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Larry77

Larry77 RN

Trauma/ED
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Larry77 has 10 years experience as a RN and specializes in Trauma/ED.

Larry77's Latest Activity

  1. Larry77

    Epic Charting System

    I've used both computerized Tsystem and now Epic, you will hate Epic at first. It is not nearly as straight forward as Tsystem but after awhile you will get used to it and have a new normal. There is nothing like left clicking for circling and right clicking for slashing as well as the great chart summary you get from Tsystem. The good part about Epic to me is it is commonly the same system that the inpatient world uses so you don' t have the issue with inpatient staff unable to easily see or understand your Tsystem charting. Epic is a little different, it is an inpatient system that has been altered to do ED charting as well. Tsystem was designed for the ED and it shows. Epic is very customizable so even if you are familiar with the system and you go to another hospital you will still have a slight learning curve.
  2. Larry77

    difficult ETOH pt

    I would talk to your Medical Director and come up with an ED care plan, you do not need a PCP for that. On some of ours over the years we would have a plan in place to only treat objective findings (i.e. withdrawal s/s). We would have a plan to NOT feed them, to NOT give them a treatment room. If they were SI the plan would be to put them in a hold room with nothing but a mattress. Some of this may seem extreme but the only way to decrease the abuse is to take away what the reason they are coming to your department. As far as for you, please be careful to not let your frustration show in your care, and do everything you can to not bring it home. I feel sorry for someone like the person you describe and feel that it must be sad to be killing yourself just to escape whatever he/she is trying to escape. Many cases came to mind in my own experience that are nearly identical to what you describe, the last I can remember died in an ally after passing out drunk in the winter. She was 26 and in our department at least twice a week, never wanting help just angry that someone called the cops to land her in our department. Just keep swimming and really appreciate those cases where you can make a difference. Drug and alcohol addiction is an illness in my opinion and your patient is afflicted. If you think about it in that sense it might be a little easier to handle. L
  3. Larry77

    8-vs-12 hour shifts?

    Almost all 12
  4. Larry77

    Hindrance to professional growth

    Wow, I've never heard of this as a policy. What part of the country is this in? I've been wearing scrubs for 20 years and have worked in many hospitals in the NW as agency and I have never been told I couldn't do peri-care or cath a female. I have always looked for a female RN to do my cath's when possible but there are times when that is not available and if the patient is sick enough, young enough (baby), or old enough to not understand what is going on I have never hesitated and I think my female peers have always appreciated that. Also I have always jumped in to take care of the unruly drunk or psych patient for them...as well as cath their young men that would sometimes ask for a female (in a creepy way). We are all a team and I have never been offended when a female seemed uncomfortable with me seeing them naked, it most likely has nothing to do with me personally and I'm here to make them feel better not force them to see that I'm a descent person. I and my coworkers know I'm not a creep and that's enough for me. This feels a little like all the threads about guys being offended by the whole "male nurse" label...personally I have more important things to fret about :-)
  5. Larry77

    Being an ER Nurse, is it worth it?

    I'm curious why the ED Manager is looking for you to apply, do you know him/her or someone from that dept? If so, what do you know about the department, are people happy there? I ask because the good department's I have been involved in don't really need to recruit new grads...new grads and experienced RN's were applying in droves. I agree with the other advice above. It used to be that I recommended a year on Med/Surg but lately it has become so difficult to break into the ED that I would never advise turning down an opportunity if you believe the ED is for you. I do believe you should do anything you can to get into a hospital because that can be another very difficult hurdle, but once you are in the hospital world you can more easily move to different, more acute departments. It's very uncommon to come from subacute care and land a job in the ED or ICU. Good luck!
  6. Larry77

    Shouldn't that patient go the ICU??

    If you knew the nurses name could you send him/her an email to ask why they charted what they did. Maybe you could meet for coffee and discuss both points of view? I'm sure she was covering her bum but to direct quote something that wasn't said is falsifying charting and maybe she doesn't understand that you were the one looking at the patient and if you had concerns about sending her to the Tele floor you would have brought those concerns up with the admitting doc. I always think this type of approach helps the culture in your hospital much more then just reporting each other to managers.
  7. We had a lot of PA's that worked with the Trauma service and some of the other specialties (Surgery, ENT, Urology) but I don't think I've seen many NP's. I'm used to seeing them in the clinic and the Fast-track areas of the ED. I have a couple NP's that work under me in the ED as regular ED RN's because they only work part-time in the clinic doing primary care.
  8. Larry77

    Iv mag or k+ which do I hang first?

    I was merely being facetious. This is an interesting topic and I was pointing out that it is not a typical discussion that is had in ED's, but rather one that my ICU friends would spend time looking up. I'm wondering if those ACTUAL ED nurses were offended by my sense of humor, if so, I apologize to YOU. If you have never worked in the ED you may not understand the normal ED mindset...life is too short to be so serious! Cheers...
  9. Larry77

    Iv mag or k+ which do I hang first?

    Isn't this an ED Nursing thread? Start another line and run them both if you are worried about running them together. Save me from this ICU'ish intracellular speak :-)
  10. Larry77

    Best Drug Seeker Stories

    Yeah I think we rewarded him for his determination after that :-) When he came back he had added to his care plan that he was to be escorted off the campus by security when DC'd
  11. Larry77

    Best Drug Seeker Stories

    We had a regular that we wouldn't give narcs to for his "complaint of the day", he was DC'd from triage and then he walked over to our 2 story stair well and jumped! Bilat Tib/Fib fx's, said, "Now you will give me pain meds!"
  12. Larry77

    Considering applying for nurse manager....

    I would really look at how your philosophy aligns with the organization and your Director. What has the turn-around been like in the position you are applying to? Do you want to spend your life in meetings, and dealing with staffing, projects, and budget? Personally I love management, I love the fact that I can affect so many by changing processes and working on culture...I can touch so many more than I could at the bedside. But you are correct on the Mon-Fri thing...it does have some perks but gone are the days when I used to get basically every other week off. Everything is a trade off but definitely don't go into management for the money (just try figuring out your hourly wage...barf!) and don't go into it for power because if that's the case you will NEVER be good at it. Good luck, it seems you are looking at it with the right attitude and are asking the right questions. Larry
  13. Larry77

    I don't know if I want ER or ICU

    I think the best thing about the ED is the variety of patients. We can be taking care of an infant one moment then a 90 yr old the next. I also like the teamwork with the MD's as they are right there discussing plan of care with you. And don't forget if you have a difficult patient you only have them for hours instead of sometimes months in the ICU. There are also benefits to ICU, you get to know your patients better than any other nurse. You get to know drips and lab values better than any other nurse and you can plan your day instead of never knowing what will come in the door. If you aren't sure, just get whatever job you can in either and transfer if you don't like it. It's not like you will be stuck forever if you choose one.
  14. Larry77

    Difficult situations

    I used to spend a lot of time thinking about how terrible the tragedy was for the victims that come to us and almost guilty for my own happiness but one time my wife gave me the best advice I've ever heard. She said, "Besides thinking about the hardship of the families, also think about how much your kindness and compassion was a blessing to them." She asked me one time what it was like to be the one person that had the final conversation with someone who has passed..."Ugh, I never thought of it that way" was my response. The next bunch of times I was in this type of situation I was very conscious to make every word and every second count. We are so lucky to be involved with strangers in such an important time in their life that THEY will remember forever as well as us. I agree that talking about your emotions is very important but so are healthy habits like working out, having fun, and spending time with that little extra hug to our loved ones...try not to turn to ETOH like so many do :-) Hugs, Larry
  15. Larry77

    Are headaches a contrainidcation for 12 hour shifts?

    And now I remember why I don't usually read "General Nursing" page. Sad thread.
  16. Larry77

    Impossible standards

    Nursing definitely has a role in making sure a consent is done before ANY invasive procedure is done (ie LP, Chest tube, Conscious Sedation). I personally would not assist in any case like that until a consent is signed (if not emergent of course). To Coneohead, I'm not sure if you realize how Management works but I've never heard of "Blaming nursing" to "get a pay raise"...that sounds like you have some issues with your view of leadership. In management we get pressure from our superiors just like you do. If it's noted that the ED staff is not revitaling their patients we have to act. We may have to come up with a mitigation plan for a resolution of the issue to our director or CNO. It certainly doesn't help us to have an issue called out and often times we are getting the brunt from our leadership as it is ultimately our responsibility to make sure the nurses are doing their jobs. I've seen plenty of Managers fired because they couldn't lead there direct reports to success. I do not think hourly rounding (not always VS) is too much to ask from ED nurses and I also do not feel that VS q2hrs is too much to ask...if you are caught up with an acutely ill patient you should be calling your team to check on your other patients--this is basic ED nursing.