ernurse2244

I am a solo ER nurse in a small rural hospital. I have cared for friends, neighbors, co-workers and family members and never really gave it a thought. I have never gotten any negative feedback and have frequently gotten positive feedback. They seem to be grateful that someone who cares for them on a personal basis is at the bedside. Additionally, people I did not know would be in the ER and from then on, when I would run into them at the local grocery store would stop me and make small talk, feeling that I was now a friend. I have worked codes on friends and on children I didn't know...the friends were easier, I can assure you.

I am trying to recover from 3 12's + in a row. Our county population tripled over the past 10 days due to a local fair that has a big draw. No extra staffing this weekend. At 61 I am too old for this s***. But in normal times I love my work, usually know almost everyone who comes in because this is a really small town. Guess we take the hard times with the easy ones. Count my blessings that I can still work in top gear.

God bless you! can you afford to look into other avenues like ambulatory care? or is the emergency room your kind of thing? Hi, ambulatory care isn't really an option for me. I hate doing home nursing. The paper work is a killer for me. And, on good days, I love ER nursing...so many people say..."I am so glad you are here, I wouldn't have worried if I had known you were on duty". I have a good reputation in the community for being a good nurse. I just want some support.

This is the situation...I work in a small hospital in a rural community. Hospital has 30 beds, ER has 5 beds, usual visits/day about 15. This time of year it is more. We have a 110 bed nursing home associated with the hospital, so several patients a day are from the nursing home. We have 4 ER docs who rotate through. One I work with every Wednesday and at least one day on my weekends. He does full court press on most patients despite their presenting complaints. For instance...if you are an old lady you need a cath urine specimen, even if your complaint is fall with hip pain. I worked with him yesterday, mainly had respiratory complaints...lots of wheezing going on. Everyone had cath UA ordered. I work solo...med/surg can be my back-up but we were admitting everyone we saw yesterday so they were way to busy to come out and help. No clerk...on day shift we have a pink-lady who mainly comes out wringing her hands and saying there is someone out here who needs to see the doctor????? Gushing blood? Blue and gasping for air? For suture removal? Oh, I didn't ask...or notice. I have to clean up each bed after each patient unless the pink-lady notices and comes out and does it for me. My shift, which should have ended at 7 pm lasted until 11 pm because several pretty critical patients came in as I was trying to catch up on my charting after the pm nurse came in. Leave with two patients getting full cardiac work-up and two peds getting IV's for dehydration...I don't think so! One cardiac was less than 50 years old and EKG showing acute MI, getting TNKase. Other one was saturating in the 80's. Peds were showing ketones in their urine. No lunch break yesterday...nurse manager came out about 4 to give me a break before she left. I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired!

Thanks for all the answers and questions. I have worked 24 of the last 36 hours so haven't gotten back to you before now. I didn't give you alot of details about my DIL to keep my post short. As an ER nurse, I see mental health patients in crisis situations, but don't have much other psych experience. However, I did do alot of research on the 'net about Paranoid Personality Disorder after my counselor suggested that as a possible dx for my DIL. It certainly explained her reaction to many things I did that I did not understand caused such a problem. Just a couple of examples of her behavior...I wanted to put their picture in the paper with an engagement announcement before their wedding. I live in a rural town in Georgia, less than 600 folks...she said no because her ex-boyfriend, who lived in Texas, might see the announcement and "go postal". She won't take the baby to a mall if she can't wear her contact lens because if she has her glasses on she doesn't have good periphereal vision and someone might run up and kidnap the baby. All I am asking is for you guys, the professionals, to give me advise on how you approach paranoid patients. I am convienced as I view many of her past behaviors with definitions of paranoia and realize that this explains her behaviors, that she is Paranoid, with a capital P. I can't help her, I doubt that I can get her to seek help. I doubt that I can convience my son to push for her to get help. I only want to know what I can do. I can only change my behavior...not her's and not my son's. I feel that now I am a target for her paranoia...maybe I should let that keep happening so she won't change to my grand-daugher and/or my son. Just don't know. I have been carrying the burden of this for several years, blaming myself and trying to jump through the hoops that she has created, thinking I could change our relationship if only I did something different. Each hoop I jumped through created two more hoops. Please...just some suggestions about how you approach and carry on with paranoid patients.

My experience with families in the code situation is when it happens without warning and they are already at the bedside. No time to waste a member of a rather small code team to usher them out. I have never had a bad experience. Recently it was only the patient, doc, wife and I in the room when patient went into symptomatic V-tach. Fortunately he responded quickly, but wife witnessed the rapid treatment and recovery of her husband. She was standing aside, quietly crying as she watched. My first move when I saw NSR on the monitor was to go to her for a very brief hug and to say...he's ok. I recently ran into them in the grocery store. Mission accomplished.

guy came in two nights ago...admitted up front to having a foreign body in rectum. even brought a duplicate of the glass cylinder bottle, rounded at presenting end, capped at the other end. he was using the one in his rectum to push in his hemorrhoids and somehow it ended up well up in the descending colon...off to surgery for him. he was very disgruntled when he had to call his wife and explain he was going to surgery instead of coming home.

I need help. I was having alot of trouble with my daughter-in-law and just couldn't figure out what was going on. Our relationship had deteriorated over several years from warm, close to hostile and lots of control issues. Being at loose ends, I sought counseling, knowing the only person I could help in the situation was me. Half way through the session, the counselor, Linda, stopped me and said "you aren't the person here with a problem, you have a daughter-in-law with serious mental health problems." While I had recognized that she was paranoid, I didn't realize she was Paranoid. Linda let me know that her problems were going to be difficult to get help for and that, if left untreated, would get beyond the point that treatment would help. I don't want to go into all of DIL's problems...the post would be too long, but I would like to hear your experiences dealing with paranoid patients and any helpful hints you can give me. I greatly fear for my son and their 7 month old little girl. Right now I have decided to back off from seeing DIL or the baby since that always causes a crisis in their life. Thanks

New overtime rules are murky Fine print sure to stir flurry of lawsuits By MARILYN GEEWAX The Atlanta Journal-Constitution Published on: 04/24/04 WASHINGTON-This week, Labor Secretary Elaine Chao will go to Capitol Hill to tell lawmakers how the nation's new overtime pay rules will work. Good luck The Labor Department's Web site says nurses who are "registered by the appropriate state examining board generally meet the duties and requirements for the learned professional exemption, if paid on a salary basis of at least $455 per week, may be classified as exempt." At the same time, the government says licensed practical nurses "do not qualify as exempt learned professionals ... and are entitled to overtime pay." That seems to settle the matter: Registered nurses don't get overtime pay, while licensed nurses do. But in reality, the nursing shortage is forcing employers to pay overtime to a great majority of registered nurses. Such complications are common in the modern workplace, where many lines between professionals, managers and workers have been blurred by new technologies and educational requirements. full article: http://www.ajc.com/business/content/business/0404/25overtime.html

New overtime rules are murky Fine print sure to stir flurry of lawsuits By MARILYN GEEWAX The Atlanta Journal-Constitution Published on: 04/24/04 WASHINGTON-This week, Labor Secretary Elaine Chao will go to Capitol Hill to tell lawmakers how the nation's new overtime pay rules will work. Good luck The Labor Department's Web site says nurses who are "registered by the appropriate state examining board generally meet the duties and requirements for the learned professional exemption, if paid on a salary basis of at least $455 per week, may be classified as exempt." At the same time, the government says licensed practical nurses "do not qualify as exempt learned professionals ... and are entitled to overtime pay." That seems to settle the matter: Registered nurses don't get overtime pay, while licensed nurses do. But in reality, the nursing shortage is forcing employers to pay overtime to a great majority of registered nurses. Such complications are common in the modern workplace, where many lines between professionals, managers and workers have been blurred by new technologies and educational requirements. full article: http://www.ajc.com/business/content/business/0404/25overtime.html

I agree with what you are saying about the family, but what is the criteria? Rigor mortis had set in. I am ok that we went out and said "we did all we could do". But I am really asking, professional to professional, what criteria is set for when you call the ME and when you go gang busters to the ER.

Local EMS calls in last night, code 3, cardiac arrest coming to an ER near me...well to me. Lady arrives, intubated, no IV access. Asystole on the monitor...all they got too. Family hasn't seen this person alive for over 2 hours. I pick up her arm to start IV access and her hand stands out, no limpwrist here. Pupils dilated and fixed. Back is bright red/purple to midline. This lady has been dead for a while!! What criteria does your EMS use for calling the ME or heading for the ER?

I have re-read the article twice now and don't see any criticism of bush providing universal health insurance in Iraq...I only see praise for his doing that. It is only critical of his inaction on health insurance issues in the USA.

Hands on care works best for me. I try to make it a back rub, but a foot rub works well if turning would only increase the pain or is contraindicated. Soft, geniune verbal sympathy is needed too. Unless I am super busy, I never give a pain med and then just walk away.

When I was younger, I worked nights, 7 on 7 off with one 8 hour shift in the middle. I must admit to being grouchy when I first woke up each afternoon, but I felt alert by the time I got to work. The 7 days off were wonderful! Now we work 2 or 3 or 4 in a row and seldom have only 1 night off between stretches. We self schedule and are on a permanent 3 week rotating schedule. All of us are flexible about filling out when someone calls in sick or takes vacation.

During the flu outbreak in December, our Infection Control Nurse put a sign on the ER door for folks who thought they had the flu not to enter! Nice gesture, but I told her to move it to the visitors entrance.

I work in a small ER, but we usually refer at least a couple of folks a month for inpatient mental health and/or substance abuse. I have never had one turned down because of lack of insurance and most do not have it. I'm in Georgia...don't know about other states.

Have any of you had experiece using lidocaine patches? If so, what types of pain did you use it for. How often did the patches have to be applied? Thanks

Thanks for the post! I don't shop Sams or Walmarts because of their employee unfriendly policies. I had never heard of Costco (I live in a tiny, tiny little town miles from a big city) until a couple of weeks ago on another discussion thread here. I located the nearest Costco which is about 15 minutes from where my son lives. I will join next time I visit him and shop there some. I am still sticking to my small town local merchants as much as possible, but I will also shop Costco for things I use in large amounts.

Alot of good points here on both sides of the argument. Some of corporate America is greedy. Some of corporate America still sticks to old fashioned integrity. Sam Walton worked hard to get his billions. But, I no longer shop at Walmart because of the way the company eventually evolved. I will buy a Toyota Prius in the coming months because no American company has a comparable energy efficient car. I bank at a locally owned bank. The majority owner also owns a hardware store and shows up every day despite being over 80. During a blizzard 10 years ago he walked over a mile to open the store because he knew people would need extra heaters, etc. I don't begrudge him a dime he makes from me. I try to read the news and not do business with companies whose policies I do not like. Just my take on things.

I called tech support for Andale counters (I use them on my ebay auctions). The tech support person had a heavy Indian accent and admitted to being in India when I asked. I gave him the same spill you did about resenting US jobs going overseas. He aswered "I don't have a command for that". Guess it wasn't in his script. I wrote Andale but doubt that anyone read it.

if I had to work a med/surg type unit I would be out of nursing for sure. I volunteered to come in and work med/surg one night last week because someone had called in. There were two RN's on, no LPN, no NA's, no ward clerk, no respitory therapist... We had 13 patients, 9 were incontinent and had to be turned. One patient was having significant bleeding, another got 3 units of blood during the shift. We had one admission. I was pulled to the ER for a code, was tied up about 45 minutes doing that. We made rounds on the patients at MN and again about 4:30. Forget turn q 2 h. No way could I live with myself if I had that on a routine basis.

Another reason Medicare costs are going through the roof is the Pharmcay Industry friendly drug program just added to it. Our "fiscally responsible" Republicon-men made sure their good buddies and benefactors in the Pharmacy Industry would have plenty of money to pass around: Jan. 28, 2004 Public Citizen Calls for Ethics Investigation of Tauzin Did Tauzin Negotiate Lucrative Job With Pharmaceutical Lobbying Group While Crafting Industry-Friendly Medicare Drug Bill? WASHINGTON, D.C. - Public Citizen today called for an investigation into whether U.S. Rep. Billy Tauzin (R-La.), who had a key role in writing the Medicare prescription drug law, broke House ethics rules when negotiating a lucrative job with the drug industry's top lobbying group. Tauzin has received an offer to represent the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry's main lobbying group, which was heavily involved in the crafting of recently passed legislation to create a prescription drug benefit under Medicare. The legislation contains key provisions beneficial to the drug industry; it subsidizes private insurers to provide prescription drug coverage to seniors - thereby increasing demand for drugs, bars the Medicare administrator from bargaining for lower drug prices and effectively prohibits the reimportation of lower-priced drugs from Canada. link to the entire article: http://www.citizen.org/pressroom/release.cfm?ID=1635

Hillarycare isn't returning because it never left. After spending huge chunks of change to run endless TV commercials scaring folks with "you can't choose your own doctor, you can't choose your own hospital" the Big insurance companies adopted those very same ideas! How many of you have insurance that doesn't have PPO's?

I'm not sure Universal Healthcare would equal Medicare for the masses. Some interesting posts at your other thread on Universal Healthcare that contradict that assumption. One of my arguments with Medicare is the contract MD's must sign saying they won't charge anyone else less than they charge Medicare. This means the MD can't give a discount to someone without insurance, yet, it would cost the MD less if a cash carrying patient walked in.