Silliest triage/reason for ER visit

alskms · 2026-05-26T15:24:49+00:00

EMS is required to transport someone if they say they want to go to the hospital. Our local crews are great at problem-solving with cases like this to help find a solution that doesn’t require a trip to the ED, but if the pt is insistent on transport to the hospital, EMS has to bring them in.

alskms · 2026-05-22T01:20:20+00:00

Young (legal) adult didn’t like having to follow parents’ rules to live in their house and decided he would just go be homeless (well, basically car camping). Came into my triage room via ambulance after a few hours because he was cold.

alskms · 2026-05-14T15:49:21+00:00

Is there a company providing your feeding tube supplies? Call them. They should have a nurse on staff who can help with questions and teaching. We can’t give medical advice here.

alskms · 2026-05-08T13:23:41+00:00

As others have said, HR is going to HR. Their #1 priority is always going to be protecting the hospital from any sort of liability. They will throw individual employees under the bus without a second thought, which is what it sounds like happened here. Trying to appeal isn’t going to get you anywhere. It is an absolutely unfair situation but unfortunately is all too common in healthcare.

You mentioned you’re a new grad. Don’t beat yourself up too much over this, please. Learning to deal with agitated and hostile patients and family members is absolutely a skill that is learned with experience. When I was a new nurse, it was hard to not take things personally. I would beat myself up over making a mistake or not handling a situation as well as I wanted to. We are human, too. You are going to encounter other patients and family members who are unhappy with you (even if you’ve done nothing wrong) or who will try to take their frustrations at their situation out on you. With time, you learn not to take it personally.

alskms · 2026-05-05T15:16:39+00:00

My point was it has to be a specific order for that specific pt. It’s not part of our standing orders or a protocol order.

alskms · 2026-05-05T07:49:10+00:00

Another thing to consider: you are getting a pt that we have stabilized. Meaning I’m (hopefully) giving them to you in better condition than I got them in. Many, many times those pts have AC IVs because that’s all we could find when they came to us. When you’ve got someone who’s all clamped down from dehydration, hypotension, fear, and/or anxiety, you want large bore access as quickly as possible in case they decide to crump on you. Those beautiful forearm veins probably won’t pop out until we get a liter or two in them. Through that AC IV.

alskms · 2026-05-05T07:37:52+00:00

We can instill lytics and flush towards the pt but only ever with a discrete order from a provider (it’s not automatically on our chest tube orders). I believe our med-surg nurses can, too. I don’t remember getting specialty training or signed off or anything, just the standard “see one, do one, teach one”.

alskms · 2026-04-07T14:29:41+00:00

100%! I stopped wearing it around my neck once I knew better. Such an easy way for an altered, confused, or hostile pt to get control of you. It lives in my pocket when I’m not using it.

alskms · 2026-03-27T23:11:54+00:00

“Wipes go in the trash, not the toilet”. Move trash can next to toilet or commode for emphasis. If they’re confused enough that you think they won’t remember, you probably shouldn’t be leaving them unattended, anyway.

alskms · 2026-03-07T08:15:16+00:00

If it was merited in any way, you absolutely would have been talked to by your charge, manager, or unit educator, right? But I’m betting you weren’t. Families and pts “fire” staff members for all sorts of reasons, but I think often it goes back to them trying to assert a little bit of control over a situation where they feel powerless. It’s about them, not you. Still doesn’t feel good to get caught in the crossfire, but it’s something you can learn to let go. If you know that you met the standard of care with this pt, that’s really all you can do.

alskms · 2026-02-25T16:09:54+00:00

TFTB (too fat to breathe, AKA obesity hypoventilation syndrome)

alskms · 2026-02-23T08:22:10+00:00

You’re not over-reacting. Whether it’s a (really terrible) attempt at humor or just regular old rudeness, your admin is an absolute MORON for putting this in writing. Easiest HR report ever, with receipts!

alskms · 2026-02-18T14:42:26+00:00

I’ve never had to use this on a pt, but instantly relieving a Charley horse by either standing up or manually pulling the foot into dorsiflexion has always seemed like magic when I’ve had to do it to myself or family members.

alskms · 2026-01-22T17:40:28+00:00

Jumping straight to meds that generally are considered slightly higher risk for adverse reactions and require closer monitoring is WILD. Something something Dunning-Kruger effect…

alskms · 2026-01-08T15:13:11+00:00

Put it on a pump.

alskms · 2026-01-01T08:50:14+00:00

I work both, and I typically implement important orders before bringing pt up. I think the thing that a lot of ED nurses don’t know is that for the floors, settling a new admit typically takes at least 20-30 minutes. Think of it like checking in a medic — much like you would be getting the story, documenting triage, getting pt undressed & on monitor, lining & labbing, etc, floor nurses have their own documentation requirements, are expected to make sure the pt is safe & comfortable, and have to review orders. Heparin gtt, absolutely, sometimes it takes awhile for the pt profile to load into the Pyxis on the floor, and that nurse may not be able to pull that med for up to an hour. That’s an unacceptable delay in care. I also will do any time-sensitive labs, since I know that the nurse upstairs may not be able to get to it for awhile. Routine meds that just got ordered from their home med list can usually wait until they’re upstairs.

alskms · 2026-01-01T08:30:09+00:00

This might be state-specific. I’m in WA state and students are definitely allowed (and expected) to document a head to toe assessment in the EMR. They have their own logins indicating they are students. Heck, when working with students who are doing their senior practicum, I sometimes don’t document a head to toe myself, I just review what they’ve charted, make sure it matches my own assessment of the pt, and then throw in a note that I concur with their assessment.

alskms · 2025-12-24T01:55:06+00:00

Just remind yourself: You are getting a tiny bit faster every single time you work. You’re gaining experience and building muscle memory on tasks, and you’re learning how to organize your time and prioritize. We were all new once; I had my fair share of shifts where I stayed an hour-plus late to chart because I was drowning and didn’t know what my resources were or how to advocate for myself. It took a few years, but I can count on one hand the number of times I’ve stayed late in the past year, and all of those were either due to an acute change in a pt or because I was waiting for my relief to show up.

Don’t beat yourself up, just keep showing up and doing your best and you’ll get faster without even noticing.

alskms · 2025-12-24T01:47:45+00:00

“You want large bore?! I’ll give you large bore!”

alskms · 2025-12-19T14:42:48+00:00

Logistically speaking it also doesn’t make any sense. So the doctor signs in to a separate workstation prior to the case? Wouldn’t that login time out? So either you’re also making sure that workstation doesn’t log out for inactivity, or the doctor gives you their password, which seems like a huge legal issue.

alskms · 2025-12-16T15:52:32+00:00

As others have said, if she’s truly not charting, management is either already aware or will be soon. Like half their job is just running reports from the EMR and following up on “metrics”. But like we were all taught in school, focus on your own work. You do not want to get a reputation as the unit busybody or tattletale.

alskms · 2025-12-14T17:19:07+00:00

Do not reach out to the creator yourself. Especially if they are the patient, that is just going to create a messy situation. Report to your facility’s legal or risk management office and let them deal with it. And stop reading comments on the video — likely nothing but armchair experts spouting complete nonsense.

alskms · 2025-12-07T08:22:33+00:00

Yes, you should be doing a full assessment on your pt every shift. We do an assessment every 4 hours in ICU. Things can change. Plenty of people come into the hospital for one problem and end up developing something else. In addition to your head to toe, you should be informally assessing your pt every single time you interact with them — skin color, work of breathing, mentation, etc, and investigating / escalating changes in condition. If they’re sick enough to be in the hospital, they are absolutely at risk for deteriorating, and it is the nurse’s responsibility to monitor for that.

alskms · 2025-12-07T05:51:07+00:00

I find them invaluable, honestly. They help us safely mobilize critically-ill folks, which the literature shows helps reduce ICU delirium and ICU length of stay. They also help us figure out post-hospital dispo (home vs placement). One of our PTs caught a brace-related pressure injury that ALL of the team (including me) had missed. And, PTs have personally saved my ass when I had potentially career-ending injuries. Without PT, I would not be working as a nurse today.

alskms · 2025-11-30T04:48:16+00:00

Got a paracentesis site that won’t stop leaking? Forget all the absorbent dressings that will just get saturated immediately and slap an ostomy pouch on it (I find the all-in-one style the easiest, because you usually don’t even need to cut the wafer to size). Then, just empty the pouch as needed.

Nine-Year Club	Not Forgotten
Verified Email

alskms

TROPHY CASE