Showing posts from 2011

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.

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?

Floating ER Nurses

Interesting dialogue I was following at allnurses.

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?

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?

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?

Schedule Your Next ER Appointment!

What do you think about systems that permit patients to schedule an ER appointment? 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?

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

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?

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?

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?

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?

The Horrible state of America's state funded healthcare

It's not good. Period.

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?

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?

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?)

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?

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?

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.

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 @ 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!

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 hurts to urinate!" The elderly gentleman in the next room started cracking did staff! W
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 sh

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 che

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 outsi

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 hea