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  1. So I have to throw these meds away when you leave. But I’ll set them on the counter well you get your stuff. If they are gone when you leave I’m sure housekeeping just beat me to them…

  2. I straight up tell people we are short. It’s not my fault y’all didn’t hire enough staff and I’m not getting chewed out for something I didn’t do. So yep it’s jus me. We are super short and I have no tech so yes your juice didn’t take me long but it was the least urgent on the 15 tasks I needed to do. Yes the wait time is 20 hours because we don’t have enough beds and they don’t have staff upstairs to get people admitted. I often tell people we are doing our best in a broken healthcare system. I agree it’s shit but all I can do is take the best care of my patients possible.

  3. Don’t blame yourself. It got caught. That nurse can stop being holier than though. It’s the triage nurses job to assess the patient too but just take your assessment blindly.

  4. Because a large number of your enemies aren’t “average” and if you are walking by a group you are bound to have a few with passive wisdoms over 10

  5. Most creatures don't have Perception proficiency, and very few have a 20+ Wisdom. Passive Perception for most creatures is rather low.

  6. But that’s not including proficiency or the observant feat.

  7. Honestly peds and adults are two different worlds. If you don’t want to take care of adults there isn’t much help in working an adult med surg floor first. It used to be necessary to work med surg as your first job but given staffing that’s not really the case anymore. It’s an old school way of thinking, don’t let it bother you.

  8. ^ this is the stuff they should teach in nursing school not stupid care plans! Thanks for sharing!!

  9. 100% I played one for a one shot because I liked the vibe but it was so overpowered. My DM and I reworked it so that the two twilight aura still granted advantage on saving throws against being charmed or frightened but instead of the continued temp hp, I could use one reaction to heal another character 1d10 + my cleric level. That was you still have a cool ability but it doesn’t just negate all damage.

  10. I would look into a PA over an NP given that you don’t have a nursing license. All NP programs I know of require a nursing license first and NP education is built assuming you have an RN license. I’m in NP school so I’m not an expert but that is my understanding. You can try to reach out to programs for more information and they can probably give you the official answers.

  11. The ER is a lot of hurry up and wait. If your hospital has beds (and pray that it does) you stabilize and shop out. I’ve had days where I work more critical cares than I thought possible and days where I have none. There is a lot of puzzling through what could be going on a with a patient and how to fix them. With all that being said, you treat everyone that comes in the door including the person who stubbed their toe. You can to be ok with not always having the most exciting patient all the time. With that being said, I find that most of the time by the time patients go to the icu it’s already clear what is going on and some of them are there for close monitoring (this varies greatly from icu to icu). I also like the fact that you see different patients everyday (you get your regulars but you typically don’t have them all shift). It also really depends what ER you are at. I work at one that’s a lot of worried well followed patients who are often very medically complex and another where people come in incredibly sick but they tend to be more straight forward.

  12. Yeah that's what I do. Problem, in this particular scenario, is that the patient's family literally already knew all of that.

  13. Sometimes I think people just need to hear that again or hear it’s not getting worse. I know for you the update is just there is no change. For them it’s some hope that even if things aren’t getting better, they aren’t getting worse either.

  14. I’m sorry. I’ve been there. It’s not ok. It’s not safe. Every inpatient floor gets to refuse patients when they don’t have staff. I get it, it’s the safe thing for them and their patients but we never get to refuse another patient. Honestly that’s one of the most difficult things about working in the ED. I’m sorry. I wish I had advice or something I could say that would help but it’s shitty every time.

  15. I did but only because we had a house rule to reroll ones. Meaning the odds were 40% below 4 20% 4 and 40% above 4. Plus it makes it more fun to roll!

  16. Tbh I’ve found it to be a mixed bag like any other specialty. Some great ones, some terrible ones. Tbh I think the fact that residency is 7+ years gets to a lot of them.

  17. Channel Cad from critical role. Very good at reading people but very isolated and not knowing much about the world.

  18. Yep. It’s not uncommon. Now you have to wait in back of the very long er line to get a note just because your work wants it. It’s going to be a huge bill and a pain for all of us. It’s not a quick process because we have tons of patients to see who actually need treatment. I know it’s not their fault their work needs a more but it’s a waste of everyone’s time.

  19. In my opinion a lot of it comes from miscommunication and misunderstanding. When I worked on the floor I thought I was rude that the er sent us patients at 6pm. It happens because patients don’t get discharged from the floor until 3, the beds don’t get cleaned until 4 maybe 5 and then you can’t put in for transport until 5-6 and then there is a long line of people waiting to be transported. Additionally, it always feels like the emergency department is trying to push patients up to the floor as quickly as possible. This is true but it doesn’t come from a place of rudeness it comes from the need to get people upstairs to not get so overwhelmed but the 40+ person waiting room. I also find a lot of the floor nurses don’t realize that we are timed ok how quickly we call and how quickly we get patients upstairs. I got yelled at by a floor nurse the other day because I kept pushing to give report. The first time I called do was told one of her patients chest tubes was removed. Ok no big deal I’ll call back in 15 minutes. I called back too more times and kept just getting told “she’s busy.” Unfortunately we all are and I still need to get this patient up to y’all. It turns out her patients chest tube FELL OUT. No one told me they just got mad when I kept trying to give report. I told the nurse to let us know next time. I can delay things and I’m happy to work with you but if I don’t know I can’t help. I am happy to delay sending people up for emergencies on the unit or to keep everyone safe but if I don’t know I can’t advocate for you.

  20. ER - AAAs you don’t get much (if any) warning until they crash and burn, same with cerebral aneurysms or SCADs

  21. Let me guess, you work in the er, right? You can’t make this shit up

  22. Someone in the hospital can’t keep up with their shit/hospital decided to downsize staff, their solution: “nursing can do it!” No no we can’t.

  23. It’s been this way for a long time. We have been screaming. This didn’t start from Covid but Covid has certainly made it worse. We are trying I promise but we are all working in a broken system. I’m an emergency nurse and right now we are in a shitty holding pattern. Inpatient doesn’t have enough beds or staff so they can’t accept more patients. That is reasonable and safe, unfortunately I’m never legally allowed to close the emergency room doors so people keep coming in. The system is overloaded and it feels like there is no help coming.

  24. On a few occasions when I was sending a patient to the floor, they jokingly asked if they could take me with them.

  25. I had a patient ask if they could take me home with them when I was discharging them home from the floor :) no thank you I’ll stay here but it’s always very sweet

  26. I had a post arrest patient the other week. He was in talks with palliative care but still a full code and was still processing his diagnosis. He coded at a snf and was brought into our ER. We got a plus but he ended up intubated, lines, the whole nine yards. Family came to bedside and it was their first time seeing him like that. I was lucky to have an assignment where I had the time to spend some extra time with them and talk everything through. When we transferred him up to the icu his wife said “you made a hard situation a little easier” sometimes that’s all we can do and I think it’s one of the best complements I’ve ever gotten. The family ended up withdrawing care and he passed later that day but I’m glad they got to spend a little more time with him and I’m hopeful it helped them process.

  27. All three hospitals I’ve worked at an insulin drip was considered imc minimum. So 1:3 nurse patient ratio. In theory, if the insulin drips are q1h for 4+ hours they should be icu. Honestly if your other two imc patients are sick and your insulin drip is requiring frequent blood sugar checks or frequent titrations it can be less safe than I would like.

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