From: Givens, Timothy ([log in to unmask])
> resistance to the use/implementation of treatment protocols in the ED?
--> No EFFECTIVE resistance.
I am generally AGAINST potocols in principle, but that's mainly for doctors, who are trained more in the direction of "working things out", so I'd prefer GUIDELINES over protocols. Still, a few things really do work better with a protocol - a few.
I would generally be against nurses at triage issuing drugs by protocol, but I am VERY in favour of them being trained and allowed to prescribe certain drugs if they are confident that these are suitable - i.e. a guideline again.
We have a number of nurse prescribing guidelines with which some of our nurses can make patients better before they get seen also by a doctor.
> ...decadron for croupers, zofran for vomiting... required nurses in triage to diagnose...
--> I see how this could be infuriating - there is, of course no need for the nurse to DIAGNOSE a patient in order to safely and correctly decide to treat certain symptoms, especially if it is with drugs less likely than most to cause harm... Not that a doctor would need to diagnose in order to treat either! Actually, one of my favourite things about EM is deciding when to DO, rather than to KNOW. Quite a buzz to confirm you have done the right thing, not too much of everything, when you eventually work out later what it was you did it for!
> ...this violated the scope of nursing practice
--> We have a word for this sort of thinking in the UK and it's to do with what male bovines do to get rid of what they've already digested...
Unless I have missed something and "violated" is now a synonym for "develop" or "advance" or "expand"...
From: Chamberlain, Jim ([log in to unmask])
>...not a diagnosis (because nurses aren't allowed to diagnose)
--> Not allowed?
Lay people can diagnose - why are nurses inferior?
My 6YO correctly diagnosed a knee abrasion just last week AND correctly & efficiently ruled out any complications requiring attention AND decided correctly on the need for further investigation (i.e. none)... He did mess up a bit on treatment by being somewhat over-zealous and suggesting that an ice-cream was required in addition to a dressing... Worry not - I did point out to him that there was no high quality evidence of the benefit of ice-cream, but we then still agreed together to provide yet another anecdote (a vanilla-flavoured one with a positive outcome)...
Surely we can train at least SOME nurses to diagnose like this... ;-)
Do you have a story that started on Hotmail? Tell us now
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: