Mobeeb

Thanks, guys, for your responses. I think it helps this old nurse to read your comments (especially the rants) because I am reminded that the problems (or challenges---management term) of nursing are the same, no matter where you go. :)

We do have a Fast Track as well as Emergent, Urgent and 4 Trauma bays (soon to be increased to 8).

Yes, protocols are used in the Triage process.

Does anyone out there have concerns about the ESI Triage protocols, specific to the length of stay incurred when a certain "number" ESI score is given? It's not news to anyone that over the past 2 years, the volume of ER patients has grown exponentially and folks are waiting in the lobbies longer. The majority of patients who are triaged "3" compose the largest number of patients. Here's where my concern comes in: Patients who have lacerations, fractures of single limbs, head injury with LOC, etc., are given scores of "4", so they are waiting for hours while abdominal pain for months, etc., are being seen because they use more resources. As an experienced ER nurse, I can project what the cited "4" examples will require as part of their treatment, but there are a lot of newbies out there who cannot. At what point does management step in and say "Hey, let's use some common sense here", and get the injured folks seen before the belly workups, especially the ones who had the same workup last month, and the month before and the month before? {{{ sigh }}}

http://taimapedia.420chan.org/wiki/Opioid_comparison_chart

I think that a lot of surgeons went through a course of "if it can't be cut, then I don't care" philosophy. Several years ago a young man (24) was transferred to our Trauma Center with a "severe crush injury to the chest" (according to the transferring MD) which he sustained as he was working beneath his car. The jack slipped and the engine block compressed his chest. Expecting the worst, when the patient arrived I was surprised to see no respiratory distress or other acute ongoing process. We did the routine trauma scans which did not show any broken bones, internal injuries, etc. What the transferring MD had seen on the CXR was a huge hilar mass which he interpreted as some kind of strange traumatic injury with which he was unfamiliar. The surgeon, along with a couple of the trauma residents, went to the patient while he was still on the CT table and told this young man that "you don't have any acute injuries, but you do have a mass in your lung and it's probably cancer and you need to see an oncologist. We are going to discharge you, yadda, yadda, yadda." He then walked from the CT suite while the poor patient (in a state of shock and awe) was trying to assimiilate what he had just been told. I "tactfully" grabbed the surgeon and after a long heated "discussion" he finally agreed to admit the patient and get an oncology consult. During this conversation I could see the trauma residents stretching their ears and mentally placing bets as to who would win. I only hoped that they would begin to learn that the patients who will be entrusted to their care in the future are fellow human beings and not just a "grade III spleen, or PTX or fx femur, etc." But, to be fair to surgeons, I have seen many who go out of their way to try to get folks the care that they need. BTW.......the above mentioned surgeon left our facility to practice in another state. He died 3 years later of liver cancer at the age of 50.

I agree with all posters, but President Nixon signed on the dotted line of the HMO Act in 1973.

I thought the following article might be helpful to you-----"Facing Neuro Assessment Fearlessly". I work in a busy Level I ED and we do quick initial assessments which include each of the practices you mentioned. I find it helpful to know the distribution of the spinal nerves when I have a patient with spinal cord injuries, so that when I learn where the level of injury and if it is a complete or partial cord injury, I will be able to expect loss of specific muscle control and sensation below the area of injury. Re: documentation----I document what I observe and let the docs be more specific about their exams in their documentation. However, I digress. Here is the link to the article about neuro assessments. Hope it helps. http://findarticles.com/p/articles/mi_qa3689/is_200202/ai_n9081643/pg_1?tag=artBody;col1

My place requires us to work either CD or CE and the same with NYE and Day. Can't have both days off together. Therefore a lot of our folks who have out of town families can't make a trip to see them. In addition, no vacation days may be taken during this holiday period.

The use of the TB syringe is only for the IV admixture. Some of the older RN's use the TB syringe for subcu doses because they can see the lines of the syringe much better. I want to add that the admixture procedure I mentioned is a standard with our pharmacy. We also have to mix our own ABX and many other IV drips. We follow the pharmacy P&P regarding amount of diluent, etc.

We have to do this all the time in our big ED. We use a TB syringe without the TB needle. If you use Insulin 100units per cc, then 0.1cc = 10 units and so on. We use a 22ga needle, draw up the Insulin and inject it in to the IV bag. We usually put 100units in to 100cc to get a 1:1 drip. Our patients who get these drips are admitted to the unit and not the floor. Does your hospital policy/procedure allow Insulin drips on the floor? Just wondering.

Go here. Maybe this will help. http://www.biology-online.org/1/3_respiration.htm

I have about 10 of these shirts that I wear underneath my scrub top, plus I purchased several buttons to wear, also.

I would do it again. I have been an ER nurse in a busy Level I Trauma Center for 20 years. Are we understaffed? You bet. Is the turnover of nurses high? Yup. Is the census high? Once again, yep. Do the powers that be ram JCAHO and other regulatory agency requirements down our throats? Uh-huh. Do the drug seekers and other annoying patients get on our nerves? Oh, yeah. So....why do I stay and why would I do it again? I really love what I do. This is my passion. The chaotic and rapid paced environment keeps my juices flowing and when I help to "snatch someone from the jaws of death"....wow! What a rush to make a difference in a person's life. So.......hang in there if nursing is really your passion.

Old thread addresses your question. https://allnurses.com/forums/f35/rhogam-question-214267.html