Leaving the emergency room for endoscopy

yrmajesty3 · May 23, 2012

Hi Cadency,

I just started in a GI lab as well. I have heard similar comments by a NP. She knew that I came from a rather stressful pediatric vent unit and thought I would be bored. Frankly, I am motivated by the hours as you said. I'll do anything not to work nights/ holidays or a 12 hour shift. I don't mind being low key for a change ( especially since Im working on a new business in addition to the lab). Having said that....there was NOTHING low key about the unit today. It seemed to have just enough points of stress to keep you alert but not panicked. I am most worried about a perceived hostile environment between nursing and medicine ( too soon to accurately assess the scope of the prob). That kind of issue will have me job hunting again real soon if it gets ugly.

Feel free to PM me.

brownbook · May 25, 2012

Hey all!
Just wanting to introduce myself and talk about endoscopy. I'm going to be starting a new position in the field in the next two or three weeks. I'm pretty excited - I shadowed for a little while and the area is interesting, lots to learn, and totally different. I presently work night shift in a level 1 ER. I've been in the ER nearing three years and I find the nights and politics of the area wear my body out. I get sick all the time and we are chronically short staffed.
I've had a few naysayers who, when they find out, keep telling me that I'm going to hate it. When I ask why, they simply say I will be bored compared to the ER. Has anyone had this experience? I see mostly people on this forum wanting to go into it - for the hours and type of work load... not people complaining about how boring or how intensely stressful it is. Really, I'm going to start school for my masters soon. I think I could use easier and less stress!
Has anyone had experiences with Endo being very cliquey? Along with the, "you'll hate it," I've also been told that...
I guess the fine point is: If you started somewhere from endo, where did you start? What was the transition like for you? Would you do it again?
Just from meeting people on the unit, once you get in endo... you stay there. Most of everyone had been there for a long time.

I worked 17 years in various floors in an acute care hospital (I always liked floating.) I got tired of nights, weekends, etc. and transferred to the out patient surgery department that also had a GI clinic.

Our department was small so not enough staff to get cliques, I guess you could find that in any unit?

I loved all aspects of the job. I LOVED working days, no weekends, etc. We rotated two months GI, two months pre-op, two months recovery so I did not do only GI. However I thoroughly enjoy GI nursing.

I may be totally wrong but I think people who naysay are jealous you will be out of the high stress, lousy hours, of ER nursing?

I know this doesn't exactly apply but to people who say it will be boring I always think of the saying "only boring people get bored." I find it fascinating, I don't know why? I never get tired of seeing the inside of our bodies? I don't take it for granted that a case will be "routine."

Just wait until you get an active GI bleeder and find out out boring it is!

yrmajesty3 · May 26, 2012

Unfortunately, I will only be in the pre and post procedure rooms. I think that's why some may think it will be boring.....I don't think so though. If I become at all bored, I would request to work in the procedure rooms when I feel comfortable.

I'm still in orientation in a baptism-by -fire sort of way. Have only been on the unit for 2 days. The focus has been on paperwork and shuffling patients around. No one nurse follows the same pt. It's a whoever-is-available sort of system.

Can you experienced folks tell me what meds you come across most often? It seems that antibiotics and Zofran are the most common.

I'd also love to hear any "pearls" of wisdom you may have about difficult situations.

brownbook · May 26, 2012

yrmajesty3,

I need to know more about your unit. In my 12 years of doing part time in hospital, and out patient GI nursing I think I have given Zofran twice. Are your patients nauseated after the procedure due to whatever sedation was used? Or nauseated before the procedure due to whatever cleansing laxative prep they had to take?

I occasionally give antibiotics pre-procedure. Nothing too special about them, just whatever the Dr. orders.

I can't think of any meds we use very often for pre and post nursing care in gastroenterology? The Dr. may order them some proton pump inhibitor or laxative for the patient to get at their pharmacy?

The difficult situations are mainly in the procedure room. Working in the procedure room usually isn't too difficult, but I don't know what your unit is like. Would you be assisting the Dr. with the scope, giving the sedation, or labeling biopsies? Or some combination of all three?

yrmajesty3 · May 26, 2012

Hi Brownbrook,

I wont be helping in the procedure room. Apparently, our hospital wants only ACLS/Endo Cert nurses back there. Im not qualified for that. I asked about meds because I have NOT really seen any given yet....just a Zofran for a 22yo obese female who was reacting to anesthesia....so she said. I think I forgot to mention that my new unit also does Bronchs. They come out coughing quite a bit. It's hard for me to tell if they are in bronchospasm/wheezing or just irritated. Gave one woman a albuterol neb just in case....did nothing for her. I was told that one doc in particular uses an extra small scope that goes deeper into the lungs. This requires a deeper anesthesia. Those patients cough the most and seem to require a little extra monitoring/time post procedure.

Can you tell that I am REAL GREEN? I've been nursing for 20 years but feel like a fish out of water in this new arena. I hope this phase passes quickly. So, again, any pearls of wisdom are welcomed...especially regarding nursing interventions for the common complaints.

brownbook · May 26, 2012

I remember having exactly the same feelings, fears, worries, when ever I would transfer to a new area of nursing.

So many fears seem so silly in retrospect. but I think intelligent, thoughtfull people like you and I, ha ha, are just hyper viligant and alert for the what if's, and want to be ready to deal with the worse case scenario without looking like idiots!! (And worse yet a bad out come for the patient).

Honestly all I can think of is either a post sedation patient not maintaining their own air way, (chin lift, jaw thrust.) And GI patients getting painful gas cramps, (various remedies for this, but none of them guaranteed.)

Even working in the Endo room is really easy. ACLS is becoming extremely user friendly. I have never been Endo certified, only moderate sedation certified. So don't be afraid to work in the procedure room if the opportunity arises.

If you have specific questions ask here, also there are other good sites on the Internet for GI, Endo, nurses.

brownbook · May 26, 2012

PS

Even though you have been in nursing 20 years you have to have the guts to admit to your self, and co-workers, you are not, and can not be, an expert in every kind of nursing Say to co-workers, doctors, "I'm new to this kind of nursing", or "I've never done this before".... so bear with me." Ask a lot of questions.

So many nurses, technicians, doctors, love to teach, share their knowledge, explain what they are doing and why. And if you run across someone who does not like your questions **** them!

yrmajesty3 · May 26, 2012

Thanks for the encouraging words brownbrook. I agree with you that we must never misrepresent our skills. I never have trouble asking for help or letting staff know to keep an eye on me. My worry lies more in the patient outcome. When everyone is too busy to help me, I want to know exactly how to help relieve discomfort and anxiety. With that said, I'd love to know what are the best online resources you have found.

brownbook · May 27, 2012

http://www.endonursing.com is a good resource, but still the best is on the job training, learning, asking.

brillohead, ADN, RN · May 29, 2012

As someone who has had more EGDs than I can even count, how about if I give you a patient's perspective? I've been getting EGDs regularly since the mid 90s, and I've also had an unmedicated colonoscopy within the last couple years.

In the pre-procedural area, your typical patient is going to be scared and uncomfortable, particularly if they've never had a 'scope before. If they're having a colonoscopy, they're likely going to be fatigued from having been up all night pooping their brains out. If they didn't get the advance warning to purchase wet-wipes during their cleanse, they also have a ring of fire where their anal sphincter used to be. If they haven't been actively rehydrating, they may be a difficult stick for the IV start. If they're having an EGD, they're probably going to be starving and thirsty and dehydrated. Regardless of which procedure, they're probably at least a little scared about what is going to happen, unless they've been through it before.

If you haven't observed each type of procedure, I highly recommend it. That way you can explain the nitty-gritty details to the patient (yes, the MD is supposed to do the actual informed consent, but as the nurse, you are going to be the one spending face-time with the patient before the procedure). You can explain to the patient that you'll have them change into a gown, get vital signs, start an IV, take a short EKG strip on them, have them sign papers, etc., then they'll be wheeled to the procedure room where the lights will be dimmed, they will be placed on their left side, and if having an EGD they will be given an anti-bubbles liquid to swallow, they will be strapped down so they won't move during the scope, a hard plastic thing will be placed in their mouth so they don't bite the tube, and medicine will be inserted into their IV for the procedure itself. Then after the procedure, they'll wake up in the recovery area and be there until the sedation wears off enough for them to go home. Also, tell them now, when fully aware, that it's normal for them to forget things that happen later in the day.

A few things for post-procedure -- don't tell your colonoscopy patient that it's okay to pass gas freely because it's just the air that was pumped into them. Unless you know for a fact that they had a completely clean bowel, you could end up having to wipe up some residue if you have them fart at will. (Fortunately I was unmedicated for my own colonoscopy because I wanted to watch it myself, and I had seen the little bits and pieces that were still inside me. Had I not been fully conscious, I would have followed the nurse's advice and left skid-marks all over the bed!) Don't panic if the O2 sats are low for a sedated patient -- just remind them to breathe (some of us kind of forget that until the sedation wears off). Make sure that the responsible adult escorting your patient home knows that it's normal for the patient to forget stuff for several hours.

I hope that helps with the patient's perspective a little bit.

brownbook · May 30, 2012

Brillo, Thanks, I really appreciated being reminded of your, the patient's, point of view.

But (of course there has to be a butt, ha ha) about passing gas. I would rather have the patient pass some stool in the bed than keep it in and get cramps? I can easily clean the bed. Not so easy to relieve abdominal cramping.

How about if I tell the patient to let the gas out and if some stool or liquid, comes with it don't worry, the bed is padded and we can clean the bed easier than relieve their cramping.

Also I have no problem letting a patient get up to use the toilet soon after the procedure, if I judge they are not too sedated.