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

I work in ED of Level 1 Trauma Center and we are bursting at the seams. Unfortunately the Academy of Medicine in our city has prohibited any ED's to divert patients. So, we pack, stack and rack the ambulance cots in the hallways until the next available bed is ready. There are 6 other large hospitals in our city and a childrens' hospital. All of them are feeling the crunch. But, we're the only trauma center in town and it seems that EMS thinks all MVC's, assaults, etc., should come to us. *sigh*

I am a preceptor for new RN's and nursing students in our Emergency Department. I have received cards and small gifts from many of my preceptees. I cannot tell you how very much these tokens of thanks and gratitude have touched my heart. And, most of all, I have been greatly encouraged in my own nursing practice as a result. So....encourage your preceptor with a small gift. This will motivate him/her if ways that you cannot imagine.

CID = cervical immobilization device

hmmmm......despite the info below about pancreatic failure, it seems that soap heroes usually recover from the majority of life threatening illnesses. after all, how many of them have come back from the dead? the pancreas is about five inches long and looks like a comma in shape. it is located behind the stomach, with its head fitting into the curve of the duodenum and its tail ending near the spleen under the left diaphragm. the pancreas has two different functions that assist in the processing of food. it produces strong enzymes that help break down fat, protein and carbohydrates in food during digestion. it also produces two hormones, insulin and glucagon, which help regulate blood sugar. because of it's role in regulating blood sugar levels, one of the major disorders affecting the pancreas is diabetes mellitus. patients with type 1 diabetes who are likely to develop vision, kidney or nerve problems are considered for a pancreatic transplant, according to the national pancreas foundation. many people with pancreas failure also experience renal failure, so a kidney is often transplanted with the pancreas, according to the organ procurement and transplantation network. as of april, 2003, 1,414 people in the united states were waiting for a pancreas transplant and 2,423 people were waiting for a simultaneous kidney/pancreas transplant, according to optn. the first simultaneous kidney/pancreas transplant was performed in 1966. the first isolated pancreas transplant was not performed until two years later. in 2002, 545 deceased donor pancreas transplants and 1 living donor pancreas transplants were performed, according to optn. in 2002, 905 deceased donor simultaneous kidney/pancreas transplants were performed, up from 886 in 2001. in 2001, 2 living donor kidney/pancreas transplants were performed, down from 6 in 2000. a pancreatic transplant may involve the whole pancreas or a segment of it. a segmental transplant is usually performed when a living donor is involved. although the pancreas does not regenerate itself, donors rarely have problems because of reduced function, according to united network for organ sharing. since 1988, there have been 22 living donor pancreas transplants. since 1994, there have been another 42 living donor simultaneous kidney/pancreas transplants, according to optn data. pancreatic transplants are sometimes performed to improve quality of life, not necessarily to save a life. the transplant is an alternative to insulin and dialysis treatment. although it may seem like an easy way to "cure" diabetes, it is not, mostly because of the extensive time needed for evaluation and long waiting periods, which can vary from one to three years, according to the university of southern california pancreas transplant program.

At our place, it's a tornado.

Hmmm.......as of today, our facility has 94 RN vacancies......makes ya wonder.

In our Level 1 Trauma Center ED, we follow the above guidelines with the exception of those trauma patients needing to be aggressively resuscitated with blood/FFP/Platelets. Then we use the Level 1 Infuser attached to a central line (8.5fr) and infuse each unit over 45 seconds.

If God is calling you to serve Him in the area of nursing, then......this will be your ministry, and it's not to be entered in to without a great deal of prayer for His direction. I have been serving Him in a busy ER of Level 1 Trauma Center for 20 years. These hallways I walk every day are mission fields. God presents spiritual opportunities daily and He only asks that I be available and obedient to accomplish His purpose. I taught SS for several years, but only on alternate Sundays. Most hospitals expect employees to work every other weekend. Fortunately I had an apprentice teacher who taught on the days I worked. Blessings to you as you seek His will for your life.

I've been a nurse for over 20 years and these years have all been in the Emergency Department of a Level 1 Trauma Center. Over the years, I've had good times and bad times...too many patients, not enough staff, management difficulties,etc., etc.. and after reading a multitude of posts on these forums, it is plain to see that the challenges of nursing are universal. As for me, I still love what I do. To me, it's a higher calling. I know that I have made a difference in many lives over the years. I have the following poem on my locker at work. It pretty much describes the way things are in nursing. Good luck! Being a Nurse Means ... You will never be bored. You will always be frustrated. You will be surrounded by challenges. So much to do and so little time. You will carry immense responsibility and very little authority. You will step into people's lives and you will make a difference. Some will bless you. Some will curse you. You will see people at their worst - and at their best. You will never cease to be amazed at people's capacity for love, courage, and endurance. You will see life begin - and end. You will experience resounding triumphs and devastating failures. You will cry a lot. You will laugh a lot. You will know what it is to be human and to be humane. By Melodie Chenevert, RN

In our ED of Level 1 Trauma Center, we encounter many folks wanting pain meds. As a matter of fact, Tennessee was listed as the #1 state for drug abuse in 2007. I know, kinda hard to believe that southeners would switch from Jack Daniels to oxycontin, percocets, etc. Anyway, our docs have access to a state sponsored website which lists all controlled substance prescriptions with date filled, quantity given and prescriber. Therefore, folks can't lie and say they haven't had any narcotics or Soma or other local favorites.