CX_EDRN

We've had similar situations with PICC lines, etc. Since our patients are not allowed to leave the floor it's their visitors bringing that crap in. So their consequence is no visitors and our security enforces this. Pisses them off but too bad. Your management really needs to get a handle on this and they especially need to make a more safe environment for their staff. We call PD when people get rowdy and that usually takes care of the problem.

And if we find out that they've snuck out, they're considered leaving AMA.

Wow. I can't believe your facility puts up with that stuff but I also can't believe you have that many long-term patients! We usually have a handful but that's about it. No one is allowed to leave the units, once you're admitted you're here to stay. No leaving the floor, especially with IVs, etc. Our long termers get to walk (with staff) if they're reasonably behaved and not a true fall risk. As far as the nurse who got stabbed? Why was that patient not arrested?! That's insane! I'm sorry you have to deal with all that. Ugh.

I'm going to have to agree with what's already been said. As an ED nurse, we truly get a bad rap for literally everything (including what's not in our control) and while it can definitely be frustrating for patients and their families sometimes you don't get the care you want. Sometimes I don't have time to sit down and discuss things, much less pee. What were her symptoms? What is the recent medical history you referenced? Because as an ED nurse, what you (general you) think is relevant often isn't. I think the take away here is yes, it is awful to wait in the ED for 8 hours but that's just reality sometimes. It sucks but that's what it is. Also, thankfully, she wasn't having a stroke so I am not sure why you seem to be upset about not getting an incredibly expensive stroke work up? Unless I am misinterpreting your post. You never want to be the one we're rushing back. Ever. I have no idea what went down during your mom's stay. I know that at any of the five EDs I currently work as float pool, there is no way she would not have had an assessment by someone, much less not having separate ones by the MD and the RN. If that's true, that is alarming. Now about not getting neuro checks, there are many different ways to assess neuro function and it doesn't sound like your mother warranted a NIHSS or something similar. Also, it does not sound like you were present for this so you are hearing everything second-hand and sometimes things are lost in translation. Also also, our TPA timeline is 4.5 hours. It's definitely regional on the window.

Not surprised at all. Have you ever seen Rose's "VIP" floor? Good grief. Private chefs that make fresh made chocolate chip cookies every few hours. Rose (and HCA as an entity) has no monetary incentive to keep those two practices open but I'm still surprised they're doing it. Probably shouldn't be though.

I can only speak for where I live (not Texas), but we don't consent anyone. I can be a witness to consent, but the MD has to actually consent the patient. If I was asked to consent someone I think I would literally laugh in their face. Not my job! Luckily it's never been an issue.

I've had interop for several years and yes, I love it. I think it dramatically decreases the risk for errors, but like anything else has its own inherent risks. Every single drug given in the entire hospital system is in the "library" so there is no manually entering at all. If a new drug is introduced, pharmacy adds it to the library ASAP so we don't have to manually enter it. I've heard OG RNs complain about it, about how we don't calculate anything anymore, but 1) I always double check the math before starting something (especially with peds patients) and 2) there are some RNs I know who I wouldn't necessarily trust to calculate on their own anyway. Sad but true. When we went to interop there were definitely hiccups. Mainly in the guardrails for drugs as different departments used drugs for different effects, etc. Very rarely do I override the guardrails and when I do it definitely gives me pause. Really our biggest hiccup was the barcodes we used to scan, when the pumps were being cleaned it was fading them very quickly and there were constantly errors forcing us the manually enter everything anyway. They finally figured that one out after a few frustrating months!

If there's a FB page, can someone post a link? I have a deactivated FB that I won't reactivate but I will create a new one for the school page. So it will look like a fake profile but I promise I'm real!

I just received my acceptance email!!! So excited! Good luck to everyone else. :)

Per diem staff is lower than per diem float. Of course everything depends on the system and there are a few big systems and only two independents that I can think of in the big metro areas. In Denver, as staff per diem you can expect mid-30s with 3 years and low to mid 40s as float per diem. But again, it varies with the system and each has its advantages/disadvantages which are my personal opinions and wouldn't post online.

Yeah, you'll definitely make more as a float nurse in Denver but the cost of living isn't that much lower in the Springs depending on where you are. I would not expect you to get $35/hr with 3 years experience but I could be wrong. I hope I am for your sake. :) Memorial is UCHealth and they are known to pay a little more and they also recently got their Trauma 1 designation. Colorado is notorious for underpaying its nurses, especially considering the cost of living in the urban areas.

I can't stand Danskos, my sister was being sweet and bought me a pair for Christmas so I felt like I had to try them. Well, once was enough because I almost fell out of them and face planted while running to respond to a code in the parking lot. Ha. Wear whatever is comfortable, I personally wear sneakers with good insoles in them. I have worn Adidas Superstars since I was in middle school so I have just continued to wear them for work. I buy a new pair in a different color whenever they need replacing and they live in my garage. I get a lot of comments on them and wiping off blood and other body fluids is pretty easy, which is definitely a bonus.

Qualified or not, are you applying for other jobs? I would definitely apply because experience is experience in non-specialty areas. Do you like NICU, etc when you float there? Why not talk to the managers of the other units and see about either getting cross trained or hired on with them permanently? I know you said you want to leave your hospital but you have connections you can use to make yourself more marketable in the future. Put in a year or two on another unit and then leave if you still want to get away. As far as surgery centers, around here you are golden with ED or PACU experience so they may want that where you are too. Being miserable at work is no way to live so I hope you can find something else soon.

That's the first thing I thought as I read your post. You sound like you have a lovely heart and while this patient does need a higher level of care, she is also going to continue doing what she's doing until someone puts their foot down and says no. She has options- trying to reconcile a relationship, selling assets, etc and yet she does none of that. Why? Because she is fine with things the way they are. It must be incredibly hard to lose your independence but you also can't burn out everyone around you in order to keep it. Change your assignment. You have done all you can for this lady, probably more than others would have done.

Honestly, I would be more worried that they are giving a new grad a 10k sign on bonus... That would be a bigger red flag for me. Unless I am reading that wrong? As to your actual question, I think there is merit to med surg and that you can learn a lot about time management and prioritization on the floor. Everything is what you make of it and unit culture has a lot to do with it... which brings me back to the sign on bonus for a new grad and makes me wonder why they would have to do that.

Oh man... This made me giggle for longer than was probably necessary.

I guess I don't know the dynamics of your unit but... yes, it is about experience. One year does not an expert make, especially not in a specialty unit and someone who thinks otherwise is naive or worse, arrogant. I work in the ED and you have to have x amount of experience before you can run a big trauma, x amount before you can triage, etc. You don't even know what you don't know yet. Maybe there is some cattiness on your unit, I have no idea. But if a one year ED RN said to me what you just wrote? Ohhhh boy.

THIS IS MINE. Your adult son/wife/husband/mother, etc. can speak for themselves. SHUT IT. I am not bothered by much anymore but that one still hurts the insides of my teeth. I used to get worked up over the "suck my ****" and the blatant hitting on me but now I just tell them they can't afford me and skip out of the room.

1. I've worked EDs that were separated into different zones and each zone was named either Team A/B/C or Team 1-3, etc. Team A/1 is usually where the big t10/trauma rooms are lcated. I've also worked in EDs that had one big main area that included the trauma rooms and then a separate fast track. 2. We get notifications from the biophone, it's a line(s) used exclusively for EMS. We don't use the verbiage "Code 2/3", we use emergent/non-emergent. 3 & 4. I think you're asking different things, at different times in your career. For starting out and for reference- always and forever Sheehy's. ENPC has its own book that you get with the course and that is required within 6 months where I currently work. There are a ton of sources for CEN stuff, I personally like the Solheim manuals for all the ENA certs.

THIS. I mean, good grief. All the Ativan was there and this should have been used as a teaching moment, which are far more effective than write ups. We have to give each some grace, especially our new grad RNs who are under more stress just because they are still in the initial learning phase. Seems so silly to me.

I work in the ED and we love these! Great for the black out drunks to the grannies with hip fractures. I haven't seen an issue with them being hard to keep in place and we always place a chux underneath in case there is some leakage. I wouldn't use them with someone who was really restless/squirmy though.

I had not read that particular article, thank you! I am pretty familiar with Purdue Pharma and what I consider to be their unethical (at best) relationships with MDs who then influenced JCAHO policy, etc. Hard to comprehend really, but not at all surprising.

Word. I have mixed feelings about this because people are in this position because for so, so long opioids were pushed by big pharma (hellllo, oxycontin!) and labeled as "safe" by JCAHO. Won't get into the politics of all that except to say now we have a literal and figurative mess on our hands. The healthcare industry aided and abetted in this crisis and what the crap are we going to do about it now? I watched a TED talk on chronic pain several years ago and it was fascinating... About chronic pain being a disease itself and showed this amazing example of a girl that sprained her wrist and how it adversely affected her life and then what they did to fix it. It's Elliot Krane and the mystery of chronic pain. It's fascinating. To the OP, I am sorry you're in this situation. I feel that this is going to be increasingly more common in the next few years and I do hope you are able to find a way to successfully live your life opiate-free, or at least opiate-almost free. There have to be answers out there somewhere.

My actual boyfriend does not get to call me on my work line much less a guy that I don't know and have turned down. Repeatedly calling someone at their place of work for personal reasons, regardless of the reason, smacks of immaturity and a lack of boundaries. I would not tolerate it. Not to mention, you've already told him no. Unless it was a cutesy "oh, I couldn't possibly" since he's still calling your work, meaning you are probably sending mixed signals. So either you want to date him or you don't but want the attention since he's not doing it in a "stalking" way (your words). Either way, you've got to figure it out. Sounds messsssy messy messy.

We do the same as others, and this has been standard in the several other EDs I have previously worked. Initial EKG, hook up to monitor for rest of time. Repeat/serial EKGs are sometimes done with evolving CP but the only time we print from the monitor is when we've caught significant runs of something, i.e. VT. But that's not very often because we'll just get another EKG. We also document current rhythm in with VS, minimally q30 for anything possibly cardiac related, i.e. dizziness/SOB.