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Content by Dixielee

  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. Quoted MassED: You've been in the ED for 38 years? Geeez, I know I won't last that long at this pace. No way. I don't think anyone could. I think for some, leaving the ER would bring a fear of boredom, perhaps? I think, "Boredom? Bring it on!" I can deal with that, so can my feet, my knees, and my BACK. Most of all, my brain and psyche can deal with that. Boredom doesn't lead to burnout, but verbal/physical/emotional abuse, lack of pee breaks and food breaks sure do!! I think working ED has actually kept me healthier because I am sure I have been exposed to everything in the book! It is now to the point where I fear for my patient's safety because of the workload and I fear for my own safety because of the increase in violent behavior of patients. As far as lunch.....I can't tell you how many meals on the run have consisted of chicken strips and tater tots because they are portable and fit in your pocket!! I know, gross, but you do what you have to :) Best of luck to all of us as we carry on, doing the best we can.
  11. Thank you for this wonderful article! I became a geriatric resourse nurse for our ED last year and this article is exactly the type of information that needs to be shared with ED nurses. We have a number of retirement communities in my area and we do see a large number of older adults who are living independently, but who have different challenges than a younger population. Thank you again for the time and effort to put forth this information.
  12. What a great thread that speaks to me! I, too, have been an ED nurse for many, many years and know that my time in ED is coming to a close soon. I don't think this is just a summer problem and it will end in a few months. I think it is here for the long haul for a number of reasons. The economy in general is in shreds. Everyone is tightening their belt just for survival. Gas costs are up, food costs are up, taxes are up, so it is no surprise that health care costs are up, reimbursements are down, and cuts are being made at every level. I work in a very busy ED 120,000+ per year. We are in better shape than others I have seen on this forum in terms of staffing. I really DO believe our ED management is doing the very best they can. They are not above coming in on holidays, nights or just horrible shifts to help out. They don't take patients, but will transport, start lines, make runs to the lab, and order pizza for us! But it is still very quickly taking it's toll on everyone. At peak times, we have 2 triage nurses, 2 triage techs and a "greeter" nurse who does a quick screen to decide if the patient is appropriate for fast track, needs to go to the main ED quickly without triage, or can safely be triaged and wait for a room to open. We have 4-5 hour waits every evening with 40 or so in the waiting room at one time. These are the ones who are too sick for fast track but not sick enough for the main ED immediately, so they are our level 3 patients...urgent. At any given time we have 8-10 trucks inbound with the sick and injured, or 1-2 helicopters on the way in or out. We are a regional trauma center so we get transfers from all local hospitals within a 100 mile radius. It never, ever ends. The floors or ICU can say, "Stop, we have no more beds". We never have that luxury, and being a referral center, we can never go on ambulance divert. The psych issues are becoming more and more of a problem and a danger to staff and other patients. We can't get psych patients transferred many times for days or a week. We have to staff extra police and security just for them, plus additional staff as sitters because of the danger they present. We are seeing more and more homeless with huge medical, psych and of course social issues. We can't send them anywhere, so we are the end of the line for many of them, their last resource, and we are stuck. Then, you have the "real" ED patients, i.e. MI's, traumas, strokes, general medical, orthopedic or surgical patients. Even with a 3:1 ratio on the acute care side with no available floats, it is a scary place to work. When you are tied up with a critical ICU patient who is not going to surgery or cath lab, you can't get out of the room to even admit your MI patient, or your new drug overdose. Oh, and your "stable" drunk hall patient who is there to sleep it off, but doesn't! He wanders in and out of patient rooms looking for something to eat. Then the mother of the bratty febrile kid gets mad at you because you won't blow up gloves for the kid to play with! AGGGGGG! Lunch?? OK, in my 12 bed pod, I have my 4 patients, 4 patients of the nurse who went to lunch, and the 3 patients for the nurse who had to go to special procedures with her critical patient. Then they ask you to hold the charge phone while the charge nurse goes to a meeting!! No, I don't think this is a passing problem that will be resolved anytime in the foreseeable future. What will healthcare "reform" bring? More nurses, less patients?? I don't think so. I pray for those going into the profession, I pray for those of us still in it and mostly, I pray for our patients, current and future who are getting less than they need. After 38 years of acute care, primarily ED nursing, I'm ready to sit in a cubicle in an air conditioned environment, be around people who bathe everyday, and talk to people on the phone about their insurance coverage and if their particular ailment is covered. I will miss the patients, the other staff who share the "we're all in this together" battlefield attitude, the great ED stories, the adrenaline rush and the exhilaration of making an immediate difference in someone's life. I will miss the gratitude of the child who was afraid, but I was able to soothe their fears, the little old lady who recently lost her husband and came to the ED after a fall who gives me a kiss on my hand for taking care of her wounds, the raucous pizza dinners in the break room with those who understand, but I just can't do this much longer. To all those new, fresh faced new grads who read these forums and ask, "Am I cut out for the ED?" I can only answer, "I certainly do hope so!"
  13. Dixielee

    Finding job in Atlanta-is it hard for a fairly new nurse?

    I'm afraid I can't help you find a job, but I can say you should protect your marriage. It is more important than any job. Jobs come and go, presumably, your marriage is permanent. A year separation can do irreparable harm. There is not enough email and skype to make up for not being with your spouse. I would give anything to just spend one more day with my husband, but that won't happen in this life. Jobs and things are temporary. People you love is eternal.
  14. Dixielee

    Our jobs as nurses is to protect/help/serve the doctors.

    I do wonder if he was impaired (nothing obvious except of course his actions). He is fairly new and I have not been impressed with his judgement. He is sloppy and careless with the way he practices, and that is NOT acceptable. I went to one of the ED docs who is responsible for the PA's and explained what was happening. I am not the only one to point this out and we are documenting. I work in a very busy trauma center (120,000 pts/yr) so these kinds don't last long. As I stated earlier, I do not advocate that nurses are here to protect the doctors. The original poster was being facetious and I followed in that vein. I have NEVER been afraid to call a doc on orders that are dangerous or just erroneously written (Like Rx for Vicodin 1 GM IV written by a very tired doc). The nurses have a wonderful, trusting relationship with our ED providers and we have each other's back but we will not tolerate incompetence or poor practice.
  15. Dixielee

    Our jobs as nurses is to protect/help/serve the doctors.

    i could have worded my comment better. what i was trying to say was the nurse is responsible if she implements a blatantly wrong order. it is the nurses responsibility to make sure those orders make sense and will do no harm. you are absolutely correct that we are doing these things to protect the patient, not the physician. the original post while tongue in cheek contained a lot of truth.
  16. Dixielee

    Our jobs as nurses is to protect/help/serve the doctors.

    I think you pretty much summed it up! Unfortunately, you are correct!! I was working with a PA the other night in a VERY busy Fast Track. We see 100 patients per day. He kept writing orders for the wrong things for the wrong patients, IV meds when he meant PO, knee immobilizers on people with lacerations of feet, discharge orders on people he hadn't seen, etc. I am trying to figure out what he really means because I actually triaged the patient. When I would point out an order in question and asked for clarification, he responded saying, "you know what he needs, just fix the order to make it fit". He was not the only provider fortunately, so I could focus on "fixing" his errors. I finally told him, "I can do my job or I can do yours, but I'm not doing both". It never got any better, but I have a feeling he won't be working with us very long. Nurses have to learn at a very young age that they are responsible for implementing a blatantly wrong order, so if it sounds wrong or you don't understand it, then INSIST they clarify and make sure you understand! I saw a t-shirt once that said, "Thank a nurse! They are the ones who keep doctors from killing you".
  17. Dixielee

    A Diabetic rant

    I hope this attachment works. I took a diabetic resource nurse course last year and for my project, I made cards regarding types of insulin and their actions. They fit in a plastic sleeve to wear with your name tag. I refer to mine a lot! I gave them to all of the nurses in the ED. It has been most useful! If this attachment works, you are more than welcome to use them. There are good resources out there that can be made into pocket cards for quick reference.
  18. Dixielee

    Signed a contract for ICU, being put on IMC unit

    I think it boils down to how much do you need a job right now. You are not going to lose any skills in 13 weeks. I took 4 months off with the birth of each child, and I did not lose any skills. If your contract said ICU and they are not scheduling you for ICU, then you are well within your rights to cancel. If you need the job, it certainly wound not hurt you to talk to the IMC manager to see what the job entails. Good luck
  19. Dixielee

    Help with Pharm question please :)

    I don't have the answer to that, perhaps your prescribing physician will. Since you would be immuno compromised however, you may need to choose an area of nursing that does not expose you to so many sources of infection. You don't have to disclose your medications when you apply for a job, but for your own health and safety, you just need to be careful what you expose yourself to. Best of luck!
  20. Dixielee

    Seeking a first job with planned travel?

    I am not a nurse manager, but since you won't have your license until August, and it is already July, and your trip is planned for September, I don't see a problem. Most orientation programs start on a set schedule depending on the size of the facility, so they may only begin orientation once a month or every other Monday, etc. Since your trip involves leadership and special skills and is not just a family vacation, I would think you could use this in your favor. While I would not mention it in your cover letter, I would certainly highlight your skills and accomplishments in your resume. It sounds like you already have the makings of a great leader and a solid nurse. I think as you get interviews and begin to tell your story, managers and recruiters will see the value in your trip and accommodate you. It takes a while to get the paperwork, reference checks, drug tests, etc done anyway, so your timeline may be quite reasonable. Best of luck to you in your travels and in your nursing career.
  21. Dixielee

    Dietary policy- vent

    I agree that it is our job as nurses to offer teaching regarding diet as well as a multitude of other health related issues. It is NOT, however, my job to "allow" or not allow a competent adult to exercise his free will to eat or drink what they wish. As already mentioned, most people in the hospital are there for a short while and we are not going to change any long term habits. Our job is to do for someone what they can't until they can. (my philosophy, anyway). Sometimes they will never be able to return to the lives they had before the life changing event occurred that landed them in the hospital in the first place. I am a nurse, but I do not have the power to "make" people do the right thing. No, I am not going to run down to the liquor store to pick up a bottle of Rum for my patient, but I don't have a problem bringing them an ice cream if that is what it takes to give them a sense of control, normalcy, or what ever. My father was a strong willed, stubborn man, and it ultimately killed him, but he had the kind of life HE wanted. He was diabetic, legally blind and hypertensive, but would never change his diet. He had a stroke, was in the hospital and the first thing he asked for when he was lucid and able to swallow was for a chili dog and onion rings from the Varsity in Atlanta (local greasy spoon, and if you ever get the chance to try it, you should). So what did I, his nurse daughter do? I marched my happy butt down to the Varsity and brought him a chili dog and onion rings! I have never seen anyone eat with such vigor. We do what we can for people, but I consider that my job is to make someone as comfortable as possible during a very difficult time in their life, and if Dairy Queen or the Varsity is the answer, then so be it. Maybe my attitude comes from years of watching people suffer the indignities of the hospital, or maybe from losing some of those who were closest to me, but judge me if you will, but if you are in bad shape, you want ME to be your nurse!!
  22. I don't have that answer either, but your post reminded me of those huge Aminophylline vials that actually came with a little saw to hack through the narrow part of the ampule. Those were the days...
  23. 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!
  24. 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!
  25. 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.