aaronrnmedic

Yes, we are in this together. And as long as we are all striving the the good of all it is healthy. However he does have a socialist mindset. If that sounds extreme, I'll call it "socialism-light." But I fear it could open up the doors for more extreme measures at a later time. We do not need a nanny state. We need a system where these funds that are used for, say, medicare, cannot be touched by those in Washington. If they can touch it, they will spend it and untimately waste it. Socialism-Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy. http://www.thefreedictionary.com/socialism He publically admitted this. In fact, I just heard it in his own words on the radio early this morning. He said he wanted to redistribute the wealth of the better off and give it to the poor. This sounds good up front. In fact, this is what I believe each of us should do on our own for the good of our fellow man. However, this has been tried before in other parts of the world and it just doesn't work (especially when you let a corrupt goverment run it). Robin Hood was never one of my favorite stories a kid.

Character assasination? On whom? Obama? Please. No, I'm not apologizing. You're right. We should push for politicans, or rather, public SERVANTS, to understand what is best for our pts. Somewhere along the line they forgot that they are supposed to serve us, not the other way around. I am not going to vote for someone, in this case Obama, who says he is for nurses because he has a socialist mindset. Its not worth it. We are on our way to a communist state......

Great, I was thinking the same thing. As a patient advocate, I enjoy teaching my patients, their friends, and families to be sure to ask those questions. Especially in ICU where I work. Hospitals push doctors to move their patients to a lower level of care when they're still at risk for serious complications. Generally when I share my concerns, the physicians agree that the patient still needs the higher nurse to patient ratio. Why transfer patients who still have one foot on a banana peel? Do no harm! Instead of staffing up based on acuity, hospitals try to get away with marketing and using the rapid response teams. "Just in time rescue?" Why not staff with sufficient numbers of RNs to provide ongoing assessment and to be present and available to intervene and act in the first place? Staffing up based on acuity is often enough to avoid crisis and serious complications and codes. Talk about evidence? There's plenty of studies out there now that show improved outcomes, shorter length of stays, and the cost effectiveness of enriched nurse to patient ratios! Barack Obama is educated and committed to the idea of national standards for RN ratios, and that's why I believe Obama/Biden is the right choice for nurses, patients, and workers. He's got my vote. :smilecoffeecup: http://obama.3cdn.net/15ac0c5ca92ebc8450_6824mv5te.pdf O no. It's turning political! That would be cool to have a politican that supports those beliefs. I frankly just don't trust him. In fact, I distrust him more than the average politican. He lacks judgement. Look at his associations. I have a child that was beaten and shaken at 4 months old by his nanny. He is now MR, has SZ, has a VP shunt possibly for life, and is nearly blind. And he wants to nationalize healthcare?! Scares me to death to think of the goverment trying to organize and manage that! I'll have to vote for the lesser of the evils. AGAIN!!! Where are those third party people?! Sorry to the person who started this thread about handwashing. Not really sure how we got off track.

That wasn't very friendly:argue: I don't think she posted this to try to begin an argument.

I picked up a lady who had been lying down on her kitchen floor for a day or so (as a medic) who had a nice little lump on her forehead. We then noticed that that lump seemed to move. You could see through the thin layer of skin tiny maggots moving around. How disgusting. I don't think that is as bad as the maggots in the trach though.

I don't know. I give up. Where?

Our ED consists of teams. Each team is assigned 4 ED rooms (and then there is always the hallway:no:). Each team consists of an RN and one Paramedic. Team one has the highest acuity pts while, say, team 7 should have lower acuity pts. I think this system works pretty good. It is the charge nurse who will assign the pt to a team.

Our ED too has this problem with many pts who abuse the system and never have a ride home. We give cab vouchers but only if all possiblities have been attempted. We tell them all that we no longer do this but we do give these out as quietly as possible. These pts quickly catch on to this as I'm sure you know. We have pts who will go to the ED just for something to do (kind of sad, really). We have the frequent flyers who have shown up to the ED for the same complaint 3 times in a 24 hr period! By this time the ED docs end up admitting them probably because they fear legal action. If they are harrassing others in the waiting room we have our security call the local police. The more times you can get it documented the better I think. Once these guys are discharged they are discharged. There is no reason we as nurses should be held responsible for them at that point. If anyone should be it should be the hospital for not coming up with an action plan for these instances.

For atypical H/A's in our ED the doctor may order CT of the head, especially if they say the magic phrase "its the worse headache of my life". LP's may be ordered if the CT is negative. The usual blood work is done for this complaint. As far as treatments go we usually give toradol, compazine, or reglan IV. There are some docs who will order Dilaudid but not too often. Normal Saline is given as a 1 liter bolus IV for those without a h/o renal failure or CHF.

Our ED requires us to notify security right away and to place them into blue paper gowns. This makes it easier to identify them when they attempt to run out of the ED. We see a lot of psych pts and usually have on average 4 of them either being seen or waiting to be seen at any given time. To be honest, somedays I bet up to half of our pts could use a good eval! After security goes through their belongings and determines that they do not have anything that can hurt themselves or others, their clothes and belongings are placed in bags and kept out of the pt's reach. Ideally, they are placed in a room that does not contain any cords and is monitored also with a camera. But our ED is so busy that many times these pt's are placed in "normal ED rooms", which are closer to exits (and running ambulances!). Don't ask! An affidavit needs to be filled out and they need to be medically cleared before being sent to the floor or transferred. We rarely have people that can come and sit with these pt's and we have to pay much more attention to them. Kind of hard when you have other critical pt's. We have sec. techs that can help but they are usually extremely busy. We have Paramedics but they operate much more like RN's in our ED and are needed for the more critically ill or injured pts. In a pertect world (at least in the ED) most of the psych pts would be sent directly over to the psych floor where they would be evaluated by a doctor to be medically cleared. They would then be admitted, transfered, or not. That is just my opinion though.

You are right. That is insulting. Bad decision on their part for sure. They would be wise to invest effort into reinforcing the importance of hand washing. It would be much more beneficial for the pt to actually see the nurse wash their hands before touching them rather than the nurse to wear some ridiculous button.

Sounds to me like you should go for it! Especially if this is the ED that you already work in. You probably know the "flow" of your ED which will help ease your way into that position. Do what you know and love.

I have not been turned down by anyone yet. Then again, probably not going to happen too often in the ED. I have asked pts if they would rather I get a female to help out with procedures such as a pelvic exam.

Legally, as long as you informed him of the risks of his condition, I don't think you should be worried. All you can really do is make sure he is alert and oriented, not under the influence of narcotics or mind-altering meds at the time he signed the AMA, and to make sure that another person signed as a witness. We can't force people to make wise decisions. We can only attempt to lead them down that path and to help them be informed. I once had a middle-aged female with an obviously fractured tib/fib (who was still attempting to bear weight on that leg!) sign out because she didn't have insurance. I spent as much time with her as I could to try to change her mind and to give her the possible and probable outcomes of her decisions. She would not listen. But you only have so much time. It would be great if we had more time to educate pts but it is not a reality in most healthcare settings.

I close the door. I guess as you know there is hardly time to keep finding female employees to do ECG's on female pt's. If they wish to help that is great. Otherwise I think I just use my gloved wrist or hand to hold them up. Some pt's look uncomfortable so I ask if they want to help out holding and moving. If there is a lot of people in the room I try to cover her chest with a towel or sheet as long as I can still get a clean ECG tracing.