ER-RN2

Needing some advice. I love the ER-I really can't see myself elsewhere. But I have a problem with "leaving it the door" when I'm leaving work. I don't sleep well because I am stressed out so much. So does anyone have any good and simple ideas for me?? I have asked to work shorter hours but it didn't go over. I just want to love what I do and not feel defeated when I leave. It seems like more and more people come in with stupid complaints and I really have a hard time keeping up with them (and the call light) and the critical patient that just rolled in....Hope this all makes sense. Thank you in advance. PS. I know that I will probably get the "burn out" phrase, but I'm not leaving the ER because I do like change that occurs everyday. It is just the other crap that gets on my nerves!!!

I have been in the ER for 5 1/2 years, yet people still completely shock me with their stupid comments. So 3 vents for me.... 1. "I don't have the money" when I asked WHY the child was 2 years behind on shots..Yet, the mother had a Blackberry, Coach purse, VERY nice nails and clothes. And tylenol and motrin (according to her) are the same thing and cost a lot of money. WHAT?!?!?! I just don't understand WHY these people even have the nerve to say "I don't have any money" when clearly they have money for things they WANT and not what the child NEEDS! She looked at me like I had 15 heads when I told her there are TONS of free clinics, etc. 2. "I'm allergic to Latex so that is why I have a ton of kids." OK--first of all, I'm just asking "are you allergic to latex" not if you have a ton of kids. So I bounced back with the comment "There are non-latex condoms." VERY quickly he said "They are too much money." PRETTY SURE KIDS COST MORE!!! But then again, I'm "paying for them".... 3. Patient comes in for a follow up..stating he didn't have a ride to the specialist follow up appointment...so HOW did you get to the ER??? Clearly these people need a wake up call, but no one wants to do that...We just baby them / spoon feed these people over and over. I work all of the time to pay for everything I have...and I still don't have half of what these people bring in with them that are saying "I don't have the money." Craziness is all I can think of when I'm leaving work....

I am sure this has been done before, but I just spent the past 3 days in a row listening and being completely annoyed with patients coming in through triage. Anyway, this thread is just for triage "rules / rants.":banghead: 1. At the end of the 3 days, if I heard "It's in your computer / files" one more time-I was going to start screaming and then need a pysch consult. 2. Everyone (of course) said "My doctor told me to come here." 3. And the urgent care / immediate care centers, etc sending patients in and then they are expecting to have an ER bed all ready for them--because "that doctor called and said I was on my way and I'm really sick." And then, of course, their paper from these places are just so retarded..The doc writing diagnosis without even doing any sort of test. Do they have a magical / crystal ball?! 4. And I can not understand why patients drive hours (passing several hospitals) to my hospital for stupid s*#t! I guess for pain meds....All of the hospitals you passed probably know you all too well. 5. A ton of toothaches-- Guess all they really want is pain meds--Because there is an open dental clinic walk-in 24/7 which I told them about and still want to see an ER doctor. And then coming to the triage desk a million times complaining that people were going ahead of them. 6. Drama Queens...Enough said 7. Drug Seekers...ARGH! 8.The people taking a million meds, but "I don't have any medical history. I'm healthy." 9. Chief complaint going on for months, years, and even just 15 minutes. 10. Six million people in the TINY triage room--all have to add in their 2 cents and answer all at the same time when I ask the patient a question and all of them have different answers. Everyone was quickly removed from the room. 11. And WHY do parents not give tylenol / motrin for fevers? Or not give the kids neb treatments PTA? 12. And "I need a prescription" for any OTC med 13. "Name dropping" I really don't give a crap who you know..because usually if you really know that person, a bed would have been blocked for you. 14. And if you curse at me, complain, etc don't think I will even begin to triage you until you chill out...or if you continue to complain after being triaged. I have the power to make "theraputic" waits. 15. The nurses in the back complaining that the triage position is soooo easy-you sit around and do nothing. REALLY???!!! I have 25 patients in the lobby and I'm the only nurse (but with a GREAT tech). I bet I can tell you everything about each of those patients and then some. Don't think I just sit and do nothing. And you probably don't even know your own patients and sit around talking and eating while I'm running around putting patients in rooms. 16. If you are fat and lay down on the floor (drama queen)-do not think I will pick you up. 17. People coming in asking for wheelchairs and help getting whomever out of the car-How did they get in there the first time. 18. If you are so sick, then why is your hair and makeup done so perfectly?! 19. Why do you have disability or whatever "medicaid"? You look fine enough to work somewhere. 20. Ladies-It is time to close those legs and quit popping out babies so you can have a free ride on everything. "I don't have money" excuse to old and I don't care. You have a cell phone, a coach purse, etc. 21. Don't tell me you don't smoke when I feel like I just smoked an entire box just by being in the room with you for 2 seconds. 22. AND BEST OF ALL...ALL THAT DRAMA GETS YOU NO WHERE....I HAVE THE CONTROL ON WHO GOES BACK IN THE ORDER THAT FITS. I'm sure I can think of more, but I really needed to vent to people that would understand! Sorry for typos / spelling. I'm so tired but can't sleep. Maybe now, after ranting, I can. Thanks...and please feel free to add-on. I'm so shocked that some people even make it in this world..... Courtney

I agree with you all too..Thanks for your input. I just can't understand the reasoning behind the "no wait shot time".......

As of today, we were told there were not to be any more "shot time waits." We are to give the shot and send the patient out right away. I am having a huge problem with this. I keep thinking...I give the shot (IM) and the patient has a reaction by the time they get to their car, etc and then "who's fault" is it when something terrible happens? I said I would make my patients wait for safety reasons, etc but of course that went over like a lead balloon. Does anyone have policies in their ER for "shot times?" Or know of any "real" information to present to say that not waiting shot time could be dangerous?? Any thoughts, etc???

Has anyone heard of prescribing adderall for bipolar--no history of adhd? Has anyone seen this? Good, Bad, etc??

Anyone ever had a stress fracture??? How were you treated? I'm afraid I have some in my right foot. Xrays didn't show anything but it kills me to walk and even to press on the gas and brake while driving. Thanks!

Trying to come up with a common ER med list to help better orient new staff....Any lists / suggestions/ special tips/ hints would be a great help to me!!!!!!!!!!!!!!!!!:wink2:

Pretty much having trouble with everything!!!

Hi. Just need some advice from you all..... I have oriented a lot of nurses to the ER-all of them having background from another unit, etc. Now I have a brand new fresh new grad nurse...with little to no background or much clinical experience (went to a 1 year program that didn't really require much-plus the program isn't known for the best). So any suggestions on the best way to start?? She isn't really picking up on stuff very well so anything that could help would be wonderful! Thanks

Any new ones?

If you are well enough to go out and smoke, then you are well enough to go home NOW. If you call the ER to ask what the wait time is then you are not that sick. The more you stand in the door way and stare us down, the longer you will wait. Everytime you ask the traige nurse "how much longer" you will be placed at the bottom of the list to go back. In other words...don't tick off the triage nurse...and even if you do talk to "my supervisor" they will ALWAYS back me up. You will NOT starve to death if you miss a meal.

Has anyone seen any "Red Dress" theme scrubs out there? I found one at Life uniform but did not care for it. Thanks!!!

While I don't work in home health, I'll give you a situation that happened to me. (I work in the ER) I had a patient that was brought in my his fmaily for confusion that I just kept talking to. He never really said much back to me. Finally the patient's family said to me "Honey I don't really think he understands what you are saying." I told them I didn't mind that I just wanted to talk to him so he didn't think I was talking "over" or about him. They responded to me about how kind that was, etc, etc. They even said that a lot of times people would ignored him when he was in the hospital because he couldn't talk back to them. I think it is very very important to talk to patients no matter if they can understand or respond back. Home health is hard and I know it takes a very special person to do that type of care-sounds like you are on the right track with your new patient!!

Regarding the craiglist letter...I don't see that as a nurse having a bad day. I see that as an average day working in triage. I would like to print that letter and pass it out to patients!!!

I triage all of the time. The main problem that I see is that some patients don't tell you their history, meds, etc. Sometimes the story changes after they are put in a room. It is very hard to place those type of patients.

Thanks everyone!! I am just so tired of fighting with everyone just to get some relief. It doesn't help that when the doc gives me a med rx (finally) and i have to wait forever to get it cleared by insurance. so basically i'm stop-start-stop-start meds which everyone knows that isn't good. also annoying is seeing those who don't work, lay around, etc get everything for free-no questions asked. but if you actually work and have insurance you get screwed.....

Has anyone tried the new sleeping medication Lunesta? How does it compare to Ambien?

I'm giving up on ever being painful or even close to it. I spent a whole year in and out of the hospital with kidney stones, bladder infections, etc. Finally found someone who would actually listen and give me a diagnosis-interstitial cystitis. I was so relieved...I finally knew what what wrong and now I knew what to do about it. Boy was I wrong. I was spent the past 2 years doing everything I could to stop the pain-and I really mean everything. Never given anything for pain. Finally got thrown to a pain specialist-"because I don't know what to do for you". Spent over 2 months to get in there and finally...someone listened. I got a script for 1 month of topamax. It helped some-it was loading doses. Today I went to pick up my scripts and my insurance won't cover them--and they are not narcs. So I am just giving up. I wish I knew what I did to deserve this. I feel like I have a knife in my right kidney and bladder. All I do is scream and cry when I get home because there isn't anything else to do. I live on tylenol and motrin. I know that long term use of those aren't great but at this point I don't even care. If I had an hour of being pain free I don't even know what I would do. OK...I'll stop venting....Thank you for listening...

Hi-I started this thread in pain management-got a lot of viewing but no responses so I thought I would set it up here. :-) Hi all. I was just started on Topamax a few weeks a go for chronic flank pain related to my interstital cystits. I have read through some other posts regarding topamax but thought I would start a new up to date thread. I know that this is given for multiple diagnosis but has it helped for you? Any major side effects? I've slowly increasing my dosages each week per his directions and seem to be doing ok. The pain doesn't seem to be as bad as it was so that is good too. I guess the main thing that I have noticed since taking it is that everything that I eat or drink (more drinks than foods) tastes weird. Thanks in advance for your thoughts!!!

Hi all. I was just started on Topamax a few weeks a go for chronic flank pain related to my interstital cystits. I have read through some other posts regarding topamax but thought I would start a new up to date thread. I know that this is given for multiple diagnosis but has it helped for you? Any major side effects? I've slowly increasing my dosages each week per his directions and seem to be doing ok. The pain doesn't seem to be as bad as it was so that is good too. I guess the main thing that I have noticed since taking it is that everything that I eat or drink (more drinks than foods) tastes weird. Thanks in advance for your thoughts!!!

Hope you all have a wonderful week!!!

We were given these pins too. Basically everyone threw them away. Maybe they should use the money spent on these pins on actually hiring more staff, or better equipment. Plus how many of your patients actually wash their hands....

Does anyone have any chronic pain but still work full time? How do you do it? I'm having a tough time. I work full time but it takes lots of time to recover after 12-13 hour shifts. (My job only has the option of working 12 hour shifts.) I don't mind to work my butt off but lately I'm having a really hard time getting through the day without wanting to scream and yell about how much I hurt. I have a chronic disease and I do anything and everything I'm suppose to do per my doctor's orders. I work in the ER and it is hard to see others come in over and over getting pain relief even if they aren't followed by a regular doctor. Thanks in advance for any advice you can give.

I had a patient that came in for chest pain. She had been there about an hour when a pizza was delivered to her. She said she was hungry and she didn't know how long she would be in the ER so she went ahead and ordered food. She was discharged about 2 minutes after her pizza came.