A guy who injected too much heroin. his "best brah's" dropped him off in the valet parking lot....took many pictures of him pulseless on the ground and saying "ahh naw"... CPR started, narcan administered IM into the sternum. IV started eventually. Dude wakes up. ****** because we cut his shirt and ruined his high that cost like $45. tries to leave but falls because he's still half high and half asleep...get him back in the gurney. states "*** **********! why you cut my ****! You dont own me, this is a free country. i gotta be home by midnight because my mom said i have to." When explaining to this idiot that his friends were taking pictures of him when he was clinically dead, he said "yeah, well they had to. we were driving some fools car that wanted it back at 10, but because i OD'd, they needed proof why they didn't return it on time."
One more thing. Dont worry about getting written up. When i was new, I was written up like 3 times in the first 6 months for things that were out of my control. At first i got all offended and was worried they'd can me... but they never did and never would because we were so short staffed anyway. New grads should never be expected to be perfect at their job and know everything.
Being worried about this situation just shows that you care about your job. You're going to be just fine :-) Every new grad, no matter if they admit it or not, feel this way. It gets better, i promise.
What is your facility policy. I have also had the horrible experience of holding an ICU patient in my ER for longer than i should have. I basically told the charge nurse, "hey, this patient is 1:1, i cannot take on any other pts unless they are and acuity 3 or higher." Each hospital should have a policy in place where the acuity of the patient and nurse/pt ratio whether its 2:1 or 1:1 where you can file an assignment despite objection form. Basically you are signing a document that says i do not feel safe caring for more than this critically ill patient, and it's there to save your license.
Also, the ICU patient that you have, as long as theyre stable in regards to the ABC's, the inpatient orders can wait... antibiotics should be hung in the ED if the IV access is available...also, if they're tubed, you HAVE to make sure they are properly sedated...but home meds, maintenance fluids, even skin care (unless they have a disgusting draining wound that needs attention now), that can all wait.
What you did sounds just fine to me. You are NOT an ICU nurse. My charge nurse told me once when we were completely full one night, "ICU nurses have a 1:1 or 1:2 policy. you should never have to manage more than 1-2 ICU patients in the ER. and if you do, the inpatient orders can wait."
the docs who got upset with you and said "what would you do if this was your family member..?" They should also think the same way. what if it was their family member?...im sure they would coordinate a little better with the other specialists.. thats not your job so dont feel bad
If you're waiting more than 3-4 hours, you're probably not sick, go home and come back later...or even better, go to urgent care. With that said, I've seen a wait time of 9 hours...the guy had a splinter in his finger and was too scared to take it out himself.
Am I the only one out there that has no idea what a brain sheet is? I'm assuming it's some kind of organizational thing, but I've never heard that term before. Can someone be so kind to explain it to me?
Remember the interview panel's names and dress NICE but not ridiculous. dont wear too much makeup...
KNOW the mission, vision, values of the organization AND department.
Think of a situation where you had use critical thinking, talk about experience.
Know the answer to this question: "why do you want to work in the ED?"
They will ask you a specific medication and what it does/contraindications/what to do pre and post admin and outcomes...(think ER meds: nitro, pressors, pain meds, etc..
Know how to answer conflict resolution questions
They may ask "what would you do if you learned that a fellow RN was diverting narcotics
Think of a sick patient that you had - know their dx, what you did, what you should have done, what their outcome was (nursing process question.)
If they ask you how you're doing, be honest. Tell them you're nervous because you really want this job. On my interview they said "good, because I dont think we'd hire someone who said they weren't nervous in a stressful situation."
Bring a list of legit questions to ask them...and YES, bring the list with you, it's OK to look prepared. QUestions to ask have to be relative to the job. for example: when can i be trained in trauma, when can i get my CEN, what are the goals of the department, how long is residency, what are your expectations of me after residency... DONT ask questions like "what are benefits like"...thats HR stuff
Last but not least, CUSTOMER SERVICE IS HUGE. MAKE SURE YOU MENTION THE IMPORTANCE OF CUSTOMER SERVICE AND EXAMPLES OF HOW YOU DEMONSTRATED CUSTOMER SERVICE IN YOUR EXPERIENCE.
Your "rambling" makes me think you'd be a GREAT ER nurse. I'm a lot like you. I dont go out of my way for small talk, in fact i hate it more than anything. I found that ER nursing is what i was born to do because of that fact. i like to keep busy and i like to learn a lot...and most importantly, i dont like seeing the same person and changing their linens 3 days in a row. I know that may seem mean, but the thing I love about er nursing is the fact that I dont see the same people days in a row. I may see the same people...but most of the time it's because they're not sick, they just need their fix. I think ER nursing is perfect for you...
Mondays, especially our Trauma Mondays are the craziest! (We share trauma with another hospital in our city every other day.) Anyway, I've never had a Monday when i wasn't fully loaded with patients. However, last monday, a trauma monday, i had a 3 minute stint where I had ZERO patients. it was the most amazing 3 minutes i had ever experienced in my life.
The patient's who actually WAIT for 6+ hours in the ER to be seen. Sometimes I understand why, but when someone waits for 6+ hours to be seen for an ingrown toe nail then asks for narcs to go home with, that drives me crazy. If you're still alive after 6+ hours, you dont need to be in the ER.
My favorite conversation in the last month after ingrown toe nail extraction:
Pt: "motrin wont TOUCH my pain."
Me: "well, you just had a piece of your toe nail removed. It's going to be painful. But luckily you have prescription strength Motrin which will help with the swelling, which will minimize the pressure on those nerve endings. And with the decrease in swelling, it will really help with pain. Besides, how would you know if it's getting better if you're masking the pain with the strong stuff? *SMILE*"
Pt: "I can't function like this!"
Me: "Well, you REALLY can't function on narcotics. It messes with your cognitive processes amongst other things. Did you know you could get a DUI if you were taking narcotics and driving or riding a bike?"
Pt: "Fine, I'll just go down the street to the other hospital. they always give me the narcs."
Attitude, willingness to take criticism (from patient's and co-workers, whether it's warranted or not), thick skin, and ALWAYS BE WILLING TO LEARN and do research... Oh, and dont be afraid to ask for help EVER..even if it's something you should probably know. Especially with meds.
A guy who injected too much heroin. his "best brah's" dropped him off in the valet parking lot....took many pictures of him pulseless on the ground and saying "ahh naw"... CPR started, narcan administered IM into the sternum. IV started eventually. Dude wakes up. ****** because we cut his shirt and ruined his high that cost like $45. tries to leave but falls because he's still half high and half asleep...get him back in the gurney. states "*** **********! why you cut my ****! You dont own me, this is a free country. i gotta be home by midnight because my mom said i have to." When explaining to this idiot that his friends were taking pictures of him when he was clinically dead, he said "yeah, well they had to. we were driving some fools car that wanted it back at 10, but because i OD'd, they needed proof why they didn't return it on time."
Priorities.
Like everyone else said.
and if you dont feel comfortable mixing it, have pharmacy do it.
I put it in a 250mL bag, and ran it WO....this guy did not have CHF...if they did, you can put it in a 100mL bag and run it over 10 min.
Stomach flu is the only thing that drives me nuts....especially when one of my RN friends say it.
^ exactly what @meandragonbrett said
One more thing. Dont worry about getting written up. When i was new, I was written up like 3 times in the first 6 months for things that were out of my control. At first i got all offended and was worried they'd can me... but they never did and never would because we were so short staffed anyway. New grads should never be expected to be perfect at their job and know everything.
Being worried about this situation just shows that you care about your job. You're going to be just fine :-) Every new grad, no matter if they admit it or not, feel this way. It gets better, i promise.
What is your facility policy. I have also had the horrible experience of holding an ICU patient in my ER for longer than i should have. I basically told the charge nurse, "hey, this patient is 1:1, i cannot take on any other pts unless they are and acuity 3 or higher." Each hospital should have a policy in place where the acuity of the patient and nurse/pt ratio whether its 2:1 or 1:1 where you can file an assignment despite objection form. Basically you are signing a document that says i do not feel safe caring for more than this critically ill patient, and it's there to save your license.
Also, the ICU patient that you have, as long as theyre stable in regards to the ABC's, the inpatient orders can wait... antibiotics should be hung in the ED if the IV access is available...also, if they're tubed, you HAVE to make sure they are properly sedated...but home meds, maintenance fluids, even skin care (unless they have a disgusting draining wound that needs attention now), that can all wait.
What you did sounds just fine to me. You are NOT an ICU nurse. My charge nurse told me once when we were completely full one night, "ICU nurses have a 1:1 or 1:2 policy. you should never have to manage more than 1-2 ICU patients in the ER. and if you do, the inpatient orders can wait."
the docs who got upset with you and said "what would you do if this was your family member..?" They should also think the same way. what if it was their family member?...im sure they would coordinate a little better with the other specialists.. thats not your job so dont feel bad
If you're waiting more than 3-4 hours, you're probably not sick, go home and come back later...or even better, go to urgent care. With that said, I've seen a wait time of 9 hours...the guy had a splinter in his finger and was too scared to take it out himself.
Am I the only one out there that has no idea what a brain sheet is? I'm assuming it's some kind of organizational thing, but I've never heard that term before. Can someone be so kind to explain it to me?
Remember the interview panel's names and dress NICE but not ridiculous. dont wear too much makeup...
KNOW the mission, vision, values of the organization AND department.
Think of a situation where you had use critical thinking, talk about experience.
Know the answer to this question: "why do you want to work in the ED?"
They will ask you a specific medication and what it does/contraindications/what to do pre and post admin and outcomes...(think ER meds: nitro, pressors, pain meds, etc..
Know how to answer conflict resolution questions
They may ask "what would you do if you learned that a fellow RN was diverting narcotics
Think of a sick patient that you had - know their dx, what you did, what you should have done, what their outcome was (nursing process question.)
If they ask you how you're doing, be honest. Tell them you're nervous because you really want this job. On my interview they said "good, because I dont think we'd hire someone who said they weren't nervous in a stressful situation."
Bring a list of legit questions to ask them...and YES, bring the list with you, it's OK to look prepared. QUestions to ask have to be relative to the job. for example: when can i be trained in trauma, when can i get my CEN, what are the goals of the department, how long is residency, what are your expectations of me after residency... DONT ask questions like "what are benefits like"...thats HR stuff
Last but not least, CUSTOMER SERVICE IS HUGE. MAKE SURE YOU MENTION THE IMPORTANCE OF CUSTOMER SERVICE AND EXAMPLES OF HOW YOU DEMONSTRATED CUSTOMER SERVICE IN YOUR EXPERIENCE.
Your "rambling" makes me think you'd be a GREAT ER nurse. I'm a lot like you. I dont go out of my way for small talk, in fact i hate it more than anything. I found that ER nursing is what i was born to do because of that fact. i like to keep busy and i like to learn a lot...and most importantly, i dont like seeing the same person and changing their linens 3 days in a row. I know that may seem mean, but the thing I love about er nursing is the fact that I dont see the same people days in a row. I may see the same people...but most of the time it's because they're not sick, they just need their fix. I think ER nursing is perfect for you...
Mondays, especially our Trauma Mondays are the craziest! (We share trauma with another hospital in our city every other day.) Anyway, I've never had a Monday when i wasn't fully loaded with patients. However, last monday, a trauma monday, i had a 3 minute stint where I had ZERO patients. it was the most amazing 3 minutes i had ever experienced in my life.
To piggy back on the wait time pet peeve...
The patient's who actually WAIT for 6+ hours in the ER to be seen. Sometimes I understand why, but when someone waits for 6+ hours to be seen for an ingrown toe nail then asks for narcs to go home with, that drives me crazy. If you're still alive after 6+ hours, you dont need to be in the ER.
My favorite conversation in the last month after ingrown toe nail extraction:
Pt: "motrin wont TOUCH my pain."
Me: "well, you just had a piece of your toe nail removed. It's going to be painful. But luckily you have prescription strength Motrin which will help with the swelling, which will minimize the pressure on those nerve endings. And with the decrease in swelling, it will really help with pain. Besides, how would you know if it's getting better if you're masking the pain with the strong stuff? *SMILE*"
Pt: "I can't function like this!"
Me: "Well, you REALLY can't function on narcotics. It messes with your cognitive processes amongst other things. Did you know you could get a DUI if you were taking narcotics and driving or riding a bike?"
Pt: "Fine, I'll just go down the street to the other hospital. they always give me the narcs."
Me: "ok."
Attitude, willingness to take criticism (from patient's and co-workers, whether it's warranted or not), thick skin, and ALWAYS BE WILLING TO LEARN and do research... Oh, and dont be afraid to ask for help EVER..even if it's something you should probably know. Especially with meds.