WonderRN

Thank you to everyone who responded. I took this to Leadership, expressed my concerns and they agreed we should not be staffing LPNs in triage/comms.

I work in a very busy ED with high EMS volume that is a stroke, stemi and trauma center. We are trialing LPNs in the ED but nobody has been able to define their role for me. They are utilizing LPNs in triage, and having them be the primary point person to answer and triage EMS calls. We have both high volume and high acuity patients that arrive via EMS and this is concerning to me. I thought this was outside of their scope of practice? Curious if anyone had any more insight into this? Are you currently using LPNs in your emergency department and in what capacity?

I am creating an escape room experience for trauma education and I was wondering if anyone has done this before and has any suggestions for successful puzzles. I have several puzzles already that generate a number or alpha code which will be used as a combo for a lock. For example, I have a photo of a trauma room and want them to pick the 4 things that are missing from the room. There will be a word bank of options. They will pick the correct items and put them in alphabetical order; the first letter of each word will be the combo for the lock. Like if the four things that were missing were Airway Cart, Monitor, Suction, Crash cart- the code for the lock would be ACMS. This lock will open a cart or lockbox which will have the next clue. I am using this same kind of thing a few times, at least once with an number code. My issue is that I don't want spend a lot of time on intricate puzzles that have no bearing on the actual scenario or contribute to the learning itself. Decoding ciphers etc may be too time consuming. Any suggestions are appreciated! Thanks!

I would encourage you to keep your head up and work hard. Learn on the job. Look up stuff you don't know. Find a mentor and ask questions. Look stuff up in detail when you get home. Review patho of certain disease processes that you weren't fully comfortable with that day. The fact that you desire to immerse yourself in knowledge and get up to speed shows that you can make it. Perhaps you expect too much of yourself too soon- I did. it was almost my downfall.

1) This is not an ICU forum 2) What is your contribution to the OP's question?

You should jump on in. You'll never know if you're ready until you do it! Skills come with practice and experience!

whoops, I just read that its not an advanced practice program. Well, I don't really know that much about it..... but would just wonder in the end, if there would be any real difference in the amount of money you make with a Master's verses a Bachelor's degree. Even with a specialty degree, will you be hired with no experience, to be an expert in your field and lead others in this higher paying role? Is it worth the extra time in school and extra tuition spent? after reading the brochure about it, I do see the potential there, and see that they are trying to elevate the nursing profession, guarantee quality care, etc But real life is real life, and sometimes you just wish you didn't have all that debt, especially when you are working alongside a damn good diploma prepared RN who knows her stuff and makes just as much money as you do :) Cheers!

There was no AGMSN program in 2008 when I did the ABSN. If there was, I just might have done it! Just thinking about it, i would be intimidated by the idea of going from knowing next to nothing about nursing and being an advanced practice nurse in only 21 mos time. But I guess thats what a lot of PAs do! Good luck to you.

I know I am a little late to the party, but I just wanted to add.... Perhaps she charted "pt taken off the bedpan" to indicate she was in the room and provided care to that pt during that hour? I often chart things like that because there is nothing else eventful to chart and it shows that I have done my hourly rounding duty....haven't been ignoring my patient, etc. And I have done my part to feed/water/toilet them. And i don't chart the color and contents of stool unless it is unchanged from my initial assessment. And perhaps she didn't chart it because it wasn't anything too striking (like c diff, melena, bright red blood etc). AND if someone ran off to lunch without telling me the patient was on the bedpan, I seriously wouldn't scoff. That is small potatoes to me. If they made it a habit to do stuff like that, then, well maybe. Things that get me mad .... handing off a patient that has a ready bed upstairs and they don't have an IV (actually has happened), giving me a CHF patient who cannot toilet his/herself who we are diuresing and you failed to put in the foley that was ordered 2 hours ago (that has happened)..... {NOTE: these people did not get away with these things} you know, that kind of stuff. Don't worry to much about things like that. you will burn out WAY fast.

They can call a ride and wait in the waiting room. Or we will call a cab for them and the cab can take them by an ATM on the way home. If they are really belligerent I will call the charge nurse and let them deal with it. Thats why they get paid the big bucks. Then they MIGHT get a bus pass.

OH, YEAH- He also orders.... 2.5 mg of morphine on EVERYONE- we only have 5mg and 10mg vials. So i have to waste 2.5mg on EVERYONE..... and then I have to go back in there in an hour and give another 2.5mg because whaddya know, the first 2.5mg didnt work! 500mg bolus on everyone then 100ml/hr infusion- NOT A LITER, god forbid. (And these are all people that DONT have renal failure or CHF.) SO if I am going to be anal, then i will hang a half liter, and then gotta go BACK in and hang another bag in 20 mins. Its all this little stuff that takes up time that I don't have! just venting....

She did have CKD (no dialysis), and for that reason probably lives above 5.1. She had EDEMA everywhere (CHF) and used to be on lasix everyday but was taken off (dont know why). Lungs were clear. This doc happens to be the medical director of our ED. He treats every little abnormal lab. A person with a potassium of 3.3 (normal, young, 25 year old patient) must get PO potassium. Its just a little annoying. (Mostly its annoying because he gives you admission orders, you start to get the patient ready to go up, and he orders 5 more things. Don't get me wrong, i will always do whats right for my patients, but he is a little order happy)

oh, no. She was giving the 300mg as a IVPB. We then did a drip. I have given this drug several times in codes, always as an Iv push. I am at a new facility now and they are driving me batty. Causing me to second guess everything i have learned...... For example: all IV infusions must be put on a pump. Even a NS bolus They expect us to do this with an insufficient amount of pumps. A doc today ordered for me to give kayexalate and an albuterol neb to a patient who was "hyperkalemic", her K was 5.7 (3.6-5.1 is normal at our facility) AND she was being diuresed with Lasix. Where I come from, we don't treat anything less than 6, ESPECIALLY if we are diuresing them. BUT, the ratio here is 3:1 most days during our busy hours, so I guess, in the end, I can't really complain.

Thanks, Lunah. I have pushed the Amio myself before in a code, different facility. Just wanted to check with y'all, make sure I wasn't missing something.

Documenting a code today. Full arrest, kept going into pulseless vtach, vfib. Drug pusher mixed the 300mg of amio to hang PB over a few minutes...... ?!? Don't you just push this in a code situation?