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TRAMA1RN has 15 years experience and specializes in ER.

Mother of three Penn State University Students

TRAMA1RN's Latest Activity


    Medication issue

    At will employers can fire you for no reason at all, get a lawyer to handle your unemployment. You probably will not get unemployment. Do not be surprised. Sent from my iPhone using allnurses.com
  2. I have experienced the same problem, if every nurse is MSN and PhD who is going to do the bedside care? Bullying is pervasive and is an epidemic in nursing with absolutely no recourse for the nurse being affected. I hate nursing and have been unemployed for 6 months now. I never abused sick time in fact only used 3 actual days of sick time when I had my gallbladder removed and have always come in early stated late and worked plenty of scheduled days off. We fire nurses for having opinions, yet we will keep nurse that show up impaired, and come late and leave early. Amazing. Sent from my iPhone using allnurses.com

    The Unwritten Laws Nurse Managers Live By

    Exactly, I would never have imagined being 13 years experienced, using micro sick time, working tons of overtime. Come in at the last minute, got along extremely well with all of my co workers, but because my manager and I had personality differences she has sabotaged my career in my local community. I work for an at will employer and believe me, being fired 2 x by her has absolutely soured me to nursing. She followed me to my last job after my manager there retired. My previous manager asked me to come work for her, because she knew I was an excellent worker. Bullying is very pervasive in nursing. In fact I believe it is an epidemic in nursing. Sent from my iPhone using allnurses.com

    Glynco GA training for BOP nursing

    Thank you. Sent from my iPhone using allnurses.com

    IV Phenergan and Toradol "Push"

    Phenergan should never never never be given without a running IV or at least diluted in nss. I have made it a habit of diluting all my push pain meds and antiemetics in at least a 10cc nss syringe. ( expel the amount you are going to add). Toradol does burn as do most IV meds. Dilution serves several purposes. People tend to not get the head rush they are looking for, also they tend to not get near as nauseated from pushing too rapidly. The pain associated with push meds is diminished greatly. Also when you increase the volume of the drug you are pushing it allows you to push your medications over a slower period of time, which most nurses I have watched push all IV medications too fast, other than in a code situation. Also Toradol is not compatible with just about anything, so if the Toradol and Phenergan were mixed that also was an error. If you have a high port on tubing that is the port best used, you can always run your IV at the maxium rate for 25 to 30 cc to allow proper dilution and flushing of the site. Hope this helps.

    Study: Uninsured No More Likely To Use ER Than Insured

    I think what it boils down to is laziness. It is simply easier to go to the ER than wake up in the morning and call your family MD for an appointment and wait. It is also priority now for all ER's to put customer service first, this means order x-rays when it is already known that it will read negative. Give narcotics for back pain when the patient has not even attempted anything else, because "nothing helps". It is amazing how many times we give narcotics, and order unneccesary tests, because it is what the patient or parent's want.

    IV starts and drawing blood

    Believe it or not, you can actually start an IV as small as a 24 gauge and use a device from Kendall tyco/healthcare called an Angel Wing attached to your extension set to draw blood. DO NOT FLUSH YOUR EXTENSION set first and draw only your essential tubes, tubes DO NOT NEED TO BE COMPLETELY FULL. YES, you can draw from a 24 gauge IV catheter I have done it very successfully 100% of the time. I draw all my patients this way. Not all my patients are 24 gauge IV sticks by any means most are indeed 18 gauge and 20 gauge sticks but I do use 24 at times for very sick babies, and do draw my labs on them this way if needed, if I don't go IO. Angel Wings are the way to go instead of with a syringe, the pressure created from a syringe is what causes the hemolysis of the RBC's.
  8. I work in a small ER. I am wondering who transports the patients in your hospitals to the radiology depatment in your hospital? Do they take your patient off the monitor? Do they put them back on the monitor when they return the to the room? What about the IV? Do they insist that the IV be locked before transport? What size hospital do you work for? My ER has 8 rooms. 6000 visits yearly. Getting increasingly more busy and radiology wants us to take our patients off the monitor have our patiens in a wheelchair and IV locked and then transport our patients to the department. They will then bring the patient back when the study is done. As the RN I have tried to explain to adminsitration that I am in charge of 6 - 8 patients at a time doing all the IV placements, blood draws, EKG's, breathing treatments, and drug adminstration (no pyxis) in addition to all the addmissions of said patients and transporting to the floor of these patients, I also start all the IV's that go bad on the floor and insert foley's for any outpatient radiology US. Oh I also triage my ER patients, and their are only 2 of us on 7-3, 3 on 3-11, 2 on 11-7. No secretary No tech, only RN's and only one MD ever. usually have wait times running average 1-4 hours.

    An interesting policy

    Having worked ER for many years this should be standard poicy in ALL ER's. All experienced ER nurses and ER MD's will tell you how big a problem RX pain medication addiction has become. Acute exacerbation is different from abuse, as the policy states. But the problem's we are seeing in our society all are a result of the same thing. Lack of personal responsability and a personal code of conduct, and a sense of entitlement like no other generation has ever had. I know I am going to get blasted for this but read the policy first before blasting me and think first and realize all the abuse that goes on in the ER, if you are new to the ER don't even waste my time commenting because you have not seen enough to tell me how horrible I am, the other experienced ER nurses will tell you about the abuse of the ER as well. A child with a painful ear infection at 0300 I understand.
  10. TRAMA1RN

    Haldol and Ativan cocktail IV

    Okay have been working in small ER over one year. I cannot remember How often and the maximum dose you can give of H and A. The larger ER I used to work 2 years ago that saw quite a bit of psych, used to start with 10mg Haldol and 2mg Ativan, then every so ofter till patient was calm. I had an out of control patient the other night and ther ER doc would not give more than 10 and 2, patient ended up in four point restraints and was still able to cause some minimal harm to staff and self. Any suggestions would be greatly appreciated.
  11. TRAMA1RN

    Twins...Gest. age and induction/c-section

    Speaking as a mom of now 16 year old identical girls my Ob Gyn was on call for me personally as she was al her high risk moms, and c-sections were avoided as much as possible, I did end up with c-section as twin A would not decend through birth canal and twin "A" became twin "B", however I did have epidural and remained awake through entire procedure which was fantastic, My girls also apparently came early on their own approx 1 month but they were 6.1 and 7.2 # I would never had made it another month at that size. I beleive sections should be avoided when the pregnancy is going along without probs.
  12. TRAMA1RN

    Leaving Level I ER

    Been ther done that almost exactly one year ago this month, gas prices a year ago caused me to make the decision. I to drove 55 miles one direction and worked night shift, left level 1 and went to rual ER 10 minutes from home, same thing with benefits and such, I truely miss it and almost daily regret my decision except for the fact that I am closer to home. Good luck in making your decision. Sorry I cannot help you.
  13. TRAMA1RN

    ER Nurse----> New preceptor for new grads

    IMHO no new nurse (less than at least 2-3 years) should ever be precepting another new nurse, especially in any specialty field. Good luck to you.
  14. TRAMA1RN

    IJ catheter for Dialysis

    By no means should you feel like an idiot. I think that it showed great critical thinking on your part to ask the pysician for an IM or peg med order. ALL dialysis catheters are off limits to anything except dialysis. If you worked with me I would have been very proud of you and honored to know that you had the clarity of mind to think twice about the MD order.:clphnds::urck:
  15. TRAMA1RN

    2 hour reassessments in Triage

    First of all if you are truly using a level 5 ESI system narcotics should not be given in triage if someone is having that much pain that bumps them to a five, and having been burned by narcotics per protocol in the past, patients leaving ER I no longer use the pain protocol, and you are responsible for that patient for 12 hours after their depature since they did not sign an informed consent about how the narcotic would affect them. Secondly most of your higher level od care systems are going or have gone to 2 hour reassesments, yes very time consuming but you know people enacting these protocols and policies are not the one using them.
  16. TRAMA1RN

    72-Year-Old Woman Gives Birth to Twins

    Makes no sense to me, they wanted an heir! Give me a break they had to mortgage their lives to pay for the fertility treatment who wants to pass that burden onto their children? Even though it is their cultural belief it still is crazy.