EDrunnerRN

Valium and NS have a different pH, hence the crystalization. Valium should be given undiluted. In fact, I have slight OCD and even put a tiny air bubble in the saline lock before and after I administer Valium so the saline will have no chance of mixing with the Valium. I have never had anyone complain of burning at their IV site with this medication or lost an IV.

I work in a cynical ER...really who doesn't?! Last shift being cynical caught up w/ us. I often hear from my co-workers that I am "so naive," regarding the drug seeker patient. I have always interpreted this statement as an insult or perhaps indicating I have a weakness. However, after witnessing a patient who was being treated as a "seeker" turn into a code, I quickly realized I will take the "you are so naive" reputation any day. I guess I just want to remind everyone that we need to remember that our patients come to the ER for help and if they rate thier pain 10/10, we should treat it as just that, because what if it really is a 10/10...

I was expecting a horrific nursing story with a title like this. Is that as bad as it gets for you? Sounds like your a pretty good nurse. Have confidence in yourself, you are a nurse, you obviously know something! Next time you are in one of these situations take a deep breath...you are going to be great! Oh and when you doubt yourself grab that experienced nurse, you know the one who LOVE LOVE LOVES to show what she has learned in her 30 some years of nursing experience...

Ohh please tell me you are joking?! Sadly, I could see my ER forcing one more juggling act on the ER staff nurse. The ONLY time I note skin assessment is if there is reason. For instance, my patient comes in with altered mental status I will note the decub on his buttocks as he could be septic. But it he comes in with respiratory distress and gets himself a tube, then no I did not get past The "B" in my ABC's, his skin tear is besides the point. The ER should be a focused assessment and take care of the emergency at hand, not the besides the point diagnosis. When do the ER nurses perform these detailed assessments? In between intubating room 1, getting the MI in room 2 to the cath lab in

Babies/Children are ALWAYS the worst! As for advice, be aware of your religous/spiritual aspect. When I have a patient die I say a prayer for the family/friends and find comfort in comforting the family. I also run and many, many of my long runs occur after stressful ER days! Additionally, at my hospital we have an inservice to help cope with death, check and see if your hospital does this too.

Off the top of my head I would say I give Zofran, Phenergan, Albuterol, Solumedrol, Prednisone, Decadron, Benadryl, Pepcid, ASA, Tylenol, Motrin, Toradol, Morphine, Fentanyl, Lopressor, Metoprolol, Integrilin, Nitro, Adenosine, Cardizem, Dopamine, Levophed, Atropine, Regular Insulin, Lovenox, Heparin, Haldol, Narcan, Versed, Ativan, Succinylcholine, Sodium Bicarb, D50, Lasix, Rocephin, Flagyl, Levaquin, Vancomycin, Cipro, Bactrim, Ancef, Tetnus; the most

I dont know all the details but if a Nitro drip is involved I use a bedpan. One of our hats is to keep the patient safe. Any cardiac complaint gets a bedside comode and if drips are involved or the patient continues to c/o CP stick to the bed pan. You can never be overly cautious with these ones. Acuity 3's and below I tend to use bedside comodes/bedpans.

It's true we, nurses, are not perfect...gasp! I keep a note pad on my night stand because it seems that around 2 am I wake up and remember that I forgot to chart something. Personally, I have noticed that these instances happen more when we are "slammed" or do not have adequate staffing for the shift. Senior nurses tell me this is not something that changes with time...

I know a D.O. who did this. It is my understanding that DO programs are more likely to take people from the medical field than an MD program. But heck, I also know anesthesiologist who went from GED to RN to MD. You have a dream go for it, it doesn't matter how you get there!

Ok...a few days ago an ICU nurse, at my facility, stated that stable intubated patients on the Unit use bedside comodes. My first thought was you are joking, right?! No, she was serious! I don't pretend to be an ICU nurse or know the aspects of care that pertain to ICU nursing but in the ER I would NEVER place an intubated pt on a bedside comode for obvious reasons, they are not stable. Can any ICU nurses out there back up her statement? For some odd reason, I keep picturing an intubated patient on a bedside comode and find it HILARIOUS! I think I need to see this to believe it!!

How do the different hospitals out there charge for IV fluids and IV tubing??? We currently use a pharmacy charge sheet, where we place pharmacy stickers, that are located on each package of the fluid/tubing. This is not working well and lots of lost charges. Any better ideas?

As a brand new nurse, I remember thinking no one told me in nursing school how HARD being a nurse is. When I say HARD, I mean HARD. There are days when you get off work and feel as if you literally cannot walk. You are exhausted mentally, physically, and emotionally. My fiance refers to this state of mind as "zombied out." This is something you will ONLY understand after being an RN. Secondly, you will be shocked at how unappreciative the public is. Hearing a "thank you" is rare, even after you busted your a** off to make sure the patient will live to see tomorrow. Those are the days you browse online for change of career opportunities. However, those rare instances when you do hear "thank you" or know that you are part of the reason someone has a second chance at life is something you will never forget and that's what makes it all worth it! There will be days where you ask yourself is this really my life? But, as many times as I have asked myself that question, I could not imagine doing anything other than nursing. Enjoy your nursing adventure!

It is also required where I work to swipe the top of each bottle with an alcohol pad. I ALWAYS do this step because I have received many phone calls from lab with "out of range" blood cultures, which includes one abnormal blood culture, most likely caused by normal flora that contaminated the culture. If only one bottle is contaminated it is thrown out as an outlier.

I ALWAYS, ALWAYS dilute with Lido. When administering this medication I do a slow push allowing the lido to numb the area, as that is the intention of the Lido. I also make sure the medication is well mixed by rolling it several times between hands. Word from the wise, never spill this medication on yourself...if you want to get back at someone spill this medication on them, accidentally of course

In the ER where I work we have both MD's and DO's. I LOVE our DO's. Unlike many of the MD's they are not so quick to prescribe a "cure all medication." In fact, one of our DO's gets a lot of grief from patient's because she refuses to prescribe antibiotics to the patient with cold symptoms for 3 days, instead she gives them a print out on how to treat the common cold...I am definately a fan of the DO's!