JoeDEDRN

Greetings! Looking for input as to how other departments go about recruiting Per diem RNs to fill schedule holes, cover vacations etc. Any pay incentives or other magic???

I agree with you 100%. It is my time to sound like the daynursaurus I used to mock when I was younger and had hair. Back in the day, all had same shifts, we all came on and left together. We had much more "therapeutic " time with or without alcohol. We had an opportunity to vent, to talk and to hash over the days events. It was neither formal, nor professional. The point is we spoke and things were talked about. I am not sure if it helped or not. It was good to hear others had the same ideas and feelings. It certainly was more than we do now. Staggered in and out times make these informal gatherings next to impossible. We do have formal debriefings, but with those debriefings come expectations and time constraints. Probably not the best method for those who are less than outgoing with their emotions. I am in no way saying to go out and get blitzed because it is not about the alcohol. I think it is more about the comradery, the time away from work with those that you work with that is the biggest help.

A quick question. Does your department offer any critical incident debriefing or specific employee assistance?

Bad day?

Agreed. What I was trying to convey was that, as a paramedic, your situations are usually focused on a single patient. In multiple patient scenarios your choices are usually fairly clear cut. In a mass casualty scene you say who goes first, but transports are lined up for the next and your receiving hospitals are usually dictated by trauma levels. Again I am in no way taking anything away from the paramedic. What I am saying is the opportunities to make a bad decision presents itself many times over in the triage area of the ED than out on the streets. I really do think they are two different types of triage with two sets of very different considerations. Granted the basics are there.

I'd love to agree with you, but I can't. Agreed, triage is a common task to both professions, that is where it stops though. As a paramedic your scenario is pretty well set for you. You are responding to an emergency where you will be triaging mostly life threatening situations. Your transport rules are set. Most is fairly concrete, not all though. Now you are in the ED, nothing concrete here aside from the obvious, breathing or not, fever or not, fracture or not, etc. Anyone who has triaged for a while will admit, it can be a very humbling experience. History plays such a large part, yet so does intuition and experience. Aside from the rare multi-casualty incident you come upon on the streets, triage is relatively straight forward. I am in NO WAY trivializing what paramedics do, because I am not. I have done both sides and I know. On the outside you have a 38 year old male with chest pain and a good story and you are going in with him, no brainer. Now take that same scenario and toss in the vomiting child for two days with 12 hours of limited output and only one bed in the ED. Now it gets gray. Do I think an experienced paramedic can triage in an ED? Of course. Do I think they do it as effectively as an expereinced RN in an ED? Sorry, but no, we possess different educational experiences.

I have been there and done that as well. I think the key thing most of us overlook is that is not about us. It's about the death itself, the fact we are educated, that we can walk this through in our minds and we can acknowledge we did all we could, makes it no better. It usually has more to do with the patient . Did they remind you of your child/relative/friend's child? Did the reaction of the care giver strike a cord in your mind? What was the circumstances of this death? We are all very resilient people but the cumulative aspect of parts of our job can be taxing. Never underestimate the small stuff it can be just as significant as the big events. Sometimes you just need to talk and although not everyone has been in your shoes most can relate to a child's death and sometimes that is all it takes. We all need to take care of ourselves.

Hello fellow ED RNs. The ED I presently work at has just undergone a huge expansion of square footage. We are now seeing a rise in falls. The people falling are your usual folks, ETOH and demented folks come to the top of the list. We already have all the signage we need. Bed alarms in place. It seems the major problem is that, with the expanse of the ED, comes the decreased awareness of the alarms and the plant design itself makes it impossible to visualize these people every second. Any of you guys have any ideas. Thanks in advance.

I am thinking if you bought your concerns to administration, but spun it to say you have concerns over a patient taking photos of other patients, might perk up their little HIPPA ears. That would be my main concern anyway.

How many of you folks have heard of the all too common techness shot?

Hey folks, New to the forum. I am looking for some help. We just moved in to a brand new ED. 3 times the size, with an increase in beds. The place is amazing but for some reason now that we got the patients out of the hallways and in to rooms it seems as if we are running ragged. I am hoping some of you guys can direct me toward any links or personal ideas/thoughts/approaches regarding staffing. We are presently 5:1 (ideally), we do zone nursing with two nurses, so meal break means 10:1 or more. Despite the new, larger digs we are at wits end. Emotions are high and proving need for more licenses is at least a year down the road, between getting numbers, submitting reqs. for extra nurses, then training etc. So again any source for staffing ratios/ideas would be greatly appreciated