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Roy Fokker BSN, RN

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Emergency/Trauma Nurse. Free Mason. Reading, hockey, guns, shooting/hunting, hockey, libertarian and anarchic philosophy, hockey, "dad" jokes, did I mention hockey?

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  1. Karen!!! How ARE you??
  2. Roy Fokker

    New grad nurse in Emergency Department

    1. THINK FIRST. ACT SECOND!! I can't stress this enough! Never forget - it is not about you, it is about the patient! 2. If you are in doubt about ANYTHING - meds, procedure, patient condition, whatever - ask another nurse or talk to the Doc! If you are drowning, ASK FOR HELP! Remember - it is not about you, it is about the patient! 3. When you do/witness something, document/chart it as soon as possible. You never know what's rolling down the aisle... 4. Assess. Assess. Re-assess. And assess again. A patient who looked stable 10 minutes ago might not be so stable right now. Patients roll into the ER with unknown etiology and maybe poor historians. NEVER assume anything! 5. There ain't no such thing as "too many vital signs." 6. If you're transporting someone on a monitor - be it to CT or be it to Tele/ICU - take some Epi and flushes with you. Having a patient crump in the elevator on the way to ICU is harder to deal with if you don't have resources. 7. NEVER ask someone to do something you are not willing to do yourself. Help your techs. Stock rooms/carts. If you find you have a few minutes to spare, ask around if anyone needs help. Trust me, there is ALWAYS something that needs to be done... 8. Be your own master. Don't let other nurses'/techs/team members dictate your practice. Set a good example. Be a team player - even when others aren't. 9. Take your breaks. Drink enough water. Go pee when you have to. Eat something nutritious during your shift. Take care of yourself. Unless someone is coding or unstable, they can wait 10 minutes... 10. Lastly - try and enjoy your shift. Me personally? I like sharing puns and "Dad jokes" and every once a while, I'll put on a clown nose while doing patient care. Both my colleagues and patients get a laugh out of it and it makes for a less stressful shift. I hope this helped! cheers,
  3. Charger? My gaming computer decided to die on me. Right before Christmas... Best of luck to us finding our electronic needs!
  4. Possum Mom!!! Each time I drive up to see my cousins, I pass by Opossum Lane. And each time I see it, I'm reminded of you! And each time I'm reminded of you, I forget to stop and take a picture! Hope you're doing well!!
  5. Any "downtime" outside of work is "ok time" in this ER nurse's book!! How are you doing Ms. "traumaRUs"? Still in the B/N area? It has been a while...
  6. That sounds absolutely lovely Ruby Vee! Glad you had a great time!
  7. Roy Fokker

    Time Management in ER

    Here's my take on the issue (keep in mind I'm still new in the ED). I work a Level II 50 bed (including hallways) ED averaging 200 - 250 pts. a day. - Always document as soon as possible. It's one thing I have difficulty with sometimes but as my preceptor kept drilling into my head during orientation: you never know what's coming down the pipeline and before you know it, in the blink of an eye and you're at least 2 hours behind on documentation! - Prioritize, prioritize and re-prioritize. And this rule applies every minute of your shift. Sure an ambulance may come in bringing in a new asthmatic patient ... but don't forget about that borderline chest pain you've been working up who starts to show changes in the ST on the monitor (who is the priority now?) - Learning to delegate is crucial. In my ED techs do transport (to x-ray/CT/Ultrasound/to floor) as well as certain tasks (blood draws-not IVs/EKGs/fingersticks). So if you have two tasks: Transport "A" to CT for abdomen/pelvis and get EKG on "B" for chest pain - what should be the course of action? - Somethings can absolutely wait: and sucks as it does sometimes, comfort measures fall into this category. Despite all the glares and "my husband is a diabetic and hasn't eaten all day" etc. - nobody is going to crunk and code because they waited an extra half hour for a meal tray or a blanket. Urgent needs come first. - I've gotten into the habit of hooking practically ALL my patients onto the monitor (unless they are an ESI 4/ESI 5 or I'm working track). That way I can set up the monitor to automatically take vitals (say every 30 minutes) - not only do I have a ready trend of vitals on my patients, the monitor can also catch a patient heading south sooner. - DO NOT feel shy/embarassed about asking fellow nurses and/or charge nurse for help. If you feel like you're drowning, there is no shame in asking for help. Patient safety first. This kinda applies to the doctors too (depends on who you work with) - I work with a bunch of awesome docs for the most part and if they see that the nursing staff is getting murdered - they'll take verbal orders from admitting docs, or they'll start IVs/foleys... heck, I've had docs wheel patients down to X-ray, take 'em to the bathroom or get 'em a sandwich! If you're super busy and can't find a nurse to take the telephone admit orders, ask the doc if they can spare two minutes and take 'em. cheers,
  8. Roy Fokker

    Afraid of Nursing as a Male?

    I don't mean to be confrontational ... but I have to say - the stuff you've read, by and large, is nurses venting their frustrations. An analogy I can readily summon is enlisted men grouching about the officer(s) in their unit. Wow! Congratulations! You're way ahead of your peers. Heck, when I was 16 I didn't know the difference between football and soccer! Good on you mate - atleast you seem to have an inkling of what you want to do with your life! Here's my humble opinion: 1. College and 'bad experience' are not synonymous. Even if they were, the fact that you went to college and earned a degree outweighs everything else. 2. "Bad experience" is quite subjective. Did I have trouble during my nursing school? You bet your hiney I did! Do I regret it? NO! I quote my platoon sergeant: "the two most important teachers in life are "success" and "failure". They both impart lessons no classroom or textbook can ever give you". Yes. Infact, I work with some at my current job. Not really. On the contrary, 99% of my patients are either very receptive that a 'nurse' is present during the time of their need or don't care either way... of the remainder 1%, I'm more than happy to accommodate their wishes. It ain't about me, it's about them... To use an analogy - what's your response when a girl refuses your advances for a date? Do you sulk and mope about it or do you say 'too bad! She's missing out having fun with a great guy!' ?? One of our long-term members here on this website has this statement as part of her signature: 'attitude - it's the difference between an adventure or an ordeal'. And THAT is exactly what it is all about... Have I been discriminated against because I am a man in nursing? YES. Would I change anything that led me to this point? ABSOLUTELY NOT! Do I "hate" my job because some of my co-workers aren't exactly 'team players' - NO! Idiots come in all sizes and sexes - be it in an all male platoon of recon infantry in the Army or a band of mixed-gender nurses working in an Emergency Department. My advice? Don't let the b*****ds grind you down... Take the good and reject the bad. Promise yourself that you'll "never be the horrible nurse you've seen/observed" around you. Be the best PROFESSIONAL you can be. cheers,
  9. Roy Fokker

    Work place violence

    A-ha! Someone who mirrors my own thoughts! My only question is - do you mind detailing all the "items" in that photograph (besides the sweet lookin' M&P )?? I've honestly been looking for a 'good' "carry case" (i.e. some place secure to store my stuff when I'm not "carrying" and when I'm "on the road") Who the heck uses their pocket - for/from ANY DRESS - as a 'holster' for a side arm??!! It's bloody awkward! Me likey! Can we have more of y'all around my hospital please? :) I don't care what the AMA of the SHA say - I'm not too COMFORTABLE with the Taser. Rather than it being used as "an alternative to violent/fatal force" it has all too often become a method to "induce compliance through pain".\ The original idea of the "Taser" was that "rather than draw a lethal firearm, the officer could draw the Taser and debilitate the threat rather than shoot/wound/kill". The idea was that introducing the taser would be beneficial for both law-enforecement AND the general publuic. However, history shows that more and more - tasers are used as a "compliance" tool. In other words - they are being used even in situations where there is NO VIOLENT ACT IN PROGRESS. A famous example would be the "don't taze me bro!" of Andrew Meyer. There's dozens of other examples where trhe tazer has been drawn and USED as a "compliance tool" - violating it's 'original reason to be introduced'. Good for ye. I agree! I applaud your foresight when it comes to firearms in hospitals (not just how you described your RoE but also how you describe the perils and potential dangers of setting off a firearm in a hospital). And given your response - can we please clone you and have y'all assigned to my ER? :) cheers,
  10. Roy Fokker

    ER Burnout

    Just to clarify: I'm assuming you mean "25+ patients on average PER RN during the entire shift" and not "25+ patients assigned to EACH RN during the entire shift". I know it sounds absurd but I thought I'd just like to clarify. The reason why is because I've done my fair share of 30+ patients during 8 hours of Fast Track. I've also had nights when my pod-partner and I have dealt with 9 patients a piece --- including an intubated patient each along with active MI patients (and not to mention the 4 year old brought in "almost intubated" because of severe resp. distress...) And just to clarify: I'm not trying to 'brag' or 'one-up' or 'things could be worse' or anything like that (which is beyond childish to begin with!) I'm interested in knowing what the status at other EDs are. Our management seems to be fairly open about staffing - but they seem to 'favor' certain shifts over others (i.e. pulling staff from the "other shift" so as to satisfy the "prefered shift" even if it means that sometimes it'll leave the "other shift" lacking). cheers,
  11. Roy Fokker

    New Grad Woes

    motivatednurse, First off, let me congratulate you on surviving nursing school and passing your boards! Please believe me when I say - if you can get past THAT, you can truly do ANYTHING you choose! :) I've always said that "if I had the choice between army boot camp and nursing school, I'd choose boot camp in a heart beat!" Secondly, I like your username. Motivated Nurse. That's an excellent attitude to have, especially in someone new to a career/field/profession. Subsequently: - I'm still a "new nurse" and I hope I'll always be open minded about learning new things on the job. The day you feel like "now I know it all" is the day you should hang up your stethoscope, retire your nursing shoes and QUIT! - I agree with the others who have chimed in and said "sounds like it's par for the course". Because it is. Not only are you a new nurse, this is your first nursing job. Add to that, you have the unique pressures associated with the chaotic, dynamic work environment that is the ED! - Being scared to death is normal. Remember the old saying: "Courage is not the absence of fear, it is taking a step forward when you are afraid." However, what I have found is that as the days wear on and one's confidence and proficiency increase, the fear does not decrease ... but ones ability to face it improves. - Never forget this: "Good judgment comes from experience. Experience comes from bad judgment". I'm including this quote not to further scare you but to highlight the fact that your peers and mentors have also gone through the same trials and tribulations. We've all had our "days" and "certain cases" - both good and bad - that have left an indelible mark on us. Now that the "lecture" is over , remember to: * THINK before you ACT. It's better to spend the extra three seconds to think something through than plunging in willy-nilly. * When in doubt, run it by another nurse or run it by a Doc. The great advantage of working the ED is that you have nurses, techs, Docs, NPs/PAs all working around you all the time. Make use of 'em. Nobody will think less of you for doing so. * As an adjunct to the above - believe you me, as a "new nurse" I had a hard time with "delegation". And as a "new nurse" I had an even harder time with "asking for help". This is important! You MUST recognise when you're "in over your head" and ask for help! Just remember, it's NOT about YOU, it's ABOUT the PATIENT! Keep THAT in mind, all the time. Don't ever think about "but I'll be looked on as someone who can't hack it" or "I'll be percieved as needy" or other such nonsense. The prudent nurse recognizes when s/he is overwhelmed and asks for help. Simple as that. Remember - it's about patient care, not YOU. * Try to have fun (Yes, you CAN! ) You work in a stressful environment but there's always time for smiles and a light hearted joke or two. * Don't forget to take your breaks. If you've survived reading this manifesto this far, I must also commend you for your patience! Patience is a wonderful virtue to posess - especially in nursing! SO! Stop 'freaking out'. Take a good, deep breath. Calm thyself. And then jump right in! Welcome to Emergency Nursing! cheers,
  12. Roy Fokker

    So... How real is the show ER?

    I liked the first few seasons of ER. I liked Dr. Greene. I liked the "tension" between Dr. Carter and his 'mentor' Dr. Benton [an under-rated character IMO]. Then I kinda quit watching it regularly after the first 2-3 seasons. I'd watch it if I was flipping channels and it came on - but IMO the show had become repetitive. They tried to spice it up with the docs travelling to Africa - and I'm 50-50 about that. I liked seeing 'the dark side' of Luka but a lot of the other stuff was a little too far-fetched. As far as medical "dramas" (note I didn't use the word "show") go, I think it lived up to it's name. It was pretty fantastic - but it was supposed to be fantasy, right? Of course, as an ED/ER nurse - I am weary of all those folks who look at that show and think that real life ER is like the show ... be it the "miracles of resuscitology", the "quick and speedy care" or "sex every other week in every other room"... But for entertainment wise, it wasn't half bad [the earlier seasons. The later ones were ridiculous]. cheers,
  13. Roy Fokker

    Meditech ER Software

    Another Ibex/Pulsecheck fan here. Despise Meditech. Too horrible for words! cheers,
  14. It's no longer just "media hype". It's "all around hype". I've had MANY patients being discharged from the ED with discharge papers clearly stating "Flu like symptoms (H1N1)". What I want to know is - how the hell did they diagnose it as H1N1 and not regular flu (or just a bad URI?!!!) Why is this a problem? Well, said patient goes home and 4-5 days later, pts. family member comes in thinking "well, my sister was just diagnosed with H1N1 last week... now I have it too". No amount of "Ma'm, there is no way for us to tell if pt. has H1N1 unless we send a sample to CDC for testing" convinces them... becayse they wave the discharge papers in front of your face and say "but the Doctor says she has swine flu!" :banghead: So now we have a seprate respiratory section of the ED waiting room ... and everyone with "flu like symptoms" needs to be in a mask and placed in a room. I'm telling you, we ain't seen the worst of it yet. Wait till the usual, seasonal "pneumonias" from the nursing homes start to hit! BINGO!! I was on a flight heading home from vacation last month. I had a bad head cold and a cough (mild fevers if any - highest was barely 100F). The looks I got from fellow passengers ... Apparently in the age of swine flu, no one is allowed to have a cold anymore :icon_roll cheers,
  15. Roy Fokker

    are southern nurses better educated than northern educated nurse?

    Are green nurses better educated than purple nurses? The OPs question (and some of the responses in this thread) make just about as much sense. cheers,
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