Latest Comments by UK_RN_AJ

UK_RN_AJ 2,331 Views

Joined: Jun 15, '12; Posts: 24 (21% Liked) ; Likes: 11
Registered Nurse; from GB
Specialty: 2 year(s) of experience in Emergency/Acute

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    Hi all

    Just wondering if anyone is going to do there SEC assessment this June at kawaltan Uni in British Columbia ?

    I'm a UK based RN , find the whole process very daunting !! Anyone done the assessment recently?? If so how did you fair and how did you prepare? I'm only having to sit the med/surg exams.



  • 0

    Hi all, I am currently a nurse in the UK awaiting my registration to work as a nurse in Alberta as I know this is a long process I was looking at gaining some more employable skills in the hope that I am successful. From previous posts I understand ACLS and TNCC transferable to canada. , I am just wondering wether the ITLS ( international trauma life support) is used within Canada if anyone has experience of this course.

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    joanna73 likes this.

    Unfortunately nursing staffing levels are a concern worldwide, here in the UK on my previous unit there wasn't a day when someone didn't report unsafe staffing levels, they tried to placate us with agency nurses which made the situation worse in my opinion worse as they couldn't preform all the duties needed by the type of unit I worked on, and didn't have the same amount of ownership to the Unit that the full time staff did so didnt seem to care that we were failing on aspects of care.

    Governments and managers, didn't seem to realize how it was on the front line, they only see results and when we always produce those results they believe that the system working. What they fail to see is all the extra hours we have to put in, the absence of breaks and how we drive our selves to exhaustion because its about the patient, If we fail it could ultimately mean death or worsening injury to the patient, which with 95% of nurses in unacceptable.

    In regards to your questions "Wondering what else I can do? If nothing should I just quit before I ruin my career?"

    I have felt the same way as you do many times, but if you work to the 5 P's, prior preparation prevents poor performance, you will give yourself a chance, plan you workload, use triage and work as a team. It is by no means easy being a nurse, but if you have the passion and the drive to make a difference you just keep going. Sometimes you may have to tell yourself to keep going and at times you may go home and think I ain't going back and I'd be extremely surprised if upwards of 50% percent of nurses on this site have not felt that at one point in there career.

    Don't give up !! The reason you will go back is because you are a nurse and you are the airway of health, without you a child somewhere has got a less of a chance at life , an old lady has no-one to hold her hand in the last moments of her life.

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    jtmarcy12 likes this.

    Without any doubt I would start CPR on anyone who needed it.

    On a personal note My grandfather suffered a cardiac arrest last year, he was found by a a close friend of his who was a nursing aide who lived next door, she had come round to help with my grandparents washing as she was on sick leave, my grandmother watched as as this nursing aide did CPR for around 10-15 minutes on her own until the paramedics arrived, my grandfather fought for a while but unfortunately passed away in hospital. It people like her who fuel my passion for helping others and nursing in general.

    just read this article about a nurse refusing to do CPR due to polices .............. Shocking

  • 1
    SummitRN likes this.

    Nurses can preform endotracheal intubatation in the UK within certain roles, such as resuscitation officers, critical care practitioners and other specialties. Advanced airway management depends alot on the hospital as well as the roles allowed within a said trust. For example in standard UK Basic life support you are more than competent to places an OP airway and a NP airway as a nurse. If you complete the advanced life support (much like us ACLS in the us and canada) we can preform LMA airways if needed. Then you need to take futhur courses, have in house training and alot of years experience to preform intubation for that hospital if you job role needs you do to do this. Many hospitals will not allow you to do this even if you have been doing it for years and have the skill.

    A lot of the time it comes down to senior doctors saying that this is a doctors role and doctors should be the ones to preform it. On a personal note I feel that a large majority of senior emergency department, ITU, and acute care nurse's who wish to learn this should be allowed to preform this skill within there role if they are competent and if no doctor is available to do this. I have attended several "codes" where a definitive airway could potentially have prevented complications. I have no problems if a doctor is there to preform this skill instead of a nurse as by the many people noted above I have many other things to preform, but why should my patient wait to receive a definitive airway if a doctor is not present??

    A question for all. Within you roles as nurses are you allowed to preform interosseous access in an emergency situation ? what other roles as nurses do you feel you should be allowed to preform in a emergency situation ?

  • 0

    Coming from acute medicine to emergency I was blessed with a fantastic mentor and I use the same rules that they taught me from day one. To start, along with my mentor I was taught to master initial assessment . For every patient on arrival much like moremoney$ I used ABCDE, even on the time wasters, everyone got the same full systematic (which works really well for me) assessment on initial attendence.

    A- Airway and C-spine = assessment + if adverse signs = intervention and Treat it !!
    Breathing and ventilation = assessment + if adverse signs = intervention and treat it!!
    Circulation and hemorrhagic control = assessment = if adverse signs = Intervention and treat it !!
    Disability and neurological = assessment = if adverse signs = Intervention and treat it !!
    exposure and enviromental control= assessment = if adverse signs = Intervention and treat it !!

    I focused on these initial assessments to start with and then Following that learned to do a a more focused assessment on there specific problem, if i did know something i would write it down and add it to a book and look it up and was actively and constructively challenged on my knowledge. I was always given plenty of targets and goals which helped me to see my own progress.

    Now that I help With new starters I do much the same, find out what they know and what they want to learn in the long run. Focus them on the initial assessments from that work onto more complex assessments and nursing skills.

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    Sounds like a nightmare situation and i do feel for you. Personally from experience, when a patient comes in unwell, the only people in that initial assessment are myself, the doctor and the patient. I have no quams in asking any relatives to wait outside while I conduct the first part of my assessment.

    Number one because as part of my assessment I have to get the patient into a gown so i can examine the whole patient.

    Secondly I need to assess my patient not the relatives, and the only way is to examine everything is with the patient and its hard to do that when someone else is present. only then do you get any other information from the family.

    Also who knows, that patient my not want the relative to do anything with there care as as stated by several members on the board, unless they have a signed document stated that this person is in charge of there care then until that patient can give consent for the family to know more about there care, say nothing.

    In regards to speaking out the vitals, its is simply good communication, In trauma when a patient is unwell , I will make damn sure that the whole team knows the vitals and i will do it by raising my voice clearly, loudly ,as a order and with pauses. You as a nurse cannot waste time by whispering in the ear of every doc in the unit especially in the extremely unwell.

    So in conclusion, if it happens again my advice is tell the family to wait outside while you conduct a through assessment, you will be with them shortly to discuss the care if the patient is happy for that to happen. If they have a signed medical document stating that they are in charge of care still ask them to wait outside and you and the doctor will be along shortly to discuss everything.

  • 0

    Trauma shears and Clamp
    Pen torch
    marker for board and surgical marking
    Several Pens
    Tape + SWABS
    Iphone and Little cash
    Always have a tray with IV start and blood taking kit set up.

  • 0

    Yes!! Thank you so much for that reply Janfrn . So once experience is gained and courses taken, from your answer I'm guessing the only real option would be to take the Canadian certification course it order to gain my status as a emergency nurse and/or critical care within Canada, also Is possible to attain both certifications ??

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    Hindsight is a wonderful thing, now that I see how I have phrased the question I do look a little stupid. However looking back at the boards a lot of emergency nurses in Canada have completed the American CCRN and CEN rather than the Canadian version, just wondering why ??

    What are the differences between the American and Canadian courses?

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    Hi all

    Just a quick question in regards to emergency/critical care nursing in Canada. From what I can find out on the internet there are several courses in emergency nursing and critical care nursing in Canada.

    I know there are several courses such as the ALCS , TNCC and ENPC which are much like courses we have in the UK but under different name with slight differences to practice.

    However I am a little confused when it comes to the CCRN and CCNC-(C) for critical care and CEN and ENC (C) for emergency nursing, I understand that one of these in each specialty is American and the other being a Canadian course for each specialty.

    Is there anyway of choosing between these courses ?? I.e is one held in higher regard within Canada? I am just trying to find out information as I hope someday to work within Canada as an emergency nurse.

    Any help would be great.

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    Quote from canoehead
    My last triage shift two babies with colds came in, stable vitals, low grade fevers. Both to the waiting room, and one was a 3, one was a four triage level. Obviously the three went in first, but the four was fussy and crying in the waiting room, resulting in more snot, and general misery. Dad came to triage angry that the less sick baby got to go in first, and I told him the sickest are seen first. He felt his child was obviously sicker, and got some support from the waiting room crowd.

    His child was more vocal, and better hydrated, and not as sick per triage rules. The other baby had an RSV and intubation history, but I can't tell them that because it's confidential. But the entire waiting room turned hostile that night, because it was obvious to them who was sicker. No matter what I said or how, in their eyes I was wrong, and could potentially be called rude. I offered all the nursing interventions I could, like juice, or diapers, but they wanted to see the DOCTOR, not me.

    Some variation of this happens every night. Twice I've had patients pee in the triage chair and all over the floor, and say they couldn't possibly go to the waiting room, triaged a 4 before they peed. There are lots of tricks to get ahead of the line, and it gets wearisome.

    Vomiting is another one, a retching patient looks pitiful and usually goes back, but they've jumped several hours of waiting. A young woman was overserved the night before and came into the ER with the dry heaves with her Mom. Mom didn't know why she was vomiting. Pt wasn't orthostatic, and she was clear about the cause, so I made her a 4. My life would have been much easier if I'd brought her right back, because with the chest pains and an MVA she was lying on the ER chairs for 4 hours, and had stopped retching, but looked darn pathetic. A volunteer firefighter, unrelated to the patient, helpfully told me how sick she was, and that she needed to see a doc. (Thanks a lot.)

    So who else has this problem, and how do you avoid the triage nurse hatred syndrome? I've tried bringing out unused gerichairs to the waiting room, but I have to police that, so it has drawbacks. Also, next time people come in they ask for a recliner that may not be available, or they may not even be the sick one in the group. (roll eyes)

    Anyone have ideas?
    As harsh as it sounds, there is no hard and fast way of keeping everyone happy. Your the nurse and at the end of the day, the one whose decisions will save someones life and its not up to the patients to decide who goes first as it will be you who will lose your registration not them, if something goes wrong.

    Some of the things I do is to keep the patient and family as up to date as they can be. Explain things to them as you do it, explain there signs and symptoms , and why your doing a blood pressure, keep you tone light and friendly and smile back. Answer any questions they have as honestly as you can, be in control.

    if you get a spare minute (on the extremely rare occasion) redo there blood pressure get them a glass of water if allowed. If someone is stirring up trouble in the main waiting room as esme12 says try and move them away from the others, it doesn't mean they will get seen any sooner but they will be one less ingredient to disaster.

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    Last nights peeve

    Doctors prescribing stat meds , but keeping the chart, not telling you about it and then having a go at you for not giving it to the patient.

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    Quote from joanna73
    Ok. Well textbooks are fairly standard for most nursing schools in Canada. You may want to see if you can get copies of Potter and Perry: Canadian Fundamentals of Nursing and Carolyn Jarvis: Health Assessment and Physical Examination. These texts will definitely come in handy when studying for the CRNE. Also, you can download a copy of the Code of Ethics from the Canadian Nurses Association website, which you will also need to be familiar with. I hope that helps.
    Thanks Joanna73 Ill have a look at those .

    Quote from Fiona59
    Online applications, attach k resume, space provided for a cover letter.

    Loads of hospitals all over the province. Decide where you want to settle. Everything from dedicated cancer centre's to 'worldclass' cardiac centre's. You mentioned ER earlier, we'll we have plenty of them.
    Yeah my area of interest is trauma and resuscitation, so makes sense to be in a ER, which is currently where I am in the UK. Ive been looking at Calgary and Edmonton as I would love to be working in a level one trauma centre such as Foothills medical centre and i like the idea of living in the city to get settled , but I understand its hard to get jobs in the Major Hospitals for IEN's without current Canadian experience.

    So my Best guess is to try and and work a little further out from a trauma centre and then with experience try to get in some where like Foothills. This is if t I get accepted by CARNA , pass my SEC assessments , pass any courses that need to be done and then gain any form of employment. :S alot of work ahead of me !!

    Yeah we don't tend to have to do Resume or cover letters in the UK, not many employers ask for them. Its an application form online that you provide all your Information and then a personal statement within it tailored to the job your going for and Im guessing a Cover letter is much the same ? Including why you want the job, what you will bring to the job and so on ?.

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    Quote from joanna73
    The previous thread that you started was answered by a few AB nurses, myself included. Your best bet would be to contact CARNA for any licensing questions.
    It's not in regard to licensing, , just wanted to have a chat on more general questions such as

    1. What textbooks do you use, as I will undoubtably have to study up on peads , ob and gyn and have a general look at your med/ surg textbooks, wanted to know the most popular titles and so on.

    2. Cover letters and cv's is there any basic formats you use.

    3. Wanted to know about hospitals in the Alberta area and the health system in general and so on.