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littleRNthatcould's Latest Activity

  1. littleRNthatcould

    Good triage stories

    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
  2. littleRNthatcould

    ENA Conference Baltimore

    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!!
  3. littleRNthatcould

    Policy on ED violence

    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.
  4. littleRNthatcould

    Policy on ED violence

    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
  5. littleRNthatcould

    Policy on ED violence

    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.
  6. littleRNthatcould

    I'm going to dump a full urinal....

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

    What is your ED policy in these circumstances

    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.
  8. littleRNthatcould

    Rushville, IN Helicopter Crash

    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.
  9. littleRNthatcould

    The Patient I Failed

    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
  10. littleRNthatcould

    The most beautiful curls I'd ever seen

    All I can say after reading this is THANK YOU and GOD BLESS YOU for being able to share this story and to have the emotional strength to do this job. I know that I have such a horrible time keeping my own emotions in check when it comes to the deaths of these precious children that I most likely could never do the job that you do. I thank God daily for nurses like you.
  11. littleRNthatcould

    EMTALA Survey

    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.
  12. littleRNthatcould

    My First Patient

    Thank you to those of you that have responded to my story. It means the world to me to be able to share it with other nurses who have had similiar experiences. So again, thanks!
  13. littleRNthatcould

    Need opinions RE: Fetal Demise in ER

    I think this is a wonderful idea. That being said, allow me to play the devil's advocate for a few seconds. In many emergency rooms, the staff are already overburdened and understaffed. It makes it extremely difficult to deliver the sort of psychosocial and emotional care that we would LOVE to be able to provide our patients. Even the most in-depth discharge instructions (wound care, fracture care etc..) are given in such a rushed manner as to deliver the most amount of information in the smallest amount of time. Granted in most instances there are chaplains available, although on night shift one would have to wait for them to arrive. Unless your focus group or department is willing to place a resource person in the ER to handle these delicate matters (that do require sufficient time and tact) then I can see you meeting some resistance with the ER staff. Please don't take this as ER nurses (or even just me) as being insensitive. We DO care. We just sometimes need extra help getting that point across (from ancillary departments). I wish you the best of luck with your program
  14. littleRNthatcould

    Has anyone ever reported your employer?

    RN1989, I applaud your efforts. The staffing issue, I don't believe would take a lot of documentation. Just comparing the patient census with the nurse availablilty (consistently) should be enough, shouldn't it?
  15. littleRNthatcould

    Has anyone ever reported your employer?

    Has anyone ever reported their employer for unsafe staffing issues? I've read numerous threads about unsafe staffing on this site and other nurses taking the issue to the administration with nothing being done to correct it. Last night I was reading an article on the ANA website about "being vigilant in reporting unsafe staffing". (If I can figure out the link, I will). It had a hyperlink to the JCAHO website and a hotline number. Now, JCAHO has no actual "Safe nurse to patient ratio" number in effect. But one would imagine that some of the numbers I have seen on this board (LTC- 60:1, MS 9:1 etc..) plus what I have seen in my own practice (ER 45:3) would be considered vastly unsafe and jeapordizing patient care. My question is, has anyone ever reported to JCAHO, and if so, what were the results? Thanks in advance for all replies:typing
  16. littleRNthatcould

    Most common non-emergency visits

    Pelvic pain ( as above seeking pregnancy test..sometimes just for menstrual cramps) Dental Pain "Crazy" Granny drop-offs on the weekends New Momitis - brings in new baby for every burp in a panic (i can't be mad at them though..God bless 'em) I'm sure there are more..I'm just not feeling creative enough to name them all right now:D

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