erjulie

what does shearing effect mean? what's the mechanism? Thanks!

We're having a lot of trouble keeping up with +culture callbacks. Currently, all cultures are routed back to the ED via printer from the lab as they become positive, and the secretary pulls the chart for the + results and places it in the "culture book" for the charge nurse to check. Well, we are currently overwhelmed and under-staffed, and cultures are missed because we're busy and things slip. No bad outcomes so far, but it's a recurring nightmare! Lab states they can't run a "culture report" because they don't have time ( a computer generated list once a day of all + cultures) for double checking, and who could actually double check? We really rarely have time to sit down and concentrate on the culture book, and the case manager has volunteered (she's an RN) but her boss has a "territory" problem with that. What do other departments do? It seems that no one takes this seriously except staff and our manager, so I'm trying to see what other departments do about this so that we can be systematic and thorough. Any suggestions? Thanks in advance!

I've worked critical care all of my career, both ICU and ED, also briefly in Tele and cath lab. I understand all sides of the issue. However, it is a power game that nurses play when they ask questions about obscure medical symptoms/events etc. When I worked in ICU, even a very busy ICU, I usually had some time to sit (or stand) and read the previous charts on a patient. I never asked who the patient lived with and what their social situation was at home, then gave the "sigh" when the RN didn't know the answer. The only time this is relevant is if the person is in imminent danger of coding and advance directives are unclear. I have learned something from this thread, and that is to not respond with the freaking anger that I feel, but say: "I'm sure that you'll have time to read the chart to find out what the patient's ejection fraction was on his last admission." "Have a good shift!"

Illinois has programs, as does the county we live in. Most areas have women's shelters, or a crisis line that can provide info for you to get the information. I would hope that every town, city, county and state of the Union has something in place. I don't think my friend ever left her husband, she has since taken another job and I rarely hear about her. Good luck!

I'm an ER nurse, and the estimate is that 30% of the females we see are victims of domestic violence. We have a state mandated screening tool that we ask every patient if they are safe at home. I've rarely had a patient answer yes, and it certainly isn't 30%. So, the question may be "wrong", or people are un-willing to disclose this info. I have seen it all from dead (or soon to be dead) patients who were obviously victims, to beautifully dressed/maintained women who had that "haunted" look, a partner who wouldn't leave the room, and not an incriminating mark on them. My strategy is to walk the patient to the bathroom on the pretense of getting a urine specimen, and offering them the chance to verbalize. If they are not forthcoming, I ALWAYS tell them that we're always here, and that they would be safe while in the ER. The bathroom has a disply of brochures offering help. I've learned that the most we can do in many cases is offer an alternative. One of the saddest experiences of my life was with an RN whom I admired greatly. An excellent RN, a great teacher, a flight nurse. She came to work one day smelling of ETOH with "bracelet" bruises on her wrists and finger bruises on her neck. All I could do is tell her that she was welcome at any time in my home, her husband would never find her there. She would not have been able to hear me ask her if she were a victim (of course she was),and I doubt that she'd ever have talked to me about the abuse. However, the look in her eyes when I told her that was most gratifying. She just understood that I would help if she could ever ask for help. Sometimes (many times, I'm afraid) that's all we can offer. There is no time in the ED to do follow-up phone calls, and the thought that the abuser would answer the phone is frightening. Good luck in school, I hope that your study gives you greater insight into this horrific silent epidemic and allows you to save at least one person.

you're taking the first step down the burn-out road, one which I know well! The nurse following you is there to continue your work. Work is never done in the ER, as you know. I'm better about this once I realized that. You've got to trust yourself and the nurse following you. I have stayed with a particularly bad trauma to ease the transition for the on-coming RN and family. I have called back in to see how someone is doing, much less now than before. I think once you realize that obsessing about something makes no difference in the outcome, you start letting that go. ER is so chaotic, and we think that if we can control something, we can change the outcome. I have given exquisite care to patients who then die, and conversely just by sheer luck I've saved someone's life. I learned to open a door in my mind, shove work into it and close the door and not re-visit it! Takes some practice, but it really does work, and you are not so exhausted mentally rehashing your day. It helps when you understand that some things just are going to happen no matter what you do or do not do...and that just takes some time and a comfort level. Good luck!

you'll have the quickest asessment skills on the planet...what an advantage that will be! Plus, they'll be right on about 90% of the time. Plus, you'll be humble enough to learn from the other 10%!

NG tube- then run it slow (like to gravity) helps to have the NG tube placed when their "sort-of" sedated, but good timing is rare... Really you can warm it in the microwave? I ALWAYS have trouble, but then again I have trouble even cutting off the end of the tube. We use those Evac-U-Kwik kits with the tube the size of a garden hose- I hate those...I'm such a klutz I never get the right things hooked up, you'd think I was the village idiot setting it up. I usually give up and have the techs help- they think it's hilarious!

:chuckle love that. If they only would listen...

congratulations! laugh at yourself, learn a lot and try to have fun...then kick butt in medical school, and never forget your colleagues: ER workers.

changing the dose of the drug in response to a change in the patient's condition. For example, escalating chest pain pt's nitro can be titrated (in htis case,increased) until the pain is relieved. or, insulin drips can be increased or decreased in response to the pt's blood sugar. The order should be written with specific parameters, however, in our ED, we titrate some drugs without a written order, but believe me the doc is fully informed.

had a guy bring in his son with the 3 way hook embedded in the kid's cheek, just like the fish gets it. the guy was leading the kid by the fishing line still attached to the hook- sounds cruel but it was FUNNY. He was a little aggravated with the kid, and when we got the hook out, we figured out why. what a mouth!

are the rules changing for babes under 2 months with fever? in the peds er i used to work, anyone under 2 months with fever over 100 got the "works". (I always found the residents had better luck with the sitting position.) The tap, I think, is much harder on us than the kids...anyhow, would be interested to know if weptic work ups are still the gold standard for babies with fever...

why journalists? I particularly hate spoiled yuppie scum...but I cna't for the life of me remember if I've ever had a journalist...

this just enrages me...the simpering pandering crap the manager/director/"leadership" shovels at these patients. It does nothing but undermine the work of the triage/bedside staff member who probably has every good medically sound reason in the world for not placing the patient in a bed immediately. This is de-moralizing to staff, and reinforces the bad behavior of the abusive patient. I am getting awfully sick of patients being "customers" with all the bad connotations that brings on....we provide a service, yes, but it's not a freakin' McDonalds. Yeah, I spent 6 hours in triage today with 6 hour wait times. Couldn't clear beds 'cuz nurses upstairs were "in report"- ah, for the luxury of "report"!:angryfire

dc orders I've been tempted to write: 1. Always be looking over your shoulder. After verbally abusing me and my co-workers for the last (fill-in-the-blank) hours, and suggesting what we may do to enhance your sexual pleasure, you can be assured that I will get you, some day, somewhere,:rotfl: and in some very nasty way.

in our 21 bed ED (40,000/year) level 2, there are no room assignments. The charge nurse assigns pt to you depending on what you have going on. We have a tracking board. This works well with most of the charge nurses, but there's always one! She is clueless as to acuity/timing, etc. Finally I asked her why I kept getting slammed, and she told me because I never complain. Well, that changed pretty darn quick. I think she's clueless because she a) doesn't like confrontation and b) hasn't too much experience in ED. She is expected to start patients who appear in our beds, if we're not available. Sometimes that happens, most often not. I think the benefit of room assignments would be that you'd be sure that your rooms are stocked...that's a nightmare without room assignments.

seriously, that could have been me as a new grad in a PICU. I had the most psychotic mean woman in the world as a preceptor who essentially destroyed me in one year. It was awful despite the fact that I had a previous degree, tons of experience and was pretty tough. I was grateful to get out of there with any shred of sanity left,and went to the peds ER where I was literally astounded to realize how much I knew. What a terrible way to learn that you're good at your job. Please don't let your preceptor shred you like that. Rely on the feedback from the majority of the staff. Currently, I'm the staff educator and my main purpose, 20 years later, is to never allow that to happen to any other new grad. We review the orientee's progress biweekly (at least) with the preceptor, educator and clinical specialist. This allows the orientee to get more than one perspective, and it allows the educator to guide the preceptor (and keep him/her in check if need be). We are very careful about who precepts and how quickly information is fed to the new grad. I tend to be protective of them, but have had success stories and am happy with that. So, even if it's a bad experience for you, you'll get something out of it, even if it's how to deal with psychotic co-workers. And, there are a few out there!

This reminds me of an article that I read last year about a Nurse assistant in a nursing home in Texas. He was arrested for using drugs....he was taking the fentanyl patches:barf02: off of the old folks and cooking them in water, then injecting the water....all I could think about was that flaky flaky skin and those horrid skin things on the oldsters floating around in the fentanyl broth....eeewwww, you'd really have to be a junkie to do that!

We're having a huge problem with just this issue....any advice would be appreciated. There is not ONE decision that can be made by senior staff/ charge nurses that does not have to be run though the Director (who is currently managing the unit due to no manager...)It is demoralizing and extremely frustrating. It makes one want to run screaming from the room. And, God help you if she finds out that you are not happy and totally accepting of every pronouncement, retribution is swift and painful. Any suggestions?

I'm not an NP, wish i were, actually.. Our ER started using PA's about 5 years ago. Many ER RNs were insulted by this. The Medical Staff decided they would rather go with PAs. The ER docs weren't actually consulted, but I think they had input. The ER docs contract is held by the hospital (i.e. Medical staff). I'm an OLD feminist, but it seems to me to honor the employees who make up probably 75% of your professional staff, and do probably 98% of the actual work, you'd hire from that same profession, i.e. Nurse Practitioners. I like our PAs, but some have the attitude thing going...and you know, their education is way different from ours, and one admitted to me that it was sorely lacking. And he went to a great school! I would welcome NPs into the ER, but don't have that opportunity. To top it off, the PAs can't even do what they're educationally prepared for, so they merely add another level of care (or layer to get through) in the ER. Some insurances won't reimburse for them, so that the patient eats that bill. Doesn't make sense to me...

never assume that you know what's going on....it'll come back to haunt you! ALWAYS ask if unsure, no matter how many years you've worked. There is no shame in failing, only shame in not asking for help. old erjulie

evil patients/families do suck the life out of you, but really only if you allow it. I'm not sure how not to allow it, there are different strategies depending on how you yourself are doing that day. I usually get very quiet and businesslike, and they do not get to benefit from my humor, or even eye contact. What enrages me, however, is management's response to these boors. They reward the behavior with bumping the patient to the front of the line, bringing extra "treats" like soft drinks, etc. for family members, etc etc etc. This totally and completely puts me over the edge. I think boorish patients are spoiled brats, and the way to treat them is to ignore their behavior AND NEVER REWARD IT with any type of response outside of what is absolutely necessary. When management rewards it, they 1) have the behavior reinforced, and 2)management is telling them that yeah, you really are the bad nurse they think you are. This makes me HATE my job. So, I ignore management, too! Interestingly, the "goals" posted by management, on which our raises are based, are not weighted towards good clinical outcomes, (that's only 25%) but "customer service" at a whopping 45%!

:chuckle It's Tallulah...that's how Tallulah Bankhead's name was spelled, she was a great favorite of my mom's. Here in the ChiTown suburb, I had a pt whose nephew was first name was Ryno, middle name Wrigley...

Thanks so much for the advice, I am SO looking forward to this trip with the daughter and baby, I can't tell you. My son loves the area too. He came there from Iraq, which he hated. Now, he's crabbing a little about the rain, and I just say "better than sand, son!" I hope his computer is up and running when we get there, in case I need quick advice...thanks agin, and if you're ever in northern Illinois, let us know! Gas is down to $2.19 here, peaked at $2.35 a week ago...hmmm