dan_dfc

Wow "Wooh", you sure can jump to some absurd conclusions and hurl needless insults can't you! Feel better after getting that off your chest? Actually, I have no problems with my ego, I assure you it is fantastic. Allow me to paint you a picture. Let's say you arrive for your shift to receive report and the nurse before you has 2 of her 4 patients who have been in the ER for 2-3 hours and not only has she not assessed them, she doesn't know their chief complaint. Is that safe? How about if you receive report on a patient sent from the doctors office for a hemoglobin of 4.0 with active rectal bleeding, and that patient has not been type and crossed, or had an IV started, or had O2 or vital signs taken in the last 4 hours. Safe? Or maybe, you receive a patient who is being held in the ER for an ICU bed and has had no vital signs documented in the past 8 hours? Sound good? Oh yes, all of these things happened, and yes I cleaned them all up with minimal drama in front of the patient. I even turned off the nitro drip on the patient with a pressure of 70/30 without making them "super-needy" I tried to offer some constructive criticism to this nurse in a polite, proffesional manner. didn't work. Then I spoke to the charge nurse and nurse manager. . .no effect. Now, let me ask you this, would you want to give report in front of the patient if you had no idea what was going on with them? I'm simply hoping that bedside report will introduce this individual to some aspect of accountability. I'd rather spend my entire shift caring for a "super-needy" patient than spend 1 hour doing post-mortem care on a patient I found dead after a report that consisted of "There's a patient in room 2, they're here for a nosebleed or something, I think" But maybe that's just my ego talking, I dunno?:icon_roll

We are going to this in our ER, personally I love the idea. No need to round on your patients AFTER you get report, you've already seen everyone and you can get right to work doing what needs to be done! Also, I'm hoping it will solve another problem. There are a couple of nurses on the shift before me who consistently have no idea what is going on with the patients, I've tried gently several different ways to bring them around with no effect, I don't know if they just don't care or are really that ignorant. I can't WAIT to see what happens when they can't answer my most basic questions IN FRONT OF THE PATIENT!

FYI, the most recent nurse that retired on my unit (last week) is 82 years old..., and that was in the Emergency room. She graduated nursing school, taught by catholic nuns 20 years BEFORE I was born!!! I say GO FOR IT! you're only as old as you think you are!

1) going with B on this one. C and D are either both right or both wrong since they say the exact same thing. 2) D. AB&C are false 3) D 4) C 5) B

OUch! that was actually painful to my ears. . .I had to mute it about 20 seconds in and just read the lyrics, they were funny though!

I would definately ask about any preceptor/mentor/residency program that they have to help you transition from school to work. As a new grad you're probably not ready to jump straight into a full assignment in the ED without shadowing someone for a couple of months at least. GOOD LUCK to you! Hope you get the spot and enjoy working the ED as much as I have.

I'm all confused now. Was the original post asking for advice to help reduce the rivalry and animosity between ER and ICU or did it say "I'm bored, I'd sure like to see a shameless ******* contest with lots of petty bickering between ER and ICU nurses"?:argue: I've been in ER for three years and started there right out of school, we had a lot of these same problems when I first started, but they have slowly gotten better. In my opinion, it all starts with you, someone has to take the first step. Forget about you past issues and start tommorow fresh. Acknowledge that the ICU nurses job is every bit as difficult as yours, although entirely different. Go an extra mile to help out the nurse who is going to be receiving your patient without killing yourself in the process, little things count! If your putting in a foley and know your patient is going to the unit, grab one with a urine meter so they can accurately measure output, go ahead and start a second IV even if they don't need it right this minute. If they're goin to ICU they probably will need it before the shift is over. If the patients pressure is 95/40 with a heart rate of 115 and septic ask your doc to write a prn order for a pressor so the ICU doesn't have to wake up the primary doc two hours later when their pressure bottoms out. I won't hold a pt in the ER for two hours after getting a room assignment as some nurses ask of me, but I do acknowledge that the ICU nurse is probably every bit as busy as I am, and have no problem giving them 10 or 15minutes to pee, prep their room, or whatever. It's going to take me a few minutes to bundle the patient up for transport anyway! Treat your patients and coworkers with dignity and respect regardless of whether or not they return it. Lead by example and encourage others to do the same. Over time those mean ol ICU nurses will realize that you are competent, caring, and playing on the same TEAM! Granted-some people are never going to change, they are bitter for reasons of their own, they work in every department in the hospital, smile at them, kill them with kindness and move on about your business. Three years ago bitterness between our departments was a given, just accepted and dealt with. Now many of us in the ER and ICU are friends and occaisionally go out for drinks after our shifts, there we laugh and joke together about the cranky, anal ICU nurse who has a gripe about everything we do in the ER, as well as the Idiot ER nurse who transported a pt with bilateral PE in a wheelchair on a nasal canula. Anyway, that's my 2cents, :twocents:it aint' worth much but I figured I'd throw it out there anyway.

Quick electrolyte question, would fluid replacement with NS in a slightly dehydrated pt lower pt potassium level?

What is the routine in your ER for checking BP on infants and toddlers. I'm a pretty new nurse, 1 year out of school and at our ER BP is RARELY checked on infants and toddlers, routine vitals would usually be pulse, respirations, pulse ox, temp, and appropriate pain scale. (this is assuming the pt is alert, pink, cap refill I'd love to hear from some of you guys on what your guidlines are, espescially those of you in pedi ER's.

Last night was probably the worst of my short career, I have been an RN in the ED for almost two years, We had an 18 month old come to the ED who was lethargic and had a high fever and vomiting and began having seizures shortly after arrival. The child apparently aspirated and had to be intubated as well as developing a pneuomothorax and requiring a chest tube placement, there were complications and the child had to be extubated and re-intubated, we almost lost him in the process. To make matters worse the pt is the son of an officer who is a great friend to most of us in the ED and also is the spitting image of my own 18 month old son. we flew the pt to the nearest metro hospial and got word towards the end of the shift that he is in MODS and isn't expected to survive. Looks like meningitis. I don't know how, but I managed to hold it together till end of shift but am falling apart now. I am not a religious man, but tonight I said my first prayer in nearly 15 years. Kudos to all you pedi icu/er/oncology nurses, how do you guys do this?