olddog1

Thanks to all for your responses. My patient was 104 (yes that is correct) and had vomited coffee ground emesis x1- she came in with it on her gown. I felt like I was torturing her for no good reason because, as was stated by others, it wasn't going to change what we did for her and was more likely to cause harm. She had all the other treatments started 2 hrs before the doctor saw her/ I took over her care and hadn't vomited/had stable vs during that time. I love octreotide but have found my ED docs don't use it because they don't know about it (that's for another post!) and are reluctant to use something new.

Does anyone know the current thinking on "lavage til clear" for an upper GI bleed? Is this still recommended; does it actually work; aren't there more current and effective therapies.

Congrats to all even thinking of taking the CEN. Even if it's only for "personal satisfaction" sometimes that's all you get in this profession. I took a review course offered by ENA and don't think I would have done so well without it. It really helped to focus where my knowledge deficits were. There are so many areas that ED nurses need to be proficient in, it helped me to have someone say, focus on this. Good luck to all.

Broken FAKE fingernail. She got a work excuse and Vicoden. And we wonder why people come to us with stupid stuff!

Does anyone else have a problem with all our focus on pain? I agree that we should make people as comfortable as we can and think anyone in a terminal state should have access to any and all meds available to them, but we've gone a little overboard. The ED where I work doles out dilaudid like it's skittles so that now folks come in b/c they stub their toe and expect a dose of dilaudid!!! and the scary part is that they get it b/c no one wants them to leave unhappy. Of course no one cares that we are creating a whole generation of legal drug addicts. When were we guaranteed a completely pain free life?

I appreciate all the dialogue and even thank those of you who blasted my use of the "N" word (being from the south, I have to say that I never realized Nazi was the "N" word...we have a different one that's equally if not more offensive to me!) All of this has helped believe it or not. I think I'm going to try to catch more flies with honey if you know what I mean. Leaving the facility isn't an option I want to explore just yet and I hate to leave a the ED since I get more satisfaction working here than anywhere else I've tried in my 25 yrs as a nurse. I have extended an olive branch to my director and we'll see where it leads...

Wow! Certainly didn't mean to offend as many as I did. For that I do apologize. I compared her to a Nazi because of her dictatorial leadership style not because I am insensitive to the plight of millions persecuted by this group. That being said, I do appreciate the support and suggestions. I have actually attempted to befriend her and offer support; I know she stepped into a dept. in turmoil as our last director had been gone for over 6 months and our interim was actually the line admin. for nursing (read very busy and not able to run our dept. so we were left to our own devices.) She has taken 2-3 nurses into her confidence and doesn't even pretend to listen to anyone else's concerns/comments/suggestions. My main question that probably got lost in my initial diatribe was how to handle her infamous staff mtg? Should I let it go or follow the chain of command which is weak at this facility. I just can't forget how 9 yrs old she made me feel by yelling and slamming her papers down. I had already sat through a similar staff mtg 2 months ago and left feeling rather humiliated. I just don't think that's the way to motivate people to do better. I'm of the "lead by example" school and I think she acted worse than the people she's accusing. I did not storm out of the meeting, rather left before I became too angry and said things I would be fired for. I also called her later and explained my actions and how I felt about the public flogging we all received. I explained that I would expect her to pull me into her office for private discipline if I was one of her "core group" of troublemakers, at which point she assured me I wasn't. So why was I there? Why were most of us there? Don't get me wrong; I know she has a tough job. It just seems like she's trying to alienate herself from her staff and that only makes her job harder.

My new director is driving me crazy! She had a meltdown at the last staff mtg; came in yelling at us and said we had lowered the bar for professionalism so far we'd never get it back, told us we were all getting a written corrective action in our personnel folders for an anonymous letter that one of our new nurses found in their locker (supposedly) that told them to get out of the dept. She slammed the stack of papers she was holding in her hands down on the table twice and told us there was a core group of staff who were undermining her and bringing the dept down. Lots more derogatory comments were made suggesting that every nurse was horrible. At this point I walked out of the meeting and went to personnel to request a transfer. My co-workers told me later that I missed the best part of the mtg. Evidently she became so overwhelmed with emotion, she had to leave the room twice because she was sobbing! Any advice on how to handle her? I love ed nursing but can't work for someone like this. She doesn't want any input from staff on what works or doesn't. Said we were going to "no wait triage" to improve throughput times but did nothing about any of the things that bottleneck the dept. and thinks that no pt will have to wait if we just put them all into beds immediately. Of course she had no answer when I asked what to do when there aren't beds as is always the case at 7pm when I come to work. Lots of other annoying habits from her and she seems to have gone out of her way to alienate the staff. Help

HI, Re: HIPPA and calling pts, we just started using raffle tickets; we keep one part and the pt gets the other, then we call them by the last 3 numbers. Of course, now pts think they get a prize with their visit. I guess the next thing is to provide them with a halloween mask so that they don't get recognized in the waiting rm. Gotta love HIPPA.

welcome to ed nursing! I'll share some things I've noticed in less successful new ed nurses: 1. Be an active member of the team and try to see and do as much as possible in your orientation period. If not, you'll be surprised how fast that time flies and you'll end up frustrated (as will your co-workers). 2. Remember that ed nurses are type A personalities out of neccesity; try not to be too sensitive to any perceived negative comments and learn from the constructive ones. 3. You already did the hard part-you became a nurse! You know how to take care of people. The skills are learned tasks and will become second nature with time so don't sweat them. 4. Take ACLS, PALS, ENPC, TNCC as soon as you can; they'll make you more comfortable with the populations you'll see. 5.Bring food! God knows, you rarely get a chance to eat during your shift and nurses LOVE to eat. 6. Learn from the whole team. The techs, secretaries, CNA's who have been there a while are a great resource. 7. Have fun, cuz if you can't have fun then what's the point? Hope this helps some and good luck!