tlf91

In our facility we use "Power Pudding". All natural. bran, prunejuice and applesauce mixture. The residents love it and can not get enough. Ask for more. We use it in out protocol and boy is it effective. We give it at night and the next morning "look out". Works like a charm for us.

I work for a company that was purchased by UHC last year. We function much like Optum. When training with UHC, I had the pleasure of visiting two different Optum sites. One was in Plano Texas, the other in Rhode Island. Both sites were very impressive. I sat with the nurses and watched them do their work.As far a disease management, I think it is very rewarding work and you will really enjoy it. Get to help and educate alot of people. The computer system is awesome. Both places that I visited seemed like great places to work. UHC is big on education and you are about to learn alot of information. I have really enjoyed the transition to Optum and the UHC way of life. I wish you the best of luck. This is a big company and there is great opportunity with United.

This is very true and good advice. At the very least, you have it in writing. Make sure you go through the chain of command and notify someone of the situation at the time it is occuring. Most of the time, the administration will at least get the info. BUT..........beware. In a Charleston WV HCA facility they fired a nurse for this. She would not discharge a patient from the ER with a 6.7 k+ level. The ER MD ordered discharge after giving 1 dose Kaexelate PO. Pt also had renal failure. After the MD would not listen to her , she called the primary who admitted the patient. Supervision was aware. The call to the PCP was made from the supervisors office. She was fired for " not following the chain of command " after the Primary Physicians stormed administration for unsafe conditions in the ER due to unsound decisions by the ER docs. The HR director basically told her that she caused the Administration alot of problems and they wanted her fired. The one thing that will help her in court is the fact that she documented the calls and notification on the incident report. Awaiting the trial date at this time. Now here's the kicker.......... WV nursing board told her that she did the appropriate thing and if she had not she would have risked her license. So, I guess the lesson to be learned is that a hospital can fire you for raising a stink about an unsafe environment. This may hurt your feelings and pride. But the nursing board can take your means of living. If you do nothing and it is found that you knew and did nothing. They can take your license or at the very least make you miserable to have one. Protect yourself because the hospital will be the first to say they had no idea that there was a problem because you did not tell them. They wonder why no one wants to go into Nursing and why Nurses are leaving the field. Go figure...................

Boy, you have had a long week........ I had to change the way I looked at these people to keep out of the homicidal side of my personality. Yes, I know it sounds silly but I turned it into a game. Sickest patient of the day. Most pitiful acting job of the day. Drama queen for the day. Biggest pain in the %#*&^$&* for the day. I was at least laughing more. The only thing I can say about patients who really do not need to be there is that that they are job security and character builders. I do not ever see this problem going away. Just make an effort to try to find ways to make it fun and try not to let it get you down. Venting is good . Real good!!!! We are right here with ya!!!!

I do not think there is an ER Nurse that can not feel your pain. Most of the time the answers to fixing this problem are process related and require administrative intervention. We know how that goes!!! When I managed the ER, I had the joy of talking with each and every complaint that was place on satisfaction surveys. Needless to say, I worked very hard to decrease the amount coming in. What I have found is that honesty is the best answer. I had them begin in the triage area. They were told on triage that there could be an extended wait if things were backed up. My charge nurse and triage nurse were if continual communication so the approximated time would be realistic. I placed a Welcome letter in the ER waiting room to explain the processes.( What we did, How patients were taken back, What would happen when they can back). This was given to each patient as they were triaged. Once in the ER, I began a trial with some of my nurses. Instead of tucking under the desk when patients poked their heads out the door, (At the point of anger, I might add) we decided that consistent communication with the patient might help. We began upon being placed in the bed. We introduced ourself and explained what would probably occur in the next hour. (Labs, xray, md exam, etc...). I had these nurses go in every 30 minutes when possible and tell them what we have back, what is pending , how long approximately it would take). Being informed was the greatest help. Even if they did not like the wait time, the level of satisfaction dramatically increased. The consistant contact made the patients feel that the staff was there and that they were informed. 9 out of 10 patient complaints included the fact they they were uninformed in one way or another. You have to keep your word. If you say 30 minutes be there even if just to poke your head in and let them know there is an emergency and you have not forgotten them. My nurses were reluctant and simply told me they did not have time when I introduced this. Once they tried it and realized it saved them alot of time in the end, they really liked the results. There are always going to be those you can not satisfy. I always told those patients how sorry I was that they dissatisfied. It really did'nt hurt me to say it either. (except for the lip I had to bite first) A sorry ,even though it is not your fault, at least takes the sting out of most. If it makes them feel better to hear it then why not. Nurses who take the things that patients say personal are going to be really unhappy and unnecessarily stressed. Let them vent and always realize the beauty of the ER is they will eventually go away...........................Hope this helps.

Thanks. You are absolutely right. In some situations it is better to rotate charge. I was very slow in placing fixed charge nurses in my department. When I did, they were held to the highest standards and expectations. Disrespect was not a part of the job description and never acceptable behavior. I was blessed with very great employees. Rarely had problems except with one nurse and with time she came around to my way of thinking. The only problem with the "hostile environment" as least where I worked was that administration frowned upon using this route. Usually labeled the person as "trouble".Of course I worked for HCA who writes really pretty words in their policies about this but does not quite seem to follow them. I just think its really sad that we can no longer just take care of people. I wish you so much luck. You sound like a good Manager.

I applaud your knowing when to take a breather. I'm sure your coworkers respect you for that. I try to live by one rule. If I can not come up with something to say that is respectful I dont say anything at all. ER nurses go to the trenches everytime they walk through the door. Good shifts are far and few. You have to love it to understand why anyone would subject themselves to such an environment. I was charge nurse for 5 years and manager for three. I have walked away to gather myself on many occasions. I don't know about you but there are enough battles with patients, family members, docs, administration, EMS, etc..to have tensions among the staff. If there no team work not only is it miserable but dangerous. Great response. Wish you all the luck.

If you were awake and talking , there was really no need for reversal. The beauty of Narcan is that it works fast but the down side is that it is short acting. So it would probably not affect the Vicodin. At times you have to repeat the dose because they will begin getting drowsy again.

If you have hospital email this is a good way to document that can not be placed in the trash or disappear. remember to make a copy and take it home for safe keeping. The quality aassurance/ incident report is another avenue to think about. The are required to investigate by the Joint Commision. Make sure you go through the policy book and follow the notification process to the letter. Look at it this way. If you report and lose your job you can always get another one. If you do not report unsafe situations the nursing board can take your license and you can not work at all. There is no easy answer. PROTECT yourself because believe me they hospital will not run to your rescue. Notify the appropriate chain of command and document dates, times and names of who you spoke to and the also the conversation. I kept a journal. Saved my butt a time or two. I was a manager and this is why I left. I could not ask my nurses to work in an unsafe environment that I myself was not willing to work in. I loved ER but the legal risks are too great and quite frankly my children need food more than I need to love my job. Good luck!!!!!

As a former ER Manager I can tell you the problem is not uncommon. The best advice I can give you is to document every event. In the time of confrontation or in discussion with the Manager or Director you will need this to reference. The problem is everyone is afraid of this person. Probably have been several to leave the department because of her. Make sure any confrontation you have with her is witnessed. House supervisor would be good. "He said she said" is not a good thing to have in this instance. If confrontation occurs, tell her very plainly that you will not continue the conversation until the House Supervisor is present. She will very soon avoid doing this with you because these people never want a witness. Demand respect. You tell her that she does not have to like you but you will not be treated unfairly or unprofessionally. You need to report this to your Manager. Most of the time they know whats going on but quite frankly without formal complaints and documentation, their hands are tied. Others will follow the lead. I hate that you have this situation. It makes for a miserable work environment. Good luck!!!

There is a depakote fitting a description. Only other one I know of is Phenteramine (diet pill). Fits description pretty close. It is a generic brand I think.