ERNurse678

We tube report. We have computerized charting and we print a copy of the chart, tube it to the floor, give them 15 minutes and take the patient upstairs ourself. We have transporters until 3am in the morning, after that the RN has to transport. Every month each nurse gets an individual report in their box that tells us what our average admission times. The report breaks down into times for bed ready-report sent, and report sent to patient discharge and bed ready-patient discharge. We try to get our average time for bed ready-patient discharge in the 30 minute range. This past month our patient satisfactions scores dropped and the biggest complaint was the time that it took to get admitted, so that is our goal!

I can't believe that phenergan is given straight without dilution. My grandmother was in the hospital recently for a pretty bad ankle fracture and the nurse came in the room and gave her 6mg of morphine iv push, no dilution over about 2 seconds, of course the minute the nurse walked out of the room she became very nauseated and began vomiting. I walked out to the desk and requested something for her for nausea and the nurse returned with phenergan that was not diluted and went to push it straight into a heplock. I stopped her and questioned her as to whether she was going to dilute it and she looked at me like I was out of my mind. I know someone who got a PE after receiving phenergan undiluted which he developed a DVT from and eventually a PE. Dangerous drug, dilute and give slow!!!!

Very well said. I have dealt with both both RN's and Paramedics that I would not want taking care of me or my family and I have dealt with RN's and Paramedics that I would trust with my life in their hands. We need to all learn to work together and stop talking about whose job is harder. We all have a hard job and I give EMS a lot of respect, because I don't think I could do their job. And because I respect EMS, they respect me when they bring me patients in the ER. None of us are superior to one another. We all have a different job. So, EMS does a wonderful job. Keep up the good work.

I am not going to argue with you over what I am for and what I am against. No, I don't support telemetry nurses having a ratio of 1 nurse to 6-7 telemetry patients. However, in nursing school nurses are taught to be advocates for our patients, not have someone else be the advocate for us. Part of the role of nurses needs to be to take some responsibility in getting things changed that they are unhappy with. Write to legislators, be politically active in trying to get things changed. This is what I believe we can do. If you want to pay someone else to do that for you, more power to you. I believe in mandatory staffing ratios, I think they are a necessity. I just think that there is better ways to go around it. I am a nurse, one of the few that seems to have become a nurse because I do care and I do want to make a difference so why would I be "knocking nurses" as you say I am

I have recently started doing triage more often and have also noticed that I have been geting colds more often. Our triage area does not have a sink nearby to wash our hands in between each pt. We do keep antibacterial hand was up there, but personally I don't think it is the same as washing your hands with good old soap and hot water. Fortunately, they are in the process of renovating our triage and the new triage will have a sink. Maybe until then the glove and mask thing would be worth a try.

Look, I am not knocking the unions, if that is how you choose to work then that is fine. All I am saying is don't knock those who decide to actually step up and take care of the pt's when you guys walk away. I am sure that the hospitals that all of you union members work at are wonderful hospitals. Just because we don't have mandatory ratios doesn't mean that our hospitals are not wonderful hospitals. Fortunately in this country we are all able to choose which hospital and which state we work in. Lets all just leave it at that.

We do rectal temps on all pt's under the age of 3. This is the most accurate way. And it does matter whether their temp is 101 or 106. As for our ER we have different protocols for tylenol and motrin depending on the fever. Also, if a child has a temp of 106 and I am the triage nurse, they are going to the critical care area versus the intermediate area

For our ED that depends on how bad the patient is. We don't admit all of our RSV patients.

Well I live in south carolina where no nursing unions exist. We only have 9 BSN programs in the state and 13 ADN programs, all of which have waiting lists. I was one of 30 people admitted to the BSN program at my college in 1999. We do not have mandatory staffing rations and our nurses per capita is 70 per 1000 and the national average is 78 per 1000. So the staffing ratio and the waiting list for entrance into programs is not a factor here. Yes, we are below the national average for nurses per capita but not 30% below. I am not saying that CA is a bad place to work I am just saying that everyone who thinks that unions are good, need to look at these statistics.

I work 3 12 hour shifts. Work the same days every two weeks. Everyone has a set schedule. I love it. I know what I am working 2 years from now. Most of us do every other weekend. There are a few schedules with no weekends, but they are not really popular due to the great shift/weekend differential we get. This works great for planning vacations and time off

You know what I find interesting? If CA is such a great place to work because of the unions why is their nursing shortage worse than everywhere else? CA has 30% fewer nurses per capita than the national average. Something to think about for everyone that is so much "for unions"

How about this one. Had a cardiac arrest the other night. Pt. was DOA, we pronounced it upon her arrival. The ER doc and I walked over to the family room where there is 50 family members. The doctor gives the news and then quietly exits the room as I am left to try and calm the family and support them however I can. Now, also let me mention that due to renovations in our ER the family room that we were in is not actually in the ER, you have to walk down the hallway away from the ER to get to it. So I am in the room with the 50 family members crammed into this little family room and the daughter "passes out" So I am trying to get her out of the middle of the floor and put a cool cloth on her head when the next thing I know the son is having a seizure. So here I am by myself climbing over the "passed out" daughter to get to the son who is having a seizure and whose airway is becoming non patent very quickly from all of the secretions. Would have to say that was my least favorite in a long time. Needless to say after getting him stable for a second I ran to the phone, called the ER told them to send me another nurse and a stretcher. The other nurse and I lifted this 230 lb man off the floor and onto a stretcher. He then starts seizing again. We run back over to the ER, get a line give him some ativan and eventually find out that he is supposed to be taking dilantin but hasn't taken it in months. Dilantin level is next to nothing. Sad to say, this was only in the first couple hours of my shift, any guesses on how the rest of the night went.

I agree. Our cafeteria just started opening from 1am-3am and you would think that we were getting served a gourmet meal. We were so excited. We don't get food brought to us on night shift. So, before the cafeteria opened we either brought something from home or the vending machine was our best friend

Well said!! Not to mention the fact that these drug seekers end up getting addicted to these drugs and then come in in a coma like my pt. the other day who was a 24 year old who apparently had been given fentanyl patches by his pain management doc and is now a vegetable for the rest of his life becuase he put several fentanyl patches on, had periods of apnea which led to hypoxia. He will now be unable to function on his own for the rest of his life, not to mention that he does not have insurance so you and I are paying for it. Now, please don't take this the wrong way because I feel like he definitely needs medical care, however this all could have been avoided by someone not supporting his drug seeking habits!!

Ok, sorry if everyone misunderstood my post. There was some parts of the story that were left out. First of all, pt. had "just moved to area" but had had several previous visits to our ED. Second of all, the minute that I walked in the door to assess him before I could even find out what was wrong with him he said "Let me tell you the only thing that works for my pain is Dilaudid" Third of all, I understand that he had a chronic back problem, however what he doesn't understand is the role of the ER. We gave him a shot of toradol and gave him several prescriptions to get filled. He was driving home, so he wasn't going to get a shot of dilaudid. Toradol is about the strongest thing he was going to get due to him driving. We gave him several prescriptions to get filled and see if those helped his pain. If they didn't then he was welcome to return or get a second opinion. No, I am not happy and I am not sitting around laughing when someone leaves with pain. We took x-rays to see if there was any emergencies. Also, and maybe I am wrong here but if I had a chronic back problem and I was on prescription medication for it and I was moving then I would be sure to get things in order before I left. Since he didn't, we gave him some prescriptions to tie him over however the doctor did not feel comfortable giving him narcotics. So, I am sorry if I came off as a mean cold hearted nurse, because believe me I am about as far from that as you can get. Hope everyone understands a little bit better.

Well, just remember that you do know this stuff, if you didn't you wouldn't have passed boards. Try and relax and take some deep breaths before your first shift starts. Don't be afraid to ask questions. There is no such thing as a stupid question. The most important piece of advice I think I could give you is "GO WITH YOUR INSTINCT" If you feel like something is wrong with a pt, chances are you are probably on the right track. Get a good preceptor. If you end up not liking your preceptor, go to your nurse educator or nurse manager and let them know that you want to change, because your orientation period is so critical! Good Luck and you will do great!!!!

Toradol is a wonderful drug. We use it for kidney stones, pulled muscles, back injuries and often times headaches. It is an antiinflammatory pain medicine and that is why it works wonders with kidney stones. I have given kidney stones 10mg of morphine IV with no relief and you give them 30mg of toradol IV and they are pain free. A lot of our doctors do give that as a first try, however a lot of drug seekers have realized this and are now conveniently "allergic" to Toradol. Long term toradol everyday can cause some problems, if I remember correctly it could cause GI bleeds however this is when you take it everyday, because it does come in PO form as well. Hope that helped explain the mystery of it....:)

Sounds like there is some serious problems with the unit you are working on. First off, the fact that new employees, especially new grads are only getting 3 days of orientation??? In my ER we get 12 weeks of orientation. How do you guys justify to JCAHO that your nurses are trained to do the job? We are required to have paperwork on file for every employee showing what they did on orientation and the classes and training that they have been provdided. Granted, the ED I work in is a good bit larger than yours but I feel like the nurses still need the orientation that we get. I would move on if I were you, your license is on the line. Congrats on going back for your RN!!!!

Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!

Our hospital has a rule that requires nurses to transport if they are on one of those critical drips. Also our hospital requires that if an order is written "Stat" or "Now" then the ER has to get it done before transporting the pt. to the floor. That seems to help the floor out. At one point there were nurses that were allowing pt's to be transported to CT, X-ray or the floor while on critical drips and they then developed the policy with a list of drips where a nurse must escort. Makes sense to me. I would think that all nurses would realize the potential complications of these medicines, but unfortunately they don't all think like that..:)

We don't get a differential for ER. I don't think anyone in our hospital does. As far as they see it an RN is an RN no matter what area or whether you are an ADN or BSN. We do have good shift differentials though. We get 3.00 for nights during the week, and 6.00 for weekend days and 9.00 for weekend nights. Night shift also gets a 1500.00 bonus every 6 months

I am sorry if you took my comment offensively. As I said earlier, I completely understand that the telemetry and med surge nurses have a hard job, one that I wouldn't want. The only point I was making was that when you said how would we feel if we had to walk out on to the floor to that, we do walk on to the floor to that everyday. I agree that we have more of the resources available to deal with those emergencies and that does make it somewhat easier, if that is possible, to deal with. I respect all nurses, no matter what area they work in because nursing itself is a hard job. I love my job, and I am sure you love ours and that is why nursing is such a great job because there is so many areas one can work in if they don't like the other. Again, sorry if you took it offensively.

Well I am sure nurses on the floor are busy, however in reference to the qoute of "How would you ER nurses feel if you had all that to deal with as soon as you walked in the door?" Well let me ask a return question. How would you feel if you walked in to work and had to take report on 4 pt's of which one is on the ventilator after a cardiac arrest, one is a CVA who continues to be unresponsive, one is in respiratory arrest and is about to be intubated and a traumatic arrest is 2 minutes out? That is what we walk in the door to.

Our nurse-pt. ratio depends on which area we are in. We have fast track, critical care and intermediate. Fast track is 4pts per nurse, Critical Care is normally 3-5 pt's per nurse and Intermediate can be anywhere from 5-7 pts per nurse