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To-Keep-open Infusion rates
We use 10ml/hr as KVO in my ER.
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glass of water-stat
We have one doc who uses: Provide patient with TV remote He gets pissed when we see it and don't do it right away. In my mind the BP meds for the MI patients or the pain meds for the kidney stone take priority.
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Paramedics in the ER
We just started having paramedics in the ER about 2 years ago, so it is still a relatively new venture for us. We staff 1 medic on 7a-7p and 1 on 7p-7a and they are assigned to triage. We assign 1 RN and 1 medic to triage. If we are short nurses, then our medics can pick up shifts in the main ED. I personally think they are highly underutilized. They transport monitored patient up to the floors, start IVs, can give ACLS drugs in a code situation, and do EKGs. If weare busy, they can fill out the triage portion of the squad arrival patient's assessments. Other than that, they pretty much just help out the techs.
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Emergency Room Charge Nurse
We have 3 designated charge nurses on the 7a-7p shift and 3 designated charge nurses on the 7p-7a shift. We do get paid more base pay than the non-designated charge nurses by about $1.50. If one of the designated charge nurses aren't there, one of the experienced nurses gets 50 cents extra an hour for relief charge. We don't get a lot of extra pay, but we are only a 19 bed community hospital with an 8 bed fast track area. Charge also doesn't take a patient assignment unless we are short staffed.
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Taking floor orders in the ED?
We just changed our system recently. Our ER docs liability insurance company gave them a deadline to make changes or they would drop them. So here's what we do now: ER doc calls admitting doc. There are 2 options: Option 1: ER RN can take verbal floor orders from admitting doc. Option 2: ER doc can write very basic orders which are only good for 4 hours. The docs stamp them with a custom stamp we had made that states when they were written, expiration time, and admitting doc to call for further orders. We haven't had had too many issues so far. Most of the admitting docs will just wait for the floor to call them and let our docs write the basic orders for the first 4 hours. The admitting docs that wants to RN to take verbal orders generally are pretty good about knowing what they want. We use basic floor protocol orders depending on admitting diagnosis for most patients. Charge nurse tries to take orders when they don't have an assignment to make it easier on the other nurses.
- Excelsior Grads - Where are they now?
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Professional skills in Toledo
I graduated from Professional Skills when they first opened in 2004. The school has gone downhill in the past couple years. They had an incident last year where two nursing students got into a physical fight at a clinical facility. Needless to say, the school is no longer welcome to do their clinicals there. Their NCLEX pass rates were high when I went there, but they have dropped. I have also had 5 people from my graduating class of 21 who were either unable to take the NCLEX because of felony convictions or who have lost their licenses for narcotic violations. I went on to get my Rn without a problem, so I obviously learned enough there. But, with the distractions (such as the fight in clinicals) it makes it harder to concentrate. They don't have a very good reputation right now at the 2 hospitals I worked at. If you have any more questions, just let me know. Elizabeth
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Filling baldder for Ultrasound...do you
We routinely cath them and ultrasound fills their bladder with NS. I hate doing it! But on night shift, US won't even come in when called unless the pt. had a foley in place. I hate telling a petient having a miscarriage that I have to foley them. Like these people aren't in enough pain and anguish as it is! Elizabeth, RN
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Medics vs Nurses in the ER
I an RN who just moved to the ER from neuro. We have RNs, EMT-Ps, and techs in our ER. RNs take the main responsibility for patients. Techs help out with ADLs, EKGs, and transporting non-monitored patients. We use EMT-Ps for two main things: traigae and transporting monitored patients. We have both an RN and a medic at our triage desk so that when people come in, we have 2 different people to decided their priority and whether they go to the main ER or Express. We also use medics in the main ER if we have more than 1 scheduled. They start lines, put people on monitors, get fluids set up, and transport patients who need monitored to tests and to the floor or ICU if they are admitted. Our medics have told us that they money is better, but they feel like they lose some of their skills because they are usually stuck in triage. We have only had medics in the department for about a year and are constantly revising what they do. Our philosophy is if we are short an RN, we would gladly take a medic any day. Our hospital doesn't permit them to do meds or full asessments, but I feel medics are very valuable. They can check on patients and giv me a much better description of what is going on than a tech can.
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Home Health in NW Ohio
Hi! I noticed that Hospice has some per diem positions available for home nurses. Also, I have worked through Interim Healthcare both as an aide, LPN, and RN. They have a lot of flexibility. You can chose to be a primary nurse on a case, or you can just pick up some fill in visits or shift work. Up to you. Plus they do some of the health screenings and you can pick up hours doing that occassionally. Elizabeth, RN
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Is this a normal policy?
This is how it has been at the 3 hospitals I have worked at. ETO or sick pay is paid at your base rate. It does not include any shift or weekend differential because you are not actually working for the off shift.
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Going back to NW Ohio
Hey all! I got the job at St. Luke's in the ER!! I'm so excited. I have been in neuro as both an LPN and as an RN and was ready for a new challenge, so here it is. I start hospital orientation for 2 days on Monday and will be in the department starting on Wednesday. I'll be working 7p-7a. Elizabeth, RN
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excelsior college lpn to rn
I live in Toledo, Ohio and went through Excelsior's LPN to RN program. I graduated in August and took my NCLEX and received my Ohio license in September. I loved the program. I continued to work full time throughout the program, so it's flexibility was nice. The CPNE was stressful, but as long as you keep focused, it is definitely do-able. Elizabeth, RN Just starting in ER after 2 years in Neuro
- New ER Nurse
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New ER Nurse
Hi everyone! I just got a job in ER working 7p-7a. This is my first journey into ER. I worked for just over a year as an LPN in neuro/neurosurg and for just over 6 months as an RN on neuro/nurosurg/trauma. I sent in my resume for kicks even though the ad said they wanted experience in ER, but I got the job anyways!!! The nurse manager said I am only the second person she has hired without crit care or ER experience in her 6 years there. So, I know I'm in for a challenge, but that's what I'm looking for. I start hospital orientation for 2 days on Monday, then to the department. Just wanted to say hi to everyone!!! Elizabeth, RN