littleRNthatcould

Maybe not an actual triage story, but a pretty funny sign in sheet story. The paper comes through to the triage nurse and it reads, "Kicked in mouth by whores". Now, I realize the fellow might have been mighty upset at the "old nag" but what he was trying to write was..."Kicked in mouth by HORSE"! The docs and the nurses had a field day teasing this guy (don't worry he was in on it too after he realized his error). And he got off lucky, no broken bones, no missing teeth:D

I'd love to go, I think it would be a great learning experience. I've been an ENA member for over a year and outside of the monthly journal haven't taken advantage of the educational opportunities. Thanks for the reminder to do so!!

Thanks to everyone to replied so far. Just so I'm making myself very clear about the situation and not to make it seem like our local PD isn't helpful, they ARE. They always come when called and beleve me, I won't hesitate to make that call if any staff or other patients feel threatened. My concern is; even a 5 minute response time is too long when there may be a loaded weapon involved. I've read some information about de-escalating tactics and have some ideas about beefing up what little security we have that won't cost too much (because we all now that's the bottom line) some as simple as re-arranging the furniture in the triage room so that the nurse is closest to the door. I have even asked for a limit to visitors (one per patient) and that all visitors must be verified with the charge nurse prior to admittance. I was truly surprised by the amount of nay-saying I got for that. Fellow charge nurses state "we get enough phone calls". My opinion is, I'd rather take an extra hundred phone calls a night than risk having to make one trauma call for one of my nurses. As everything, it's a work in progress.

We were told that it s not enough to threaten, they must prove that the patient in question had intent to follow through OR the patient must actually commit a crime in order to be arrested and charged. So no, as far as we understand, it's not a crime until one of us is harmed. I'd like to be a little more pro-active than that. I'm sure others would as well

I'm curious to find out how your hospital handles violence against nurses. Recently (within the last several months) we have had a FF/known and documented drug seeker pull a knife and threaten the life of the RN and the unarmed security guard. Two days ago after confronting another known FF/drug seeker (professionally), this patient returned to the ER and threatened to bring a gun and kill the doctor and the nurses(me specifically) involved in the patient care. We have also had a known non-compliant schizophrenic become fixated o n one nurse and began stalking and threatening her. All of these were investigated by the police but to my knowledge no charges were filed because no actual crime was commited. According to our current policy, we still HAVE to see and treat these patients, regardless of the personal and very real danger to ourselves. Our ED is not equipped with metal detectors, nor is it a locked unit. The doors are locked, but security is lax and all anyone must say is "My sister/brother/parent/friend is in room #9" and in they go. Our triage area has only one exit and it is behind the patient, not the nurse, leaving them essentially trapped. I know that Emtala states that everyone is entitled to emergency care (to paraphase), but am I wrong in thinking that we should have a zero tolerance policy on accepting patients who have threatened to KILL us if they get the chance? I have been very verbal to my management that as the charge nurse I refuse to let these people through the doors and they will never get the opportunity to harm one of my nurses. The physician in question agrees with me. But upper management is sticking to the motto, "everyone reacts differently to being sick or in pain, some lash out and say things they don't mean." So I ask, what are your policies, how is it handled? If I can piece together enough real information, maybe I can do a better job at protecting my staff. Thanks in advance for any replies.

I'd like to recommend a bed side commode...it's bigger!

1. Central lines are preferrable for pressors like Dopamine and Levophed, however it is acceptable to use a large bore cannula in a large peripheral vein to administer (18g-16g in the AC for example). Of course always watching for signs of extravasion. If the patient is unstable enough to require it, give it now and work towards the central line placement. I don't like to do it, but if it's a life and death situation, I will. 2. Never, we always go with the least invasive, least traumatic course of treatment. 3. But anytime you give medications like Versed (even in small doses) it's a sound idea to have airway management nearby and monitor, monitor, assess, assess. If that is what falls under your conscious sedation policy, then yes. 4. No propofol unless anesthesia wants to come over and do it (and monitor it themselves) Unless of course it is a continuous drip on intubated patients as previously mentioned.

This company is trying to bring a crew to my state (WV). I recently was offered and refused a job with them. I have never been so thankful for my fear of heights after reading this. God bless the families of the lost crew.

Oh man, been there and dealt with that. I've never seen it written so beautifully before and from the aspect of what WE see and the sense of betrayal that we feel as we "force" life on someone who's made the choice not to continue. An amazing read, thank you

There is an ER in town doing something similiar to this. From what I understand it's used for LWOTs...making sure they didn't leave while being medically unstable..etc. Not sure of all the details, but i believe that to be the essence of it.

When I worked on the floors the hours from 0300-0500 were the absolute hardest. All the patients (or most) were sleeping. I never fell asleep, but I caught myself doing that infamous head nod then jerking yourself awake thinking, "what did I miss? where am I?" Things changed once I hit the ER..too busy to even think about sleep and usually too wound up to fall asleep for several hours after my shift.

I'm sure this has already been written 100 different ways in 100 different posts, but this is really about the basic principals we all learned in kindergarten: You do not have the right to hit anyone. You do not have the right to threaten anyone. I don't care what the excuse is; Grieving families, exhausted patients, or people angry because the procedure didn't go as planned (IV starts as a previous example). No one reserves the right to strike another human being in anger (however pained they may be) I am, as most nurses are, sympathetic to all that familes and patients endure in the hospital. I am not so sympathetic that I won't be the first to press charges against an abusive person. Their lack of coping mechanisms does not constitute my becoming a punching bag.

Here's my issue with scripting (aside from the obvious that I am a highly trained and skilled medical professional and the English language was a pretty much a prerequisite to my program) When our NM introduced the idea, she actually had the gall to use her recent to trip to a drive thru resteraunt as an analogy. "Would you care for any condiments? How many napkins would you like? Will you need any silverware?" This ol girl almost fell out of her chair!! I stood up and said, "Are you actually comparing an overworked, understaffed, underpaid ER to Denny's??? My theory is I know I don't "have time", NM knows I don't have time, the patient I just told "I have the time", doesn't know any better in most cases. So when I promise the moon and then don't return for an extended period of time because I've been pulled into a code, an acute MI or a crashing kid, the patient is simply left to believe that I A: Don't Care B: Am incompetent C: Am lazy Because after all, I told them "I had time" to attend to their every (trivial) need. I out and out refuse to set myself up for that. If hospitals want us so desperately to deny that we are busy and insist on us lying to patients, then they need to make it so we aren't busy by hiring and paying for more of us.

I worked in my uncle's garage (which I still maintain was my BEST job ever). Then I worked for a while in a lumber yard before starting Nursing school. Believe me loading sak-crete and 2x12's really gets you ready for transferring those large patients!!!

We also don't admit for detox. Our docs philosophy is "come back when you're sober and tell me you wanna stay that way." I agree 100%, too many people take up space in my ER drunk and claiming they want help, taking up resources, only to "sober up", change their minds and go AMA:twocents: