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.

Jump in with both feet, ask to do anything and everything you can.

I want to start off by saying that you should feel a little uncomfortable about this since it is going to be something your ER has not tried yet. But, I believe based on what I have seen first hand from the paramedic curriculum, that any well educated and well experienced paramedic should be able to do the job at triage just fine. Medics learn about all the worst case scenarios in class, even from the beginning in their EMT-B class. They are taught when to "load and go" or "stay and play" which can translate to a sudden onset chest pain that walks in that any nurse would take back to a room right away vs a abdominal pain x 3 weeks that can afford to wait a little longer. Our ER Techs are Medics/EMT-B's, and sometimes when we are really short we have them in triage alone. They do a great job and we have never had a problem with them. Just last week we had a one of them rush back with a chest pain, he did the ECG and saw the ST elevation x 3, he yelled for a doc and had a clerk put orders in, got blood and sent it down all before a nurse ever stepped in (we were real busy plus he is very good/fast and *only* a EMT-B). My point: If it is properly implemented, with the right people, it can work out great. But when it comes to liability and negligence issues, that I don't know about.

Unless you want to thank the Charge RN also, don't bother, sending letters to everyone else you listed should work just fine. Thank you letters are awesome, it is a nice reminder as to why we do this job. Edit:Also, I love the non-latex balloons!

The place I use to work at had doors slam shut and the sound of footsteps when no one was around, but the freakiest of all was the sound of children laughing over the intercom system.

We usually have several nurses pregnant at the same time, I think some kind of pregnancy rotation has been set up. As other have said, most of them work till their due date if they are physically able to and are cleared by their doctor. But we also have some that have not been able to, and there is absolutely no shame in that, every pregnancy is different, and believe me that your coworkers will understand. You should get lots of help with your daily pushing and pulling tasks without asking for it. Hell, I sometimes get a little overzealous with it...but I have never heard a complaint so I will continue to do so.

1. Pt. talking on the phone while I am trying to triage, assess, or discharge. I tell them they can either get off the phone or they can wait till I am done with the next patient or anything else that pops up. They put down the phone right away. 2. To many patients family members in room- can't barely get to the patient. (Even though there is a sign stating 1 visitor per pt.) Usually start off with reminding them that we only allow 2 visitors per room (I am trying to reduce it to 1 visitor), and kindly ask them to thin their numbers. Most of the time, I don't care, but if the visitors get loud or needy, I ask them to leave. Our people in the front desk are great about calling back and seeing if there are already visitors in a room. Also, in situations like chest pains, the front desk/triage asks all "visitors" to stay in the waiting room until we are done with the line, labs, ecg, and chest x. After that, visitors are more than welcome, even if it is over the allowed number. 3. Pt's or thier family members standing in the doorway/hallways listening to everything at the nurses station, staring the doctors/nurses down being impatient. Like others have said, I tell them to stay in the room or they can go to the waiting room due to patient privacy laws. 4. How long is the wait today? Do you tell the pt's it is going to be several hours?? I do try and give a number, based on their triage acuity and longest current wait time I try to estimate. But I always say that it can be longer, especially if ambulances come in with really sick patients. I usually overestimate by at least 20 min. 5. The patient that is on their call light every few min. for stupid things. First couple times, I answer. I even bring in blankets and pillows to make them comfortable which sometimes stops the constant buzzing. If this does not work, I take the button away or disable it. (I have done this very few times, never with a critical patient.) 6. The family member that rings the call light constantly to adjust mom's pillow, feed her, fix the blanket, get water etc. I tell the family members that they can do simple things themselves and show them where the food and water is only if the patient can eat/drink. 7. "I had to wait here 6 hours last time and you (the ER) didn't do a *@#! thing and it better not be like that this time" 8. Little kids running around the ER, in the room even though there is a sign at the door stating no visitors under 12. 9. Family members, friends, cousins, etc all calling for the same patient, we don't have phones in the rooms and this is very time consuming and then when you ask to have one person designated to call they get nasty or state- I don't have that phone number and can't get it unless I talk to ---(the pt). or worse- you have 50 people calling to "give messages" to the patient. HELP! We have phones in the rooms, so I have not had this problem. I would follow other peoples advice. A common thing I hear, especially in triage is something like "Why are people going before me? I was here first." I simply explain that while we do bring people in back based on first come first serve, we still need to cut people to the front if they need immediate life saving attention. I never ever ever ever ever ever say things like "because that patient complained of chest pain so he needs to go back first." If I did, I am afraid everyone in the waiting room would have a sudden onset. I believe in being direct and explaining why. It usually solves all problems the first time.

Patient had a huge plastic bag that he liked to put his entire body into, attach it to a vacuum, lie on his bed face down and insert his manhood into a hole in the mattress. EMS called him in as a DOA.

"I have never had to unbuckle a fatality, but every wreck where the occupant was ejected was a fatality." Officer from the Major Accidents Unit

The best thing I have ever heard from one of our docs when ordering something out of protocol is, "Be prepared to explain why." She was helping one of the new nurses who had questions about what to order and why when she said this. Basically, what the entire conversation revolved around was order things for a reason. I don't think I am doing the conversation justice, I am probably leaving some things out. It was very enlightening. Even some of our more experienced techs order things (for the obvious stuff, chest pains, etc.) We have never had a problem. Anyway, I registered just to post this, so, hello everyone.