ThrowEdNurse

I worked my way through nursing school as a vet tech. We always did this for animals as a standard of practice.....cat and dogs do have stretchy skin and are so less dramatic than people. Which is why I think it would be an awesome technique for the elderly....behind biceps and to the chest wall....right?

If you don't want anyone to respond to your opinions, then don't give them. What makes you think that? Voice your opinion, just try not to let your obvious hostility show. It's slipping out for whatever reason. I haven't killed any 20 yoa CPs. Take a breath.

Oh, come on! The OP put chest pain in quotation marks! We all know what that means. Not sure how triage works in your house, but in mine, it demands that everyone is evaluated on a case by case basis. I thought this post was about IV size, not my person opinions about young people with CP that has no bearing on how I treat them professionally.

We don't work up every 20 yoa cp that comes in the ED, doesn't mean they don't get EKGs.....

Ridiculous! I would have come unglued. Despite his opinion about the size of IV needed, he shouldn't speak to you in a rude manner, which I assume he did by snapping at you. I would have also insisted he explain it to the pt. I also can't believe a 20 yoa cp gets worked up in your ED. He would've needed a hx in mine. Our requirement for contrast is a twenty. Also, if he was so concerned about this pt and thought he was so ill to require larger IV access, why d/c the existing, functioning 20? This just doesn't make sense to me. Sounds like he's going to be a challenge to break in.

Yeah, I was waaay to low. Forgot about the nipple line...:nuke:

I don't understand how these people can ask you to use nursing judgement to make important decisions. You don't have nursing judgement. It's ridiculous. To be safe, until you get this sorted, I would rush everyone back as an emergency. You can't go wrong with that. If they don't like it, they'll need to triage.

I broke a sternum in nursing school. Super gross.

I think we're all so used to suctioning, we don't think much of it. But I am thinking of the other kids. How many of them are bothered by it or freaked out? Are they able to understand with it and accept it? How does the pt feel about it? Does it embarass him to be suctioned in front of everyone or he is more embarassed by leaving class constantly. I think the decision should be his and the other students' opinion at least weighed.

Also, I have given a lot of thought to moving to one of those cushier, nicer hospitals...where the pts have insurance. But, I've heard there can be a lot of......pillow fluffing. I'm not sure I would be very good with the customer service as I am trying to focus on safe and good nursing. We don't even have pillows in my ER!

Sorry, Altra. I didn't intend for my response to come across so....charming. I have an injury and have been laid up for a month and a half on back and I've realized lately that I am losing my grip on reality and am having a problem keeping things in perspective as well as the ability to use basic reasoning skills. I am literally losing my mind from staring at four walls, watching tv, and reading. But, I don't think I was hurt at work. Well, probably was, but it's nothing I can prove. Plus, not everyone gets my sense of humor and it definitely doesn't read in text (flat) as I would say it in my head or outloud (jokingly.) Please forgive me!!!! Anyway, yes, someone gets assaulted that frequently in the urban hospital I work at. There is really no response by anyone. It sucks. I actually followed through on one guy who was on cocaine. I wound up going to court and making 3 separate trips downtown to court to follow through on the charges. The judge continually allowed him to postpone the trial as he alleged that he didn't know about the court date it, didn't have his judge, his judge didn't know, he was the ER for seizures (nope), and couldn't remember a thing. I just wanted to jump up and scream, "Liar, liar, pants on fire!!!! He was high and drunk and never once seized!!!" But apparently that is frowned on in court. So I gave up all this time, energy, money, missed days at work, left my coworkers short staffed, and repeatedly inconvenienced the cop who was working nights who filed the report, etc to make all these trips and get wound up and anxious about the court date for the case to eventually be dropped because his mommy (the man was 49 yoa) wanted to get him placed in a "long term care facility for drugs." After I informed the DA that those places didn't exist here and that even if he was placed somewhere that within the week he would be thrown out or leave andhe would be back living at the hourly rate motel down the street from my hospital and that he better not come back to my ER, I rolled out. I definitely learned my lesson. I suffered more during the process than he did and was taught a bigger lesson. I refuse to let the criminal get anymore of my time and the law protects them more than me. Sigh, my taxes at work....

Ummm? Well, clearly it's a cause for celebration. Usually I throw a big party and tell the story repeatedly over dinner? What do you mean???? File a report, press charges, see employee health as needed....and scrub down with cavi wipes head to toe.

Aside from the senile geriatrics and the pts with elevated ammonia who both spit, scratch, grab etc, I've been shoved across the room by a young healthy man who was 6' 4" who wanted to leave because it was time for his cocaine fix. I've been punched in the face and kicked multiple times in the head by a young girl in an acute psychotic state without warning because the clock said something ugly to her, I guess. She was talking to the clock and I guess the conversation didn't go well because she was mad! I've had full grown drunk man with extremely poor hygiene and the remaining teeth in his head were various shades of yellow and brown spit in my face when I told him to stop screaming racial slurrs down the hall in my hospital who's pt population is mainly black. Then of course the psych pt who doesn't take her meds, despite my taxes paying for them, come in and verbally abuse me for two hours as the resident refuses to chemically sedate her, eventually grab me by my hair and repeatedly scratch me in the face with her filthy, unwashed claw/hand. The only pt I don't mind having assault me are the confused geriatrics. The rest of them either choose to stop their meds, abuse alcohol, abuse drugs, etc and put themselves in the situation to have this illness that results in their assaulting me. The worst is when the family shows up and acts like they don't care that their family member assaults people with educations and jobs who are trying to help their behinds that have never done anything to contribute to society. I guarantee that if the people who make the rules regarding restraint usage and documentation got assaulted as much as we do, things would be different. It's ok to be injured as a health care worker but not to be restrained as a mentally unstable pt? They got it twisted. On average I have a major assault about every six months. Don't get paid enough!

I agree to go for all the easy ones first. They get you confident and used to how it should feel and how it should go. Als, this might sound horrible but try to get practice in on hard veins on people who aren't going to complain. The hard veins on a whiney pt who is puking or crying as you try to focus are a challenge for the most experienced nurse, oooh especially if they have an overbearing family standing over you and criticizing. Therefore, it may be good for you to practice on the dead, the near dead, the comatose, the sedated, the nonverbal, etc. I also recommend this for NG tubes. They are terribly difficult on someone who is awake and alert enough to cough, gag, grab, cry, etc. But you feel less pressure when you do it to someone who is intubated and sedated.

Please don't think this is a luxury. What this means is that we do everything in our power not to have to call. The doctor only gets called when we need intubation. Otherwise, we manage everything and keep the pt alive until the doctor pulls the chart. I think this is like ICU? I mean, you guys don't call the MD everytime the pt pukes or asks for the doctor or complains of the worse pain ever. I don't think we call for them anytime you wouldn't in ICU, just we have to manage their care until then without orders.

Oh my God, if you're gonna move, move to Texas! Everything is worse in Louisiana! But if you come to BR, I think you probably want to work at Woman's if anywhere, they are magnet and from what I understand actually respect their nurses. The EMTs that come through my department express that the nurses at Our Lady of the Lake are....."rude" and they seem to think the ones at Lane are....."incompetent." They don't really say much about the ones at Earl K Long or Oschner though, that's probably a good thing. I think the reputation of nurses is a big deal at a facility because it reflects a culture and how the hospital treats its staff. If I were to start over, I am thinking about a job where you would work for the state, like Hunt's prison or EKL....or move to TX, AZ, NM......

Kings of Leon- Your sex is on fire Every time I am attempting to rush somewhere with a crash cart: DMX- Move *****, get out the way

Here's another thought. When the pt dies or falls or becomes ill, and it's inevitable with her being morbidly obese, the family (because they sound unstable too) is going to blame you. What do you have to defend yourself? A hx of being abused and assaulted. In the court of law, that's called motive. Just sayin'.... On another thought....you allow a pt to touch you, verbally abuse you and now stab you and you didn't call the police and your boss laughed and you still go back????? No, you deserve it, don't quit.

I hate that! It's like when you have a pt being seen for emesis. Everytime they puke they run straight to you, "he's throwing up." I return a blank stare, "yes?" We are waiting on an order and they are well aware but they NEED you to come stand at the bedside I guess and watch. Everytime they puke at home is there a nurse standing there watching? Then they point to the room like "well come on!" I can do more good for the pt by not standing in the room staring but by advocating for them so stop interrupting! Geez so annoying! He's doing a fine job of puking without me so be the supportive, loving family member you're supposed to be and wipe his mouth for him. Don't need a license for that. It's like when they complain if hiccups. "um..good luck with that"

More and more relevent. Had a shooting IN my hospital this pass month and now this crap at John Hopkins. I have a CCL and I carry my 38 special in my purse, against hospital policy. Oh well they can fire me. I'd rather be alive and unemployed than have something happen to one of my coworkers or myself by some wack job with poor coping skills while standing there like some fool waiting on one of our crippled, unarmed, elderly, overweight security guards to come hobble to my "assistance." Clearly my hospital doesn't think my safety is a priority but I do. The day after the shooting in my hospital, after administration put out a press release stating they would be tightening visiting policies, I had a pt with 5 visitors in her room while our policy allows for 2. We had extra police on duty but only for about 4 days. Today when I got there, there were no police on duty. Please remember that the hospitals we work for are all big businesses and we are just the money making peons for them.

Wow, Shiccy. Sounds like you aren't real familiar with the role and function of the "EC" nurse. But I have one question I've always been curious about. If you want an extra 15 min or whatever before you see the pt, why can't they lay in your bed as opposed to mine. I may have up to 10 pts who have been holding in the ER for hours waiting to get that ER stretcher. What's the difference between the admit sitting in your hospital bed, upstairs, waiting to see you for ten minutes or them lying in my high in demand ER stretcher for ten minutes, unseen by you? Just curious. I have never been unable to understand that. If I get a new pt and can't see them immediately, guess what, I don't! And these are ER pts that can have anything going on . If I am telling you I am a sending you a stable pt that's been laid up in the ER going on 14 hours, what's the difference other then your way delays the care of ER pts? PS, hope your venting helps. Sounds like you needed it. Fair warning, you'll probably get flamed. Just sayin'

I do, but the assignment is torture and unsafe. I've had as many as 40 pts. No beds or monitors. Just running around, getting tasks done in chairs, small rooms for privacy for IMS, fluids, urine, accuchecks, tx bp, culture, out of what is essentially a WR. Major lawsuit waiting to happen plus the pts never appreciate the reduction in total wait time or the fact they've been tx'd sooner. All they want is a bed.

I know I am burned out but really, quit for a while? In this economy? That's unrealistic. I can still save lives and do my job burned out. I may not be happy at the end of every shift but my job is always done properly. I could never seriously offer someone heat or ice or repositioning if they were in excruciating pain. It would sound sarcastic. Plus, I don't think heat or ice or repositioning are going to help an abd pain in the lobby. And why didn't you just tell the receptionist (note not the nurse) that you would like tissue? Faster for everyone! Plus I find that not all men consider these kind of things like offering tissues, etc. My husband is trained to offer me tissue if I am crying but it has taken years!

People need to pay due respect to the spidey senses of experienced ER nurses. I know, I get the feeling, I d recognize the walk, the talk, the story of a seeker. Me thinking this, feeling it, and believing it doesn't make me a bad nurse. Not appropriately treating this pt and not erring on the side of maybe the pt isn't seeking until a definitive diagnosis is made, would make me a bad nurse. By the way, the OP was referring to rude, abusive, hostile, demeaning seekers who don't care about the other pts in the ER, yell and cuss and don't care about a visitor here to watch Grandma pass away in the next room or the small kids down the hall. The OP was talking about the seekers that are disrespectful, have no clue of what an ER nurse does or knows, demeans them, and acts as though we are powerless imbeciles that will be subject to their every whim. That behavior is infuriating and sucks your soul clean, making you less of a nurse for everyone else.

No, I don't think they are just as sick as a hip fx. 50% of the people with hip sx die within a year. 50% of drug seeker don't pass away with in a year after being seen in the ER. They can ambulate, they are usually younger, alert....nope. I don't think they are just as sick.