Need info

Well, I do both. I work full time in the ER as an RN although I have kept my MICT current. I do occasionally pull shifts in the field. Once in a blue moon I work in the air. Not often though. Now that I am pregnant, I try to limit myself to ER. (my server drops me constantly, so this will probably be in parts-sorry) In the field, we are pretty much flying solo of course we do call in for orders from time. In the ER, it is not even close to the same. We often get docs that want to order the saline to wash the wounds with. Drives me nuts. speaking of driving me nuts, the dogs are whining to go outside and chase squirrels. The only way to get them quiet is to take em out. So I will try to get into this more later today. Sorry

Funny, but we have two RNs in our ER now that were both Law Enforcement, and they are great nurses.

Anyway, a day in the life of an ER nurse, hmmmmmm, besides putting up with frequent flyers, temperamental ER docs, and snippy coworkers, life is just peachy!!!!!!

Seriously though, in our ER our nurses can order certain xrays on their own, but we can't initiate any kind of treatments except for fever reducers, before the doc sees the patient. Well, we can start IVs and draw blood, and order EKGs on chest pains before the doc sees them, but that is about it. Once the docs give the orders, they don't stand over us to see if they are carried out, it is expected that we do what we're there to do and take care of the patient.

Our patient to nurse load is 4:1 which is great compared to some ERs I've read about here. Anyway, with that many patients, things can get a little hectic, especially when you have two doctors throwing orders at you. And that doesn't even count the times that specialty docs come in and throw orders at you.

Things move rather quickly in the ER and we are expected to tell the doc of any changes with the patient. If we are in triage, we are expected to be able to tell at a glance which patients are critical and which can wait to be seen. (this isn't as easy as it seems).

We are expected to do what needs to be done in a timely fashion. This means that we don't usually have time to have a long friendly chat with patients. We can't take an extroidinary (sic?) length of time getting an IV in place and getting medications given. It is ok to talk to the patients and comfort them, but sometimes you just don't have a lot of time to do so if you have a couple of other patients that also need something.

Which leads us to another big thing; prioritizing. Would it be quicker to check that back pain in and then start an IV on the belly pain down the hall? Or can you get that IV quickly, give meds and get that patient to xray without delaying check in of that back pain? Which patients need your attention more? The little old lady that needs a bedpan for the fifth time or the back pain who wants their pain med NOW, who is in the ER at least once a week with the same complaint.

ER is where the rubber meets the road, critical thinking skills are essential to quickly assessing patients. That's my story, and I'm sticking to it! :chuckle

Pam

Ditto to Pams post. Except our nurse to pt ratio is usually about 6 or 7:1.

In the field we have standing orders, so its just memorize, memorize, memorize.

I think it is good for me to pull shifts in the field. It reminds me how hectic things are out there and I can actually defend the crews when my extra special coworker is constantly complaining about how long it takes ems to get a patient to the er. All ER nurses should at least do a ride along once. It is so much easier to understand why extrication takes so long.

My Daughter Had her CNA in the show me state of MO. and she wants to move to Georgia Will she have to retake her test or what are the laws for cna renewels.

I work an RN ambulance in Phoenix...

99% interfacility xport (we do roll up on an MVA on occasion)

Lots of Diprovan and Vents w/ PEEP (medics can't do PEEP in Phoenix)

Had a Solumedrol drip last week, that was new...

Otherwise pretty routine stuff, but I like it. It's way better than ER...

We have "offline protocols" (like standing orders) for most stuff (intubation, central lines), so we practice 95% independently, otherwise we have to patch to titrate drips...

sean

Was a paramedic for 20 yrs, went to nursing school. Worked primarily in an ED for last couple of years doing the medic thing part-time. Kept up my NREMTP. Now working full time for a Critical Care Transport company. In the state I work in I have both my Paramedic Cert and another one called Prehospital RN. It lets me do everything I can do as a medic, intubation, interosseous, give meds, all on standing orders and I can contact medical control for other orders. I can also work as a emergency responder. For me it was the only way to go as I just can't given up the feild but I gettin' to old to crawl around in wrecked cars at 0330hrs in February in the middle of an ice storm.

As a paramedic for 10 years and now a RN for the last 7 i'd say ditto to the above.

Most of my cohorts above could attest that most of us would be totally bored to death if we worked med/surg- just recall your clinicals- i know I was but definately learned alot. It was difficult at times to make the transition to RN though. You go from relative autonomy to such a controlled setting- although this varies too- one ER you can do alot the next you can't start an IV on a chest pain until you have spoken to the Dr. I have found teaching hospitals are my preference as most the residents tend to trust your judgement after a while and give you just about any thing the patient needs.

Rj http://smileys.smileycentral.com/cat/3/3_9_3.gif http://smileys.smileycentral.com/cat/3/3_2_1.gif