EMTSNA

Hey all I find that I have been in triage a lot recently in the big inner city ER where I work. How do you all manage to keep the faith in people? I have always been known for my patience and caring, but recently I have been feeling less compassionate and a little angry. It's like trying to put your finger in a leaking dam holding back a tide of humanity. When people lie to you and swear, and give drama and attitude it's hard to not judge people. Its hard to give every new person a fresh chance and not let your previous tough triage callous your heart. I truly care about people and am very patient, but it is hard sometimes. I would like to hear some other peoples thoughts on this. Thanks

Have you ever thought about working in an ER? I know several nurses with ADD that thrive in the ER environment. Good luck with your situation. Peace

If you are not using a pump, then you must calculate gtt/minute in order to infuse a given amount of volume over a given time. For example 3.375 grams of zosyn in 100ml of fluid can be run over a half hour using microdrip tubing with a drop rate of 60gtt per ml. Calculate (60 x 200)/60 to run 200gtt/min or 200ml/hr. Or if you are using tubing with a gtt rate of 15gtt/ml. Calculate (15 x 200)/60 =50gtt/minute in order to infuse 200ml/hr, either way the goal is to infuse a volume of medication over time. If I am worried that the medication might be dangerous, it is safer to use a pump. Take Care

I have been in the ED for 1.5 years and have seen a few ICU nurses come down to join in the fun. Most do great once they get the hang of it because they are not intimidated by very sick patients. One pitfall to avoid is getting tunnel vision on one patient. Even if that one person is very ill, when you forget about your other patients situations tend to snowball very quickly. Good luck and have fun!!

Hello Everyone, I was hoping I could get your thoughts on this issue I have been under the impression that the use of propofol was limited to anesthesia providers when used with non-intubated patients, and as such I have refused to administer it as an agent for conscious sedation. I was backed up by our pharmacist in my decision not to administer the medication. However in casual reading of the october 2007 journal of emergency nursing, I found an article where they specifically state that propofol is acceptable for administration by a registered nurse for procedural sedation when an board-certified emergency physician is present to manage airway. For that matter ketamine is also listed as acceptable in the ena article, I believe there has been some debate concerning this medication as well. I was hoping that the board would help me reconcile these views. Thanks

710. got narcan and a ct-scan before the serum level came back on the other hand we intubated an 18 y/o who couldn't protect his airway at 165

Awesome, thanks for sharing!

Now this is just not true "You've already had more training than they will get". Paramedics and nurses operate in very different environments and thier training reflects this. A paramedic's focus is very interventional and based on what can kill a patient now. Nurses are more geared towards promoting continued healing. Nurses are not Paramedics and vice versa. Becoming a Paramedic is great and will make you stronger in the ER, but unless you actually want to practice as paramedic, you are probably better off taking TNCC, ACLS, PALS, PHTLS, ect... Peace

Point taken, I did indeed have 15 patients at one time, and this happens occasionally at this facility although 8-10 is more of an average. What gets me is that this is a big name regional trauma center that regularly wins awards for it's excellence, mostly the ICUs. I don't understand how the ER can get shafted so bad. I look at other nurses who seem so adept at balancing the chaos, and think if I just get a little quicker and more efficient, with experience I could be that good too. The night shift gets about half the volume of days with about the same amount of staff, so there is a lot more support. All the other ERs in the area have pretty insane volumes as well so I don't know how much better off I will be switching hospitals locally. On the other hand I could head upstairs to one of the units.

I love working in the ER, I will be off orientation in 2 weeks after a 5 month orientation. I feel pretty confident in my abilities and I can roll pretty well with a busy team of 8 or 9 patients. Recently we have been too crazy and busy. Management has implemented a new triage system designed to get patients out of the waiting room and into the treatment areas as fast as possible. I did an AM shift today and by 2pm I had 15 patients. There were no inpatient beds and the patients just kept coming. Before working as an RN in this environment I had no comprehension of the level of stress that a person could maintain for 12 hours. When things get that busy really sick patients start slipping through triage and ending up in the hallway. As I said I really like the ER, but I don't want to lose my license. I know everyone is going to say get the heck out, I think I'm going to switch to night shift as soon as I'm off orientation and see how that works. I rotate days and nights now, and that side of the world seems a little bit more sane. Thanks for listening

I love it, I will be off orientation in 4 weeks. There is always something really interesting coming through the door. At the same time, It gets so crazy sometimes. There is good orientation, but at this point I need to be able to run the team on my own. I am a great nurse, but sometimes there are just too many patient to provide as much care I would like to. Whenever I have a question there are always experienced nurses around to ask, so I'll never really be on my own.

Sounds lovely, In the NE where I work, I'll average about 8 patients on day shift in the ER. Having a tech is a luxury and can't be counted upon.

I strongly recommend working as a tech in order to get comfortable with the flow of the ED. If you work at the hospital where you will end up as a nurse, the relationships you will build with the staff can really help once you transition as a nurse. It's your relationships with your coworkers that will get you through a tough shift and it will be helpful to already know who has your back. Many ERs require an EMT-B cert to work as a tech and you will learn things in that course that they don't teach in nursing school. If you can get some prehospital experience with a volunteer EMS company it will definately serve you well in the ER as you will have some perspective as to what happens before the patient comes through the doors. Good luck, the ER is awesome

Hey, I too started in July. So far I've found that by multi-tasking and planning ahead I stay ahead better throughout the day. My preceptor promotes starting the IV and getting labs while obtaining the Hx. Making sure that when i go into a room I have everything with me that I will need so I don't have to leave the room to get something I forgot. For example, going into the asthmatics room with a combivent, because I know that the MD will order one immediately. (by the way, is anyone familiar with ipatropium bromide being contraindicated with soy and peanut allergies?). Good luck, I feel for you. It seems like it gets a little easier each shift (most of the time). When in doubt about a med you can call pharmacy for a good resource. And if a resident tells you to give something that makes you uncomfortable, talk to the attending.

My very first patient of the day today yelled obscenties at me when i attempted to administer her pain meds. The 4mg of morphine just wasn't good enough (3rd round in an hour and 1/2), and what the $%#@ did I think I was doing, didn't I know she was in pain. I did not deserve to be verbally abused, and I explained that to her kindly and respectfully. I know people act out when they are pain, but some people are just out of line sometimes. The sickle cell crisis I had down the hall in 10/10 pain seemed to be able to act like a person. I really don't understand the sense of entitlement some people feel they have at the expense of others. It definately took several deep breaths, before I was able to let it go and move on with my day.

This past thread may be of some use to you https://allnurses.com/forums/f19/rn-paramedic-bridge-course-17852.html

I find breathing through my mouth to be the most effective when dealing directly with the offending product. However peppermint spirits in a nebulizer and hung on the wall works wonders.

I got hired for the New Graduate Internship Program in the ED at Yale. I'll start in July once I pass the NCLEX at $27.04 per hour.

Just a thought, so far nursing school has not provided me with any kind of pre-hospital training except for home care nursing. Responding to a MVC is very different from working a trauma in house with relatively controlled conditions. Glass, sharp metal, traffic, fluids (both from the vehicle and patient), ect... If a nurse sees a situation where they can help by all means do so. Just be carefull, sometimes your necessary PPE should to include a fire truck blocking traffic.

I can do it, but I get really creeped out about the feeling of crepitus with broken ribs during compressions. The effect for me is kind of like fingernails on a chalkboard. When someone is very fragile and everything just crunches with that first compression and you can feel it grating with each subsequent one. Ewww creepy

The reaction to throw the baby out with the bathwater in the case of a generally good nurse who screwed up is as shortsighted and judgemental as refering to "fat cows" and "crazies". This is a knee jerk reaction. With regard to the situation, what will be gained at what cost? I suppose you would have to look at the whole picture. Is this a nurse who regularly is rude to patients and oversteps physical boundries. Is this a nurse who is usually exellent and caring. Had they just been pushed too hard at one moment during a particularly stressfull shift. Was this action actually damaging to the patient, causing physical damage and/or emotional turmoil. The nurse responded poorly, but this could be utilized as a learning experience. If the nurse is receptive to an honest and open realization that they were stressed and made a mistake, it might be more therapeutic and effective to let the nurse reflect on what he/she was feeling that led them to act in that way. I feel that positive remediation could be more effectively accomplished through peer support as opposed to a punitive response from administration. Oh well, maybe I'm seeing this too optimistically. Probably would be better to hang the nurse out to dry. Most likely everyone would be better with this individual out of nursing.

A lot of folks seem to advocate going straight to your superviser in order to avoid confrontation. While this is always an option, the first step should always be to address the issue with the nurse personally. I hate when people won't speak directly when they have a problem with something. It shows a lack of respect and creates an atmosphere of distrust between coworkers. Granted the nurses actions where totally inappropriate. If you had done something wrong would you prefer to have another nurse speak to you personally or would you rather speak to your manager. The nurse screwed up, but going behind someones back shouldn't be your first choice.

Hey All I'm not an RN yet, finished this semester's finals today, 1 semester to go. Woo Hoo!! In my opinion new grads can work out in the ER with the proper support. I have been a Tech at a Big innercity level 1 for a year and a half now, and most of the new grads seem to really thrive. The orientation is 7 months and includes ACLS, PALS, TNCC and a couple other certs. Usually they pair new grads up so that 2 grads will work with one experienced preceptor. The patient loads can be up to 10 or 12 when it is busy, but the new grads will split that with the preceptor overseeing. Also they only hire new RNs who have some ER experience prior. It sure feels good to see my fellow techs graduate and do good. Granted there is a steep learning curve with a lot of stress, but everyone I have talked to is positive about the new grad program. This isn't the situation everywhere, but i figured I would throw my 2 cents in that it can work. Peace

So I get that HIPAA doesn't cover other patients. Does anyone have any policies at thier institutions for interpatient privacy? Such as upon addmission the patients could sign a statement that they will not share personal information. This could be done at registration and provision of care would not be dependant on compliance. As an EMT, I regularly provide patients with a privacy information pamphlet along with the statement that thier personal information will not be shared with anyone that is not involved in thier care. Should that little privacy spiel include a disclaimer that it is actually impossible to completely protect privacy. I know i'm playing the devils advocate. It seems like this is probably a dead end alley. It is often difficult if not impossible to protect people's information. How many hospitals use big white boards for patient assignments. Double rooms, hallways etc... My hospital is finally using initials to call people up to triage. I'm just wondering if anyone has found this to be an issue worthy of being addressed by a policy. Thanks for the responses

Hello everyone. I ran into a situation at work the other night and I wanted to get some input. I work at a major ER and had the unfortunate pleasure of sitting with 4 patients in for psych eval. Day after thanksgiving and we were overloaded so these patients were lined up in a busy hallway. We had a series of traumas come in that had to be wheeled right past my patients to get to the trauma bays. One of the physicians allowed one of the psych patients to use the telephone, and this gentleman immediately began telling his mother in law that he thought knew one of the traumas and what he thought had happened to that individual. The patient was asked in a very calm and professional manner both by myself and a nearby RN to refrain from speaking about other people in the ER. Unfortunately the patient took this as a major insult and the incident almost lead to the patient assaulting staff and being restrained. Kind of long winded, but my question is. To what extent is patient privacy protected by the law against other patients? Does this guy have a right to say whatever he wants because he is not an employee? If not what can be done? I understand if blackmail, slander or libel become involved then this is another issue. What about simple protection of privacy? I'm sure this is not just an issue in the ER. Thanks