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Dixielee

Dixielee BSN, RN

ER
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Dixielee has 38 years experience as a BSN, RN and specializes in ER.

Spend my time rambling around the ER looking for something useful to do.

Dixielee's Latest Activity

  1. Dixielee

    Whats your biggest pet peeve working in the ED?

    My current pet peeve is people texting or talking on cell phones while I am trying to triage them! I have had people answer their phone while I am trying to get their history. Not just answer but hold conversations! I had a MVC come in EMS last week that took call after call on his phone and I couldn't even get his vital signs. I told him to ring the bell when it was convenient for him to be evaluated! He nodded OK. I made a note to that effect saying I was unable to evaluate pt at this time. Ergggg I was walking a patient out to discharge recently and he was so engrossed in texting as we were walking down the hall, he ran right into a wall. I almost lost it laughing! Oh well, you can't fix stupid!
  2. You said she was profusing, but she was barely maintaining her sats with no activity, and you said her H&H was low, so regardless of what her vital signs say, she was just barely hanging on! You didn't give much medical hx, i.e. age, COPD, etc. I would have probably taken her from NC straight to 100% non rebreather. She was anxious because she was hypoxic. ABG's would have been a priority, also another line as large as you can get, preferable a central line. Bipap would have been a fairly rapid next step. Did she sound wet? She may also need diuretic since you are going to be hanging several units of blood. When you have a patient who is that sick, don't hesitate to ask for help. Get the doc in there, that is their job! At very least, go tell the doc what is going on. I fortunately work in an ED where nurses have a lot of autonomy, we have 24/7 board certified ED docs, RT, etc. Everything I suggested would have already been implemented even if the doc was not in the room. If your ED does not have protocols in place for basic life support orders, then do what you can to make that happen, or you are going to find yourself in this situation again. Best of luck.
  3. Dixielee

    Question regarding Tetanus toxoid

    I don't have an official answer, but will tell you how we do it in my ED. We recommend every 10 years if you are a person who never gets their hands dirty, never work in the garden, never walk in the woods, etc. If you are every exposed to "dirt", it's every 5 years. I have never seen anyone draw a titer to see if it is time for another one. Generally speaking, if you can't remember when you had your last one, and you have a contaminated wound, then get one. In the past year or so, we have been giving the Tdap, tetanus, diphtheria and pertussis. Some information says give Tdap up to age 65, then just the DT (diphtheria, tetanus), but some says give if over 65. Pertussis is on the upswing and we recently were told about an infant death from pertussis in a nearby county. We very rarely just give tetanus toxoid, and it is if someone has an allergy to the diphtheria component.
  4. Dixielee

    Ethical/Personal Dilemma - What would you do?

    I would not say anything to her employer because you are not involved there, but I would most definitely tell the director of the nursing program about it. This is extremely unethical behavior and should not be tolerated on any level. She violated a most sacred trust, and should not be allowed to remain in the nursing program. You would not be responsible if she is removed from the program or lost her job as a result. She is the one exhibiting the behavior. You are simply the one who recognized it for what it was. I would not want this person to share the title of Registered Nurse with me.
  5. Dixielee

    Newsflash: Med/Surg RN's have the toughest job

    I have to agree! I have been a nurse 39 years. I worked med surg the first year out of school and could not do it today. I think I would have to leave nursing if that was my only option. My hat is off to those who do. It is a great learning experience, but not one I wish to re-live!
  6. Dixielee

    Medication tidbits an ER nurse should always know

    With few exceptions, i.e. adenosine, and apparently hydralazine (which I didn't know about), if you are unsure, dilute and give slowly. Always read the side of the vial if you have it available. It will give you valuable information such as what diluent to use, if you can give IV push, etc. NEVER give procaine penicillin IV. In general, if you have to open more than one vial of something, you are giving too much. Of course there are exceptions, but it should at least make you pause and think carefully about the dose. Also, with rare exception, if you are giving a med IV and the patient says, "I'm feeling funny", then STOP giving the med! It may be an adverse reaction or you may be giving it too fast. Dilaudid does that to a lot of people. Adenosine is also the exception....you can tell the patient, "you will feel like you are going to die", because their heart stops and resets, so they feel awful before they feel better. Even if you have checked and double checked the chart, always tell a patient (alert ones) what you are giving, ask if they are allergic or intolerant to it, and why you are giving it. That little rule will save you and the patient a world of problems! If you have the slightest doubt about what you are giving, or how to give it, don't hesitate to ask. You will not be thought stupid for not knowing! If you don't ask and you do something that is against protocol, THEN you and your patient will pay dearly for it. If a patient tells you, that pill doesn't look like my regular med....pay attention, and double check the 5 rights. Most times, it will be just a manufactures variation, but it may mean you have the wrong med, or it was ordered incorrectly. Common med usage can vary from hospital to hospital and state to state. You mentioned Inapsine....we don't give it at all, and I haven't in years, but when I worked PACU in the 90's, we gave it like candy to everyone! Some hospitals still use Demerol, but it is not even on our hospital formulary. If you are reconstituting a powdered med, and you cannot see thru it when you are finished, WARNING...you probably used an incompatible diluent. Generally speaking, if it looks milky in the syringe, don't give it. (Obvious exceptions, propafol, lipids). Most hospitals now have internet or hospital intranet access that allows you to check for med information and compatabilities. Use it. If you are new to nursing, keep a little notebook in your pocket, and as new meds, procedures, diagnosis comes up, write it down to more throughly research it later. Be careful with sound alike, look alike meds, i.e., hydralazine, hydroxyzine..looks similar but very different meds. Many vials of IV meds look alike and have small print. Double check med name and concentration. As far as pharmacy prepared med boxes, Pyxis etc. Trust but verify! Just because that little pocket opens when you click the patient name or name of the med, double check the label yourself. These are stocked and prepared by humans, and humans make mistakes. Heparin dosing has caused many errors over the years. If your pharmacy does not label such meds with red warning stickers that say double check your dosage, then you may want to try to get that implemented. I think with publicity surrounding this particular med, people are more careful, but it can happen with any med. You may have a syringe that says heparin, but it could be 100U/cc, 1,000U/cc or 10,000 units per cc. Epinepherine can be 1:1000 concentration or 1:10,000 concentration. So just pay attention. It is really amazing that there are not more drug errors! I know I didn't give many specific meds, but just be careful and don't hesitate to check with another source if you are unsure at all. Lives depend on this.
  7. Dixielee

    Do you think Dental Hygienists make more than Nurses? (RN)

    I agree with others. I have a friend who has been a hygienist about as long as I have been a nurse and our salaries are comparable. She, however has much better hours! But I have more flexibility and options. If I get tired or bored with one area of nursing I can do something completely different but still be a nurse. Hygienists have very limited options. Another big difference is I love the variety nursing offers and would go crazy doing the same job for 40 years!
  8. Dixielee

    So confused-What to do?

    It sounds like you would like to "audit" the classes to obtain the information you might need to become an RN. As others have stated, no, you have to be in the program, do your clinicals (hands on part of program) and successful graduate. My advice is to take all of your core classes and make the highest grades possible. Nursing programs are very competative! It sounds like you need to research some BSN programs in various states, or even on line, and see what pre req's you will need. Make A's in them all, and when you get settled, then get into a BSN program which will serve you better in the long run anyway. Nursing programs are not like anything else you will take, so if you have all the pre req and other classes like the required biology, chem, statistics, etc., your life will be easier. I would also suggest you get your CNA and begin working as a CNA. It will give you invaluable experience and insight. Good luck and work hard. Preparation and participation is the key to success. Just showing up is never enough.
  9. Dixielee

    Thinking of re-entering telephone triage

    I have a friend who is doing it from home now. I can't remember the name of the company, but she makes $25/hr with no benefits. I have another friend who lives in Oklahoma and works for a company who primarily work with worker's comp injuries related to the oil rigs. She stays very busy, makes about $70,000/yr with benefits. So, there are probably a number of options. I also have been looking for something similar and indeed.com lists United Health Group and Liberty Mutual jobs for work from home options. Good luck!
  10. Dixielee

    Commuting 1 1/2 to work???-- new grad

    If you are working 12 hour shifts, it really is 12 1/2 or more, then add commute to that and decide if you can do it. I have commuted an hour and it is rough. Since you are living with your parents, you may be able to stay in a motel for the days you are working if you can get your schedule arranged with your shifts together. Will you be working days or nights? It is very dangerous to add a long commute to a night shift. Most schedulers will work with you if you are willing to be flexible. You may be able to work your shifts in a row if you agree to work every week end or parts of every week end. When it all comes down to it, you may just have to go where the jobs are. I worked a travel assignment that was 5 hours from home once, and worked every other Thursday, Friday, Saturday, Sunday, Monday, Tuesday. That way my days were together, no overtime was involved because it was split between pay periods and I stayed in an extended stay hotel with a kitchen for the week, then drove home and had 8 days off. It is doable, it just may involve a little creativity, and you will need your sleep. Don't discount that fact and as a new grad, you will have enough stress to deal with. Good luck!
  11. Dixielee

    how to submit formal positive comment about a nurse?

    l think you should put in writing what you just told us, send it to the Director of Nursing, or Director of what ever department she was working in at the time. You can give the dates you were there and the nurse's first name and if she is still working there she will get the feedback. These things always make it into the nurses record and many times are copied and posted on bulletin boards, newsletters etc. Even if she is no longer working there, you will probably get a response from someone in charge. There is no need to send anything to the board of nursing, especially since you don't know her full name. So many times, people send negative feedback, and it is really nice to hear the good stuff. Even if she is no longer working there, the people on the floor will appreciate the fact that someone recognizes the hard work they do. Good for you!
  12. I think it boils down to family. Do you look at nursing as a job or as a career? I've done it for 38 years and it has always been my job. My family is what defines me, not my job. If you truly want to persue anesthesia school, there will be time later. You have one shot at getting it right for your family. I have taken breaks over the years when I needed to be home more for my children. I was in an FNP program when my daughter left for college and my son started having problems at school. I dropped out of the program and devoted my time to getting my son straightened out. My thinking was that I could go to school anytime, but my son needed me most at that very moment, and I dare not miss it. In the long run, you probably would be better served to stay minimally PRN just to make it easier when and if you want to return to work full time. The longer you are out, the harder it is to get back in the groove and who knows what the future economy will hold. If you worked one 8 hour shift per month, or even pay period, you would stay current with your BLS, changes in equipment, trends, etc. without sacrificing your family. You can still read nursing journals, take online classes for CEU's, keep your license current, etc. while devoting yourself primarily to your family. Good luck with your pregnancy, and may your family enjoy a long, loving and enriching life together. Consider yourself blessd.
  13. Anyone should be able to clearly see that this is an attempt by the ED staff to cause massive outbreaks of communicable disease on each and every floor of the hospital Those lazy ED nurses want to get rid of the patients as fast as they can so they can go back to watching TV and eating free pizza. They don't really care what happens to the patients or the floor nurses as long as they can have their own way. I think you should go to the ED, steal a copy of the schedule and write incident reports involving each and every ED nurse, physician, tech and clerks because this is clearly a conspiracy and you are just lucky to still be alive. Those ED nurses could have turned those patients away at the door as soon as they saw they were coughing up blood, but they let them in so they could create havoc on your floor. I'm sure a good and complete write up and complete re-education of the ED staff is in order. Better still, they should just fire them all and start fresh. That will teach them. We know our rights!! We should never have to take a patient who might not be appropriate for our floor! The nerve!!!
  14. I have read this entire thread and intentionally did not respond to it the first time I read it. I do not hold the same views on this as many of my peers, but here goes. I have been an RN for 38 years. I graduated at age 19 from an AS program at a community hospital. My mentor in school was an "older" LPN (aged 38) who was returning for her RN. She was twice my age so I classified her as older. When I started working on a med surg floor, I also was mentored by an "older" LPN. She taught me time management skills, coping with difficult people skills and taught me how the system worked. I will forever be in her debt! I transferred to ED where again, my mentor was an "older" LPN who took me under her wing to teach me how to be an ED nurse. I will never forget her influence! As I raised my family, worked weekends, holidays, double shifts etc., many "older" nurses continued to teach me the value of what I was doing. I went back to school and obtained my BSN in my mid 30's. I took advantage of all the classes I could at work. I became a BLS instructor, then ACLS and PALS. I became a preceptor, mentor and teacher. Now I am one of the "older" nurses. I work full time, recently obtained my CEN, still teach ACLS and BLS, serve as preceptor, committee chairman of several committees. I have begun work on my Masters and will complete it just before my 60th birthday. My husband died 4 years ago, my children are grown and on their own. I make as much money as I want to. I work overtime, fill in anywhere I am needed and am a team player. I own a modest home, a 3 year old car and a dog. I have worked hard to get where I am. So my comment to anyone who complains about my salary, the hours I work, or how "entitled" they are to what I have would be....so what! This is America. It is a free country and still the land of opportunity. Often opportunity is disguised as hard work and sacrifice, so many don't recognize it! I am entitled to work as long as I want to and do with my money what I will. I tithe 10% to my church, regularly volunteer for service projects and offer my time freely to those who need it. But even if I never gave anything back, it is still MY choice. If I wanted a doctor's salary, then I would have gone to med school. If I wanted a CEO's salary, I would have gotten an MBA. I don't care how much they make or what they do with their money. It is their money!! So if anyone wants to whine about their situation, it is up to them to change it. Be your own advocate. You can't expect anyone else to. The ONLY person on earth who is responsible for my health, safety, warmth, well being and happiness is ME! And I am always looking for ways to make that happen!
  15. Dixielee

    Surprise!?!?!!

    Rectum: 3 golf balls, 2 Bartlett pears, Coke bottle, Large can of Scrubbing bubbles, splinters left from ladder back chair, gear shift knob, a number of vibrators. Vagina: light bulb (unbroken) Penis/urethra: Glass thermometer, BB's inserted into urethra. Large Craftsman wrench (the kind with the open wrench on one side and closed one on the other side a little bigger than a quarter) stuck near the shaft of the penis. Required fire dept "special tool" to cut through that one!! Wrapped around scrotum: Very thick brass ring = Versed, urologist, and a special saw. Ouch!!
  16. Dixielee

    did I make a huge life mistake?

    Do you want to work psych when you move? If so, then I think you should have no problem getting a psych job. We are seeing more and more psych patients in the ED. Many ED's now have a separate section for psych eval and holding until they can be placed at a psychiatric facility. I want you to be a psych nurse. If I had to do psych nursing, I would have to go work at Lowe's in the garden department because I KNOW, even after many years of nursing, I couldn't do it. So press forward fearlessly, and go for what you are good at!