errn7

So many to choose from..kinda like "dumb crook news" Anyways one was a guy who was out mowing his yard he and disconnected the kill switch on his seat ended rolling his John Deere and trying to jump but jumped the wrong way ended up landing on the upturned mower deck with the blade taking a swipe through his left butt cheek. The laceration was big and deep enough for the MD's closed fist......nothing critical but meat involved. A local pastor who lived close to the river kept a 22 cal. derringer in his pocket to kill the water snakes that would wander up into his yard and carport. He came home and found one and reached into his pocket as he was pulling it out it discharged shooting him in the leg. By the time he got to the ER his thigh was huge and blue he was taken right to the OR ...sadly he bled out on the OR table.

My own thoughts.....This has been debated and will continue to be for ever....When the govt became more involved with health care they pushed it over the edge and now its a runaway train headed down the mountain without brakes..There was a time when if u had a PMD you could call up in the am and usually get in sometime that afternoon...now that Uncle Sam had decided that the PMD's can only get paid a set amount for said treatment our local Family Practice MD's now have to increase their pt load to make up the difference thus eliminating those "open spots" for call ins. When you call hoping to get in you get a message..."if its an emergency go to your local ER"...So those that do have a PMD cant get in to see them for something unplanned...That doesnt include those that have repeatedly been given "DR's List" and encouraged for the 100th time to find a PMD for their chronic back pain..or a dentist for that single rotten tooth in their head...All of that is a BIG problem..another problem for us is the "DUMPING" of LTC pts for this reason or that reason...the most recent one..Pts running a fever.....reported by EMS that according to LTC staff said pts temp upon EMS arrival was 97.6F. So because LTC had reported it as a fever the ER work up had to be for fever...labs...u/a...cxr...dispositing diag...NOTHING Wrong with pt...Then to the other extreme..pt comes in from LTC uros septic because they have been sick for days with fever and no one pursued the obvious... With the advent of the precious P/G survey everyone is affraid to say what they really need to in order to get some people's attention but something has to be done to restore some order and sense to Emergency Medicine. Dont know if I will see it but I hope it comes to pass... BTW...10yrs ER exp..and counting...Burnout...lol my flame was blown out along time ago..and not planning on refiring anytime soon...

Just another attempt to control healthcare via the long arm of Uncle Sam. No matter what industry you are in when you involve "consultants" its always just a money drain so that the powers to be cant pass on a raise to their employees. Our merit raises are tied into PG"FOS" scores. We havent gotten them in two years. Imagine that !!!!!!

Well if you travel on down I-81 to the Abingdon/Bristol Area you have a variety of choices in all of the fields you mentioned. Plus the quaint town of Damascus VA which host "Trail Days" each year is only about 20/30 mins from the Tri-Cities. There is also the "Va Creeper Trail" which is a 30 mile trail from Abingdon to the White Top Mt.(NC/Va border)

Not to take away from the problem with your co-worker....but Where is this ER thats not busy....I would like to find it. It has been so busy at the one I work in its getting way past ridiculous....

Cant remember if I posted this or not...but working in ther ERRRR you tend to see stupid people doing stupid things on a regular basis. I have worked there long enough to know that most of the population is as GUMP would say "stupid is as stupid does" (1) This happen several years back...First of Dec and this middle age gentleman was trying to hang his Christmas lights in the dark and stepped off the roof of his house.... (2) A multitude of "toy" stories both young and old....male and female, regular "adult" toys and those that could be used as such. (3) A more recent story a sunny warm Oct a husband and wife were out horse back riding. When they stopped to open the gate the man went to open the gate while the wife stood and held both horses. The husband's horse turned his head and bit the wife in the breast area. When she got to the ER and we took her bra off...her nipple was lying in the cup....OUCH. The Plastic guy re-attached it and sent her home. (4) Boyfriend/Girlfriend were together for the night. sometime during the night the GF preformed certain "oral favors" on her boyfriend......however, the ball came off her tongue ring and boyfriend had a laceration to his male member that required suturing.....OUCH.....

In the local ER I have worked for the past 10yrs. We have 13 beds we have 5 nurses from 11/11 plus 1 triage. We have 3 rooms each with the charge nurse taking the Code room. We see 36K and usually stay full most of the time. The traige nurse most of the time will rotate until we are full and then its whoever has an open bed. When we get full and an ambulance comes in then we use hall beds. Usually whoever is free will take care of the hall pts....Most of the time we all work together if something needs to be done regardless of whose room it is...

About 75% of the public that enter the doors on any given day would fall into the category of "pet peeves". One of the biggest that seems to be growing larger is Doctor's offices telling their own pts that they wont be able to see them until two weeks from this coming Thursday..."if its an emergency, please hang up and call 911" thus planting the seeds of going on to the ER for whatever the need. This just happened last Tues. night....LCF sent in a pt at 11pm who the night med tech said..." he wont stay awake"...Pt was sitting in the day room asleep when transport arrived...Pt aroused to verbal command and got up and got onto cot...Pt was transported to ER with the above C/O from the LCF's astute med tech.....upon arrival Pt moved from stretcher to ER bed. After triage and going through his med list it was noted he had been given Ambien 10mg at 9:30pm also Seroquel 100mg at 8:00pm..wonder why he wouldnt "stay awake".......The biggest waste of tax payer $$ of the day, and the most ridiculous reason to have a resident of a LCF sent to the ER.

Just some food for thought....from a different view. A few years ago the regional hospital added a telephone triage or "ask a nurse"...It was staffed with exp. RN's and they had alot of takers due to the fact of the ever dreaded "burnout". Those positions lasted until the first fiscal budget deficiet......guess what was the first to get cut...? So now those RN's had a choice to make and most couldnt get back to their old units so they had to take was available or leave. It sounds like a good job but when the budget knifes start slicing those are usually the first to go.

ER nurse for over 9 1/2 years.....at the beginning of each shift its : Carpujet Sm sissors Red and Black Pen Critical Care/EMS Field Guide And $1.00 and some change in hip pocket.... There isnt a need to carry all that "stuff" when its located in the rooms and or the med room.

After the 6th drug seeking piece of human feces who claims to be allergic to "Toradol, Ultram, Codeine, and NSAIDS...And the 10th curtain climbing rug rat with a runny nose and "temp" of 98.3F with onset of 2.5 hours ago.....You want to scream "are you all completely ignorant or were you born that way"...Then you realize that the gene pool was closed for cleaning that day and these are the ones overcome by the clean smell of chlorine....I need a vacation...QUICK

Nine years ago this month, I sat down in front of the computer scared to death. My lively hood basically hung on the test I was about to take. I had heard rumors and tales of this and that....My computer shut off after 76 questions and I like you just knew that I had failed...However, three days later, all that work and sacrifice was rewared. You either missed all 75 questions or you got enough of them right to pass. Its a big mind game but I havent heard of anyone that only had 75 questions failed. Usually they get all 265+....questions. Dont get too out of shape...I bet u passed with flying colors......

I just wonder, how far this will go before it truly ends. Even when teri is gone, because of all this uproar and ignorance, there will be ultimately, changes made by our gov't officals to try and pry there way further into our private lives. The sad part of all this is...how many people in our hospitals where we work each day or even each hour are removed from life supporting medical devices, that prolong their lives. Wonder why you dont hear a thing about those people. They are humans just like teri. Just think of all the time and money that has spent spent by all these people and what it could have done if used wisely instead of trying to bring about one person's selfish wishes over another's. All that money spent on both the federal and state level's might have made a difference in helping to find a cure for spinal and head injury pts..........JMHO

In our little small town community ER we draw from 5 counties and two states. We have 13 beds and 2 MD's from 11/11p. Depending on the combination of MD's and day of the week our times can be from 20 mins or so to lately 4 hours. Use to we would always "bed" ambulance pts but lately if they are ambulatory they go through triage and wait their turn. Use to "back in the day" there was immediate attention for anyone that came through the door. Now d/t PMD's not wanting to see their pts or take new ones. We get slammed on a daily basis....and then you have into account those that swim in the shallow end of the gene pool as their numbers continue to increase.

WOW assigned holidays.....and every third weekend....what a dream. My local hospital is small compared to the ones above. We see 35/40k per year in a 13 bed ER. We have 4 7/7p nurses 2 11/11p nurses and 3 7/7a nurses with one clerk and sometimes a 7/3a nurse......We work 80hrs in two weeks, every other weekend off.. If a holiday hits on your day off...your lucky if not your in hades because all of the MD's offices are closed for at least 3 days by now and the ER is packed. Every ones schedule is the same in that you know for the most part which days you are off and which days you work from month to month and you can plan accordingly...I worked for a place that did self scheduling and it was difficult to get into a regular days on/off schedule.

This happened this week actually. A resident from one of the numerous local group homes came in to the ER via paided ambulance service for abdominal pain ie. constipation. Sending him thru triage in the front d/t a full ER and approx 1 1- 1/2 hour wait time. Upon arrival to the back and after the MD eval xrays were ordered and completed. Diag. "full blown" Constipation... When my fellow ER RN went in with the 3H's enema the pt promptly told the nurse I am allergic to soap suds......Ahhhhh so thats what the smell is .....The MD after regaining his composure walked into the room and came out and ordered glycerin supp. x2. Upon return back to the room with the butt rockets in hand the pts jumped up and said I think I can go now.....and ran to the bathroom where he preceeded to fume-a-gate the whole ER.....After the usual laughing and gagging we had a new saying......" T, u literally scared the s#*t out of him"......Our tax dollars at work.....

** wonders what it would be like to see only 20pts aday.....** I work in a local community ER with 13beds and annual average 36/38K pts seen. We have had LPN's on and off through out my 9yrs there. Up until the last few years it wasnt a big deal they worked side by side doing anything that needed to be done. Now, however, for whatever reason, if you are an LPN you must be in school for your RN degree and you have limitations as to triage and some IV push medications.... My personal opinion is that if you can do the job and work together then I dont see a problem. Most LPN's I have worked with have been great team players....

My only r/t exp with Go GO juice was when I was a newbie on the ortho floor and we had a male pt s/p ORIF of hip fx. He was mildly MR and 2 days out his belly began to swell and swell. So MD ordered NG tube and Go Go juice via NG tube. Every 2hr round we would give him a few 60cc syringe fulls of the stuff when we turned and repositioned him. Now I was working 11p/7a at the time and right at 6am the orderly and myself got him up to a BSC and I swear he ran it over.....I thought man he has got to feel better......but sadly at 8am he crashed and they had to take him to the ICU and a few days later while I was off he passed on. Apparently the sudden drop in K+ threw his already unstable cardiac pump into arrythmias which later worsen....GO GO juice can kill ya... Since then I have taken care a a few who have been hypoK+ from GO GO juice which induced not only diarrhea but constant vomiting.

I feel your pain and anquish.....I have had shifts like that myself and cringe until its time for me to clock out. Unfortunately, in this day and time unless something tragic happens nothing will change. Because you are a caring individual you will see that what's right gets taken care of and that everything gets done. From your description you seem to be able to "think on your feet" thats something that comes with time and exp....however, there are those that are in the ER that you would swear couldnt even find the strings to tie up their scrubs. Hang in there.......Hopefully, when u are finished with school you will get paid close to what you are truly worth to them in critical situations.

Last year our hospital came up with a Narcotic Policy in that the ER MD's will not give narcotics for Chronic Pain. It is up to the pts PMD to manage their pain. They will give NSAIDS and suggest f/u with their PMD.....Now that is all well and good but you have those MD's who still give out Narcs and those who wont give anything. It has cut down the ##'s of seekers but not all.

In the ER where I work, we have 13 beds. Three of which are designated as urgent care beds. We run U/C from 11/11p with a MD and one RN. During our busiest times which is 11/11p we divide up the rooms so that there are 3 rooms per nurse....Now we have worked codes in every room there, some are so tiny you cant whip a cat in them but if its empty and you get a critical ambulance pt in it goes in the empty room so acuity can change at any given moment. On most days when we are fully staffed we have a total of 4 Rns three with rooms and one float that goes between U/C and the ER to assist with and help where ever needed and a triage RN too.....There are times and pts where you need all 4 RNs there to help out for a given amount of time....But then another problem has arose in the face of short staffing in the ICU we are now holding pts in the ER for up too 28 hrs d/t either no beds or short staffed....so on top of taking care of what comes through the door you also have ICU pts to take care of as well......

Whats your least favorite type of patient to take care of in the ER..... Mine would have to be the drug over dose....had one on my last shift the treatment is pretty much the same What we normally get are the ones that havent done it right only taken enough to make them sleepy or beligerent so they dont end up intubated......Its pretty standard care....Large bore IV's monitor....foley....narcan/romazicon....charcoal...which always ends up all over the place........lol.....and sometimes NG tubes...they can be a real work out of your nursing skills....iv's, foley's, ng tubes...an of course restraints and the restraint paper work that goes with it.............Give me a lunger or MI any day.

Maybe I am cynical or something. But unless I am on duty, I walk away going on about my business. The woman who "vaulted over three pews" probably has "RN" on her license's plate. There is the "good samaritan" law but are you willing to be the one that puts it too the test? I deal with "dudes and dudetts" everyday for 12 hours. When I am out on my time.....its just that my time. Now before I get "flamed to death".......if its a TRUE and I repeat TRUE emergency .....ie choking or cardiac arrest etc..... I'm there lending a helping hand.

All I can give you is what I did. I went to a State Mental Health Hospital from working in the ER for 7yrs. Fortunately I kept on as PRN. I worked in geri/psych as well as the infirmary. I lasted all of 15 months. I totally disagree with the way they were treated. The way they were medicated. All the extra paper work and the general knowledge of the MD's that were on staff there. Psych pts especially those in the system can be very smart...cunning...and dangerous. With you as the only RN..that means you will be in charge and also responsible for meds and the like. Ten pts doesnt sound like much but that can be more than a whole unit of 36 LTC pts.......if things go bad. But this is just my 2 cents worth....I had wanted to find a "good state" job and retire there but My conscience would not let me...GOOD LUCK

Hospital healthcare........no such things as holidays or weekends. We work 12hr shifts. We either work Christmas day or Christmas eve. All other "holidays" are just days to us. Long time ago they use to give you a day back if you were scheduled to work a holiday. Now, however, it goes into a PTO bank along with your "regular earned time off". This year Christmas was on my scheduled weekend off...Had to work that Fri and then again the whole next weekend.(New Years). Sometimes being a RN.....sux's......LOL