DeadHeadRN

The problem with not filling it out entirely is that if you didn't chart you you didn't do it/assess it according to the law. The questions on a form used for an initial nursing assessment are designed to be answered by nurses. The fact that the physicians don't like it is really neither hear nor there. It's your license and you a$$ on the line. I would tell them that leaving out answers isn't an option for you. Explain nicely to them that the questions need to be answered to the best of your ability, because that is part of your job. If they don't like it at that point, I would say too bad. I'm doing my job and if you don't like it take it up with nursing administration.

My very first day in the ED we had an 8 year old Down's Syndrome pt come in via ambulance. The family had been at church when the little girl started seizing. She had no history of seizures. So when she came in she was talking and laughing, no signs of any problems. As soon as we got her onto the stretcher she had a seizure, so I ran to the med room to get Ativan. I was in the med room for all of about 30 seconds and when I walked out to bring the Ativan to the pt, she had coded. The girls mother was a pediatric nurse at another hospital too, so she knew exactly what was happening the whole time. We coded that little girl for over an hour. Toward the end the mother just started talking really quietly while she was holding the little girl;s hand. She just kept saying over and over "My baby! You can't die, I don't know how to live without you." It was the most horrible experience of my life to watch a mother lose a child right in front of her eyes. That was the worst code I've ever been a part of. A few weeks ago we had a 3 month old baby come in coding. It appeared to be a SIDS case, and the baby did not survive The family was heartbreaking. These types of things are going to happen and they suck. Watching people die is heartbreaking. But I promise, it does get better. I suggest going to your nurse manager or whoever you feel is appropriate and ask about support groups they have at your facility to help people deal with these types of things. Hang in there. You'll find that the good definitely out-weighs the bad. Good luck!

This reminds me of a pt we had a few months ago with acute abdominal pain. This man was literally in tears from the pain. Anyway, he got the full work-up, (Bloods, CT, Fluid, etc.). He even got a sono thrown in for good measure. Needless to say there was nothing wrong with him other than a LOT of stool and gas. So the ED physician goes to talk to the pt and give him the results of all the tests. I happened to be at the bedside putting up another liter of saline. The doctor says to him with an absolutely straight face :Sir, you're perfectly ok, all your tests show that you have no acute disease, but you are suffering from TFS." So the man looks at him and says "What is TFS?" And the doctor says "Trapped Fart Syndrome," and walks away. It took everything I had in me to hold it together until I got out of the room. Hilarious. Now, whenever an abdominal pain comes in we make sure we rule out TFS

Sorry if I'm repeating here, but I don't have the energy to read 83 pages of posts. Here are my pet peeves: 1) Calling 911 for an ambulance because you think it means you won't have to wait, think again. If your here for nonsense, ambulance or not, you will be triaged and sent to the waiting room. And no, you cannot have a taxi voucher for a ride home when you're d/c'd. It's really not my problem or concern how you get home. 2) If your here because you have nausea and vomiting with abdominal pain, you will not be getting something to eat. Use your head. 3) If you walk up to the nurse's station to ask for a something for your family member/friend, please specify who you are talking about. Don't point in the general direction of the pt and say "she wants a blanket." First of all you can walk up the linen cart right next to you and take as many blankets as you want for "her," and secondly, I don't know who the hell "she" is. This is a 50 bed ED. Please be a little more specific. I forgot my mind-reading powers at home today. 4) If I am in the middle of something important such as chest compressions, please don't yell at me through the curtain that you want a glass of water. You're just going to have to wait. Or maybe I should stop what I'm doing to be your waitress. "Oh I'm sorry, you're chest compressions are just going to have to wait, the pt next to you wants some water." 5) Please don't stalk me to find out if your sister is ready to be d/c'd yet. I promise you, I want her gone just as much, if not more than you do. If I haven't been over with her papers to d/c her it's because A - I'm doing something more important, like saving someone's life, B - She's not up fo Discharge yet, or C - the doc hasn't given me the papers yet. Whatever the case, I swear I will be over to get her out of here as soon as humanly possible, if for no other reason than to get you off my case. 6) Giving me the stink eye from across the ED is not going to make your family member's test results come back any faster. 7) When I come over to start an IV, don't ask me if I'm good at IV's. I'm an emergency nurse, yes I am good at them. I can blood out of a stone. Asking me that question does nothing but aggravate me. 8) Please don't complain that you've been waiting in ED with grandma for 2 hours now. 2 hours? That's nothing! 9) If you come the ED because you've got abdominal pain and you've been vomiting for 4 days, you are going to get an IV, you are going to have a CT of the abd/pelvis, and you are going to have to wait a few hrs for all of this to be done. Don't try to refuse these things. If you don't want us to help you, why the hell did you bother coming in? 10) Don't tell me you have 10/10 pain and then proceed to walk around the ED to find a snack, talk on your phone, play a game on your phone or text your friends. I had a compound fracture of the humerus. I know 10/10 pain and trust me, I wasn't chilling out talking on the phone. 11) Don't bad mouth my coworkers. The physician that you're ******** about to me because she won't give you Dilaudid, is someone that I work with everyday. She knows what's she's doing. I know her husband and her children. She is a close personal friend of mine and talking bad about her is going to get you nowhere fast. And I promise, making disparaging comments about her isn't going to get that Dilaudid anytime soon. 12) If you just left you PMD's office 2 hours ago, and he or she gave you a script for Cipro for your UTI, please don't come to the ED after taking one dose and tell me it's not working. Use your head!!! 13) I will be happy to get you a glass of water if I have time. Please don't call the nurse's aide over and tell her you need to see your nurse right away and then ask me for a glass of water when I come over thinking something is terribly wrong because you needed me "right away." Unless your having chest pain, respiratory distress, paralysis of one side of your body, Vfib or asystole, you don't need me "right away." And here's a tidbit of information to remember - the aide CAN get that glass of water for you. Better yet, if you're a walkie-talkie you can get your own glass of water. 14) When you hear an announcement asking ALL visitor to please return to the waiting room, please do not ignore it. This applies to you. If we're asking you to leave, we have a very good reason for doing so, and you are not special, and you are not excluded. 15) Keep in mind that you will get a lot further by being nice to me than by being a jackass. Being nasty to your nurse isn't going to do anything other make things take a lot longer than they need to. 16) I am not a waitress, a therapist, a doormat, or a punching bag. I am not your buddy. I am an RN, not a servant. 17) If I am sitting at the nurse's staton, it doesn't mean I am not in the middle of something important. I am not being lazy, I am probably documenting something, speaking to the physician about something, looking up a drug, looking at test results, looking at a pts heart monitor, Giving report to the floor nurse, etc. If I am using a computer, I am not surfing the internet (honestly, I don't have access to the internet - I don't a have a password for it). 18) If your child has a fever, please give him or her Tylenol. 19) Finally, and this is just an FYI, the curtains separating the beds? NOT SOUND PROOF BARRIERS!!! Believe it or not I can hear what you're saying!!! And here is just a note to the nurses on the floors or the Units - I swear I didn't go out into the street and flag these people down begging them to come in. I promise, I didn't write the admitting orders, and I'm sorry if you don't like them. If this is the case, please take it up with the physician who wrote them, don't yell at me about them. I'm sorry that you're upset that you're getting a patient, but that's the way hospitals work. If you have such an issue with getting admissions, maybe you shouldn't work in a hospital. I'm also sorry that you have however many other patients it is that you have, and don't feel like doing the admission paperwork on this one. Keep in mind that I've also given 7 other patients to the other floors, discharged 5 people, and I have 4 telemetry holds and 2 ICU holds. Your night could be as bad as mine is. Please just take the report, and save the attitude for someone else. I'm just trying to do my job.

Oh my this reminds me of one night a few weeks ago. I was triage that night, and the way our ED is set up, triage is completely separated from the main ED. So I had triaged a gruesome twosome, both there for back pain (one of my favorites). So the two of them walk up to my window and before the lady even opened her mouth the little light bulb in my head popped up - "DRUG SEEKER!!!" Anyway, I triage them, and they eventually go back to be seen. The lady's father is now in the waiting room pacing and carrying on that we won't let him go back to visit her. Just a side note- If we ask visitors to leave the ED there is a very good reason, in this case we had just had a 2 month old code who did not survive (SIDS), so no visitors were being permitted in. So he's carrying on, and now I won't let him back just on principle cause he's ******* me off. So he walks up to my window for about the 50th time and proceeds to tell me that his daughter just texted him and she would like her Dilaudid now. Really? I told him I'd be sure to pass that message along. Needless to say his darling daughter got no Dilaudid that night. What is wrong with people?

I don't know about the rest of you, but one of the biggest problem we have in my ED is the nursing homes. They send pts over for the most ridiculous things sometimes, and I often find the people who work there to be completely incompetent. Here is a recent example: Local nursing home sends pt to us for a fever. On their paperwork it states the pts temp= 105.1. Upon arrival I do a rectal temp which is 106.3. I immediately look through the med sheets from the home to see what time Tylenol was given. Now I look and look and look and cannot find ANY documentation that Tylenol was given at all. I give the pt ibuprofen, put her on a cooling blanket and call the home. The conversation went like this: Me: I'm calling to find out what time you gave Tylenol. Nurse @ the home: I didn't give her any. Me: Come again? Nurse: I didn't give her any. Me: You do understand that a temperature that high in an elderly pt can cause seizures and can be life-threatening, right? Nurse: I guess. Me: You guess?! I'm sorry I'm have some difficulty understanding this situation. I see on your paperwork that the pt had a temp of 105.1, which is why you sent her to us (keep in my that they called a private ambulance which normally takes about 60 minutes to arrive, not a regular ambulance). The pt has a prn Tylenol order which specifically says to give for temp >101. and the last time I checked, 105.1 is greater than 101. So now the pt has a temp of 105.1, a life threatening problem in anyone, but especially an 86 year old woman. I would very much appreciate it if you would enlighten me as to why you did not give this woman Tylenol. Nurse: Well we didn't want to mask anything by bringing her temp down. WHAT???!!! Sometimes I really wonder about these nursing homes. What ever happened to basic nursing care?

Don't you love it? Sometimes I truly feel the the docs and I are seeing different pts. It never fails, the pt tells the doc one thing and then proceeds to tell me a completely different story.

I LOVE retained objects too!!!! We've had a couple of good ones. One of my favorites was an 18 year old girl with a vibrator stuck in her rectum. The best part was that it was still turned on so when I tried to listen for bowel sounds all I could hear was BBZZZZZZZZZZZZZZZ. Then there was the man with a cucumber stuck up there. Apparently his girlfriend put it in there and couldn't get it out. He ended up with a colostomy! Sucks for him!!!

I love these pts. I think my favorites are the ones who call EMS for Nausea and vomiting for 2 hours and then have their wife/husband/sibling, etc. follow the ambulance. Really? That just makes me crazy!!! But I love the ER and can't imagine doing anything else. And let's be honest, as rewarding as saving the truly emergent, truly critical pt is for all of us ER adrenaline junkies, stupidity is our job security.

Ugh! Absolutely awful feeling! I learned the hard way on my 3rd day working as an RN to ALWAYS, ALWAYS, ALWAYS wear gloves when handling NTP Never made that mistake again...

We've had 2 recently that were ridiculous. The first was a pt via EMS sent by nursing home because pt is refusing to take meds for 1 day. This was a 98 yo female, alert and appropriate with very mild dementia. I called the nursing home to ask why they thought this was an appropriate reason to send a pt to the ED. The nurse started rambling on about how the pt won't take her meds. I asked her what she thought we could do about this. I asked her if she thought I should tie the pt down and force meds down her throat. The woman is 98! If she doesn't want her meds, let her be!! The other was also a nursing home pt brought via ambulance for bradycardia. The nursing home reported that her HR was 48. After speaking to her nurse at the nursing home I discovered that the pts baseline HR is about 55. and she took the pt's pulse after giving the pt her morning does of dig (I did mention that you're supposed to get the pulse BEFORE you give the dig, not after, and it's supposed to be be an apical pulse, to which she replied "What?"). The nurse also told me that she was concerned because the pt was tired when she woke her up. REALLY???!!! I have to wonder where they find some of these nurses that work in nursing homes. Nothing against nurses who work in nursing hones, Needless to say, we sent her back to the nursing home.

At my facility, I do not need an order for an IVL.

What about a D-Dimer?

This is the policy at my hospital. I have never EVER seen contrast dye injected through an EJ/IJ. A 20g is acceptable. I tend to put 18's in everybody (if I can), but I've never had a 20g in the the AC turned away for a CTA of the chest. I don't know where you work, by which I mean what state, but where I work we are not allowed to push contrast. It is not within my scope of practice. I work in NY. I know we cannot do this in NY because we have a particular ED doc who always tries to get us to administer contrast dye. She always asks us to do it when she doesn't feel like going to CT to do it and the house PA/NP is unavailable, and we always tell her we can't. She was giving us a really hard time, so we went to the NYS BON and got it in writing.

Ugh. So nasty. I actually put an NGT in a pt last night who hadn't had a BM in 12 days (HELLO?! 12 days???). I got out about 4 liters of stool in just under 30 minutes. :barf01:

Yes Legz, 6 and then 12, not all at once.

You guys are absolutely right. My bad I was confusing the cardizem and the adenosine (as far as IVP time, not action). Maybe that's a sign that I should go to bed. I did just work 14 hours and I probably should be sleeping not on the computer. But I'm glad to see you guys are paying attention!

I have edited this post. Please refer to my later post, since I made an error and everyone yelled at me.

This is true also. Sometimes it takes multiple doses to convert the pt back to sinus. We have a lady who comes into my ED periodically and she always needs 18mg of Adenosine to convert. She knows it too. The first time I triaged her, she walked up to my triage and window and said "I'm in SVT and I need 18mg of Adenosine to convert." We all thought she was a kook, but she was absolutely right. Now we see her coming and we get out the correct dose for her, give it to her and send her on her way.

No. It's not supposed to "stop" the heart. I've administered Adenosine numerous times and have not ever had a problem. I've seen people have a pause during administration, but a very brief pause, before the pt converts back to a sinus rhythm. I have never personally given Cardizem given for SVT, only to pts for rapid Afib, at least in the ED. Adenosine acts on the AV node, so it is the drug of choice for SVT, unless the pt has contraindications. As an emergency RN, I've seen a LOT of people get Adenosine. It's very effective when given for SVT. I can't speak to the feeling of pulling out the body or the limb pain, as I've never been given Adenosine, nor have I ever had a pt describe those feelings to me.

Eyeballs. I HATE them!!! I can't even do an eyeflush without gagging. Something about those gelatinous, squishy globes makes me want to puke. I can take anything else, but eyeballs do me in. Limbs hanging off, guts falling out? No problems, bring it on! But please, keep your squishy eyeballs to yourself!!! A close second: The time I put a foley in a little old lady and got pus out. Literally. Straight pus. Gelatinous, thick, white pus. UGH:barf02: Maybe it's the gelatinous thing. I'm starting to see a pattern...

We had a great one the other night! Young adult female, chief complaint: Bloody nose after "cleaning nostril with finger" (Her words, not mine). And I triaged her. It took everything in me to keep a straight face. We had another one a few months ago. Middle-aged male, EXTREMELY odd. The conversation went like this. Me: What brings you to the ED tonight? Pt: I can't sleep. Me: How long have you been unable to sleep? Pt: 20 YEARS!!! He went to one of our psych rooms that has a camera. He gave a urine for a Utox, and he changed into a gown. We could see him on the camera and he was dancing around in his bright red bikini underpants before he put the gown on. He had a little necklace on that he kept putting up to his nose. Didn't think too much of it until the Utox results came back. + for cocaine. Um sir, I think we figured out why you can't sleep. And really? Snorting coke in the ED? Not cool.

That's seems very strange to me! First, in my ED it is not the policy to place Foleys or straight cath pts with a + UCG. Second, why would any facility promote catheterizing a pt unless ABSOLUTELY necessary? Not best practice by any means. No matter how careful you are, there is always a chance of a UTI with any catheterization. Why would we put the pt at risk without a damn good reason, ESPECIALLY a pregnant pt? I don't like that policy at all. I agree, the focus should be educating the pt regarding how to do a clean catch. Also, I can't imagine the Joint Commission would agree that unnecessarily catheterizing a pt simply because she has a + UCG is best practice, or in line with all known evidence-based practice regarding infection prevention.

We had a good one just last week. A 55yo F called the ambulance about 2300. When she got to the ED this is what she told anyone who would listen "I had a big fight with my neighbor today and I figured if I was taken away in an ambulance he would feel very bad. I want him to feel very bad. Now I'm sure he does."

AMEN!!! Also, I too check everything for myself when I get a pt from EMS. This has absolutely NOTHING to do with me not believing the EMT or questioning their skills and/or abilities. I need to see and hear everything for myself so that when things change or the pt is crapping out, I can tell the doc what's different. I can just see it if I didn't do that and the doc asked me what the pt was like when he/she came in. "Well Dr. so and so, I don't know because I didn't listen to the pts lungs myself, but EMS said she had some rhonchi on the left side." That would go over well. I think everybody needs to toughen up a little bit. Me doing my job should not be taken as a personal insult to the EMT.