ER Nurses Blog

What a day! Every day in public health nursing is a new day with new challenges, new faces and loads of obstacles! Having come from LTC – it’s a whirlwind to say the least! After a Holiday and a Monday at that, I begin to wonder if I will ever see the bottom of my paperwork pile… probably not today. The phone rings and another patient need more medication. I place them on hold, just long enough time, that my provider asks me to check the vaccination record. The patient on the phone gives me her number and her pharmacy information – I give her a promise that I will speak with her Doctor and call her back. With that cleared up, I begin to getting the Childs vaccinations, first by checking the child’s name through the state registry. It shows that the child is due for her regular 6 month shots and is due for the flu vaccine as well. I step into the patient’s room and ask the young mother if she would like the flu vaccine. To which I get a puzzled look and an “I don’t kn...

Continued from part one on understaffed and sometimes dangerous ERs in our country here . To pick up from where we left off.... Nurses associations are advocating to end violence against nurses. The Pennsylvania Association of Staff Nurses and Allied Professionals had a conference in early November, Massachusetts Nursing Association is one that has done a lot of work in raising awareness. The Occupational Safety and Health Administration office has issued guidelines for medical centers to address this challenge. However, these guidelines should become enforceable standards. The survey shows that hospitals with a zero tolerance workplace violence program have less than half the number of incidents of other medical centers that have no policy. In Massachusetts, a House representative and a senator have introduced an act requiring Health Care Employers to Develop and Implement Programs to Prevent Workplace Violence. 26 states now have more strict penalties for assaults on nurs...

Seven Mondays in a Week: The Consequences of Society’s Decline in Civility Part 1 Would you look forward to work each day if you knew there was a possibility you would be verbally or physically abused? Emergency departments are experiencing an increase in use by the public. Hospitals are unable to keep up. An analysis of this use points to one unintended consequence of a non universal private health care system. The emergency department of a hospital is the only location in an overburdened health care system where any patient who shows up must be treated regardless of ability to pay. With state facilities and programs for mentally ill citizens, and those suffering drug addiction being eliminated these patients often end up in emergency wards. Visits to emergency departments(ED) for alcohol or drug related incidents are on the rise. Emergency departments are often overcrowded. Overcrowding is defined as all beds in use and the waiting room full for more than 6 hours a day, patients plac...

Patient number 1 is a early 40ish man with no medical history that comes in from his job at a construction site where he suffered a sudden onset of right flank pain. Driven in by a co-worker he is barely able to walk in, hunched over, pale, sweaty, diaphoretic, writhing on the gurney, tachycardic and hypertensive. Shortly after getting to triage he starts vomiting. During triage he seems apologetic when he rates his pain a "7 or 8." Patient number 2 is a twenty something who is brought in from the parking lot in a wheelchair by a friend, they are laughing and talking on their cell-phones when you bring him in for triage. Chief complaint is a twisted ankle. Despite apparently being able to walk to the car at home he is now unable to walk and has to be brought into triage in a wheelchair. In triage his skin is pink, warm and dry and vitals are normal. He rates his pain a "12." Patient number 1 is given Toradol and Compazine IV and has complete relief of his pain. He i...

Let's face it, ER's are crowded and noisy. Despite our best attempts to maintain a patients privacy, when the next patient is six feet away with only a thin curtain between them, it is hard not to over hear what is going on next to you. One night we had an elderly gentleman in curtain area 1 and next to him a prim, middle aged lady. The PA was trying to explain to the man what his diagnosis was but his efforts were being hampered by the fact that the man was very hard of hearing. The problem was something of a personal nature so the PA was trying to be discreet. PA: Sir, you have pubic lice PT: What's that you say? PA: I said you have pubic lice. PT: What? PA: You've got lice down there PT: Can't hear you son, you have to speak up PA: I SAID YOU HAVE BUGS DOWN THERE PT: Oh. Of course we all overheard the conversation, including the prim lady in the next cubicle, who was red as a beet by now. The ER staff, dignified until the end, were draped across the counters shak...

Do you think medication reconciliation works in the ER? Giggles comes in from home. She lives alone with a caregiver that comes three times a week but didn't accompany her to the hospital. She is a very vague historian, has no clue what med's she takes or what pharmacy she gets them from. She gives me her physicians name so I put in a call to his office. Three calls and much time on hold later I finally get in touch with the medical assistant who is finally able to tell me that the patient is not theirs. Close to 45 minutes wasted and still no clue what medications she is on. He last hospital record is from three years ago and she was admitted by the hospitalist then. I could start randomly calling pharmacies but there are 39 of them in the area and that would take hours. Nice mid sixties gentleman comes in with Chest Pain. He knows he takes a blood pressure pill, a water pill and something for his sugar, not the names or the dosages. He gets his med's through the mail from...

We are very concerned about the nursing shortage in America, if the paperwork nurses actually did some nursing, no shortage would exist. 1. Nurses that do not provide direct patient care on a daily basis should not develop policies for nurses that do. (Have you ever noticed how the policies for your nursing practice are written without any input from the people who have to carry out the policies?) 2. Nurses that do not provide direct patient care on a daily basis should not develop forms for nurses that do. (that way a nurse won't have to waste her time putting the VS on the flow sheet and the graphics form and a report sheet etc. etc. etc.) 3. Nurses that do not provide direct patient care on a daily basis should not represent nurses that do in any advertising portraying them as bedside nurses. If you don't do the job, you don't get to claim the glory. ( I don't know about you but I've never seen any of the people who are portrayed as nurses at my hospital or they ...