Intubate89

I go to Fresno State getting an MSN

I beg to differ. Triage is simply more than deciding if someone is dying or not; it's not that cut and dry. We can argue the issue until the cows come home but ultimately, I'm glad that my state affirms what I strongly believe.

Are you ready to say No to a doctor and tell him/her what you want? Are you ready to be a resource for the rest of the staff? Are you ready to take on the added responsibility and liability for the entire unit? There's a fallacy out there that charge nurses simply create the staffing assignment for the next shift and ensure everyone gets breaks. Be careful!

I refuse to give it IV (I've seen patients go hypotensive and no one, including pharmacists, can give me a clear okay) and if the physician insists on it, then I give him a syringe, needle, alcohol swab, and the vial. :-)

sounds like the hospital is covering their butt from a few addicted boneheads who give themselves the narcotic rather than the patient.

Be careful. If you take this information outside of the hospital, you can be in trouble according to HIPPAA. The chance of that is relatively slim however. The idea that these "brains" will help you remember what happened etc. sounds good but a good prosecuting attorney will question their authenticity and whether they are original. (or did you just create them?) Also, going back to chart something later (like several days later) is a red flag unless you chart a "late entry" and why you're charting several days later. If something goes wrong during your shift and you're worried about a lawsuit, simply go home. Write down the events of what happened to the best of your knowledge, place it in an envelope and mail it to yourself via a certified letter. That way, it's dated and unless you open it, it's evidence of your interpretation of the events.

I didn't think I would have to justify why I was "just a nurse and not a doctor" on a routine basis.

Hey there, I went to Ottawa U in the mid 90s. Anyways, what I tell my students is to totally submerge yourself into nursing. Eat, drink, sleep, talk, read nursing. Nursing school only gives you the basics. In order for you to come out flying ahead of your counterparts and be a great nurse, you need to do more than just the curriculum requirements. Ask questions, volunteer to assist holding a leg while the RN puts in a foley (even though you haven't learned it in school yet), read more than you're assigned. I guess what I'm saying is that in your 2-3 years of nursing school, you cannot possibly be exposed to everything and unless you take the bull by the horns and seek out experiences, you'll miss a lot.

6 weeks? OMG, I hope you have at least some experience as a tech, CNA, or student nurse elsewhere in the hospital. Over the last 10 years or so, specialty areas have been shortening their orientations due to the severity of the nursing shortage. As well, new grads. have been accepted into areas traditionally reserved for experienced nurses. Please be careful and ask yourself why this ER is only giving you 6 weeks. Are they that desperate for staff and if so, do you want to risk your license? Your first year of nursing will be your hardest year of your career. This is when you truly learn what nursing is all about and the added stress of a specialized area, without proper orientation, will only compound your worries. At my place, new graduates are hired but only if they've been working in the department as an EMT or tech. Then, they're given a minimum of 3 months with a preceptor. After that, further buddy time is negotiable.

Hi there, I work at a level 1 trauma center, average census >300/day and frequently work triage which is staffed with a minimum of 3 RNs, sometimes 5 depending on the census. I'm shocked at the responses of nurses who agree with EMT-Ps working at triage. In my state (CA), RNs must perform the initial assessment whether the patient is received by ambulance or walk-in. Aside from that, I appreciate how medics work and function in the field but there exist fundamental differences between the professions. Medics are taught to follow and function according to protocols. Nurses are able to think outside the protocol. Yes, some experienced medics are more knowledgeable in emergency care than some nurses and medics perform assessments under very difficult circumstances. However, nursing is able to address a wider spectrum of patient care than medics. Even the educational requirements of the professions differs and nurses are exposed to so much more. Assigning a triage number based on ESI is more complicated than following the algorithm. From my experience and education as an ER nursing educator, it makes me nervous to even consider a paramedic working the triage zone. Considering the liability alone, I firmly believe that paramedics can assist in the emergency department however, assessments and triage should remain solely a nursing function.

A couple of years ago, my city's EMS system discontinued diversion. So now, now matter how busy we are or how many admitted patients we're holding (up to 40-some at times), we continue to receive ambulances. I remember how confusing and time consuming diversion was prior to this. Medics were smart, AMA the patient to destination, and continuing taking them to the hospital of the patient's choice, even if they were on diversion. Regardless of the base hospital's request to divert, the patient can refuse and request transport to the diverting hospital, as long as they sign the AMA and are a GCS 15. This was kept hush hush but as patients figured it out, diversion ceased to properly function. Diversion is such a mess. You receive patients who have never been to your ER and then it's a mess trying to get old records from the other hospital etc...it's so time consuming. Of course, there are extreme instances when hospitals must divert like in the event of a disaster or equipment malfunction. But having a full hospital (which is most of the time) is no reason to divert anymore. In my honest opinion, EMS works better when diversion isn't an issue.