Need advice from experienced ER nurses!

adriano05 · Feb 23, 2011

I'm a relatively new ER nurse (18 mos exp) and just transferred from a small ER to a big one for more experience...the problem is this ER sees SO many kids!!! I am not familiar with peds and it seems like we start IV's on all of them...any tips on keeping the kids calm?? They are such a different breed!
Also...any advice on how to not look so dumb in a code??? That was another thing we rarely used to see! Im on a long orientation thank the Lord so hopefully I will be more comfortable when time comes for me to be on my own. Any advice is so appreciated!

Hi! I need advice I'm reviewing for my nclex pn and I will be taking the exam this August. What is the best review center to attend to? I'm quite confuse I have review materials at home like saunders is this enough? Some are suggesting the Judith Miller dvd but its too expensive. It's my first time to take the exam, do I need to attend a review class? Thanks. adriano05

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Feb 23, 2011

If you can keep the parents calm, the children will take a cue from that. That will help, but unfortunately there's no perfect way that I've found to always have a calm child. If children are able to take fluids by mouth, be the patient advocate and ask the doc to forego the IV. You'll probably still need to help with a lab draw, though. Some docs want IV's just so they can show a higher acuity in their billing.

allstudentnurses, ASN, RN · Feb 23, 2011

You're not going to look dumb during a code, just take ask lots of questions and don't be afraid to jump in. If you've taken ACLS you know a nurse in a code primarily does one thing, either pushing drugs, writing what happens, helping with compressions, or assisting with other things like trying to start INT's helping others. If you haven't taken ACLS, you need to take it, if you have taken ACLS just get involved with as many codes as possible and be active in the code, help out. It took me about three codes to feel comfortable. Remember, we all have to start somewhere and we ALL had to learn, and we ALL felt the way you do now. Good luck.

MADDOG70, BSN · Feb 26, 2011

Most kids are going to be crying just from you being around. I find that explaining to the parents and calming them down does wonders for myself. If they start to freak out you have a harder time oncentrating and not feeling nervous. I also ask the parents if they want to step out in the hallway or go get a cup of coffee. I explain to them that their child sometimes does better when they cant see mom or dad for comfort and that if the child sees the parents they sometimes feel like the parents didnt protect them and just stood there. This usually works. (No parent wnats to be the reason their kid is traumatized!) Use a sheet to put around the kid along with a papoose and plenty of help from ED Tech or so. The second part of your question is, if your uncomfortable with a code, offer to document for the first few times. This will get you used to the meds and dosages you will hear being called out. Or offer to do chest compressions. You will get the hang of it the more you do them. Dont stay away from them whatever you do cause you will NEVER feel comfortabe then. Godd Luck and Welcome to the ER world.

Christy1019, ASN, RN · Mar 1, 2011

when i was a newbie i felt the same, like i was just in everyone's way, but i never shyed (no idea how thats spelled lol) away from them because they were exciting and you see and learn a lot of important and cool stuff. i don't know what policies/standard practices your ed prefers, but at mine which is a very large inner city level 1 tc, in an ideal situation (no other pts coding/other trauma or medical resus pts), our resus team consists of two rns, and usually our charge is in there too, the staff md and 2-3 residents, as well as our er pharmacist (makes things so much easier). pt is brought in by ems, everyone helps transfer pt to stretcher and cut/remove clothing, one rn is writing everything, the other is either hooking the pt to the monitor or most of the time our pharmacist will b/c he's not usually doing much until u get the iv anyways. the mds are gonna be controlling airway, if compressions are necessary there's always someone in there capable of doing that while you work on iv access, or hopefully u would have the luxury of a thumper which frees up everyones hands. get your iv, hook it to a bag of fluid, then be ready to give meds if u dont have an er pharm, or assist the docs w/anything they need, otherwise help w/cpr if needed, if a non-coding pt, i.e. stroke, mi, etc make sure u send the labs, bag up pt belongings, get a temperature/blood glucose/art stick/foley/og tube, whatever that specific patient needs, but just remember to stay calm, you have plenty of resources in there and noone is going to be focusing on ur look of fear if there is a patient coding lol. so relax, enjoy the experience and education of it all.. i hope i helped somewhat.. :nurse:

inteRN · Mar 4, 2011

Most kids are going to be crying just from you being around. I find that explaining to the parents and calming them down does wonders for myself. If they start to freak out you have a harder time oncentrating and not feeling nervous. I also ask the parents if they want to step out in the hallway or go get a cup of coffee. I explain to them that their child sometimes does better when they cant see mom or dad for comfort and that if the child sees the parents they sometimes feel like the parents didnt protect them and just stood there. This usually works. (No parent wnats to be the reason their kid is traumatized!) Use a sheet to put around the kid along with a papoose and plenty of help from ED Tech or so. The second part of your question is, if your uncomfortable with a code, offer to document for the first few times. This will get you used to the meds and dosages you will hear being called out. Or offer to do chest compressions. You will get the hang of it the more you do them. Dont stay away from them whatever you do cause you will NEVER feel comfortabe then. Godd Luck and Welcome to the ER world.

Thank you so much for your reply! This helps :)

remoteareanurse, LPN, RN · Mar 15, 2011

I can't believe I didn't work this out until I had my own kids. One of the scariest things for a kid is having to talk to a total stranger. So don't talk to them or question them. Introduce yourself to them and the parent(s) together, " Hi, I'm (name), your nurse" in their general direction, then address all questions and talk to the parent/caregiver. They will relax hugely once they realise they're not expected to speak to you. Let them initiate the conversation- most will when they're ready, some never will.

And if you are talking to them, DON'T LIE (eg. this won't hurt/ only a little sting), don't give them options that don't exist (eg. is it ok if I look in your ear? should be 'I am just going to look in your ear') and the calmer and more relaxed and matter-of-fact you are the better they'll be.

And learn how to effectively hold and immobilise a child, because often the kindest way to do something is to immobilise and do it fast, far less traumatic than ten minutes of trying to get them to co-operate, meanwhile they're getting more and more wound up and scared.

Good luck , hang in there. I LOVE paeds- I always say that if I'm going to nurse someone who is behaving like a four year old, I'd far rather they WERE a four year old! lol.

sir.tipene · Mar 23, 2011

The other good thing is to have a good supply of distraction toys and techniques, always smile always use their first names.Get to know what the younger kids ;like your spidermans,Wiggles,Dora the explorer so you can chat about them.As the above always get the parents on side they're usually more scared than the kids.Oh and the best thing ever bubbles (yes the humble bottle of bubbles) the real littlies love it Even the docs carry around their little bottles of bubbles.And 2ndly portable DVD players with a good stock of DVDs.Our paediatric ED would not survive without those 2 things.

Steve

Gurmo · Mar 25, 2011

Get help! Pretty much whenever a kido comes in and an IV is ordered, other nurses in the ED realize this and come to help. Wrap the kid in a burrito, one to hold the arm, another to hold the body still (some times the parent can help with that).

Just remember that kid's veins are not tiny. I've considered throwing in 20s in peds but typically use a 22. I just think a lot of people think they need to start with a 24 right away.

Also in a code, remember your role. I often get caught up in wanting to do a bit of everything. You can't push drugs if you are doing compressions. If you started on drugs, stick to drugs. If you find yourself not actively doing anything, or waiting for your turn for compressions, try to think about what else you could be doing. Will the pt need an extra line? Will you have to crack another drug box? Is the room a mess that could cause hazards for those working on the pt? Also, if there are more than ample enough people in the room, consider helping by looking after the pt's of the nurses actively working on the pt.

Scout12 · Mar 27, 2011

Peds and Codes. They will get easier the more you have. Remember to take a deep breath to calm yourself, and step in.

gardengal1, ASN, RN · Mar 31, 2011

First, our doctors are VERY conservative on dehydrated peds. Their theory is to Zofran them, wait a while and then start oral rehydration. It may mean a much longer ER visit while the rehydration takes place but the child has not been traumatized by the holding down, pain of an IV start. If an IV is absolutely needed, we talk to the child first, without bringing in any equipment about how they are going to get a "drink" through a tiny tube that we put in their hand or arm and that as soon as we are done, Mommy/Daddy can hold them while they are getting their "drink". Then, we bring in the equipment, make sure enough extra hands are present (depending on the child's age - 2 year olds have the strength of a bear) or, if age 6 or so, can understand the steps needed to get this job done. Parents almost always want to remain at the bedside during this painful procedure. Lots of times, we use EMLA cream prior to IV insertion if time allows. Parents are responsible for holding the opposite hand/arm quiet and talking closely to the child, trying to keep the child's attention on them as much as possible and not watching what we are doing. Second nurse holds the IV arm still while first nurse starts the IV. Depending on the age, we often offer bribes (special stickers/activity book/game - provided by our local donors just for peds) which works with those 4 and up. And, for those 4 and up, step by step explanation of the process "I am going to put this wet stuff which is a cleaner on your arm and then I have to let it dry". " I am going to put a tight rubber band on your arm that might pinch a little bit but I will take it off very soon", "Now, the tiny hurt part is coming but if you hold very, very still, we will be done very soon and the hurt will go away in a short time" and then lots of praise on how they held so still or were so good to let us do this and make sure the bribe (if one was made) is presented immediately after all the taping/splinting/coban is in place.

The code information others have given will get you through. You should be assigned a task by the code leader (usually the doctor) and that is what you do - whether it is giving meds, compressions, applying the monitor/NIBP, etc. Do your assigned job that is given to you at the first of the code, observe what others are doing as part of their job and with each code, it will get easier and easier for you to become more comfortable.