northshore08

I so appreciated this article! I left ED nursing in 2012 after 27 years, and now am orienting as a hospice nurse. Next month I join the peds hospice side. In all my years of ED nursing I felt like the ED nurses that posted in the article, that if I internalized the grief and pain I saw, that made it about me and not about caring for and supporting patients and families. Now I find that on the hospice side, you really are closer to the family dynamic and grieve with them for their loss, not so much for the passing of the patient. I'm busy watching the hospice teams support each other and seeing how they work with the families. The peds team meetings are full of tears and support; I am grateful for the peds nurses in the article sharing their experience. Thanks!

Three weeks into orientation, I really appreciate tips like these. After over 25 years as a nurse, I feel like a newbie again. I am alternately challenged and overwhelmed. I find the case management part is quite overwhelming, but looking forward to getting it right. I'm learning the phraseology and the documentation is unparalleled in my experience. Newfound respect for those who can do all that AND provide tender care for the dying and their families.

Thanks so much for your responses! In my experience, choices concerning patient care for those who are not able to consent for themselves rests with their health care proxies or with the next of kin. Is that not the case in LTC facilities? I can't see how consent can be implied for dementia/Alzheimer's patients who cannot consent for themselves.

I have a lot of questions about this issue, and I am probably wrong about a lot of my thoughts, so I came here for clarification. My experience is hospital based, ED and OP. If residents are in the nursing home because they are demented and cannot care for themselves, how can they go farther than hand-holding or hugs? I understand the need for close human contact, but we don't allow minors to have intercourse (unless I am wrong) and aren't demented patients in that same category? Are dementia patients considered consenting adults? I think about surgical consents, where these patients cannot consent for themselves, their POA or family has to be present and consent for them. I learned Maslow just like you all did, but I don't see that sexual intercourse is the same as nutrition or cleanliness. Help me understand all this. I like the idea of the decisions being made in conference with the HCP family members. I know if my mom had wanted to be with someone it would have been okay with me, but maybe not with my brother or dad.

aloha, LL! Keep on trying; and sign up for multiple agencies if you need to. I used Altres and Island Nurses with success a couple of years ago; they both kept me busy and I could pick my own schedule. Keep in close touch with the schedulers and they are great!

"Unprofessional" is how your manager is acting. You are not the problem, and your manager is taking out frustrations on you. Make sure your departure date is okay with your union and enjoy your new job! Huzzah! ps...bet that manager won't be there long. shedding good staff is a symptom of a larger problem....

Now that one gets my vote.

I've never seen a patient fake nystagmus. Is it something to do with heavy nicotine?

From what I've read, this is not considered acceptable labeling. In my book it is, but according to JCAHO, this method is not what they want. A good example of what they want is posted on the last premixed med your inpt pharmacy delivered to your department. I can't see writing all that information on every syringe of Zofran I have to administer. I really believe all these med standards (current and future) will never be met until every medication is prepared and labeled by a pharmacist on site before it is delivered to the staff nurse on site for administration. From what I have read about the pharmacy world, they are less than prepared to fulfill this role. In the last 50 years or more, I am surprised nurses have not killed off more of the population. I'm sorry, but IMHO these "national patient safety goals" continue to be someone's way to keep their administrative position. Requiring increasing mandates of every move workers make will not ensure the safety of patients. More staff and the time/freedom to do the work results in less safety problems. I feel a little bit of environment change could help with many of these safety issues. If you are so concerned with handwashing, install sinks in my rooms; the sanitizer you have so nicely provided doesn't clean pee, poo or the C. Dificile off my hands. If you want all specimens labeled at the bedside, provide pre-printed labels for me to use; the lab has them, why can't we? Just a few ideas....Okay, I'm better now, and ready to follow my scripting for phone calls and patient contacts!

Network with other nurses, do a little travel nursing on the side, see other hospitals with their work environment and types of patients. It's not all like you are experiencing, and you know the old saying that whatever doesn't kill you makes you stronger. Sometimes you just know it's not right for you. Your experience there at that place can only be beneficial (experience-wise), but don't get sucked into the idea that this is the only place for you. Unless you are contracted to stay at this facility, keep your options and your eyes open for a change if you really need it. Your career is more important than this one job. And I have a feeling the staff argues with one another because they have no control/say over how the patients treat them.

It's all kinda fishy. I even called ENA to make sure the email was authentic (that the sender really DID work for them.) Bad business to have no other shipping options but their choice (UPS ground.) Give me some other choices! Also REALLY bad business to try to get more money on the back end of an order instead of keeping up with your website. I cancelled the order. That's it for me. Ah, well. Another day in paradise.:icon_roll

Perfect! Someone finally understands the silliness of the pain scales/descriptions we have to use. And he didn't even get to the domestic violence screening or the tetorifice shot! The moaning had me ROTFLMAO! Love it! He had it right on about the parking/validation scenario. No, honey, the valet parking is in outpatient with the folks with insurance, not in the ED where it needs to be.

:redbeathe You are a great nurse. And a wonderful writer. God bless you, Scrappy!

I ordered a CEN review manual the other day from ENA, 50.00 (for ENA member) plus 12.50 shipping. Okay, expected all that. So today (two days later) I get an email requesting permission to INCREASE the s/h charges to $29.50! Dang! Another 17.00? And for a BOOK? That's 30.00 shipping for a 50.00 book! Anyone else see the sense in this? I refused and asked them just to send it by USPS in a flat rate box for 11.95, or even book rate; the response was, "we are raising all our rates as of 2009, sorry!" Well, my calendar says February, and I don't see why you didn't already take care of your needs for rate increases, or at least post a one-sentence disclaimer on the website. :angryfire I don't mind paying for the book, but that will be the last thing I order from the ENA! That's outrageous. Okay, done venting now. Thanks, you guys. :redpinkhe

Sorry for assumptions, but you could have clarified sooner than 4 pages into the posting. It's not what satisfies you. The hospital has to satisfy the feds.

Oh, my. There. Feel better now?

Unless he is going to have a preceptor to work with for a long time, I would recommend a new grad do either 7a-7p or 7p-7a. The mid shifts require nurses that are skilled and flexible; the new grad doesn't fit there yet. Great responses from everyone!

Biggest point misunderstood by nurses not in the ED.... Nurses in any other areas of the hospital have total control of their environment. You say if and when you will take patients, you are able to accept or refuse to take patients, and you also have the ability to make a big stink about the condition those pts are in when they come to you. We in the ED do not EVER have that luxury, yet we carry on. We care for those pts you refuse to take, all the while continuing to accept the more and more patients that line the corridors from EMS and approach the ambulatory entrance. We are placed at the front door of the hospital (the triage desk) to face ANYTHING and ANYBODY that walks in the door, in any condition it appears. And I don't know about other EDs, but I know that at mine, the crowds come in together, and my manager wants the crowd of 10 that just walked in to be triaged within 5-10 minutes. It can take that long to get one Granny to tell me what is wrong and finally identify all her meds! Thank goodness for my ERT and the other nurses! I don't see nurses in other areas facing this as a routine shift. And I think that is also the point of the article that trauma nurse posted. Yes, we can all work together, but it can never be the same. Sorry if that hurts feelings, but this is the emergency nursing forum, in a specific thread addressing ER Nurses.

And I thought I was the only one!! Oh, yeah, sing it! Where's my "yeah, that ^" sign?:chuckle

That's a good way to weed'em out! That is SO TRUE! Pts so often don't want to be the bad guy; when I get a family group, I do my best to have a moment with the pt alone (like in the bathroom or something) to ask what they want me to do with all these visitors; I tell them I will take care of it for them. And I do, any way I can. I have sent family home to get Mom's favorite blanket and picture, or anything else I can dream up if the patient and I need time. It was a great idea to get another nurse to assist/support, too. Maybe a visit from the charge nurse or an administrator/pt advocate might help, too, before you call security or the popo. Privacy issues aside, the nurse's insecurity about performing a procedure is not sufficient reason to chase out family. If you are not sure about yourself with a certain procedure, get some help. Take the procedure manual out and review; maybe even take a copy in the room with you. I've known critical care nurses and other ED nurses to do that quite often, especially with procedures that involve a lot of specific steps. That's your responsibility as a professional. You can do it!!

Valmore, I agree with you. I love AN, but there are times that everything seems to be focused on those who are not working health care providers and/or trying to get there someday. When the forums get too fussy and full of students and gonna-be-a-students, I have to take a break. What bothers me the most is new threads where it is obvious that the OP did not bother to search the forums for answers before asking the SAME QUESTIONS again (usually related to schools, testing or moving or some such.) In the beginning for a while I had set responses copied to Notepad, and I just copied and pasted. Then I tried to link them to the other threads. I got tired of that, and stopped responding to those altogether. I like to actively ignore those who fuss at us because they perceive some lack of love for our patients or jobs. But I still come here very frequently (per DH.) I get great support and guidance from this site; thanks to everyone. :redbeathe

ThrowEdNurse, I..I..I don't know what to say. Actually, I am wiping the tears of sympathy and laughter out of my eyes. Your description of that neverending un-code is priceless! Sounds like your docs were missing a few Legos that day, and the patient has you to thank (?) for helping her live. Did that poor lady ever get her celestial discharge? May God have mercy on her; I hope so! (She's done her share of teaching!)

I did not read the thread this discussion is based on...so forgive me if these points were already addressed. I want to say up front that I am thankful for the great prehospital care that our local EMS provides. I have never worked with "paramedics" in the ED, but I have worked with lots of paramedics who were working as techs. So with that said.... I had 5 years of prehospital prior to graduating from nursing school (many moons ago, I confess) and I've been in the ED since. I did not continue to follow the educational requirements for EMS. I am surprised to hear that the education has moved into the associates/bachelor degree area. Things have changed a lot if this is the case. A further Google search shows conflicting information about licensure vs certification for EMT-P's; some have only one, some have both, not all states require licensure (for example, some job sites for Kansas only require certification.) IME, paramedics work under MD guidelines with protocols/algorithms. Nurses in the ED many times work under standing orders. In the field, paramedics have access to the MDs by phone/radio contact (at least they call us all the time,) and in the ED the nurses can page/yell for help if the doc is around. If you are at a cardiac arrest scene or slid into the back of a bloody MVC starting a line and giving meds in the dark I don't expect that you will be on the phone with the doc. Conversely, if a cardiac arrest or a major trauma is lying in my ED stretcher and the doc is busy at the other end of the department, I will institute the lifesaving measures needed without his presence or direct orders. Sounds similar to me. All in all, we make a great team. I love working with EMS.

My response is usually to ignore the comment. Occasionally I respond with "I bet you could if you needed to."

It doesn't sound like self-scheduling is going to work for your ED. Someone needs to do it (at least for now,) and share the wealth of the 9's and 10's fairly across the board for dayshifters. Would it help to offer a differential for the evening from 3-9 or 3-10? Some folks might snap that up and take it off the ones who really have to go home at 7p. Another option might be to schedule in 4 hour time slots, giving seniority preference. That might give you more flexibility, with some night shifters picking up pieces of shifts after 7p. One ED I worked at did the 4-hr slots, and it seemed to work well. The giant board was up for at least 3 weeks for everyone to enter their time, reviewed and adjusted as needed by the manager, then posted. That way you had negotiating time. It was most important to get your "R" (request offs) listed on there so others could see when you needed to be off, and schedule around you. The dayshift and nightshift each had an informal "specialist" who was really good at working the schedule and making calls to try to work out something if you had a problem and couldn't fix it on your own. We had very few callouts, and it seemed to work smoothly. But I think this ED had been doing this together for a lot of years.