Dragonnurse1

Given the current policies regarding any narcotic prescription this entire situation is a mess. All physicians must now justify every narcotic order every time one is written. With the DEA, FDA and CDC breathing down the neck of physicians, pharmacists and patients we are treading lightly or running scared as hell. Physicians that are NOT pain management are restricted in their writing of narcotics and as a result many are refusing to write for narcotics under any condition. Pharmacists are now allowed to refuse to fill valid prescriptions. Physicians must document each RX written and justify the dose and number of pills the patient requires. The physician may have forgotten to do their documentation for that specific script and is throwing the RN under the bus to avoid responsibility.

I went to nursing school at age 38 with 4 children (ages 10, 5,3, and 1) and my spouse was a cop that worked nights. My nursing program (ASN in 1990) was difficult to get into and had a passing rate of 100% but you had to get past that one instructor in the first quarter. She would let you know that it was her job to flush out students that they felt would not make it through the program. When she made something particularly hard and a student passed she always had a little grin and when they failed she would just shake her head and walk away. She pulled something, I cannot remember now what, on 3 of us and I challenged her, we passed and 15 years later when my son was taking nursing courses he had her and she remembered me. I found after talking to several nurses from other schools that there seems to be that one instructor that was the designated "hit instructor", the one that "sorted" out those that would not make it. You make it past her class and things will start smoothing over. I never felt like I had enough time to study, half of us taped each lecture and it played constantly no matter what else I was doing - well NOT when I drove as audio tapes and the road feel put me to sleep. If I did not have a lecture tape to listen to (I went through 3 or 4 recorders) I would spend a few minutes, literally a few, 30 or less, reading before passing out. I would wake with the Big Blue Book on my chest - now when I think about it I think I learned by osmosis, the words soaking into my body while sleeping under the book. Study groups - that is a tough one. I had been out of school for 20 years and back then we really did not do study groups. Everyone learns differently, if you can find a group that does not stray from the material and you learn well that way do it. I learned better just by discussion so my kids learned a lot of A&P, assessment and so forth because I would cover the material out loud. My kids coasted through their science classes in middle school. Your children may learn that way too, you will be surprised. My 10 yo daughter, back then, ended up in AP classes in Latin - she loved testing me on medical terminology the reason - the latin words to her were fun. We did homework together, the younger ones would play and sometimes listen. My ASN program had two tracks - one for those that had taken all the basics like history, english and so forth but they also had tracks for older students that included the basics at night, some days I would get to go home and cook for the kids and then head back to night classes. I could not have gotten through school without my daughter's help with her little brothers. I left the meals ready and she would fix the plates, beep her Father to come get his, got the boys to eat, in their PJ's and they would be ready for bed when I got home from class. In between quarters the 5 of us would do something special even if it was just turning the den into a "camping site" and snuggled while watching something they wanted. One thing that I did for the kids was keep a wall calendar with my classes marked on it and my kids would get to mark them out knowing at the end things would be better. Sort of like an advent calendar, at the end of each section they knew playtime was coming. It was not until the last quarter I worked nights in the ED I was going to work for after graduation. It was hard, looking back I still cannot believe I got through school, 22 months with no more than 3 hours of sleep a night or that in-between my first summer and fall quarters I had a neck fusion C3,4,and 5 and one carpel tunnel release at the same time. I do not think a single one of my class of students thought we were keeping up, we felt like we were just barely hanging in until the end. After each test, while waiting for the grades, we would compare answers, pace and stress and we all just KNEW we flunked. Many times after the grades were posted there were the moist eyes of happiness and a few out right cases of relief crying. We loved that last quarter of clinicals because we could write our care plans and the rational could be filled in by one word - because (I said so). Hang in there, if you truly want to be a nurse. Remember the "one" instructor in the beginning is trying to weed out those that they feel will not make it or are not serious nursing students - that same instructor later in the program will (if like my program) bend over backward to coach you to the finish line. Between each semester or quarter do something with your kids even if it is no more than sleeping in together or a family movie night with popcorn. When you have to study and they have homework y'all share the table and study together. Record those lectures for playback later and I almost forgot 3 x 5's or 4 x 6's with the major points, definitions, medications, disease processes written down for a easy study aid. If I could go to nursing school (on a bet with my Mother which I never paid up) 20 years after graduating from HS, take between 11 to 13 hours each quarter, night classes, day classes, psych clinicals out of town, while dealing with 4 kids, 4 Yorkies, 2 cats, hamsters, a spouse that was never there and a Mother that was a whole another story, major neck surgery and my Dad having a heart attack you can do this. You can do this, I know you can, just do not give up.

Especially for Latex Reactions. H1 and H2 blockers are among the primary drugs to get control of the histamine. Those with latex allergies are also advised to use them as "Pre-medication" before going out of the house.

Apply to all of them if you want to work in the ED. I was a new grad that went straight to the ED. Be willing (if possible) to work nights. You have worked in the ED before so you would not be a total newbie just a novice. Be sure to recap everything you did in the old ED, your skills might be a little rusty but point out that you feel that it will not take you long to get back in the groove. In your introduction letter express your passion for the ED. That can make you stand out. I was adamant when I applied for my ED that I had no intention of moving to another department and I never did. I do not know how ED nurses are viewed in the North but down here no one wanted to work in the ED much less on nights but that is what I was determined to do. Express your determination it might help.

I have been out of nursing since 2003 but I was a new grad that went straight to the ED, 2 weeks of orientation with one of those weeks being with my preceptor. After 2 weeks went to nights on my own and spent 9 yrs 4 months and 17 days there before a severe latex reaction/allergy knocked my legs out from under me. That said we had a lot of nurses float to the ED to see if they would like to transfer - not one stayed. One even called the nursing supervisor and asked to go home as she was beginning to panic. The best new grads were ASN/ADN, for some reason the BSN new grads always seemed to need 12 weeks or more on orientation which, at that time, was considered too long. My ED was barely controlled chaos, they had a hard time with the steady stream of patients, non stop ambulances and the residents on top of that. Survival in the ED depends on your ability to track multiple patients and not let the chaos unnerve you. The focus of the ED is different, we receive, stabilize and admit or greet 'em treat 'em and street 'em. Trying to think of the range of patients I had, GSW's, stabbings, wrecks, traumatic amputations, burns, and everything in between. You need to be able to go from cruising to mach speed instantly and you also never get the "rest of the story" on some of your patients. I applied to my local hospital right before my last quarter and wanted the ED. I worked as a "PCT" (patient care tech) until graduation. I graduated on a Friday and was working in the ED as a new grad the following Monday. Perhaps you could do something similar. When I was beginning school I was advised if I wanted the ED to go straight there as you continue your education and hone your skills differently in the different areas of the hospital. I was told the ED was unique and they were right. From pushing Methylene Blue on my first patient to starting Levophed on my last I loved everything about the ED.

Just a thought here. Perhaps the changes need to start when the women are much younger. I would go to my son's science class once a month to talk about health. When you have 5 young black girls (my son was the only white child) in the class, 13 to 14 years old on BLOOD PRESSURE medications and one young lady was a Type 2 diabetic already, perhaps the problem starts much younger. Food plays an important part in the health of our children and all schools are failing. Physical education also plays a major part as well. Why was PE, at least in some areas, removed from 1 - 9th grades? What happened to health and nutrition teaching? Why are there no programs that reinforce the idea that fresh vegetables and fruits are very important in the diet? I would send home sample menus, inexpensive but not high caloric meals, some that I used often. Why is EBT being used at gas stations that only sell snacks and fast foods and not at some local farmers markets? Why are there no farmers markets in areas easily accessible for those who must use public transportation or walk. One changes the outcomes by starting at the root and for my money the root is the crappy way children eat, the lack of teaching and the lack of available fresh foods for some. I taught nutrition to those young people, while in scrubs, after working all night but it was too important to say - let someone else do it. Think about it for a minute - 13 and 14 year old girls on blood pressure medications. What do those medications do to a developing body? I was devastated when I heard that. Some of those girls only had prepackaged foods in their homes or their mother brought home fast food for dinner because they worked all day. That is the root cause - now fix it. For those keeping score I live in the deep South, fried everything and starch country galore. I am also white and MD's treat all women in the ER with distain, white, black, hispanic or any other heritage. I worked there and was a patient in my own ER, I know how women are treated.

I loved my nursing job. When I began school my intention was to work in the ER. I achieved that goal despite so many instructors wanting me to go into VA psych. Nursing was a "second job". I was older, had been in computers but I had always been the "family nurse" for too many years to count. I knew when my kids had broken bones even when their pediatrician did not want to do an X-ray, I knew when ears were infected, wounds were questionable and so on. I knew when a man in a hardware store was having a "heart attack" years before nursing school so I finally went. I decided on day one to go into the ER. In fact I started Nursing school 20 years after high school. I loved that job every night no matter what came in or what occurred. The losses made the wins more sweet. The 13yo that looked so much like my son, discharged too soon from another hospital, whose chest we cracked but we still lost - I kept my son home that day. The 50ish brother and sister whose Mother was brought in from a nursing home at end of life, who wanted to make her a DNR and needed someone to walk them through the process. The residents were untrained in the nuances of how to talk to the family. The woman that came in who had been seen the night before at another ER (by the same Doc) complaining about chest pain. The Doc went in and told her she could NOT be having a cardiac problem and wanted her discharged but the other nurse and I had already started the Cardiac Protocol. She was having an MI. She went to the Cath lab that night and lived. The ER Doc told her the we saved her life. The little old lady that walked in with an O2 sat of 46 on room air, we got her admitted and administered levophed, she went home a few days later. The little things, the little wins became more important. I would have been there still if not for the Anaphylactic Reactions to latex. I was 40 when I started working and not quite 50 when I had to quit. I miss my job still.

Not calling report is not only dangerous but stupid (probably should not say that but it is true). Sure we wanted to get patients upstairs asap but we never just dumped a patient upstairs without report. We would not call during the last 30 minutes of shift. The floors had too much to do with shift change coming. As far as the write up I cannot begin to understand that - you found the error and corrected it. The pharmacist admitted it was her mistake. That was a good catch. Sometimes (to me) it seemed that write ups were done just to "complain". I swear there was a dart board in my Manager's office with our names on it and once a week she threw a dart to see who she was going to "counsel". I was called to my managers office because she had to give me a complement from one of the Ortho Docs. He also requested that when I was working if any patient of his needed splinting I would be assigned that job. My manager was so livid that she "counseled" for a comment I made at the desk 3 months earlier and then told me about the Doc. She got more angry when I told her that the Doc's comments were more important to me than her petty complaint. Not in those words but you get the gist. Do not let this write up get under your skin. You will never know who got on their high horse but you did right. Be proud that you caught the error. However you might want to find a new hospital where report is still called. Not giving/receiving report is a dangerous thing.

I graduated in 1993 and started working 2 days later in the area of my choice. I got 2 weeks of "orientation" with 3 other nurses. Went to the ER on days for 1 week with a preceptor that did nothing by tell me go do this and call if you have a problem. Then to nights (my desired shift) and my very first night an overdose. The other nurses ran as it was an overdose on pyridium. The ER Doc and I were left to treat this young woman. Lots of fun pushing methylene blue and watching your patient seize for a few seconds on you first night shift. The ER Docs changed nightly and the second one in the group I worked with had a burn patient. He was giving me conflicting orders so I quietly told him to "make up your damn mind" and he stopped, looked at me (2 weeks into my job) and said OK take care of this. I did and figured the flow rate for fluids before he gave them to me, when his and my flow rates were 1 point off he nodded his head and said OK. A week later, same doc, patient brought in after falling through his shower door, sitting up on stretcher with no neck protection. Called X ray and got stat pictures done. He put the films up on the view box and asked 2 of us what was wrong with the picture? I was already running to the supply room for a C-collar. Yep I could see the hangman fracture! The Docs called us the A-team. I was the de-facto leader. Night supervisors would tell others to call me if they are unavailable. One never even came to check on us unless he was absolutely needed. His response "I don't know why are you calling me - get (me) to take care of it. I was an ASN. I was a "second career" nurse. I was a bit older than the others. I was the only one of the 4 that lasted. I watched as BSNs, after 12 weeks of orientation would break down crying because they did not know what to do with a patient, called in as an "unresponsive" could be hear from the elevator screaming "I CAN BREATHE". I was sent to be our representative for one of the first "chest pain clinic" meetings, I was sent for WMD treatment training, and I was sent for burn training. I loved my job but exactly 9 years, 4 months and 17 days later I had a massive Latex Reaction that cost me my career. My hospital tried to say it was not that bad but I was put on disability despite their objections. As I said I loved my job, my pay was good, my shift was perfect and when I asked for time off it was granted. Doctors wanted me called in when not working, I was called for certain types of patients but that all ended with a severe latex allergy that was to airborne latex from the beginning . I do not understand the apparent distain for nursing that so many nurses have. And the "looking down" at those of us that did not get a BSN. The best nurses I worked with were diploma nurses that "eventually got around" to going back to school. Nurses eating their young has always been a problem but it seems worse now.

I was working nights in an ER during that time (93/03). We did paper charting, pyxis for meds, phone orders from physicians and the other usual things. I was sent to Atlanta for the first Chest Pain clinic, I was selected to do WMD training, was sent for burn training and helped to set up pathways for certain presentations by patients. All the Docs on nights loved to see our shift come through the door, one doc called us the A-Team. I never noticed any disrespect from the Docs that worked the ER and only had 2 Doctors and 1 Resident give me trouble. I could put a chart down in front of the Doc and "tell" him, "I am starting/doing 'x, y, z'" and he would just sign off. If the patient was going to need narcotics I would let them know so they could come on in the room. We also saved a couple of Doctors butts by catching their mistakes. One was a 67 yo female 2 days with chest pain- Doc said women cannot have MI's, one was a burn patient I started a 22 across the arch of her foot while the Anesthesiologist could not get a line, and the resident's screw up involved snake antivenin. And on NYE '99 everyone in the ER was huddled around the computer wondering if it was going to die or explode, I was just laughing my you-know-what off. I worked in computers before nursing.

My son told me about this and so I began looking and reading about the idea. They have this already established in Kentucky. I read through that entire program. Quite convoluted, begins in the 9th grade and the outline goes through "Grade 15"? They spend 1/2 day in regular state required courses and then move to 1 of 3 pathways. Depending on how the student chooses they can get a CNA by graduation from 12th and have some of the basics for an ADN. They then continue during Grade 13 and 14 which qualifies them for the ADN and then they need 120 hours to get the BSN. The program is running into problems with 16 and 17 year olds doing clinicals or working in a lab. No kidding, most hospitals require you to be 18 before working like that. Also the high school students there are at the bottom of the reading, writing and math required for the ACT. The program insists that this will benefit Kentucky, seems there is a tremendous nursing shortage in the state and regular (real) nursing school are not turning out enough new grads. The program requires input from a standard nursing school and the school assists in approving the students going into the program. The University with the nursing program provides teachers or train a school teacher how to teach these students. They have a pathway for "at risk" students as well. I do not know about anyone else but if I am in the hospital and my nurse comes in with a 16 or 17 yo in tow and asks if the student can start an IV, replace a foley or what ever I would be saying Hell no. https://www.sreb.org/sites/main/files/file-attachments/17v12_beginning_the_bsn_nursing_pathway_report.pdf

Worst days - too many to count, young boy died despite cracking his chest to try to stop the bleeding from his heart. Walking new residents and the family of their patient through a DNR and then the death that followed. The Pyridium overdose, my first OD on my first night as a new grad and dealing with the kids that forced her to take the meds. The young woman who shot herself in the head, the teenage boy that set himself on fire to "prove" he love for a girl, the just married (2 hours before) 97% burn patient(family demanded total care), the old man that lived alone and drove himself to the hospital while having a heart attack. Best day - catching a "silent heart attack" the ER physician had seen 2 days in a row and did not recognize.

The first thought that popped into my head was the Willie King mess from 1995 or 1996. The surgeon amputated the wrong foot. Shortly after that happened patients began to write things like "not this leg/foot/arm" and also "this leg/foot/arm" on themselves before surgery in marker. I even put a star on the side with the kidney that needed a stent before going in. And Yes Residents do need more supervision, I had one accept a patient from a small rural hospital that was a snake bite victim. The Resident did not ask or receive any information as to treatment there, condition of patient, just that he was bitten by a rattler. He did not even contact his Attending or the House Supervisor. It was a mess and on top of that the two Residents were arguing over who would intubate while I was calling sats out like a countdown, 90, 88, 86, 84, 82, 80, 78, at which point our ER physician took over. The Resident argued with all of us in the ER that night. I do not know what would have happened had the patient suffered permanent injuries or death, glad it came out well as my name was the one on the line for all the antivenin we had to call in. Sometimes staff is doing everything they can and are not responsible for the ultimate foul up. Oh yes the Resident was let go from the program very shortly thereafter.

We always had off duty Police or Sheriffs working nights in the ER with us for things just like this. They often observed the treatment and responded without us having to call, if they were in another part of the ER they were paged over head to come immediately. There was no time delay. They were there and took care of the offender often long before the Nursing Supervisor got to the ER. Perhaps your facility could do the same. If fact all the ER's in my city have security in this form working especially on nights. I am glad you were not badly hurt and reported this to the Nursing Supervisor, your Dept Manager and the police.

I worked in the ER for just over 9 years and I cannot tell you how many times I could feel what my patients felt. I felt the fears, hopes and desperation of so many I lost count in the first year. I could "feel" the frustrations of my fellow nurses and knew when they needed to de-stress. When I would leave work after an uneventful night I would just sit for several minutes, then throw on some music and head home but after a bad night I would get the others to gather and let them vent about the night. I talked them through the events until they felt relaxed and then we would head home. I would hold those tears until I was alone, allowing myself to feel all the emotions that I absorbed all night, analyzing each one and putting it into a little cubby hole until I was once again on an even keel. Being an empath is tough and can be a help or hinderance depending on the setting. Feeling what your patient feels and their family/friends feel can be overwhelming but it can also help when the problem is emotional at its core. Overdoses that are doing it for attention, for example. When you walk into that room and feel the smugness of the patient and the desperation of the parent you have more ability to know how to treat that patient. Or how to tell a family that their daughter succeeded with the gunshot to the head and be prepared for the families emotional needs. I finally faced the fact that I was an empath while in nursing school and had to do my psych at a VA unit with veterans suffering from PTSD. I was warned that they would not talk to me because they would not talk to the Doctor. Funny. By the time I was finished with psych every instructor in the school was pressing me to go into psych nursing and I said NO. From the beginning I intended to go into the ER where the "feelings" would be easier to deal with as so many of the patients were quick turn arounds and the more serious patients I would have more time with but only for one night. Being an empath means you "feel" the other persons feelings and in a few cases their pain. Being an empath means you have to have a balanced attitude and a good control of your own emotions. Being an empath can be difficult but having a child that is an empath is just a pain in general. I talked my oldest son out to going into nursing, one of the reasons I did was because he is an empath too. He has not yet had the experience of not only feeling the other persons emotional pain but their physical pain and I hope he never does. Of course it gets interesting when either one of us is in a bad mood as it always ends with both of us upset or doing silly things to try and dispel the others bad mood.