scubanurse

I'll ditto what Doc said. It really depends on the type of transfer done, company policy, and personal practice. There are frequent fliers where I work that I don't go through every single part of the admission history with them because we all know it well, we click through that part of the record. Yeah you should always do a full assessment, but again that's dependent on personal practice and your company policy. Some companies allow for a focused assessment only and VS. I also agree that once you assumed patient care, you assumed the documentation for that patient and should have documented the violent outburst in the record. Sorry kid, you can be at fault for that one. I would try and wipe that transport out of your mind, you did your due diligence and talked with the partner and supervisor and neither seemed concern. Try to move on and not let it affect future shifts. As for the new partner not listening to the FNG, unfortunately that happens a lot in this field. Doesn't make it right or ok, but it happens. Slowly she'll start to realize you know your stuff, or not, and a partnership will develop. When I was a new ED nurse, my charge nurse wouldn't listen to me one bit, she would but in on my patients and give her opinion constantly. Eventually she learned that I knew my shit and left me alone. Sometimes the more experienced providers feel responsible for your actions as a FNG and that's why it may seem like they aren't listening to you. Rather they just want to make sure nothing gets f'd up.

Sometimes people may be asymptomatic but their EKG is telling me otherwise, should I ignore ST elevation or extremely peaked t-waves? How about multifocal pvc's the patient is oblivious to?

Welcome. I've always used a leatherman multipurpose tool and so has my husband. Having screwdrivers and such comes in handy sometimes and they're small enough to fit on my belt without being bulky.

I agree, the tracings are too hard to interpret because of movement. I would have obtained a baseline 12-lead on scene as they are notoriously inaccurate in a bouncing ambulance. Just curious, why did you place a c-collar, was there midline tenderness?

I second Mike... don't buy a gun. I would get a different doctor, but not because of the Valium, more to help with your mental state. And probably a cardiologist for those chest pains. Also, don't be a dummy and mix the valium with ETOH... you provide too much amusement to this site and you'd be missed.

Great, I'm heading into work

Welcome!

The most recent I have is from 2011 when my husband went through....mine is from 2006 so it might as well be a door stopper right now.

I think sometimes employers factor age in, but it can go either way. I have a colleague who has the same time as a RN, BSN as me, we had similar GPA's from comparable schools, and same employment history. I got hired for a hospital position over her. Catch was, she was 58. I think employers look at your longevity, and see a 27 year old employee as having at least another 30 years of working ability versus someone older. Conversely, younger employees (mainly female) are likely to have kids and not come back to work or come back part time. So it's all a balance. I agree with what mikey said in an earlier post, sell yourself in the interviews. Sell why you would be a better employee than a young buck. Best of luck to you!

I've had a med error while a nurse, never in EMS though. I gave Fioricet instead of Fiorinal (GASP!) the patient was fine, the provider wasn't upset but I have seen some tragic medication errors. One nurse gave 160mg of Oxycodone to a patient and it had the potential to be tragic. I also know of a nurse who didn't call in a PT/INR and the patient died of DIC.. pretty extreme. Most hospitals I know have a non-punitive response to med errors to encourage their reporting and monitoring. There have been several safeguards that I'm not sure would work in EMS. After my medication error, I slowed my med passing down a bunch, took time to double check the med I was pulling against the MAR and review the 5 rights.

I remember her as well, we talked in chat often. Thank you for sharing the news, condolences to her family.

I'm guessing they took the blue trach collar tubing and placed it directly over the trach instead of just placing the collar over the trach, that would allow her to breath in the O2, but not breathe out CO2 if it's a cuffed trach. I can picture it, but not sure if that made sense. I feel like when the medics were wheeling the patient out, someone should have noticed?

It's true ruff. I had one medic argue with me over what the patient's baseline was... I have only cared for this patient 36 hours a week for the last 6 months, and you just spent 2 minutes with them. I think I would know their baseline better than they would.

No worries. I know the good facilities are few and far between. I just like to remind people that there are still some decent NH/LTC nurses out there

I have to agree with ruff. Basing on NH nurses isn't always the answer. The facility I work has mostly BSN nurses so we aren't idiots. I have fought time and again on the phone with doctors when they just want to send a patient out for no good reason, but ultimately, I have to listen to that physician. If they give the order for the resident to be sent out then we have to send them. An example: I call physician to get haldol orders for a combative patient. This is common for the patient and the regular doc has decided to just rely on on-call for orders when they get like this instead of a standing prn order for IM haldol. I get some random on-call doc who was not with the program and refused to order IM haldol and told me to send the patient to the ER emergent for altered mental status. I tried to get different orders, but ultimately I had to send this guy out. It sucked. I called the ER and talked with the charge nurse and explained the situation, patient rolled in combative, ER doc gave IM haldol, wrote an order for 48 hours of IM haldol q6h and called it a night sending the much calmer patient back to us within an hour. We have a great relationship with our local EMS and ER's so this worked out. I know my facility isn't like most LTC facilities though as we have PICC lines placed and have several patients on vents, but sometimes it isn't on the nursing staff.

HIPPA...

congrats!

Keep it up girl!

Now that's a big gulp.

Very cool!

neat! My old county had a mobile triage bus that could transport 20 something patients on cots with O2 hook ups and all the equipment for a MCI.

Thanks for letting me vent and joining in guys Our facility has vent patients and so we manage A LOT in house. We have a company that can come place a PICC line, we do a majority of the management in house so for us to call EMS is a big deal since we hate sending patients out. In this particular case my patient had quickly become septic and it wasn't something we manage in house because we don't have the 1 on 1 resources an acute ICU has. That's a good idea Mike about the compression sleeves, I know a few nurses who use them and I might look into them. I have a hard time saying no so I end up working 60-80 hrs a week and last week worked 6 12's straight. With my crappy joints, awful hip, and now sore ankle, I think I need to cut back some.

After a marathon 16 hour shift last night...in at 1430 and off at 0630 the next day, I have come up with a b*&%$ list that I'm going to share... I wish I knew... How much my feet would be hurting at the end of a shift How much I despise the sound of call lights How much I can't stand being asked for pain medication on the exact 4 hour mark for a q4 drug, only to go in and the resident is sound asleep How much I dislike the smell of c-diff How much my feet would hurt...omg How much I feel like a drug dealer and not like a nurse How crappy EMS treats me when I call them for a very sick resident How much that really bugs me and makes me wish I were still in EMS That's all I have now, time for a drink, a hot bath, and my hubby to rub my feet OMG they hurt.

you tell us research is your friend! And yes, p-waves have to do with the atria, but what about the atria??

Rate looks borderline for a junctional rhythm though... I see no p-waves but I can also see where you think they're inverted.