GDog7NYC

The long and short of it (no pun intended).. patient came in with a rather large cucumber in his rectum. We got it out.. he wanted it back.. everything was a bit garbled.. something about him being a vegetarian.. *shudder*

Grape juice and Gastrografin.. If water could serve as contrast media, how much easier would my life be??! LOL

A Trauma Registrar is usually responsible for collection and analysis of data regarding the incidence, severity and causes of traumatic injuries. He/she also monitors the facility for compliance with designated state trauma operational guidelines (unless that happens to be pawned off to your Trauma Coordinator). Paperwork.. paperwork. Also, depending on your state specifications, data on patients meeting inclusion criteria into your Trauma Service usually needs to be submitted to a State designated Trauma Registry on at least a quarterly basis. Some of this information includes basic demographics, EMS response and intervention, nature of injuries, ICU data and patient outcomes, to name a few. Did I mention LOTS of paperwork? LOL. Good luck!

I use grape juice.. it tastes better and smells better if the patient ever throws it up.

Sounds like it will be just another typical night in NYC then! LOL

Being the Night Shift Manager of my Emergency Department, I understand that there will be times that one may become snippy or a flat out b--ch. We all have our moments. But to deal with a Charge Nurse that is that way day in and day out? Sounds like someone needs a reality check and fast. I agree with what was said previously about someone being so burned out that perhaps they may need to step down and enjoy a change of pace. That helps tremendously. There have been times that I have felt like I did not want to be in charge for a night. When this happens, I talk to my staff, and hand over the desk to someone else while I take on a patient care assignment for the next 12 hours. I'm all the happier for it. Fortunately, I have worked with the same strong and very cohesive night shift for the last 4 years and I can virtually put anyone in charge and know they will be able to do a good job. Someone should suggest this approach to that Charge Nurse via your Nurse Manager. Go as a group. Write a letter. Whatever it takes. Just realize that there is strength in numbers. The person in charge of an ED should be seen as both an advocate for staff as well as patients, and should conduct themselves in a calm, organized and decisive manner. Anything less than that should not be tolerated.

When my triage times exceed a half an hour and there are 5-6 ambulances lined up still waiting because there's no room to put any more patients, then I know it's time to call the EMS Conditions boss to close me to ambulances. Even though the walk-in's continue to come, every little thing helps. Depending on what we're holding in the ER, we're given free reign to bump up staffing as we see fit (either with OT or agency RNs). Also, when patients are admitted to Critical Care and my nursing staff is drowning, I call down the medical (or surgical) interns to do as much for patients admitted to their respective services as they can. The unfortunate thing is, sometimes there's just NO one to get. What do we do then? We do the best we can and repeat the night shift mantra.. "morning will come.. morning will come"..

If you've ever received Gastrografin po contrast, you'll find it to be very irritating to the stomach.. that stuff is nasty! Ugh. So I always recommend a dose of Reglan or Zofran prior to drinking it. Works like a charm!

We use a system called Emergisoft, and have been using it for approx 7 years now. Last November, we upgraded to its newest, Windows-based version and there was a lot of moaning and groaning from both the Physician and Nursing Staff. 6 months later, it doesnt seem to be so much of a problem anymore, as everyone has gotten past the learning curve. I'll tell you, I love our documentation system. It's fast, convenient, user-friendly and provides for accurate and succinct documentation. We've tailored the system to our specific needs (i.e., built our own order sets, medication and treatment lists). Radiology and the Lab are interfaced into the system so results are automatically flagged and able to be read even while you're in the middle of documenting. We're slowly moving towards the goal of a paperless ED, so that will definitely be a joy! Furthermore, we're able to print a multitude of reports from the system including a shift report on ones assigned patients as well as an admission report that tells me how many patients were admitted on a specific date and what the breakdown on lengths of stay were for that day. It's an awesome system that I highly recommend! :)

This August, NYC will be hosting the 2004 Republican National Convention. Have any of you worked in a city that has hosted one of these political conventions? If so, how bad has it gotten? In the light of all the violence that's occurring recently, I'm inclined to gear up for the worst. Any thoughts?

fantastic.. simply fantastic!

Just remember, if you're ever faced with a loud, obnoxious, foul-mouthed drunken patient.. take a few cleansing breaths and remember: YOU have the power..the control.. and the Haldol and Ativan. :rotfl: Knock yourself out and enjoy your first day!

God, I would LOVE to have a staffing ratio of 1:4. Right now i'll be lucky if we meet 1:8! There are 23 beds in the Main ED plus 8 virtual beds (i.e., hallway), 1 Trauma Room, 6 in the Pediatric ED , 10 beds in Urgent Care and up to 35 seated patients (let's not even count what's in the waiting room). There is a Nurse Manager on at all times (or an assigned Charge RN) and they dont take a patient assignment. That being said, both the Nurse Manager and the Triage Nurses are counted in the mix when determining staffing levels (average: 20 RNs and 9 Techs in a 24 hour period). We average 70 to 73,000 visits annually. Ok.. i just got dizzy all of a sudden. LOL.

It's definitely an article that provokes a lot of thought as to the direction that Emergency Care is headed, but at the same time, it makes me think about a couple of things. I have a dedicated Minor/Urgent Care area in my ED that is open until midnight and that is staffed with an ED attending, a PA and 2 RNs. I think triaging out, like the article describes, defeats the purpose of having that area (as many ED's do). Also, we have a Walk-In Clinic directly across the ED that is open during business hours that our medical and surgical residents rotate through to provide continuity of care for many of our chronically ill patients. Are we still constantly overcrowded and inappropriately utilized? Of course. Part of the problem there is that many of the Attending Physicians with admitting priveleges in our hospital constantly tell their patients things like "well, if we want to get these tests done faster, go to the ER" or "if you can't get ahold of me, then just run over to the ER and we'll get you patched up" even if it's not a medical emergency. Many times, I can't help but feel like i'm treated like the 7 Eleven of the healthcare industry - cheap, open 24 hours and most convenient for all involved. Of course, many physicians who dont work in an ED fail to tell their patients how expensive it is be seen by us, particularly for non-urgent matters. I believe that if misuse of EDs is to be tackled, then there has to be a concerted effort between all medical disciplines who constantly view our departments as the paths of least resistance and thus advise their patients to "go there".

Our visitation policy is 1 person per patient (and both parents allowed for peds). Visiting is every hour on the hour for 15 minutes. We will of course make exceptions as the need arises. There have been times that I have had to cancel visitations because of a tremendously packed ER or multiple critical or trauma patients.