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Jennifer, RN

Jennifer, RN

ER, telemetry
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married, 4 children, 2 dogs, 2 cats

Jennifer, RN's Latest Activity

  1. Jennifer, RN

    What supplies do you carry on you?

    As a floor nurse, I carried a lot of crap with me. As an ER nurse, I have downsized, now carry stethoscope, roll of tape, trauma scissors (if I haven't lost them), carpuject (the zofran sticks, really) and maybe a flush or two.
  2. Jennifer, RN

    NRB & COPD your input please

    I would place the patient on a NRB at 15L/min, page doctor, respiratory for bipap, call critical alert (which gets lab, xray and extra hands to the room), and get someone to bring crash cart with intubation supplies to have nearby, just in case. The ABG would probably be done after the patient was hooked up to bipap.
  3. Jennifer, RN

    Trauma roon in your ED... who gets it?

    We have 2 trauma rooms. At the beginning of each shift, a trauma nurse is assigned to one of the 2 rooms. She also has 4-5 other rooms assigned. We work on teams though. A team consists of 2 nurses and 1 tech. When a trauma comes in, the other team nurse and tech take over taking care of the trauma nurse's patients. Which means, the other nurse ends up 8-10 patients to care for. Not the ideal situation. But, it's better than no one looking after your patients while your in the trauma room.
  4. Jennifer, RN

    What is your WORST ER story?

    The worst thing I have seen is a woman came in by medics, 38 weeks pregnant, hypertensive 140s/90s, headache, n/v, proceeded to rapidly become more hypertensive and coded within 5 minutes of being in the ER. We were unable to get her back, emergency c-section performed (INSANE!!) and baby coded. NICU got baby back, rushed to the NICU. Pt's husband sat with pt for hours in the trauma room after her death. Tragic! And about 1 month prior to that, same thing, except pt was 28 weeks pregnant, brought in after witnessed collapse, coded in field, brought in still coding, emergent C-section but baby did not make it.
  5. Jennifer, RN

    Questions about ENPC?

    I personally found ENPC quite valuable as an ER nurse in triaging and recognizing sick versus not sick peds patients. PALS teaches basics in resusitation of pediatric patients, but the key (unless pediatric code coming in) is to recognize signs of distress and treat prior to patient crumping. And ENPC is great at teaching those skills. Quite worth the money, IMO.
  6. Jennifer, RN

    Critical care drips

    This is my favorite IV drug book by far. It is located on every PICIS in our ED and I have a copy of my own in my locker, just in case the others disappear. It is not pocket sized, but such a good reference for compatibilities, rates of administration, side affects, and dosages, not only for IV critical care gtts, but for IV pushes and piggy backs too.
  7. Jennifer, RN

    Trauma Room Staffing (not ratios...)

    I work in a Level 2 trauma center with 2 trauma rooms, 1 designated as a pediatric room (but still able to take adult trauma as well). We have 1 nurse assigned to 1 room and another nurse assigned to the other room. On the arrival of a trauma, the charge nurse comes in and tasks and the assigned trauma nurse documents and oversees that everything is going as it should be. The assigned trauma nurse has an initial assignment of 4 other beds plus the trauma room in the event of a trauma/code/etc.... If a trauma comes in, the trauma nurse is, of course, 1:1 with the trauma, so her teammates will watch her other patients (hopefully). The system is not perfect, by any means. To have 1 nurse assigned to all the trauma rooms seems very overwhelming to that particular nurse. I cannot imagine having to take a code and a bad trauma at the same time. I wouldn't last long there.
  8. Jennifer, RN

    Why I'm sick of the ED

    I have a love/hate relationship with the ER. I have learned to do things as fast and safely as I can, whether that means the discharge or calling report waits, so be it. If the charge nurse, or whoever needs the bed that bad, they can get off their tush and do it. A little teamwork never hurt anyone. As for ER techs. There are good ones and bad ones, just like ER nurses. I have learned that if you treat the techs with respect and don't overuse them or abuse them they will bend over backwards for you. I have also been burned with a crappy report. I always get report while reading over the other nurses charting, making sure things are charted accurately, making sure assessments are in, tasks are done, med list put in, etc....
  9. Jennifer, RN

    Pediatric death kits

    Does your ER have some kind of kit for pediatric deaths, with stuff in it like hand print kits, hand molds, lockets for hair, etc...? What exactly does it have in it? How does your hospital handle pediatric deaths? Our ER doesn't get a lot of them, but when we do, it is traumatic for everyone involved. What do you do to try to comfort the parents?
  10. Jennifer, RN

    Administering Narcs and nurse liability

    this is kind of what concerns me. Monitoring patients receiving narcs is a no-brainer for nursing practice in the ER, or at least should be.
  11. Jennifer, RN

    Administering Narcs and nurse liability

    The patient in question was getting 2mg Dilaudid IM at a time, but got 5 doses, totaling 10mg over about a 2.5 hr period. The patient was narcotic dependent, so her tolerance was high, I'm sure. She was properly monitored by her primary nurse. Just want to make sure that we as nurses aren't going to get in trouble when doctors dole out pain meds.
  12. Jennifer, RN

    Administering Narcs and nurse liability

    So, after a co-worker expressed concerns about one of our ER doctors prescribing high doses of Dilaudid to a patient with chronic abd pain with frequent visits as well as a couple of past visits for polypharmacy drug overdose, I started wondering what our role as the nurse is and what liability do we have. The patient in question was receiving IM injections of Dilaudid, being continuously monitored on pulse ox and bp (as is our routine for anyone receiving narcotics in the ER). So, on the nurse's part, she was doing her job of assessment and reassessment of the patient. Do we as nurses have any say or rights when it comes to narcotic administration that seems inappropriate? Any documented cases that you all know about where a nurse was found negligent for administering large amounts of narcotics?
  13. Jennifer, RN

    Hyperkalemia and order of meds

    I agree. Highest K+ I have seen is 8.6. Pt was weak and bradycardic 30 and 40's. As soon as I gave the Calcium Gluc, she immediately went up to heart rate 70's. I always give D50 before insulin as well.
  14. Jennifer, RN

    Are ER nurses burnt out or just uncaring??

    Where I work, if you come in on a backboard with a c-collar on, it is standard practice to take the patient off the backboard immediately even before a physician is present and leave the c-collar on. Unless they are a trauma or are complaining of severe back or neck pain. Then we, the nurses, go get the doctor to get the pt off the board. Being on a backboard for 4 hours is completely unacceptable, and almost unbelieable.
  15. Jennifer, RN

    How do you triage? How do you assign levels?

    Agree with this except I would probably bump the SO2 up to 95% for kids, since they really should be in the upper 90's. As a triage nurse, you have to look at your patient and make quick assessments, based on initial vital signs as well as how the patient looks and presents themselves. If in doubt, always triage up a level. Triage can be tricky.
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