wildlaurel

I don't think most hospitals consider BSN vs ADN when setting the hourly rate. I've heard that Duke is now starting new grads out at $25/hour. I was surprised by that because they used to be the lowest paying hospital in that part of the state!

You don't say you hate nursing or caring for patients...you hate the hours, the place, the people...You will most likely not find your dream job right out of school, but you might find one that is a little more compatible with your lifestyle in terms of hours and working conditions. As long as you don't "hate" caring for patients - I think it's the environment/situation more than the career. The other thing to keep in mind, many people feel depressed and tired when they first work night shift - especially when they're trying to balance a day life as well. This might be part of what you're experiencing right now. Good luck with everything!

I agree with several of the other posts, call RT - get them to assess the patient. If the patient had a hx of COPD - you have to be careful about over oxygenating. Go to the EDP and say, "I'm really concerned about this patient and need you to come assess her again." A central line would have been called for if she was septic or had poor vascular access. I'm not so sure you could have gotten anything beyond a 22 in someone like that - she was probably vasoconstricted if her H&H was that low...so don't beat yourself up about that. Nursing - all nursing, but especially ED nursing - is a team sport! You're not a marathon runner out there by yourself. You could also call your charge nurse and tell them you need help. I've been an ED nurse for 4 years now and I sometimes still call someone more experienced than me and say, "I need a nurse who's been doing this longer than me." Ativan would have calmed the pt some - she was probably oxygen starved and that is a scary feeling.

I had a lady take an ambulance to our ED at 2 am once because she didn't get her piece of fruit before bedtime...because nobody was home to give her "care and comfort." I wanted to give her a fruit cup and send her home - the EDP wanted to work her up for a CVA!

Hello, We're getting ready to implement the use of pharmacy techs in our ED with ALL patients. We already have techs who come in and verify meds on patients being admitted, but we'll soon have techs doing all patient meds. We're having conversations about the best way to have this flow...do the techs come to triage and do it, does the nurse do triage, then tell the tech...We'll only have 2 techs in a 60 bed ED... So, do any of y'all use pharmacy techs or people to do med recs separate from triage? If so, what is your flow?

Yeah - there was no reasoning with this patient - they were completely psychotic. Those people just scare me - I can take a mean drunk or a manipulative personality disorder - but psychotic people just cannot be reasoned with.

I would like to hear about how various ED's handle violent patients (psychotic - not a patient you can reason with) in the ED? A patient who became so out of control that one of their family members was injured (by the patient) and a nurse was injured trying to get the family member away from the patient. A patient who was so out of control that after being tazed by the police 3 times they took the police's tazer away and finally went down after being wrestled to the ground by 8 or 9 people. It is such an unsafe situation for the patient, other patients, staff and the police!! I have never been so afraid at work until I saw this because I was afraid the patient was going to get a gun away from one of the officers. So, how do other ED's handle this kind of situation? The patient will be with us for a while because the aggressive behavior makes it difficult to find placement.

I have passed out one time - in nursing school in the OR...and I knew it was coming, so I got to a wall and just slid down into a sitting position! The worst fainting episode I've ever heard was a patient who'd just been discharged and was at the discharge window. I was around the corner at the nurses' station and heard this sickening thud...the cashier said the patient's eyes had kind of rolled back, and then she just fell! Poor woman!

When I was studying for the NCLEX I read in several places not to study the day before - relax, see a movie - just let yourself come down from the studying! That's what I did pretty much. I made some flash cards with lab values and things like that and glanced at them the morning of, but other than that, I studied right up 'til the day before and then I put it down! Good Luck!! Be prepared - the NCLEX is like no other test you've ever taken - but it is passable. When I was taking it I thought, "I don't know any of this!" but I passed in 75 questions. You know it, just be calm, call on what you know and you'll be fine!

Thank you guys! I did document on it, but I guess my main question was - do you confront the lying? With the patient who said she'd called out for 30 minutes I finally said, "I'm really concerned that you aren't happy with your care and I'm sorry about that because I've tried really hard to take good care of you today." Then she was all, "Oh, you haven't done anything to me, you're a good nurse honey, don't worry about it!" I just get so frustrated with the manipulation and craziness of some folks and it seems like I've had more and more of these patients in the last month! I hope it's just the heat and they'll get better. Of course, I do need to constantly assess my own behavior and make sure I'm not doing something to provoke the complaints - I realize that too!

Oh, by the way, I'm an ED nurse!

I have had a recent spate of plain old rude, manipulative patients. I can ignore rude behavior, but it amazes me when people lie to/about me. For instance, the other day a patient called out for assistance to the BSC. I was charting and a tech immediately got up and went into the patient's room. I came in about 5 minutes later. The patient said, "I've been calling out for 30 minutes and nobody came in here." I had been in and out of the nursing station and in the room next to the patient's during that time and never heard her call out. I asked the secretary about it and she said that was the first time the patient had called out. So, I told the patient that I didn't think she'd called out for 30 minutes and if she had, I certainly hadn't been made aware of it. The patient insisted she had called out for half an hour....and I know she HADN'T!! I had another patient who would call the hospital operator and say nobody was helping her instead of calling out with her call bell. I noticed several times when I went in the room the patient would be on the phone and say into the phone, "She's here," and hang up. I thought that was weird...The operator finally called our secretary and told her the patient was calling her and when I asked the patient about it she said, "I didn't know how else to get help." I said, "I gave you the call bell and explained how to use it and I've been in and out of this room every half hour. If you need help, calling the operator isn't the way to go." I just get so frustrated with these patients! It seems as though they're just looking for a way to get staff in trouble or make it seem as though they aren't being cared for. What do y'all do about patients like this? My fear is that these patients will complain that I didn't take care of them and I'll get in trouble.

We have a 4:1 ratio on acute side and it can be 6:1 in Fast Track. There are times though when we may be short-staffed or really busy and we'll have to go up by a patient or two. That is pretty unusual though thank goodness.

In my ED we don't call Code Blues when we have a pt arrest or a CPR in progress come in. ED staff handles all codes in our department. If there is a Code Blue called anywhere else in the hospital, one of our docs responds with one of our EMT's and the rapid response team also responds - but none of those are ED nurses. The ED charge nurse does respond with the EDP if a code blue is called in a off-unit area (e.g., lobby or CT scan). The RRT also responds in that situation as well.

Thank you! I'll try to figure out how to post in that forum!