ascRN

Ambulatory care = all outpatient care where patients are well enough to not need to be inpatients. It's a very broad and vague definition. Ambulatory surgery = what is listed above. Usually takes place in an outpatient clinic or ambulatory surgical center. The procedures that occur in this setting typically are invasive (though minimally so) and require a standard of intake, sedation and recovery.

I understand this and it's a two-way street. I think the worst experience I had was a floor nurse who called and complained to my charge nurse and then also called ME back to tell me she had complained to my charge nurse. Her complaint: My patient was AMS with a diaper and had been changed but on a stretcher in the hall for 6 hours waiting for a room for admission. He got to the floor and she found that he needed to be changed immediately. Does this suck? Yes, and I get it. It is a common courtesy thing. Did I even bother checking? No, I didn't, because even if I did, I didn't have an open room to move his stretcher into to change him in. Yes, it's night time and that sucks for med-surg nurses because that's when they get all their admissions. But there's a reason for that, it's because the ED is way over capacity from 7 pm to 3 am. There's a disconnect between the ED and other floors because we all have very different priorities and demands placed on us at any given time.

I did not read all 84 pages, so I apologize if any of these are repeats. Like all of you I had a love/hate relationship with the ED. 1. Your mom/dad/grandma/grandpa decided to receive only palliative treatment for a reason. No one forced them into hospice. Those wishes that you or your siblings are directly defying when bringing them to the ED and making them suffer a traumatic arrest or worse will not bring you into the good graces of your ED docs and nurses. Yes, I do know why your loved one appears so gaunt/thin/lethargic. They're DYING, and your inability to cope is not garnering any sympathy. 2. Please don't tell the police you're on PCP, they will be required to bring you here. Furthermore, if you injure one of my coworkers while coming down, five of us will be on you in a second and you'll be in 4-points before you can say "this is bull****". You very well may get injured in the process. Drs: If we ask you to be attentive to a substance abuse pt, it's because we can feel one of these events coming and would like to avoid it. Do us all a favor and get them out of here, or if you have ICU players to attend to, at least honor our request for prn ativan/haldol. 3. Triage is the least fulfilling and most dangerous place to work in the ED. Do us a favor and don't assault/harass your triage nurses. As many people have already stated, you should expect a wait. 4. Don't spread your ****ing quarter pounder w/cheese value meal over my difficult airway cart. If I need it, it need it fast, and all of that will be going into the nearest trash can/on the floor should I come to retrieve it.

While I am all for creating a therapeutic environment, when you come into an inner city ER complaining of HI/SI, your safety and everyone else's comes first. Period. No questions. Of course the order of my actions will reflect exactly what a patient is telling me and/or what I am assessing. Even for patients that are distraught, when rationalized the vast majority have no problem putting their belongings into a bag and changing into a hospital gown.

I commend you TennNurse, I gasped in horror not once, but TWICE while reading this.

Don't know where all the DRABCD'ers are from. It was new to me as well. I went to school in Virginia and it was just ABCs at the time. edit: in retrospect, it appears you are all from Australia. Must be a difference between the AHA and whatever your CPR credentialing body is there.

GWU has one.

If you have an ACLS book from your last training, go read it and focus especially on the difficult airway/airway maintenance section. Pull out your pharmacology book and flip to anesthetics, paralytics, sedatives, and hypnotics. You will want to be intimately familiar with every drug used by your hospital for anesthesia (everything from roc to vec to succ to ketamine to versed to propofol to etomidate, etc etc etc). Particularly know your side effects and antidotes, and focus on the side effects that might correspond to whatever the surgical chief complaint/significant med hx was (dysrhythmias and BBBs when combined with bupivicaine or what have you). If you're lucky enough to be assigned to only one type of post-operative patient (OB, cardio, etc) then know the adverse events associated with whatever the most common surgeries are that you might see. Brush up on your non-responsive assessment skills as although patients are SUPPOSED to be extubated before getting to you (though I know some hospitals extubate in recovery), if it's busy you might find yourself with someone whose LOC is still pretty altered. Most of all, check on your patients often! Most hospitals have policies for exactly how often and what sort of assessments you need to do for the first 1 or 2 hours post-surgery, so make sure you're well within those guidelines. Good luck! I love perianesthesia nursing and I hope you will too.

Great a physician who isn't concerned about the safety of his patient or the other staff/patients. CiWA protocols are wonderful things.

Yeah, I don't care who you are. You come in with any psych/substance abuse complaint and the very first thing that's happening is you're stripping down to nothing but a hospital gown and your belongings are going in the locker while psych evaluates you.

Night shifts in the ED. I never personally got hurt but I routinely participated in restraining patients who had injured staff. Usually PCP or some other psych/substance abuse thing.

My best advice (along with most posters it seems) would be to remove yourself from the situation entirely. Your actions have jeopardized your nurse-patient relationship and you risk further potential litigation by remaining involved either as the child's nurse or as its former caregiver continuing to be romantically involved with a family member.

As long as HR isn't going to come down and spill all your news to your nurse manager (I don't know just HOW small of a hospital it is) then why not? As far as your chances are concerned - if it's your first 4 months on any floor with no critical care/OR experience, you may not be taken seriously. But as others have said, what does it hurt to try!

My apologies for misunderstanding the original question. I thought you were talking about a medical resident as in a doctor! Telling anyone, especially another patient about another's treatment is of course a violation of HIPAA. I'm surprised your coworker is so cavalier about it. The only situation in which talking about a patient's treatment in front of someone not involved in their care is appropriate is when that patient orally or in writing gives permission to discuss their care with XYZ person.

if both parties are involved in the patient's care and need to share information pertinent to the patient's care, then it's not a HIPAA violation. if patient identifiers are left out and a case is simply described in the context of the resident's action then it's not a hipaa violation (gossipy though it may be). if one medical professional gossips to another about a patient without taking care to remove things that might identify the patient (date, room number, name, birthday, what have you), then it's definitely a hipaa violation. it sounds like you just might have a friend who likes to gossip about their coworkers =)