Knoodsen

Study the ENPC Manual. You should have it by now but, if you do not, contact the course director to get one.

MSE's have been done by many ED's in my area for several years now; hospitals are trying to find a way to stay in business and this is an effective tool.

I did not presume, nor state, that any particular person could afford this course. But, I do believe that it is an expense that an RN can afford.

We are professionals. ENPC is not a large expense (and is deductible). The course presents material that is essential to our practice.

By the way, I'll be nice to you because I treat people the way I like to be treated. With respect to pain meds, or any other type for that matter, I will give them to you if they are ordered if I believe the order is appropriate. Sorry. Can't give anything without an order. And, by the way again, no personal guilt here about "failing to understand and treat pain adequately in the ER". We give people narcs for twisted ankles. My stars. What has this world come to?!

You are the kind of patient that would post a question about pain control on an emergency nurses' site. Speaks volumes.

It's funny. Also an infuriating reminder of where we are as a culture.

I have been an emergency nurse for many years and couldn't begin to pick the most ridiculous complaint. People just have no idea. A major portion of our business is completely ridiculous. ER's attract nuts. Personally, my favorite ridiculous visits are the performers. I am endlessly entertained by the people willing to fake seizures, strokes, unconciousness, and who knows how many somatic aches and pains. Fibro my ass.

At my level, I don't really care about OSHA, JACO, etc. That's for administrators. I have always worked twelves; you telling me I can't have fluids available to me for that kind of time? I'd be guilty of malpractice for telling you the same. Sure, there of plenty of shifts where it isn't an issue (buffet in progress at "chez breakroom"). There are some that I must have a drink right there, electronics and all. Let common sense prevail.

I find many aspects of ER culture to be endlessly entertaining. I understand the frustration related to dealing with the pain issue; it is a big part of our lives. Pain and anxiety are the biggest reasons for ER visits. (If you work nights, as I do, you may be tempted to say, "what about all those fever babies?", but that's more about parental anxiety than baby's fever.) Charting can be fun. I enjoy the challenge of accurately portraying ER people. Quotes are always great. I include their grammar and pronunciation. If they rate the pain "beyond a ten" and have a big smile, then that is exactly what I chart. Also, they do not understand the pain scale so I never again ask them to rate their pain...even on subsequent visits. It can be useful to chart who assisted the Pt with their pain rating. Isn't it charming to watch the family members rate the pain? Anyway, learn to enjoy your charting because you will be doing a lot of it as an ER nurse. You have to be succint and you have to protect your license. You cannot possibly chart "everthing you do". Stable/normal Pt? Get in, get what you need to do done, and get out. Be nice to them. Then, while they marinate, visit every hour or so. Keep them comfy, offer the family coffee. Be nice to them. Then, go chart, "resting quietly. NAD. AOx4, pulse strong and reg, skin warm and dry, resp even and unlabored. No complaints. Awaiting.....". If you sense trouble, then avoid any unnecessary visits to the Pt and document exactly what is done or said. Don't let them intimidate you with that "if you didn't chart it, you didn't do it" stuff. (I can't believe any serious person could believe something so ridiculous.) OK. Next time someone accuses me of being rude, check my charting. There is no chance that I documented that I was rude to them. Therefore, I could not have been rude. There'll be a good chance I documented rudeness on the part of the complaining party.

18Fr NGT is the standard size gastric tube. Every ED I know stocks them along with 16Fr Foley caths. Yes, they both appear large relative to the orifice that they go through, but they go, don't they? As for the task at hand, it's gonna take a 30-36Fr orogastric tube to get those somas out.

The hospital tells me that I cannot accept gifts that have any value, but I think they will take "donations". In fact, they seek them out. They have set a limit on the monetary value of snacks that I may accept. It's lower than the limit established for more important people, of course. My opinion? That's our culture. In many countries, the police augment their incomes with bribes. That is not acceptable here and yet those at the top may be bribed ad lib. They who lie, cheat, and steal are very concerned about my ethics.

"fiberoptic cysts"

the allergies claimed by the Pt are intended to leave nothing else left to give but "something that begins with a D".

allergies to toradol, morphine, fentanyl, all NSAIDS, and any other non-narcotic pain meds = the demerol funnel