RNwillie

Only the person who did the charting can alter the charting. If a RN must sign behind a LVN, then they MUST make their own notation if their assessment differs from that of the LVN and put their name to it!!!!!! Highly illegal to alter anyone else's documentation. If they are worried about getting paid, that is simple to fix. Just chart either pt stated weakness or observed weakness, but observed steady gait. And I agree......do something to stop this because Medicare does NOT mess around with false documentation. Especially if it's to get paid.

You can get your ACLS/PALS both online at www.aclsonline.us. Also, I did my two years MED-SURG, then moved to a different state, and now work in a rural hospital. And let me tell you what....I now do ER, OB, OR circulator, charge nurse, MED-SURG and even just moved up to ER Manager/Trauma Nurse Coordinator. I have learned a lot in this rural hospital. So my suggestion is, if you can't find what you want at a big hospital....think rural. You can gain a lot of experience that will open up the job field and make you more of an asset!!!!! And don't think you won't see anything!!! You see everything and do everything. Your skills become more defined!!

The thing with OB is the more time and experience you get, the more comfortable you get!!! I was strictly a MED SURG, ER, Step-down nurse, before I attempted OB!! It's been 1 1/2 yrs and I still get nervous when it comes to a birth. You just have to remember, that the doctor is always there and believe it or not......if something does go wrong....they do step in to help!!! Nurses aren't perfect!!! You gain knowledge from mistakes!!! You have to learn to gain what you can out of them and move on or it will eat you alive. I believe the most rewarding part of OB is being part of God's creation. It is the most natural thing and is a miracle everytime!! See the good, not the bad!!! Good luck!!

Sorry forgot one more thing. The average stay for an "extended ER" pt is 16 hrs.

GM2RN, My problem is we are a rural hospital with no CDU. We either admit (full admit or observation, treat and release, or transfer). Somehow, over the years "extended ER" has developed in our ER. Basically, doctors place this pt in that status to receive numerous treatments. It varies from IVF, to q 1 hr FSBS, to just watching the pt. We do not have a policy covering "extended ER". Several Pts are being kept from anywhere from 2-24 hrs as "extended ER". Our "extended ER" is unofficial and needs guidelines. Just attempting to get an idea on how others handle or even deal with situations like this. I am finding most do not!!! I have found that at Stony Brook University Hospital, they have a policy in place to make a decision to admit, DC, or transfer after 8 hrs.

Thank you for all the information!!! Leads me to another question. How long does everyone keep their pts in the ER? For example, a pt comes in dehyrdrated and IVF are started. This pt is not put in obs, but kept in the ER recieving fluids. Anyone have a policy stating how long a pt like this can be kept? Is anything over 4 hrs acceptable in other ER departments? Do other ER departments have a time limit on whether to admit a pt (either full admit or obs)?

Just wondering if anyone else has extended ER at their facility? Working on a policy and was hoping to gain some ides. For example, how long can a pt stay extended ER? What qualifies a pt to be extended ER? Any and all information would be very helpful!!!