RN_rescue_ninja

im in also an ER nurse. I believe that for stable, non-critical patients, the no phone-report thing is okay so long as the receiving nurse knows that there is a pt coming, and the ER nurse is going to be transporting / with the pt to the floor where bedside report can be given . Personally, I call report and 9/10 times also bring the pt up.

I wouldn't take home anything that had a pt's name on it, and I wouldn't mention the pt's name as a reference to anyone or for any reason, either. Not going to take a chance violating HIIPA that way...

Insecurity.

True. I've caught maaaaany mistakes by docs that would surely kill patients if I had carried out the orders and not used my brain to think it through.

I was a nurse aide for 3 years before finishing nursing school. I still work for the same hospital. I'm pretty observant. I feel like the NA's attitudes about nurses largely depends on the culture of the unit. For the day shift group, which is what I worked, I very, very rarely felt like the nurses were being "lazy" when it came to tasks that the aides can also do. However, in the same unit's night shift group, the aides felt like the nurses were "lazy" in that regard; sitting around, gossiping, reading, etc. while ordering the aides to do every bit of primary care to the patients, even when the aides were spread too thin. A nurse I worked with recently got a job on nights on this unit, and she agrees with the aides opinions. In other words, on the night shift, the nurse culture was "that's not a nurse's job, that's the aide's job." Call lights going on for way longer than necessary because most of the nurses felt that it was not their job to answer the lights. Personally, I work ED nights where there is a real community effort to ensure all patients needs/safety are met by all nurses and medics/aides, like there was on the other unit where I worked days. I can't imagine prioritizing chatting with other nurses and enjoying down-time over answering call lights and helping pts to the bathroom, bedpans, etc.

There was a pt in med/surg who was confused, had a very distended belly, felt awfully bloated (ended up as a complete SBO) and called 911, screaming "It's gonna blow!!" (referring to his abdomen) and that was at first treated as a bomb threat, until they figured it out.

Maybe this was their [dysfunctional] way of grieving?

continue strict hand washing techniques...good and often. Promoting this to parents, children, elderly, etc. I'm always irked by the elderly people who's idea of washing their hands is running water over them for a few seconds, turning off the faucet with their hand and grabbing a paper towel. They've been doing this how long?

Yes! All this is definitely true. One thing I have noticed (when I have time to stop and think about these things long enough ) is that when the catheter flushes,but does not draw back, it is because the catheter is not an optimal size (i.e. too big). It presses against the wall of the vein tight enough where it creates a vacuum effect and blood either will not come out or is hemolyzed, even if you "fiddle" with the catheter. It's also hard for venous blood to get around the catheter, if it is that tight of a fit. There's articles that are well researched about this, too.

This is ridiculous. it is counterproductive, a waste of time, causing unneeded pain for the pt to name a few. Wouldn't the logical first step to resolve this issue be to have an in-service for the nurses/techs (if applicable) on how to prevent hemolyzed samples from IV starts? BTW, the colored bags are supposed to be the "stat" ones; the ones the lab treats with priority. Another issue with hemolyzed specimins is that it could be from the samples sitting for longer than needed, as you pointed out, also because they are often drawn and the order for tests for them is not put in immediately, so they sit in the lab. The way to avoid this as much as possible is with the nurses putting in as many protocols as they can, to speed things up and not let the sample sit in the lab any longer than what they should. As for pulling the phlebs, this is silly as the ED, being and EMERGENCY department, should have priority, although I can see the argument that nurses can do the sticks, too. I have only been a nurse for a little over 3 months, but I already hate when the "high-up" admin make decisions for the whole hospital that affect the ED, when in reality, the ED is so different (and has to be) that you really cannot apply these principals and make them work in the best interest of the patients. Also, no phelbs on night? What's up with that? Nights are just as busy as days. Your director and charge nurses should be pulling together with some arguments and facts to bring to whomever made this decision, to come up with an alternative.

Talk to the MD who actually ordered this medication. Does he/she have a belief that this patient's episodes are related to pain? Could be the reason for the Norco order. Also, talk with the MD about your observations that pt symptoms/QOL improve with just the anti-psychotics, and go from there.

There still has to be an MD order.

FYI...most states do pretty much the whole shebang electronically; this is a huge benefit to new grads who are anxious to get instant results. In FL, for example, who recently went completely electronic, my pass/fail status was available on the BON website before it was time to pay the $8 to see if I passed/failed with Pearson Vue.

As my mother used to say, "Two wrongs don't make a right". Mind your own, continue on...these types of people have a tendency to weed themselves out of programs/jobs by their attitudes and actions.

"this ER is unique that it have a designated peds ER unit and willing to train new grads in peds trauma" That says it all. You and your patients deserve to have a nurse who has had all the training she can get. Having the Peds ER experience is so excellent in opening doors for you in the Peds unit and in other hospital Peds/NICU units as well!