asapstat 1,144 Views
Joined: Jan 4, '04;
Posts: 22 (0% Liked)
To answer yoiur question..the ED is a mix of every kind of nursing..from bumps and bruises to massively critical..you get what comes through the door..and be ready for it.
I read your reply also... and my gut tells me that you are either burnt out. looking for utopia..or should choose a whole other profession
I am considering a major career change. have been working in acute care setting as Rn for all my career (30+ years)...in critical care/emergency dept.
Recently started per diem in long term care facility..while keeping FT position in hospital.
Have considered moving full time into long term care...but am concerned about the "culture shock" and the change of pace ..
Those who have made this switch please advise..:roll
I still say FEET!!!. Stinky, sweaty, socks so toasted they are stuck to the skin..toenails that have been growing so long they curve under the toe...eight hundred layers of dirt...and when you take the sock off and a gangrenous toe comes with it...I'm done.
LIne up 50 patients...remove crusted stuck on socks with teeth..without taking off any toes.. drop in basin of already removed underwear...time limit two minutes. NO puking.
I read the first three pages of responses, and sorry to those I didn't read, but this argument has gone on way too long!!. I have been a nurse for 31 years, all of them spent in acute care setting and the same argument has been going on for all my career. I have worked med-surg, ICu and now in ER nurse and all I can say is CAN'T WE ALL JUST GET ALONG!!!.
In my opinion, every area is a specialty area, including med-surg. We all have knowledge and skills we can share. And in each area we will find our frustrations. Some problems we can solve, and need to solve. Some problems are beyond our control, ie the volume of patients and their individual medical problems, and when they "show up".
I worked Triage yesterday, relatively busy day. Several of the patients had acute problems, some have had their complaint for three weeks , three months.etc. Why did those people wait so long, and why did they choose to pick yesterday as the day to show up??? Not in our control.
I triaged "five" patients between 8AM and 9A but between 10 and 11 Am there were "15" patients (numbers hypothetical)...Why the imbalance? Not in our control. By the end of the twelve hour shift I had gone through 3+ boxes of thermometer probes ( my way of counting volume) And these were just the "walk-ins" not the ambulance patients. Not in our control..
One patient came in because he only urinated a little bit from 8PM the previous night, and thought he was having a "blockage" problem..wanted to be taken care of early so he could go home to visit with his grandchildren who he last seen in June.....his heart rate was 33..and he ended up in ICU with renal failure/heart block dual diagnosis... Not in our control
So why don't we just recognize that each area has its difficulties, we do all get slammed from time to time. and know that there are days that we will impose on each other, but there are also days that we repay each other.
ER nurses do take two-three pages of "routine orders" for admission even though they may not be any "stats". We do try to get the patients to the CT scans before they go to the floor.
We don't time the admits, we contact the admitting physician, wait for him'her to call back..sometimes they call back right away, sometimes they call back as they can (between office patients),. sometimes they say wait until I come in to exam, sometimes its wait until the consult comes in...the "I'll be right there" scenario...all of which is not in our control.
So why are we on each other's cases when most of our frustrations are not anything we have control over...they are the nature of the business that we are in..
and we should always keep the lines of communication open ..because that is something we can control.
We also use Phenergan IV frequently...and dilute it in 10cc saline if pushing through a hep lock..
The salary definitely goes up when you work closer to NYC or Phila. In the middle of NJ it is markedly lower. The "Raritan Bay Bridge" (it has another name) seems to be the dividing line. But factoring in time to travel, tolls, wear and tear on a vehicle etc.. the margins get a little closer. For a new grad...experience and education should be priority over $$$...get a good baseline knowledge, spread your wings and when you have established a repetoire then look more toward the $$ and perq's. Find a place that will help pay or cover cost of higher ed. or has multiple opportunites for advancement. A good thing is that so many of the hospitals are linked and inter-hospital transfers are possible..change jobs without losing time earned adn benefits. I work at Kimball Medical Center, part of Saint Barnabus...and it is a great place to start or finish a career..good"launching pad" ...very culturally diverse.. and "landing zone" enough variety to keep it challenging .
We have chest pain, abdominal pain, sepsis protocols, and we have some standard Triage order sets to choose from Makes doing the diagnostics go quicker ..Much better than knowing what to do and having to wait for a specific order before you can actually do it..
Having worked both Critical Care and ER, and taught both groups of nurses,,,I say hands down the Critical Care area has the most "anal" individuals. They want numbers, numbers and more numbers!! In the ED if the patient has a carotid, brachial or radial pulse you are off to a good start. (there is a blood pressure) The ED is a great place if you like to be mostly autonomous, think on your feet and can switch critical thinking mindsets among the variety of age groups, conditions and degrees of acuity that you will care for simultaneously. Always at the ready for the next challenge. The patient enters and you start the process. If you are the type of nurse who needs that "chart" first and must know the absolute details..(ie. "let me print out the care plan".then ER nursing will be frustrating to you. ER nursing is 'treat and street" or "treat, stabilize and transfer", no long term patient-nurse contact..and often you don't learn the results of your quick and immediate intense efforts..thus perhaps added frustration...and few patients will remember that you were the one who saved their life... HOWEVER...you and your co-workers know the real deal..Not to upset the ICU/CCU nurses because you all have a whole other set of challenges and knowledge base and TOGETHER we are all for recognizing and promoting excellence in patient care. I believe that each of us has a corner, a liitle niche in nursing that we do best and we are lucky if we find it early in our careers..so go out and explore all facets and find the one that gives you the most satisfaction,,regardless of your "personality type" Good luck!!
My son was diagnosed with Duane syndrome-bilateral when he was 3..had excellent compensation, minimal head turn. Hearing fine. Also has gross and fine motor difficulties. Has been in learning disabled classes but progressively mainstreamed. Now he is HS sophmore. I have done literature searches etc...but not found what I am looking for.. Is there anyone with real life experience who can share info?? He is smart,with a very wide spread on his verbal (excellent) and written (poor) expression..(stunned the child study team) We were advised to pursue vocational high school but he had no particular interest in any of the programs...and wants to go to college. So I am reaching out to my colleagues for personal/professional info. Thanks
It sounds like everything snowballed and was blown out or proportion!!! I think you did the right thing to call security in an effort to regain control,... whenever we feel threatened, we need back up .. Too much workplace violence risk,especially with freaked out parents. and of course the fingerpointing is always going to go in our direction ,as in "how could we have handled this better " except that the "suits" have never had to experience it first hand- or have forgotten how frightening it can be..I can deal with the verbal stuff because it comes out of a frightened parent who is feeling loss of control of the situation, but when it starts to escalate beyond frantic parental yelling...it is time to call for security backup and prevent physical injury.
I say, chalk it up to another day in the life of the Er and don't let waste any more negative energy on it..concentrate on all the positive things you did...
Side effects are those that might occur...adverse reactions are the unexpected, therefore may not be preventable.
"IV Bolus" meds are given as quickly as possible, IV push meds are given over a prescribed period of time & lesser volume of fluid ie. 50 cc or less
The idea behind narcan is get it into the patient so the port closest to the patient is the one I'd choose.
IV push meds are given so that you can reach therapeutic blood levels quickly.
We were discussing this very thing at lunch the other day. I think it is insane that the hospital would expect or demand staff to come in..and then have repercussions... . first things first,,family and safety should be priority...it should be voluntary reporting to assist. if the area is to be evacuated, as it was ...48 hours beforehand...then the patients should have been moved to safer locations..and there is plenty of warning time to accomplish this.. transfer to other hospitals... My family will always come first, they are irreplaceable. If I had no one to worry about except myself, then I would volunteer to assist. Here in the Northeast, where snow can be an issue, it is understood if someone can't get in to work. Not everyone has 4-wheel drive..or child care...My thoughts and prayers for those in the line of Ivan..
Tip from a former Acls Instructor-The handbook and the review materials sent out by the AHA are easy to read and follow. Review your rhythms beforehand. and review the uses and doses of the drugs. Remeber to read about psot-resuscitative care. And don't panic- it is a learning experience, not a just a testing experience.
I agree ...your role is to support your daughter and applaud her decision to take control of her life... promote the positive ...
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