Terryw

In my opinion it is not necessary. However we are being told that it is a JCAHO requirement to screen all pts for domestic violence, functional and nutritional needs. If a need is identified, then we must have a plan. I'm just wondering if or how this is handled elsewhere.

I worked in the OR for 13 yr, and now in the ED for 14 yrs. Without a doubt, ketamine and propofol are wonderful drugs. In my opinoin they shouldn't be administered in the ED by RN's for exactly the reasons that Veetach mentioned. Let's have these same MD's who are ordering it, take responsibility and administer it themselves. Let's see how often they want to do it then? I find that they are unwilling to do themselves what they want us to do.

Small hosp without 24 hr anesthesia. ED MD (directs), ED & ICU RN (monitor & meds) RT (airway), Med flr RN (compressions) Surg flr RN (records)

Propofol is taboo in our ED also.

Ketamine is specifically EXCLUDED from our conscious sedation policy

Is anyone doing functional and nutritional assessments in the ED ?

No wonder you can't win. I guess I'm lucker than I thought, being able to work in such a supportive environment. Our docs are all on the same page with this problem. NONE of our docs order narcs for "seekers".

Providing false information to obtain a controlled substance is illegal. Yes I do call the police, and yes they are arrested.....and I might say, they don't return. Our state has stricter guidelines than others. They have be have provided false demograchic info to be charged. In some other states they need to only request narcs under false pretenses. We have a zero violence policy and that includes verbal threats. If they become disruptive, we call the police and have them escorted from the premesis. When they get ornry with the LEC, they end up in crobar hotel on a disorderly conduct charge. Our administration backs us 100% and initiates action to obtain restraining orders when necessary. I am sorry that you practice in an area where you obviously lack support from your administration, etc. No wonder you feel defeated. Fighting the seeker battle is one thing, but you are right.....without support.....it's a battle you can't win.

Well, teeituptom, I been there and doing it for 30 years and have more than my share of gray hair too, but I happen to think that honest patient care is not enabling addiction. If we're going to give up on these people, then we might just as well give them a gun.

You know, it you want to be an ED/Trauma nurse from the get-go, I suspect you'll get there. I could never go back "to the floor". I'd rather work at Walmart (I think). After all these years, I am constantly amazed at the # of nurses who say "I don't know who you do it". Well, I don't know how they don't.......but that's why they make Chevy's and Ford's. It's a good.......we all don't like the same thing!

ABSOLUTELY!!!! I am a 30 yr nurse who still loves what I do and agree completely with erjulie! Give me a young, enthusiastic new grad any day, who challenges my thinking and keeps me on my toes! There's a lot to be said for training them the way you want them....and not trying to re-train or break bad habits. I don't think that a new grad increases your chance of getting a poor ED nurse any more than a "bad" transfer. Some of my biggest nightmares, over the years, have been "experienced" nurses.

I agree, there but for the grace of God go I, or my family. However, I have a strong feeling about enabling negative behaviors. People do what they do because they can, and it works. Our ED only sees 25K pts /yr so we have the luxury of doing some police-ing. We, and some of the smaller ED's around us have a "special needs" list. So far that seems to be flying around HIPPA and our MD's are willing to call one another with problem pts. We also document the Rx's given to all pts in our computerized ED log, that gives us a quick way to spot "seekers". There are no easy answers, but I'm not willing to give up and roll over, (that is what the seekers are counting on) just because the problem seems overwhelming.