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

"all patients are liars. if the patients is incapable of lying, the family will lie for them." - anonymous USN ER nurse.

Perhaps emergency nursing is not for you. No shame in that. Very few people can do it.

"nursing shortage" means there are jobs available for nurses

I've done "male nursing" for a good while now. (You will have to accept that label; it's a female-dominated profession.) Lots of problem nurses fall by the wayside, but none, that I know of, ran into trouble for being "shallow". There is no reason you should not become a nurse. The fact that you are thinking of it indicates some level of interest, right? But, keep thinking. I get what I need from nursing, but it can be terribly frustrating.... on many levels. Healthcare is a dysfunctional business. Most employers treat their employees much better than you will be by hospitals. As for the money, I think that we are underpaid and overworked. As for the germs and fluids, they're on you!!!! Here are my two cents: A germaphobe with an aversion to bodily fluids may want to consider alternative endeavors.

After we had a non-monitored Pt that received IV vit K go into V-Tach (probably), one of the pharmacists gave us an inservice. He said it takes 12hr for onset of action no matter what route. Personally, I don't have a warm, fuzzy feeling about giving this drug IV.

"smotach hurts", CC="constipation" (guy had had diarrhea x 4d), "mosquito bite", "mental", "real sick, need lots of xrays", etc.

All these meds should be decriminalized and sold over the counter. I must be completely pain free; so what if it causes me to run your kids over.

ok nurses, let's think about this. I am seeing lot's of comments about not being judgemental coming from people who appear to be judging one another. Let's get real. Some of us need to vent. So what if I make fun of the freaks that are attracted to my ER. Watch what kind of job I do, do not worry about what I say.

Remember what AIDS did for us. We treat everybody as if they have a horrible disease. That's so we avoid offending a few people, possibly. Here it comes. We are now going to treat everyone like they are suicidal victims of domestic abuse. The nanny state marches on. Makes me homicidal (almost). (I put that last in for the moderators. They seem incapable of recognizing humor.)

I do not believe there are any easy answers. Like all things legal in this land of ours, the decisions are made on a case by case basis in court. It cannot be said, "do this and you will be immune from prosecution" or "don't do this or you will be guilty of a crime". Yes, I know, I have heard it many times; "we are a nation of laws, not men"". It just isn't true. You are guilty of kidnapping, or whatever else, if you are found guilty by a court. It pays to be careful and act in a prudent fashion, and it certainly helps to know the laws that apply. Trouble is, we nurses can get in trouble regardless. And, we are handy scapegoats when something goes wrong. Personally, I do not give mind bending drugs to anyone without a responsible adult driver and I try to keep anyone that seems altered from leaving the ER. Sounds like pretty much the standard nowadays, right? Question: if some one leaves against instructions and I call the police, can I give them the name in light of HIPPA?