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Pudnluv ASN, RN

ED
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Pudnluv has 20 years experience as a ASN, RN and specializes in ED.

Pudnluv's Latest Activity

  1. Pudnluv

    Burn Nursing

    God bless you burn nurses! I know I couldn't do it and I am glad you are there.
  2. Pudnluv

    "Your ER sucks!" and other pleasantries...how you handle them?

    We were intubating a pt the other night and the pt on the other side of the curtain was complaining that no one had been in to see him. When his wife told me they were going to leave, i replied, "so leave". I told her it was absolutely her right to leave if she wished and that we were not going to hold them hostage. She told me they were upset that no one had been in to see them (EKG was done, IV inserted and pt placed on monitor at time of arrival). I explained that non breathing pts had priority over pts who could breathe well enough to complain. I don't remember if they left or not. Also had a family member who kept complaining to other staff members that no one had been in their room all night. This was after I had spent a good 10 or 15 minutes in the room for the umpteenth time. I confronted him directly and all he could do is stutter. I tend to get a bit crabby at about hour 10 of my 12 hour shift.
  3. Pudnluv

    Share your unit's new Ebola protocol

    We do much the same. As one of the designated "Ebola" hospitals in my state, our guidelines exceed the CDC guidelines. We have a special room (negative pressure) for the patients and we have converted another room for doffing. We use three people for both donning and doffing, one to get in and out of the gear, one to assist and one to observe. We have added a cowl to our gear and an outside waterproof gown. No skin is left uncovered. We are also limited in the time spent with the patient (no more than 20 minutes, I believe). We started working on Ebola preparedness a couple of months ago and now have mandatory training every 30 days. I feel much more confident with all the precautions we are now taking.
  4. Pudnluv

    Drug-seeking in prison? Rx narcotics?

    I just tell them flat out that we do not give narcotics. I also tell them that people with chronic pain will NEVER have a pain level of zero. That is an unrealistic goal and taking more and more narcotics, will only exacerbate the problem. Then I ask them, knowing your pain level will never be zero, how much pain can you live with and still function? If you are up, walking, talking, playing basketball and working, then you are living with your pain. I find that the people who really do have chronic pain conditions are more willing to try alternative methods. The bull*******s will just continue to ask for narcotics.
  5. Pudnluv

    Negligence in correctional nursing

    The photo Huffington has was clearly taken before all the toes were gone. The picture in the Denver Post shows all the toes on the right foot have been removed. We only see one side of the story, but from what I can see, there is clearly negligence involved. I've been in corrections for about a year now (part time, I work full time in the ED) and here are some things I see in my facility...... 1. Hiring new grads with poor assessment skills. I'm not saying they are bad nurses, they just lack experience and I have seen many develop really good skills as they gained experience. 2. Sick call slips not answered in a timely manner and lack of prioritization in answering the slips. 3. Medical records staff pulling inmates off the schedule to be seen in clinic. (This one really ticks me off). 4. Not having the proper equipment. 5. Having to pull teeth to get someone sent out to the ED. Personally, if I had seen someone with bleeding toes and necrosis, I would have sent him out. Sometimes it's better to beg forgiveness than ask permission. I'm sure that not all facilities are like that, but as with anything, there is good and there is bad.
  6. I would think they would tread carefully. They have already been found guilty of unfair labor practice. The last thing they would need to is a suit claiming a hostile work environment.
  7. There is no nursing shortage and there hasn't been one in years. There is however, a staffing shortage. Hospitals are cutting back on staffing, so more and more nurses are working short staffed. Adding to that is that the patients being admitted are sicker and sicker as admission guidelines are changing, and only the sickest people get admitted. Health care has become more about the bottom line than patient care. Go online, look in the paper, you will see quite a few job openings for nurses. Actually apply to those jobs and many will be told that they are not hiring right now. Hospitals use this ploy to perpetuate the myth of the nursing shortage to justify the continuing practice of short staffing. Talk to hiring managers. They will tell you how many times they have to jump through hoops to get a position filled. Many hospitals are enacting hiring freezes, wage freezes and are even laying off nurses. Back during the time of the real nursing shortage, a nurse could pick up the phone, call a nurse manager and boom! land a job. There were sign on bonuses and job fairs every week. Didn't like the job you were in? No problem, you could get a new one and be working within the week. This is not the case any more. Competition is fierce. Many are on the job hunt for months at a time. Many new grads are struggling to find that first job. It is definitely not what it once was. Nursing is a great profession if that is what you want to do. But the days of going into nursing because it was a guaranteed job and big money are long gone. Nursing has become like so many other professions. With so many hospitals trying to cut back on spending, nursing is the first to go. With so many new nurses out there vying for the same positions, hospitals are in a position to offer lower wages. Eventually the nursing shortage will come around again (it always does), but don't be fooled, it is not happening today.
  8. Pudnluv

    Correctional Nursing Pros/Con and Environment

    In the jail, I am surrounded by correctional officers. Inmate movement is monitored and boundaries are clearly established. Also, every inmate is searched before entering (although I am sure some get away with contraband). In the ER, people just come in from the street. They are patients first. They are not searched at the door and we are not accompanied by security when we go into rooms. As we are dealing with patients, we must be careful not to offend. Certainly boundaries can and should be established, but not in such a way as to offend the patient. I am sure that violence against nurses occurs in corrections also. It occurs in every aspect of nursing. It just seems to me that corrections has a few more safeguards to prevent it. I'm still loving the ER though. And loving my jail time.
  9. Pudnluv

    Correctional Nursing Pros/Con and Environment

    I have been a RN for 20 years and have worked in various settings. After spending 11 years doing med/surg/telemetry, I moved to the ED, which I absolutely love. Recently, I decided to take a part time job at the county jail (I still work in the ED), and I love it. In some ways it is like a breath of fresh air. I see many of the same people that I see at in ER, but usually they are a little better behaved in the jail setting. I don't have to worry about press ganey scores if I say the "wrong" thing. I am a big stickler on boundaries and personal space, and I am able to make it perfectly clear without worrying about offending anyone. Also, we have had a rash of violence against nurse in the ER, and so far, it appears to be a bit safer at the jail (sees ironic, doesn't it). I also find that there is less physical stuff at the jail, and at this point in my career that is a plus. It is nice to go home in the evening without that horrible feeling of frustration that the happens when I work at the ER. I'm not quite ready to give up the ER just yet, but I can see me making a move to full time corrections in the future.
  10. Pudnluv

    What to do with a head banger?

    I know in our ER we have had inmates come in due to mental health issues. If they are having a psychotic break, this is a mental health emergency and should be evaluated by a medical professional. There have also been a couple of times we have had to admit these patients to our mental health ward to get their medications under control. When they are discharge, the sheriff is called and they are escorted back to the jail. If you are truly concerned about the headbanger, send him out. Say you want him evaluated for a head injury (which is reasonable). When he gets to the ED, they will medicate him and/or restrain him. Once he has calmed down, he will be sent back. At least this will take the burden off you, especially if he has the potential to seriously injure himself.
  11. Pudnluv

    Seizures real vs fake

    I just started working in corrections, but still have my job in the ED. We get a lot of fake seizures in the ED. One thing I usually find, is that the fake seizures are usually preceded by some comment like," if I don't get my pain med, xanax, ect, I will have a seizure." Then lo and behold, when we tell the patient they are not getting the meds, voila! seizure! One night I had I had a young girl tell me if she didn't get her morphine dose, she would seize. I left the room only to be called back by the tech and sure enough, she was flopping on the bed, eyes rolled back. I called another nurse in (he also works in corrections) and very loudly asked him how to perform the "Oklahoma Seizure Test". He responded back, while doing it, that if you rub the instep of the left foot, the right arm will jerk. Interestingly, we got just that response from the young lady. Needless to say, she did not receive any pain meds and was discharged home. Later that night, I had another young lady do the same thing. She was actually not the patient, but a visitor of the patient. She would have her seizure,and her girlfriend would coddle and coo all over her. She passed the Oklahoma seizure test also. Then whenever I tried to discharge her, she would do the staring blankly at the wall and become unresponsive. I finally got tired of it and used an ammonia capsule. Not only did she become fully responsive, she jumped back about 3 feet (she previously state she couldn't walk), yelled "***", grabbed her coat and ran our the room.
  12. We have hospitalists that come down and do the admission for all patients. Once the patient gets to the ICU, the ICU doc takes over. So it is up to the hospitalist to make the initial determination, although the ED doc usually is the one to make the recommendation when he/she first calls the hospitalist. Also, sometimes it is floor policy that determines where the patient will go. In the case of the OP, the floor would be well within their right to refuse accepting that patient. I've been in that situation where I felt my patient should go to the ICU, but the doc insists that the patient can go to the floor. I gently let him know that if the patient goes to the floor, the floor will surely call a rapid response and then the doc will have to go running to the floor and the patient will end up in the ICU anyways. This usually gets them to change their mind, especially when they see it happen.
  13. Pudnluv

    Pregnant woman removed from life support?

    It is sad to think that women in these situations are merely human incubators. I agree, it is a very gray area. Would it be more acceptable if she were 35 weeks pregnant and the life support would only be to keep her alive long enough to deliver the baby? At 14 weeks, she has a long way to go to viability. I know from the example I gave before, my son's friend's mother was delivered at 8 months because her body was finally just wearing out. She had been on life support for four months. It would be a double tragedy if the baby is born stillborn or with severe neurological deficits. How sad for the family.
  14. Pudnluv

    Pregnant woman removed from life support?

    This is very sad. It is kind of creepy that these states are looking at these women as nothing more than incubators and ignoring their wishes. On a side note, my son has a friend whose mother had a brain aneurysm when she was 4 months pregnant. This was 21 years ago. She was kept alive on life support even though she had no brain activity and when she was 8 months pregnant, her son was delivered by C-section. The baby survived and 21 years later he is doing well.
  15. I live in one of the snowiest places in the country. There are only really two times that I can remember where everything was completely shut down and the roads were impassable. Both these times were times where several feet of snow fell in just a few hours. I can remember driving to work when the snow fall was 5 inches an hour. Pretty much everyone makes it in to work during these times. We certainly don't begrudge any nurse who takes their time in these conditions and we are more than willing to stay until they make it in. In the event that we cannot leave, the hospital always provides a bed, shower, and clean pair of scrubs. That is just the way of life in my neck of the woods.
  16. Pudnluv

    Sick

    Everyone makes mistakes. No one was harmed. All you can do is learn from this. I am willing that you will become a "house expert" on the use of the pumps and blood administration. Don't lose sleep, just don't do it again.