susi_q

Wow ... I've been MIA for a couple months of busy work ... and this is still an issue. Had one of the worst days ever a couple weeks ago ... computers were down ... had a structure fire ... overcrowded with stupid complaints AND legit serious stuff ... and our manager came down to inquire (not so politely) why the boards weren't all up-to-date with "very good" for each patient. Also wondered why the triage nurse hadn't re-vitalled the 30 people in the lobby (never mind that she had 7 more waiting for primary triage ... and hadn't caught up in 4 hours).

Love ER ... Hate ER ... would never want to work anywhere else (for now at least) what you hear on these boards is a lot of venting. we deal with some crazy stuff from all sides ... bosses, fellow staff, patients ... but there are so many options out there for nurses, there is no reason for anyone to stay where they don't feel is a good fit. Try it for yourself. Where you start does not determine where you stay ... It's not for everyone. You need to be sharp, assertive, flexible, tough & tender ... but if it's for you...you'll love it.

Had a patient come into ER last week with same complaint ... we also sent him home ... the ER does not have the facilities or expertise to do a paracentesis...all we'll do is give a referal...the LTC doc could have accomplished that without an ER visit. It's a known history with a known solution ... IMHO

First ... if I'm "saving" the syringe is always labled. And I save it only if I think the original ordered dose won't be enough (or if I'm supposed to be giving to effect (0.5 dilaudid repeat x 4 to pain) And it's only me that will be giving it. As far as how it works from the Pyxis ... when I pull out the 2 mg dilaudid, I just say "yes" to "am I going to administer all." If I don't use it with that patient, just go back into the pyxis and waste later. We have lock boxes on our nurse's stations where we can keep these syringes as long as they are labled with patient name, drug, dilution/dose ... etc. And yes, in a code, the drugs are flying, and we have one nurse that draws, another that administers ... but with verbal check as the meds are passed along.

Our docs tend to use narcs (grr) ... but one started using imitrex ... until 2 weeks in a row the patient died! (Unknown, pre-existing aneurisms that blew). Please just know that it is not an inoccuous drug!

Guess what we get to do now .... we have a sheet on every door with every 30 minutes marked out ... we must go into the room ... ask 4 questions ... and initial. At this point it's "practice" .. they say it will be cause for dismissal if not done in the future. (4 questions: do you know who your nurse is? is your pain under control? do you understand why you are waiting? is there anything else i can do for you ... I have the time?) I really do like my hospital ... we have great autonomy as nurses, have good rapport with the docs ... but our managers have lost a few marbles!

We normallly only document for admits ... even then, I can get a little relaxed about it. However ... we just had one of our FFs claim that he had >$1000 in his wallet that was missing (picked up drunk)...because we hadnt documented when we took his belongings, the hospital settled. Thankfully that one wasn't me, but I am more careful now when i take possession of belongings.

Hey Trauma ... do I work with you? I think our managers use the same consultant at least! That is word for word what we have to say! The looks I get from patients are priceless! (Of course, if we do have the same consultant ... I bet I know what will be next for you:uhoh3: )

Thanks everyone ... I guess I wasn't too far off in my rant ... y'all seem to be thinking along the same lines as I have been ... maybe I'll take Larry's suggestion ... wear a button that says "in order to give you very good service today ... I'll keep you breathing!" Think management would mind????

:angryfire Need to rant a minute ... then would appreciate your suggestions... Our most esteemed powers that be have said that for each patient we bring to a bed...we need to ask them "what is the one thing that I can do for you that will assure that I am giving you very good care?" WHAT??? I understand in the in-patient setting that the "little things" matter, as they do in the ER, and I'm all about warm blankets and coffee for visitors (or whatever) ... when I have time. But by asking the question, aren't we setting the expectations higher, and then when I can't "get me out of here in 1 hour or less" or "get rid of my pain" or "keep me fed (belly pain)" ... I totally have no chance of meeting their expectaion! Besides ... I really thought ER was to take care of the presenting problem ... and say GoodBye! Truly, I treat my patients extremely kindly, I keep them informed, work my tail off ... but am I crazy to feel like this is setting up a disaster?

Our docs are calling it the "heck if we know what's wrong ... lets make sure to CYA and watch em for a couple extra hours" Our case managers are drilling into us and the docs that it is for 23 hours OR LESS!!! OR ELSE!!!!

Maybe I'm just a bit left of center (well, of course I am...I work ER) ... but I like the questions. I like explaining (isn't that kind of like teaching???). I like the admiration ... but always temper their response and explain the "real" patients that we usually get ... what the day really looks like ... how truly interesting the people I work with are ... but equally how truly un-dateable!!! I'm proud of what I do ... not as opposed to other nursing jobs ... but I do love this one most (for now)!!

Question then ... why have them breath thru their nose? Do they hold the neb in front of their nose? If the neb is in their mouth and they are nose breathing ... it would still carry to Lido to their lungs wouldn't it?? Just a might confused. Thanks.

I'd be interested in hearing how someone likes it, as well. Our ED is expanding ... and will now include a CDU. The ER staff will be required to rotate between the various levels including the CDU. Lots of the nurses are throwing fits because they purposely left floor nursing, and feel like it's a step "backwards" (for them, I know that's not how you floor nurses feel ...)

Funny you should mention the Hurricane spray. That was the primary reason she sited for switching to lido. Had never even heard of methemoglobinemia ... but apparently that is a serious risk found with the use of Benzocaine. Looked up a site to find out what she was talking about ... http://www.jhasim.com/files/journal_p45(V3-1)ClinicalV.pdf if you are interested.