lyraesullivan

Any of you that work in hospitals that don't require Doc's to do this may want to remind risk management of OSHA. The hospital I work at is pretty good but there were a couple bad apples. One ER doc.....I just smiled and told him that unless he wanted to be responsible for all of my future medical care and the cost of raising my children and maintaining my household then he should clean up his mess. I've never had a problem with him again, well at least about that

Can you say UNION? That will stop that nonsense

Welcome to the ER. Things I always tell my preceptees. 1. Give yourself a full year to adjust and feel comfortable. 2. Ask questions please, there is nothing more dangerous than trying to figure it out on your own. 3. If your work is caught up, help others, this is a team and we all help each other. 4. In a code, the patient is dead....you can't hurt them but anything you do may help them. Relax, take a deep breath and do one thing at a time. You will do fine. 5. Good charting is essential, ER nurses have a higher incidence of being involved in litigation. ER patients make more complaints to administration also, if the patient was cursing and spitting and assaulting you make sure you get that all down because they or their family will be calling your director tomorrow to tell them how badly the nurse treated them. Things that will make your patients love you: 1. Give them plenty of warm blankets and a pillow. ER carts are uncomfortable and ER's are cold. Both make being sick worse. Keep the sheets dry and unwrinkled, when you are sick and in pain those wrinkles feel like mount Everest. 2. Turn down the bright flourescents and do the best you can to keep the environment comfortable. 3. Keep them informed...."We are going to do some labs and an xray. The lab work takes about an hour, I will let you and the doctor know when everything is back." or "sorry about the wait, the doctor has been caught up with a critical patient and a trauma but everything is under control and he is looking at your stuff now." 4. address pain and nausea.

The thing about Press-Ganey is they only call a very small percentage of the patients so the odds are not really good if one or two of them were drug seekers that didn't get what they were looking for. It is sad that hospital administration place a lot of emphasis on this kind of nonsense. Instead of looking at the patient making the complaint and seeing that they visit the ER 14 times a month for back pain and have never yet made any attempt at paying their bill, they immediately censure the ER nurse. How about telling the pond scum that they are in the wrong and please do not ever darken our doorway again? I like the nurse that answered that she would get a motrin RX and then tear up the T3 RX. You are my kind of nurse!

Nowhere else do you have the variety. The staff is usually a pretty close knit team (not unlike combat troops!) We have a lot of autonomy and our docs are always right there. I made a foray to the ICU for a year and got floated out to the floor one night (YUCK) my patient started to crash so I gave a fluid bolus, got an EKG, drew some labs and gave the patient some oxygen. The charge nurse yelled at me for doing stuff without an order and the attending was rude and obnoxious until he realized who I was and then he thanked me. It was a pretty big shock because I am used to being part of the team.

"my toa is mest up" (Broken toe)

HAHA! Most of the docs I know haven't even mastered the telephone;)

I don't hold on to patients til the end of the shift just to annoy the floors, but I think we have already covered the myriad reasons why that happens. what gets me is the floor refusing to take a patient at change of shift, does all nursing care come to a halt because of report? Of course not. There is no reason the patient can't go up to a bed, get greated by a nurse, quick set of VS and tucked in until the next shift comes out of report. Don't tell me that this can't happen because I have worked the floor and ICU and that is exactly what we did. Please remember why we are here, to take care of patients. They are our customers and we have to treat them well or they will vote with their feet. Good customer service is not keeping them laying on a hard uncomfortable ER cart in a noisy chaotic ER. Would you want to be in that environment if you were sick? Good customer service is having someone from the floor in the room to great the patient and make them feel welcome. Have the furniture moved and the bed turned down. The patients see these things (or lack of them) and it makes them feel welcomed. Think about how you would want your mother/father/etc treated if they were in the ER and needing admit or sitting sick in the lobby because there was no open bed in the ER to lay down on. We are all busy and overwhelmed, no one place more than another but remember, the ER is the front door to the hospital. The ER I work in brings in 60% of the hospitals admits. Without those admissions we'd all be out of a job!

The most interesting thing, have never encountered and now have had it happen twice in recent events. What? Trying to cath a little old post-menopausal woman and not being able to find the urethra anywhere and found it behind the pubic bone in the lady parts! slide the index finger of the non cath hand over the pubic bone and slightly into the lady parts and you will feel a circular dimple. Use a coude catheter and insert it around the pubic bone and up into the meatus. The second lady was very difficult, very atrophied with an opening in the labia less than the size of a quarter it took two of us, one nurse located the meatus with a sterile gloved hand and left the index finger just under the meatus for the second nurse to use as a guide to insert the catheter. I don't know about you, but I they never told me in nursing school that you'd find the darn thing there! Anyone else have any handy tricks or tips?

I've always felt that if you need to go to the BR more than once and it requires my interventions then foley it is;)

funny you should bring this up, recently we had a patient that drove 45 miles and passed up three closer hospitals to come and see us, red flag # 1 right there and despite being told several times no pain med until a ride is there (yes the Dr. did prescribe Dilaudid despite us obtaining a visit history from one of the other hospitals and ER records there raising the question of drug seeking -***?)spent a good hour trying to get every nurse that came by to medicate her and ultimately ended up leaving in a huff. She will be the one they call to get the press ganey score for this month.:angryfire in the last year we had to have someone arrested in the parking lot because she snuck out and ran into another car in the parking lot. That makes for a lot of entertainment for the people in the waiting room. We had another guy swear his wife was driving (luckily it was documented several times that he had been duly instructed blah blah blah) and then left and dozed off and rear ended another car 4 miles away from the hospital and the icing on the cake was a disabled Highway patrol officer that told me his ride was waiting in the car - oh really sir? You want me to believe that you have someone waiting in the parking lot in a car when it is 117 degrees outside? Nice try. Oh yeah, almost forgot about the one that drug in some stranger from the lobby who was too scared to say otherwise and declared that her ride was there - all for one vicodin. Pathetic. Our policy now is no ride? No meds. If you need to have a ride you either have it with you or you get sent back out to the lobby to find one and then we will put you in the next available room. If two patients come together neither one gets narcotics (except in certain cases but we've been burned on this one before) The sad thing is how little the doctors back us up on this

How about "staff infeksion" caused no doubt by the local killer spiders;)