robinzkj

Our door to EKG times are not good. They should be 10 mintues or less. I have to do a PI project to help us decrease our times. Right now when a patient arrives to the ED, they stop at registration to give name, dob and complaint. If they state chest pain, the registration person calls the charge nurse (who has a full assignment) and the person is brought straight back and EKG and triage is done at bedside. If no open rooms, the EKG is done in one of the triage rooms. However, we run into situations where registration is not telling us the complaint, the triage nurse may have the patient in the triage room when the patient adds on a complaint of chest pain to their original complaint and now we are past the 10 minutes, and other issues. What is your process to get EKGs done quickly? The only thing I can come up with is doing EKGs in triage and not having the patient stop at registration first. Any ideas would be appreciated.

I am taking it also. It starts Sunday. I don't think it looks too bad. Robin

I love my Alegria shoes! They are very comfortable and stylish. I wear them in the ED for 12 hr shifts and my feet and legs never hurt.

Yes, that is the first thing I did. I went to his website and all they have for sell are the books I purchased.

I went to a one day CEN review class by Jeff Solheim (wish they had the 2nd day but they didn't) and I purchased the set of 6 pocket guide books. I am looking for the CDs or a pod cast with him for the material we missed out on. Does anyone know where I can purchase them? Thanks! Robinzkj- ED RN

You have the right answer on both questions. On the 2nd one, I rounded the weight to 42kg and got 6.3 ml for my answer. When it comes to peds it is always a great idea to have someone double check you math. when in doubt ask... If something just doesn't seem right.. ask... good luck! Robin

Alegria shoes. I got the Alegria Seville about a month ago. I work 4- 12 hr shifts in the ED and my feet feel great. They are very comfy and stylish too.

I am an ER nurse and we once had a patient complain that "the nurses all ignored me, they were ALL in with the patient across the hall". Well, said patient was here for a non emergent complaint and the patient across the hall was a full arrest. So, you bet we were ignoring her because we were all in with the code! (all meaning the 3 nurses and 1 doctor that we have on night shift in the ED) Some people are just too ignorant.

Wow,that's a lot of stuff! I carry 2 pens, trauma scissors, my phone. Maybe a dollar for a diet coke at 1 am. Can't imagine carrying anything more. Cant do CPR with a pocket full of stuff. Everything else I need is in the room, tape,gloves etc.

1) How many RNs do you dedicate to the practice of triage? All ER nurses take turns in triage, must be an ER nurse for 6 mos before they can be in triage 2) Who is the FIRST PERSON that interacts with and takes the complaint of your patients when they come through the waiting room doors? Is it a licensed nurse or patient care assistant/registrar? We always have an RN in triage, the triage window is the first place the pts stop and give their chief complaint. Pts get "quick registered" name, bday, by the ER nurse and triaged according to acuity 3) If your answer to #2 was pt care assistant/registrar, are they supervised 100% of the time by licensed staff? 4) What is your yearly volume? 18000-20000. we are a small community hospital w a 20 bed ED. 1 doc, 4 nurses on nights, 5-6 on days with a medic I dont want to say where because I am at work right now :)

don't be afraid to ask lots of questions, volunteer to do things without being asked, see and do anything you haven't seen or done before because this may be your only chance. Do compressions on a code, start IV's, hang drips....

In our ED we are able to do POC troponin, influenza swabs, rapid streps, ua dips and urine HCG. All are kept in individual logs with pt info, result, lot # and exp date of test and RN initials date and time. We then put the results in the computer with our computerized charting. Troponins have to get faxed to the lab and they place the result in with the labwork for the DR to see.

"I'm sorry ER, but our ICU is often just an extension of your situation. Unstable patients with another one rolling through the doors. (And sometimes two at a time.)" My ER doesn't send unstable patients. However, we do get many unstable patients at one time, via triage and by squad. 1 RN who also 4 or 5 other patients. We don't have the luxury of asking EMS to hold a patient because we are too busy or at lunch. I don't even get lunch in a 12 hr shift. WE find an open room and we take the patient. It's very sad that some of our ER pts wait 6-7 hrs in the ER and most being bed wait times to the floor.

NFL team pens, earrings, socks, stethescope cover, covered cup,---

Where I work you must have 6 mos ER experience before you can go to triage. No rules here for charge but I've been in charge and have 18 mos nursing experience, 9 of which in ED.

opps I forgot the over 20 min part. 200ml over 20 min would make 600ml/hr

40 g needed (0.5g/kg 80lb pt) converted to 40000mg have 200mg Xml 200ml/hr

"Sometimes I want to tear my hair out when I get the same patients for weeks at a time because they are now chronic but too sick to go anywhere else. I crave a little variety, and maybe this is why the ED appeals to me." I was an ER tech while in nursing school. When I graduated I went into a Surgical ICU where I learned a ton but your quote above described me to a T. I missed ER so much and went back to ER just 8 mos after starting in ICU. I've now been an ER RN for 9 mos and I LOVE it. I like the fast paced environment, the team work and I love having the docs right there with us. We pick their brains and they pick ours. I often get so many learning opportunities, the doctors like to ask us our opinions, what we think are diagnosis, what meds we would give.. you know just to keep us on our toes lol. I feel like I am actually helping people as an ER RN. I never felt like I was making a difference as an ICU nurse. (not knocking ICU Rns because I know first hand it is hard work!) but I want to fix people and I feel like I can do that in ER. We have very basic reports, why they are here, what we did and plan on doing, etc... Never stay over my shiftand never get called off or have paid on call. We staff for what might happen not for the census. They are many times when it is crazy busy that I wonder WHAT AM I DOING THIS FOR??? but more often I go home feeling like I made a difference. My last patient the other night thanked me and told me I was a great nurse as I handed him off the the Step Down nurse. Things like that make you feel like there is a reason for you to be there. Good luck! Sounds like you'd make a great ER nurse.

"I was just wondering if people come into the E.R expecting you to treat these chronic conditions a.s.a.p ...?" yes they do and I make them wait. Chronic pain is NOT an emergency. Call your dr. I don't care if his office is closed, he has an answering service. If he tells you go to the ER for chronic pain, then he's as sick of you as I am. Emergency rooms are for EMERGENCIES.

I was an ER tech while going to school and wanted to get into the ER as a new nurse however there weren't any openings. I went into a surgical ICU as a new grad and learned a ton. Then I went to ER about 9 mos later. I'm so happy i did it that way. the ICU experience helped so much as far a assessing and caring for critical patients. I had a older nurses tell me I needed to go to Med/surg for a year before I chose my specialty but I listened to my heart. Nothing against med/surg but I knew I didn't want to do that. If you know what you like, go for it!

How about a Stroke alert teaching packet? Last time known well, if they are in the window for tpa, if they need a dysphagia screen and how to do so. How to mix tpa if needed, neuro screen, history... Or the same for a STEMI alert...

I'm an ER nurse and often send out burn patients out to a burn center. I have had multiple different instructions on how to dress the wounds. I was wondering if I could get some advice from actual wound nurses. I recently had a 15 yo who was burnt 2nd and 3rd degree burns on face, neck, hands, wrists and upper thighs. Pt was sitting around a campfire when someone threw gasoline on it and guess what? It exploded... We started 2 Iv's on and gave NS bolus. Saline soaked gauze and ABDs with light kurlex drsg around. She was shivering so I covered her w/ multiple warm blankets and medicated the heck out of her. A "seasoned" er nurse told me to put xeorform and then drsg but I didn't, I was taught wet to dry. When I called report to the burn unit, they told me wet to dry was the best. The other nurse was concerned since the pt has a large area of burns that she would loose heat quickly and was why she wanted the xeoro and not wet drsg. So, what do you all do/recommend?? Thanks Robin ER RN

I work for UH and as far as I know they are still hiring, there are jobs posted on the website. I am at on of the community hospitals. I know they hired new grads here in Jan but I'm not sure if they are now.

www.wonderhowto.com has some nursing how to videos. Hope that helps you. http://www.wonderhowto.com/how-to/video/how-to-administer-an-intramuscular-ventrogluteal-injection-259906/

http://www.geocities.com/tmhrx/drips.html this is a great site - shows concentration, what you mix it with and loading does. I booked marked it on my blackberry and pull it up at work all the time. Just make sure you go by your hospital policies. For example I mixed a Cardizem drip as I was taught at another facility 100ml/100 mg (100ml remove 20ml and add 20mg(20ml) med) for a 1:1 ratio. well the dayshift nurse freaked out and said it was wrong because it should be 125mg/100 ml which is also a1:1 ratio. Well I was perfectly right but that isn't this hospitals protocol so they all assumed it was incorrect. Hope the site helps you!