E.D nurses "set up to fail" - page 4

Hi, I'm currently a nursing student about to graduate in May (2012). I am working as a nurse intern in a level 1 trauma hospital and got the chance to work in the E.D the other night. I loved the... Read More

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    I think it's important to note that the JC and CMS standards are for CAP. Some institutions apply them to *all* patients in respiratory distress in order to increase their compliance. In doing so, patients that don't need antibiotics are getting them, which contributes to antibiotic resistance. This is what I find silly.

    I find it hard to believe that the antibiotic order was six hours old, if the patient was in the ED for six hours. It just doesn't make any sense. Nor does it make sense that the midlevels meet all the ambulances at the door. Am I calling you a liar? No. You put that word in my mouth. I'm just pointing out things that don't make sense to me.

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    Are we done hijacking the thread yet?
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    LOL, yes!
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    Based only on my own development as a nurse the ER was way, way, WAY too much for me as a new grad. I might have managed in urgent care, but I wouldn't have learned as much as I did working on the floor. Even 6-7 years into my career I seriously had no idea how much I didn't know, and it was better for me and the patients to get more critical care experience. Granted, that could have happened in a mentoring ER situation, but new grads, be careful. Just emotionally, at 19, I wasn't ready to deal with the ER situations.

    About your prof's statement, that we are set up to fail, my initial reaction was that we get the ICU level patients, (and a lot of our med/surg folk are ICU level for the first hour or so.) but don't get ICU staffing. So if I get 4 level 2 patients at 30 min intervals, and they all need multiple interventions and ongoing assessments, I'd better know by just looking who is having the real MI, and who has gas and anxiety. We can get called into a trauma, but we still have 3 other patients. Our coworkers will help, but the ultimate responsibility stays with the assigned RN, at least in my ER.

    I recently came out of a trauma room and did a quick peek around at my other people. My coworkers had checked that they got meds and ordered tests, but no one had gotten fed, and someone who had come back from Xray was still on the portable tank. The tank read empty, but there was still gas coming out, so she was probably 5min from going dry. I was once in with an 80yo who was going in and out of Vtach for a couple hours. You cannot physically leave the room if you have someone like that, but I was still assigned other patients. Yes, you can do written follow up to your manager, but once you accept report those people are yours, unless you can report off to someone else. When you accept report in the ER you have no way of knowing what will come next, and no way to dump your other patients if one goes south.
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    I have actually felt more support and back up in the ED then what I felt on the floors or saw in the floors. I have never felt like I was set up to fail.
    Maggie09 and hiddencatRN like this.
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    Quote from ~Mi Vida Loca~RN
    I have actually felt more support and back up in the ED then what I felt on the floors or saw in the floors. I have never felt like I was set up to fail.
    My coworkers are awesome, but the system is the set up.
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    Quote from Sezgirl86
    i couldnt agree with you more!!
    i am a new grad in the ED (i am just in my 3rd week now)
    Luckily the newgrad program that I am on allows me to have 6 weeks orientation with a preceptor (an amazing nurse-- i am very lucky!) so i am not completely thrown into the deep end on my own... i recommend finding out how long of an orientation you get because i really think it is crucial. I am slowly learning how to handle 2-5 patient loads. All of the staff have been welcoming and extremely supportive given the chaotic (organized) environment!

    I have had previous experience as an EMT which was a HUGE help.

    My advice to you as a student is don't just stand and observe thinking that you will do it next time... just get into it!! Ask to do things.. ask other staff if they need help (if you have time to spare of course)
    6 weeks seems pretty short. Our hospital makes all new Grads have 6 month orientation all while taking new grad classes geared towards the ER. Even the experienced nurses get about 8-12 weeks (experienced non ED nurses)
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    Quote from canoehead
    My coworkers are awesome, but the system is the set up.
    How so?
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    Quote from Altra
    Though this is not a floor vs. ED thread ... I find it interesting that you pin deficiencies in physician orders on the nurse. Many a time when giving report I have found myself saying, yes, that really is his blood sugar ... that's why he's being admitted. If it was a fast fix, we'd have done it and discharged him.

    Back to the regularly scheduled thread ...

    Altra, I thought the exact same thing when I read that post. If there were that many issues with that pt at the time of admission then the ED doc is seriously incompetent. On the other hand, I would also expect that the ED RN should be competent enough to question the pt's condition and have good answers ready for the receiving RN if there are any, and if not, advocate for the pt and have the doc address the issues of concern.
    Altra likes this.

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