Adenosine_Addict

Unfortunately, comparing military nursing to civilian nursing is impossible. The military doesn't hold any standard of care (we make it so on paper, but staffing is horrible). We have understaffed and overworked everyone and left dead pt's in the wake. The problem is that everyone in medical corps is afraid to say anything (heaven forbid they don't get a dream job assignment). We killed our latest baby recently, so it looks like staffing might improve where I am, but that isn't the norm. 80 hour weeks with no holidays is the norm....or you might get a clinic job working 3 or 4 six hour days each week. Military nursing is unpredictable at best. We have nurses that don't work...and we have nurses that are so tired they can't think. Best of luck to all that think the military is for them.

That's awesome and I'm going to use it tomorrow. I'd love to have a sign up at the triage desk that says "enablers, please tell your loved on not to fake chest pain, belly pain, headaches or a seizure or generalized all-over body pain. Please sign in and let us know if your loved on would like Ativan, Valium, or Demerol and the requested dose....the nurse will be with you shortly." BTW, Paxilpenia is a recognized DRG.

Demerol should be banned for ER use. I worked at a facility that had a pharm policy stating that opiates are first line pain drugs and Demerol is not. It feels waaaay to good to the folks that seek it. Pts state "I'm allergic to opiates, NSAIDS, Haldol" , but it holds a risk of seizure as well. Why risk seizing a pt when you have opiates. Fentanyl or Dilaudid are great ER drugs and don't cause seizures. Encourage your docs to not use Demerol or refuse to give it. I've told every doc I know that I'm not giving Demerol to a pt (with my rationale) and nobody has ever challenged me. For the pt allergic to everything....offer RICE.

I precept many people to the ER. Unfortunately, what you will find is that the more you know, the more you realize how much you don't know. Learn the basics and treat the ABCs. Everything else is gravy. Who cares how long Rocephin takes to go in? If you absolutely must start IV ABX immediately with no reference (a scenario I can't imagine even with Zosyn) start it over an hour and look it up. Learn to know your resources. That is where you make your money in the ER. I don't remember every differential between every disease, but I can look it up. Also remember the big stuff is life saving. The rest can wait. If I had one single pearl for ER it'd be ...."learn the difference between sick and not sick"...and what is the most important thing RIGHT NOW....unfortunately, that doesn't require a checklist...it requires time.

The mention of "the longer you are a nurse...the less you carry" fits me well and I agree. I have my Palm T5 in my pocket, a pen, and my thumb drive. I don't carry scissors because they hang everywhere and I lost the only pair I ever bought. I don't carry tape because I demand that coban be everywhere in the ER. I hate penlights and prefer real flashlights or the overhead light for neuro checks. What would I carry if the technology permitted? Discharge chips. A SD mini to hand the pt instead of writing all of that redundant over and over info we do all day. It would have the entire chart, all labs, all rad studies, and all discharge instructions. I'd settle for a CD of the entire encounter. Any informatics experts...please help change the ER!!

We do peripheral Xrays at triage only with a mechanism of injury/trauma, never a CT (that amazes me), and only medicate with Tylenol and Motrin (we have standing orders for Maalox and Benadryl...but I have strong beliefs against Maalox at triage). Benign hives might LWOBS if you give them a whiff of Benadryl and feel better...but I'll only have to call them back and it makes me more miserable to do paper and calls then to have them sit all day for hives. There is a distinct line that should never meld between being the triage nurse and directly performing pt care. I wouldn't even give the Cipro to a confirmed UTI with no allergies and been on Cipro before for UTI. A UTI is a primary care complaint and if it's bad enough for the ER (like finally ascended and is a rip roaring symptomatic febrile pyelo) then they aren't at the bottom of ESI or "non-urgent" anyway.