Cathy RN

These are known as the date rape drugs. And from what I understand from our sexual assault team nurses,the drugs are sometimes just dropped into an individuals drink I think everyone gets the rest of the story. Some are laced with Ketamine. There is a test that can be done but it is metabolized rapidly in the body.Drug screen was not done our Doctor did not feel it was necessary as it did not change his standard of care and there was little legal benifit. Scary isn't it?

Work in ER. Recently had a 21 yr old female brought in by ambulance. GCS 3. No deep tendon reflex could not arouse, pink warm and dry VS stable BP slightly decreased pulse 88. History was in a bar found passed out in stall by staff. They thought she was drunk, friends had not seen her for an hour or so. Staff took her outside going to send her home in taxi but she began to vomit and not very responsive so amb was called. Parents came in, seemed very caring and concerned. WE did all knids of tests. After two hours with no response we did CT head..normal and she began to wake up. within 15-30 mins she was fully away. states she remembers becoming very nauseated and vision very blurry, dizzy remembers going to BR but that is it. doesn't remember ambulance etc next remembers her dad taking to her but being unable to move and the Dr. looking into her eyes but not being able to focus or control eye her eye movement. ETOH 35 (over 17 here is high) but I have seem people with 80 and I can always arouse them if only for a few seconds. Dr did not feel this was drug related but I'm not too sure. Ther was no sign of sexual assault though we did not do a gyne exam she was fully dressed when she came in. My NET search was surprising as it seemed she had all the symptoms of GHB I haven't had any experience with these drugs so would appreciate your input. How have these patients presented to your ER? Anything that alerts you to overdose? Or that this is what you are dealing with?

Well many years ago ....... I worked in a CCU, I was new and it was a major hospital. When I started there I didn't know but a p wave was fit to eat. There was very little orientation back then and after two months I was put on code. I thought I was OK to do it as I had been in on several in the unit. Well no one told me that the Monitors on the floors were totally different than the ones in the ER. So I ran to this code and conected the patient to the monitor, turn it on, and nothing. I had no clue what was wrong and as there was only two of us on in the unit I couldn't get the other nurse to come up and help, when I called down he had no idea either. The doctor kept asking will someone please get this monitor working. Finally someone pressed an odd button and we were in business, what was the odd button you ask....lead selection. Lesson learnt, now I make sure I think ahead and am fully comfortable with all equipment. It was a very hard and embarassing lesson to learn and the patient survived despite me.

Well it use to be a minimun of two years Nursing experience and you could be concidered. Now with the shortage you can go right into ER even the major trauma centers. They are in dire straights so many have put together clinical courses that they will put you in. Here it is a six week course followed by a clinical orientation. After that you can and should get your ACLS and Your PALS, TNCC is not always available, it is a very good basic course. I think if you do your senior practium in ER then you may just get to go right into this field. Smaller hospitals probably have lower acuity but often do not have the best education resourses. Staffing levels are lower as well and this may affect your orientation experience. If you apply ask about these things up front, if the education is there and the orientation is there go for it.

I find myself in this situation as well. Though I do have the respect of my peers we do have a lot of new staff not experienced in ER Nursing. And I have been called intimidating as well which I might add was very upsetting to me as I do not see myself as this, more of a mentor. However if I'm incharge, I'm incharge....you only have to realize how liable you are in this position to understand the responsibility. So if I know I have a sick person in my dept I do check to see things are getting done. Case inpoint recently had a person with DKA on insulin drip when I noticed the RN was not doing chem strips I asked her what the chem strips were, she got the point when she couldn't tell me. Or the Overdose with no NVS done. The fact that ETOH was on board does not preclude NVS. Patients that are in your dept for 8 hrs and no VS yet have recieved IV and Narcotics. No...not good enough. Nurses who are assigned to a certian area who when I ask them how a certian patient in their area is doing and they say, I don't know anything about that person....I do recognize they are new and need to be mentored along. SOmetimes we are so foucsed on new tasks that we really do not see the big picture so I try and remember that. But I guess in that light I may be intimidating. One Nurse may say thanks I didn't think about that while another may get upset. Either way you cna't please everyone, and we are all different. So which is mentoring or intimidation, its in the mind of the reciever.....

OK I'm an RN 25 years this year. My Mom was an RN we graduated from the same school of Nursing. I love Nursing. I'm a Nursing advocate. I'm very involved in my Career. I consider myself a Professional. But over the years this topic has caused me great distress. I am happy being a bedside Nurse I work in a busy Emergency Department, I am always researching, learning, preceptoring and teaching. The fact I do not have my degree bothers me only inthat I hate being made feel that I am not as good, not as rounded, not worldly as someone feels I should be. If BScN becomes the entrance level for Nursing fine I can accept that. You have your degree great, I'm happy for you. But come on, when we do the same job, we are the same right? If you want to go into management that is your right and you will probably get that over me...but thats ok. I just want to Nurse, do a really good job and come home to my family. I think we need to look at ourselves and see what we are doing to each other and value RN, BScN, MSN etc This has got to stop.

OK I'm an RN 25 years this year. My Mom was an RN we graduated from the same school of Nursing. I love Nursing. I'm a Nursing advocate. I'm very involved in my Career. I consider myself a Professional. But over the years this topic has caused me great distress. I am happy being a bedside Nurse I work in a busy Emergency Department, I am always researching, learning, preceptoring and teaching. The fact I do not have my degree bothers me only inthat I hate being made feel that I am not as good, not as rounded, not worldly as someone feels I should be. If BScN becomes the entrance level for Nursing fine I can accept that. You have your degree great, I'm happy for you. But come on, when we do the same job, we are the same right? If you want to go into management that is your right and you will probably get that over me...but thats ok. I just want to Nurse, do a really good job and come home to my family. I think we need to look at ourselves and see what we are doing to each other and value RN, BScN, MSN etc This has got to stop.

Our region is looking into the possibility of beginning a 14 mon Nursing program with a 6 wk clinical......Can you believe this. They are trying to focus on those people who for one reason or another have not been accepted into the Nursing Faculity but are presueing Nursing courses. As entrance criteria they have to have completed 5 core Nursing courses. On completion of the course they would be eligable to write their RN's and work as same. I graduated form a three year diploma program 25 years ago, I've seen alot of changes but never have I every seen such a Nursing shortage. Our region needs 400 nurses/yr but the degree program only graduates 170/yr. We have a big problem. But I feel we are devalueing the Nursing profession. The powers that be decided many years ago Degree by 2000 now it is 2004. That process was so poorly planned the Degree granting facilities couldn't produce the Numbers, they say because they did not have the academics to accomidate/teach the number of students needed. So now... lets look back at the past... but now we are in so much trouble lets set up a 14 month course. I JUST DO NOT LIKE THE SOUNDS OF THIS. They seem to be looking for the Body. Any one heard about anything like this before and what are your feelings on this? Would love the input.

I work with a RN in the ER. She is most senior nurse in our facility has been ther for >390 yrs. The last few years she has been difficult to work with especially the newer nurses, me I guess I ignore her quirks and kwams. She comes on and starts to stock, all hell can be breaking loose and she stocks. When she is your partner she does her own thing. She works hard she just doesn't prioritize anymore. I've talked to her about a job in OPD, (no disrespect OPD nurses I know you work hard but it isn't high acuity at least not at our hospital). She won't think about that because she feels she will loose she skills. The other day one of the new nurses asked her to assess a patient who required cardiac monitoring, nothing seriousweak and dizzy. Her reply was, is he dying? I'll get to it.....THe poor nurse was so upset with this she looked at her and said if that is how you feel then maybe you should look for another job. It is really brewing and our manager doesn't seem to be able to handle it. I feel for this Nurse she should be retired. I feel guilty in a way, as this nurse has worked very hard for many years and now that she is older we don't want her.....it is sad I just wish she would realize she needs a slower pace before something drastic happens.

Good luck Chilli I am glad that you talked to the others and expressed your concerns that is the only way we can survive address ti ourselves, because nothing even seems to change or get done. The health care system is a strian on everyone. I do think it is unfortunate that you have resigned your job but I wish you the best in your future endevors. What are you planning on doing?

My brother is an asthmatic and has been all his life. He is now 43yrs old. Two years ago he got fed up with all the meds, the weight gain etc. and right or wrong, he took himself off everything even his steriods which he had been on for years. Only taking lots of Ventolin via MDI's. Anyway he has this terrible itch and his skin is so dry. I thought it might be related to the withdrawl of the steriod but his doctor doesn't think so. Nor has his doctor sent him for any blood work. I'm thinking all kinds of thinks including cancer but he has no weight loss except that that he lost after the steriods were stopped. Our Mom was on lots of meds as well and when she tried to decrease her steriods she suffered from the same rash. Steriods made both feel better but going back on steriods is not something my brother wants to do. As you can imagine he has suffered from this itch for two years rather than go back on the stuff. ANY SUGGESTIONS PLEASE? I can't stand seeing him like this. It is keeping him awake at night and he is continously scratching his body, I know he is suffering. What do you think it might be? What Blood work/investigations should he ask his Doctor to do? Do you think this could be steriod withdrawl? That his body has stopped producing steriods himself due to prolonged steriod use? Thanks.

I work in an ER. I got supreme hell from a patient once when she thought the Doctor had seen someone else befoer her and she had been waiting ages to see a doctor. She left in a real huff. What had actually happened when I investigated was that a male nurse had taken a patient in to the room next to this lady and she had assumed he was a doctor. I was so upset with this lady I actually called her back and explained what had happened. She was still made but I felt better. You could tell she pulled in her horns......

I guess I'm sensitive as well, and I wasn't there either. It was nice of him to buy you all pizza. But me I prefer respect. The fact he gave you little notice of his visit doesn't show me he really showed you that. I really hope his intention was sincere and not, this worked well, I gave her no notice , I got to do this at my convience and its worth the pizza to me to come and go as I please. Sorry.

chili2641 Enough is enough of this I don't want to get in another arguement. The professional ladder is not my doing. But as education goes the LPN, CNA do not have the education the RN does to do these jobs. End of point. You can have a masters in Business, but if you work as a LPN and I as a RN then on the professional ladder I have more responsibility/accountability than you. Accept it. I also encourage and mentor all the time I work with LPN's I have encouraged and even precaptored in their RN studies. I'm not affraid to work and work hard, I just hate this issue and it has been around since I entered Nursing 28 yrs ago. So please give it a break, accept it and move on.

Nitrous is used in ER to help with pain relief. I do not see a really good sedation with this and have not seen it used for conscious sedation only pain control. It is administered to patients through a mask or T-piece.To prevent over sedation, and as a safety precaution, only the patient holds the mask/t-piece. This prevents oversedation as the patient becomes sedated he will weaken his grip and either the seal will be broken or the mask etc will fall to the side. Again I have never seen a patient overdose on this.Unfortunately I wasn't aware of the air concentrations levels. I'll read more thanks for posting.

Hi I'm from Alberta. Just interested in why you want to go to the states there are lots of ICU jobs here and the Capital Health region here in Edmonton offers critical care course to new hires. Beginning salary $21.54/hr. If you want more information write me [email protected]. But perhaps you are looking for the US adventure and thats ok too.

I'm sorry. This is a topic that has been around for so long it makes me sick to still be discussing it. As long as I can remember CNA's, LPN's and RN's have gone around this topic. She is too good for this work, she is lazy, there is no team spirit, they think they are too good, it is beneath me.....Give me a break.....I'm and RN I have my scope of practice and Job expectations, you have yours. You respect me and I'll repect you. We have two different perspectives here.... I have more education and more responsibility/accountability please respect that. If I am called into do your job I still am expected to function within my professional boundaries. I think your management is discusting if they can not find the right person to do the right job this is not cost effective management, but heh, if they called me in to do CNA, LPN duties and are paying me RN salary, what the hell. Lets not isolate ourselves here ladies and gentlemen. It is about time we start respecting and valueing each others professions and accepting where our place is in the professional ladder. It is not beneath me to help with patient care I think this is a joint/crossover function but understand that I do more than the physical/hygiene/Activities of daily living care.

Sorry Doc. You know working with someone who conctantly makes you feel worthless, upset, not wanting to go to work falls under harassment. This Nurse has been spoken to reported and still continues this behavior. These people are very difficult to deal with on both sides of the fence and it is unfortunate the soundslikesirens had to settle this herself . It takes alot of courage to confront a coworker like that but I believe it is better to do that than to go along as if nothing is wrong or letting someone away with treating you like that. I'm sorry it came to that for you sirens but I'm in your corner.

I remember 1.When a doctor told me it actually told me to obtain an accurate temperature the glass thermometer had to be left in 8 minutes. Even then I laughed. 2. When we mixed what was similiar to TPN on the floors. It said we had to mix it under a hood even then. The hood, you ask.....a sheet attached to a upper cupboard the reached the floor. You would get under the sheet and mix the soultion. 3. When we were in the Nursery we would let newborns suck on our knuckles. Yuck. 4. When we were in nursing school we had a cerfew-2230 hrs every night with two late passes or overnight passes every two weeks. And a house mother that made sure we were tucked away in our beds. 5. When you were only allowed to wear you nursing uniform always dresses and you couldn't have your knees showing.

Having worked both Medicine and Emergency we usually started IV's in the affected arm of a CVA patient with the idea being, we did not want to further hamper he independence by starting the IV in his good arm. Recently I was orientating a ICU Nurse to Emerg and she couldn't believe we did this. Her rational was that if you put the IV in the affected arm the patient also has decreased sensation therefore he can not tell if the medication like Kcl is burning etc. In ICU she says they always start in the good arm. I do understand there are some drugs that we prefer to go through central lines but I'm talking iv hydration or kvo maybe antibiotics. What is the standard practice you all follow? Would appreciate you input.

We use the level 1 fluid warmer as well it infuses at 40 degrees. To the best of my knowledge you only want to warm about a degree an hour. Feel free to correct me if I am wrong......

to the majority of our patients we give an IV bolus 500 - 1000cc and maxeran 10mg IVP. Wait 20 minutes and then give DHE .5mg IVP can rereat DHE in 20 minutes PRN. It works really well for most headaches.These meds can also be given IM but seems cruel to give so many IM's

There is a great shortage out there!!!! Go figure heh? If this is something you really want to do then maybe it is a test how just how bad you want this career. Don't give up your dream because of one persons view and someone who doesn't even know you. Try again at another facility. Preserverance, where there is the will there is a way. WE need you.