errn911susan

First of all, I commend you for using your head and giving your coworkers analgesics and antacids from your personal supply. You are fortunate you can afford to keep them painfree and a pleasure to work with. However, once again points are being missed. Tylenol is not the issue. Tyenol as written as an order by a physician for a patient/resident is the issue and what is being referred to in the "conversation". Just wait and watch. It is only a matter of time. It's those nurses who attempt to simplify and become complacent naysayers who get popped for violating laws. Hopefully you never run out of your personal supply. But if you do, go ahead...see to it that your coworkers are painfree and comfortable and happy and cozy despite nursing and drug administration laws. See how long you remain licensed to practice(that's assuming you are a licensed practitioner).

This response is ridiculous, knee jerk reactive, and is obviously made by a non-licensed care giver. Otherwise he/she would understand the seriousness of diversion. Diversion is diversion no matter the compound of the pharmaceutical. This issue is black and white. If the medication is meant for patients, it must not be handed out to staff. If the medication is meant for staff, have at it. This has nothing to do with the nursing staff's opinion of the person seeking the med. If you want to split hairs, then yes, it would be inappropriate for you to use an alcohol wipe to "clean up" after being injured by a resident. The proper course of action would be to go to your supervisor who would then complete an incident report after accessing the First Aid Kit and cleaning your wounds appropriately. It is not impossible that one could develop a serious infection S/P that type of mechanism of injury, and an incident report would ensure proper treatment if and when that did occur. Who knows where that residents fingernails have been? Calm down and let the nurses do their jobs and make the decisions they were trained to make. Target has great prices on analgesics.

Yikes! Which proves the point that Nursing is not to be taken lightly AND admin does not always have our backs! Our practice is completely on us!

Shock Trauma in Baltimore...? Holy Cow!!! Well, I am sure it all must be economy related. Truly. No doubt they would not want to pay me the high wage I make per hour in favor of a new nurse's wage. Hopefully all these EDs have awesome mentors and offer lots and lots of support. A few inservices on ER Nursing and Addiction may help these newbies too! A healthy means of stress reduction is a must as an ED nurse! A 0400 ride on my stationary bike before work is my ticket to sanity and rejuvination after a noc of cleaning brain matter up from the floor!!

It is curious that CWhitebn misconstrues my post as being critical of new grads. I understood the author of the original post to be asking for opinion of those of us with good experience under our belts. I gave mine based on my personal experience as a Level I Trauma Nurse, Certified x 15 years having worked in a large and progressive Westcoast Level I Trauma Center for years and years. I hope that my well earned wisdom has been useful to the new grad who asked and that he/she knows it was offered in good spirit and care of the new inexperienced nurse. We all have to start somehwere, and I stand by my opinion(shared by many an ED manager) that the ED is no place for a new grad. Most EDs require at least 2 years previous med-surg experience. Those that don't or who have decreased their requirements are more than likely feeling the nursing shortage and weary of paying high dollar for agency nurses.

The answer to your question is remarkably simple. If the medication is supplied by pharmacy for the patient/patients and you provide it to a staff member, you are guilty of diversion no matter what the medication. If the medication is supplied by pharmacy for staff use and you are being asked for it when you are busy, then talk to your DNS and ask that a place be designated for staff medication. The CNAs can then be responsible for retrieving and taking the meds on their own.

Who would be liable? The person administering the medication! Doctors and admins can bark orders all they want, but good nursing judgement dictates that you know it is not safe to administer one of the strongest respiratory depressing opiates out there to patients who are not monitored by pulse ox at the very least and one RN with full monitor at best. You know in your gut this is not ok!

Not only should you not take the job, it should not have been offered to you in the first place. The ER is a discipline of nursing that requires years of finely tuned nursing judgement and instinct which a new grad does not and cannot possibly possess. I had several years under my belt(some to include ICU), and I still looked like and felt a deer in headlights during my orientation when something really, really bad rolled through those doors. Of course there are many 'levels' of emergency departments, and I suppose some rural centers are akin to medical clinics. If you are in this type of setting it should not be too much of a problem. But if you are working in a large metropolitan hospital(and honestly I cannot imagine a large Trauma Center hiring new grads), then I would run screaming into the night for the sake of your career and, more importantly, for the sake and safety of the patients who present there for care:yawn:!