Rena RN 2003 4,142 Views
Joined: May 14, '02;
Posts: 726 (1% Liked)
; Likes: 16
wow, broad subject. LOL
i guess i have a system but never really thought about it. it just developed on it's own.
i chart my initial impression of the scene when i go into a room. "pt sitting up in bed. safety rails up x 2. call light in reach. pt. laughing and talking with friends/family."
i then get a hx from the pt or family member.
then a focused assessment with any relating assessment factors. "crackles in bases bil. no lower ext edema noted." or whatever.
then i chart what i did about the assessment. "pt placed on O2. rt called for hhn."
that's the guts of my charting. but i also chart the little things. md to room, to ct per stretcher by rad tech on O2, po fluids given. tol w/o nausea/vomiting, etc.
make the time to chart even if it's "no deficits noted" because that says that you at least addressed the symptoms. a board of nursing isn't going to care if you feel it clutters up the chart. they will want the whole picture of care a pt received.
as far as trauma goes, GCS on arrival, any changes noted, and on discharge is my rule.
traumatic mechanism of injury always gets GCS, resp assessment, and belly assessment. "GCS ___, resp easy & even, no abrasions noted on chest, equal and even chest wall rise bil, BS clear bil per scope. Abd soft, nontender to palp, nondistended, BS x 4 per scope. urine sample sent to lab for eval."
keep your charting short, sweet and to the point but most of all CYA because it's your A on the line if/when that patient crashes. the procedural charting is important but the physical aspects of what you see is just as important. look at your patient.
ink pen, sharpie marker, and alcohol preps in the right scrub top pocket.
PSO packets, carpuject, NS flushes x 3 (10 ml each), and miscellaneous in left.
tape on scope around neck.
PDA and small amount of money/change in left pants pockets.
trauma scissors in right pants pocket.
always in the same place so i can find it quickly.
in our facility, we simply write "patient prefers to take at ________" beside the MD order. if there is a question regarding switching the time, pharmacy calls the MD.
we do focused assessment with more detail the more acutely ill. VS every 2 hours or more often if needed. VS within 30 min of sending a patient to the floor. we chart q2h for all patients and more often if needed. within the next year or so we will be doing computer charting.
the times i've seen poor charting has been with nurses that are new grads or new to the ER. your unit based educator should be addressing your problems. talk to him/her. find examples of good charting and pass them around. if you don't have standards in place, make some. ex: right ankle pain. assessment guidelines: color, warmth, bruising, edema, pulses, cap refill, pain scale, injury, wt. tolerance, etc. intervention guidelines: elevate extremity, ice applied, xray ordered, tylenol/motrin (work with the docs to get premedication order protocols established). then write it all down.
the facility i work with now is awesome about nursing protocols. we have protocols for damn near every c/o out there. if they aren't used, the docs will come to you or your charge nurse and say "what's up? why isn't anything done? why wasn't the assessment done?" etc.
we have had volunteers in 2 of the ERs i've worked in and their duties were about the same. they brought pillows and blankets to patients. walked around to see if a patient needed anything. gave out directions, took people places. they couldn't do anything "hands on" like transporting patients (possible fall risks). basically, they kept the cool and talked to people. a godsend when you have those patients that feel as if they are being ignored simply because the nurse didn't stay at the bedside for their fractured ankle.
i used to work tons of OT. loved the money. that didn't last long before i was feeling overtired and burned out at work.
i can't tell you the last time i had OT. 6 months ago? 10 months ago? when asked to work OT, i simply say that i have a full time job and do not want OT.
definitely enjoy the ride. you will see and do much before you have to make a decision on which area to work. do not go in with a preconceived idea about what you are going to do. gather as much from each area taught by your school and make up your mind from there.
our hospital policy changed to squad stick changed within 24 hours because of sentinel event in which the patient lost an upper extremity due to an infected IV site. before that, policy was to change all IV site q72h regardless of origination of start.
i feel your pain. i just left an ED for those very reasons you listed. good luck...
you deal with this by telling him to speak to you with respect and until he can do that you will not respond. then walk away. if you wouldn't take that kind of crap from your children/husband/mother/father (and i'm guessing you probably love those folks), why take it from a doc (which you obviously don't)? nothing says he has to like your nor you him. but respect is a must. end of story.
i've worked a couple of ERs and yes, you do become close to your peers. i know their kids and birthdays and anniversaries and favorite foods. you don't have to know these things to work well with people. it's all about personal comfort level. share what you want and keep the rest to yourself.
our rotations vary throughout the day, 7 to 7 being the main shifts. there are other staggered 12 and 8 hour shifts throughout the day to cover "busy" times.
ER has many dangers, some hidden, some in plain view. there are the obvious Hep, HIV, MRSA, TB, etc. a person can protect him/herself from those with PPE. then you have the druggie looking for his/her next fix and pissed off because it's not coming from that ER doc on that specific night. so the druggie threatens to come back and slit your throat. then you have the friday night drunk that was given the option of going to jail or the ER because of ETOH. (i've never understood this) so he/she comes in with arms a swinging. then you have your basic unmedicated bipolar and/or paranoid schizophrenic that winds up in restraints because he/she tried to throw a chair through you. then you have the family of great-great-great-great-great grandmother and they are pissed for any number of reasons. either you didn't allow all 105 extended family members in the patient room or you gave too much morphine and she can't talk to visitors or you didn't give enough. then you have the boyfriend of the hangnail patient that is pissed off because it's been 3 hours and she hasn't been seen and "she's in pain dammit and i want to see a doctor in here NOW!!! even though you are working up an MI, GSW, CVA, __________ (fill in the blank with your chosen life threatening disease process).
you know all of these things to be true ahead of time yet you are still willing to work there?
i can't speak for you but i would be looking elsewhere for a place of employment if i had that many concerns before the job actually started.
overtime at our facility is done voluntarily. if there is an open shift, a person can sign up ahead of time for that shift. if there is a call off, we are all called to see if we want that shift (with some $$$ thrown in as incentive).
i work ER and there are times i'll have something big come in the door at 0755 and need to stay 20-30 minutes to finish up a few details. i don't mind that as it doesn't happen often and i'm usually out on time (0800).
i don't mind working overtime at my leisure but would not work for a facility that required mandatory overtime. i generally pick up 2-4 shifts per month if the times work to my advantage. there are times when we work short because no one picks up the shift. generally, someone will "drop down or up" on their own shift to make sure the prime times are covered. if not, we do what we can do with what we have to do with. that means the big stuff is covered and the fast trackers will have to wait.
vote with your feet, canoe, and get the hell out of there fast. if they won't back you on something "simple" like this, you can damn sure bet they will hang you out to dry on something bigger.
the st. joesph's baby ASA commercial?
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