sirendip

Jackstem-compelling post from Oct 31,2011. I'm been in recovery for years. Never required to. Voluntarily placed myself in IOP before I got "caught". Your right. I will never disclose to co-workers that I am in recovery. I feel like Dexter with my "dark passenger". I wish I could be more proactive about educating others about the disease but I am stifled by my desire for confidentiality. The stigma is to great. But it's great to find this place and read these post from others like myself.

I agree with the de-escelating thing being learned. there is no one answer for all situations. In our ER we have a no tolerance for rude and belligerent behavior and foul language. It's posted on the wall. So Security always backs us up when some gets really mouthy. I've learned that I don't have to tolerate verbal abuse and I don't. But there are definitely situations that call for special handling and that is where the experience comes in. Somebody coming down off PCP ain't listening to anything you have to say, but an upset husband might. Live and learn. Thick skin comes with confidence and faith in yourself.

I Feel inspired by your post with some new weapons in my orificenal!!!!!!

Yeah you hit the nail on the head. The problems in our healthcare system have forced the ER to be the Gateway of care for poor and indigent at all levels. Even more so now that unemployment as skyrocketed making keeping affordable healthcare out of people's reach. We have a fast track that helps lessen over crowding in the inner city er where I work. I know we have a problem with payor mix where I work. I also think we do have to think out of the box to fix this problem. As long as the screening exams are performed with accuracy, I don't see most providers being vulnerable to litigation. (Anymore than we already are!!!!)

what I usually do if I'm not totally slammed to prepare for the change of shift is to make sure pts are d/c or moved to the floor if ready, pts in holding pattern are up to date with vital signs, meds, labs,,etc and any pt arrivals in the last 30 minutes who are stable into my section I will start their tasks etc. That stuff is the easiest to turf to the next nurse because personally, I'd rather start with a new slate of patients than finish up old because I can get to know the whole case from the beginning. Most nurses seem to be agreeable to that. Although u will find some are never satisfied. It takes a while to hit your stride with all the shifting priorities in the ER. Naturally, the emergent stuff trumps everything!

If I had a dollar for everytime a DNR/DNI pt was resuscitated in our Er... My initial impression is that it has to do with family concern and misinformation. What sometimes upsets me is how overzealously we try to fix them before making every reasonable attempt to communicate with the pt and or family about the patients wishes. There is a doctor I work with who is very persistent about getting this information and I appreciate that so much when he is there.

Stargazer- I know where your coming from! I too am stuck in a ER job in a high intensity inner city trauma center. Jumping ship is not much of an option for me. I'm 50+ and have tried alot of the fields out there. My financial situation is dismal. I am the breadwinner in the family. I've been burnt for quite a while. I've been waiting for the time when my financial situation improves to just cut back on my hours. I have to say that it is such a disappointment to me that skilled clinicians such as ourselves have to make such choices. Our employers our obviously not taking care of us. We hear these stories time and time again. No rest for the weary. I love ER nursing, I can deal with all of it, but not without support from administration, access to breaks, ability to use vacation time, cooperative support staff etc etc etc.... All the other posters are right, we must take care of ourselves no matter what. What i'm about to do is cut back my hours to 3 12's per week even though it's a financial hit. I'm also transferring to a smaller satellite er associated with the hospital that is much kinder and gentler. I know from past experience that if I don't take care of myself now, my body will find a way to stop me in my tracks later. I'm also on here reading what my colleagues are talking about. Knowing I'm not in it by myself helps. Just gotta keep the good fight going for me and my family and the patients that I care for!!!!

Hi, try to get a job as a tech in the er even just for a couple of months, or an internship. that's the best way to get an idea first hand of what you'll need. The best prepared nurses for working in the high paced, high pressure environment of an ER are those that have worked as techs in my experience. As a new nurse, you have so much to take in and so much to remember it can be overwhelming. Just getting a taste without the responsibility can be very helpful. Good Luck with your career. Karen