buckeyeRNED

No she was actually there visiting another patient and decided to check herself in. I later heard her complaining about how little we did to help her.

I love when I'm in triage and see people through the window walk up perfectly fine... but as soon as they get inside they're limping and need a wheelchair. Same goes for when I have an assignment and someone is in too much pain to even undress themselves to get a gown on... but as soon as you tell them the doctor ordered them toradol d/t the fact they've been here 6 times this month for the same symptoms, they walk out AMA completely stable.

I've heard discussion of this in my departent, but I'm not sure it will ever actually happen. We get very bogged down with psych patients at times. The other day, we had 14 psych patients, out of our 31 bed ER. I think we have a lot of system issues with the way psych patients are placed and the fact they have to sit in the ER until then. We typically have about 3-6 psych patients per day, and nobody jumps for that assignment. Personally, I've never aspired to be a psych nurse, and I think a dedicated MH RN would be better suited to handle them than I would.

Anticipate what is needed as much as possible... line/labs/EKG. Ask for help. I try to not make more than one trip places... if they ordered multiple things on a patient I'll try to get them all done in one visit... if multiple patients need things from the stock room I'll get them all at once... if I'm triaging a non-critical patient I'll do a quick assessment on them so I chart it in the computer at the same time. Take a look at your work flow, and see what you can condense. If IV meds are ordered do you start the line, and then go to the pyxis and return to the patient's room? Or do you pull your meds ahead of time so you only have to make one trip? Also, remember to prioritize, and then don't stress about the things that aren't a priority. If you have to get blood cultures and hang ATB on a septic patient, the orthostatics and toradol and charting on your other patients can wait.

It took me a while to realize how hard you really have to sternal rub the drunks to wake them. Lol

I'm confused what exactly you were checking on the label? Uncrossed blood has nothing on the label to match to the patient. Honestly it sounds like a situation where the priority was to get the blood going ASAP and worry about anything else as secondary. Not that I take transfusion reactions lightly, but I would rather treat a transfusion reaction in a live trauma patient, than be prepping a dead trauma patient d/t blood loss. All of our uncrossed blood is O anyway, so the risk of reaction is lower. Coming from an ICU to ED, I know how difficult it can be to get used to things like that, when it's been beat in your head for years that you ALWAYS double-check. But in a true emergency, it's all about prioritizing... sometimes you have to take the big risks because it's a bigger risk NOT to do it. I don't think anyone feels COMFORTABLE doing those things. Whether ED, ICU, or Med-Surg, nursing in general will put you in situations you're uncomfortable with all the time. It's all about how you react, despite feeling uncomfortable, ... which I believe those things just come with experience. The nurse who was backing you up probably has faced this choice before. Somewhere down the road, you'll be in her shoes, coaching someone else through it.

Many of the medics near us will let us know when someone is "triage appropriate". If we have open beds and no one in the lobby, we don't send them because we immediate bed anyways. But it is very helpful when we are full with 15 more people in the lobby. Your STD check can wait in line. Some folks have figured out that they can claim suicidal ideation, and get a bed, anxiety meds, unlimited food, nurses and techs a call light away, a shower and unlimited personal television access until psychology comes to clear them-which unfortunately can take well over a day, especially if it's the weekend. I can see why this is much more appealing, since if you're claiming chest pain we're not going to let you eat or drink until you're medically cleared, which can take hours of tests.

I'm not a new nurse, but new to ED. I previously worked in babyland and have only done compressions on neonates. I'm fairly fresh out of orientation, but helped with a code that was near my assignment. I took over compressions for the nurse so she could do meds and write and the doc started yelling at me that I wasn't compressing deep enough. I don't have a lot of upper body strength, and I underestimated how much force it would take to get really effective compressions. In retrospect I should have gotten onto the bed for leverage, but the doctor intubating asked for a pause to be able to get the ETT in, and when resumed, one of the techs (who typically do the compressions in our ED) took over. They were actually able to bring her pulse back within a few minutes (two successful codes I've seen this past week). I just felt so useless, people were asking for things I didn't know where to look for them, and I just kept thinking "I'm a staffed nurse here. I should know these things." But I just don't, because I never had a full on code situation like that in my orientation. I just feel like I'm that incompetent nurse that everyone prays they don't have if they're in a real emergency situation. Anyway, I'm planning to verse myself better over the crash cart and stock room tomorrow, and I feel like in future situations I will hopefully do better, but I'm beating myself up over it. Part of me is trying to be logical and tell myself, this is how we learn things. But the other part of me just feels like a failure. Please tell me it gets better.

The whole shift-change thing is a lose-lose for everyone. I work ED. We have no control over when our pt gets assigned a bed. I have no choice but to call report if they get a bed at the end of my shift. The only alternative would be to let the next shift call report to the floor on a patient they know nothing about. I get that the floors are busy at shift change, so if they get snippy with me, I just thank them with a smile. I try to do everything in my power to package them nicely before I send them, but as for bad timing, that's just plum out of my control.