obliviousRN

I haven't found that. I moved to Eastern Oregon from Portland and haven't seen any evidence of racism here. Our community is very accepting of any background.

Wow. Talk about nurses eating their young. Now I'm a seasoned ER nurse who gets irritated by many things - even someone interrupting a vent. BUT - she explained herself and what she was really meaning wtih her post - did you guys not read that? She very clearly spelled out what she meant. She even apologized. And yet many people continue to attack. If this is what is happening to our younger or newer nurses coming in on a message board, imagine what it is like at work (hers or yours). Must not be pleasant working with some of you who are not able to have a "conversation" even on a message board with someone who 1. makes bad comment 2. explains what they really meant 3. apologizes for it 4. you still yell at her. So I here I sit waiting for the attack on me now because I stuck up for someone who apologized and hopefully learned their lesson and yet some people still have to attack her. Very sad.

There are a couple of programs where you can get a forensic certificate without a bachelor's degree.

I started as a SANE at our hospital and furthered my education from there. I had to do a lot of self starting to get the experience needed to round out my education. Luckily, I hooked up with some pretty great forensic nurses who could guide me and let me come train with them. I now work with the Medical Examiner's office doing death investigations. I also have a partnership with the local DA to perform functions needed for criminal investigation and/or prosecution (assault exams, bodygrams, evidence collection, crash investigation, etc.). It took a lot of self initiative to get to where I am. People are resistant to this newer field of nursing, but professional respect and education of the partners go a long way. Law Enforcement is pretty receptive to your education and abilities after you show them what you can do. I say to all who are interested in this field - be a self starter! Go on ride alongs, hang out with the DA for a day or so, put together presentations to educate those professionals on how they can utilize your abilities and education. Make friends (bring food! LOL). But, nothing is worse than a nurse coming in to "show them boys how it's done." That just goes down in flames. The same goes for hospital staff and physicians throughout the facility.

I've found that using lidocaine increases my rate of missed IV's. Without it, I can get in virtually the first time every time (except for those "everyone has a bad day" type of days). If I use lidocaine, it's almost a guarantee I'll have to stick you again because I feel it displaces the vein or causes some type of irritation to increase irritability in the vein which them causes it to spasm. Maybe it's all in my head, but I much prefer to start without - quicker, one stick, and therapy initiated faster. This is not torture but providing fast, competent, professional care to my patient.

I talk to my patients about test results all the time. Potassium levels, INR's, Dig levels, etc. It's giving data - not a diagnosis. I am not diagnosing someone by saying "your pregnancy test came back positive." Just like I am not diagnosing someone by saying "Your potassium level is high." It's data. And I would have done the exact same thing you did. Educated the patient in relation to the data given on the test. Big whoop. Your doc seems to be a little defensive.

Infants are notoriously hard to get because it's so darn easy to pop on through. If your hand is not steady and you are not ready for that initial pop into the marrow then it is almost a guarantee you'll go through. IO's are awesome on older kids/adults. Love them. Infants and IO's - scares me. Hard to get.

I actually make more here than I did working at a trauma center in Portland

Eastern Oregon - completely "outdoorsy" area. Union hospitals - wages good. I love love love it!

Oh my gosh! I love those. Off to go shopping.

I work in a rural/frontier ER. We have 4 beds, 2 of which are critical care. We have one nurse to staff the ER and we get back up from the med/surg floor when needed. The nurses in our facility cover ALL areas - ER, OB, Med/Surg, ICU, Peds. I moved here from a Level I trauma facility in Portland, Oregon. Talk about culture shock! But I love it! I have so much autonomy as a nurse here in rural burg that it is absolutely amazing.

In the state of Oregon we are required by state law to report any DRIVER of an MVC who is under the influence. Or if the MVC is used as an assault (i.e. trying to kill someone with their car). Otherwise MVC are not reportable. We live in a small town and the cops pretty much come straight to the ER after a crash and walk right back to the room. They're never hard to find.

I just laughed so hard I snorted. This is the best thing I've heard in ages.

It's none of your bosses business until you decide to tell them. Definitely give them enough time to plan for your maternity leave though.

Alphabetical diagnosis - who can write out the most diagnosis in alphabetical order (appy, broken arm, cardiac arrest, dementia, etc) Who can make a 100 link paperclip chain the fastest Good ole' hangman (the paper game, not a noose around each other's necks. LOL)

21 y/o male ejected during rollover MVC. Nasty head injury, facial fractures, lost one eye. Expected to be in a vegetative state for the rest of his life. Happened on Thanksgiving day. Woke up on Christmas day asking for his wife. Released from hospital in late January with minor deficits.

Number one - check your state regs on this. I'd ask your local DA to be sure you are in compliance with these. Maybe they can consult on your policy as you develop it. That's what we did. Number two - implied consent as stated above, covers this. Number three - I would collect it no matter what as evidence is time sensitive. You might not know how long they've already been down, etc. Our docs are also good about holding off on foley, etc. if medically possible until I can get my swabs at least. Good luck!

What makes a good ER nurse? The realization that "some dude" will never be caught because he does not exist. For example: "I was just sitting there minding my own business when some dude walked up and shot me." Ok seriously - I like the one that someone said above about a sense of humor and a thick skin. ABSOLUTELY! Could not exist in the ER without it. And unfortunatly you have to very quickly rid yourself of the idea that you can "help" everyone that comes in. Some people you just plain cannot help. Period.

We also have 1 nurse to staff our ER at night. They usually waste with the med/surg nurses since our hospital is small enough to run and get them (i.e. 100 feet down the hall to med/surg type of arrangement). I've been known to make the pharmacist waste with me also - but I work day shift so much easier. It's a challenge, that's for sure. Be very careful of what your own state regs are regarding this issue. You might want to check on that. Have your pharmacist print them out for you. I wouldn't wake a doc up to waste a med though. That seems so stupid and a waste of their time - especially if they are on 24 hours straight and their sleep time is limited anyway. good luck.

The radiologist reads the Xray. We wait for the dictated report. Doesn't take long at our facility as it is not a huge ER.

I'm in Oregon and we do MSE's at our facility. First and foremost we determine emergent vs. non emergent (MSE) - this may include some labs and/or Xrays. We then triage them into the order to be seen. It is 2 separate procedures, but you basically do them at the same time. You just chart it differently. Say for example, you do an MSE on someone with ankle pain. We deem them non-emergent so we discharge them from the ER and recommend follow up in clinic the next day. We may have ordered an Xray or not per our clinical guidelines depending on swelling, deformity, etc. Change that to MSE on someone with ankle pain with obvious deformity and open area in skin. Xray ordered per clinical guidelines shows fracture, possibly open so MSE = emergent. They are then triaged into the appropriate level and seen in the ED by the physician. It gets confusing at times, but you really are doing it all at once. It just matters how you document. Clearly define your MSE in your documentation and then assign them a triage level separately.

We routinely do follow up calls on our pts we transfer out. We use it as a QI process. By obtaining the info we find out many things: 1. could we have changed the outcome by our initial treatment? 2. was there something we could have done better/quicker/etc.? 3. how can we use this case to improve care given in our ER? 4. were actions deemed appropriate by the receiving facility? It's not just a nosey "how are they doing?" It's a true data gathering process that can change how we provide care in our rural ER. In Oregon at least, there are state statutes that allow us to receive this information and it is NOT a violation of privacy.

What size chest tubes do you stock in your ED for peds cases? I feel like we are overloaded with multiple sizes that we don't need. What are your PAR levels?

OH! One more thing. Stress the value of an emotionally stable work environment. "Studies show.....blahblahblah". Stress the fact that Patients (of whom are the most important piece of the puzzle) are adversely effected by her actions.

I'd suggest a written complaint with copies to your DON, CEO, hospital board, State Board of Nursing, and union (if you are union). Give factual information, not emotional. Such as: Ms. Smith's actions effect her patient care in this way: blah blah blah Ms. Smith's actions effect the staff in this way: blah blah blah Ms. Smith's actions are a detriment to creating a team at ABC Hospital because of this: blah blah blah Give specific examples and not hearsay. And keep writing the letters over and over if need be. Get all the other nurses or staff members to sign them together. Present a united front (or as much of one as you can). Be professional in the presentation. Good luck!