Llana87

Amen!!! I could not agree more with this statement!

My experience working side by side with the doctors in the ER has been great. Not only do I learn loads more than I did on the floor, but I also have way more autonomy. Not that I practice outside my scope, but once you get to know the docs and what they look for then you have "protocols" that you can initiate. For instance, giving o2 is something that requires a MD order. In the ER, while we do get an order, we just go ahead and place the O2 on the patient then we mention it to the doctor. OF course, we learn when it is appropriate or inappropriate to administer O2, like in certain COPD patients. We also can place foley catheters, when appropriate (we are trying to keep infection rates down) without going to hunt the doctor down and get the order written first. We just do things in a different order. Fluids is another thing we initiate also certain medications can be started, at least where I work, before the doc has laid eyes on the patient. Examples would be starting breathing tx in triage. Obviously, if you are brand new and the doctors do not know or trust you, it is a much better idea to approach them first. As time passes and you get to know one another an amazing thing starts to happen. They learn to trust you and your judgment! I find that most of the time the doc will come to us and ask our opinion of the case, especially in difficult or interesting patients. We help with their differential and we learn how to spot subtle, yet serious signs, of impending acute illnesses because of the relationships we have formed. We also forge tight friendships and a lot of times we talk on the phone and go out and do things just like we are friends because we ARE friends. Most of the doctors do not act like they are above us. Sure, just like with any other job, it takes time for these relationships to bloom. The doctors, just like other people, are not going to just automatically trust you because you work in the ER. It comes with time and in time you become a partner, not just a nurse working for a doctor. It is what makes the ER so fun and unlike any other place! You are around the providers so much you begin to think like them. A patient comes in altered with noted high BS. We already know what to do so we begin working the patient up. We order labs, may start fluids and even initiate our hyperglycemic insulin protocol all before the doctor has time to write the orders. It becomes autopilot. And no, this is not practicing outside the scope of practice, it is being proactive. It is being present with the MD and going over the treatment plan as you are starting the IV. You get the supplies ready and start them while the orders are being placed. I guess you can call it verbal orders. It really is an awesome learning experience. I also find that there are a lot of times where we save the doctors butts (this happens on the floor too) but they also save our butts! I have worked in several different ERs and they are all different. Some doctors are more approachable than others, but overall, my experience with ER MDs is much more interactive, productive and positive than the doctors I have experienced outside the ER. Once again, I am not suggesting that one just goes and treats a patient assuming they know what the doctor wants. I am simply saying that you learn to anticipate what the doctor wants so that you have it ready when they call for it. You also learn with time, that sometimes what may seem like the obvious treatment for something, actually turns out to be the worst thing that you can do. An example of something I learned through experience would be the way you may treat a benzo OD. Like Narcan does with narcotics; Romazicon reverses bensos like Ativan. However; if someone is truly addicted to benzos it can cause seizures that can be life threatening and difficult to stop. So often times that drug will not be given in a possible benzo overdose because it is hard to determine whether someone is benzo naïve or not. I s it proper to withhold that drug in such a situation? Not according to most books, but according to experience, it just might be. Of course, as a nurse you will not order that drug. In some cases it may be completely appropriate to give the med. This is where having a great relationship with the doctor can come in handy. You will not be afraid to speak up and ask the reasons behind giving or not giving such a medication. I learned this as a brand new ER nurse who was working beside a seasoned, well respected ER doc who was willing to teach me. Later, I was working with a resident who did not know this and when I casually asked if it was possible that the drug would make it worse he scoffed at me and stated that I had no business questioning him and that the nurses he worked with on the medical surgical floor were far more respectful. I apologized and told him I was not trying to be arrogant (which I was not I was simply asking if he heard about such a reaction.) As it turns out, the patient did received Romazicon by a less experienced, new ER nurse (it was not my patient so it was not like I refused to give anything, I was in charge on this particular day) Anyway, the patient did have to be intubated because of prolonged seizure activity. The attending MD , who also happened to be the one who taught me so much, came to me and angrily asked why I did not question the resident's order and why the med was given. This clearly was not a nursing issue, but an issue between attending and resident docs and they way they communicate. The patient did recover though but I learned a valuable lesson. That is obviously just an example of something I learned working side by side with some amazing doctors. On the floor, I simply did not have that kind of relationship and never would of learned that. Most of the time the doctors were so quick to get off the phone leaving me clueless. I know this was a long, ridiculous answer but I just wanted to paint a picture of true teamwork.

Like some other people have stated, dehydration. Most of us walked around dehydrated and do not even realize it. As you know, it is needed sometimes in certain medical conditions like heavy vomiting, diarrhea, hyperglycemia ect. This should be obvious. The other reason I think fluids are ordered on most people, including those may not need it, would be patient satisfaction. Yes, I said it. Most people are so clueless when it comes to what their true medical needs are. If they come to the ER they expect to be served just as though it were a hotel or restaurant. So giving fluids is a good way to make them feel like something was done for them thus hopefully increasing patient satisfaction scores. At least that is how admin views it. Forget the fact that most of the people who make up administration are not medical at all. So that would be my answer. To make the people who waste beds in the ER not feel like that is what they are doing. It makes them feel as though they really "have a bad disease" and gives them something to post of facebook about so that they can "get prayers." Please forget my cynical ways. I have been doing it a long time and that is the answer I have arrived to when it comes to giving fluids to someone with a hang nail. Also, some people truly may need the fluid even if their medical problem does not appear to warrant it.

I hated medsurg nursing too!! Have you ever thought of transferring to the ER? I worked on the floor for almost a year and then transferred to the ER. I have now been an ER nurse for 8 years and I love it! It is def not for everyone but I would give it a shot!

Hello! First of all I am sorry you got wrapped up in that because it was not only unfair to you, the nurse taking over, but MASSIVELY unfair to the patient. So I read that you are not allowed to start IVs in your facility? Is that true? I have never, ever heard of anything so crazy. IVs can be intimidated but after you do a few you realize it is not so bad after all. Plus, it can be a life saving intervention at times. What if this was more serious and no one who was checked off to do IVs could get there? Can you explain to me why this rule is in place? I do believe that while you can cause lasting harm doing an IV improperly, it is VERY rare and I have yet to see it happen just from an IV start. Granted I have seen medications infiltrate and cause a lot of damage. So did they give you a reason as to why they are so strict on this policy? Also, as far as the question goes, I hate when people report other nurses. All too often it seems as though one nurse is trying to tattle on another for personal reasons. HOWEVER; in this case I think that it is necessary because it could of cause a lot of harm not to mention it seems like true laziness on the other nurses part. Not only that, but the charge nurse was involved. Sad. Especially when the IV that the patient had worked just fine, as you mentioned. This would be a situation that I would report the nurse. Plus, it may come back around and you don't want to be in trouble because you "passed the buck" too. I work in the ER and I know ER nurses and floor nurses seem to have some unspoken rivalry. I can understand why but it is sad, after all we are all nurses and deal with the same tough situations. But I am not here to get into that argument. I have worked in the ER for almost 10 years but I will never forget my year on the med/surg/oncology floor on night shift. I was once afraid to do IVs myself because we never had to! Even mediports were typically accessed before the patient arrived to the floor. But one thing I did not do was ignore an important order due to IV problems. If you are not allowed to place the IV because of rules then I would have norified the supervisor immediately. If you ARE allowed to do IVs, it would have been a great time to practice because that is the only way you will get better. Also, in my hospital, the floor calls the ER occasionally (actually probably a little more than just occasionally) to come help start a difficult IV. Most of the time, if we are asked nicely and it is not too busy in the ER, we are HAPPY to help out. I know I am at least. I just hate it when I go up to the floor to start the IV and everyone is sitting around and no one bothers to help me find the equipment or even say a simple thank you. Most of the time that does not happen and people are very thankful. Plus, it helps relationships between departments! Having worked a short time on the floor I respect you. I have no idea how you do it. I was terrible at it! You nurses have a tough job especially when it comes to calling doctors. Most of the time I found I had no chance to form any type of relationship with the hospital docs and they would get so angry if they were bothered by anything. I do not have that problem in the ER. In fact, we are friends with most of the docs and we have a lot more autonomy because of it and that makes the job easier. So I give you all kudos for the hard and thankless work you do!! Sorry to make my answer so long. In short, I would report this, because this is actually not just a petty oversight. This can cause blatant harm to the patient and imagine how you would feel if it were your family member! Hope this helps. Please, let me know what happened! I hope it went well for you!