DiannaK

in our ed, if you had the pid shuffle, you might get a hhi .... hoo-ha inspection

I agree with this one .... especially for the folks who go to one ER, sit and wait, get ticked off, then come to our ER!!

I say something very similar to this ..... I also may add, to the pt's who don't want to answer questions, because they are in too much pain, etc, etc .... "The quicker we get through this process (triage history), the quicker you will be seen by a doctor."

Sometimes .... if we aren't completely slammed, I ATTEMPT to teach pt's a little ... ex: mother who brings her baby in with diaper rash, not getting better with treatment. "doc will see you when we have a bed available. She might benefit from some 'naked time' at home .... no diaper, let her run free" ex: woman who had vag bld for 6 wks, did not see GYN due to no insurance, family stressors, etc. "doc will see you when we have a bed available. Be prepared to get a pelvic exam, CBC, etc. I understand not having insurance, but we have clinics in different areas of town specifically for uninsured/underinsured. Here's the number ...." I feel like this might save them a trip to the ER next time around.

Thank God we don't have an express care .... I get irritated when half the patients I have, could have seen their PCP for treatment. I suppose I have the most fabulous pediatrician in the entire world, since no one else can seem to get into their kids' peds offices. Here's a question .... do pt's really call their own doctors, or do they just come to the ER because there's a possibility that they won't have to pay for their treatment??

What a fantastic post!! I'd echo a lot of the things you said, and I think I did, in my post, but not quite so eloquently/entertaining! I'm really shocked that you had no withdrawal! EWW! It's NASTY!! One therapist I saw "diagnosed" me with PMDD, and recommended Prozac. Dosing for PMDD (at least at that time) was to take it for the 14 days before you were supposed to start. So .... 2 weeks on, 2 weeks off. Anyone see what happens here? Eww! So, first time I went through withdrawals, I decided, "OK, guess I'll take it daily." No headaches anymore, but had the dreaded anorgasmia. Switched to Paxil, same story, then over to Celexa. No sexual side effects, but I did not feel as "up" as I did on Prozac. Eventually, over the course of a year or so, ended up going off the meds. Told my therapist I was getting rid of the reason for my depression (exhusband!) I agree with you ... I fell into the whole "if the doctor says it, it must be true" ... as I have gotten older, I've began to research things more and more, instead of just taking my physicians knowledge at face value. The comment about "Junior" caught my eye as well ... I know a nurse who just recently opened a new ER -- 60 hrs/ wk, blah, blah. Guess whose child was diagnosed with ADD shortly thereafter, and is now on meds ...... Ever wonder if we need to start re-thinking our priorities??

First of all, thank you for sharing .... and I'm sorry to hear about your son's illness. I don't believe that anyone has said that people are bad parents for medicating their children, and I'm not judging people. I'm honestly trying to understand why, suddenly, there has been such a gigantic increase in the prescribing/use of anti-depressants, anti-psychotics, anti-anxiety drugs in children/young adults. In my opinion (and everyone is entitled to their own), I feel like society is pushing us as parents towards "quick fixes", and encourages us to to medicate our children so that they won't be a bother. :angryfire Our power to parent is being taken away, little by little. We need to have support systems to build up our confidence in our parenting skills, not tear them down. What's the FIRST thing that is said when a little boy is acting up in school?? "better get him tested for ADD/ADHD" I've seen this time, and time again with my close friends and families with young boys. Kids are KIDS ... not tiny adults. You can't treat them the same as adults, nor can you expect them to act as such. For MoonGirl .... when you were in school .. how often did you have PE? If you were like me, we played in the gym before school, had PE EVERYDAY, and would go home and play outside until dinner. Schools don't have time to fit PE in ... they are too concerned with teaching such wonderfully important things like web page design, and broadcasting. Do a Google search for 'non-pharmacological treatment for ADD/ADHD' -- know what comes up the most? EXERCISE.....could that be part of the reason that we didn't have ADD/ADHD kids when we were in school? Kind of makes me wonder. Kstec .. no one is saying you are a bad mom, and quite frankly, I don't think any of us would have wanted to have been in your shoes. I'd be sick, being forced to make those types of decisions. I'd like to know, did the psychiatrist suggest anything else -- holistic medicine, therapy, behavior modification, for examples; or did he just present the ideas of medications as the only option?? Is your son currently in therapy? Something else I've noticed, especially with the folks I come in contact with in the ER, is that they look at their child's behavior as an incovenience to them. Many people don't have a clue what normal child development entails. Case in point -- traige-ing a 11m old, in for hives. Asking Mom questions, and baby is crying. She says to baby ... "BE QUIET! Can't you see I'm trying to talk!" WTH?? It's a BABY -- not a tiny adult. This may be a mom who later thinks her 3 yr old is ADD because she "won't listen". Once again, let me clarify .... I am NOT downplaying/dismissing mental illnesses, nor the need to be treated for such. I am simply stating my OPINION that medication should not be used as a quick fix cure all.

I love this .... too funny! What an awesome story!!

when I read this ... I thought .. "wonder if she went to school with me?" When I was in high school ... worst things kids did was to bring alcohol to school, smoke in the bathroom, and MAYBE smoke pot. They were the really wild kids ..... If 2 thug kids were fighting, they would just throw punches .... no knives, and certainly no guns. My school wasn't locked, either! I'm not entirely sure what has happened to our world today -- I blame a lot of things -- the breakdown, and general disrespect for the family unit -- the "everything is relative" attitude -- in other words, nothing's right or wrong, depending on the person, situation, etc -- the media, as well as health professionals, giving parents the impression that they are incapable of parenting without pharmacological crutches. Please don't get me wrong .... I fully understand that mental illnesses ARE diseases, just like TB, heart disease, cancer, and the like. I've suffered from depression and anxiety before, and have been on medication. Know what helped me the most?? Therapy, exercise, and a divorce from my 1st husband. I feel like medication, withOUT therapy, behavior modification, education about the mental illness, is like putting a BandAid on an arterial bleed. The underlying issues are STILL there, being masked by meds. ... off soapbox.....

I did end up posting in the Psych forum as well .... haven't heard anything back from them yet. I'll keep you posted. I'm glad to know that I'm not the only one who thought this was very wrong .....

Hey fellow nurses! I'm hopping over from my home in the ER forum to ask a question of you guys/gals. I was in Triage the other night, and had a 3 year old that was on Abilify and Risperdal. When I asked Mom "why", she told me he was bi-polar. I was totally and completely floored. Are children HONESTLY diagnosed with bi-polar disorder at such a young age? Are they placed on these potentially dangerous drugs on a routine basis??? Hope you all can shed some light on this .... maybe I'm just naive ..... Dianna

I may have to cross post this in the Psych Forum, if there is one .... Last night, while doing time in Triage ... I had a sweet 3 year old boy ... I'm asking meds/allergies, etc. Turns out, the child was on Abilify and Risperdal. I give Mom the raised eyebrow ... "Why is he on these meds?" She says, "Oh, he's bipolar...." WHAT???? The child was 3 years old!!!!!! Am I the only one who is FLOORED by these kinds of things?? How in the world could/would you diagnose a child that young with bi-polar disorder??? Dianna

ewww ... Our ER too .... we (on evenings/nights) call it "Triage- atory":devil:

If I'd seen the same pt in Triage, I would have placed a C collar. All it took was one time getting screamed at about NOT putting a collar on a pt .... If there's a question about whether I should place a collar of not, I will call back and ask the MD. When I place a C collar .. I will always "spine precautions" in the comments. This lets the MD know the pt is collared, and (hopefully), they will be seen quickly and potentially cleared. As far as your documentation, you did nothing wrong, either. You documented facts, not opinions. Good luck

we see about 60-80 pts per day ... Our C/P complaints seem to wax and wane .... when I worked last night, we had zero C/P on my shift (3p-1a). It seemed to be a dangerous night to be at the ball field, since we had 4 or 5 (unrelated) pt that were hit with softballs/baseballs in various places!! To me, it seems like they come in spurts.

I gave this for the first time last night ... we give it in ibuprofen to kill the taste. My pt (8 yrs old) swallowed it like a champ, and chased it down with some Sprite. He didn't vomit at all. Sorry .. I don't have any info about the efficacy/safety. Did you check with your pharmacist??

I think that the whole comment from your NM is a bit ridiculous, and part of me is firmly planted right beside you, as a nurse new to the ER. First .. we are adults, and like it or not, the majority of us are not Pollyannas. There are folks in this world that I like, and folks that I don't. I will be kind and civil to everyone that I work with, but I'm not going to kiss people's butts to fit in. You can't MAKE people like you. Not talking or socializing .... did anyone stop to think that you're trying to DO your job?? Focusing on your patients ...since when is that a problem?? If you're hanging out with your patients, while the rest of the nurses there are drowning, that's one thing .... from the tone of your post, that's unlikely the case. I agree with you that ER nurses can be intimidating ... and not just to a new grad. I've been a nurse for 14 years, all critical care, and I feel like I've had to "work at fitting in". On the nights that I'm working with some particularly clique-y folks, I act a lot like you do .... I focus on my patients, and offer to help out as much as possible. Fitting in, and becoming part of the team is something that takes time, and is unique to each person. Some of it depends on personality, experience, etc. Relax, put yourself out there a bit, but don't stress too much over it.

oh no! not more toxic spiders!! they've migrated to Kentucky, as well. Someone HAS to stop them!!

very well written ... and I think it's difficult to see both sides, unless you've done both. (see my previous post)

I work in a stand-alone ER, which is a part of a larger hospital network in the city. We always take admission orders from the admitting MD when we are sending a pt to be admitted. In our ER, the only problem we have is getting to a computer, so that we can review labs/home meds/actions taken in the ER as we talk to the admitting MD. When I worked in CCU ( a number of years ago, in a different facility), we rarely had admission orders when pts came up from the ER. That always aggravated us, since we felt like we were "under the gun", to get the pt settled, get an assessment and pt history, then call the doctor for orders.

My best friend is an ER nurse there .. if you have SPECIFIC questions, I'll ask her, and get back to you. She seems to be pretty happy, and she's been there for a few years.

I started at BHE, in TCU ... YEARS ago.. this was back before we had Vencor/Kindred, so we had vents on TCU on a regular basis. I left for a while, went to Caritas, then came back to BHE, working CCU, then OHRR. I loved BHE, and would have probably be working there, had I not found a job in a facility closer to home. I can't speak for the ratios, unfortunately. Where did you do clinicals?? Dianna

I've not heard of any cath lab paying more than floor/ICU/ER nursing. Where you could pick up more money would be in the call pay, depending on the hospital's policy. When I worked OHRR, I was prn. I always signed up on call, because if they needed me, it was $5 per hr, plus my prn rate per hour. If they did not need me (didn't happen often), I got $5/hr to stay home.

From what I've seen, lipid control seems to be an issue, at least in the primary care realm. I can't tell you how many times, when taking a history before doing a stress test on a patient, folks told me that they had high cholesterol, and their doc was "just watching it" .... Just watching it do what?? Did they LIKE to watch plaque form??:trout: Just my 2 cents .... this could be handled much better

speaking as a former ICU/CCU/OHRR nurse, RELAX! I just started in a free standing ER, after working for a cardiology group for about 5 years. I was petrified about starting in the ER, for many of the same reasons you've expressed. Things I've learned .. already... --you will use your stethoscope infrequently! We (as ICU nurses) are used to a head to toe assessment. In the ER .. it's problem based, or focus based. In other words, if the guy comes in with a mangled toe, I'm not necessarily listening to breath sounds. It sounds weird, but you'll figure it out. --it's a team effort, really! I had a pt the other day who walked in with chest pain. We brought him straight back, and triaged him (not sure if that's the correct word .. did his history, etc) at the bedside. Turn out, he was infarcting. I stayed with him, giving NTG, etc. I overheard the ER doc on the phone with the cardiologist. I came out of the room ... and the other nurses had called report, as well as called EMS for transfer. --peds is something I need more experience with. I'm not sure what it is, but I start quaking whenever I see an age under 13! We get a lot of kids in our ER, too! I can't avoid it, so I need to learn to deal with it! Bst of luck to you .. keep us posted!