Daisy Doodle

I am currently challenged with this also. Decreased FTE's and a decreased Unit of Service per patient. I spoke with my staff immediately about all of the changes. We approached it together as a team. So far we realigned the schedule but have found that with the new UOS we are too lean. I am currenlty working on a presentation to lobby administration to increase the UOS.

We use an equal mix of mid-levels in Colorado. PA and NP's. In my ER the see both Fast-track (verticle 3's, 4' and 5's) Some of the more experienced MLP will go into the core of the ED and work up more acute patients and collaborate with the docs. I think its a great role. From my own expreience the PA's do have more procedural experience than the NP's but after a few years it equals out. I have see ED Bootcamps that teach suturing for example. I may just have to go that route.

There aren't any ED Fellowships in Colorado that I have found. Where are you located?

As a triage nurse I am looking at Stable or Unstable. Many people are living in chronic A-Fib. We do the best that we can with the resources at hand. It is all about perception and expectation. 15 minutes is equivalient to urgent treatment in my ED. I am not surprised by the positive outcome because that is what we do. We face multiple "sick" patients with multifaceted challenges. Had that patient showed any sign of instablility there would have been a gurney. Also going straight back to a bed does not equate being tended to immediately. My patients rountinly are direct bedded only to wait 45 minutes for my first opportunity to to complete a focused assesment. Welcome to healthcare, its only getting worse. We have seen a 7% increase in total patients every year since 2007. Do the math........ Our bed numbers remain the same and our staff is leaving.

In actuality, we start MANY drips in the ED. Dopamine, Dobutamine, Norepinephrine, Nitroglycerine, Amiodarone, Labetalol, Diltiazem, Epinephrine, Lidocaine, Integrilin, Heparin, Magnesium, Diprivan, Mannitol, and Nitroprusside just to name a few off the top of my head. I kept a running list of the drips as I hung them. Looked them up understood what their actions were and any special notes such as if they needed to have a filter for example, and an idea of what the starting doses are. Definately look them up, use your pumps, and a second person just to verify with you. Daisy

OP, How did you prepare for your CEN?

I have thought about it too. I just requested information from Creighton University. They have a RN to Paramedic program. It sounds interesting and I think I would have both a better picture of patient needs and a better appreciation of our prehospital staff. I have cared for many trauma patients but have not really ever seen an accident scene. I think I would be able to understand mechanisms of injury better. I think many times our prehospital staff is under-appreciated. I llok forward to hearing from others! Daisy

Definitely add your OCN! That knowledge and experience will serve you, your patients, and peers working with you. We see CA patients all of the time in the Emergency Department. We have an ocology nurse that just started with us and it has been so nice having her on shift because she makes the patients feel more comfortable because she knows the meds, diagnosis, and common problems. Every nurse that has come to us from different departments brings knowledge and experience to the table. I did NICU and people appreciate the experience! Daisy

I agree with Lunah, this is a common notion. I struggled with it when I got out of the military. I was FMF and when I got out of the military I worked as a CNA to get through nursing school. I notified many a nurse of subtle changes in a patients status that they had not noticed. The difference is, is that the Nursing approach to patient care is different than what we have been taught as Corpsman. As a Doc, I knew if "A" happened then I should do "C". In many cases I really didn't know the *rationale* as to why I was doing it. An example was if there was a blunt trauma to the head and the ICP increased to X amount- I was told to give mannitol as a pre-specified amount and complete neuro checks. I wasn't exactly clear as to what mannitol was or or the the exact A&P of it all. I don't think that one is better or more educated than the other. I have worked with many Outstanding Doc's and some dingy RN's and visa versa. Both groups fundamentally approach pt care differently.. Daisy

Ours is long and drawn out . We just jot it down on paper and then input it into the computer. Our old form was paper and we have now moved to computer. Not real handy and the learning curve has been steep Daisy

I too wanted to go back active duty. The recruiter told me that they only want "recent" critical care within one year. I have worked Emergency in the last two years, and the Navy does not cosider Emergency critical care, so they are not interested. I am a little dissapppointed. I am waiting to hear back from the recuriter to tell me what my rank would be if I go reserve.

I spoke with a Navy Recruiter today . Just waiting for a return call has taken three weeks. I have 6 years prior service and 9 years as an RN so I thought that I would at least have a chance getting back in. I have a honorable discharge, BSN, 3.9 GPA, working on my Masters and really want to get back in to serve my country. Today he told me that the Navy is being very picky right now and that I should send in a resume first before filling out the application. He said that they only want "experienced critical care" nurses right now. He wasn't sure if my prior critical care experience was recent enough or if the Navy even considered Emergency nursing as a specialty. I am going to send my resume to him so he can send it up to see if they are interested. He told me it could be another 3 weeks as his supervisor is on leave right now. Maybe my expectations are too high. When I enlisted I left 10 days after talking to the recruiter, LOL. Daisy

Right....I hear the whole AMA thing but our hospital is so focused on patient satisfaction. I feel so limited in what I can do. I take the heat from all directions. I have to hear it from the MD that they are not gowned and then our patient satisfaction letters come back with poor reveiws because we made the CP pt. wear o2 and get an IV. I feel like I almost have to beg them to let me start an IV and get labs. Its too exhausting. Isn't it just accepted that when you go to the hospital that you wear a gown and recieve basic aspects of care. What do I say to these patients. Daisy:banghead:

How do you deal with indignant patients that come to the Emergency Department asking for help and then refuse certain aspects of care. Lately, I have had numerous patients simply refuse to put on a patient gown, they simply do not want to be bothered by putting on a gown. Most of our physicians really want (demand) patients be in a gown no matter the chief complaint. Then the physician comes out of the room and says, "she not in a gown, I want them in a gown". I also have patients complaining of chest pain, so we start our chest pain protocol and then they say, no I won't wear this oxygen, no I don't want an IV, no I won't put on this gown, and why do I need an EKG. I sit there trying to reason with them, I explain the rationale, and I am getting to the point where I think, "hey you came HERE asking ME for help and now you are going pick and choose". I get the whole loss of control, anxiety, pain, and fear of coming to the ED. I assess for other reasons that a person may not want to don a gown but seriously........I would not go into a business and then pick and choose certain things to downright refuse to do, like refuse to sign paper work at the bank or wait in line. How do you deal with this. I have come to the point where it is beginning to frustrate me. What do you say?

Otessa, I understand exactly where you are coming from. Moved to a new town, just had twin boys, 3 months old. I have been off work for 7 months related to the pregnancy. I will be starting back to work in a new hospital, new specialty. This to help my poor husband who has been so supportive and working two jobs to get us through. The mom's at school , my older son 8 years old, have also looked at me slanted as they all stay home. I am almost beginning to question myself. Should I jump in this early? I was looking at working weekend nights.