12/27/11

Nurse Pragmatics: Stethoscope

Now that you have your Christmas monies are you going to upgrade on some of your tools? Some of us are lucky enough we can purchase/replace accessories and tools (stethoscopes) on the dime of the employer. But many of us either have specific preferences, or we don't have the luxury of a benevolent employer--we have to buy some additional stuff ourselves. What are your recommendations for stethoscopes? Why? Background noise reduction? Ones that don't feel as if they're squeezing your brains out? Share your thoughts with the community.

12/19/11

Nursing Pragmatics: Your Shoes of Preference?

There was a time when nursing shoes were a distinct white flat. Before that, a distinct white mid-low heels. More recently the comfortable but the sometime impractical croc shoe was a favorite. (Who wants an open toe anyways?) What shoe do you use at work? The popular choice is of course the day long sneaker. The choice of footwear is important since you're on your feet all day (plus it saves your back). Choices? Styles? Price points? What's your preference. One thing that's evident, if you can swing it try to get some more info on your feet. Even if it's the Dr. Scholls machine at the supermarket, knowing you have high, mid, or low arches impacts the shoe you purchase.

11/17/11

How do Rules and Regulations Affect Your Care?

You've heard the horror stories, patients dying in the parking lot of a hospital, or the front steps, because nurses were bound by rules and regulations implemented by administrators to satisfy insurance regulations, HIPPA, hospital policy, etc., in a litigious society.

The age of "I am going to sue you for everything," has had an impact on healthcare delivery. How have you been affected in your workplace? What are the weird things that you cannot do? Anything that concerns you with respect to prevention from doing an adequate job delivering healthcare?

Anybody have their own story of failure to follow procedures? Note, instead of putting the blame on nurses and other hospital staff, there's an unfortunate reality imposed by hospitals policy and procedure manuals.

What's your experience?

11/10/11

Male Nurses - the Murse

Not a purse, a nurse. We're talking about male nurses again. The profession has always been dominated by women, and still is. But we're seeing a few more males entering the field. THe stigma of an all female profession is slowly lifting.

Some of the change is due to cultural changes where women are no longer seen as the sole primary gender capable of offering care.

How many male nurses are you working with? Have you noticed an increase? Any gender bias in school that may prevent male nurses from entering the field?

11/4/11

California: Hospital Jobs vs. Population

Last post we looked at how employment numbers in hospitals in California faired in the past ten years. for the most part there was consistent upward trends. Why do hospitals continue expanding, and do they expand at a rate of population increase (that is, the number of employed counted as 'expansion' in this post.)

Looking at this graph that look at the percentage change between the population in California and the change in employment in the hospital sector during a ten plus year period from 2000-2011 we get an idea of the trend.



Surprisingly, as population has increased on average of about 1% a year, the hospital sector has grown more. Although we can't conclude how the hospital sector reacts, there is a close relationship between the increases and decreases in jobs to population. If there is a decline in population the hospital sector will respond in the ensuring short term.

Of course, what would explain why the hospital sector increases more than the population increases? Although population may increase in California, it still does not account for the demographic. If there are more older people (which as a nation as a whole that's true) you'll find a greater strain on the health sector. Expect an increase in the number of people who need medical attention and thus growth in the hospital sector beyond the normal population additions.



Data compiled by San Diego Bankruptcy Lawyers derived from RAND.

10/31/11

Employment in Hospitals - California

How many jobs were there in hospitals over the coarse of the past 10 years? A prudent question to ask to see, among other things, whether funding for hospitals has declined, whether the recession has had an impact on the health sector, and how many are employed in the hospital sector.

I pulled up some stats for the nation's largest state, California, and got numbers in excess of 300,000. Since 2000 the number employed in Californian hospitals (not just nurses and doctors) rose 25% from around 315,000 in 2000 to 379,000 last month in 2011.

The sector did experience a loss of jobs in the 2010 period as did pretty much every other industry in the state. Population took a downward spiral during that time as well (all stemming from the 2008 crash.)

Check out this graph from 2000 to 2011 showing number of employed persons in the hospital sector.




So this data is another example of how essential services remain mostly recession proof. Or put another way, there are job opportunities in Californian hospitals. Next post I'll show the relation to employment in Californian hospitals and population.


Data compiled by San Diego Bankruptcy Lawyers derived from RAND.

10/26/11

Nurses Intuition

Nurses develop knowledge, skills, and clinical judgment all of which are accented by experience and reflection. But sometimes you just go with your gut. Now, you may not treat based on your gut, but you may adjust your testing procedures to find a or solve an issue you think is there.

How many of you have stories about your 'nurses intuition' in action?

10/16/11

Technology in the ER - Do Smartphones Hurt Care?

Honest question: are you fiddling on your smartphone phone/ phone at work? Texting in the corner? Checking out the news or Facebook? Facebook on a computer anywhere?

The advent of cheap data and smartphones with snazzy bells and whistles means you can easily get lost in something more interesting than boring patients. OK, maybe it's obvious most of us aren't so flippant when it comes to our jobs, but is it an important issue to address? Do you notice a drop in patient care, or overall care, with added distractions?

Does your unit/place of work have criteria in place to prevent the use of personal electronic devices while on duty?

9/22/11

Schedule Your Next ER Appointment!

What do you think about systems that permit patients to schedule an ER appointment? http://www.ghs.org/inquicker Some hospitals are trying out the online scheduling system. Have you experience anything like it before in your career? Let's not pretend that all nurses are experts in organizational development and management, but what are your ideas to improve efficiency and decrease wait time in the ER? Sometimes the bright spots (What's working) need to be highlighted. Other times the whole system needs and overhaul. Usually the answer is 'more _________' but more __________ rarely comes when asked so what are the highly effective yet simple things you've seen work at improving the ER?

9/17/11

How's Vacation and Down Time?

Taking allotted breaks is important, but frankly let's face it, there are times when a break is rare. But downtime is necessary to retain sanity, and frankly, your health. What types of strategies do you use on the job to ensure you get enough rest to offer the best care you can? Does your job have a maximum amount of hours and shifts you can work consecutively? What is your vacation time and do you take it? I know most of the nurses I know can't wait to take their holidays, so that doesn't seem to be a problem :P

9/2/11

Pay Scale the Same for Nurses?

Any anecdotal evidence that there's pay discrepancies in your hospital/clinic. Generally nurses are paid based on experience. Many are unionized but many are not.

However, there are also reports that there's pay discrepancies based on other aspects such as gender (male v female nurse), schooling (where and how many years), and dare we say--race.

Any thoughts and observations? Or is the system pretty equitable?

8/25/11

Treating Patients Based on Status

Ok, so the title is probably a bit more negative than I would intend, but here's the question posed through a story.

In the ER you see a number of patients who shouldn't be there. Or the class of patients who should be there but delayed treatment because of cost.

There you are, the nurse in the ER, treating your patient. You think to yourself, "man 1/3 of my pay check is going to fund me right now treating this person." You, of course, don't think 'this person', you think, 'this person using medicaid' or whatever term you use.

Some nurses make a point not to check the insurance status of patients so it doesn't impact their treatment. Others can't help but learn a bit about their ptn.

Do you ever think about the roudabout way you get paid and pay for those you treat?

8/8/11

Why Nursing?

Why did you choose to become a nurse? Was someone in your family a nurse? Where you a ER or Scrubs fan?

What made you jump into the foray of healthcare? A bit heart? the money? The change to wear scrubs to work? :P

Assaulted on the Job - Patient Abuse

In the ER you're prone to see more patients of all walks, sizes, and ailments. The highly transient and variety of patients seen also means behavior is less predictable.

How many have been subject to patient abuse? In what form?


What would you classify as patient abuse?

Finally, how has your hospital addressed the concern and what have they done to protect your health?

8/2/11

How do you keep work and life apart?

Anybody take their job home with them? How do you keep the stress and stories, and heck even the patients, out of your mind when you leave?

It's a tough question, and of course you really can't flip a switch and somehow develop short term amnesia.

Any tips to debrief bad days, bad patients, or particularly traumatic days?

7/15/11

Injury prevention tips on the job

save your back! lift with your knees! wear good shoes! nurses, what are some tips you can share on preventing injury on the job?

6/27/11

Scarcity in the ER?

Let's take a quick survey of your hospital: is there a shortage of ER nurses?

There's a different between a shortage and the desire to hire cheaper nurses.

What state are you in and are you hiring ER nurses? Are you always hiring? Is it because of quick turnover of nurses?

Do you find that the upcoming demographic change (more aging nurses set to retire) is starting to open up more positions?

Or is it hard to find a job in the ER these days?

6/24/11

Overworked in the ER?

Are you overworked? Working double 12 hour shifts?

What are you doing, or your unit, to ensure nurses and doctors are well rested and prepared for their shifts? Or what could be done to improve work place conditions? Looking to hear from those who've tried some new things and have found success (or failures)

6/20/11

ER Nurses Salary

Although this is an unofficial survey designed to give prospective ER nurses a heads up of what to expect, but what is your salary as an ER nurse?

Past or present, please include a range of your salary and your state. No need to post your personal details :P

Here is a 'current' estimate of nursing salaries for those with a BSC (seems a bit high?)

6/10/11

Tips for Becoming an ER Nurse

We had a post on brand new nurses looking to jump inton the ER, but what about those who wish to transfer? The ER, that's your dream cause you're a glutton for punishment, (what can you say?)



What can you do to transfer, improve your chances of making a transition, and succeeding in the ER?

Get some courage and talk to your supervisor? Apply discreetly? Maybe you want to be a tech in ER first?

What does the community think? Any current/past ER nurses with experience from their transition?

5/25/11

What is the Most Pretentious Unit?

Be honest. Are ER Nurses the biggest drama queens in the hospital? Yes, ER nurses are front line staff and see all the cool stuff like stab wounds and gunshot holes. But, is there a level of arrogance at the frontline? Anybody encounter ER nurses snubbing other units in a kind of smug "I do more than you're lazy a$$" attitude?

Or are ER Nurses really that cool :D Perhaps the level of stress encountered in the fast paced life and death environment (I mean come on, think of life as seen through the lens of all those TV shows) warrants a level of hubris?

Your thoughts?

5/18/11

Advice to Nurses Entering ER for the First Time?

We'd like to poll the community with a question that has come through the email a few times. For those nurses who have worked or are currently working in the ER, what kind of advice and expectations can you give to new nurses in the unit?

Please offer some helpful advice in the comment section below.

4/27/11

Don't Forget

We're mostly driven by user submitted content. If you have an anecdote about your time in the ER then please send it our way and we'll post it for the community to read. Email to ernursey @ gmail.com

Try to make your submissions at least 300 words long.

Oh yea, we'll send you a free gift card for some free scrubs for your troubles!

3/31/11

Loud Urogenital Symptoms

Here's another entry from a nurse who emailed us at ernurseyblog @ gmail and won gift certificate for a free set of scrubs.


20 year old male and his female companion come to the er. They are c/o of urogenital symptoms. (Translation: had unprotected, dirty sex and are now paying the price)

They get their workup and appropriate antibiotics are prescribed. However, they will not leave without pain medication!

It is explained to them multiple times by multiple staff that they are not getting their requested lortabs for an STD. Take tylenol, motrin, antibiotic as directed. (A bar of soap was also provided :>) Increase your fluids, bath, use a condom and you'll be fine.

Male is getting agitated (did I mention his UDS was positive also?) and is now standing in the middle of the ER corridor screaming "You don't understand...I have a really small pee hole and it f...ing hurts to urinate!"

The elderly gentleman in the next room started cracking up..as did staff! We replied (as we called security)
the size of your penis is a personal problem that cannot be resolved in the ER, please leave now!

3/23/11

A nurse submitted article, part two of a two part series that started here....


.....I went back to my alcove to start charting around 2100. I felt good about that at least. I had already assessed both of my patients and had given nighttime medications. Did I mention this was my 3rd shift on the floor as a new travel nurse, and my 1st shift on my own? The charting system was new to me, so I was glad I had a chunk of time to devote to navigating the charting system.

As I was in the midst of checking boxes and tabbing along, the alarm went off for my patient’s arterial line for a low reading. I looked at the tracing and wondered why it had dampened, when it was brand new that day. My patient still had an EKG tracing, but I went in to check on her to make sure she was okay.

I should also note that my patient was in droplet isolation. I gowned up, put on my gloves and mask and started in to see that my patient was not the responsive, bright eyed, smiling patient that I had come into that shift. I tried to rouse her several times, and then proceeded to check a pulse and did not find one. I called out to call a Code Blue. She had pulseless electrical activity (PEA), which progressed to asystole. I started compressions almost immediately, her frail body surrendering to beneath me. Must. Pump. Hard. It’s an indescribable sensation to feel someone’s ribs moving under your hands, as you try to do the work the heart cannot do itself.

My coworkers ran to assist me, the Code team arrived, someone else took over compressions, someone else gave ACLS medications, and there I was watching (and also providing what I could remember about the patient’s condition and history).

They let her go with just enough effort and called the code at 2133, which was about 15 minutes after I discovered the change. Coming from an open-heart surgery background, I was astonished by the short duration of the code, but also felt at peace
with it. I’ve watched a code go on for over an hour, thinking, when are we just going to give up? There are only so many medications you can give before the body rebels. I’m sure many of you have had this same thought, just know you are not alone.

What I’ve taken away from this experience:

That it can happen to anyone, anywhere.
That nurses are great team players when there is a code.
That my nursing skills transmit to a variety of environments.
And that my gut is never wrong.


If you get the feeling that something is not quite right with your patient, but you can’t put your finger on it, you’re probably right......

3/18/11

Nursing Instinct is Never Wrong

ER Nurse J sent in this story. BTW, all of the details have been changed, in fact, this is a mere anecdote of what could happen in the ER :D.

It started with a feeling. You know, that gut feeling that nurses get when something is about to go wrong. They call it “nursing instinct”, but no matter the name, it’s never wrong.

My first assessment was nothing out of the ordinary. My patient was on the ventilator for recurrent sepsis, and looking to improve. She responded to my questions appropriately, nodding her head yes when I asked if she felt warm, which correlated to her above 100 degree F temperature. I offered her a cool, wet washcloth for her forehead and a fan, for which she smiled. I asked if she had pain, to which she shook her head no. I continued on, listening to her chest and abdomen, checking her pulses, looking over her IVs, and finished by asking her if she was okay, to which she nodded yes. I informed her I would be right outside her room and would be in periodically to check on her. She smiled, but something still did not feel right.

I sat in an alcove between her room and another patient’s, which allowed me to both see my patient, as well as her monitor. In report I had asked about the patient’s ongoing sinus tachycardia, to which the off-going nurse replied, “The doctors know about it. They’re not concerned, and just want us to keep an eye on it.” How many have heard the “keep an eye on it” warning? That set off an internal alarm, when I continued to watch her heart clipping along in the 130’s. Had it been that high all day? As I looked back in the telemetry monitor records, it seemed it had. I knew her heart couldn’t stand much more after all she had been through.

But I was optimistic. Here she was, on the ventilator, no sedation, no pain, completely appropriate with talks of weaning in the morning. But then, her fever went up. It went up a whole degree in the course of an hour. I went back in to check on her, offered her some Tylenol, to which she eagerly nodded, and administered it via her OG tube. I thought, that the fever could be part of her tachycardia, that hopefully the Tylenol would help, which in turn would help decrease her heart rate. I wanted to believe that things were going okay for my patient, but that internal nudge wouldn’t stop telling me the contrary...... part two next week.x

3/12/11

Free Ambulance Ride With Every Broken Nail

This blog post was submitted by a nurse who won a free gift card for her contribution.

Working in the ER one of the funniest things that I remember is the day we received a call that the ambulance was bringing in an accident victim with more to follow on arrival. That usually means they are so busy working on the patient they are unable to call report.

We set up our trauma bay and then got everything set up for any major trauma so those tools were close at hand. As the patient rolls in, Ginger, she's sitting up on the stretcher wailing holding a hand wrapped in what looks to be several towels applying pressure. Several of us enter the room while the ambulance crew asked to speak with the triage nurse outside.

Ginger is crying hysterically and we are trying to calm her down and remove the towels to see what damage has been done. She continues to cry “my hand, my hand” as we get down to the last layer still no blood as we are trying to figure out what is wrong, We hear a laugh outside the curtain as we get the last towel off to see no injury that I can see. I ask the patient what happened. Still crying she replied,
“Can’t you see? You must be blind. I ripped off my nail. I need the rest of it off.
” I look at the nail in question which is artificial and excuse myself from the room. She called an ambulance to bring her in because she ripped part of her nail off did not have the money for gas or to get it repaired and wanted us to fix it for her.

I forgot to mention, I work in a military facility where if you’re a dependent all your care, medicine and ambulance rides are paid by the government. I see so many things that just blow my mind working in the ER. My government dollars at work for things you just can’t make up.

3/9/11

Submit Your Story, Win a Gift Card

We want to hear your voice! Rather than just one or two writers typing away about the ups and downs in the ER, or any unit for that matter, we'd love to turn ERNursey into a collection of voices.

We want to hear from you! If you'd be willing to submit at minimum a 300 word anecdote about your day (changing details, names, etc.) then we'd post it up here.

But wait, there's more!

Apart from being one of the top nursing blogs, we want to reward your contribution!

We've struck a deal to giveaway $20 gift cards courtesy of My nursing Uniforms.

All you have to do is submit an email with your contribution to ernurseyblog @ gmail.com. Include the subject 'ER Nursey' and brief note that you're submitting from the blog.

Right now the first 10 submissions will automatically win (we reserve to reject ones that are obviously fabricated.

Apart from that, help us make ERNursey an online resource for nurses and medical professional to vent, learn, muse, cry, and laugh.

2/8/11

Healthcare per capita


Is it true that America spend more per capita on health care compared to other developed nations. For for a second that we're going to pay through the nose when the baby boomers arrive (they already have), but what about the actual cost of healthcare?

I've read reports that suggests America's per capita healthcare spending is HUGE.

Oh wait, I forgot to add something, we spend MORE for less healthcare. Countries with universal healthcare spend LESS.

Too many fingers in the pie when it comes to healthcare costs.

Which means that universal healthcare, if possible, could be possible at even LESS the money we spend now.

Think about it, anybody given the choice between no healthcare or free healthcare will chose the latter. If you're sick and you run out of money, healthcare isn't a stupid political discussion, but it's a matter of life or daeth.

Plus, we can do it for less money.

Let's assume for a second we can't. We can't do universal healthcare for less money...... but would we do it for the same amount? MORE healthcare essentially for the same amount of money?

Inefficiencies galore is the name o the game in health, and I for one want something done about it NOW before we all wind up in the poor house, or worse.