Gabby-RN

Where. I work we start with toradol 30mg, zofran 4mg, a liter of NS, and Morphine 4mg q5m x 3 doses. I give the toradol, zofran, fluid, and 1 dose of morphine. Then send them off to CT. The morphine starts to work faster that the toradol and tends to relax the patient a little, enabling them to stay still for the CT . True kidney stones HURT! Many patients never require the additional doses of morphine, many do. We do not use Demerol in the hospital where I work. Once the CT confirms its a stone and able to pass, we make sure the patient is somewhat comfortable, has a ride home, give them a screen, a urology referral, some teaching, an Rx for ibuprofen 600mg, percocet 5/325mg 5-10 tabs, and zofran 4mg ODT. A true kidney stone is very painful, I have no problem giving narcotics when narcotics are needed.

From the information you providex, I would have given the prn ultram and passed on to the day nurse that you did so. It is up to that nurse to decide if they will give the scheduled ultram, hold the ultram and to document why. The patient requested a medication that they were ordered to be able to get q4h prn. From what you stated the order did not specify to hold prn med if within 2 hours of scheduled dose.

Patients in the ED often tell me their IV hurts...hurts when they bend their arm, hurts when they touch it, hurts when they look at it. Usually they just hate IV's. If I cant find an actual problem with the line to indicate a need to change out the line I still always offer to start an IV elsewhere to see if it's more comfortable and then discontinue the IV. I am usually told "No! I hate being stuck I will deal with it". I let them know I will be more than happy to do it if they change their mind. Sometimes the patients pain isn't even related to the catheter, when they turn their wrist a certain way the tegaderm pulls on their skin or arm hair or other minor things. Regardless what I have experienced is that 9 times out of 10 the patient just wants to vent about the IV but doesn't want anything done about it-well except for their problem to go away so they can get the IV out and go home.

25% is just the Federal tax. I pay state taxes as well, mine are 6% I believe. Maybe some states pay a higher state tax, not sure. Between Federal, State, Medicare and SSI, net pay could be close to 40% less than gross pay when it is all said and done.

Where I work, gabapentin administration also generates a pain assessment field and 1 hour re-assessment. So does 81mg of aspirin and Tylenol given for fever. We have been told if the medicine is not given for pain to put "0" in the pain scale field and then comment in the comment box "given for fever" or "ACS protocol". Many people are just skipping the pain assessment all together which is making the hospitals scores go down and making it look like we don't address pain.

When I was hired at a union facility there was no option to not join. Being in the union was a requirement. Unions have many great advantages but also some disadvantages. I have been passed up for a promotion because someone with more seniority bid on the same job as me, even though I was better qualified. I do think it is good that they gave her a chance even though it didn't work out for me. The good outweigh the bad in my opinion.

I just meant that every cardiac arrest doesn't go to the cath lab, at least not where I work.

What do you mean cpr in progress has to go to the cath lab?

Trauma sheers and a pen. Everything else I could need is readily available in the ED.

It is never ok. Its just my opinion.

You should not feel bad for saying no ever as long as you are polite and have a valid reason. If appropriate I would tell the nurse you are in the middle of cleaning up another patient and will be done in xx minutes. I think she was rude regardless but maybe she thought you were taking vitals or do something you could easily walk away from? Maybe she too had been busy 5 minutes earlier and sat down thinking you had gotten to it? Thats probably not the case but everyone deserves the benefit of the doubt at least once.

I was induced at 39 weeks with my 2nd child. (cervidil no pitocin) There were no complications, I had the baby without pain meds in less than 5 minutes of pushing. Sounds like she wouldn't want a medical induction anyway but I just wanted to say not all go bad or are more difficult.

The hospital where I work does not allow staff to use their own O2 sat because it would mot be calibrated and its accuracy can't be determined. Definitely do not waste your money, they aren't cheap either! Congrats on the job.

That is certainly not the case everywhere. I feel like we over treat pain. Sometimes it seems like everyone except migraine sufferers get morphine or dilaudid.

We are not allowed to use lotion from home where I work, the hospital provides fragrant free lotion made by the same company as the sanitizer. According to infection control, we cant use our own lotion because it could interact with the hand sanitizer and break down the gloves. I dont know if that is true but the hospital lotion does work well plus the hand soap and sanitizer have emollients in it to prevent dry hands. I find using warm water instead of hot helps prevent dry hands the most though.

I work in the ED too, I should have specified.

What is your hospital's policy on removing the ET tube during post-mortem care? We can remove it as long as the medical examiner is not taking the case, otherwise we have to cut it at the lip line. I personally prefer to cut the tube rather than leave it because it can be a scary last image for family to have stuck in their heads . Other nurses prefer to leave it saying it shows the family we tried to save them.

Working in the ED I see a lot of patients that are brought in for things related to their noncompliance with dialysis. They just don't want to go and in that moment feel like they would rather die happy than suffer with the long treatments and side effects. I think your intentions are pure and I am glad it works for you. I think the drawback would be that the patients will want every nurse to break the rules for them. It would be nice if there was a way to come up with strategies facility-wide to increase compliance with the patients that find it difficult to tolerate dialysis.

That is what I have used too.

Google "hijab and stethoscope use" and go to images. You will see lots of examples. I have seen the stethoscope used over and under.

The other day I called to give report to the intercare nurse, the patient had been pretty stable for a couple of hours, downgraded to nasal cannula, talking, etc. After giving report, I put the patient on the transport board. The orderlies were a little backed up, I let the nurse know it would be about a half hour. Meanwhile, the patient ended up having difficulty breathing, respirations increased to mid thirties, tachy 120-130, audible crackles, patient tanking, paged inpatient MD twice and ended up putting patient back on bipap and notified ED docs they may need to intervene if inpatient MD didn't get down here soon. Inpatient MD shows up orders lasix, dig, dilt, continue with bipap, prepare for possible intubation. Transfer to unit on hold until patient stabilizes. I do not want to hold this inpatient or any inpatient. Things can go south at any time. My assignment is supposed to be 4 patients. Patients don't stop coming in, I may not get level 2 patients but I still get more patients. This day 2 of my 4 patients were inpatients we were holding waiting for rooms, the above patient and an NSTEMI on a heparin drip. Understandably both families had a lot of questions and took up a lot of my time. Im fielding questions from family, the inpatient MD's that are coming down to assess their patients, the ED docs asking about their patients, families, coworkers, etc. I do not know how other ED's run but I never hold on to inpatients any longer than I have to. If. I had been able to transport the above patient immediately It would have saved me a lot of time and been better for the patient because their nurse on the floor would have had them and one other patient and had way more time to focus on their needs.

The other day a family member asked me if I could come change her mothers IV site now because it was hurting her when she moved. I was extremely busy and behind and I kind of blurted out I'm really busy right now I can't as as I rushed by. The family member rolled her eyes and looked disgusted and went back in the room. While I really didn't have time to change the IV that EMS had started right at that moment, I should have quickly stopped, made eye contact, smiled, and said I would be more than happy to check it out after I finish up what I am doing or something along those lines. I gave bad customer service and did not make a good first impression with this family member. When I got a minute I apologized for being short with her, changed the IV site and took a couple minutes to talk to the patient and their family to hopefully show them I care, their concerns are important, and that even though I am busy I will take care of them. Maybe you could think of a time you brushed off a patient or family member and talk about that and what you learned and how it changed how you will approach similar situations in the future.

Attorneys are not told which suits they are required to wear. Physicians are not told specifically down to the brand and style what professional dress means. I dress professionally every day. Nobody needs to dictate where I shop, what brand I buy, and what specific style dress I wear in order to ensure I am a professional. I do that all on my own every day in both my work and professional life. I am sure if attorneys were told by their firm that they could only wear a specific brand suit in a specific color and fit they would think that is ridiculous too.

Or they will complain that they cant tell which nurse is their nurse because they are all dressed alike.

Its not just being told what to wear, the OP is also being told where they are required to shop. If you had to buy your own clothes for work and ruined a uniform wouldn't you be a little upset if you were forbidden from purchasing a new one at your local store and told you had to buy it from the hospital, maybe at a higher cost even? And sorry if the hospital is dictating the color, brand, and style I have to wear then they should pay for it. I never complain about buying scrubs because my employer lets me where whatever scrubs I choose. If they made me wear a specific uniform/scrubs I would expect them to provide it.