mercRN

If they have to be on a monitor for radiology then someone ACLS goes with them. Some of our pt's the docs will say they don't need to be on the monitor to go to radiology.

Just love reading these. It makes us all appreciate our jobs. I had almost forgot about this pt. until the other night when the Doc that took care of her brought it up. She come in stating that she was "lactating". Now the weird thing is she had a complete TAH. When I did her secondary and asked about it, she said that her and her fiance' were messing around and he was sucking on her breast and unlatched and spit this white stuff out of his mouth and said WTH was that and she said it is breast milk. The look on the docs face when she told him was priceless. I had to look away from him or I would of totally lost it.

I have to agree with the other posts. Ask lots of questions not only to the ER docs but to the nurses. Some of the nurses will be more receptive than others. You will figure that out in the first couple of hours probably. Do lots of EKG's. Anyone who comes through our doors with SOB or CP gets a EKG done automatically or anyone who OD's. On the back of our leads for our EKG's it shows you where to put the leads at. Then the actual leads tell you where the lead needs to go. RA, LA, LL, RL, etc. If ED is somewhere you want to work, most ER's have standing orders for different scenerios, like chest pain, fractures, fevers, etc. Get copies of them and study them so you know what the docs want before they see the pt.

To go to a tele floor has to have someone ACLS certified on a monitor. CCU I am pretty sure has to have an RN plus someone else and one has to be ACLS certified.

I just had a pt the other night c/o epigastric pain and needed to have lab work done. Well she was one of those ones scared of needles and yes I did have to baby her. I told her let me have one stick and when she said yes and turned her head I put the needle in. Went ahead and put in a SL just incase she would need any meds. It took me about 10 minutes to try and convince her to let me stick her. One of my co-workers said on one of our "regulars" that all you have to do when she gets there is take a lab tray in and tell her you need to draw labs and she throws a fit and signs out AMA.

We use NP in our fast track area. We don't use them in the main ED but they do staff fast track. There are times when I think some of them know more than the ED docs do.

Thanks alot. Have to take this to work to show the docs. :)

Last night at work was horrible. I am thankful I was in triage. Our hospital typically doesn't get codes or traumas unless we are the closest facility. Well we got them last night. 3 code's in a row, d/t a house fire. We had a brother and sister 6 & 7 and the children's grandma's boyfriend. I heard the call for a trauma but our sister hospital was to get 2 pt's and we were to get 2. The nurse orienting me came out to triage and said don't put anyone in the back. I thought she said we have 2 non-rebreathers coming but it was we have two non-breathers coming. I am triaging and see the first squad pull up and am typing something and look up and go "Oh my, it's a child". The little boy in in full arrest. I can't remember who came in second but all three of them were in full arrest when they came to our facility. We are not a very big facility. I think b/t the two hospitals we can house 200-250 pt's inhouse if that. We were just lucky we had the nursing staff and the docs. It was getting close to change of shift and our night doc came in at the right time so we ended up with 4 docs total plus a pediatrician that came in to see another pt went to help. When it was all said and done with we lost the little girl, flew the boy and older man out. I wasn't in any of the 3 rooms, even though I wanted to but I didn't want to, at all but it is so sad. I had to stop at my children's day care on my way home from work this am to give my children a hug and a kiss. We had 6 crash carts all cracked sitting in the nurses station after everything was over with. Our pharmacy closes at 8pm and this was at 945 when everything started. I am just glad that nothing else happened through the night b/c we didn't have a crash cart that was completely stocked to use.

It depends on how high the temp is where I work at. If the temp is below 102 we usually give tylenol unless the parents actually gave them some within the last 4 hours. For temps over 102 we start with Motrin unless it had been given within the last 6 hours. Our docs alot of times if we give tylenol or motrin in triage to a pt and the temp is still up when they see them, approx 30 min if we are lucky, they will order us to give the other. Do your hospitals do that? I was always told 2 hours between but they don't seem to think so. I know at our small community hospital where my sister in law works at, one of the peditricians doesn't want his patients medication for temp, no matter how high it is. He said that the temp is fighting infection and wants the temp to stay up. I don't think it is right, but who am I to say I am just a nurse. :)

I know our hospital is not supposed to do EJ's but I think there are a few who have and will do them if need be. We are getting ready to do all of our competencies in March. We have JHACO coming in August so we need to do all of ours early. I am hoping to have a night where I can get the art line kit out and not open anything but get out what we would need and set it up so I at least look like I know what I am doing.:)

With IBEX when the doc puts orders in it comes right up on IBEX. When we finish an order we mark done on the task and then go chart it in the appropriate spot, either under medication, IV's, lab draws, ua's, whatever. We still have to go to the pyxis to get the medications but the orders are right there. We have found a little glich in the system. Sometimes it will mark all of the orders as done when they are not all done. So you have to keep going under tasks to see what orders you have left to do. It is really a neat program. If the doc gives us a verbal order we can go in and put the order in ourself. It will have after the docs name our initials that we received it as a verbal order. Sometimes with me being new to ED when I do my secondary I will type it in and being busy forget to put something in the secondary. I can always go back in and put it in with having the computer charting. When it was paper you had to put it in as a late entry. They still know if it is a late entry or not but at least I don't have to type late entry. Also wondering for you night shift people. How many of you when you get to work and get report do a reassessment of your pt's. I have noticed that most nurses where I work don't do that but I thought it would be a good idea, esp since someone had the pt before. Something might have changed that they didn't tell there nurse before or something that they might not of told the nurse. Just a thought.

We have 2 visitors per pt. When we had the bad flu outbreak in Dec we had everyone who walked through the door put on a mask if they had flu sx's. We are not real strick on the 2 visitors unless they are in our way. I was very thrilled with all of the responses to get family out of the room to do secondaries and ask the pt personal questions. I will have to remember that for future reference.

I agree 100%. Ask your questions. If you don't you might not ever understand something. If the answer you get doesn't make sense ask again. The day I stop asking questions will be the day I die.

I like the idea. I know with us having room assignments we try not to place a bunch of critical pt's in one block of rooms. At our hospital we have the three blocks. The front block has two major medical rooms and the back block has two major medical rooms. The middle block usually has the code/trauma room but it is very rarely used unless we have a code come in. We don't see hardly any trauma at our facility unless they are a walk in and if they do come in alot of times our ER doc will have them sent to the sister hospital since it is our trauma center. It upsets me at times when they do this because we are all nurses and doctors and can do all of the same things but in order to keep up our level 3 they have to go to the sister hospital. Most of the time if we are full in the ER our charge nurse makes sure that none of us are drowning and helps out.

IBEX is really great. Make sure when you go live that the "super users" from IBEX are at your facility 24/7. They would leave our facility at midnight and come back between 6 & 7 in the morning. The nightshift nurses didn't get any help from them at all. The templates are basically self-explanatory and really help. There is more stuff on the templates then what you would probably do but you only mark what you have done and then there is an area for you for free-text anything that you might not want to mark. It just takes time getting use to it and once you do, you hate it when they make upgrades and you have to do paper charting for a while. Once our doc's went to IBEX it made it alot easier to get orders. You don't have to try and find the chart you just get on the computer and there are your orders.