darius000

on a different note we had this elderly man who was constipated so he decided to straighten a wire coat hanger and insert it rectally to clear the blockage. He ended up in theatre having multiple repairs to his bowel and may have ended up with s colostomy

well I guess he was off to the night club and intended to impress the girls (or boys) with his appendage - which by the way he never got there, admitted for overnight obs.. Maybe we should have confiscated the said appendage,sliced it and put it out in the break room for "nibbles"

so have you had the interview yet? if so how did you go?

well i am not sure about the differences between WA an VIc (ANF wise). Here in WA the ANF provides online education plus in house courses. You get covered etc by lawyers but i have also heard bad stories about poor service. I guess that the main thing is that the ANF is negotiating your pay, the fees are tax deductable and you are covered by professional insurance - not sure the costs if you do this privately. although then ANF is not the strongest union in Aus, I did hear rumours about them combining with the police union. One thing that I cannot understand is why are EN's under a different union (they can join the ANF though)

I work in one of the busiest ED's in Australia (Perth). The department is designed to hold 28 patients but the are nearly always patients on trollies in the corridor. Often there are 8 or more with trollies side by side (5 inches between them). My concern is that we currently have a walk around handover so not only do the 11 patients in the corridor hear all about poor "Mrs Jones" so do others. The hospital does have a confideniality policy. What I am interested in is how do other cramped, overcrowded Emergency Departments handover between shifts. thanks Patrick

I have been an ED nurse for 10 years. My worst experiences are taking patients to ICU, some of the Nurses just don't want to talk or know you. I worked for awhile in after hours management and did my best to educate ward (or floor nurses) as to why it was important to move patients out of ED ASAP. Now in ED I do my best not to send patients close to handover or shift change unless we are really clogged up(which is all too often). During the day we now have what we call the Emergency Department Transfer Coordinator or EDTC. It is his or her job to liaise with the wards in regards not only getting patients out of ED but also getting patients out of the wards to make room. But i think the biggest problem is the lack of understanding between the work load. There is fault on both sides and communication is important here. Oh and if I got offered $10 to keep a patient until after shift change I could probably make an extra $400 per shift....

well probably the strangest one was finding a guy in an MVA with an apprx 12 inch long x 2 inch diameter salami strapped to his leg!!!

well this is the first year that we have had new grads in Ed, Previously we only had 2nd year grads. Personally I have not had many problems with 1st year grads and I think that it is a wonderful advancement to have them. But if you are the preceptor and your grads are not listening is that where the problem is? (No offence, I am not judging your precting skills). In our ED if there are issues with grads that cannot be resolved betwen them and the preceptor, then we get involved with the hospital wide grad preceptors (the ones who oversee the 1st and 2nd year program). But are we going back to the old argument about Uni trained v Hospital trained nurses? and another thought what about ED Nurses who have been in ED for a long time but fail to keep abreast of evidence based changes to best practice?

i work in ed in perth western australia. we are a tertiary level hospital and the states designated trauma centre. we have a 5 level triage scoring system: 1 = life threatening - straight in seen immediately 2 = should be seen by dr within 10 minures 3 = should be seen within 30 minutes 4 = 1 hour 5 = 2 hours. obviously with the workload it does not happen, 1's and 2's generally get seen. we are trialling a system now where 3's 4's and 5's get seen in time of presentation order on the basis that a patient triaged as 3, 4 or 5 should not have a serious life or limb threatening problem. i quoted because i am not sure what you mean by "blue coats" or how your triage works. do you mean that all but the sickest are sent to a waiting area? here the triage nurse will either triage people to the waiting room, quick assessment area, or directly inside (or back i guess). also here in australia hospital care is basically free for all and having insurance makes no difference although there are some private ed's that the insured can attend.

I work in ED in Perth western Australia or ER as you know it. We often see post surg hip disclocations and do clesed reductions, prior to sending patients back to care facilities or on to the wards for management. By no means am I claiming to be an expert in ortho stuff, but my understanding is that after a closed reduction, the legs need to be immobilised in waht we call a "charnley pillow". This semi triangular pillow goes between the legs and both legs are strapped in to prevent too much movement of the newly re-located hip. I am not sure how long this should be insitu. But if your patient now has shortening and pain, my guess is that although the hip was ok on initial post reduction x-ray, then mayby it has moved or slipped out again. I "googled" the following because I did not know that shortening post surgery was a possibility: leg shortening post hip replacement and found 200,000 hits, the first is here which explained a lot to me http://www.medscape.com/viewarticle/421041

Hi Zee_RN At my hospital we have recently introduced online learnng packages. One of them is all about bullying in the workplace and consists of a number of multi choice questions. This "e-learning" package is one of several compulsory ones that all nursung staff have to do yearly. I am sure that we have a policy that goes with it. I am not back at work for a couple of days and would be happy to check it out. (I work in ED or ER in Perth Western Australia). If you want to send me a private message, I will get back to you. Patrick

1 - Where did you go to school? Griffith Univerisity, Brisbane Australia 2 - What is your job title? And what are your responsibilities? Senior Registered Nurse, Emergency Department, Royal Perth Hospital 3 - How many years have you been in this profession? about 12 4 - Any prior positions? remote area nurse Clinical nurse ED manager After Hours Hospital Manager 5 - What tasks do you perform in your job? depends on where i am allocated triage - self expalnatory except we have a senior triage nurse, a triage nurse and in the arvo a triage liaision nurse who cannot triage but deals with relatives resus - normally in charge of 2x medical bays and 3x trauma bays monitor - deal with chest pains and overdoses assessment - if in charge of assesment it is moving patients from cubicles etc for drs to see and moving them to the wards (floors) or home etc. Co-ordinator - in charge of the ED 19 nurses in AM, 22 in Arvo and 18 at night. Organise the disaster team, helocopter retrieval team, meal breaks and on night shift the coordinator allocates staff to ED for the next 24 hours. 6 - Tools used (computers, books, etc.)? MIMS - a pharmaceuticle guide to meds EDIS - Emergency Department Information System, basically the triage sheet, time triaged, triage score (1 - 5 in Australia) time seen allocated area, allocated nurse, Dr, diagnosis and disposition - where they went, it also alerts us to frequent flyers, trouble makes and people with medical alerts we have CARPS which is used to call the orderleys to take a patient to the ward etc A system that tells us where meds are located in the hoapital Sunrise which is for lab results and PACs which is for all x-rays, CT and USS and MRI etc - Any future career plans? After hours management 8 - Are you satisfied with your job? love my ED very busy by Aus standards but I am very satisfied here 9 - Any advice to someone just starting out? Listen. Look. Learn. Ask questions. It is not always as it is in the text books. I guess we are lucky where I work because most of the Drs really appreciate our input (some of us have been in ED since before they started med school). Do not put up with abuse from patients, relatives or other staff!!!

and also once the ED gets your file it should be well documented in regards to your previous history, treatment and what works etc. If you move around a lot it may be worth going through the process of FOI and getting copies of recent admissions etc

My advice as an ED nurse in Perth WA is to be honest (which you have said). Accept what meds or advice you are given. Paracetamol is a very effective but under-rated analgesic. When taken regularly (2x4 hourly) either alone or combined with opiates (morphine etc) it works. Also don't front up and state that you need "morphine" or similar. Personally, I will give what is needed and annoy the Drs to write up effective analgesia.

forgot to add that if I am the shift co-ordinator, on dayshift we allocate meal breaks, organise teams to respond to disasters or the chopper coming in and in addition on night shift, the co-ordinator allocates the nursing staff in ED for the next 24 hours - 19 in the mornning, 22 from 12-1300hrs and 18 at night. hope this helps you Patrick