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ERERER

ERERER

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ERERER's Latest Activity

  1. ERERER

    do you go to work sick?

    Sitting here with the flu, yuck. debating on whether or not to call in sick. what is wrong with nurses that we give work notes to hangnails, but don't take time off for ourselves if we're sick? how do you decide when to stay home? i have not called in sick for many years, and dread doing it today but due to fever/cough etc don't think i have a choice....... and, i bet that i caught this bug from another nurse!!
  2. ERERER

    CEN exam tomorrow

    so, how did you do? mind sharing some tips for the rest of us? how has the exam changed, where is it's focus, etc. thanks!
  3. ERERER

    Anyone currently studying for the CEN exam??

    30+ years as RN, 20+ in all kinds of ER's..... used to be CEN, but unfortunately let it expire, so have to retest. Have heard that they changed the content last summer, anyone noticed??? also, wonder why Laura G-VonFrolio has not updated her tapes, i really enjoy her but they are really old. Has anyone else tried "http://www.mo-media.com/cen/" that a previous poster suggested? just wondering, never heard of it before.... guess i'll have to crack open the old books, learn the actual NAMES for what we see: LeFort fractures, etc. Hope to hear from those of you who have taken the test in the last couple of months as to whether or not they made it more real life
  4. ERERER

    "Do you miss the ER?"

    well, I'm still in the ER, at my advanced age and bad feet every day I ask myself how much longer can i maintain this? There are only 12 hour shifts, new grads counted as full staff (not their fault), corporate mentality (right now you have some empty beds, send a nurse home!), not to mention all the other crap. but, i have a hard time picturing myself leaving....... how did you do it?
  5. ERERER

    Vit K

    after handing the syringe to the doc to give, he changed it to IM and we haven't had that problem anymore. are you giving it for a high INR from Coumadin? we generally use FFP too if there is a critical need
  6. ERERER

    room assignments/responsibilities

    we are trying to deal with this among ourselves. I do not like to "write someone up" or blah blah blah to management unless it is something we can't handle ourselves. This particular nurse has been taken "outside" and talked with, given direct orders, given report from triage, etc. Whatever intervention we have tried has only made the situation worse. Is there a better way to divvie up the ER than assign rooms?
  7. In our ER we are assigned a group of rooms for the shift. Patients placed in those rooms from triage or EMS are "our" patients. If we are getting "slammed", everyone else usually pitches in to help out..... Lately we are having trouble with one nurse who focuses in on one or two patients (out of 4 or 5) and ignores the others, assuming someone else will pick up the slack (IV, labs, meds, etc). She does not even acknowledge that there are pts in those rooms (how can you walk past one of your rooms, see a pt lying there, and not know it?). It is getting worse. My question is aren't you legally responsible for your assignment? is triage placing a pt in one of your rooms considered a "hand-off" by JCAHO? Can anyone give me some constructive suggestions on how to deal with this escalating situation???
  8. ERERER

    Ummmm..are they ALLOWED to do that?

    you cannot transfer a patient to another facility if you have the ability to care for them. this does not mean bedspace, it means specialties (burns, neuro, etc). i've been doing this a long time. you would never find a physician to accept an established pt just due to "bed problems". THAT would be an emtala violation. Emtala addresses inappropriate transfers, started out as an "anti-dumping" legislation to prevent sending self-pays to other facilities. For example: we send out all our OB's because we do not offer, or have OB physicians on staff. This would be even if the entire hospital was empty. the closest facility that offers OB and has bed space is obligated to take the pt, insurance or not. THAT is emtala in a nutshell. Someone above said it "emtala ends when the pt leaves the ER". It does not cover in house patients at all. If the powers to be think that the pt would be safest in the ER, then that's where they go, like it or not. The patient still has their admitting orders, physicians, etc the same. The only way the ER doc gets involved is if the pt codes. Which would be the same if the patient was upstairs.
  9. ERERER

    Ummmm..are they ALLOWED to do that?

    +++++++++++ I have researched Emtala quite a bit for some problems we were having. No where did it address this issue. The patient is not "dumped" on the ER. They keep their same doctor and their same orders. The ER doctor is not involved. It is similar to sending a M/S patient to the ICU. I really do not understand how you think this is an Emtala violation. If it is, please send me the references, because we sure need to know this if it's true.
  10. ERERER

    Ummmm..are they ALLOWED to do that?

    I do not understand why this would be an emtala violation. When the patient comes down to the ER, they continue under the care of their admitting physician along with their orders. The ER doc does not get involved in their care. If we need an order, we call the attending. Why is this different than say going from tele to ICU?
  11. ERERER

    Ummmm..are they ALLOWED to do that?

    I can see both sides of this problem. I am currently working in a dinky non=teaching REDNECK hospital. If a patient goes bad, ICU is full, there have been a couple of occasions where they were brought back to the ER. SIDE1: where is the safest place for the patient? SIDE 2: in the ER we take care of non-stable pts before they go to ICU. frequently the load is quite heavy. the initial care of these patients is high: starting drips, intubating, stabilizing, etc. In the ICU, the nurses have their set limit of patients. In the ER there is NO set limit. The other night i actually had an ICU nurse say to me after hearing report "sounds like that patient is too unstable to come up here". huh? then can i send my other 5 patients to you?
  12. ERERER

    Resources for ER Newbie

    hey... i've been a nurse since the dinosaur age. This is what i carry in my pocket: "Emergency and Critical Care Pocket Guide, ACLS version" by Informed.(Paula Derr). i'm pretty sure you can get in from Amazon too. Just remember, there is no way you can keep all that stuff in your head. It is in your best interest to look stuff up (see the post about the Dilantin overdose)
  13. ERERER

    Do You Have a Voice?

    so what is the answer? as professionals we should have input on how we conduct our profession. I personally resent all these "like it or leave it" memos that come down from above. i don't think that admin has a clue as to what is actually going on with patients. The mid level managers report to admin what they think they want to hear, not what actually is happening, to save their own hides. Do any of you have free access to the CEO/CNO?
  14. ERERER

    Do You Have a Voice?

    Do staff nurses in your facility have any input in policy making, clinical decisions, etc? In our hospital there is upper management, who get their information on problems on the units from managers. I have read of some hospitals using shared governance to solve problems and make policy. Here staff nurses are not even included in committees that discuss clinical issues and problems, and managers are not relaying accurate information. How involved are staff nurses at your hospital in committee work, clinical issues? We are professionals, after all, and should have a say in how we conduct our profession.
  15. ERERER

    Have your own malpractice insurance?

    always, always, have your own policy. your employer will tell you that "you are covered" by theirs. smile and say thanks. then get your own. more than once, when a hospital has been sued they have turned around and blamed the nurse, then sued her to recover $$$. they do not have your best interest in mind. they have the corporation's best interest in mind. malpractice ins. is not expensive: i have a big policy for $116 per year. access to a lawyer, even if just to run something by. coverage if i give advice to a neighbor or stop to help on a highway. your hospital employer does not want suing parties to know that there are "deep pockets": more than one insurance carrier to go after, therefore a more agressive case. DO NOT LEAVE YOUR HOUSE WITHOUT MALPRACTICE INSURANCE!!!!
  16. In our ER, PT, PTT, INR are part of the cardiac panel (lab tests ordered on all chest pains, SOB's, etc). We draw them on all pts presenting with these symptoms, they are not individually ordered.
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