freki

The abuse from drug seekers is unacceptable. In Washington there is a law about disrupting a hospital that includes yelling and shouting or otherwise threatening nurses or physicians. I am pretty firm with the people who put on a show and point to that law...and then they usually walk out. I have been advocating more and more the opioid-free ED (Home). This guy has studies and information about treating common painful conditions with alternatives to narcotics. He has run trials of "shifts in the ED without opioids" successfully. I think part of the problem is that numbing people to their pain with narcotics is the easiest way to deal with patients in a busy environment. Physicians and nurses need to take time and utilize their knowledge and evidence to address pain more deeply, rather than spraying everyone with happy juice. Then those with true pain get the relief they deserve and the abusers come out of the framework.

Yes! This is what I'm looking for! What's been your experience with it? Do you have any policy documents or training materials?

Yeah I've been reading the history on this and it's very interesting! Sounds like subq was kind of the gold standard until flexible angiocaths and then it just went away. But from the reading, there's a lot of renewed interest specifically because of the hyaluranidase. I've seen demonstrations of 1liter in 30 min without much site swelling at all. And it seems to me that if a momma can hold a kid and get a subq infusion between the shoulder blades they'll be much less fussy and parents will be happier.

I would follow suit with what others have said and leave that place. I'm currently in a 9-bed rural emergency department with an annual volume of ~13,000. We staff a minimum of 2 ED RNs at all times, with increased coverage from about 11:00-03:00 (up to 5 RNs at the highest staffed times). There are nights when I feel that 2 RNs is unsafe - what you are describing is just playing dice with a lawsuit. I believe that ENA standards of practice recommend a minimum of 2 RNs at all times staffed in the emergency department, although you should verify that. ACEP also has a policy on ED staffing that includes minimum competencies of RNs who provide care in the ED. You also might find this helpful, it's a document that has a tool for determining needed FTE's based on your volume: http://umms.org/shoremagnet/Attachments/pdf_folder/EP11l.pdf. I'm assuming you are not unionized, but if you are you should definitely partner up with them and talk to your rep. Fill out "assignment despite objection" forms at every chance, describe and document the unsafe conditions. Keep copies of every time you tell management that the conditions are unsafe. Because like I said, it's only a matter of time before a lawsuit happens under those conditions, and if you've got a good documented history of telling management that the work conditions are unsafe you will be in a much better position when that happens.

I was wondering if anyone has any experience with using subcutaneous rehydration for pediatric patients that have failed oral (ORT). ENPC is currently teaching it and I've seen a lot of literature lately that seems to support this as a good alternative to IV rehydration in that subset of patients who aren't quite sick enough for admission and just need a little boost. I'm especially interested in protocols that use hyaluronidase to help improve flow/comfort. Does anyone have any policies or training materials on this? I'm part of my hospital's practice council for the ED and was thinking of bringing this up to perhaps trial before the next cough/cold/flu season. Thank you all!

In our ED, the policy is to ask about sexual activity, LMP, and domestic/relationship abuse if the female is over 12-years-old or has obvious secondary sex characteristics. I believe this is a requirement of "meaningful use" for CMS, but if you think about it this is much more than just "is it medically necessary". The ED ends up being a filter for many high-risk populations and often the chief complaint isn't the biggest problem for that patient. I've witnessed this several times with women who would repeatedly come back to the ED for "abdominal pain", but divulge that they are being abused, are fearful of their lives, or just don't know how to get help for whatever is going on in their lives. Yes, this happens in teenagers as well. Whether we like to admit it or not, sometimes mommy and daddy (or more often, step-dad/mom) are abusers. So I would say, don't be afraid to ask about this kind of stuff. Emergencies aren't always the broken bones and heart attacks.

I've been in 3 hospital systems in WA that use EDIE (employed at 2 different ones, an interview at another). For those that don't know (maybe from out of state), the hospital can choose to either get a phone call and a fax report or just a fax report. It's triggered automatically when the patient is checked in with registration staff. My experience has been that its impact is somewhat minimal on the treatment the patient receives. There have been a few cases where we discovered a patient was seen xx-number of times on the west side of the state and all of a sudden is showing up in our ED, but those are rare cases. More often than not, it simply prompts the providers to check out the patient's prescription history before writing anything narcotic. The narcotic prescription database is much more valuable, in my opinion.

I went to school in Idaho. One school required a CNA for entry, but the others did not. I obtained my CNA in high school (senior year) and I think working as a CNA prepared me for nursing more than any other thing. The most important thing I learned as a CNA was how to interact with patients and co-workers. They may teach that in nursing school, but I think think it takes most nurses a while to learn the skill, and some never seem to. Besides, more clinical exposure isn't going to hurt :)

Thank you, I've been wondering about the one-on-one thing.

I graduate in 2 weeks from my ADN (RN) program and want to take the NCLEX just as soon as possible thereafter. Our school uses ATI testing (atitesting.com) as a benchmark; I hear many schools use something similar, like HESI or Kaplan. My question is, how well does passing the ATI Comprehensive Predictor correlate to being able to pass the NCLEX-RN? Does anyone have any experience with this? I'm also willing to hear from those using the other programs (HESI or Kaplan).

I graduate from my ADN program in a few weeks, and will be taking my NCLEX-RN as soon as humanly possible after that. I'm also delving right into an RN-to-BSN track this next semester. My program is in Idaho, but I am applying for my initial license in Washington (why are they not a compact state?). So my question is, what can I expect as far as job outlook goes? To clarify, I will be living in Yakima and realistically am willing to drive 30 minutes each way to work. Looking on the hospital websites, the RN jobs seem to be fairly scant. Ideally, I would like to start out on a surgical or intermediate-care floor, but am open to nearly any position in a hospital setting. My ultimate goal is flight transport and/or ICU. Would love all the feedback possible about finding jobs in the Yakim area. Here are, what I believe, are my qualifications: BLS, ACLS current Advanced EMT, working for an ILS service for the past 14 months CNA since 2005. Experience in LTC, assisted living, and hospitals Emergency Department tech in a Level II trauma center for just under 5 years; tech in another regional ED for 3 years. Each has an average patient census of >100 pts/day. Phlebotomy experience Leadership Vice president for school chapter of NSNA Director at large for state chapter of NSNA [*]High proficiency with computers (previously managed a computer shop) Proficient with Centricity, T-System EV, AllScripts (HMED), and Meditech Also, what bits of this should I be putting into a resume? Anything I may have left out? Thank you in advance for any advice!

Okay, I did not read all 43 of the comments before I posted this, so forgive me if I repeat something... But as an RN student graduating in the next few weeks, I have to say that I hope to find a preceptor in my first job with this outlook and philosophy. I can count on less than one hand the number of nurses I worked with during clinicals who actually pushed me or actually tested my knowledge base. I appreciate this kind of honesty and belief in potential. Thank you!

I work for St. Luke's Health System and I hear mixed feelings on working for St. Luke's vs Saint Al's. I have friends who got hired on with Saint Alphonsaus in Nampa at $26/hr as a new grad RN. I know the starting wage at St. Luke's is $21.50/hr for a new grad (at least at Magic Valley, which Boise repeatedly tells us is the same as in Boise). Personally, I feel under-appreciated with St. Luke's. They are very patient-centered and provide great care, but sometimes it's at the expense of the employees. I've always heard great things about working for Saint Alphonsaus. By the way, these are both religious, private, not-for-profit hospitals. St. Luke's does not emphasize the religious aspect much at all; Saint Alphonsaus is a Catholic hospital and it is pretty evident when you walk down the halls. West Valley Medical Center in Caldwell is owned by HCA (Hospital Corporation of America), if you've ever heard of them. This is the largest hospital network in the US. I worked for a hospital they own in Idaho Falls and loved, but I hear a lot of mixed feelings there too. All in all, if you have experience I wouldn't settle for less than $25/hr in the Boise area. Boise is a beautiful area with a lot of big-city features and a small town feel. Just be aware that you are basically locked into either St. Luke's Health System or the Trinity Health System (Saint Alphonsaus). Good luck!

What kind of special needs are you talking about? Idaho Falls has a bigger medical community, so if your child has special needs that require a neurologist or peds specialist, I would try Idaho Falls. I grew up in Blackfoot and lived in Idaho Falls for 4 years. I would say that of the three you mentioned, Idaho Falls is best for raising a family; it's cleaner than the other two with more cultural events and is closer to more outdoor activities. The only downside (for me) is the highly religious nature of the area, but for others that may be a plus! I don't think I would choose to raise a family in Blackfoot, it is small and rural and very closed-minded. There is also a high amount of drug trafficking compared to the population size. Any questions, feel free to ask me. I have a lot of experience with the hospitals around that area and the activities offered. I did live there for 23 years

Thank you for the help guys