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Jen2

Jen2

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  1. Jen2

    Stupidest reason to go to ER

    I never get sick of hearing these no matter how many old threads there are on this board. I want to share in the stupidity that I like to call, JOB SECURITY! "Walking outside and saw a bat fly by. I want a rabies shot." "I was visiting my neighbor upstairs. The nurse took my blood pressure and it was 132/80." My reply: How do you feel? Patient: Fine I just thought that was a little high. "I have an appointment for an MRI." "I was having sex with my boyfriend and I got really hot and could feel my heart beating all through my body, and I had These like jerky movements, do you think it was a seizure?" This is my favorite. Consider yourself lucky honey, you just had an orgasm.
  2. Jen2

    transferring pts. from ED to floor

    The above would never happen in my ER. The second we get a bed, we have to call report no matter what time it is. I do not know one charge nurse in my department that would let any staff nurse wait until shift change to call report just to "hold on to the patient". There are times that If I am in another room working a code and I get a bed on one of my stable patients, my charge nurse or another nurse will call report if I am unable to do so. However, "holding on to a patient", in the ER just does not happen. Especially when the waiting room and hallway is full and there are ambulances comming in and three helicoptors are scheduled to do hot off loads with in the next 15 minutes. When we get a bed from our H.S. we call report upstairs. If that nurse is unable to take report we ask to give it to the charge nurse. Once we call report we take the patient up in 15 minutes. There have been many times when we have gotten a bed at 17:00. Call to give report and "the bed is dirty". Somehow the bed would not be cleaned until 19:00. Not my fault it took house keeping two hours to clean a room. We started monitoring this by sending up the nursing assistants to see if the room was actually dirty. We found that 8 times out of ten the room was clean. We initaiated a stat housekeeping policy in my facility that if the housekeeper on that floor was busy we could send another team to go and clean the room. Also discharges are a floor nurses last priority. If a patient is not discharged until 18:00 and the room is cleaned by 18:30, guess what time report will be called? It is always a no win situation. As an ER nurse you are the red headed step child of the hospital. You try to do the best you can with what you got. I have never had someone be happy to hear from me. However, on the opposite end we have a very good relationship with our EMS and flight teams and depend on and respect them to give us information to plan care for the patient. I couldn't imagine having EMS or flight standing in the next room with a patient and tell them, "I am too busy doing this dressing change to check in that patient right now". Also cannot tell the helicoptor to circle around a few more times until I finish eating my lunch. I don't know what the answer is. We just have to try a respect each other and understand. Even though it's so hard sometimes.
  3. Jen2

    Just thanks, ER nurses.

    First I would like to say that I am so glad that friends hubby will be fine. I am glad to hear of a positive experience in the ER. We are mostly chastized for being cynical, and uncarring a lot of the times becasue of the way we feel about people using the ER as a PCP and so forth. However, when it is someone critical that is in need of the ER the experience is mostly positive. We rarely get to hear about positive experiences and least often an outcome of the patients that we work so hard on the save their life. I just called the ICU last week to ask about a patient that I worked on for 2 hours in the ER and was told that they were not allowed to tell me becasue of HIPPA! Anyway thanks so much for posting.
  4. Jen2

    In ER for final preceptorship

    You got some excellent advice already. I will add a few. 1. Believe it or not and dare I say, (sshh! don't tell anyone). Every once in a while there will be down time in the ED. Ususally between 3:00am-8:00am depending on what time you are orienting. This is the time the nurses will be "venting". You will be introduced to a sick twisted sense of humor and will probably cringe. It's O.K. the nurses are only mildly psychotic. 2. During the occasional down time ask questions, stock rooms (the only way to find out where anything is in the ED in my opinion), discuss cases, ask your preceptor to quiz you. 3. When things get crazy, don't expect your preceptor to stop and explain everything to you. I myself will tell students, "Put your running shoes on and stay close behind me, I'll explain later.) Make sure you take mental notes and then ask questions when things start to settle down. 4. Being in triage is a great experience. This is one aspect of nursing that even many nurses don't understand. Unless you are an ED nurse and regularly do triage you cannot fully understand ER nursing. Even our critical care float people that are awesome nurses and great resources have no clue what goes on out there. This is probably the most important role in the ED. This is where you learn to assess a patient by how they look. Too many new nurses are going to the ICU's etc. and being taught to read monitors and calculate numbers. A good triage nurse will watch a patient get out of the car and call the charge nurse to find out where they can put the patient before they even make it to the desk to sign in. When I tell people what I do they are like, "Oh my you get those patietns right off the Helicoptor how exciting." I always say that it's not the ones in the helicoptor that worry me. It's the ones that drive themself to the ED. 5. You will use a little of everything you learned in nursing school. Be prepared to remember your Psych rotation and keep yourself safe. Just because someones chart says that they are there for "abdominal pain" does not mean that they are not psych. Always look for signs of agitation/escalating behavior. It only takes once to be cornered in a room with the door shut to never let your gard down again. 6. Finally you are in a very good place before you take state boards. I exterened in the ED before my boards, and found myself pulling from the experience the whole time I was taking that test. Have fun and enjoy. Post about your experience.
  5. Jen2

    Med Ed seminars

    Thanks everyone. Finished the seminar today and enjoyed it. I want to try and take the test asap though, just found out they are changing it July 1st.
  6. Jen2

    What do you love about ER nursing?

    The unexpected, the organized chaos, the teamwork/support that is unlike anything that I have ever experienced, taking care of the entire lifespan instead of just one particular age group, knowing what is wrong with a patient without all the bells and whistles hooked up and before a single test comes back. Wow thats a run on sentance. I could keep going on, but those are my favorite things. I would say not having take care of the same patient for longer than a few hours, but times are a changin in the ED world with all the borders. Oh, and I love the adreneline rush of hooking a chest pain patient up, seeing the STEMI and rushing off to the cath lab. I also love having the freedom of working up patients before they are even seen by a doc. I think thats it for now.
  7. Jen2

    Capnography

    We use it for every intubated patient. We are a level 1 trauma center. It is the trauma surgeons that request it.
  8. Jen2

    Eye care on ED intubated patients

    During the "Golden Hour" so to speak, I will take a quick second Before going to scan and tape the eyes shut before I start pulling at monitors and tubes. Once the trauma resuscitaion is complete and before family comes in I will take the tape off.
  9. Jen2

    Med Ed seminars

    Anyone ever take any of the Med Ed seminars? I am taking the CEN one. They boast a 98% pass rate on the CEN and money back if the exam is taken and failed within 90 days. I took a CEN exam prep course last year that was given through a local hospital and was too chicken to take the exam afterwards, because I didn't feel that it prepared me. I am hoping to feel prepared to take it this time.
  10. Jen2

    Art lines in the ED

    Level 1 Trauma center 35,000-45,00 patients a year. We do A-lines and central lines on a daily basis.
  11. I cannot take care of anything and actually said that in my earlier post. Not being arrogant and actually said that ER nurses are not ICU nurses, but they do critical care nursing to an extent. Also said that I was not an ICU nurse, never said that I wanted to be called one. We were given a 2 day advanced hemodynamic monitoring class which included IABP, and had to spend one day in the CCU with an experienced ICU nurse taking care of a patient with IABP. This does not mean that I am proficient in anyway and was on the phone with the CCU charge nurse during the patients care, as well as my charge nurse who was a former CCU nurse of 10 years. All I stated was that I took care of a patient in the ED with a IABP. I am glad that anesthesia is looking for nurses who deal with critical care daily. They should be! I personally have no desire to go to anesthesia school, but two nurses I work with, 1 ED and 1 flight nurse did get accepted without ICU experience. Nope, probably couldn't take care of a whipple. Have never had to before. Besides an ER nurse has no clue how to keep a patient alive especially long enough to get them to the OR or ICU.
  12. Unit bed was available at time of acceptance. We are the only level 1 trauma center in the state. This particular patient had to be packed up and transported to us which took quite some time. During transport to our facility there was two codes on the floor that took the last two unit beds. Patient had to be boarded in the ED until things could get shuffled around upstairs. Nahna nanana!
  13. Nope! We have still had to take them from other hospitals that were transferred to us when no unit bed was available. CTU doc comes to the ED and sees the patient, writes the orders and we wait until a bed is ready before we take them upstairs.
  14. Actually, I do know of CRNA schools that except ER nursing as long as that ER is in a level 1 trauma center. I am a ER nurse and a critical care nurse, however, I do not work in the ICU and do not want to or thats where I'd be. I have taken care of patients with balloon pumps, LVADS, etc. I do not believe, I could just go to the ICU and take on a fresh heart. I also do not believe that just any ICU nurse could do it either. I highly doubt that the ICU nurses would be able to take care of half the heart babies etc, that we see either. I believe that every facility is different. I worked in one facility that if a patient had in a chest tube they were automatically in the ICU. In the facility I work in now, there are patients with chest tubes hanging them off their IV poles and ambulating in the hall. About the comment about the patient being too unstable to be in the ER. Thats pretty funny. However, I will say this: ER docs are just that. An ER doc is not an ICU doc the same as an ER nurse is not an ICU nurse. So, yes we have had docs wanting to get a patient upstairs ASAP because of their condition. We do have parameters however, before we can send a patient upstairs. Systolic BP must be above 70 for instance. We cannot, and will not transfer a patient that is too unstable for transport. It may be nice to have a doc in the ER however, they are not the ones running between all 30 beds in my ED. It is the nurses. I have had 4 and 5 vented/critical patients at the same time, and oddly enough when we are boarding this many ICU patients in the ED, there is a bad accident and the traumas start comming in. That ER doc is with those traumas. He could care less about the other "hold ICU" patients. They are no longer under his service. I am the one hanging/titrating gtts until I have a bed ready. I once asked an ED doc to write me an order for propofol for a vented patient and was looked at like I had 3 heads. Our patients have A-lines, we monitor end tidal CO2 etc. Am I a critical care nurse Yes! ICU nurse however NO!
  15. Jen2

    searching for ER myths!!

    If a room is empty, shut off the light. Never say the Q word (We all know that one is not a myth) Hanging a pressor at bedside for a hypotensive patient, epi drip for analphylactic patient, etc. wards off the evil spirits. The first time you don't jump on the frequent flyer and do the cardiac protocal within 10 minutes of hitting the door will be the time that they have their MI for real this time. There is one room that we leave empty until we absolutley must fill it. It seems as if almost every time we put a patient in it something bad happens. Thats all I can think of for now.
  16. Jen2

    Hey ER, what takes so long???

    I agree with the systems failure part. There is only so much a nurse can do as far as workup. Yes I can order and draw labs/cultures etc., However when the white count comes back to be 18,000, I need an MD to write an order for that antibiotic. Even with the high white count and first round of antibiotics started by the ED, that does not gaurantee that the surgeons will get there any sooner. Basic wound care can be done by a first semester nursing student. The problem is and it is hospital policy that if the surgery has been less than 30 days. The sugery team that performed the surgery must evaluate the patient. Nine times out of ten the patient has already called the surgeons office and was told to go to the ER, becasue they have no appointments available for the day. Once the patient gets to the ER, the surgeon will not come and see the patient until all testing from an ED standpoint is done, and they are done doing their rounds, scheduled surgeries etc. I wish we had the luxury of an assessment bed, but that is not the case. We cannot turn a patient away and say, "It sounds like a problem of the surgeons, sorry but we will not be able to see you today." There is a thing called the EMTALA law.
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