Peg804

I am a first born, Dad was not alcoholic, Mom also a nurse and a first born-no alcoholic, cousin Anne-first born, aunt Edith-second child-no alcohol, aunt Helen-5th born, no alcohol, etc. I come from a family of nurses, maybe we need more alcohol??????

Yes, you are employed by the hospital that sent you, but are you legally covered if something bad happens. I do not think you are covered by the state, you can only do what is in your nurse practice act. And that does not cover you for what could happen on a transport gone bad. You cannot perform the prehosptital skills of an paramedic or a phrn/hp. Can you legally intubate?? Perform a cric???? If you are not a prehospital provider, no you cannot. What is your hospital going to say when you have a patient go bad. Who are they going to protect???? Certainly not the lowly nurse who did not know any better, and only went for a ride. Better to have those trained and certified caring for the patient rather that risking your patients life and your license.

Just my 2 cents, but I must comment, RN to paramedic. There is a vast difference between and RN and an paramedic, or if you are in such a state, a phrn/hp (prehospital rn-who has challenged the nat reg testing and has the approp skills, or paramedic. If you are thinking of challenging any prehospital course, you better get some field experience. The world of an RN, and the world of a PHRN/HP are completely different. When you get that patient in the ED, they are packaged for you, meaning they are immobilized, splinted, bleeding is controlled, intubated, defib, etc. In the field you are the one who is doing the packaging. you are the one making the decisions. There is a vast difference intubating in a lab vs the back seat of vehicle which is crushed under an tractor trailer, let alone the IV start. You have you to rely on. Make sure that you have the experience to work in the prehospital world. I do both, and I have the greatest respect for fiedl medics and the few PHRN/HP;s that are out there. Most of us, atleast in PA, actually started as EMT's. Good luck to those who join us, but make sure you are ready. cause you cannot yell, start over. at 2am on the interstate. Just my 2 cents Peg

You should definately take an EMT-Basic course-this is the basis of emergency care. You have to look at what you can legally do in your state. and what you are covered to do. Just because you take and pass a course does not mean you can do everything that was taught in the course. If you are am EMT-B, recognized by your state, and the prison recognizes you in that position, then you can perform the skills. Immobilization, stabilization, basic stuff. If you take a phrn course, or paramedic course, then you learn a lot of things that you can only do under the direction of a command physician. I don't think the prison has a medical command physician on staff. Why does it take 30 minutes for EMS???? Please remember, don;t do anything that you are not legally covered to do.

I just wondered if you had approached admin to see if they would cover you if something awful happened. unfortunately I had something awful happen on a rountine retrieval for one of the units I work for. We transported a patient out of the Pittsburgh area, massive CVA-coming closer to home for rehab. actually was going to New Jersey Nursing. Rehab facility, No DNR, coded, awful trying to find a receiving facility, patient ended up intubated, etc when we arrived at a NY ed. Physician was not sure what to say Any way patient is still alive. A routine retrieval gone bad-just my luck. Let me know what happened at your facility. My inlaws lived in port deposit maryland for a while, sstill have friends there. Where are you located. perhaps I can help your situation

Right you are, follow your gut instinct. If they say they are going to die, they will. If they say they have to put their feet on the floor, watch out, death is just around the courner.

I am an HP (PHRN) in PA.I challenged the course. I was also an emt since I was 16 yrs old. I would recommend that you take an EMT basic course, if you are trully going to work the streets. you need to know how to immobilize a patient, how the extricate them, you need haz mat, perhaps vehilce rescue, etc. It is not as easy as it sounds. I see nurses who say they want to challenge, and I cringe. They have no idea what they are infor. think about it 3 am on the interstate in a snow storm, victim entrapped, you are the lone als provider for who ever is in that van trapped under the semi. Make sure before you challenge that you know what you are infor, cause, guess what, you are on you own out there, GEt as much prehospital training as you can, there are mandatory course you must pass, federally mandated- haz mat r I, I recommend operations level, basic vehicle rescue, advanced if you can find the course. PHTLS or BTLS, ACLS If I can help you in any way let me know, Just. please, make sure you are prepared.

Oh, love it, one complaint, How about when your run out of room on the triage because they have so many complaints. LOL, I have to bite my lip to keep from laughing in their face. Isn;t it sad what people think are emergencies. I just want to screen at them GET OUT. They are the one who lodge the complaints that they waited for hours for treatment, and guess what there was no FREE coffee in the urn OOPS I was caring for the patients who really needed to be there. We had one family(the entire family usually is seen when the come in once a week) who called the patient advocate because there was no hot chocolate inthe waiting room, and nothing to eat, cause they were hungry. I get hungry too=guess what eat at home or pack a lunch we are not the soup kitchen

I get paid 2.00 to be oncall for the ED or for ICCT. If I get called into the ED I do not start getting me salary until I get there, different for ICCT-I get paid for each call I triage-maybe only 10 minutes on the phone, but if I have to do the transfer I get pain from when I get the call-no I do not charge them for showering, etc. but that is how we work, I may talk to 10 different facilities during my oncall, ever leave my house and get pain 2 hrs, I also may get a call, take 15 minutes to drive to meet the ambulance or the plane, and get paid for it, also for my paper work time after the transfer-usually 15 minutes. The other service I work for 2.00 an hour for oncall, then clock starts ticking once I accept call.

Don't listen to those who discourage you for taking an ED job, it is the most wonderful place to work. The people you work with will become your extended family, much stronger than those who work on the floor. You will learn from each other. I am thankful that I work in the ED I do, I can rely, and you will too, on those you work with. the formality with MD;s is not there, yes they are the doc. but. atleast where I am, there is an "we're all in this together" feeling, The docs actually ask for ideas, especially with arrests, medical or traumatic. You trully gain an entire family. It is hard work, dinner is an afterthought eaten while standing in the kitchen, etc. It is never the same, unlike the floors, you have to know alot about everything from the neonate (rate) to the geriatric, medical to trauma, etc, But it is the greatest place with the greatest people I can imagine. Good luck to you, ignore those that do not support you, get all the education you can. If I can do anything for you or answer any questions (I am said by some to be old-can you believe that-I do not) let me know-if nothing else I am here for support,

What is it about EMERGENCY that you to not understand. If you have had the same pain for a year, why is it an emergency now???? We are not a dentist, we will not pull your tooth, perhaps you should have brushed the two teeth you had left. As one of our pa's said we should have lines for what these patients want, Line one pain meds, Line two note for day off fom work, Line three admit to hosp. etc, when max in line is exceeded too bad, come back tomorrow-like the free cheese line. Oh, but if you have the special card, that all of us who are working are paying for, pick line four-for any stupid complaint you can think of, and yes, the doctor will see you, too bad you stubbed your toe, or got hit with that sippy cup the kid threw (yes it did happen). it is ok that you have been here everyother day for the past 2 yrs. Anyway, once again I am venting, bad night, too little patience left. I cannot even imagine why someone would wait 6 hrs to be seen for anything, well I guess you h ave to make sure the welfare card still works!!!!

Welcome to the wonderful world of ED nursing. The best piece of advice I can give you is that you can only do what you can do. You have one brain and two hands. You can do one thing at a time. Don;t try to do everything. Take a look at the big picture. Remember most people that present to the ED do not really need to be there. But those that do deserve the very best that you can give them, and the others can wait. ED is by priority, that is just the way it is. Use your coworkers, maybe they cannot do the tasks for you, but remember that they are there, and you are not alone. Most importantly remember people die, no matter what we do, or how well we do it, they die. Young or old, it is their time, and there is nothing that we can do about it. Do your best, that is all that anyone can ask of you, and all you can ask of yourself. Good luck

If there is a code called in out clinic or medical arts building, or cancer treatment center (all connected to the hosp by walkways) the ED responds with prepared code bag-monitor/defib. litter, RN, tech and Doc respond from ED, resp tech, perhaps Hospitalist (hospital md). Basically scoop pt back to ED, BCLS, monitor, maybe intubate-but BVM works, first round of meds. Goal is to get pt to ED, too hard to work code in elevator. Although I have done it prehospital.

I worked nights in the ED for years before i changed jobs- slept when I could-but never got enough sleep. the worked days for a while and then eves. Hosp consolidated and found myself in home health . liked it but had to get back into hosp and ed. Well I did, night shift of course. I had to go straight home-no stops, no chatting, take a quick shower and go to bed with the tv on some nonsense noise channel. We live in the country so not much noise. If I started laundry, or anything, I was doomed to no sleep, as it was I was side awake by 2 and that was that. Tried to sleep like some to in evening, I felt like I was hung over. Now I work 3p-1a or 1p-11p, still cannot fall asleep until 3 or 4, like tonight, When I did nights there were some days that I could not get enough sleep no matter what I did. Good luck. you will get used to it, I did, my Mother worked as nursing supervisor for over 40 years on night shift.

I think you have every right to be testy and then some. I have no doubt thatthe triple alarm you are talking about can be heart everywhere, and they chose to ignore it. A memo is a good idea, but shouldn;t common sense come into play here. A patient's monitor alarm has sounded, I guess you are the only one who is tuned into that frequency, Come on, maybe they are good people, but if we do not all work together, we are done for. what it the patient have been in vent tach, or vent fib, and it was ignored or "not heard". I would not want to be that nurse when the lawsuit came down. I don;t think the excuse that i wasn;t working that side of the unit will hold much water.

First let me say that I am very sorry for how you have been treated. It is a terrible analogy, but we do "eat out young" in nursing. My clinical was a very long time ago, but I remember it like it was yesterday, Some nurses were miserable bit"""""" and some were great. We took care of their patients, they had a lighter patient load. we cleaned the ****, we fed the patients, we showered them,we gave meds,did dressings. My instructors theory was that we should have the most challenging patients as a learning experience. I swore I would never treat students like this, and I can honestly say that I never have. I an shift preceptor as well as team leader. I try to get out orientees and out students the best possible experience that they can have while they are on ED rotation. Some are scared, some love it. But, I will not tolerate anyone treating a student as anything less than they themselves would want to be treated, Nurses will respect the student or orientee, and will not belittle them. They are out future. who will be taking care of us if we scare off all the young???? No matter how stupid the question, or no matter when the question is asked, even it you are busy, there is a right way to answer another human being and a wrong way, Unfortunately a good number of nurses have forgotten how to be nice.

I work in a busy ED, here we work side by side with the docs and pa's, no one is any better than anyone else. The docs will give up a chair the nurses of they need to sit down to chart, and vice versa. If I am getting coffee, I will ask the doc it he or she wants one, and they will do the same for me. We work together-if MD is going to cafeteria for lunch, he will take orders from nurses to techs and sec, same for all. I think we work in a different atmosphere then the floors. My mother was a nursing supervisor for over 40 yrs (lots over) and the stories she tells about docs demanding chairs, throwing instruments, screaming, and even hitting nurses. Would never be tolerated today, She has even said that nurses and docs do not eat together. Not now, and not at my facility. Thank goodness.

Just have to add my two cents. I work in an ED that never has a q""""" time. We treat patients in the hallways, the support room, triple up the cardiac, trauma, and ortho rooms-what a joy-and you know where HIPPA goes. I have worked the floors-don't want to do floor nursing, love the ED and as of now will never leave. I think that all floor nurses should come and see what goes on in the ED. As others have said-on the floors , when your beds are full, they are full. As Team Leader I get to enjoy the brunt of the screaming and cursing from the patients and their families who have been in the waiting room for 5 hrs. My name is on the nasty comment cards when we have no place to put people. Our policy is that we fax report to floors and the patient goes up in 30 minutes. What happens is about 5 minutes before pt can go up we get the call-bed is not cleaned, we;re having patient go bad, or what I love-the nurse is on break. BREAK!!! I haven;t had in break in longer than I can remember, and I haven't seen the BR all shift. Didn;t anyone notice the bed was not cleaned. Maybe we can swap crisises??? We cannot send pt to the floor 15 minutes before shift change, so when do we get the beds- just over the 30 minute waiting period. Why, cause the supervisor does not want the floors mad at him-the gutless wonder ohh!!! did I say that??? Sometimes I could just scream, and of course we loose all these fights, no the cannot take the patient early, and then there is the ICU and Heart Hosp. We have to call report to them, well with the internal caller ID they know it is us, I have been hung up on and put on terminal hold (by mistake of course). No WE WILL CALL YOU WHEN WE CAN TAKE REPORT. Well you know where that goes. Still love the ED-just wish the rest of the hospital understood us.

Just have to add my 2 cents for what it is worth. I have been in prehospital care for almost 26 yrs-since I was 16. I an also an ED nurse now and hold HP certification-or prehospital RN depending on your state, I also work on a critical care interfacility transport team-land and air. Believe me, and I know others will agree with me, they are completely worlds, and I love them all. Each has different, yet the same focus. As an HP-it is my job to get the patient to more advanced care than the prehospital team can give them in the field. I have a lot of autonomy here. In the ED it is my job to be that care-to work as a part of a different team to get the patient stabilized. And as part of the interfacility team I take that patient to either a higher level of care, sometimes to a speciality facility, sometimes to a facility closer to home. It is in this capacity that I can combined my prehospital world with my ED nurse world, cause this job description calls for me to be both. I can intubate the patient, decomp chest, etc if I need to, but I can also manage the meds, and the nursing care. Yes, evens bedpans if it comes to it. Unless you are a prehospital RN, or HP you are not incharge in the prehospital world. You do not have the training or the qualifications. Even the simple things like patient packaging, Haz Mat, Vehicle Rescue, etc. yes, I have had nurses, and even an MD come up to me and ask if they could help. And yes I have had them help. I had the MD-a pediatrician helping with rehab at a multiple bus accident. Unfortunatley Prehospital people are not treated well by ED staff, I have seen it and I have experienced it. Most ED staff do not know the differences in the levels of prehospital providers, and I cannot stand it when I hear Ambulance Driver!!!!! ED staff do not realize the stuff that happens in the field. By the time the patient gets to the ED they are packaged, out of the twisted metal that was their car, off the bathroom floor where they were wedged between the toilet and wall. Sometimes I want to scream at some of the people I encounter when I hear Why did you bring that patient here???? Guess what if we all don;t work together none of us will have jobs

Cardiac has 2 beds-about 10 feet between with curtains separating, beds 3-6 are only sep by curtains, then 2 trauma beds, set up like cardiac with curtains, ortho has 2 beds same set up, gyn and peds (beds 11 and 12) are priv, as are 13 and 14(actually holding beds, but used for anything, 15 and 16 are private. Then we have hallway beds 17-????however many stretchers or chairs we can find. There is no privacy in the ED no matter how hard you try. We are currently undergoing renovations to provide us with a couple more rooms-4 I think. Plan is to build a new ED with 2 yrs-but the best laid plans, >>>>> you know the rest. I feel bad putting pt in hallway beds, absolutely no privacy there, but what else can we do???? Seem like same problem everywhere.

Currently I can wear whatever color scrubs I want, but there is talk of some sort of color designation either for each unit, or for each title-RN, LPN, Tech secretary. Not sure how union will respond-we do not get a uniform allowance now. Most nurses wear scrubs, although I know of 2 RN's who wear a white dress uniform-and they are against any color designation. The last hospital I worked at did try this-we were maroon in the ED, units were surg green, ob was pink, etc. not too bad initially, until you got pulled to another unit, or changed departments, and then there were the male nurses. We did get a 100 uniform there, but then that ended, and so did the color designation.

Yes, please tell up more. We have a fast track program-the minor stuff, but when it comes down to it they sometimes wait longer. We are in process of removating ED to provide separate waiting area for these fast tracks-but as of now they all wait in one room. And if looks could kill when a fast track gets a hallway chair after waiting a short time, and others are there for hours-you know how it is. So, how does the 3 level system work.

I have a basic lipincott stetho-it works one for the ED where I am an RN and one for prehospital. What ever works for you. You need to be able to hear. Your choice=

Hi, I work for the Geisinger System(we'll come get you no matter where you are). as well as several other transport services. I hope you never run into a problem a a transport./ Please as a nurse read the EMTLA guidelines. I work as a ER RN as well a a phrn or hp-so I am pretty well covered, I also make sure that I maintain medical command for every unit I work for-just uncase something awful happems. I have spoken to my sister in lau (actually the drinking was pretty heavy" -she is a CCU nurse who never thought about what could go wrong on "tranaport: Make some kind of agreement with an actual transport team. EMTLA says that the patient being transported must have the same case as in the hospital THINK ABOUT IT > WHAT CAN YOU DO FOR THE PATIENT> THINK ABOUT IT WHAT happend is the crump half way to their destinatoin with an EMT/EVO Driver and an RN from CCU= what happens

Sorry did not finish my reply. I am an RN. and proud of it. I am also a PHRN or HP=for which I am also proud. I worked hard for every certification I have. I have edured. For someone to say that they run with an ambulance company=and they are an RN-so they are a phrn is insane. You do not have any idea what you are talking about. You maybe an RN, but unless you have pass the national registry test and have proved yourself,-you have field training, they you are NOT A PHRN. you would be classified-I have spoken to 5 units, as an observer- you have no ackowledged prehospital skills.I have been in EMS for almost 26 years- I have seen good and bad i have seen RN's that can help me and those who should ist int he truck. I hope you atually certify as a PHRN what area are yout in, can I help you/ It is not easy.let me know what I can do// Please for give spelling,etc, I never claimed to be a secretary.