My Update

  1. New grad, came off orientation last week. I work in a level one trauma center. I don't have ACLS, PALS or TNCC yet, so I don't get to help with the major traumas yet (unit educator says it will probably be next year before I get in).
    I feel like I am kicking butt so far. I'm just so proud of myself, guess I just want to talk about it.
    I feel like I've been awesome in trying to get patients back and to get them out. I keep hearing, 'Oh, I didn't know they were even up for d/c". lol Because the shift I work is weird, I do a lot of floating.
    I feel like I've been very good with my IV's. Only once did I have to get some help, and this guy was a horrible stick anyways. After several attempts, someone finally got a 22g in his upper arm- so I don't feel bad at all about it.
    I feel like I've been good about asking for help when I'm not familiar with something, or when I feel like something isn't going right.

    I managed my first SAS patient (sick as sh*t) tonight by myself. I had help from our team leader, but it was my patient. Her K was 9!!! :uhoh21: When the transfered her from the other side, she had a 22g in her upper arm, had been stuck numerous times without success. I put her on the monitor, her heartrate was 38. :uhoh21: She was on MICU in 30-45 minutes. Most of that time was spent juggling docs and getting a central line placed. My preceptor works the same shift as me- She told me good job later. She said "I didn't realize your patient was that sick until someone said you had taken a patient to MICU".
    So I have to say a lot fo my nervousness is gone. I still get jittery with some stuff, esp stuff I'm not familiar with. I still have a fear that I won't be able to find any help (even though I know there is tons there).

    How is everyone else?
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  2. 13 Comments

  3. by   Happy-ER-RN
    Good Job! That is so great! SAS--I like that! My first week of orientation I had two really sick patients, a AAA and a thyroid storm who we gave about 50 cardiac drugs to. After that and 7 or 8 chest pains I don't get so nervous anymore. I know what you mean about being scared you won't be able to find someone to help. I memorized the charge nurses number though and we all carry mobile phones so I just call her if I really can't find someone and he/she is always glad to help.

    I just took ACLS this weekend and I really think it was a huge help. I hated transporting pts to ICU because if they crashed on the way up I wouldn't know exactly what to do, I had never even done CPR before. After the class I feel totally confident to transport patients on my own, (unless its a huge MI or something--i might get soemone to come with me).

    I have 3 more days of trauma orientation and then I start taking traumas. I have been on my own for a little over a month. I am jealous that you get to wait a while. I am kind of scared of getting used to what I am going to see visually. I have seen bits and pieces of mangled body parts here and there, but some of it still makes me feel weird. I am also not good at dealing with families and all of that drama. I never know what to say and I am afraid they are going to know I am a new nurse and be angry that a great experienced nurse is not taking care of their critical family member.

    I am pretty good at IV's most the time also. I have some days where I can't start one to save my life though. I have started to get more creative at looking for veins and I have had many pts say they are an impossible stick and then when I get it on the first try they rant and rave and say "will you be my nurse every time I go to the hopital" I love it, it makes me feel so good!

    Congratulations on becoming such a great nurse, you worked hard for it I'm sure!
  4. by   Kristen_RN
    Ok, so is this the ER thread or what? I also work in the ER. Infact, the second busiest ER in Dallas-Forth Worth. I've just finished up a 3 month internship, and have been on my own for a couple of weeks. They put me through ACLS near the very beginning of my internship, and I have been carrying a trauma room since I became certified.

    I was slightly scared at first, but now I actually feel awesome about going to to work. So good, that I've already signed up for extra shifts when the staffing is low.

    I am awesome at my IV skills, foley skills, etc. I feel very confident in my work. On one of my first days to have a trauma room, I had a AAA come in. That was pretty scary for me, but I think back to it now, and I wasn't scared during the code or anything. It was after it was all over that I got scared. My preceptor said that she took a step back while it was going ton to watch me, and she said that I did great.

    I usually have 1 trauma room and 4 regular rooms. If staffing is good, then I will have 1 trauma room and 3 regular rooms to keep it 4:1.

    My turnover is really fast. I like to "meet 'em, greet 'em, treat 'em, and street 'em." That really sounds worse than it is, but basically I like to have a fast turnover.

    I'm not afraid of the doctors, like some people are. I've questioned a few orders, and the doc. has thanked me b/c he wrote them wrong. I've given the docs my thoughts. Sometimes they've listened to me, sometimes not. But they aren't my boss...we work together. They just have a higher level of care to give to the patients.

    Anyway, I'm glad that you feel good about your job! I'm right up there with you! I feel really bad for the people who are posting that they hate their job. Maybe everyone should work in the ER!
  5. by   Aneroo
    Yeah for us!!
    I'm sure if there was a spot open, I'd be in ACLS (I've begged for it). But, we have so many new grads starting this time of year, and our cardiac center is growing so much, it doesn't work out as well.
    I too am trying to get more creative with my IV's. I usually stick with 20g's unless I know they are going to surgery, need blood, etc. I stuck two people with 18's yesterday. I really need to start practicing with the bigger gauges.
    I think my awesome skill is NGT's. My first one was in nursing school, on a 5 week baby. I think after that (even though babes are easiest), I felt I could do them on anyone. So far, I've hit all of mine. Even the one I didn't feel went as good, the lady said "That was so much better than last time I had it done". :hatparty:
    Poor hubby, I come home from work, wake him up to talk to him about my night. He's in nursing school, so he understands. I was telling him about the first lady I had yesterday, when I was floating- I looked to see why the monitors were beeping, her HR was 180. I was joking how I went from one extreme to the other (200bpm-36bpm). lol
    -A
  6. by   Tweety
    Nice to hear an update! Awesome! A K of 9????????? Yikes, the highest K I've ever seen is 8.6 and that patient died.
  7. by   prmenrs
    Gotta love kayexalate!
  8. by   Medic2RN
    Ok, so is this the ER thread or what? I also work in the ER. Infact, the second busiest ER in Dallas-Forth Worth. I've just finished up a 3 month internship, and have been on my own for a couple of weeks.
    HI Kristen_RN,
    I'm just curious as to what hospital you had your internship in?? I'm graduating soon and live around your general area. I haven't started my job search or research, but figured I would ask you. Any info you can give me I would appreciate.
    Thanks!

  9. by   Aneroo
    Quote from Tweety
    Nice to hear an update! Awesome! A K of 9????????? Yikes, the highest K I've ever seen is 8.6 and that patient died.
    Yep! I was freaked! When I heard there was a K of 9 on a patient over there, I asked a co-worker what that would do to a patient- her reply was "Cardiac arrest". Then I found out I was getting that patient! It dropped to 8.6 by the repeat one, but still- I was scared!!!
  10. by   Kristen_RN
    Hi! My internship was at Charlton Methodist in South Dallas, and that's where I am working in the ER. If you are interested in the hospital, they have an amazing "Extern" program. Basically you can work and practice all of your skills (minus assessments & meds), and they pay pretty well. They allow you to make your own schedule, and are very flexible, not to mention that you pretty much have an "in" when you graduate. If you are graduating in December you may want to start looking now, and if you are graduating in May, you may want to start your search in April. If you want any other details in specific, just let me know! Good luck!

    ~Kristen


    Quote from Medic2RN
    HI Kristen_RN,
    I'm just curious as to what hospital you had your internship in?? I'm graduating soon and live around your general area. I haven't started my job search or research, but figured I would ask you. Any info you can give me I would appreciate.
    Thanks!

  11. by   PennyLane
    How am I doing? I also work in the ED, but it's not a trauma center. Nonetheless, we are VERY busy. I'm lucky to work in a facility that has a 3:1 ratio, 4:1 if we're understaffed. We also have 1-3 float nurses during the day, although occasionlly we don't have any floaters.

    Although I don't have ACLS yet, I'm often given the 'big girl rooms' and I do get a little freaked out. BUT I get lots of support from the rest of the staff. I'm feeling more confident every day, but I still get frustrated sometimes.

    Most of the docs and PAs are surprised when I tell them I'm a new nurse. I do a good job.

    My biggest complaint is that my legs ache at the end of the day--so I'd say that's not too bad! I'm able to drop my frustrations when I leave work and not take work home with me. I have lots of 'cool' stories to tell my nursing friends (and my grossed-out boyfriend). I've only gotten the heebie-jeevies once (there were maggots involved). And I'm learning something new every day, which is a big part of why I went into nursing.
  12. by   andre
    Quote from Aneroo
    New grad, came off orientation last week. I work in a level one trauma center. I don't have ACLS, PALS or TNCC yet, so I don't get to help with the major traumas yet (unit educator says it will probably be next year before I get in).
    I feel like I am kicking butt so far. I'm just so proud of myself, guess I just want to talk about it.
    I feel like I've been awesome in trying to get patients back and to get them out. I keep hearing, 'Oh, I didn't know they were even up for d/c". lol Because the shift I work is weird, I do a lot of floating.
    I feel like I've been very good with my IV's. Only once did I have to get some help, and this guy was a horrible stick anyways. After several attempts, someone finally got a 22g in his upper arm- so I don't feel bad at all about it.
    I feel like I've been good about asking for help when I'm not familiar with something, or when I feel like something isn't going right.

    I managed my first SAS patient (sick as sh*t) tonight by myself. I had help from our team leader, but it was my patient. Her K was 9!!! :uhoh21: When the transfered her from the other side, she had a 22g in her upper arm, had been stuck numerous times without success. I put her on the monitor, her heartrate was 38. :uhoh21: She was on MICU in 30-45 minutes. Most of that time was spent juggling docs and getting a central line placed. My preceptor works the same shift as me- She told me good job later. She said "I didn't realize your patient was that sick until someone said you had taken a patient to MICU".
    So I have to say a lot fo my nervousness is gone. I still get jittery with some stuff, esp stuff I'm not familiar with. I still have a fear that I won't be able to find any help (even though I know there is tons there).

    How is everyone else?
    Ok to crash this thread? I mean, I'm not an ER RN, lol....I work telemetry/progressive care. I loooooooooooooooooooooove my job! I have had very supportive preceptors, have learned a ton and am looking forward to coming off of orientation next week. I will have ACLS in October, so I am starting to review ACLS meds now--just got my course packet.

    I was lucky enough to score a day shift position after being hired for nights. As crazy busy as it is during the day, at least I'm not in the permanent brain fog from when I was orienting on nights. Usual ratio on days is 1:4 or max 1:5. At the end of our shift the other day, my preceptor said to me, "you're sooo ready to come off of orientation", which made me feel really good! She essentially caught up on email and chatted with people all day, as I didn't need anything from her other than a couple of quick questions answered.

    Anyway, things are going well and I still can't quite believe that it's been 11 weeks already since I started!

    Who's next???
    Andrea
  13. by   christvs
    Quote from andre
    Ok to crash this thread? I mean, I'm not an ER RN, lol....I work telemetry/progressive care. I loooooooooooooooooooooove my job! I have had very supportive preceptors, have learned a ton and am looking forward to coming off of orientation next week. I will have ACLS in October, so I am starting to review ACLS meds now--just got my course packet.

    I was lucky enough to score a day shift position after being hired for nights. As crazy busy as it is during the day, at least I'm not in the permanent brain fog from when I was orienting on nights. Usual ratio on days is 1:4 or max 1:5. At the end of our shift the other day, my preceptor said to me, "you're sooo ready to come off of orientation", which made me feel really good! She essentially caught up on email and chatted with people all day, as I didn't need anything from her other than a couple of quick questions answered.

    Anyway, things are going well and I still can't quite believe that it's been 11 weeks already since I started!

    Who's next???
    Andrea
    Hi! I just finished week 10 of my orientation. I can't believe I'll be all done with orientation & on my own in just 2 weeks! I feel like I'll be ready though-I'm basically ready now. I still ask questions when I need to, but other than that I'm feeling pretty good! I've gotten very good at things that used to make me nervous before & now they aren't a big deal at all such as-discharging pts, admitting pts, taking MDs' telephone orders, hanging IV antiobiotics, IV pushes, hanging blood, doing assessments, dealing with PICC & central caths, etc.
    Christine
  14. by   Medic2RN
    Thanks Kristen for the info. I truly appreciate it!!

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