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gvrn13

gvrn13

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gvrn13's Latest Activity

  1. Hello, I'm currently an emergency department nurse.... While I enjoy this very much, every time I interact with a post partum mother who is nursing, I get so happy by being able to offer them support, being their advocate, and by offering my personal breastfeeding advice when asked. I feel like I may have to pursue becoming a lactation consultant, that it is my calling. I am in N.Y, does anybody have any advice on how to go about this? Anybody made the transition and feel like it was what they were meant to do??
  2. gvrn13

    Triage question

    Thanks. I've only been in this er for about 3 months. This particular dr is very much into pointing out EVERYTHING that you did or didn't do.... If you take initiative and do something it's why didn't you wait for orders, if you don't do something it's why are you waiting? I feel the more I try not to screw up around him, the more I am.
  3. gvrn13

    Triage question

    Thanks. I've only been in this er for about 3 months. This particular dr is very much into pointing out EVERYTHING that you did or didn't do.... If you take initiative and do something it's why didn't you wait for orders, if you don't do something it's why are you waiting? I feel the more I try not to screw up around him, the more I am.
  4. gvrn13

    Triage question

    Great points by everyone!! I think I'm doing ok but there is usually one case where I'm going back and thinking what I should have done differently so I can be better. I wasn't necessarily trying to tailor my triage to a cranky dr, but just trying to do it the best and most accurate way. Epigastric pain would have been the best chief complaint, but honestly I'm not sure that it is listed, I'll have to check. Next time I'm having difficulty getting a. SPO2 I will definitely be putting a sensor on the forehead. Thanks again for helping a new nurse think it through.
  5. gvrn13

    Triage question

    Wow thanks all for your input!! Like I said I'm new to triage so still unsure. The reason I didn't put "chest pain" is because the day before while working with a full of himself dr, he got annoyed at me for putting chest pain for a pt who was pointing to epigastric. That one I put cp as chief complaint, but than wrote a note about pointing to epigastric region. Once the word chest pain is written, it starts the cascade of ekg within 10 minutes, so I had this dr in my ear when I saw this kid. The spo2 I was thinking it would be quicker for me to get him into the back than start messing around with different probes, esp for a 20 year old who had no history and was in no distress and had no complaints besides the burning in his stomach. The mother was annoyed because they were waiting in the cubicle. It was change of shift and the dr was literally going to be in there in 10 minutes. When I went back the next day and asked the nurse who took him the kid got a Gi cocktail, normal ekg.
  6. gvrn13

    Triage question

    Thank you nurses for your feedback!!! Just curious if either of you would have thought twice about the raynauds??
  7. gvrn13

    Triage question

    Hi, so I have a long question about a pt I triaged the other night and was hoping to get some insight from some experienced nurses. On a side note, I've been an ER nurse for almost 2 years, only been doing triage for the past few weeks. I have a doctor at work who is very hard on me, so when I was triaging this particular pt, I heard his voice in my ear. A 20 year old male came in c/o chest pain x2 days. Denied SOB, nausea, vomiting, pain going down left arm or up his chin/neck,said pain 5/10. when I asked him where his pain was he pointed straight to his epigastric region, right under his sternum. I asked him several different ways, the pain was not in his chest, not on the left side of his chest, right in the epigastric. He had dusky colored fingers, when I asked him about this he said his hands were always cold and looked like this in the winter. Because of this I was not able to get a SPO2, but I palpated a pule of about 70. He had no complaints of his hands, because as he put it this was normal. I put chief complaint as "abd pain" and put him at ESI of 3. I wrote in my initial note that pt was c/o of "chest pain" but that he pointed to his epigastric region, that it was ongoing for 2 days, and denied other symptoms. I told the charge nurse, it was change of shift, and then told the oncoming dr what was going on. The pt waited longer than I guess the mother thought he should have given that he said chest pain, she though he should've had a ECG immediately. When the other nurse told her that he was put down as abd pain she was angry that he was not in as chest pain. Now this would have been the case had I put chest pain down at the complaint, but I did not think it really was. So my question, is would you have put chest pain down because that's what the pt said, or when I did my assessment and thought it was abd, would you have put that down? Also would the raynauds have had any play, and that I didn't get an SPO2 initially? The doctor that was oncoming gave me a problem on a previous night because I put down chest pain because that was what the pt said, when it was really epigastric pain. I'm still learning and looking for input.
  8. gvrn13

    Do nurses eat their young?

    I have been a nurse for 2 years, I have not experienced this "nurses eat their young". If anything, it has been the exact opposite and I have had nothing but people who have been open and receptive to my questions and have offered their guidance. If anything, I really think it's the CNA's that have tried to eat me. For some reason, it has been an extreme power struggle no matter how nicely, or how many different ways you have to ask somebody to do THEIR job!!! This has led to me doing most things myself, but then that leads to resentment as well because they are like "oh I just did vitals", or "I'll do that", but when you ask them, it's "that's not my patient", or "I don't have that room". Can't win no matter what, you just have to go with it.
  9. gvrn13

    What does it take to be a good ER nurse?

    The great ED nurses that I've worked with have the ability to take care of 10 patients, and somehow treat each one of them like they are their only patient. When you've reached this mastery of multi-tasking, you have made it. I personally have not reached this level yet!! Also the sense of humor, because seriously you can't even make up half of the stuff that you will see or hear. And a poker face... never let them see you sweat!!
  10. gvrn13

    Pain medication and the dying patient

    As shocking as it may seem, waiting 2 hours for an order is not long in my hospital. Once the pt is admitted, I can no longer ask the ED doctor for an order, I need to call the admitting doctor, which may or may not be the hospitalist. If it's the hospitalist, it will be a quick fix. If it's not, it is almost torturous waiting for an external doctor to call back, some of whom don't for several hours. I have no problem calling someone in the middle of the night for something that should have been initially included in the orders. It's ridiculous, and I feel bad, it's an injustice to my patients who are in pain. Then, by the time you get the order verified, and whether or not it's available in the pyxis, it's just crazy. Sorry you had to go through this. And as a future note, when you are a nurse, and you're going through the chart if you don't notice a PRN, it's better to call before you need it just to get it on the chart just in case.
  11. gvrn13

    I think I'm going to quit during orientation

    I agree with the other comments that you shouldn't quit while on orientation. You didn't say how long you've been at the hospital (I didn't see if you did), but everything changes when you're off orientation. While with a preceptor, you are basically at their mercy, following them and doing things the way they would do it. Their way, is not necessarily going to be your way. When you're off orientation, and have your own rhythm, you will find a way to get everything done, and they may include a complete head to toe assessment on every patient. I work in the ED, been off orientation now for about 4 months, and it is so much easier to function without somebody watching me, and telling me what they would do (not that I didn't appreciate the guidance or safety net, but just sometimes the comments were too much for me to handle, trying to remember the way that particular person likes things done, and remember that I should be doing things somebody else's way and not the way that I think is more comfortable or right for me). Give it more time, I think it will make you a better nurse. And if I heard people talking about me, I would probably confront them. Not only is it rude, but it's not right. Everybody has been a new nurse at some point in time, and they should not be pairing you up with somebody who doesn't want to be a preceptor.
  12. gvrn13

    NG tube insertion question

    This is interesting to me. I'm a newish nurse in the ED, and anytime I've placed one it has always been with a seasoned nurse, and we have always used the swallow small sips of water trick. Not a full cup, but just when it hits that area where they feel like gagging it back up, a couple of sips will help it go down when other wise it wouldn't. I'm interested in what everyone has to say.
  13. gvrn13

    Mixing meds

    Hi, my first job out of school was an outpatient oncology center where I, along with the other nurses were responsible for mixing our own drugs. I actually wrote a similar question on here about the safety aspect and got a lot of good information. The nurses at this job, did not really even think twice about mixing. It was just what they did. There was a hood to mix, and gloves were always used, a gown not so much. I was always nervous doing this, but I did do it for about 6 months. Some nurses on here will tell you to not do this, that it's not right, but I have found that this is how it is done in the outpatient facilities in my area. If you are going to take this job, I would take the "chemo provider course" that is offered through ONS, your employer may pay for it. Taking this course is not certification, just more of a background of information on these extremely dangerous drugs and how they should be handled and side effects and such. I personally felt that I was thrown into that job, and was not really given too much info about giving chemo. Do some research, and see how you feel. Good luck!!
  14. gvrn13

    how hard is it to take a BP????

    Thank you all for responding!!! Just needed some reassurance, that it really is ok! I'm new at this job, and still meeting people, and just really hate to look incompetent.. I really want to be one of those nurses that make it look easy... how do they do that???
  15. gvrn13

    how hard is it to take a BP????

    So last night in the ED during a trauma alert with a pt who had gotten punched in the head and was post ictal I was trying to get a BP because the automatic was coming up 198/100.... well, I wasn't able to get it, after trying several times and getting more flustered because I could hear all the docs telling me to pump the cuff higher, did I get it yet, the trauma surgeon was like really?? and came over and took it himself... he got 140/70.. I completely cracked under the pressure, I might have broken a sweat. I got so flustered and I had told them when I was trying that it was around 140, and they were like no it's higher, why can't you get it?? I feel completely incompetent that I was unable to get it, in front of all these people. And all I can think is REALLY???? How hard is it to get a bp???? Every time I see this trauma surgeon, I know it's going to come down to the bp!!! Anyone have similar, embarrassing, make you feel really stupid stories???
  16. gvrn13

    accessing a port for just one blood draw

    When I worked in oncology I would always ask the pt their preference. Some of them don't want to be stuck in the peripheral, and some have really bad IV access, so why wouldn't you use the port? A port needs to be accessed and flushed every 8 weeks or so, so if it would coincide with the lab draw, you would just get 2 things done at once. And on the flip side, some didn't want their port used because it took too long or what have you, and that was fine as long as it wasn't "scheduled" to be flushed. And I'm thinking that as long as it is done as a sterile procedure, you should be ok infection wise. (My opinion as somewhat of a still newbie nurse)