Lev <3, BSN, RN 52,052 Views
Joined: Jun 3, '11;
Posts: 2,884 (53% Liked)
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ED Registered Nurse
5 year(s) of experience in Emergency - CEN
These people shouldnt be in the ER to begin with. I have little pity for people who don't use their primary physicians or go to the drugstore.
I'm a new grad and currently have 2 offers on the table for my first job. My ultimate goal is to get into the ED after 1-2 years of experience elsewhere, and I'm wondering what everyone thinks would be the best route to go about that.
Offer 1- ICU in a small community teaching hospital. 14 beds, 1-2 patients on nights. The unit is attached to an IMCU and together they're the only intensive care units for the hospital.
Offer 2- oncology/medical telemetry unit in a very large health system teaching hospital. 36 beds. I would have 5-6 patients on nights. They've offered me higher pay than offer 1, and the benefits are also better. My current doctors are all a part of this hospital as well
I'm leaning towards offer 2 because one of my favorite parts of nursing is the direct patient care and conversation (and on this unit, I would be taking care of more patients than the ICU). However, my ultimate goal is to get into emergency nursing after a year or 2 of experience, so if the ICU job would help me out more than the onc position, I could pay my dues for a year or so. I know the ICU would provide me with valuable skills related to drips and vents, and the onc position would be a lot of IVs, chemo, and tele experience.
I can understand why a lot of staff are leaving. 6 patients is 2-3 patients too many for a telemetry/step down unit. P.S. insulin and dobutamine are critical drips in most hospitals. 5 weeks training is nothing for someone with no hospital experience. Sounds like you were thrown to the wolves and had an inadequate training. This hospital needs to make some serious improvements if they want to retain staff.
Your concerns are valid. I would still wait and see how you are holding up once you get a year of experience. See how you feel then. If things haven't improved much, by all means follow your former coworkers.
This is totally new for you and it does take about a year to start feeling comfortable. If you feel your anxiety is out of control, please talk to your PCP and get a script for something - even if just in the short term. Getting over the anxious feelings can make your performance much better.
Organize and try to get a semblance of a routine. Knock your assessments out and document them early. You should not be taking more than 5-10 minutes on each assessment. You also assess pain, so when you come back to do meds you can bring them PRN pain meds. The initial assessment is not the time to do wound care. Wound care should be done after giving meds, including pain meds for before you do the dressing changes on a painful wound. After your assessment, print out a rhythm strip and tape it to the chart. Then review your vital signs and give meds (including the pain meds). Once you get your meds in, take a breather and go hide somewhere to document your notes.
At the start of your shift, you will be delegating a lot to the CNA. Tell her what you are doing (i.e. giving meds, in with room 202 doing her assessment) and if she could help room 206 go to the bathroom. The CNAs are there to help with vital signs, toilet patients, and set up meals. If the CNA is available please please ask them to do certain things. Certain CNAs need to be told to do something because if given a choice they will refuse and say they are busy and then you'll see them on their phone or hiding in the corner. For those CNA you need to tell them "Ashley, please help room 206 to the bathroom. Thank you."
When you are with a patient, try to ignore the fact that you have 5 other people to take care of too. This does not mean that you do everything at a leisurely pace and listen to your patient talk about her 10 cats for 20 minutes, but it does kind of help ease the anxiety I've found. When I started doing this at my med-surg job (which I know is easier since these patients are not critically ill) it changed everything for me.
It's also important to coordinate with the CNAs. For example, if you have a patient with wounds tell the CNA to save her bath for later and you will go in together to bathe the patient. That way, the CNA can help with wound care. Remember to continuously tell your CNAs how much you appreciate their help. Also, as soon as you find out that you are getting an admission, tell the CNA a little bit about the patient (like a mini report) and where and when they will be coming.
I hope this is helpful. Hang in there.
Just something funny my siblings and I used to do. When the "gas man" came to the door growing up he would knock and say "gaass maaan" in a singsong. My siblings and I would then make loud fart noises and he would laugh and laugh. He didn't get tired of it LOL.
How do you answer this question? What are some examples of strengths in nursing and weaknesses that have a positive spin?
I am against it. I think that it makes people make a very difficult decision at a time that they are so vulnerable. When you are in pain and feel helpless emotions rule and you can't make a clearheaded decision. I also think people can be guilted into it by their families who don't have the emotional fortitude to care for them. In truth, I think it is impossible to consent for euthanasia unless you made the decision before illness set in.
I am all for hospice. Death can be a beautiful thing without "ending it" by swallowing a pill.
ETA: I see people are making a distinction between euthanasia (so called "mercy killings") and being given a pill to commit suicide.
I am against both. Unless someone made a decision about how their life will end before they became sick and miserable, a clear headed decision cannot be made. Terminal extubation is a completely different conversation. I do not agree with letting people linger on vents.
Your resignation letter (if this is what you decide to do) should be short and to the point.
Dear *name of manager*
I am writing to let you know that that I have decided to resign from my position as a *official job title* on the *name of unit* at *name of institution.* My last day will be on *exact date at least two weeks from now*. I am grateful I had the opportunity to work at *name of institution*.
I would go over to your manager and give her a written copy of the letter. If she asks why you're leaving, say confidently that you are seeking other opportunities. Then I would give a written copy to HR. Then I would email a copy to your manager and cc HR and yourself. Then I would email HR and cc your manager and yourself.
Cover all your bases.
If they offer the opportunity for an exit interview, politely decline. Resignation is not the time to air your grievances. I would keep your head down and not bring up any complaints, be police and courteous to all until you make a decision about what to do.
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