chicagobsn

CC: "hemragging to death" Pt comes into Triage with her sidekick stating "Im hamragging to death and need help now!" me: youre bleeding? pt: "Yes, from my area, theres many clogs and clauses flowing like a sea down there!" Me: Are you on your period? How long has this been going on? pt: Yeah mam I have my menspration and I cant keep up with the clogs and clauses! Me:So you have your period and there are a lot of clots? Her sidekick interrupts and states, I saw it all in the bowl! TONS of clauses in there! Shes dying! I never did find out what clauses were..thank god they didnt bring in a specimen!!!

TraumaNurseRN~ Wow, what a lesson...I will definetly remember that! Thanks for sharing that. I had a pt in Triage the other day, older lady in her 60s, presented with "not feeling well x 1 week" If u can believe it, no medical hx except for RH. So I listened to her lungs, heard fine crackles at the bases, stable vital signs...no cough, no fever, no sob, nothing. She just didnt "look right" to me...and I took a look at her feet, saw edema of bilat feet, and brought her back right away, where my charge was not all that happy...but neverless doc assessed her, breathing tx etc etc ordered, cxr came back, labs came back everything was high, abnormal EKG and...new dx of chf. Never know what ure going to find in Triage. You know what not that this makes any difference at all, but she was THE nicest lady I ever had the pleasure meeting and taking care of. She kept telling me not to fuss over her that she wasnt sick.

Oh-I forgot to add, it was new years day, and 2 ppl called in sick, one nurse and one tech.

I was venting earlier needing to get out some frustration, but I do want to comment on this: "Sorry Hon, These days it's all about patient satisfaction. There is NO excuse for a pt. being kept waiting that long for a pain med---CODE or NO CODE!! Are you saying that 100% of your staff was involved in the code situation???????????? When we have a code, there is ALWAYS one RN who will kind of look after the other pt's. After all, who knows, you could even have a second code---who would take care of that pt?? No, I really think that someone should have helped that patient. The patient could have been more understanding, but so could the staff." We are a small hospital, with 20 beds, got hit with about 50 pts in the WR, all types of screaming suicidal psych pts one who was very aggressive, 2 real CPs, took in 2 SOBs and 4 ambulance showed up within a minute of eachother, then the code happened. We had pts in the hallways, chairs, taking chairs outta rooms and making them a pt chair to be seen. The pts ear pain xs 2 weeks can wait. period. Did she get pain meds? nope. it was ear irrigation and discharge. 3 hrs for an ear irrigation, under those circumstances, I think the pt was lucky to have gotten our ENT room, and not sitting in one of the many chairs we had all over our hallways. Was every nurse on staff in the code????? get real. no, there are other pts with actual issues going on that needed to be addressed immediately by the other nurses that were working their a$$es off. For any pt to become verbally or physically abusive to staff is intolerable in my book...pain or no pain. We were all taught manners, why should having pain make some ppl forget those manners?

There has been quite a few times where pts complain over the waiting period due to a code. There was a pt just the other day who had been out in the WR for 3 hrs due to a code-and when I went out to call the pt back, the pt gave me such an attitude, stating "what in the h#ll took you so long! Dont you know I AM IN PAIN!" Pt c/o of ear pain times 2 weeks. As I explained to the pt, sorry it took so long, but we were in code situation, the pt interrupted me stating, "I dont care, What about my pain! My ear hurts!" The pt then had the nerve to demand a nursing supervisor to then tell her how rude I was to her, and how long she had to wait! And how she was "going to do something about this!" And how we didnt care about her pain! Pts complain all the time about the waiting period, but seriously? We all know they can hear the code blue emergency room call. What is that about! How absolutely mind blowing someone would even THINK ear pain TRUMPS a CODE! Then our VP came in just the other day, stating how our customer service scores were low, blah blah blah. Insane. There are so many clinics around, urgent cares, yet for some reason the ED is a clinic, and is getting customer service scores! Press Ganey, who thought of that anyway? Anyone else get complaints like that?

Pt wanted a vag exam, because of "foul order". Uopn examination, found a intact 3 week old condom lodged way up there. When the doc pulled it out, she stated "thats it ...thats the odor!" Yup when asked the pt about this, pt stated "we knew we lost it, but never thought to look for it". :smackingf

I had a pt come in tonight with, "big toe pain" and in TRIAGE stated, "how long til I get back there, Im HUNGRY!" I informed the pt that you will not be allowed anything to eat until you are medically cleared to do so by the doctor. A few long hours later after coming out of the box, Im rushing to a code and the same pt tried to stop me and tell me hey you..Im still hungry can I get some food now!! I looked at the pt and said go back to your room, we dont do that here. It gets worse, so after the code, I checked on my other pts, and there the pt was "starving to death" and upset because pt was being discharged with the dx of "big toe pain" Yup, discharged pt without slapping the feed bag on first. Ahh-gotta love them horrible customer service scores.

Pt came in with bs of 22. The scary one shouts out, amp of Dextrose IV..ok as Im about to push it, he starts yelling what are u doin? put it in the bag. Uh-you want me to spike the bag with the amp? he says yes and give the pt orange juice with 2 sugars in it. Uh-pt is unresponsive. As he walked away on his high horse, better believe that pt got 2 amps of D50 IVP. He also likes to order "4 units of InsulinR IM" on bs higher than 400. And he actually gets mad when I question the order. Gotta love the PO orders when the pt has NG to suction The list goes on and on with that one. needless to say, hes SCAAAARRRYYYY

I worked in OR for 4 yrs. I am now working in ER. I dont think its what part of nursing you are coming from..but how willing you are to adapt to the ER way. I think OR helped me a lot. Im certified in ACLS, PALS, and conscious sedation and intubation is nothing new for me. I also think I am able to adapt a little easier, as we have our own standing orders where u have to act fast...start ivs, give drugs upon ure assessment etc etc. I didnt have that thinking of needing an md order before u act fast and appropriately, which I think helped me get into the groove of things in the ER. Good luck!

RN in SC~ I would tell your boss if you feel comfortable. Where I work, (we have 4 pregnant nurses right now...I DONT drink the water there! I have enough kiddies at home) our pregnant nurses dont get our rowdy psych pts who are known to be aggressive or the aggressive drunks. They do work the rooms until their about 6-7 months pregnant then they usually go into triage and help the other nurses when they can. I warn them when theres really aggressive pts. We have certain rooms for them, so usually the pregnant nurses dont get those rooms. We also have many pts who require xray at bedside..just make sure u have lead close to you or where its handy. We dont have many walls..we have more curtains to separate the rooms where I work. I worked surgery with both my kids...worked up till I was 9 months..both are healthy as can be. Just be safe. And let your boss know that your pregnant...not quitting. I wish you the best pregnancy ever and an easy labor!! Congrats!

I forgort about this thread...well heres an update. I quit that place I was working in, in April and got a job in the ER (lovin it there!). I wrote a lengthy letter to the BON here and submitted it. To my understanding ..this place is under investigation! thanks for the support! I needed it! Magnolia-pls take the advice u are recieving, here in Illinois an LPN can not push IV medication of any type. I had to go through a ton of training to do CS as well as ACLS and the certification course to become a CSN. I ran from the place I was at ...at top speed. I think you need to find out if the state ure in allows you to do IVPs and if your allowed to sedate. The whole issue on sedating is your placing them under and you never know what reaction the pt will have ...ie a little goes a long way on some pts and others you will have to give a lot more just to get them to relax. If your not careful (even if you are)you can put them under..then whos going to intubate that pt?? Be careful...its a slippery-slope.

klcrn~ What a terrible thing for someone to say to you! That was so inappropriate of that nurse! Your obviously very experienced and very knowledgeble! 21 years! omg! Ive been in the ER for 3 months now. I came from surgery (did almost 4 yrs there)...and everyday I say to myself..omg. What has helped me, is when I get a pt with something Im not to sure about whats going on I ask many many questions to the other nurses and the docs. Then when I go home, I look it up, and try to get that..ohhhh..thats what that is, or why we did that factor going. That seems to help me a lot, because Im ready the next time I get that type of pt. I google, look in my nursing books, acls book etc etc until I understand the rationale behind it all. I also carry a pocket calculator and a drug book on me, there are sooo many meds Im not familiar with. I also have my standing orders cheat sheet in my pocket, like what to do when u get this pt. That will help in starting things off, like do they need an IV, labs, neb tx, asa, ekg, monitor stuff like that b4 the docs see em. Im at a small hospital as well, and we have 2 docs that dont seem to know what their doing, or what to order. One doc only orders a cardiac panel on every pt that comes in. (our policy is cardiac panel includes all cardiac enzymes, ekg, pcxr, monitor, pulse ox, bp both arms, and our cp protocol sheet) yeah he orders it even on our gyne pts. Go figure. You are soooo right, there is sooo much to learn! I learn at least one new thing a day! Hang in there, and take advantage of opportunities that come in. If you havent done something or seen something, ask if you can help! Not only will that nurse appreciate your offer of helping her, but its a chance to learn something new. I ask a lot. Sometimes the ER makes me feel like I dont know anything at all. Sometimes I feel like I know a little more than what I did yesterday. I'm not comfortable, in fact I get nervous and worried about what do to and how to do it and how fast to move. I guess all that takes time. I try to absorb everything like a sponge, take it in and remember what we did and why we did it. We're in the same boat, if you ever need to vent or chat again..do it, I'll listen!

We dont admit our drunk pts. We put them on one of the hallway beds and draw labs then let em sleep. Some docs will let their BACs drop down to 100 then they can go...but that might take 12 hours! Mind you these ppl are alcoholics, and a bac of 100 is sober to them. Their stay with us depends on their behavior. If their screamin and yellin about going AMA and swearin at us about food and deficating in their pants/peeing in the hallways..AND theres a sober driver....then its time for them to go! We have quite a few regulars who come via ems and wake up in the ER very angry ...swearing wheres my beer and cigarettes. I have yet heard one of them say I want help.

I just came off of orientation in the ER. Although I am not a new grad...I am new to the ER! I was lucky enough to get 3 months...what we did for my last month, was a 4 hour shift with a preceptor and the next four hours taking on the full load as staff. Its scary to be out there by yourself. But if you have a great team, you will never truely be alone. I ask questions all the time. I ask for help when I need it and help others when I can. If you need more time...ask for it! I dont think anyone will think less of you if you want more time. I think it helped me a lot with dividing my shifts with half preceptor- half staff. I am more confident now than even a few weeks ago, but still feel like I have so much more to learn!!

I feel your pain! This is something you will never forget, and you will get over it, and you will be that much more cautious with your meds. When I graduated school, I was working on Tele, and Nitro patch was ordered at 6. Well, 6pm came and I took it out of the pixis and placed it on the pt. About an hour later, the pts blood pressure dropped, not low...but low enough for me to go in and check on her. Well...I assessed her, she was ok, called the doc, said take the nitro patch off. I went into room, took it off...and saw the other patch on! I thought omg, then I looked at the MAR...it was ordered for 0600, NOT 1800! I made out an incident report, cried for days, came back to work and asked for that pt, just so I could watch her like a hawk. Nothin happened to the pt. But I changed forever that day. We all get busy, we all get the million orders at once, crisis happens around us, we get stressed. But learn to take a deep breath, slow it down and recheck those meds, then recheck them again. Then at the bedside check them again. No matter whats going on at work, no one is responsible for your license but you. So slow down, recheck those meds, check the pt, and take your time. Dont let anyone rush you. I dont care whats goin on, even if its tylenol, I do all my checks..and allergy checks before I give anything. (including a quick yet thorough assessemnt even on those that are in the ER for a hang nail) ya never know what your gonna miss...or find! Sometimes lessons are learned the hard way. The pt was fine, you will be too. your a good nurse, learn from this and move forward. I will bet you'll never do that again! I know I wont!