Are there nurse shortages in the ER?

suzanne4, RN · Apr 9, 2005

There are quite a few posts here about this. It would much easier if you just took the time to look at them...............

RN4NICU, LPN, LVN · Apr 9, 2005

why would a person choose to be a PA over a NP and vice versa? ive often read that physicians are looking for a "physician assistant OR a nurse practitioner" to offer them jobs. this makes me think that they are very similar to each other. im not interested in setting my own practice at all so i wouldnt care if i dont have my own license. what's important to me is what differenciates them from each other in what they do and how they assist their physicians. i also want to know if both PAs and NPs work in the same settings. PAs are NOT NURSES right? and they have separate educational systems?

Correct. PA's do not have to be nurses (some nurses do go on to be PAs - it is a personal decision based on which direction they want to go). However, all NPs are nurses. If you do not want to be a nurse of any kind - you become a PA. There are direct entry MSN programs for NPs which allow non-nurse students who already have a bachelor's degree in another field to become nurse practitioners, but they are NURSE practitioners. They take most, if not all of the nursing courses that BSN students take BEFORE entering their advanced practice courses.

A lot of things will become more clear to you if and when you enter your nursing courses. Just give yourself some time to get exposure to the role and some health care experience. That is the only way you will be able to decide what is important to you and what you want to do. (You may not care about starting your own practice/working under your own license now - but once you have some health care experience and education, you may change your mind, KWIM?)

pkapple · Apr 9, 2005

what is a RNFA? and what are physician assistants compared to? NPs?
also what is a per diem nurse?

Hi imastudent,

We are all glad to help you understand the different fields and titles, but I can tell you that many if not most nursing students change their specialty once they get "out there". Before you can even think of going for those advanced degrees you need to complete your BSN. It would be in your best interest as a nurse and financially to work in some of these specialties before you decide to go further. I know a nurse who went straight thru to ARNP-never held a job and she is miserable. She has a great education and is very proficient, but sooo unhappy. Another co-worker always wanted to do NICU-newborn ICU- and work with the preemies, guess what ? She did clinicals and found she just loved Public Health Nursing! So what I am saying is research away, but as you progress thru school, clinicals and that first job, you will find a spot that fits.

In fact a lot of hospitals still require new grads to do Med-Surg before the specialized areas.

BTW--Physician Assistants do hold a license, here in FL and most if not all other states they are licensed by the medical board and work under their own license, they have a symbiotic relationship with a physician who is called the supervising physician. They can not open an independant practice but can work independantly.

suzanne4, RN · Apr 9, 2005

Hi imastudent,
We are all glad to help you understand the different fields and titles, but I can tell you that many if not most nursing students change their specialty once they get "out there". Before you can even think of going for those advanced degrees you need to complete your BSN. It would be in your best interest as a nurse and financially to work in some of these specialties before you decide to go further. I know a nurse who went straight thru to ARNP-never held a job and she is miserable. She has a great education and is very proficient, but sooo unhappy. Another co-worker always wanted to do NICU-newborn ICU- and work with the preemies, guess what ? She did clinicals and found she just loved Public Health Nursing! So what I am saying is research away, but as you progress thru school, clinicals and that first job, you will find a spot that fits.
In fact a lot of hospitals still require new grads to do Med-Surg before the specialized areas.
BTW--Physician Assistants do hold a license, here in FL and most if not all other states they are licensed by the medical board and work under their own license, they have a symbiotic relationship with a physician who is called the supervising physician. They can not open an independant practice but can work independantly.

A Phycian Assistant's title is PA-C, which stands for certified.

They still need to work under a physician............

imastudent · Apr 9, 2005

so how does a PA's role differ from that of a NP?

imastudent · Apr 9, 2005

thanks to all the great inputs..i am now realizing that i have SO MANY questions bcuz i haven't had a single nurse experience yet! i cant wait to get in and find out what my area of interest is and specialize in it by furthering my eudcation :chuckle

Dixielee, BSN, RN · Apr 9, 2005

Dixielee have you ever considered working somewhere else other than ER?

In my years since graduating from nursing school in 1973, I have worked ER, ICU, home health, house supervisor, nursing education, dialysis, PACU, and infection control. ER is my favorite and the only specialty I have traveled in.

As far as the "gross" stuff, that is something you get used to and in fact that is some of the most interesting part! You are going to get "gross" stuff in any part of nursing, even school. That stuff is the basis of most of the stories you will develop over time. Just ask any experienced nurse what some of the most memorable things they remember, and it will include the worst wreck, worst burn, the open chest, delivering a baby in the back seat, etc.

As far as day shifts in the ER. Yes, they are available, but generally not to new grads. You may do your orientation on days, but your final shift will probably be an off shift. Most larger ER's offer a variety of shifts....7a-7p, 11a-11p, 3p-3a, 7p-7a and variations of the above. Don't rule out night shift, that is where the really good stuff shows up in the ER.....after the bars close!:rotfl:

pkapple · Apr 9, 2005

A Phycian Assistant's title is PA-C, which stands for certified.
They still need to work under a physician............

True...but a Nurse Practitioners title is ARNP which stands for registered.

Here in FL ,according to the Nurse Practice Act, NP's are also certified and work under pre-agreed protocols.

from the Nurse Practice Act:

464.012(3), F.S.

For applicants graduating on or after October 1, 1998, graduation from a master's degree program shall be required for initial certification as a nurse practitioner under paragraph (4)©.

An Advanced Registered Nurse Practitioner shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist.

The degree and method of supervision, determined by the ARNP and the physician or dentist, shall be specifically identified in the written protocol and shall be appropriate for prudent health care providers under similar circumstances. General supervision by the physician or dentist is required unless these rules set a different level of supervision for a particular act.

Not wanting to start a semantics war -both midlevels are highly trained and a vital part of the medical community, especially here in rural FL.

pk

jrun97503 · Apr 10, 2005

I have a question, more to get opinions than answers though. I am currently pre nursing getting my pre reqs to apply for the nursing program at my local CC. My plan right now is to get my LPN work for a couple of years then get my ADN, work and get my BSN, work and get my MSN, and eventually getting my Doctorate before I am done. I would go to med school after all of that, but I don't want to be sixty and just be starting my residency. lol. But that is my plan, I would like, atleast at this time, to work in the ER, granted I am aware that that choice may change. A question of this is, is the step ladder process a good one??? Has anybody else done this?? I don't really have a hole lot of time at first which is why I am doing the step ladder route for nursing. Just would like some opinions and imputs. Also, is there a place I can go to get all of the acronyms and other terms for nursing right now??? I keep seeing the acronyms and I don't like asking a lot of questions, for fear of annoying prespective friends and coworkers. I thank you for your imput.

Dave

Dixielee, BSN, RN · Apr 10, 2005

Also, is there a place I can go to get all of the acronyms and other terms for nursing right now??? I keep seeing the acronyms and I don't like asking a lot of questions, for fear of annoying prespective friends and coworkers. I thank you for your imput.
Dave

As far as the stepladder approach, it depends on your situation. A few years ago, I might not have suggested it, but there are so many good bridge programs, it might not be a bad idea. I know quite a few ADN students who took the LPN boards while in school and began making a little more money than they had been as a tech. That may be something you can consider. Then you can move toward further education. Some schools let you completely bypass the BSN and go from ADN to MSN. If that is what you want to do, look into those programs. I think getting an ADN first is a good idea unless you are 18 years old and have mom and dad footing the bill.

As far as the acronyms and lingo....feel free to ask. I don't think any of us would find it annoying. Or you can just PM me and I will translate to the best of my ability. Yes, you will see lots of them in nursing/medicine as a form of shorthand. There are many in specialties like OB that I don't know, but I can talk to the best of them most of the time.

You may get a report like this....Room 41 is a 55 yr. old female admitted per EMS with COPD and SOB. She is a 20 pack year smoker. She is currently on 2L O2 per NC, with a few wheezes and rhonchi. She had some right sided CP without radiation, but worse with inspiration. Temp 99, respers 24, BP 138/96, HR 110 with a few PVC's, and a O2 sat of 94%. She is getting Q4 hour and PRN A&A updrafts with good results. We got a sputum for AFB. Her skin is W/D/P with 2+ peripheral pulses. She can be OOB with BRP as tolerated. She is taking clear liq. with adequate intake. Her foley output was 600 cc for the last 8 hours. Her ABG's were OK on the 2L.

Her IV is D51/2 NS at 100cc/hr. She has a #20 in her Rt AC. She can MAE and has no change in LOC. Her CBC shows a WC of 21K so we got BC x 2.

Her ABX have been started. She has NKDA. We are thinking about a PT consult for tomorrow. She also needs a Chest CT to R/O PE, as she did have a little calf swelling last night, and we are concerned about a DVT, although her CXR was OK. The ID guy is coming by tomorrow to consult. The patient is single but has a SO who is also POA and will be coming by frequently.

Now, go and take care of that patient!:rotfl:

jrun97503 · Apr 10, 2005

As far as the stepladder approach, it depends on your situation. A few years ago, I might not have suggested it, but there are so many good bridge programs, it might not be a bad idea. I know quite a few ADN students who took the LPN boards while in school and began making a little more money than they had been as a tech. That may be something you can consider. Then you can move toward further education. Some schools let you completely bypass the BSN and go from ADN to MSN. If that is what you want to do, look into those programs. I think getting an ADN first is a good idea unless you are 18 years old and have mom and dad footing the bill.
As far as the acronyms and lingo....feel free to ask. I don't think any of us would find it annoying. Or you can just PM me and I will translate to the best of my ability. Yes, you will see lots of them in nursing/medicine as a form of shorthand. There are many in specialties like OB that I don't know, but I can talk to the best of them most of the time.
You may get a report like this....Room 41 is a 55 yr. old female admitted per EMS with COPD and SOB. She is a 20 pack year smoker. She is currently on 2L O2 per NC, with a few wheezes and rhonchi. She had some right sided CP without radiation, but worse with inspiration. Temp 99, respers 24, BP 138/96, HR 110 with a few PVC's, and a O2 sat of 94%. She is getting Q4 hour and PRN A&A updrafts with good results. We got a sputum for AFB. Her skin is W/D/P with 2+ peripheral pulses. She can be OOB with BRP as tolerated. She is taking clear liq. with adequate intake. Her foley output was 600 cc for the last 8 hours. Her ABG's were OK on the 2L.
Her IV is D51/2 NS at 100cc/hr. She has a #20 in her Rt AC. She can MAE and has no change in LOC. Her CBC shows a WC of 21K so we got BC x 2.
Her ABX have been started. She has NKDA. We are thinking about a PT consult for tomorrow. She also needs a Chest CT to R/O PE, as she did have a little calf swelling last night, and we are concerned about a DVT, although her CXR was OK. The ID guy is coming by tomorrow to consult. The patient is single but has a SO who is also POA and will be coming by frequently.
Now, go and take care of that patient!:rotfl:

OK, well Dixielee, I understood some of that for instance the 2L O2, which is if I am not mistaken 2 liters of oxygen with a saturation of 94% and the ct and some others, but some of the acronyms had me lost. lol, but I guess I will just have to ask a lot of questions so I can keep up, or buy/find a book for the acronyms so I can keep up. I thank you for you input though :confused: I do appreciate the help though, and I will try hard to not be a nuisence to anybody in my questions. One reason I decided to go into Nursing was to help people, and for the comradery that I percieve there to be, of course this is from watching shows like "ER", which could be misleading, but I do hope not. But again, thank you for your imput and I hope we can talk more. I really wouldn't mind picking the minds of some of the experienced nursed in this community, as well as at my local hospital when I get the chance. but if I get annoying please just let me know.

Dave

Dixielee, BSN, RN · Apr 10, 2005

Some of the acronyms you will find in a book and some are not official abbreviations. They may be used in report or in your own shorthand but may not necessarily be legal for charting.

As far as the comradery, there is that of course, although maybe a bit different than on ER. I don't usually socialize outside the hospital with my co-workers but I have a husband and other interests. I have however continued e mail contact with many friends I have made over the years. You may find that you have more in common with your co-workers of all ages because nursing is so "different" than the run of the mill job. That is why you see so many nurses, fire fighters, paramedics and police married to each other. We tend to gravitate to others who share the same warped lifestyle as we do. My husband is a retired police officer, and my ex was respiratory therapist.

After a while in nursing, you will find that if you are out with several people, some who are nurses and others who are not....you will quickly "gross out" the non nurses by your shop talk. And shop talk is inevitable. Where the insurance adjuster, the banker, the shop keeper may have interesting things happen to them......it pales in comparison to what you will see and do. How often does anyone get the opportunity to hold the hand of a dying man who has no family? How about making split second decisions that are truly life and death? You can see someone come into the ER just seconds from death and see them walk home to their family. You can dry the eyes of a child and make someone laugh who is facing an uncertain future. We see things in a completely different light than most of the world.

I was getting my hair cut one day and overheard a conversation between 2 women who were discussing matching the color blue on a baby blanket. One said she just HAD to have a certain color and she had gone all over town looking for it. She said words like, "this is a nightmare, a disaster, I have never experienced anything so horrible as trying to find this color". I wanted to turn around and slap her off the chair! She had not experienced life at all! As a nurse, you will never think not finding a certain color for a quilt is a disaster. You will see real life as it is, not the TV version, and it is not always pretty. Problems do not get solved in 60 minutes.

You will literally see the best and the worst of society. It is up to you what you do with it.