joyful_wanderer

Ok, so my hospital recently lost its manager and director for the ER. In the meantime we have some intermittent ones but things are just changing for the worse and the work environment is not safe. For instance someone from the management team decided to stick a nurse in the waiting room in a three walled cube to register patients. The problem is that the open side is completely open to the waiting room and all the patients coming into the ER. The nurse has no escape route what so ever. The walls are almost 6 feet tall so completely easy for the nurse to get trapped by an aggressive/ violent patient or even worse an active shooter. Second we are over run with psych pts which I realize is a nation wide problem but our solution was to take an old utility closet and pack it with chairs. There is only one entrance/exit that our security guard sits at. The room is maybe 10 feet long and 5/6 feet wide. We stick between 4-6 patients in this room with no space in between them. Male and female. This cant be safe right? At least most of us don't feel safe about it. We have voiced our concerns to our interim management staff as well as hospital administrators but nothing has changed and it has now been months with this set up. Who else can we go to?

RNGummy I love the way your unit is set up! Ours seriously was an old supply closet that we emptied out and placed chairs in it. There are no doors and its down the back hallway of the ER. Its a horrible set up. Pts try to run all the time and they feed off of each other like piranhas.

Phones cause so many issues!!!

So I realize this is a nation wide problem and I wasn't sure which specialty to ask this question under but my ER sees a LOT of psych pts. Mostly are honestly drunkacidal but the police bring them in on holds and then we have to keep them until they are sober enough to be cleared by our behavior health team. The other group of people we get are meth patients that our brought in for odd behavior and SI statements as well and we have to hold them in our ER. So here is the issue for my department. We have no set protocols or standards as to what to do with these pts. We place them all in chairs in a room and let security watch them. However, there is constant debate as to if we should get them changed, or let them keep their phones, or if we just need to take their backpack/bags away from them while they are there. It is all provider dependent. I cant even tell you how many times in the last month we have caught patients shooting up with meth/heroin in the psych room or BR. Any way, I spoke to my manager and am creating standard protocols that will apply to every patient being brought in for psych/SI/HI behavior. I was wondering what are some practices that others have at their facility or protocols that you follow when getting in a new psych related pt? I have always come from ERs where everything is removed and given a hospital gown and no access to a phone until seen by BH. Any advice is appreciated.

We have them but there are no reviews and the trauma program manager has never worked in a ER or doing trauma. So far we have no requirements, or training for the trauma nurses. Its kinda watch one, do one. Its horrible. The last trauma I went to assist with had two ER nurses who "just finished TNCC" and this was their first trauma. I work ER and ICU. For the traumas we have an ICU nurse come down to assist with the level 1 infuser, massive blood transfusion.

Honestly, I started seeing a therapist. I was at a point where it was hard for me to even get out of my car to go into work. To those saying that you are not a judge, to leave it at work, just make money what they are forgetting is that you are a person. As a person you have feelings and emotions that is what makes you a human being. The best thing I have learned from seeing my therapist is relaxation techniques and meditation. You can find some on your own without actually having to see one but it has really helped me. Take a deep breath. Release the tension. Then re-evaluate the situation. For some reason as nurses we seem to think that we are impervious but in reality our patients and our experiences can slowly chip away at us.

So I took the GRE and did horrible. Verbal was 150 and Quantitative was 131. Yikes! But regardless I have actually been offered to interview at two schools so I guess they look at the whole picture and not just the numbers (-: Granted I haven't been accepted anywhere yet.

Hey all, I was just wondering if anyone had some suggestions of questions I could ask for our trauma team evaluation. We are technically a level 2 trauma center but our trauma activations and resuscitations are kinda falling apart. We have had a lot of turn over lately and talking to staff people are really frustrated with how the traumas are run. There is lack of communication, poorly defined roles, confusion. The most recent one was a trauma --> PEA ---> coded and then called. Afterwards it was noted that the patient was never given fluids. Another one was a resuscitative thoracotomy in our trauma bay versus the patient being in the OR. The room is stocked with surgical trays but the ER nurses don't know any of the items in the trays. Anyway, Im trying to create a survey (we currently don't evaluate the traumas afterwards either) for the nurses to take in order to get better feed back. I was just wondering if anyone had suggestions of questions or if you have done something similar for your hospital.

I feel that we are in the same boat. That section is probably my worst area. At least in school I had time to write my papers way in advance and spend time re-writing them. I'm really slow at it. So far I have actually improved on the Kaplan practice vocabulary test from 40% to 75%! So I'm starting to have hope.

I've been doing the Kaplan review but have not had very promising scores :-| I guess I will find out if I get in or not with a low score.

Thanks! I have a test date scheduled. Just dreading it.

To answer my own question. I took the CCRN and passed! I know the test is not graded on a percentage but I got 82% so pretty close to the practice test. The questions were pretty similar in format and difficulty.

I was wondering as far as applying for CRNA programs if people got in with low GRE scores. I haven't taken it yet but test like this have always been my weakness! I know the schools look at the overall application but when it comes to core academics like language and math I am horrible. I always have been and have always struggled with it in school. I am dyslexic and have other learning "disabilities" which don't hold me back except when I am being tested on it specifically. On the positive side I graduated my ADN program with honors and my BSN program with honors. I have my CCRN, CEN, and CPEN.... My biggest fear is not being able to fulfill my dream because of my academic weakness.... and really only is an academic weakness. Also, are there any SRNA that have learning disabilities/dyslexic? I was just wondering if you found it to hold you back or have you been able to use it to your advantage and work around it?

Just wondering if anyone has taken the AACN CCRN SAE and the CCRN and how the two compare. I realize the SAE is only 60 questions in comparison to the 150 on the real exam but are the questions pretty comparable in difficulty? I did the SAE and passed with an 83% after listening to the lectures the AACN produced. Im debating if I need to study more or just scheduled a date and take the darn test. I know I am weak in cardiac since we don't really do that at my ICU and as for invasive monitoring we only really use art lines and cvp's...... very rarely even ICP so those were areas I kinda flubbed on.

Just wondering if other hospitals have requirements for their nurses to meet in order to be on or apart of the trauma "team"? I work at a level two trauma center right now and currently the only requirement is to have TNCC. The nursing memebers of the team is 1 ICU nurse and 1 ER nurse. Recently we are discovereing that perhaps we need to have more requirements or expectations such as at least 1 year expereince in either ER or ICU, be able to demonstrate ability to use a rapid infusor or set up equipment. Also, do most hospitals have ICU nurses attend the traumas? Im used to the ER nurses being the primary team members. Just wondering and any advice would be appreciated. I've been tasked with trying to build a stronger team between departments and not sure where to start.

Interesting about it being called Spike.... another name to look out for. Yea its intersting to see who can just sleep it off and who ends up with organ failure, CHF, or violent. I asked a patient why they use it knowing that it can be so dangerous and his response was that it was cheap.

Anchorage Fire and Spice

Incredible. I guess that is what the FD and PD here are concerned about happening is having a group spice use with people seizing and arresting while on the other end of town a mass casualty event occurs. There are only so many units for our area and only three.... well four hospitals if you count the base.

Wow. I can only imagine. Thankfully so far most of our population is older (but they can still get pregnant!). There are a few college age kids every now and then.

We have seen some that have resulted in pulmonary edema as well. However, its hard to say if it was just from spice use or the final factor. Most of our abusers are homeless and already polysubstance use as well as chronic alcoholics. Most that we see are as AZQuik has stated. The IM injections usually ketamine or versed are given by ems in the field if the pts is violent or aggressive. Sometimes they are intubated in the field because they are no longer maintaining their airway. We continue with the same meds in the ER IM or IV. It just depends on what part of the cycle they seem to be on. However, propofol seems to drastically drop their BP more than expected and most dont hemodynamically tolerate it at all so we have used a lot of precedex for the intubated ones. Or precedex drips on non-intubated ones just to keep them calm for a few hours till they can follow commands. Ive noticed the ones that end up in the ICU for longer stays are the ones that seem to already have some untreated infection like pneumonia or UTI and were probably already getting septic before the spice use. Otherwise the ones that end up intubated remain intubated between 4-8 hours usually and can be extubated in the ER and discharged. Its just crazy and it takes up a lot of resources.

Tis true about not being confirmed as spice or actually where they got it from and what chemicals its been mixed with. With peoples experiences so far do you find some meds seem to work better that others depending of if they are acting as if on PCP vs a sedative? We have found with the wild crazy some started them on propofol of 5mcg/kg/mg sometimes seems to just totally crash their BP and then end up on pressers. Its had to pick the perfect meds when you don't know what you are dealing with. Versed and ketamine seem to work for mild cases Anyone with a different experience or what seems to be working in your department?

That is crazy! Mostly have been seeing it with the homeless and young college kid and an occasional Jr high/high school kids. But it probably wont be long till we see it with pregnant moms. How sad.

Seriously! Why cant people just stick to things we know. Does your facility have any type of protocol in responding to spice or just treat symptomatically?

Yea I saw that post! I guess what we are experiencing here are group spice usage where there are 8-15 people at a time. Of course as you know they just drop, or start seizing, or just go bat **** crazy. Sometimes all of our ambulance for the city are on scene for these group calls. Supposedly one of the batches that was tested here had properties similar to water hemlock which somewhat explained the seizures we were seeing. Just wondering if any other cities/states have done their own chemical analysis. I know there are numerous different types and you can even buy it off of Amazon.... along with Hawaiian Baby Woodrose seeds. Also, I was wondering if any other emergency departments have created a protocol or standing orders (other than symptomatic treatment) for responding to spice like we do for ETOH intoxication or withdrawals.

We have been receiving dozens of spice patients recently who have been holding up beds in the ER and ICU. Just wondering if any other areas have been seeing the same increase in usage? There are three hospitals here in Anchorage and our EMS often responds to calls of group spice usage and treating it as a mass casualty event.... a few usually end up intubated. Its eating up resources and burning out EMS and ER staff. Episode 27: Spice Roulette | Frontiers | KTVA Anchorage CBS 11 Spice: Street drug continues to plague Anchorage homeless | KTVA Anchorage CBS 11