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There's two very important details that everyone is leaving out: 1 - The ER I'm from is divided into two areas of care. I don't know if many or most ER's are setup like ours, but we have a quickcare sectioned off from the rest of the ER. Esentially, it's a 12-bed area that's open from 0800 to 0100 and staffed by one or two mid-levels, depending on time of day, and 2-3 RN's and secretary. It's really like two ER's in one. People get infuriated when they have to wait, but quickcare CAN NOT see clients that are in need to true emergency care. If you have stable vitals and stubbed your toe and there is an open bed on quickcare, then yes...you will go back to a bed prior to the sicker patients. It was setup because people routinely have and always will use the ER as a PCP. However, it also encourages that BAD BAD behavior of skipping by the Dr. office in favor of the ER. Since it is QUICKcare, clients are really moved through there quickly. By definition, client should not require more than one resource (i.e., labs but not xray, xray but not labs, meds and neither xray or labs). People in the lobby who don't understand that get upset...understandable. Be mad at the people using the ER as a PCP...not me. 2 - it's pretty rare to hold admissions in the ER. Usually, the floors and ICU's are excellent about doing what they have to do to get clients moved. On the occassion that we do hold clients and they get nasty, I simply ask them: "what is different about being on the floor versus being here?" I explain that I am a RN, just like who would be watching over them upstairs, there is a physician here, UNlike upstairs. We will get a regular bed from upstairs to make them comfortable...any medication they need to recieve, I can give them. The ONLY thing that's different about here versus there is the setting. Different colored walls and a little less space. We can pull the curtain and turn the lights off and they can be just as comfortable in the ER as they are upstairs. Once that's explained, they usually see it my way because it's true. I don't like holding clients...it is frustrating for me, but it is more frustrating for them. Late, Trav

No worries! You're not a hypocrite. A lot of nurses have fear of going under the knife! That's perfectly normal.

I'm in triage now and this 20-ish y/o lady walks in, says "ya'ah'teh" (Navajo for hello) and shakes my hand. She lays a package of the large tissue/wrapping paper for making backgrounds on big bulletin boards down on the desk and says "this is to decorate your bulletin boards. I wanted to bring this to you and say thank you because you all have helped me so much here." I thanked her and before I could get her name, she turned around and walked out the door. It is an odd gift, but when you think about it, in a place where every hallway is lined wall-to-wall with bulletin boards and pictures and whatnot....probably one of the MOST thoughtful gifts someone could bring. Plus just the whole principle of the thought. Made my night!!

I was in a situation several years ago where I was convinced I had started an A-line on a young guy. He was ~18 y/o muscular, fit guy, in ER for intense abd pain and being a little....shall we say dramatic. Either way, tensing abd muscles, or rather tensing muscles all over. Elevated BP (2º pain or drama - I couldn't tell) and tensing all his muscles, he was able to produce a pulsating venous return. Mind you it wasn't very forceful, but it was certainly pulsating and it was certainly a vein (since I D/C'ed mine thinking I had hit artery)....another person stuck a different vein with same results. It's not something you'd routinely see, but it happens.

It's pretty unanimous nationwide that the court will require her to complete alcohol safety awareness program. That's a big part of the money-pit. I still maintain that the BON would MUCH rather make you jump through a few extra hoops so they can stick a couple hundred dollars in their pocket....

"PLENTY of nurses who DON'T choose to put their lives the lives of countless innocent individuals in harms way may be more deserving of a job than those with a history with the judicial system =( " I suppose no one on this forum has EVER picked up a cell phone while driving. Or did their makeup in the mirror going down the road (which my mom use to do ALL the time...and for all I know, still does)....or had an argument with the husband/wife or kids. Or drove while sleepy. All those things are a wanton disregard for human life on the road driving that big 2-ton missile.... On another note, I know and am friends with a man who has been a RN for ~10 yrs and has (as he told me after he was more than a little drunk) 3 or 4 convictions for assault, not one but TWO DUI's and has served some prison time for said convictions. Did he retain his license...yep. Has he ever been denied employment based on prior criminal record...nope. There are people out there FAR WORSE than the OP that maintain nursing licenses. If you can be convicted of narcotic diversion and prescription forgery AS A RN and still maintain your license, I'd say the OP's transgressions against our sensitivities here are rather slight.

Fact of the matter is, MOST sources will say 3 mL for large muscles, 2 mL for peds VL injections. But the fact of the matter is that there hasn't been much true research on what is an acceptable volume to administer IM. We give clindamycin 600mg IM frequently for dental complains in the ER. That's a 4 mL total volume...and if the person is very large and they request to, I have given 4mL injections several times. A lot of texts will say that "general consensus" is to limit volume to 3 mL in adults, 2 mL in children and if the patient is very small, 1 mL. You won't find much supportive, evidence-based practice proving or disproving that these are acceptable volumes, though.

I have been a traveler since March '11...and on one level HATE IT!! Houston, TX was SCARY because NONE of the docs there trusted any of the nurses...especially travelers. "Hey doc, this kid has a GCS of 7 after the meds you ordered....should we consider intubation because I think we might should consider it." Doc: "yeah ok....whatever you think." "Doc, this kid has a fever of 103.8, can I give him some Tylenol....say 15 mg/kg." Doc: "Well....let's do like 30....umm....45 mg/kg." SCARY!!! Here in lovely Kayenta, AZ, where the docs are 100% locums....are either 100% FOR the nurses or 100% against us. It blows my mind. Client is on LSB - log-roll client to assess spine. Client has tenderness so LSB needs to remain. Straps are D/C'ed and doc says "well, we might as well D/C the LSB without the straps on him." Me: "ok, so are you saying we should put the straps back on?" Doc: "well, the LSB won't do him any good if the straps aren't on." Me: "so are you trying to say that you want me to put the straps back on?" Doc: "he needs the LSB" me: "ok, so I guess you are saying that you want the straps on so I'll put the straps back on." PFT! PLEASE ******* The point to all of this is just saying that the hospital I came from was SO WONDERFUL and it was 100% because of the physicians. They were wonderful awesome people. They would come in and defend "my nurse" because a patient was acting out. It was AMAZING! These guys were absolutely the best doctors any nurse could ever hope to work for. After working with them a while, you could kind of gauge what kind of work-up would be ordered. They complemented us, occasionally asked for advice from us (despite them ALL being brilliant) and had respect for all of us as healthcare professionals. Their view was that "we are a team and a family and our common goal was caring for the client." I have yet to ever work with a more cohesive group of people. If we were wrong in what we did, we were respectfully informed and when we were right and worked well, we were told. "Good work guys...you all did exactly the right thing!" AMAZING physicians!! It's a very symbiotic relationship, which is not so easy to come by, as I've discovered.

If your patient was an adult, they were a WEENIE. The vastus lateralis and dorsal gluteal muscles on a normally sized adult can handle 3 mL (irritating med or not) with no trouble. If I remember correctly, 1.5 mL is max for deltoid. Peds is different. For pediatric patients, 2 mL is the max in the VL. If over age 2, then 2 mL in DG is ok, even though I never do it because I HATE giving DG injections. Don't even think about delt on little ones, unless it's a tetorifice vaccine. I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it). P.S. what med did you give??

At our facility, the big push for Magnet status has been well underway for a couple years. The dear people in HR even made a position for our "Magnet status consultant". At any rate, I feel certain that this has something to do with what our hospital calls CAP (clinical achievement program). It's just another name for the same thing. What's really astounding is that for each advance in your CAP level, your pay rate increases by $1/hr. CAP I and II are such a piece of cake. It's more along the lines of sitting down and forming a very elegant, fancy resume with some staff education and community service. You also recieve a $0.50 to $1 /hr raise for any certifications (CEN, CCRN, CRRN, etc.) With that said, the difference in pay between ADN and BSN is a massive $0.30/hr. YEAH!! Totally the hottness! LOL. Then again, greater education isn't only for financial gain - it should be more for personal satisfaction. I don't know exactly how HR correlates experience with pay rates, though. I would imagine that it's somewhere around $0.50 / yr of experience. Maybe not that much. Having been a RN for 6.5 yrs, I definitely would like to make more money. However, it would REALLY irritate me to think that I had been working as a bedside RN since dirt was invented and making the same wages as someone who was fresh out of school. I absolutely support higher pay rate for greater experience. However, I think patient outcome needs to somehow be factored into that pay rate determination. I have worked with some absolutely BRILLIANT nurses who were very, very new and who were very, very ancient. I have also worked with some of the most rigid, stubborn "seasoned" nurses who rarely had any communication between the right and left braincell and the same of many newer nurses. Late, Trav

"For ever 1meq of hydrogen loss you generate 1meq" I thought matter is neither created, nor destroyed....seeeems like I remember something about that. Give me details on this...I'm curious.

Search for "Lasix IV" and "ototoxicity".

OCNRRN63: THAT was a total waste of 30 minutes of your time. Anyone with more than two braincells would instantly look right past that useless heap of judgement calls. EricaSAFJAF: The most challenging thing (hopefully) to deal with is going to be guilt. Second to that is going to be the court system. Each state and county/jurisdiction will differ greatly in how they deal with DUI offenders. In general, you will receive the minimal punishment if your BAC was After you have satisfied all of these requirements with the court, I would check your school student handbook to see if they require you to report any criminal charges directly to them. My guess is most likely not, but you need to check for sure. As far as the state BON, check the nurse practice acts to see. Most (if not all) BON's stipulate that you notify them immediately of any criminal conviction. Usually, a letter stating the facts (this location at this time, this officer arrested me, my BAC was this, I was cooperative with officers, have no prior criminal record....grievous mistake and feel guilty...court said to do this and I have complied with all court mandates, paid fines and me and the courts are groovy with eachother). KEEP EVERY SINGLE PIECE OF PAPERWORK YOU GET THROUGHOUT THIS WHOLE ORDEAL because EVERYONE is going to want a copy of EVERYTHING. It is a headache. But having a DWI on your record does NOT make you an unsafe nurse. This may be slightly different, since you are applying for NCLEX and aren't actually licensed, yet. But I'm sure the BON wouldn't mind pocketing a couple more hundred dollars to afford you a license. Rule #1 - do not lie about anything on the application...they will know and you will be permanently denied licensure. Occasionally, they will request a face-to-face meeting with you before they grant you a license. I doubt it will come to that. Most state BON's deal with this sort of thing similarly. They will want to make sure that you are complying with the court orders and that you are...well, basically...just sorry for your actions. ABOVE ALL ELSE....never forget that you aren't driving a car. Think of it as a 2-ton weapon and thank God that you nor anyone else was injured. Mull it over in your head for a few weeks and eventually....forgive yourself. It'll be ok. Late, Trav

I had just recently left an assignment in Houston where ANY febrile child would receive a 500mg suppository in triage "per protocol"...regardless of age or weight. The physicians would routinely give orders for the same. "Give the kid some Tylenol." "How much, doc...15mg/kg." "Eh...give them 30mg/kg...actually make it 45mg/kg." "Are you sure...that seems like a massive dose for a little immature liver." "Oh it's fine...a one-time dose won't hurt them." So, I never would. They were given 15mg/kg. Haven't seen a place since then that did this. Late, Trav

In your experiences... What is acceptable practice for a one-time dosage of acetaminophen? What is acceptable practice for q4hr administration? Have you ever seen a child that received a one-time hepatotoxic dose ( What about hepatotoxic doses received over multiple doses in a 1-2 day timeframe? Late, Trav