Displaced

Do ask questions! Frequently!

We have had a couple, with serious injuries, in the last couple weeks.

Wikipedia has some nice basic information. Scroll down to the clinical lead groups section. http://en.wikipedia.org/wiki/Electrocardiogram You could also look in your hospital library for a book on it.

I love the look patients get when we tell them we have stopped testing for swine flu. I also love the doc offices who send them to us for swine flu testing after we have told them we no longer do it.

I have flown to many hospitals around my area that use medics for the RN role. I always saw them in the more rural areas, never in more populated places. Even in Aeromedical you have RN and Medic switch off who is primary on every other flight. I know there will forever be a Rn vs. Medic debate here, for many reasons, but we can't forget where nursing started, where it is now and best of all, where it is going. You now have Docs worried about nurses taking their jobs and I don't think it will be too long before Medics unite/come together and start challenging some of the nursing positions. It all comes down to education and competency.

No. Nurses also follow protocols/rules/policies. You say tomato, I say tomato. Yes, nurses can address a wider spectrum of care, but in triage, deciding if the patient is going to die now, later or eventually due to anything but the chief complaint is something both can do.

Up until a couple days ago managers were asking who wanted to go home early, but now that we are very busy and we actually do want to go home, they have stopped asking.

Recently, I had to get a BP on a small kid because of an amphetamine ingestion. That was a pain in the ass. Most of the time we don't bother, unless requested by the doc.

I hate to say it, but you might be better off not saying anything at all, or just thanking the person after your question is answered. You could also just be clear with your preceptor from the beginning and tell them to expect a lot of questions, even stupid questions, because you want to learn so you can be a great nurse when you get off orientation. Any kind of "attitude" from you could cause trouble down the road.

When I worked as a tech, I told new nurses to stop asking me if I had enough time to do something, and just tell me to do it. I am also the same person that would defend them from the ICU nurse attacks.... Nurse: Hey [my name], if you have a enough time or a spare moment can you please do an EKG on the chest pain, SOB, diaphoretic and hx of MI in Room 2? Me: Yes, but next time please feel free to tell me to stop what I am doing and get my ass into room 2 now.

When a patient is put in a room, a carbon copy of the triage note is placed in a rack and the actual chart is placed on a counter near the patient's room. Our rack is labeled with two big stickers that say, FIRST (on the right side) and LAST (on the left side). The carbon copies are placed in the rack by order, but if needed patients can be bumped ahead. We always leave the first spot empty for patients that need to be bumped ahead. As we start to get near the end of the rack, the copies are all moved forward to make more room for future patients. If we run out of room, we just start doubling up in rack spaces. We use a 5 level triage system, level 1 are not put in the rack, a doc sees them right away, 2s are bumped ahead most of the time, 3-5s wait their turn.

Bombard the physicians. This is what they have trained and studied for. I would hate to have some one waiting in triage who goes into an arrhythmia because their ECG looked like sinus but actually showed Brugada. I know, very rare, and I HATE writing that, but in the ER, we have to think of worst case scenarios. To ease the load on the ER docs, I have any Cardiologist floating around take a look. I have to constantly remind them that I am not looking for just abnormal (since many are), but for something that may kill the patient soon. We tried a no wait system for a few hours..... it was working until amount of patients coming in > amount of rooms available.

i guess it depends on where you go. our urgent care centers have the same protocols as our er.

Our triage area has 2 Nurses and 1 Tech. We have two methods depending on how many patients decide to walk in at the same time. The first and more relaxed method has the patient go to the registration area, give a little info, then into the triage room to be seen by the nurse. When patients come in by the bus load, one nurse goes up to the registration area and does a quick triage to decide where the patient will go next (straight back if we have room, to the second nurse, to the tech for an ECG or to the waiting room). The second nurse stays in one of the triage rooms where normal triage evaluation is done. The tech floats around doing ECGs/blood draws/vitals/bringing patients back/etc. We blast through the huge groups in minutes. We are able to bring carts up to the triage area, start IVs, give meds, use portable monitors hooked up to a central tele system which helps when the ER is in a gridlock.

We recently coded a patient on the ground in our entrance. We transfer 10+ to the main hospital ER daily, it is only 5 min away. We have a public education campaign that both advertises the urgent care centers and mentions what should be seen there. The public must see the ads since the urgent care centers are seeing increases in patients, but we can't get everyone to the proper location. Either way, they still get seen by ER staff anywhere they go, so even if they are having an MI there is no real waste of time. The urgent care center calls 911, then the ER to notify them of the patient and to activate the cath lab, and if the cath lab is ready before the patient gets there, they go straight there.