MomNRN

About every 2 weeks, there is a bunch of us who have an unofficial retreat - a liquid lunch! It works wonders for morale. Have also been known to head out for "breakfast" too.

Your RN/patient ratio seems kind of low to me. I work in a small, level 2 ED - only 13 beds. A "busy" day for us is 80 pts. On nights we have 3 7p RN's (that includes the charge RN who sees pts), 1 RN who leaves at 2230 and another who leaves at 2300. There is also a triage tech on all night. This position is an RN during the day, but usually a paramedic at night. The coverage seems to work well, but there are always those days when you never have enough hands.

We are getting slammed too! Must be something in the air. We are a small Level II ED - only 13 beds. Yesterday we saw over 80 pts. It doesn't seem like much, but for us it is huge! I swear all 80 came in between 8a-2p. Lunch was ordered up for us, but we didn't even get a chance to get to the sack lunches. I am not sure what is going on, but I DON"T LIKE IT! Make it stop!

Our protocol specifies only treating fevers over 101.

I understand the device you are talking about, but I wonder what is the difference between a manual poke and a delivered poke. I suppose there could be some difference in the amount of force delivered. In previous job as school RN, I had a kid whose device was broke. We did a manual poke for at least 2 years. It never seemed to be that big of an issue.

I had a pt today who complained of the burn and then had intense itching with transient redness to her forearm. I used my usual protocol: dilute the 12.5mg of phenergan in 10ml of saline and push slowly - usually over 2.5 minutes. She also received 4mg of morphine about 3 minutes after the phenergan. The burn and itch subsided after about 4 minutes - the redness approximately 15 minutes later. This did make me nervous. I use the same protocol every time. I never inject directly into a lock. I always have saline running - most of the time wide open. I still am not sure if it was a reaction to the morphine, the phenergan, or the combo.

Very well said. This is a difficult choice only she can make. Until we walk in her shoes, we can't truly speak.

I can't imagine working in an ED without it. We are required to have ACLS, PALS, TNCC, and ECRN. TNS and CEN are optional. I am currently looking into the SANE program.

[quote=Anagray;2069732 I am excellent with assessments and IV therapy skills, I know tele like the back of my hand, I know how to deal with families and like a fast-paced environment, I am not afraid to get down and dirty. Plus, I can use my native langauge to translate as needed. ED/critical care is something I wanted to do for a long time. I applied to ED and waiting to hear from them. what do you think? If anyone has experience with ED work or med surg, please give me some pointers. Thank you! Natasha I am an ED nurse. I could never be a floor nurse. I used to work OB, but honestly never did the floors. My hat goes off to floor nurses. I like the fast pace, the quick thinking, and the autonomy we are afforded in the ED. We have our own problems and a chaotic atmosphere, but I wouldn't trade it. My favorite part is treating and streeting. In our ED, we don't hold patients so the longest they are there depends on the doctor. When they are discharged or admitted, their family goes with them. After reading the daily grind you are experiencing, I would either transfer to get out! Good luck!

I would love to stay at home. BUT - the kids want to go to college and go on nice vacations. The husband likes to golf. And I like to shop! Add all of the above up = Mom working! I enjoy it as much as possible. On work days I want to be home and some home days I want to work. I enjoy this job more than any other I have had. I guess it is a necessary evil! I give it a 8.5 (most days).

We never have had "community" vials of narcs, but we did share the nitro and liquid ibuprofen/tylenol. We went to an omnicell system last fall and they did away with the "community" bottles. Talk about a big waste. If I have a chest pain that comes in, I give the standard 3 nitro SL tablets. That leaves 22 remaining in the bottle. If they are admitted, I send the bottle to the floor with them. If they are discharged, the bottle has to be pitched. Same thing with all eye meds. It is a huge waste! I have been known to carry the 2mg dilaudid or ativan syringes around planning to give the remaining 1mg at a later point, but never hand off the syringe.

We sold our house while I was working nights. The open house was on my weekend off so that was not a problem. The thing I remember the most is that I missed the call from the realtor saying we had a offer. I slept through it and the machine picked it up!

I am one of those perky, optimistic types also. I know sometimes the night-shifters just cringe when I come in at 0700 saying "Good Morning." I think I have become my mother. She has been eternally perky and it used to annoy the living he*& out of me! It is too much work to be crabby. I do my share, trust me, but I have found life is easier when you are happier.

At our facility, we have several Spanish-speaking employees. We are no longer able to pull them away from their duties to interpret for us in the ED. My feelings are those who don't speak English should bring an interpreter. And I don't mean a 4-year-old child. I can't begin to tell you the number of times I have had to have a child ask their mother intimate questions regarding the possible cause of their vag bleeding. Plan ahead - either learn the language or bring an adult with you.

I live around 5 miles away. Depending on time of day - approximately 8 minute drive.

I always dilute mine and give it in the furthest port. I have not heard the slow push time.

I checked out that website - they look very tiny and difficult to use. Do you use these on all pt's or just difficult sticks? We went to the "wingless" IV catheters about 9 months ago. I miss my wings - it sure made it easier to use and secure.

In our ED, there is a standing policy that what they are allowed to do in the field stops when they hit our door. When they are available and not on calls, our EMT's will start IV's and take pt's to the floor for admission. That is it! They might help a doc with an intubation, but as stated above that is not in the scope of their practice within the walls of the hospital.

Erin - I agree with what Critter Lover said. PLUS - there is a huge difference between a 4 day old baby and a whining adult!

8% for evenings/15% for nights - regardless of day of week time-and-a-half for 4 hours over your scheduled shift double time for working at least 4 hours of your weekend off We recently went to a dollar-per-hour schedule for the differential, but grandfathered in current employees. I am not aware of the new pay scale, but know there is a cap, and it is considerably less than the percentage scale.

At our ED they really discourage only using a partial dose of any narcotic type medication and saving the remainder. Our morphine comes in prefilled syringes (4mg/10mg). We almost always start with a initial dose of 4mg and proceed from there. Very rarely am I carrying around the extra. I do keep it if I know I am going to use it. I am not comfortable handing off a partial med. I usually waste prior to the end of my shift. While I do feel comfortable with the majority of my coworkers, covering my *&% is more important to me. There are some coworkers I don't trust. Sad to say, but true!

If I had a dime for everytime I heard this one, I would NEVER have to work again. Who out there puts "butterfly IV's" in? If I resort to anything less than a 20G, it is because I have already stuck the pt a couple of times and they have crap for veins. I always have the same reply - "Sorry we don't stock butterfly IV's in our ED." The pts don't quite know what to think of this comment.

It doesn't matter to me who wears what. They could be sitting there naked for all I care. I just want to work with people who do their job effectively - clothing is optional!

It is bitterly cold and snowy here too this morning - once again! Add some ice under that snow as well! Unsafe driving - probably. One of the risks of living in the Midwest. It always amazes me that people act surprised and perplexed by our weather. I have lived here for 43 years - it snows folks! It always has, it always will! Have a plan. I am glad I don't work with some of you posters. If I did, it sounds like I would be there for a week until the road is cleared and the sun is shining. If you don't want to work, don't go. Just don't ask for validation from me. I have a family and obligations also. I am just one of those that feel responsible for taking care of those people who end up in the hospital. Can you imagine heading to your ED with a child with a hot appy or a husband having a MI? Sorry we took the day off - too much snow!

I don't call it self-martying, I call it loyalty and responsibility. I knew hiring into an ER hospital position, that I would be expected to work regardless of the weather. Yes, sometimes it is inconvenient. Today for example, it started snowing about 45 minutes before I left for work. It took me a little longer, but I made it. Had I called in citing weather, who would have taken take of the three Level 2 traumas we had? Our ED was getting slammed - another day with no lunch or break to pee! If I had called in, what a slap in the face to my coworkers who were just as harried! It is an individual choice only you can make.