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!

This post is just a reminder to keep our fellow nurses in Japan in your thoughts and prayers. I am sure they are being overworked, feeling overwhelmed, as well as dealing with their own emotional battles at this time. Today's epic catastrophe brought me back to a conversation I had with a Japanese friend, a few years back. I was in nursing school at the time and I asked her about nursing in Japan...she stated that the field of nursing was not well respected. In fact, many jobs such as custodian, handyman, mechanic payed much more. Now knowing how much we, as nurses, have to invest ourselves into our work I am in disbelief by her comments. We are fortunate here, to be in a profession that is respected as well as considered "making a good living." Let's keep our nurses in Japan in our thoughts and prayers as they are needed in this time of crisis...

Never worked the PCA pumps as I am an ER nurse but how much could you have really gave him just by adding a little pressure 2 mg? Its an IV medication so you would have seen pretty immediate changes in VS if you really gave him a big bolus. Now ya got me interested in how these things work...might take a trip to the ICU tomorrow...

In the ER I work at we receive many of these phone calls. Normally they ask if so and so is in the ER and as long as they have not blocked their information we can say "yes" or "no." If more information is requested I normally have the family come to the phone or return the call. Even though we are only trying to help, patient privacy is something to be taken serious and our patients trust us to keep their information private. As far as giving out lab values that is something I only do if requested by the MD, out of the RN scope to interpret. In your situation, it doesnt sound like you will be reprimanded. Maybe just a wake up call, next time could be worse?! I would definately check out the policy where you work to find out just what information you can and cannot give out.

Maybe I shouldn't have used the word "slammed" because the amp does not allow you to slam it in. My point is...after the incident I talked to some seasoned nurses about how fast the Doc pushed the Atropine and I stated, I never push it that fast in non arrests. The overall census was to push it fast. Personally I do the full 60 seconds at a steady rate. As far as cardiac arrest I am probably guilty of pushing faster than the recommended 30-60 secs. As for the patient, the Doc pushed his own Lopressor after making him tach. He went to the cath lab shortly after....

Wear a pants suit and get some flats from Walmart..$10.00. Ace wrap before the interview and there ya go. No tennis shoes, very unprofessional, you dont want to do anything to put yourself in the negative light. Good luck!

Follow your ABC's. I would also want more info...was she hit by a car? If so, does she remember the entire event? Did anyone witness the event? How fast was the vehicle going? Where are the injuries? Did she hit her head and if so is she on blood thinners? If she was not hit by a car...what caused the fall? PMH..diabetic? Has anything like this happened before? I would also not move this patient. EMS will c-collar and backboad her, unless refused bythe pt. As for the Doc, who knows, bad day??? Maybe just a crappy person? Who cares, you were doing what any good nurse would do and helping someone who needs it. Thats our job, what motivates us....

In cardaic arrest situation's I know that Atropine is fast push/slam. However, last week I had a pt who was brady and the cardiologist, who likes to push his own medications, slammed 1 mg of Atropine in the patient which resulted in a pt who was tach. I thought that 0.5 mg of Atropine would have been sufficient and I would have pushed at a steady slow rate. On a side note, I have a huge amount of respect for this cardiologist and I know this is his specialty and I am not questioning his ability in this case. What would my fellow nurses do in this situation...how fast do you push atropine in a brady patient????

The MD did inform the pt and family that a larger IV would need to be placed. After he wrote an order for the IV to be dc'd and a larger one placed he said, "Make sure you take it out, I don't want them to try to use it." My statement, to this doc was, "a better read with a larger IV is news to me." He seemed well informed and LOVES to share his "I am new off residency" updated knowledge. So, I thought maybe he knows more about this than I know...

In the ER today I had a 20 y/o "chest pain." Of course the pt received the full cardiac workup as well as a CT of the chest. Prior to taking my pt to CT the MD asked me what size IV I put in the patient and I replied 20 G. In my opinion, I felt this size IV was sufficient. However, the MD, who is newly off residency, snapped back and said I want an 18 G in this patient. I proceded to question why and he said that he could (not sure why he said he bc it is the radiologist who does this) could read the scan better. I had my doubts but let the fight rest because for one I had no time for this and two I knew it would get me no where, fast. He put in an order for the 20 G to be DC'd and an 18 G LAC placed. I spoke to a few seasoned nurses as well as rad tech's who have never heard that the size 20 or 18 G made a difference on the scan. Anyone knowledgeable in this area??

As a new RN, with one year of experience in the ER, I am contemplatiing on the "right" time to return to school and pursue my education goal of Nurse Practitioner. With a little over a year under my belt in a busy ER, I feel I have learned a plethora amount of knowledge. However, I am still debating if I have experienced enough to change roles from a staff RN to NP. I understand that NP school takes 3 years so that will tack on a total of 4 years of RN staff experience. On the flip side, I am a firm believer that NP's are fabulous and the reason they are fabulous is because they are nurses first. Just wanting a little feed back on what my fellow nurses feel is efficient time to develop and become ready to transition from staff RN to NP. Thank you for any feed back..