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F.E.R.N.

F.E.R.N. BSN, RN

Trauma, Tele, Neuro, Med-Surg
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F.E.R.N. has 10 years experience as a BSN, RN and specializes in Trauma, Tele, Neuro, Med-Surg.

F.E.R.N.'s Latest Activity

  1. F.E.R.N.

    To give or not give insulin

    I can't speak to every BON and every state, but I agree that we are required to act in what we feel is the patient's best interest, and at some times, that certainly means questioning an order, or seeking a new order to cover a new status. At least in my state, the key is whether or not you consult the provider at the time you make the decision (unless you have orders to hold the medication under certain circumstances, "hold for SBP The reason I mentioned it, was that my facility did have problems with nurses holding meds without consultation. There were commonly held practices like "on this floor, we only give med X if the BP is Y," or "we don't give insulin to patients when NPO." There were usually good reasons motivating such practices, but no actual orders. Many times the docs didn't even know something was "common practice," and were quite surprised it was being done.
  2. F.E.R.N.

    To give or not give insulin

    Where I work, it is stressed that a nurse cannot legally hold or otherwise adjust any medications, including insulin, unless given specific parameters and instructions in the orders. If staff question giving a med as ordered, they are instructed to contact the prescriber with their concerns and get clarification or new orders. Some docs feel more strongly about this than others here. However, there was an instance of one threatening to report a nurse to the board for practicing outside their license when they held a BP med without consulting the doc.
  3. F.E.R.N.

    Equipment wish list suggestions

    Good suggestions. Even with the money there, sometimes we still have to answer the question from admin, "how often would you use that?" For many things, the answer is, " I don't know; we've never had one." If I had a Ferrari, I bet I'd find more places to drive!
  4. F.E.R.N.

    Equipment wish list suggestions

    It's all of med-surg,.
  5. F.E.R.N.

    Equipment wish list suggestions

    My staff education department has an unexpected windfall in our budget, giving us the opportunity to purchase additional educational equipment/supplies this year. I'd like your suggestions for items you've either used and loved, or things you always wanted. It could include books, training modules, mannequins, office equipment...whatever you found that made nurse education/development better. Thanks in advance to anyone who has ideas!
  6. F.E.R.N.

    Narcotic Administration in ER

    Not sure what else you had to say. If you think of something that is either helpful to nurses or to patients, people would probably read it.
  7. F.E.R.N.

    Narcotic Administration in ER

    I'm also curious about policies regarding monitoring of patients given narcs. We have an area that has no monitors, but where PAs like to give morphine and such (kind of a high-grade fast track route). I'm not comfortable giving mind- or VS-altering meds and then sending to a non-observed area (e.g., the waiting room) while labs cook. Anyone have policies about this?
  8. F.E.R.N.

    Stupidest comlaint of the night award...

    Oh how I wish that those bedside monitor readings could only be viewed by someone wearing special glasses! Maybe like the ones out of the cereal box that let you read messages written in the "invisible pencil" that came with them
  9. F.E.R.N.

    Stupidest comlaint of the night award...

    This was not a CHIEF complaint, but it was a complaint...Patient is resting comfortably, watching TV in bed, DC pending...man stomps out of the room to the nurses station and loudly asks, "Is anyone paying any attention to my wife's diastolic pressure?!" Um...no?
  10. Please don't whine. You can complain, ask for help, or tell me you're not ready for this next ambulance...but don't whine. When you get the problem patient, the next one that has to go in the hallway, the drunk, the trauma you don't feel ready for...whatever it is that scares you...it's okay to be nervous and you can share that with your preceptor/fellow nurses. Just don't whine about it. One behavior shows legitimate, sensible concern and awareness. The other makes us wonder why you came to the ER if you only wanted smooth sailing and easy patients. When you voice an honest concern, I'm likely to know just how you feel and help you cope. When you whine, I'm likely to wonder why you think you're the only one who doesn't have to work in the same conditions as the rest of us. I'm going to wonder why you wanted to be here. After all, you probably implied in your interview that you could handle anything the ER could throw at you...so by all means, ask questions, admit when you don't know something, but FAKE the confidence if you have to and HANDLE it.
  11. F.E.R.N.

    ICE " in case of emergency " apps worth it ?

    While I can't really speak for this individual ER, if it's any comfort, the tech is not usually the person who knows all that is going on with the patient. If you had ever been to that hospital before, they would probably have already pulled up relevant info on you from their computer system. I often know more about my patients than they do themselves if I have an H&P or even an face sheet from their last visit, be it for an admission or a sprained ankle. Even just looking at what outpatient labs they've had done through us gives me clues into what their medical history might be. If they drew any blood, they may have already gotten a blood sugar long before the tech was asked to get another one with a point-of-care monitor. I'm not saying that I *know* these things were done, just that it is often the case that a patient is not aware of all that is going into their care outside of the room. Either way, it's always good for people with significant medical conditions to have information in more than one place...medic alert bracelets, wallets, phones, records...anything available. You never can be sure where you'll be, under what circumstances when an emergency occurs.
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  13. F.E.R.N.

    ICE " in case of emergency " apps worth it ?

    I work in a regional level 3 TC, with many outlying rual areas and two major highways going through our town, brining in lots of out-of-towners...here's how things work in our area for unresponsive/confused patients: Our 1st responders generally don't have time to check for ICE, but if LE is on scene, someone has generally at least looked for an ID for the patient by the time they get to us. Once in our TC, someone, be it a nurse, chaplain or SW, will go through whatever belongings arrive with the patient. We first look for ID, so that we can see if they've ever been a patient at our facility before. If they have, bingo, we may have all the med hx we need on our computer files. Second, we look for a next-of-kin contact. If we found med hx on our computer, we may not contact next-of-kin for a while unless the patient is critical or deceased. If we have no hx, an outside family/friend contact becomes a more immediate need. We do try to contact someone, but it may be put on the back-burner until the patient is more stable. We also have to take into account the news we are delivering to a stranger however many miles away with a long drive ahead of them to reach us. We have used cell phones. But you have to remember that this is difficult if the person was in a wreck. I've had to clean the blood and mud off a phone before to see if it even works...often it doesn't, or us old nurses don't know how to use it. ICE is a great idea (I have it on my phone), but if you are traveling outside your home area or have people/animals depending on you on a daily basis, I would recommend keeping an emergency contact list updated in your wallet, too. Cell phones may land in the ditch, but your pants will come to the ER with you. As for service animals, I've never had one come to our ER, but we have had many patients come in who were traveling with pets when an emergency/accident happened. In our area, LE generally coordinates care of the animals. That may be with the local SPCA, or an officer may take an animal home. I would think they would check a service animals gear for info, but couldn't be sure.
  14. F.E.R.N.

    When patients attack

    Actually, in the ER, we often force people into treatments they don't want. Saw this many times on the neuro floor, too. If you are suicidal, for example, you are not given the choice to refuse a lavage if the doctor declares (1) you are trying to hurt yourself and (2) you need one as part of your medical care. For many patients, declining care or leaving AMA is not an option.
  15. F.E.R.N.

    When patients attack

    I've wondered that, too. There seems to be agreement that if you are being seriously threatened with injury to life or limb, you can react with force to protect yourself, but I've never heard of it spelled out in any hospital policy, and who defines "serious"? I *do* have prior training that gives me the skills to do serious harm to an attacker. I would have NO doubts about when it would be appropriate to employ those skills if I am on the street or at home, and I feel the law would protect me. I'm less sure what is acceptable in the hospital. I'm sure if the patient put their hands around my throat, admin and the law would support me if I took any and all measures to save my life...but I'm less sure what is "acceptable" if they just threw a punch at my face...and there's alot of grey in between. We have wrestled many patients into a bed for restraint and treatment, and while I've never been hurt, I am small, and I often feel like I'm expected to engage in a fight with one hand tied behind my back. I'm supposed to tackle this person, but not hurt them. I'm supposed to be in their face, sticking them with needles they don't want or understand, and manage to keep them from fighting back *without* causing them any harm (after all, that would be assualting the poor soul). Our security can't act until the patient physically threatens us, which means we have to try to manhandle them first and have them take a swing before security steps in. I understand I can't just punch the patient who's drunk and resisting a blood draw, but then I think the hospital should not be asking me to do any of the restraining!
  16. F.E.R.N.

    Educate me on Blood Cultures

    At our facility, if the patient is on antibiotics, whether prior to arrival or administered by ED staff, we simply make a notation of what they've had and order the cultures as a FAN. The lab has never told us the FAN cultures are any less usable for the purpose of guiding treatment. Is this not the case elsewhere? It is not uncommon that patients being admitted for infections have already been on a home course of antibio therapy. Our lab also does all pedi cultures as a FAN, although I don't know why.