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gardengal1

gardengal1 ASN, RN

ED only
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gardengal1 has 25 years experience as a ASN, RN and specializes in ED only.

ER nurse 25 years

gardengal1's Latest Activity

  1. We NEVER hold a patient during shift change - that is what the Resource Nurse is for. Admits go up as soon as they are ready, no matter what time it might be.
  2. We use the same computer system as the admitting floors. When we call to give report to an admitting nurse, if they are not available, they MUST call back within 10 minutes, otherwise, the Resource Nurse takes report. During report, they have the chart open in front of them and can ask appropriate questions while the ER nurse is giving that report. It seems to work well when the nurse calls back within the 10 minute time frame. The patient then goes up immediately after report via transporter (except ICU patients which require a nurse transport and confirmation of drip rates at the bedside). There are rare call backs with questions when both of the nurses - the sending and the receiving - are looking at the same information at the same time.
  3. gardengal1

    Succ vs Etomidate

    We use Etomidate exclusively for bedside procedures (reduction of dislocated joints). For intubation, we combine Succ with Etomidate pre-intubation as a 2 drug combo. For procedures, Etomidate is short acting with the patient waking back up in minutes rather than hours and discharges are more expedient after the required monitoring time and without many residual side effects.
  4. gardengal1

    Vodka tampons?!?

    Regarding the post that kids now will snort anything: I recently had a teen ask me if he could get high from snorting Warfarin. I calmly told him "no - but you will bleed to death". Then came the lecture. Kids believe that anything that comes in a tablet form can now be crushed and snorted. Are we going to have a future generation of young adults that are permanently brain damaged?
  5. People do this crap in our hospital all the time but fortunately, we never see them. At staff meetings, our boss will tell us we have had some write ups about ie: sending a pt for a MRI with a running IV rather than a saline lock; elderly demented female was wet when she arrived at X destination (she was dry when she left ER); there was a spot of blood on the siderail of the ER cart, ICU complains we did not do X, Y and Z before they got the patient, etc. Our boss mentions this stuff as a general learning situation and does not look at nor point out who might have been the offending nurse. Sometimes, she gives the other complaining department head an ear full (in a nice way - she never gets mad). We all let this stuff roll off our backs - we have to, otherwise, you begin to question your abilities.
  6. gardengal1

    The problem with floating ER Nurses

    We do NOT float, EVER. And, it is the rare occasion that you are allowed to go home ON CALL and must be within at 15 minute response time to get back there when **** hits the fan. I do not have sources for you to check. We follow safe staffing for ER's from the ENA recommendations. When we do occasionally have downtime, it is time to spruce up the unit - things that never get done - hosing down beds and letting them air dry, getting under the crevices of the mattresses which no one ever does; straightening out the supply room, etc. On occasion, we have other staff float to us when we are in crisis and need more bodies than we are staffed (which happens frequently) but they only task and do not chart. You might also check California rules for staffing since they now have mandatory staffing ratios - maybe you can find one for their ER's.
  7. gardengal1

    What do you consider to be nursing's biggest setback?

    Not having the TIME to spend TIME with my patients due to all the other "stuff" we have to do in addition to the unsafe staffing loads.
  8. gardengal1

    *Vent* RN's make toast?!?!?!

    We HAVE a pizza oven - it keeps setting off the smoke alarms! Would trade it for a toaster. We could then get that banned immediately also - someone needs to take lessons from us:yeah:
  9. gardengal1

    First Nursing job, and I drowned!

    You will look back on this after some time has passed and you will be very, very glad you were fired. It doesn't seem like this right now but there may be something much better waiting in the wings for you. You were in an impossible situation, tried your best to make it through this nightmare and you ended up on the losing end. There is no feelings of satisfaction from this job being placed in this mess and, after time, you will probably realize how lucky you are to get out of there. Keep moving forward, be ready to explain the situation to other future employers and hopefully, you will find the right fit for you. Good Luck!
  10. gardengal1

    paramedics in the ER

    We have one paramedic in our ER per each 12 hour shift. Because we are a rural area and many ambulance services have no staff with advanced skills, our paramedic has a SUV fully equipped and goes and meets ambulances that are enroute to our hospital and can then start IV's and give meds and have the patient stabilized before arriving in our ER. When not on calls, our paramedics start IV's and give medications and transport patients to ICU. They cannot hang antibiotics or start blood infusions but can monitor blood infusions once they have been started by a RN. They cannot do triages and operate under the RN direction. They can chart any cares that they provide. And, if needed, they do emergency intubations, IO's and other paramedic skills when needed in the ER setting. I believe each state has rules as to what paramedics can and cannot do in any given state. Ours can do almost everything except for those things I have listed. And, they cannot do foley insertions - probably only because they have not been specifically trained to do this skill. We consider them an asset to our team.
  11. gardengal1

    Documentation

    We have T-system which is extremely user friends and is specifically for the ED. It takes about a total of 10 minutes to learn how to use this system. BUT, our hospital is sick of Meditech which is what every other department has and we are now going to Cerner in 2011! We all have reservations about going from an easy to use system to one that is more complicated to learn.
  12. I had one yesterday come to the ER by ambulance from local nursing home with swollen bridge of nose. Someone had put the C-PAP on too tightly the night before. And, they had to go back by ambulance because the NH has no mode of transportation for their clients. What a waste of health care dollars!
  13. gardengal1

    I've been bullied all my life, and it continues...

    Most all the advice given is appropriate. And, you need to realize that when you go in to a unit where the nurses have been there forever, it is their territory and they are VERY territorial. They have never tried anything else and are stuck in a rut and don't have the guts to try a different unit. If it gets too unbearable, ask for a transfer to another unit rather than leaving the hospital all together. These people will never change, every hospital has them. My family moves around a lot and I have been the newbie on the block more times than I can remember and there is always several nurses like that and ones in specialized fields like ICU, CCU, etc. are worse than most. Get some counseling because of your background, and all of this may be slight over-reaction to their comments and internalizing their sarcasm rather than letting it roll off your back which you will have to learn to do if you are going to survive. And lastly, chronic sleep deprivation makes you much more sensitive to what others say and do. With very little sleep or quality sleep, I can cry at almost anything (but, I never let them see me cry at work!). Lack of sleep affects your attitude, your mood and your ability to cope. I'm sorry you are going through this right now but with a few changes (counseling, speaking up, visiting with your manager, quality sleep) you may be better able to cope with this work environment. We are all pulling for you.
  14. gardengal1

    Too many know it "allnurses"

    I have vented on this forum. There are always the ones who tell you to suck it up but then, there are those who have walked in my shoes, understand why I need to vent at that particular moment. And, by venting to those who understand, the pop-off valve has now ceased it's shrill noise in my head and I feel better. I have mostly had support from this forum but there are those who want to give advice on how I should have handled something better. If the situation needed better handling, I would have done that instead!!! But, patients, families, physician's and co-workers occasionally get on your nerves and you need to let the steam off somehow and this forum allows you to do it with more people offering understanding than those who criticize. Do not stray away from us because of a few do-gooders!
  15. gardengal1

    You might be a trauma nurse if...............

    You can use almost every supply in the trauma room you have available and the paper containers are all over the floor within the first 5 minutes that your trauma patient arrives!
  16. gardengal1

    You might be a trauma nurse if...............

    We take bets on blood alcohols - nickle to whoever gets the closest when the lab report comes out. I ALWAYS win - must have a good sniffer!
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