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~Mi Vida Loca~RN ASN, RN

Emergency Dept. Trauma. Pediatrics

Content by ~Mi Vida Loca~RN

  1. ~Mi Vida Loca~RN

    Made a med error

  2. ~Mi Vida Loca~RN

    Made a med error

    That's how it always was for the facilities I worked at too. The med was always ordered IV and we had to know that in kids we gave it PO mixed in juice. That was why I asked the poster what I did because in those settings I was in we never gave it IM. It was either PO mixed in juice or IV in older adults. So IM was never even done.
  3. ~Mi Vida Loca~RN

    Devita dialysis

    So many of your questions are going to vary center to center, even multiple local centers can be ran completely different. However, I would suggest that if you are applying to make sure you're spelling the company name correctly. It's DaVita If you spell it as you do here on a cover letter, you're not going to make it past HR. The pay in all the clinics I looked into was a lot more than the hospitals pay in the area.
  4. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    Every facility I have worked at (6 different ones total in various states) the ED has never put in admission orders as the ED doc. There isn't expiring orders or anything like that. There isn't even the option. I don't feel bad for the doc paged at 0300. They are on call, that's what being on call is for and they are compensated for it.
  5. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    Yea I never knew this was a misconception until one of the nurses in report asked me one time why I couldn't just ask the doc since they were right here. Then it clicked and she told me she thought the ER docs admit the patients and put in basic orders and then a service will come by. But I explained to her for liability reasons that's not the case because once the patient leaves the ER the doc has no more to do with the patient. Now my best friend is EM/IM and ICU and so he can have a little more pull in the way he handles his admissions, especially if he plans on continuing the care, and I know many EM/IM docs that can get some pull from their other service. But all of these are such rare occurrences. I have tried to explain in report too that I barely know the inpatient docs, now if I know it will be a while to get a bed and stuff I absolutely will go to my ER docs and try to get an order for something to get them by or go ahead and redraw a lactic of something I feel is important and I don't want to get missed. My best friend ingrained in me to think both EM/IM since that's what he did. However, they inpatient nurses are well more knowledgeable on the paging system and getting a hold of their docs than I am. If I want my doc I simply overhead them or go find them in the ER.
  6. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    Scrolling though this it reminded me of a common misconception to some non ED Folks. ED Docs don't admit patients. Inpatient docs do. So the orders you need, the questions you have concerning continuing patient care and so on has to come from the inpatient side and addressed to the inpatient docs. I have had many nurses before confused on this and they assumed the ED docs admit the patient and then the inpatient doc will make their way. No, the ED docs consults and advises an admission and if the inpatient doc refuses they have to keep "shopping" until they find a service willing to admit. Some ED docs with dual specialties (EM/IM or EM/) for example, or off service docs rotating in the ER might have some pull and can start the process on behalf of the inpatient team. But ultimately these things need to come from the inpatient nurse contacting the admitting physician. Various hospitals have various protocols on what basic orders the admitting docs need to have in to send the patient to the floor, however; in the ER we answer to our charges, and house supervisors (whatever your hospital calls them) and when we are told we have a room number and someone to give report to, we are expected to do that and the the patient our within so many minutes. So if we are going to get upset, lets get upset at the proper people for these things.
  7. ~Mi Vida Loca~RN

    Made a med error

    Except the order stated it was IV (which I have always seen it entered that way as well but for small children it was mixed in Juice and given orally) It was never ordered IM. But that's why I asked the poster how often they are given Decadron IM to kids because I know it can vary. In the 6 ED's I have worked in and the Pediatric unit I have worked in it was always oral for the kids, whether it be the IV mixed in juice or oral med. In pre-teens, and teens and adults it's been IV or sometimes IM. Just seemed there were many safeguards missed here and I wouldn't be so quick to pass it off as "ehhhh it happens" when we are talking about pediatric patients and steroids. That said I do understand mistakes happen and I just hope the OP sees the importance in this and ensuring it doesn't happen again.
  8. ~Mi Vida Loca~RN

    Patient is a sex offender with a tracker on his ankle

    It's such a relief when I read so much absurdity and I read a post that can actually see the real issue here. "Upon my assessment of the patient I noticed he had an ankle bracelet on. No worries, Googled it and turns out he is a pedophile, wanted to make sure I made that known in his legal medical record as I personally feel it needs to be in here" Lets see the chart audit on that. At the VERY MOST. on the assessment it can be stated "Monitoring bracelet on left ankle, pulses intact, no skin breakdown or redness (and let's not forget) will continue to monitor"
  9. ~Mi Vida Loca~RN

    Patient is a sex offender with a tracker on his ankle

    Some of these responses just boggle my mind. Like do you read the stuff you're saying and really think it's appropriate and OK?? Have you learned nothing in school and in policy's and patient rights. We have a van full of Scooby Doo detectives thinking that being a nurse means solving crimes and putting our own opinions into legal patient charts and somehow justifying it. We have someone else that thinks that Googling someone is a HIPAA not HIPPA violation. *PS it's not, although it doesn't mean it's appropriate on company computers and time either* So much cringe worthy stuff said in some of these posts by people with no clear idea of what their scope of practice and role entails. I am very thankful the majority of the people seem to see the clear lines here that are not to be crossed, gives me a little faith.
  10. ~Mi Vida Loca~RN

    Made a med error

    Have you ever given Decadron IM before?? Typically it is given Oral (even though IV) mixed as you stated, with children; or it is given IV. To give it IM you had to go get a needle, draw up the medication, double check your dosage, hold the kid or have the parents hold. Seems a lot a steps in place to have you kinda remember this should be mixed in juice. Besides all the medication rights you misses, when medication a child one should be even more diligent (IMO) I would think somewhere during this time it would have clicked. I have understood med errors and how they happen. Accidently giving a pediatric patient an IM injection that was meant to be given orally mixed in juice, seems like a pretty big error. Getting caught up in the hustle and completely changing medication routs can cost someone their life, especially a child. So I just hope you learn form this and it's not brushed off so easily like no big deal.
  11. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    Nope, blaming a parent for their child overdosing is not tough love, nor is it compassionate. We aren't given the history and back stories, we don't know the battles the parents faced, we don't know the many times they have tried to intervene or the countless hours they cried in defeat because they couldn't help their child that was in the throws of addiction. So to imply that calling the parent out is compassionate, or tough love or imply that it's their fault on a topic that is anything but a black and white topic, is completely asinine.
  12. ~Mi Vida Loca~RN

    They were in bed together.

    I think you only get in trouble if you join in.
  13. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    No it can't.
  14. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    So in the ER at the Mayo Clinic you're telling me that the time you are assigned your patient, to the time you have an assigned bed and are able to give report, is about 30 mins??? Which would mean you're getting work ups and labs and scans and results back in what 10 mins??? I just want to make sure I am understanding correctly, because at first I was simply being facetious, but it seems like you are now stating this is accurate.
  15. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    If they ask me when the last BM was, I just tell them I just gave them lactulose so I anticipate shortly.
  16. ~Mi Vida Loca~RN

    When will everyone understand things are different in the ER

    You work in a facility where you have your patient for 30 mins 27 of them stabilizing and they already have a bed and nurse to report too??
  17. ~Mi Vida Loca~RN

    What is a typical day?

    I sold myself in the interview and got hired! New nurse, no prior ER experience, no healthcare experience prior to nursing.
  18. ~Mi Vida Loca~RN

    Fire fighter to ER nurse?

    If I could support my fam off a paramedic salary I would do that over ER nursing any day, instead I started the path to work medic PRN and nurse full time.
  19. ~Mi Vida Loca~RN

    Fire fighter to ER nurse?

    If you want to do flight nursing ICU actually will benefit you more since a lot of flight can be more critical care transport. A lot of flight nursing will require ICU experience and some will accept ER if it's Level 1 trauma center experience. (mind you I only speak for about the 12 I researched it obviously can vary) but I have worked at a few hospitals that we had our own flight team of 3 helos each. A lot of places will also accept both ICU and ER. And some I have seen if the ER is not Level 1 trauma you have to have ICU as well. Most I have seen will require 3-5 years of experience in those areas.
  20. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    Well at first I thought they can still maintain airway to get them to the hospital, but then I saw that some of these same yahoos proposed that EMS can stop responding period to any OD calls. Like I said though, I can deal with some people just being dumb, it was the amount of people in the healthcare field, EMT's Paramedics, Nurses showing support of this and the reason always being that addicts choose to be addicts and they are a drain on society and two strikes is more than reasonable. I live in a city that has one of the highest OD rates per capita and it's a huge issue. But at the end of the day the answer is not to just let them die to "learn their lesson" (not your words just back to the arguments I saw) I actually think it's going to get worse, my state anyway has really begun the crackdown on opiate prescriptions, which is needed; however now the people addicted to those scripts will switch to heroine.
  21. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    Yes this would seem reasonable but for some reason it just seems to escape many. What they are wanting is going to seriously backfire.
  22. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    I do understand, why do you think I don't understand?? I am very well educated in the field of addiction. Letting people just die is not a solution and creates a huge grey area that is going to open up to a world of consequences and backlash that will do more destruction financially than what they propose. So many ethical issues here as well. Letting everyone die will definitely fix the issue though. So there's that. You can't just assume that they don't want help? Do you think they are thinking rationally in the midst of an addiction? I am actively involved in the addiction community, all aspects of it. What are they to do?? What we learned in Nursing school., "There has got to be a better way" Figure out a solution that doesn't involve just no longer helping or answering calls leaving people to die. Do you know how many people I have met that are AMAZING intelligent brilliant people that impact the community. Go on to find out they are 10, 15, 20, 40 years sober. So much they have done to help others, so many lives changed, yet they wouldn't be here if when the were 18 in the throws of addiction someone just decided their life was no longer worth it after they overdosed twice. Addiction is a very complicated disease. it has a spectrum with varying degrees and causes. It's not a black and white issue and not every patients battle is the same. If this passes, the backlash and what happens next will more than financial destroy that city. I would bet a lot on it,
  23. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    I always find it ironic when people speak about being compassionate and what's not funny, but right away they are condescending and insulting calling people "old crusty bats" Are bats even crusty? Is this compassionate of older people? Are bats not compassionate?? Are only "old" people not compassionate?? Deep thoughts by MiVidaLoca
  24. ~Mi Vida Loca~RN

    "I Narcanned Your Honor Student"

    HOLD UP! You have a castle???? On nursing pay??!?!?! I am offended about that! Is your key like a normal key or one of those old heavy large antique keys, I have always wondered.
  25. ~Mi Vida Loca~RN

    Fire fighter to ER nurse?

    Good grief, offended much??? They came and were transparent about assumptions they had and asked for advice and information. They only know the profession from one side and it's a common misconception from EMS side that nurses just follow orders. In reality EMS just follows orders too for the most part, the different is their orders are all laid out in approved algorithms and protocols. They still have to be approved and signed off by a physician, it's just done preemptively and if they have to vary from those laid out algorithms they have to call in and get verbal orders. Regardless, someone comes on and admits they have pre conceived notions and asks honest questions they don't deserve to be put down. You're reply came off just as much as a jerk then the reply you spoke of, except I didn't read theirs as trying to be a jerk. Yours I did. PS you don't even need a BSN and if you want to speak on Ego, might want to re-read your post.
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