RoyalNurse

As an Emergency Room Nurse for 5 years, and a Critical Care Nurse for 3, I still think the most harmful disease by far is prescription drug abuse. And with the advent of patient satisfaction driving revenue for vastly underpaid hospitals, prescription narcotic abuse has become a public threat. I have seen Percocet get prescribed to people with chronic back pain, abdominal pain with no known cause, chronic "fibromyalgia", and ovarian cysts that have ruptured months and sometimes years ago. I've seen patients receive up to 30 pills at a time, some people I see back a few days later, looking for more narcotics. I really think this is a symptom of our everything-right-now society, and I think it's probably the most harmful thing we as healthcare workers are doing to patients. A lot of Emergency room physicians have become drug dealers. They get asked for by name, because they order the right combination of Dilaudid, Phenergan and Benadryl, with a Percocet or Vicodin prescription to go home with. The entire practice has become exactly against what modern medicine was meant to stand for in the first place. I would like to do something about this. I'm writing this to see if there are any nurses with kindred spirits out there who would like to help. I'm envisioning a letter-writing campaign to Washington, and to your state senators, followed by a public campaign/education project to really teach society how bad/insidious these narcotics really are. I think a large group of nurses is what it will take to get this issue under control; the public still trusts nurses more than any other professional. Anyone with me? Feel free to pm me or reply to this thread with any comments.

I've always been curious about the perception that emergency nursing isn't critical care nursing. It qualifies as such for the CCRN, but it's included with "Camp Nursing" on this website. :) Obviously most patients are not critical in the ER, but we are definitely equipped to handle any that might show up.

Has anyone here had a successful outcome when it comes to stopping lateral violence in the ED amongst nurses? There's a big problem where I work now, the management is turning a blind eye, and HR doesn't have any policies in place. I've tried talking to them one on one, (there's three of them), but it doesn't go anywhere. I'm not the only one who's having problems, I've heard complaints from other nurses as well. These three "bullies": withhold information to certain people, make snide comments, interrogate during reports and make negative comments, and, of course, gossip nurses into the ground. Any help appreciated!

I work at a free-standing, the nurses all have a ton of experience and are really smart. It's actually a little harder to work in a free-standing because you don't have the back-up like the hospital. Patients will go to the main hospital if they "think" it's something serious, but that's just it: they're not doctors, and they often don't know what's going on. I absolutely love the free-standing, I think it's helpful to patients, we're just 7 minutes from the hospital. It's got nothing to do with corporate greed, we take a big load off the hospital ER. It's definitely not a clinic, we help intubate, give TPA, the whole nine yards.

I get it of it's a stable telemetry situation, or med-surg situation, but this was a emergency room/urgent care situation, we didnt know who was coming in, and what they would need. Then the professionalism/ scope of practice comes into practice.

Hi everyone,I just wanted to get some opinions from some LPNs on a topic.I recently worked with an LPN who was assigned to 6 "urgent-care" patients, I was the charge nurse. My duties included administering any IV medications that the LPN's patients needed, as well as mixing any antibiotics, and monitoring anyone who ended up on a cardiac monitor. One of her patients ended up needing insulin IV. I was not told about this order by the LPN, and I did not administer it. When the LPN gave report to the next LPN coming on duty, she said it was my fault that the insulin wasn't administered, as I was "in charge" of IV injections. I feel that the LPN is responsible for her patients as a nurse, and should have told me about this injection. I know that as an RN, I'm "supervising" this LPN, but she is the nurse assigned to these patients, and still ultimately responsible? What do you think?

So cool, good for you!! I'm a VA RN, graduated from massage therapy school last August, I now work at a Massage Envy in VA for experience, my plan is to become a subcontractor for the nursing homes in the area to provide massage for their residents. It was difficult to memorize all the muscles and their actions, and to get into the massage "vibe". It's a whole different world. :). You can PM me if you have any questions, I have some cool neuromuscular therapy and myofascial release books as well.

Not so much passé, as just plain unsafe. I am a BSN nurse, I've done ICU, telemetry and ER for the past 5 years, and have found myself in increasingly worsening working conditions. No lunch break for 12.5 hours, no one around to help with lifting a patient, 3 intubated patients in ICU, 2 with ET tubes, one sick Trach/vent on Levophed. The times I've had a tech really available to me in both places (ER and ICU) have been increasingly rare. And it doesn't matter what hospital, they're pretty much the same, willing to cut nursing care at the drop of a hat. I've heard lots of excuses: we have to prepare for Obamacare, we're actively hiring for nurses, (no one new shows up), etc. I really enjoy bedside nursing, and would love to continue, but not at the risk of harming a patient or losing my license.

Do you have to list this job? It doesn't sound like you really got that much experience from it anyway. What you really have to do is figure out what your negative thoughts are that are holding you back from being a great nurse. These thoughts are causing your anxiety.

I'm sorry to say, but you're just as "bad" as she is. You're judging her based on a preconceived notion about what an"professional patient" is. It's none of your business why she left AMA before, your job is to provide nursing care for her during this hospital stay. It's easy and fun to gossip about people like this, because it makes you feel good, and you're probably "right" about her, and she is "wrong". But it doesn't help you as a human being, and definitely not as a nurse. You're not growing when you gossip like this. I'm sorry to lecture you..

I pretend I'm performing surgery on the vein, I visualize what the vein really looks like, and imagine sliding the catheter right in:). The visualization helps me with nerves and negative self-talk. Sometimes I'll talk myself through it like a golf announcer: "Okay, she's lining up the shot and measuring the angle..."

1. When I try to delegate things to an ED tech because I'm busy medicating, assessing, triaging, or discharging patients, I get attitude, or "I'll get to it" while they're chatting someone up. That's if I can find the tech. 2. I have to fight to use my nursing knowledge and skills, my "job" consists of nursing "tasks", aka "tasks" that a tech "can't do": medicating, triaging, discharging, etc. My triage of the patient also doesn't seem to matter, the docs often interrupt me to ask the same questions I'm asking. Nurses don't seem to have a place in the ER, I feel like a medication monkey who starts IVs and reads preprinted discharge instructions to people, because there's not really time for anything else. The only time I feel like Im worth my pay is when I catch mistakes: wrong dose or wrong route for a med order, etc, or actually teach someone something: keep a list of the medication you're taking in your wallet. There seems to be very little time actually assessing patients, there's not enough time, more focus on CT scans, lab work and Xrays. 3. When I triage and prioritize patients according to urgency, I get flack about some non-urgent task that needs to be "done" so the patient can get discharged, aka tylenol for a "fever" of 99.4, etc... 4. I'm becoming sloppy, because "there's no time", some days I'll say "***" it and take my time to do what I consider a good job, these are the days I get yelled at the most. 5. I get no to very little report on patients that I'm responsible for, if I ask questions, I get an attitude like I'm being difficult. If I act "nice" and joke around like everyone else, I get treated well. This furthers the feeling that we're all just med and task monkeys. The last couple of months have been rough, to say the least :)

Good point :) But can't you send them into V-fib?

How fast do you administer 2 grams Magnesium for Torsades? I've had MDs tell me to push it in fast, but I looked it up, and its supposed to be over 15 minutes minimum. How do you do it?

Okay, your patient's K+ is 7.2, and he is in ARF. You have orders to give him calcium chloride, sodium bicarb, insulin and D50. What order do you give these meds in? I always put the calcium in a 50 cc ns bag and run it over 5 minutes, then give D50, then insulin IV, then the bicarb. I always thought you wanted to calm the heart and protect it from the high K first, then take care of the K. Another nurse is saying to give the insulin, then the D50, then the calcium chloride, then the bicarb. What do you do? Thanks for any replies:)