mountain_rn

WOW. As a former floor nurse, float pool nurse, and now ER i can honestly say that even on a BAD day i never felt like the ER was sitting down there laughing hysterically deviantly planning on how to piss me off by bringing up a patient at shift change. My thoughts are this. If the ER calls report on the patient, and you take it, then that's fair game to bring the patient up. PERIOD. We don't have to wait "our turn" til you get thru with your previous admission, or maybe you are getting another admission so could we hurry up? I've done the floor thing. And i was the "red headed step child" aka float pool nurse as well. Sometimes i'd get ALL the admissions that day because "i made better $$$ than the regular staff, so i should get all the hard work." Yes that's what they'd say to my face. Did it suck? yes. Was it hard? sometimes. But there were PLENTY of times when i'd get 2 admissions within 10 minutes of each other, and have a patient come back from surgery, etc..etc... NOW that i'm in ER, i honestly don't look at the clock. I call report when i'm ready to give up my patient. By giving up my patient, that means i've done all the work and here they come. I try to get them up within 15 minutes of report call, most of the time works, but sometimes it doesn't. I do not transfer patients to the bed by myself, regardless of how busy people are. Why? because ITS NOT SAFE and no one is expected to do a one person transfer, so why should i? i only have 1 back and i plan to make mine last. I try to bring up my patients in clean repair, linens clean, clean gown, with a glass of water if possible. Sometimes it doesn't happen. Sometimes things just don't go as planned, and nothing anyone can say will change that. But i know in my ER we don't "sit around" and plan on ways to screw the floor staff. we could care less what the floor staff thinks of us. I honestly think now that i've been on BOTH sides that sometimes the floor staff or unit nurses need to come spend a day with me in my ER. Try to juggle 6 patients, 3 unstable, 1 psychotic, 1 detox and 2 peds that may or may not have parents available. And draw their labs, start their lines, asses and document, trouble shoot, liason for the doc, assist with procedures. Do i think my job is harder? HEAVENS NO. I think each and every aspect of nursing whether its floor nursing, ICU, or ER has its hard days and stressful times. Who are WE as colleagues to second guess each other and point the finger? I can only assume when i call you that you are just as busy as me, and i try to keep the conversation light. I ALWAYS say "hi Jane, this is Dawn in the ER. I'm calling report on Mr. Smith, are you ready" i usually get a heavy sigh and they say "its now or never" and i say "how's it going down there? you guys keepin busy" then they tell me oh yeah or whatever. Then we ease on into report. It usually calms them down just enough to FOCUS on their new patient coming, and usually are so nice afterwards. They say "thanks Dawn, they are going to 308-1. can you wait about 15 minutes tho? i just got another admit and i need just a little more time." if i can i say sure. if not i tell them i can't and why. COMMUNICATION. But the fact that people still think that ER just sits around waiting to ruin everyone elses day is just BEYOND me.

APRV has allways been a tough "sell" to our pulmonologists in Casper. Often by the time it is considered, usually by the most talented RT's, it is deemed futile or at best experimental. It has been my experience in the past that APRV when employed early and often is helpful in avoiding ARDS or at least decreasing the duration of the disease. Also, while transthorasic flow return issues can be present with high pressures, this can be dealt with, with inotrops if tolerated. Count of the RT to guide this therapy, they are skilled at recognizing sutle and hidin changes in lung compliance. :rotfl:

Anyone who puts there own life at severe risk for a job is foolish. If you are not functioning in a military capacity or have taken a voluntary position with no expectation of harm or death, than it is incumbant upon you to look out for you and yours. I am ex-military, combat decorated and a tabbed Ranger. During my eight years of active military service, I was never asked by a commander to throw my life away or the lives of my men while some officer was in the rear tending to HIS personals. It is absolutely absurd to presume that you must throw your life away because the hospital was unwilling or incapable of managing a disaster situation. Any friggin NP who believes otherwise has NEVER been in any life threatening situation!! I suspect NP has never been shot at, stranded, injured or severly hungry. It is in this regard that NP cannot be judgemental. Perhaps NP's encounter rate for life altering crisis should ramp up a little. NP can then rank herself within the legion of "HERO" in America.

A-Line, TLC, PICC. Also would definatley re-evaluate EBP issues on q30 min accuchecks. Have used forearm in past and have noted BG's to be basically the same.

Hindsight being 20/20, if the cops, fire department and nursing home owners are running like hell, then you should too!

Yep we are both nurses. Its kinda nice, we can talk "shop" or we can talk family and kids. lol Plus we KNOW the ins and outs and can help each other as we need too and know what's going on with the ways to do things in scheduling for nurses. make sense?

The rotorest bed. Yuck, yuck............did I say yuck? Hatch care, getting up on a ladder to assess patients, hatch care, malfuntioning rotator,, hatch care.

I have met a few nurses from the uk over the years, they tell me great things about the level of practice and staffing in uk hosp's. Much cuddo's to you and your peers. P.S. We in America stand by our bretheren in the UK during these trying times. We know the spirit of the english people and believe they will NOT cave into terrorism. We grieve with you and for you. RobC

See above, SurghrtRN post. Not taking anything away from anyone. Not about acting "high brow" it is about protecting our profession, or nurse peers and out patients. If you are regretful, as I sometimes am, about assignments, job duties etc, learn from those experiences and try to grow. Vigilence, mostly an intrinsic trait, can be cultivated in people. It is my belief that a sense of vigilance in ones decision making regardless peer or managment pressure builds confidence. I have actually been told that "we don't have the luxury of 1 to 1 patients". Really? then STOP admitting them, or, better yet, force the managers to decide who lives and who dies. Sounds dramatic, but that is reality in critical care. One to one patients are there, we half to protect them. Be vigilent, be thoguhtful and be confident you are the patients nurse.

It sounds as though you are very proud of the work you did at this hospital and rightly so. However, I am not going to gloss over the clear facts that you participated in profoundly risky pt assignments. While your level of care was clearly expert, even the experts can only be in one place at one time. This particular tact does nothing to improve patient safety or improve the nurses working environment. I too have worked with nurses and surgeons who were profoundly gifted, however I did not and will never take a patient assignment that place not only my license in jeapordy but pt safety and well being. If your hospital is unwilling or incapable of staffing for CVVHD, VAD's or IABP's or they are placing bandaids on these issues then they should stop accepting these patient and stop holding themselves out to be patient centered organizations. They should admit there shortcomings and just live with it. Nurses are the people who drive this commitment, not suits.

No way in hell would I take that!! When I got started in nursing, I felt that as long as I had my stuff straight and was agreeable everything would be ok. However I have since learned that bad behaviour ignored is bad behaviour encouraged. I would'nt take that kind of abuse from someone I know and love so theres no damn way I'll take it from a stranger. If he or she is unwilling or INCAPABLE of performing a needed and ordered task then they should be BOLD enough to defer. It is not a sign of weakness to ask for help. Grow up Dr jerk off.!

No meds, no bolus' no nuttin but normal @ 3cc/hr via transducer. P.S. If you ever have a patient with an Aline, I know it will be tempting, but don't turn OFF the alarms. Seems like common sense right? Turns out its not.

Ummmmmmmmmmm...........................Yuck!

At my hospital, the house manager has his/her own set of priorities. Many times when a patient is on CVVH/CRRT the hosue manager will try to browbeat the charge nurse into forcing another patient on the CRRT nurse. They will typically start out by saying that the patient isnt that sick, or there stepdown status or some other "pitch" to get the patient into the unit. Then when the patient crumps, that charge nurse of other nurses must care for the crumper while the CRRT nurse continues on. What really makes me angry as hell is when a house manager who has never worked CRRT before assumes because your just chasing labs, bags of fluid and I&O's that your really not "that" busy. Finally, if the suits don't like to pay for one to one care then STOP admitting the patients to your hospital and send them to a facility that places ethics BEFORE economics. Peace