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.

Did something new today ... well different purpose at least. Needed to put an NG down a very skittish patient ... doc said she had been reading about using nebulized lido prior to insertion, but didn't know the process. Did a little research and used the protocol that RT uses for chronic cough (3cc of 2%). Worked like a dream. He tolerated it great. Apparently the only adverse effect they have found is some risk for increased bleeding... presumably because they don't tell you when it's hurting. Will definately be suggesting it when the need comes up again!!!

fentanyl & ketamine for CS Succs and etomidate for RSI

Just curious ... what is Tsystem? Assuming it is some kind of electronic charting? thanks

Ditto ... we gown and remove belongings from all psych, intoxicated, aggressive patients. Belongings are not searched though ... just bagged and tagged.

Thanks Wooh ... you stated a very reasonable response. As a nurse, if I know both sides (the origin of the med ... and your possible objection to it) I will of course give you that information. (Drives me nuts to hear a doc or anyone else give "informed" consent that consists of "we need to do a >>>big long medical jargon>>> sign here".) But I also think our patients have a tendency to check their self-responsibility at the door. I'm not a pharmacist, I don't know origins of most drugs. And just because you were asked at admission about religious preference ... doesn't mean we understand all those implications unless you give that information to each caregiver that you encounter.

This is so funny that you ask. Just today, had a 20ish woman come in with a new "pain". Recognized her, so pulled up some of her last charts to put in with today's chart for the doctor. On each of the last 3 visits, the final dx by the doctor included a concern about drug seeking ... 2 of the 3 she left AMA as soon as getting her drugs. Well, the doc gave me the order to give her a generous dose of dilaudid ... asked if he had read the old records ... "Yup...but I don't want to screw up my patient satisfaction scores, so narcs it is!" (And yes, she slipped out of the room and left as soon as she got dosed up!):angryfire

Last week...call from the ambulance that they were on their way in "non-emergent" ... could hear the paramedic suppressing either a laugh or a moan ... 30 something year old woman ... coming in because she had a bad dream ... she needs a psych eval. No kidding! (Of course, she wanted us to pay for the cab home or call for the ambulance to take her back). Our tax dollars at work!!!

Yup Yup to all the above... the autonomy, the ability and need of working side-by-side with the docs (respect is a great thing), the feeling of "this too shall pass" is priceless. And Yes ... stupid human tricks are a great way to lighten your shift!

We do every part of the nursing process ... squared. we assess...as they come in the door, as they get to the room, as we continue to monitor, as we send 'em on (either to admit or discharge) we diagnose...we decide what to do for the patient (usually even before we get a doctor in the room), we order tests and treatments, we decide if that belly pain is really refered heart pain? AAA? appendix? ectopic pregnancy? food poisoning? "I just want a day off work!". We plan ...We decide when to yell for the doctor NOW, and when we can handle it until the doc is available, We juggle 4 or 5 patients ... planning how to give good care to each while preserving life and/or limb for the most critical, we implement ... give drugs, hang fluids, abx, cardiac drips...we run codes ... we do all the technical stuff (with our techs) like foleys, NGs, IVs, dressings & splints. We do LOTS of teaching (please treat your baby's fever at home, really, we'll believe you if its normal by the time you get here!) We comfort the grieving. We put doctors in their place (when needed). We stock rooms, transport patients, do the charting, monitor the results, inform the doctor, etc etc we evaluate ... so we can keep going & do it all over for the next patient thru the door. Keep reading on this thread...you will get a good sense of what we do. Its not glamourous, but Er nurses are a unique breed and I'm proud to count myself as one of them!

I agree ... report should be short, sweet and pertinent!!! As to the OP situation though ... new onset afib will be anticoagulated ... recent GI surgery could get ugly really fast if not handled carefully. (Unless you like the smell of a good GI bleed in the morning ... mmmmmmm)