. I have been having some lower abdominal pressure every since then....no spotting and the pressure is irregular, comes and goes mostly when I am at work or doing heavy housework at home. I am going to my OB today and I want him to put me on disability for the remainder of my pregnancy. I feel that this would be appropriate due to the unstable environment and with the ER being so understaffed. Sometimes I don't even get to pee until 8 hours into my shift! Is this a reasonable concern to me or am I being overly paranoid!? Thanks for the input!

I am a relatively new nurse at a hospital that has several travelers. I am one out of a total of 3 staff RN's and the rest are registry or travelers. My questions is what is the difference between registry and travel nurses. I know registry is not a 13 week contract, rather day by day. What is the difference in pay? Any advice would be helpful! Thanks

Ok. I became an RN in June and have worked in a small rural town ER ever since. I love it! I work triage, trauma, side rooms and halls depending on the day. My problem is that I just found out that I am 10 weeks pregnant. I have been super sick with nausea and sometimes vomiting. Since I work nights my "morning sickness" is all day sickness. I feel awful. I have called in to work twice in the last month because of it (I actually thought I had the flu!). Our hospital is small so we often have bed holds becuase our medsurg, tele and icu floors are full of patients. We hold up to 25 patients sometimes which leaves no room for new incoming ER patients. We don't get extra staffing for this so we end up working extra hard to take care of everyone. Because this is CA, we have staffing ratios but that just means that your name is only next to 4 patient rooms but you are expected to help out with the others. My main problem is that my nausea is triggered by the smell of urine and feces. I vomit and in the ER seriously I put in several foley's each shift. I don't know what to do. I have a MD appt Jan 4th but should I talk to management about my problems. I don't want them to think that I am not trying but I work 2 nights in a row and come home and sleep for the remainder of the week and then I work 3 or 4 in a row and it is worse. I never see my husband and daughter because I am so nauseated. I don't know if being off work for a few weeks until the first trimester nausea goes away would help or even be feasible at this point .... we are always short nurses. What would be my best way of going about this?