RainbowSkye

Ha! I work in the boonies and take care of plenty of crackheads and mh patients. There was even a poor little kid who died this past weekend who had ingested mom's crack. The problem with mental health patients out here is that it takes the mental health counselor about an hour to arrive before the patient can be assessed. Then of course, there are no psych beds available for that patient. We've actually kept suicidal patients on a mental health hold for three days in a ER bed... I'm not sure where you should go next. Heck, I've been working in the ER since 1979 and I'm ready for a change myself (which is why I'm reading this thread). Good luck.

Check this out: http://www.emedicine.com/emerg/topic41.htm

I worked telephone triage for several years and although it's not as difficult physically, it is a job which requires a lot of concentration and communication. It's like trying to do ER triage with no vital signs and your eyes closed. Dont' be fooled into thinking this is an easy job. I know that opiates affect everyone differently, but...I'm personally not sure an RN should use these meds in any position in a hospital. Okay, I know about devastating pain can be, but I still wouldn't want my surgeon to operate on me on Vicodin, or my airline pilot to be on Lorcet, or the police officer who protects me to be taking Vicoprofen - I think it really can slow response time). I don't know anything about your medical history, but have you checked out any alternative or nutritional approaches to endometriosis? Susan Lark and Christiane Northrup both have books which discuss the topic. Good luck.

Okay, I'll give it a try. -suction bottles that are full or that have been removed for emptying and not replaced -the person who used the last (fill in the blank here) and did not bother to replace it -activated charcoal -- in all honesty has anyone been able to get all of it out of the bottle? -patients who tell you an entirely different story in triage than they tell the doc -drug seekers who beg you to talk with the doctor after he/she has told the same patient no narcotics and discharged the patient -patients who lie down on the waiting room floor (I'm talking attention seekers here, not the unconscious or barely conscious) -blood where it doesn't belong (floor, bp cuff, wall, siderails) -speaking of siderails, tape that has been stuck on the rail for days (weeks, months...) I could go on and on, but here's my last one for now: -Good Housekeeping magazine for telling ER patients to tell the triage nurse "no matter when your problem started, never say it was more than four hours ago; it will seem less pressing." (They do say to tell the physician exactly when the symptoms started.) November 2005, page 62.

I certainly understand what you did, and I hope the family will come to understand as well. However, your supervisor really should have made you aware of this patient's dementia as that is a crucial part of of his care. Also, I odn't think anyone would shave the hair off someone's head or their eyebrows because they were hard to keep clean. Just a thought. I also want to thank you for sharing this, it's hard to do when there might be some negative comments. It helps us all. Thanks.

I've been working in various ERs since 1979, and yup, there is a lot more testing. But golly, back in 1979 we didn't have: ct scans, mri scans, we didn't even have an ultrasound in our hospital at that time. We didn't have ck-mbs, troponines, bnps, d-dimers, or even bedside glucose testing. So, sure we do a lot more testing today. Because it's available. ER patients are totally different that patients who present to physicians' offices. Of course, the same thing may be true at the office, but we have one chance to determine what's going on with the patient so we do and should utilize everything within our means to do it (well, within reason). Which is the point of what we do, really. So far, I haven't worked at a facility that said, go do that ____ test so we can make _____ bucks. Wouldn't really work as such a huge amount of our patient population is indigent and can't/won't pay anyway. As far as sending patients to the unit or the floor at inopportune times, well, welcome to my world. I swear we don't do it on purpose to wreck your day. Really. One hospital had a great solution for all the patients waiting for beds in the ER. They decided to utilize all the patient care units to hold patients until the actual bed was ready. They would take turns - one patient to a hall bed on the medical floor, one to a hall bed on the surgical floor, one to a hall bed on the whatever floor, one to a hall bed in the ER (they checked this out with OSHA and HIPAA etc before initiating this). Worked great, and amazingly, patients got an actual bed in a much timely manner. Food for thought.

Okay, I'm dating myself, but in the old days (1970s in my case) we frequently "mainlined" drugs. I can remember drawing up the undiluted medication in a syringe (often fentanyl or morphine), accessing a vein, mixing the medicine with a little blood in the syringe and then slowly injecting it. I can't believe I actually did that, and that it was the standard of practice. I would never do it today. But I guess it would be cheaper.

Okay, here's my experience. And please feel free to disagree if it's different for y'all. Paramedics are trained/educated to provide pre-hospital care. Their license allows them to provide very specific (and complex care) and give medications under the direction of the EMS medical director and/or ER doc. However, because a paramedic can do certain procedures and give certain medications in the field doesn't necessarily mean it carries over to an inpatient environment. I mean, you may be able to give Morphine in the field to a patient with chest pain but you may not be able to give antibiotics to someone with an infection. I've worked in ERs where the policy was for paramedics to only provide care within the confines of their paramedic license. So you might have a situation where the paramedic could intubate a patient, but not give a tetorifice shot. In other cases, the hospital provides the additional skills a paramedic would need to function in the ER (like cathing a patient or accessing a port-a-cath). RNs are not paramedics and paramedics are not RNs. I think we should respect and learn from each other instead of nitpicking about who is smarter, better educated, whatever. We're all in this together.

Okay, here's what worked for me: Birkenstock shoes. They are the only shoes I wear these days. Work, play, exercise, going out... Never going barefoot. Never. Doing exercises to stretch the tendon in my foot. Patience. It took me over four years, but I'm finally pain free. Oh, and this excellent website http://heelspurs.com/index.html Good luck.

WARNING: NEGATIVE NURSING POST (and these are my experiences only): I've been an RN for 31 years. My experience has been that although hospitals pay great lip service to respecting nursing, they do not. And, unfortunately, I think this is true in even facilities who promote themselves as magnet hospitals. I had only ever worked in the nursing field when I took a job in marketing. What an eye opener. I found that there is actually a place in the hospital where employees are respected, allowed to take their breaks (I mean, they actually got an hour break for lunch in their eight hour day), allowed to linger over coffee, had the supplies and staffing required to do the job; they did not have to punch a time clock. But, interestingly enough, when nursing positions were added under marketing, this respect did not extend to the nurses. I'm now back to ER nursing in a rural facility. Here I work with one other nurse caring for over 30 patients a shift. In addition to my nursing responsibilities I am expected to perform the duties of: hospital operator, ward clerk, registration clerk, housekeeping (I mopped the entire ER last night after someone bled all over the place - this in addition to actually taking care of the bleeding patient), pharmacist, central supply clerk, sercurity officer, resp therapist, EKG tech, dietary, phelbotomist... I think that many nurses try to get out of nursing by getting advanced degrees (myself included). Unfortunately, this is a cure that is not often effective. Now, please understand that the only career I've ever considered in my life is nursing. And I don't think I'll ever leave. I just don't have any illlusions about its reality anymore. And I deal with it by working part-time. That way I get to enjoy the good parts of the job (and there are those) without being too overwhelmed by the bad. And right now, I would never recommend anyone to go into nursing. Sad, but true.

WHY does it irritate a Nurse when a patient states they are a "hard stick"? And, the patient tries to help by informing the Nurse what type of needle and where to try? I still don't understand why it angers a Nurse, because no was has really answered this question yet????? Informing the Nurse doesn't mean that you are trying to do her job or that she is inadequate starting IV's. I really don't get irritated (and I sure never get angry) when someone tells me they're a hard stick. As a matter of fact, I appreciate it when they show me their best veins. However, about 80% of the time when folks tell me they're a hard stick they're really not. I figure they had a bad experience previously, so I just do my thing. However, it seems like some of these patients are actually disappointed when you can get a line on the first stick. Go figure.

Sorry. I meant to say that sometimes you're the only RN in the entire hospital (with responsibility as the supervisor and the pharmacist as well as overseeing the LPNs on the medical unit).

I work at an itty-bitty rural hospital. It is quite a different thing to be the only RN in the ER when you get a bad trauma patient. No anesthesia, an oncall RT, no surgery, maybe two or three units of O- in the lab... sometimes you're the only RN in the ER. Add to that you're usually working with a family practice doc who is just trying to pick up a little extra cash, and you can certainly have a stressful experience. I worked many years at a Level I trauma center, and just used to kind of sigh when a patient from a rural hospital was brought in (many times with a 22 ga IV in a patient with a gunshot wound to the chest). Now that I know what they're up against, I have much more respect and understanding. Anyway, good luck to you.

I am very sorry for your experiences. I just hope in all the time I've worked in the ER I've never treated anyone in the way you've been treated. That being said, if anything will cause me to leave the ER after 25+ years it will be the drug seekers. I never want someone in pain to not be treated appropriately, but is it not just as inappropriate to facilitate someone's drug addiction? I sometimes have days where I feel like the pusher and that's about it. Sometimes I think that Lorcet and Soma (a couple fave drugs of abuse in my neighborhood) should just go over the counter so that the addicts can get what they need without overburdening the health care system. Tax it like heck then put the money into effective rehab. I mean, how many times does an alcoholic come to the ER begging for a drink? Okay, it's just a thought when I'm feeling frustrated.

I've been starting IVs on both adults and children for over 30 years, and yes, even I miss sometimes. So no, I don't do it for fun, I don't do it for "practice", I don't do it to torture patients; I do it because the patient needs it for whatever reason to get well. It doesn't help when a patient/friend/whoever threatens me before I start the IV. I've heard it so many times it really doesn't bother me, but what does the poor child think when the mom says "only one time"? Now I do agree that four times is a bit much, but, sadly, sometimes there is no other choice.

I agree that phenergain iv is a nasty drug so I always dilute it with 10ml of NS before giving it either through a saline lock or an IV with fluids running. I also give it very slowly. I haven't had anyone tell me it caused burning using this method, and I don't know of anyone who has developed complications (of course, I work in the ER, and mostly we never hear what happens after patients leave us). Toradol can not be mixed with any other medications. Is there a possibility that this happened? That the meds could have been given too close together without enough flush between them? Just a thought. Good luck on your recovery.

Aaarrrggghhh!!! The family members who feel they must tell you how much worse their kidney stone, laceration, back pain, whatever is than the patient you're triaging. I especially enjoy the ones who want to tell me their entire medical history. I also enjoy the family members who want to know a detailed history of what's going on with the patient in the next room.

Here's my thought: driving a car or riding a motorcycle is not an inherent right; it's a privilege. And if wearing a seatbelt or helmet is part of that privilege then so be it.

Some boards of nursing require that you notify them when you're taking certain medications or you have the possibility of losing your license.

Interesting that you feel the need to protest that you're not a drug addict when not one response mentioned anything about substance abuse. My personal opinion only (I don't know what your state board of nursing allows): You should not be working on Vicodin prn. And there are a lot better pain medications for chronic pain management if you need to take medication on a daily basis. I think there is an increased chance of some of the side effects of opiates when used prn: drowsiness for instance. You might want to consider a consult with a pain management doc if no other therapy helps your back pain (see above). I also think you have an increased chance of injuring or re-injuring your back when your're masking your pain on a prn basis with Vicodin. Nursing is actually a very dangerous job when it comes to back injuries - check this site out for more info: http://www.premierinc.com/all/safety/resources/back_injury/ Good luck.

My mom brought home a box of Cherry Ames books she bought at a garage sale when I was nine or so. I read them all, and decided then and there I wanted to go to a diploma nursing school and be a nurse. At 15 I became a Red Cross volunteer (complete with blue striped dress and cap), at 17 I became a nurses' aid in a nursing home and at 18 I went off to nursing school. And more than 30 years later I'm still a nurse....

As far as I remember it was the same stuff. I know, I'm amazed at what's changed over the past few years. This is off topic, but back in the 70s we hung alcohol drips and gave IM paraldehyde for DTs in the ICU. Paraldehyde was really stinky and had to be given in a glass syringe because it would melt plastic. We often gave 10cc in one IM injection. I'm pretty sure its use is contraindicated these days (at least the injectable). We had arterial lines that were hooked right into a regular BP manometers. Rotating tourniquets were the in thing for patients with pulmonary edema. I remember how cool it was to get automatic ones (instead of using real rubber tourniquets). Yeah, a lot of stuff has changed, but I think the heart of nursing has pretty much remained the same. Oh, and to go back on topic a bit - how do y'all handle medication errors in your facilities? I mean, is everyone required to fill out an incident report, go to committee, what? I know there is a huge emphasis on preventing medication errors these days, I just wondered how it's being handled.