gonzo1 19,347 Views
Joined Jun 8, '05.
Posts: 1,720 (46% Liked)
Not sure about your instance. But in my case it was easy. I had been recruited to be a new grad in the ER. It did not work out. So when I interviewed for med/surg I was able to say that I realized that ER was not a good place for a new grad to start, and that many people said new nurses should start in med/surg so that was why I was applying for med surg job.
They bought it.
You can always use the "too far from my house", hours didn't work out, unit going through many changes and looking for more stable work environment. There are always lots of nice, vague things one can say.
Always keep it simple though.
I worked ER for about 9 years, then went to ICU and am going on 5 years there. Both are considered "specialties" for good reason. The difference comes into play that in the ER everything is explore and stabilize, while in ICU you are tweaking and doing long term management. Both specialties require nurses to have great critical thinking skills and be able to multitask on a very high level.
In a way ICU is easier because you usually already know what the patients major malfunction is when you get them. In the ER you have to be a detective and try to figure out what the problem is.
Both ER and ICU nurses have to know how to code a patient, give lots of blood, titrate dopamine, fentanyl, and a bunch of other drugs. I do think it's easier to go from ER to ICU because as an ER nurse you learn to just deal with whatever comes through the door. I see a lot of ICU nurses who don't like the uncertainty, and will say, "I'm not ready to take another patient." In the ER we don't have that option. They just keep coming in no matter how busy we are.
Let's stop looking to see who is "better" or what ever, and start to appreciate the importance of each area of nursing. We are all highly trained individuals.
I agree, but I picked up a patient last night that was intubated and didn't have one. I thought that was unusual but the reporting nurse said it didn't matter.
When you're agency and/or travel nurse the charge nurses and managers will go over your charts with a fine tooth comb looking for mistakes. It's just part of the job. I (giggle) always say to myself "they're getting to see how great charting is done"
It is against the law to go and change someone else's charting so the nurse that does that is putting herself up for a big problem.
Sounds like you work in kind of a hard place.
I've used my malpractice insurance services twice. They were great and I highly recommend it to all.
I did a travel nurse contract in their ER in 2009. I loved it. For the test study up medical math, and then if you have taken CEN or TNCC etc you will do fine. I did pass it, but there is a pretty high fail rate. It's worth it, because if you have Parkland (esp ER) on your resume you can write your own ticket anywhere. At the time each nurse had between 6 and 15 or so pts. That sounds like a lot but they make it work. Parkland really respects their nurses and makes sure their doctors listen to your opinion.
I have heard that the ratios are smaller now. Also it's a teaching hospital so the residents do a lot of our work so they get the practice. But you will see a lot. My attitude was "I gotta try this" and it worked out great for me. Only place I ever cryed when it was time for me to leave. They asked me to stay, but my husband wanted to get home.
Not bad for a beginner. Usually you want to leave out stuff like who the pt is and the dx as that is already noted in chart. also you can go through and slash out most of the time you used pt as we know who you are talking about. for example just put
refused miconazole at 2100, awake, lying in bed, watching tv. you don't need to say "when I left room" you could say "lying in bed, watching tv with no needs at 2200"
you will learn to use fewer and fewer words as time goes by.
we all do
document what you see and hear. If lungs sound clear document lungs sound clear. Don't worry about using too fancy of medical language or such. Keep it simple. Remember if you don't chart it, it wasn't done.
For example, try to chart everything you do for a pt such as treatments, warm blankets, pillows, speaking to their families, doctors and any education you provide.
Just use common sense language and avoid abreviations as we are using them less now for safety sake.
Just chart what you did and when, and sometimes why.
For example: Crutch training given to pt and family, pt demonstrates safe use of cruthes.
or: 1800 ADA diet provided, pt ate approximately 90 % with assistance from wife.
Or: bedside commode provided for pt due to unsteady gait and weakness. Pt assisted to bedside commode. large bowel movement noted. pt requires assistance for hygiene
I have read a couple of books on documention and they helped a lot. Look in the nursing section at Barnes and Noble or other book stores.
I document as frequently and as much as I possibly can because this will refresh my memory on a patient if I am ever brought into court.
It also lets the higher ups know what you were doing and when so you have proof you were not eating bon/bons all night.
I have often been told I am a good documentor
I spent several years in the ER and now ICU. I have seen doctors cry, firemen cry, EMS, nurses and all the rest. At first it is hard to control your emotions, but as time goes on you learn to get the job done, then cry. I gotta say, there is nothing more gut renching then seeing a fireman cry. But I have nothing but respect for those who cry.
Most of us agree that when you don't cry anymore then you should probably get out
I was fired from my first nursing job during orientation to ER. I went to med/surg for a little over a year at a different hospital and then transferred to ER. Was there for about 5 years. Went travel nursing. Moved to another state. Started looking for ER work and got fired from an ER job after 4 weeks.
Took another travel job to get my confidence back up and went and got another ER job. Got fired from that about 4 weeks in. But the ER director told me to go ask the ICU director for a job. So I did. They hired me and I love them and they love me. Later found out that their ER hires and fires lots of people and regular employees refuse to float there because the ER nurses are mean to them.
So, my career summed up is fired 3 times. Made a DNR by a hospital x 2. Worked in over 34 ERs over the 10 year span. Most I loved and fit right in. Nursing is a strange, but wonderful world. There is not just one, but several places that are dying to have you. Neither of you know it yet though.
What helped me is that I had worked so many places, for so long that I did have wonderful references. I can also always fall back on travel nurse jobs if I want to.
Trust me, getting fired was devastating for me, but I did sit back and reflect on what I could have changed to keep from being fired and I actually identified a few things.
The nice thing about getting fired as a new grad on orientation is you just tell the next place that the last place wasn't a good FIT. That's what I did. I have some friends that went through 4 and 5 jobs the first 2 years because nothing worked for them.
I hope that as the years go by you will find nursing turned out to be wonderful for you, like it has been for me. One last thing. A couple of my favorite nurses that are now "way up" in nursing were initially told by people that they were losers and would never be nurses. So keep working at it.
Advertise With Us