Skylar86

Hey everyone, I work in a busy emergency department. Over the past few months we've been short staffed and over capacity (almost daily). Anyways, I felt unwell with niggling abdominal pain when I woke up this morning but not to the point where I felt I should call in sick (i cant remember the last time i called in sick). About 3 hours into my shift the pain gradually become worse... then severe along with nausea. I took some meds thinking it was gastritis and would settle but it did not. I was in the middle of doing an assessment and had to excuse myself. I went straight to my charge nurse and asked to go home. I was literally in tears and guarding my abdo. Without any change of expression my charge nurse looked at our roster and bluntly said, "we have no one to cover you, unfortunately you're going to have to stay until the end of your shift because its not fair on the rest of the team". Talk about a guilt trip. I felt quite shocked and helpless. I then became stressed and anxious thinking to myself.. how the hell am I am meant to work when I can hardly walk due to the pain. I walked away from my charge nurse (very gingerly) to compose myself and prep myself to go back and finish the assessment. It wasn't until a co-worker asked if I was okay that I burst into tears. My co-worker ended up bringing me into a side room, triaging me and telling our charge nurse that I wasn't able to work. I did not want to be triaged (i have never been a patient in hospital ever before). I felt i could go home,take some good analgesia in fetal position and ride it out until i was able to see my own doctor but I felt I had no choice since i was being made to stay and work. I ended up getting a full work up including IV morphine to settle the pain. I am seeking advice. Do I e-mail the charge nurse manager to express my disappointment with the staffing levels and how that charge nurse handled the situation? I loathe confrontation and I'm not comfortable approaching that particular charge nurse one on one. Or do I need to understand from that charge nurses side... being under pressure with short staff? I sometimes over analyse situations and wonder if it could have been a personal issue with me (I recently reduced my hours to part-time because I got a new job on the side). Lastly, that particular charge nurse is responsible for the roster and has been very flexible with my hours surrounding my new side job and I would hate to cause a stir since she's the one who approves the shift swaps. She's been very good to me with giving me the shifts/hours I want.

I suppose I should have used a different title for this thread. Unnecessary is more the word I was looking for rather than invasive. I realise nothing is going to be distressing for someone who already has a gcs of 3 however the time it would take to put in the IDUC for the patient is time taken away from the family to have with their loved one. Just like the 15min it took for the patient to have the CT. Imagine she had died in the CT room without the family there? I just found it all upsetting.

Hey team, I'm a fairly new nurse who works in a busy adult emerg dept. A few days ago i was working in the acute area (ratio of 1:6). During my shift I had a patient (80F, multiple comorbidities) be transferred from resus to one of my side rooms. She came to ED from a rest home with decreased LOC, GCS 3 on arrival. After assessment from the ED consultant everyone including the family were happy for the DNR decision. The plan was we would be just be providing comfort cares and transfer her to the medical ward once a bed was available. Once she came into my side room it was obvious she didn't have much time left. GCS still 3, HR 120, RR 40- agonal breathing, pale, dry.. etc. The entire family was present.. everyone was saying their final goodbyes. Then comes in the medical registrar. He finds out that theres been a history of abuse from the husband (who doesn't live with the patient and isn't allowed to be alone with her and there hasn't been ANY recent documented abuse). He decides he wants a diagnosis as to why she is dying otherwise he's going to make it a coroners case. He then orders IVABS, a CT head, wants me to go and get OBS and even asks for an in/out IDUC for a urine spec!!! I felt extremely uncomfortable with those orders. The IVABS (although i felt it was pointless I still did it since i could sneak in behind the family and not be in the way) but thought of an invasive procedure (catheter) while this woman is minutes from dying made me SO upset that I literally went completely red, filled up with tears and couldn't speak as i felt i would burst out crying. He then went to my charge nurse and yelled ''i would appreciate if your nurses didn't give me negative attitude whenever I make a decision' (apparently i rolled my eyes as well). My charge nurse could tell by my obvious body language that I was upset so she sent me off the floor to take a few minutes. I left the floor for about 10min to gather myself and get some fresh air. When I came back our transport nurse had taken the patient to CT (NAD found). As soon as they moved her back into the room the patient died. She just got back in time for the family to be with her as she passed. My question is. If she hadn't died.. would I of had to kick the family out to put in an in/out catheter no matter how uncomfortable I was doing that? What would I have done if she had died while I was trying to put a catheter in? Should i be disappointed with myself in how I dealt with this situation (i.e unable to articulate myself when trying to be an advocate for my pt). Was it unprofessional of me to get so emotional and show my personal views?

I am a New Zealand trained RN and have been working in emerg for 3 years. I am currently going through the NNAS process to be eligible to write the NCLEX and have been using Uworld as my study guide. I am hoping to move to Saskatchewan, Canada and work in emerg. So far i haven't been doing great on the practice tests (i have only just started studying) I am wondering how much of the exam will be asking about blood values. This is something that we were never taught in nursing school (i've more just been learning on the job) but its not something we've been required to interpret. Do you recommend I learn all I can about every single blood value in order to pass the NCLEX?

im not sure what your policy includes but in the emergency department that i work at we have ''standing orders''. We can give paracetamol (tylenol), oxygen and normal saline without it being charted... we just need to get it charted/signed at some stage.

wow... skirts/stockings? i cant imagine!!! all of the nurses wear light colored blue scrubs and the doctors wear navy blue scrubs. We have our own change room and are actually not allowed to wear our scrubs out of the department. We are also not allowed to bring them home to wash (infection control). I absolutely love it that way.. it means i never have to do washing!! There's been a few occasions where I've been contaminated with body fluids and have had to change into a new set of scrubs at work... (the odd occasion i've had to have a full shower!) im curious. what do you do if you get dirty at work (i.e blood/vomit?) are there spare shirts/stockings around??

on days off when someone asks you what time it is and instead of looking at your wrist you look at your chest/hip for your fob watch...

you realize that as a patient you have the right to refuse right? why didnt you refuse the ms?

if the OP is a student.....that explains everything!

13y/o boy placed 30 little magnetic balls into his urethra. he was able to pee ("shoot") the first one out and thought that by putting in more he could make his member into a machine gun? Ended up having to tell his mum when he was only able to urinate drops of blood...

Hi everyone. On my last shift I came across an interesting situation. I had a 67y/o man come in with chest pain who spoke very little English (I can't remember exactly where he was from). Long story short, it was very difficult to obtain consent from him to obtain blood. I completely understand the religion in relation to refusing blood transfusions but I've never came across a Jehovahs witness who didn't want to give blood for a test? He eventually agreed when I explained that I would be only taking a small amount and that it was to help us help his chest pain.... I'm just wondering if anyone has had a similar experience?

oh forgot to mention! I work in a university/student town.... the amount of students we get during exam week is really ridiculous. They come in the morning before their exam with ''abdo pain'' and want to leave almost right after being asessed... but NOT WITHOUT a sick note!

the patients that come in because they forgot to fill their prescription at their GP and its now the weekend... the patients that have had a cough/leg pain/sore whatever for MONTHS and decide that TODAY IS THE DAY that they will come to the emergency department and not bother to see their local GP (in saying that yes i know that there are plenty of people who don't have their own doctors but still) rich ''important'' patients who want a private room, and don't understand why they have to wait.

I am a new grad (also graduated december 2011) and got a job right away in the ER. If we didn't have enough in common.... i only had 6 weeks orientation as well! I was nervous at first.. i thought maybe I would need a longer orientation... but to be honest you learn a LOT in those 6 weeks... by the last week you should be taking your own patient load with your preceptor doing nothing but being there if you absolutely need him/her. I was ready to be on my own at the end of the 6 weeks. I am now in week 3 of being on my own and everyone is EXTREMELY supportive and helpful.... so its not like that extra support just stops at the end of the 6 weeks. You definitely work harder once you're on your own but time flys and i absolutely love it! My advice to you is to make the most out of your orientation. ASK QUESTIONS. Think of scenarios in your head "what would I do if this happened?" remember where things are... if you see another nurse doing something that you haven't done before.. go watch and see how its done... offer to help. If you ever get down time do a round and ask every single nurse if they need a hand with anything. good luck!

I am a newgrad nurse. I've been working in a busy ED for two months now and absolutely love it and I couldn't be happier. Unfortunately this morning I came across a ''situation'' and am not sure if I dealt with it in the right way. This morning I started my shift at 7am. The nurse who I was meant to receive a handover from for 3 patients had went home 10 minutes early (so i ended up getting the handover from another night nurse that only briefly looked after these patients). One of the patients presented at 0230 that morning with severe abdominal pain. From his arrival time up until 0640 he received 15mg morphine IV, 100mg Norflex PO and 50mg oxycontin PO. I noticed that the ONLY set of V/S that the nurse documented was the baseline at 0230 . The nurse also failed to put a name bracelet on the patient, didn't provide the patient with a gown-- nothing was organized. To top it off, the paperwork (assessment sheet) was only 1/2 filled out. I had a look at the patient list for the night to see if it was insanely busy but it wasn't. This particular nurse is a lovely, kind, funny nurse however he is also notorious for being very slack/lazy. I know this because he was my preceptor when I was a student nurse. I ended up going to the ACN to express my concern and show her the lack of documentation. She instructed me to write a note and document exactly what happened and that she would raise the issue with the RN. I did what she said and luckily I didn't have to sign my name at the end. Did I do the right thing? I felt maybe I should have raised this issue with the RN and let him know directly my concerns rather than going straight to management.... but this isn't the first time this RN has done this so maybe not? Could I have just ignored it... would any of you just ignored it and moved on? I also hate to be a complainer since I am still extremely new. I wrote in the ''note'' that i felt the patients safety was comprimised. Do you think that was okay to write? Any advice or tips on how to deal with this situation if it ever arises again would be greatly appreciated. Thank you!

ha.. last week had a 12y/o boy put 30 little magnetic metal balls into his urethra. I'm not certain but I personally think that he maybe thought that when he peed they would shoot out like bullets? The poor fella was so embarassed... mum thought it was amusing..

Just curious to know if anyone has ever catched anything (i.e. scabies, flu, HIV etc) from their patients?

New Zealand RN- New grad $21.67/hr $45,00 something salary and the cost of living is extremely high nurses make a bit more in aussie which is why a lot of NZ nurses go over there.

Answer: Absolutely! I am a newgrad and this is my 5th week (i get 6 weeks orientation and can request more if i need it). I hear so many nurses on here saying how important it is to get a background in med/surg before coming into ED. I think it is important (any experience is good!) the only med/surg experience I had was about 10 weeks in nursing school (it was good-- but not my passion). Having said that...I received my PCP (emt) certificate in Canada ( the only experience i had doing that was as a student-- there weren't any jobs.. hence my reasoning for going into nursing) which certainly helped! I also did a 5 week placement as a student in my 3rd year in ED which DEFINITELY helped! I recommend doing something where you can get exposure/understanding of how the ED works. It's hard work, fast-paced, very stressfull at times but I absolutely LOVE the challenge it gives me and I can't ever imagine going to a ward. I plan on specializing in the field of emergency nursing!

first year nursing student... extremely nervous as it was my first day on clinical.. first time alone with a doctor and a patient (i was to just observe and get V/S once he finished his assessment) i felt like i should be doing something so as he was asking her questions I proceeded to get a blood pressure... he then lifts his hand high in the air so my fist reaction was to give him a HIGH FIVE. Little did i know that he was actually telling me to STOP... not telling me I had done a good job (perhaps i was distracting him?). awkward doesnt even cover it... he didnt have much of a sense of humor either so he just looked at me with a strange look on his face..

I am a newgrad working in the ED (in my 3rd week). I have had previous experience as an EMT and also did a placement in ED as a 3rd year nursing student so I feel as if I am really getting the hang of things. Last night we were extremely busy. My preceptor (i am in orientation for 6 weeks with her) was getting slammed at triage so the charge nurse asked me if I felt comfortable enough looking after 2 patients on my own. At this point I was feeling confident so I said yes, afterall how hard could two status 3/4 patients be? Patient 1 (Suzy*)had a fractured hip and was awaiting a femoral nerve block before being transferred to the ortho ward... Patient 2 (Barb*) JUST arrived and was c/o L) leg pain/numbness/tingling (has had it for 3ish weeks) and all i had to do was just work her up (bloods/ECG/OBS/ etc..) Just as I was starting to get a history from Barb, the other patient Suzy called me over saying she BADLY needed to go to the bathroom. I asked another nurse for help to put a bedpan underneath her but the pain was too much for Suzy... i then decided to give her PRN morphine and attempt to catheterise her. It was difficult since she couldnt open her legs but I tried anyways.. no luck.. the other RN tried 3 times after me with no luck. It was a horrible experience and I felt awful for Suzy... I am surprised she was able to hold her bladder for that long to be honest. I was getting a bit overwhelmed with how uncomfortable Suzy was and to make matters worse, one of the doctors called me over saying he needed Barb transferred immediately to get an MRI. Luckily the nurse who was helping me with the catheter told me to just finish what I was doing with Barb and that she would take over Suzy. I am wondering what would I have done if i didnt receive help from that other nurse? Would i keep trying to catheterise her until i got it? Would i have just stuck a incont pad under her and told her to just go? I would normally reflect on this situation with my preceptor but we were too busy last night so I thought i'd get some other opinions on here.

it's interesting... when i was an EMT in Canada (before becoming an RN) most of the nurses had a stethescope but here in New Zealand i NEVER see any nurses (not even in respiratory units) carrying them! but in answer to your question... chapstick, red/blue pen, mint gum, fobwatch, notepad, eftpos card

i have 6 weeks working with my preceptor (looking after patient loads together) then i am let loose.. if i feel i need more time with my preceptor then i am able to get it... 18 weeks sounds a bit long to be honest.

i couldnt agree with you more!! i am a new grad in the ED (i am just in my 3rd week now) Luckily the newgrad program that I am on allows me to have 6 weeks orientation with a preceptor (an amazing nurse-- i am very lucky!) so i am not completely thrown into the deep end on my own... i recommend finding out how long of an orientation you get because i really think it is crucial. I am slowly learning how to handle 2-5 patient loads. All of the staff have been welcoming and extremely supportive given the chaotic (organized) environment! I have had previous experience as an EMT which was a HUGE help. My advice to you as a student is don't just stand and observe thinking that you will do it next time... just get into it!! Ask to do things.. ask other staff if they need help (if you have time to spare of course)

The good news is that I just recently graduated from nursing school last month and received a full time position in the emergency department (my passion). My preceptor is amazing and I am going to be buddied with her for 6 weeks (or longer if i feel i need the extra support). The only issue is that she seems to be put on more nights (11pm-7am) than the other staff (her request). Unfortunately I have had major issues with sleeping in the past (to the point where i had a dependency on zoplicone for 4ish months and had to be weened off it with an anti-depressant). I havent had ANY sleeping issues for a long time now but am a wee bit worried that the nights are going to disrupt my sleeping again. I find it EXTREMELY difficult sleeping in the day... i can't even nap when i am exhausted. I know what you're probably all thinking... why the hell am I in the ED in the first place? I TRULY love it.... everything about it.. i actually look forward to going to work (haha yes i'm very new!) So my question is... do you think I should ask the charge nurse (the one who does the rosters) to maybe put me on less nights (maybe i can be paired with another preceptor to do days?) or should I just suck it up and deal with being sleep deprived and ask again when I've put more time in? My other concern is that I am a fitness freak.. I am wanting to run a marathon in a few months and really don't know how to manage training and nights... any advice would be greatly appreciated!