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DesertSky, BSN, RN 1,650 Views

Joined Feb 21, '12. DesertSky is a Critical Care RN. Posts: 32 (34% Liked) Likes: 14

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  • Apr 25

    Quote from DesertSky
    Any advice for how to flip my time management to the ER?
    Others have already hit this nail on the head. Bundle care & look at Pixie's quote below.

    Quote from Pixie.RN
    The unpredictability means that your priorities will constantly shift. My biggest piece of advice: whenever you get a new patient, eyeball them ASAP — take that sick/not sick look at them. Sometimes it'll surprise you what other people miss and you'll go, "Whoa, that 'stable' person is really sick, omg!" And your priorities have just shifted again.
    Absolutely on point. Priorities shift all the time. There are some exceptions to eyeballing new patients, which you will learn. They aren't even necessarily hard & fast exceptions but more of "if the situation allows." Every ED nurse has the patient who came in for "I think I've got the flu,"
    that turned out to be a STEMI. Or some other equally unlikely scenario.

  • Apr 25

    Yeah don't sweat iv skills. You will be a pro in no time. There is a routine in the Ed, it's just different. Some like it some don't.

  • Apr 25

    Yup pretty much what emtb2rn said. Cluster care to the max and anticipate orders. Practice getting out of the room quickly. There is no time to chat. Short and sweet. If you thought the floor was crazy, you are in for a surprise. Teamwork. Ask for help when you need it.

  • Apr 25

    Just remember: ICU = OCD, ER = ADD. That is to say, you'll have to let some of the niceties go in favor of the bare necessities! And you'll understand why some patients go up to the unit without everything being "done." Also focused assessments, not head-to-toe. The unpredictability means that your priorities will constantly shift. My biggest piece of advice: whenever you get a new patient, eyeball them ASAP — take that sick/not sick look at them. Sometimes it'll surprise you what other people miss and you'll go, "Whoa, that 'stable' person is really sick, omg!" And your priorities have just shifted again.

  • Apr 25

    The routine for time management is to consolidate. Assess, line, lab at the same time. Know your standing orders and get things moving. Chart on the fly, never wait until the end of the shift.

    Good luck and have fun.

  • Apr 20

    Not being phenomenal at starting IVs doesn't matter, you'll get plenty of practice. If you're really concerned about, depending on facility policy, see if you can IV ultrasound trained and/or IO trained. When somebody comes in from the field and its a basic crew, nothing beats an IO for insertion speed.

    Typically ICU & ICU stepdown nurses can make the clinical transition pretty well. They usually have the critical care knowledge and don't need to be taught a lot of stuff (vents, art lines, etc.). I have seen a couple struggle with remembering every patient isn't swirling the toilet when they first transfer. This typically gets rectified fairly quickly.

    I've also seen somebody struggle with the organized chaos and lack of routine in ED. Since ICU already responds to all of the traumas you probably have some idea of this. But, I just mention it because I have seen people struggle with the lack of having a routine.

  • Mar 2

    It will ABSOLUTELY be helpful. I too was a critical care nurse before starting NP school. Had never really spent any time in a clinic. Like someone above said, they are VASTLY different. You will still use your CCU knowledge some but the clinic experience will be invaluable.

  • Feb 16

    The problem is, we are no longer allowed the time we need ....to be the nurse we all want to be.
    Health care is now a corporate money maker. Nurses are the commodity that make money for big business.

    I never hated nursing, I hate that the corporate masters have taken it over.

  • Feb 10

    I just finished up my program a couple months ago in Texas, where NPs, despite their best effort, are continually shut down on their attempts for autonomous practice. However, I don't think that affected my education at all. I do plan on working eventually somewhere where I'll be an independent provider as well, and being trained in Texas shouldn't affect that at all. So don't worry about finding a school in one of those states, just find a good program that suits you.

  • Feb 10

    The basic curriculum and content are the same, regardless of the regs about NP practice in the state in which the school is located.

  • Feb 10

    Your clinical experience/education may differ based on the autonomy of the NPs you are working with. Your program would be the same or similar as they all prepare students to take a national board exam.

  • Feb 10

    Doesn't matter at all.

    Michigan is pretty restrictive on paper, yet in many settings I observed the only one thing that differs is that NP's paperwork must be co-signed by "partnering" physician under whose name and license the NP works. That includes all prescriptions and procedure notes, and happens sometimes weeks postfactum, especially in rural underserved (or, rather, almost not served at all) areas. There are docs who drive 5 to 7 hours Up North every couple of weeks just to sign mid-levels' papers and orders and charge leg and foot for doing it.

    Billing is another thing altogether, but this is a completely different issue and the one, AFAIK, which needs to be studied in depth anew every time when any provider changes the work setting.

  • Jan 13

    For a tasty snack or breakfast (if you like oatmeal):

    Mix skim or one percent milk with quaker minute oats, honey, and dried coconut flakes. Sprinkle with cinnamon.

    I make this the night before in a covered container and leave in the fridge. Ready to eat in 15 seconds.

  • Jan 10

    Quote from Pangea Reunited
    I usually do eat, but I find that I sleep much better if I don't. As for weight loss, I've never found time of day to be a factor ...just what (and how much) I eat in a day.
    This.

    When I worked nights, I ended up losing ten pounds.

    I eat pretty well; fresh fruits and veggies, complex carbs, proteins and dairy with less fat-a well balance diet with a few treats in between, and lots of water, smoothies, and keep my snacking to no more than 200 calories.

    What I can recall is eating before my shift was over-at least between 0530-0630 so when I went home I took a shower, and went to bed.

  • Jan 10

    I worked permanent nights for 4.5 years. I always ate right before bed in the morning, but this was usually an egg and oatmeal.

    I drank a green smoothie in the evening before work and brought my dinner: usually fish or chicken with vegetables.

    Snacks consisted of granola, nuts, fruit, cheese, yogurt. I only drink water or herbal tea.

    Fast food and processed food are out. I can't digest that stuff.

    5'8 and 130 pounds sounds like a healthy weight, IMO.


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