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Roy Fokker BSN, RN

ER/Trauma

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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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

More than meets the eye...

Roy Fokker's Latest Activity

  1. JayHanig: "I don't understand what your reticence was about telling her you had major GI symptoms. " Its the principle of the thing - why have sick days if you can't use them? I also don't think it would've mattered - I worked there for 2 years and had EVERY single vacation request denied because of "short staffing." There were nights (especially weekends) when we were so short that we held all admits all shift long because staffing on the floors was just as bad. I was personally responsible for 4 ICU holds, a tele hold and a psych hold (who attempted to elope in the early morning and had to be restrained etc.) Same shift my charge nurse had charge, triage AND 20 odd patients in psych/crisis. That place is a disaster waiting to happen.
  2. As opposed to my old job: when I called out sick, sitting on my toilet because I couldn't get OFF of it (nasty GI bug - doing good both ends) - I was berated for calling out "on a weekend", demands asked as to "why/what reason" I was calling out for (None of their damn beeswax!) I politely explained that I was taking a sick day and that they had no right to ask me why. The Supervisor in a huff demanded that I present a Doctor's note for my calling out. That's the day I started looking for a new job...
  3. Karen!!! How ARE you?? 🙂 😄
  4. 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,
  5. Charger? My gaming computer decided to die on me. Right before Christmas... Best of luck to us finding our electronic needs! 😄
  6. 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!!
  7. 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...
  8. That sounds absolutely lovely Ruby Vee! Glad you had a great time! 😄
  9. Are we allowed to post pictures? HIPAA compliant ofcourse?
  10. Patient brought in by BLS. 0830 am. Sunday. Beautiful weather outside. Chief complaint? Vaginal discharge. Times 10 days. Before triaging patient to the waiting room, made the mistake of asking "why" she waited 10 days to be seen.... "Well, I would've come in sooner but my boyfriend liked the way it tasted...."
  11. Roy Fokker

    Mandated Nurse-Patient Ratios

    BINGO! Managers get a "bonus" for staying under budget. I know this because my best friend was a department director for years. (funny, all the hospitals I've worked for are non-profits. Somehow, the STAFF never got bonuses. You know, the same staff that helped you meet the goal and stay under budget?) I work in the ER. I doubt that I'll EVER see a ratio. If they ever bring one, it will be violated every single shift. Just on Thursday, I had a NSTEMI patient on a Heparin and Cardizem gtt, an unstable angina patient on a Nitro gtt, a vented septic patient on pressors, a pediatric psych patient in restraints and a hypertensive (but stable) Tele patient. We were on divert but that still didn't stop the walk ins and squads ("Central didn't tell us you were on divert!") from rolling in... What are we supposed to do? "I'm sorry but all the nurses have their maximum 4 patients. Can you circle the block a couple times and check again?" Or better yet - "forget about EMTALA, just go over to Big Competitor hospital...."
  12. Roy Fokker

    Mandated Nurse-Patient Ratios

    I do this ALL the time. Admin wants "informed" patients, well that is exactly what they're going to get!
  13. It used to annoy me as a new ED nurse (And I transitioned from Med-Surg to the ED!!!) Now it doesn't bother me as much. I say "Sorry, I don't know" and leave it at that. I do get annoyed when a NURSE or Radiology Tech etc. would call me (about an ADMITTED patient on the floor!) and ask "Why wasn't XYZ labs ordered" or "this test was ordered wrong and needs to be ordered as..." - How about you call the ruttin' ATTENDING (or the provider) who wrote that GORRAM order??!! Speaking of transitioning, when I worked nights and used to take verbal admission orders - I'd try to make sure the floor had: something for pain, something for nausea, something for constipation, something for insomnia and something for a fever - to get them through the night. I'd also try and advocate ("Yeah, 2 mg Morphine q 3 hrs isn't gonna cut it Doc. Wanna do 4 mg q 3 PRN?" Or "You ordered percocet. Can I get an order for some Zofran just in case?" etc.) When I worked Med-Surg and got admissions, I'd usually want to know: * Pertinent PMH. If they're being admitted for Sob, DO tell me about cardiovascular disease and diabetes etc. Don't really care if they had hemorrhoids or not (i can get that bit when I have to do my admission stuff anyway). * Change in status. Meaning? What did they look like when you first got them. What do they look like now. Better? Worse? More confused? What is baseline by history and what was baseline in the ED? * Any abnormal findings on assessment/radiology/labs. I'm going to review the chart and do a head-to-toe when pt. gets us here anyway. A heads up on what to watch for is always nice. * Treatments/meds administered. Allergies. That was pretty much it. I will admit that I used to think that the ED used to hold their patients until shift change too - until I started working in the ED. What I didn't realise was that on the floor, if you had a 4 patient assignment (for example) and you hit 4 patients, you were done. In the ED, you'd get a 5th or even a 6th patient in the hallway. And in some places I've worked, if you had a room assigned and admission orders in - if you were taking too long to call report and dispo the patient (goal was to have pt. dispo within 60 minutes of bed assignment) your charge nurse or assistant managers would call report and get the patient up! I'm glad you mentioned that. Because to me, your post is the essence of "When will everyone understand things are different in the ER", in my honest opinion. Well, no. A patient isn't admitted (since you mentioned reimbursement later on in your post) while in the ED. It matters so much with hospital reimbursement that nobody from risk management, QI, or administration has come down and talked to us sloppy ED nurses (in any of the EDs I've worked in over the years) about our negligent skin assessment documentation. Y'know, the same folks who are probably aware that I routinely take care of acute strokes, coding babies, MIs, abusive drunks and drug seekers, traumas and vented pts. on multiple drips etc... but won't let me sign up on the schedule to work if my yearly Glucometer competency and testing is not complete??!! cheers,
  14. Roy Fokker

    Verbal order-Denied by resident

    I got burned over a verbal order for 2 mg Morphine IVP on a stable patient. Since I was dealing with a new arrival, I asked a colleague to administer the 2mg Morphine. Nurse gives the meds and goes to sign it off in the chart. Doc, who was standing there the ENTIRE time, has not entered the order in the computer. As a consequence my colleague could not sign it off (no order!) Turned out Doc changed mind, just didn't BOTHER telling either me or my colleague. Thankfully no harm reached the patient. As a consequence, I got written up. Got called in the manager's office to explain myself. All kinds of detailed questioning and they mentioned the possibility of having to 'take it to the next level' (you know what that means!) It was HUMILIATING! And this was a Doc I'd worked with for years. All Doc had to do was clarrify the situation and that would've been that. I suspect the Doc thought it was no big deal. I have not (and WILL NOT) take verbal orders for narcs and controlled substances anymore. If I have to in an emergency, I am not leaving the Doc's side till they enter the order in the computer. And if you're a consult, FORGET IT - I'm not taking ANY verbal orders form you (narcs, meds, procedures whatever). Especially because you folks disappear at the drop of a hat (and use a different CPOE system than the ER), don't discuss crap with the ER attending and now I have to spend MY TIME chasing you down? Uh-uh. Y'all can talk it over with the ER attending and either they (OR YOU) can put the order in [consult Doc gives me verbal order for Ativan, doesn't put it in. Disappears. I ask ER Attending, who refuses to order Ativan because he doesn't think patient needs it. Good thing I double checked, yeah?] I've worked too damned hard for my license and sacrificed much to get to where I am today. cheers,
  15. Roy Fokker

    Why use compression bags when transfusing blood?

    Did not known that! Awesome!
  16. Roy Fokker

    Need the real truth. Are all EDs like this?

    You have ratios in the ER??!!! My old ER - I've had 12 hour shifts where I've had 2 patients on ventilators, a non-STEMI on a Nitro drip and 2 Tele patients and that was considered a "normal assignment." My current ER gig is pretty good - we are a level II ED with 2 trauma bays. When you're assigned a trauma bay, the expectation is that you'll have 3 patients (4-5 if you don't have critical patients). But what's really important is management - heck, just last shift I was literally 1:1 with a critical patient - for almost a good 7 hours until transfer. Charge nurse called it, management approved it - float nurses took over the rest of my assignment (which included another critical/septic patient!) We had 1 tech for 16 bed assignments. I could've been a disaster - but I work with an awesome crew! And ultimately, I think THAT is what makes or breaks a department - the folks you work with! cheers,