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  1. Very informative. In Canada in my academic hospital we have a dedicated stroke unit with a stepdown nurse from the hyperacute stroke unit that gives tPa (if indicated) and accompanies the patient to thrombectomy, freeing up the ER nurse for the next patient. It has helped free up nurses in ER, allows timely intervention if a hemorrhage occurs after tPa and provides better continuity of care while inpatient. Best of all inpatient strokes can also be handled by the same inpatient stroke team.
  2. erniefu

    Should Hospitals Set Workloads for Nurses?

    Hospital administrators always say that acuity based staffing ensures adequate nursing staff. But the reality is that they game the acuity assessment system such that they can hire less nurses. I have never heard of hospital administration reassess acuity once they get the numbers they want, despite increasing patient complexity, increase in documentation needs, or change in patient acuity. Acuity based staffing is a sad joke until legislation forces hospital administration to hire more nurses based on current patient acuity.
  3. erniefu

    Safe Staffing Levels for In-hospital Nursing Units

    Until management gets hauled to a board of nursing/medicine disciplinary panel and faces charges of negligence and professional misconduct for chronic unsafe staffing ratios, staffing ratios will be treated as an afterthought by management. They get all the power but none of the responsibility or the accountability when something bad occurs. The lawyers always go after the nurse, never the management team for a lawsuit.
  4. In Canada, a comprehensive stroke centre would be doing stuff like giving tPa, thrombectomies/embolectomies, along with providing stroke care for those outside the window. Patients that are given tPa/thrombectomies are admitted to a hyperacute stroke unit where they are at worst 2:1 with neuro checks to be done every hour at the minimum (a step down unit). Otherwise stroke patients are 4:1 on days and 6:1 on nights.
  5. Certainly there are positions that don't involve bedside nursing care (Infection control, public health), but every nurse has to learn to do the nursing process: Assessment, analysis, planning, implementing, evaluating care. It doesn't matter if it is treating a pressure ulcer or reducing the incidence of chlamydia among teens.
  6. If you have religious objections, then Labour and Delivery may not be for you. There are plenty of areas like Med-Surg, Palliative, Rehab that you can work, and I'm sure Duke would not object to transfer you there.
  7. "it is her right to abuse you." It is also your right to e-mail the CEO, CMO, CNO that your supervisor said those words to you and that you expect a formal apology, and to go to the news outlets if such apology is not coming. If your supervisor said those words then he/she can not be supervisor anymore because he/she has lost all respect for the nurses.
  8. erniefu

    Non opioid pain options

    Given that a lot of medical surgical patients are NPO before surgery in ER, I think that it makes sense that dilaudid is ordered as subq prn. Unless there is an abundance of IV Tylenol that can be given. Of course if it is post op care then you can advocate for non-opioid pain management if appropriate.
  9. erniefu

    What was the age of your oldest surgical admit?

    98 year old lady that got endovascular coiling for a brain aneurysm
  10. I think that people have a problem with recognizing how do we quantify qualify of life such that we would make ourselves a DNR. For me, if my palliative performance scale was 40% or lower, I would make myself a DNR. I like this scale because it does not depend on the age, just how one can go about life. Of course no scale is perfect and is subject to human interpretation. The Palliative performance scale, from Victoria, BC, Canada. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13380
  11. erniefu

    Be honest: do you feel valued by your employer?

    During this Christmas, the CEO offered to give staff a free Christmas dinner to those that worked. Of course, none of the nurses on the floors got one as the dinners ran out before the nurses could get off the floors for break.
  12. This sounds like something that a geriatician or a geri psych clinical nurse specialist should be involved in.
  13. erniefu

    Amber Does the Unthinkable

    What was learned was that the supervisor was the one who couldn't handle the pressure and did not prioritize properly. It seems that the supervisor had no idea what was going on in the holding area (already causing the hold to be over census) and sending an inappropriate patient to the hold (I doubt a hold has proper monitoring equipment and supports like the ER main to do a chest tube insertion). Amber was right to reassess the situation and figure out what to do next. Surgeons take time out during surgeries to ensure that fewer errors are commited.
  14. erniefu

    How do you deal with verbally abusive pts?

    This is one of those patients where you need to implement a behaviour contract. If behaviour charting does not show there is an unmet need (toileting, pain, hunger etc), then this patient is clearly acting like an ******* just for the sake of it, or has anti social personality disorder (which is practically incurable). Nurses don't have to accept inappropriate behaviour, and other residents shouldn't look to that patient as acceptable behaviour. Behaviour contracts should be implemented and enforced by everyone, and it would empower staff to leave the patient alone when you or other staff are at the point of tears.
  15. erniefu

    Disciplinary Action?

    I think that it would be the Board of nursing that would be in the wrong here. Why would the board of nursing be making a finding of incompetence when the OP clearly just passed the NCLEX and has basically no nursing hours accumulated? If the board of nursing accepted the findings of a test not sanctioned by the NCBSN to test entry to practice competencies and for safe nursing practice, it would undermine the whole point of the NCLEX. I don't think the NCBSN would take that very well. P.S. This kind of testing is also very stupid from a managerial point of view as that test basically undermines the whole point of the interview and the probationary process. Failing one test because you don't have the background and sound nursing knowledge to make the correct calls every time? We do have colleagues we can ask when we are unsure of something.