I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an Accelerated BSN program. Some of my classmates are starting in the ER.
My clinical instructor and my preceptor killed my chances by giving weak references and using the "everyone needs to start in Med/Surg". But I loved my clinical preceptorship in the ER and another (more experienced than my preceptor) nurse even said I should apply to work in the ED.
I am a 46-yo, ex-accountant, no medical background, but I did have straight-A's in our program.
If you are considering a career in LTC, here a a few things that may make collegiality better:
Join NGNA (National Geriatric Nurses Association). They have an online test and certifications. The august American Geriatric Association has a special place for RNs.
Like Pediatrics and Neonatal, Geriatrics is a field all its own and its patients are much different from other "medical stages of life".
(ie: the typical Geriatric patient's liver has 25-50% clearance rate of the adult. That is why we wouldn't give as much morphine or other drugs)
Next, LTC is the fastest growing medical industry in America, and with our Boomers coming in right now, its just going to geet bigger. Geriatric diabetes is rampant as in Parkinsons and cardiac. Pain and symptom control is a huge part LTC. Multiple diagnoses is the most common aspect.
We handle seizures, respiratory (big issue), Parkinsonian, Alzheimers, Psychiatric, Pain control, nutritional issues, GTs, lots of infections (URIs, UTIs, Cellulitis, Diabetic foot and leg infections, decubiti, fungal infections, VRE, MRSA, flu and eye and ear infections). We also handle factures, dehydration (big issue), behavioral issues and deal with families a great deal, measures, sensory and perceptual problems, failure to thrive issues, gastro-intestinal issues, DNRs, death pronouncements, referrals, consults, skin assessments, respiratory assessments, trach care, ROM, patient safety (big issue), many, many new meds, perotonial dialysis and others. This why Med/Surg practice is important. Medication reactions is always an issue because these patients are taking so many meds which may interfere with each other, and allergies. We do a lot. Hygiene issues are something we are fanatical about. Prevention is huge. And we are the most scrutinized part of Nursing there is.
Backside: Medicare and Medicae costs and the current Nursing reimbusement caps keep salaries low and the nursing shortage hits us maybe the hardest. Added to that, most LTC companies are 'for profit' and can play very dirty supply, pay and staffing games.
Psychologically, many nurses feel that LTC is "bottom of the barrel" and most nurses don't particularly want to be presented everyday with their own oncoming or projected infirmities. I don't find it a problem, but would fight like hell to keep myself out of one of these facilities. (Maybe I'd just, when the time comes and my Cherokee blood overtakes me, just walk out into the winter woods to let nature have me. some family members have done it.)
The spiritual issue is very large. Understanding that helps. Only in hospice and palliative care have I found like issues. The nurse can participate if he or she is careful and respectful.
Cultural issues are also big. Gypsies can die in our sun room or, if it is feasible, outside. Jews want the Kiddush. Moslems want the Suraic rites. Catholics want Communion and unction, etc. You will want to know them all.
Anyway, last week, I had to hang TPN for the first time EVER. I called two good friends who were working that night, in 2 separate ERs about any advice they could give me. Neither had ever hung it before. I was ON MY OWN. At least when I hung Nipride for the first time as a new grad, I had MANY resources from which to choose, and all were glad to help! (no veetach, contrary to your belief, this does not "bring the ER down" as I would later help them with an IV that she/he may have missed, or do a discharge, you know, teamwork:roll )
sean;)
I wasnt even going to respond to this post, Sean, but since you brought me into it....
If you had worked med/surg as a new Grad you would have learned how to hang TPN.
I'll go to any ER in the country. I'd guess that 40-50% of the "seasoned" nurses would have to ask a question or two about TPN.
For the record, I had a question about the filter only. I could read about the rest. (As many good, seasoned nurses will still use cheat sheets when hanging Neo, Vaso, and Levo...)
Please
Read the last few posts. Most are supporting forward thinking and doing away with your type of thinking when it comes to new grads.
I am nurse enough to ask when in doubt about anything and realize that I will ALWAYS have something to learn until I hang up my stethoscope. Are you?
I'll go to any ER in the country. I'd guess that 40-50% of the "seasoned" nurses would have to ask a question or two about TPN.
For the record, I had a question about the filter only. I could read about the rest. (As many good, seasoned nurses will still use cheat sheets when hanging Neo, Vaso, and Levo...)
Please
Read the last few posts. Most are supporting forward thinking and doing away with your type of thinking when it comes to new grads.
I am nurse enough to ask when in doubt about anything and realize that I will ALWAYS have something to learn until I hang up my stethoscope. Are you?
i agree. there is an old saying that says that "the only dumb question is the one not asked. " and i agree. sometimes those old sayings make alot of sense. i can say that for 12 years the phenergan vial has not changed (ampul) but at 0330 am after 2 -3 12 hour shifts, i admit i have to ask some one "is this phenergan, i know it is but i just need you to tell me that it is."
i often ask questions that i know the answer to. not that i am not confident enough but that i am careful enough. i
don't know everything, nor do i profess to. so i say bring on the questions, new grad, transfer or seasoned. bravo hogan!
Read the last few posts. Most are supporting forward thinking and doing away with your type of thinking when it comes to new grads.
I am nurse enough to ask when in doubt about anything and realize that I will ALWAYS have something to learn until I hang up my stethoscope. Are you?
Sean
awwww come on, Sean, I was just playing with you on this one... I think we have ascertained that you did well in the ED and have since moved on to bigger and better things. As far as "my type of thinking" goes, I dont think I am alone, and if the IM's from people on this board is proof, then I am sure of it.
However, I think if we all keep it in mind that nursing is an ever changing profession and it is impossible for anyone to know everything, we will be all right. Regardless of our opinions of new grads in the ED, the hospital will continue to staff them there because they are cheap, and it sure seems that money is where its at as far as hospitals go these days.....
OH BTW I continue to learn every time I work, IMHO any nurse who thinks they know it all are fooling themselves and cheating their patients.
Well, I don't have to elaborate. But do I use "cheat sheets", a calculator, the "Portable RN" and carry a brandy new 2004 Drug manual? You bet. TPN? Well, in ER you wouldn't have to know it unless someone came to you on it, and there are a lot of docs around, usually, to help out. On a Med/Surg unit you will deal with TPN, and lipids and electrolyte solutions, etc.
I'm of the old Socratic school that says: "the man who knows he knows nothing is truly wise."
By the way: The Acrimonium really is: "There are no stupid questions, just a lot of stupid people to ask them." (This includes me). LOL
No, it wont fab4. But I must say I have had a ball debating this topic with you guys, especially Sean. Heated discussions like we have had keep our juices flowing.:)
I dont think any one of us is going to change the others' opinions, but its fun trying!:chuckle
Sorry I addressed my last post to you instead of to veetach.
I hope you will forgive me, and that veetach reads both of our posts:kiss
I was about to say..
I agree with you...work where you want. I think MedSurg is a specialty, and I know I could work there. Hard, back-breaking work, as are many areas of nursing. I was often told to work at least one year in MedSurg for the valuable experience, when all I wanted was L&D...it just didn't make any sense to me. I say " Go where you want to when you graduate", you have to be happy in nursing or you will never make it.
I WANT to work in the ER so I can care for the Hispanic mom that brings her kid in because they have no place else to go. I want to care for the middle-aged guy with the toothache who doesn't have insurance because he was laid off.
Get this, I want to care for someone's mom/grandma while the other ER nurses are groaning "not another nursing home dump".
And for the migraine patient that everyone accuses of med-seeking because I understand they have no reg. doc or their fancy specialist really doesn't want to treat them when they are actually in pain.
I even want to care for the boarder patients, explaining for the 20th time why they don't have a room yet, even though they are admits to r/o an MI, which means it is our job to prevent them from coding while they are waiting.
And I know there is not a lot of time to do this, but I really want to see if it is possible to get some of the "frequent flyers" connected with the right resources so the are not coming to the ER when they should be somewhere else.
In some ways, I think I want to be in the ER to care for the patients that other people don't want to be bothered with.
You watch too much tv...and although you obviously have a big heart, I think you are a little naive. The Hispanic mom that brings her kid in? Come on...
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
cadeusus2004
44 Posts
To All,
If you are considering a career in LTC, here a a few things that may make collegiality better:
Join NGNA (National Geriatric Nurses Association). They have an online test and certifications. The august American Geriatric Association has a special place for RNs.
Like Pediatrics and Neonatal, Geriatrics is a field all its own and its patients are much different from other "medical stages of life".
(ie: the typical Geriatric patient's liver has 25-50% clearance rate of the adult. That is why we wouldn't give as much morphine or other drugs)
Next, LTC is the fastest growing medical industry in America, and with our Boomers coming in right now, its just going to geet bigger. Geriatric diabetes is rampant as in Parkinsons and cardiac. Pain and symptom control is a huge part LTC. Multiple diagnoses is the most common aspect.
We handle seizures, respiratory (big issue), Parkinsonian, Alzheimers, Psychiatric, Pain control, nutritional issues, GTs, lots of infections (URIs, UTIs, Cellulitis, Diabetic foot and leg infections, decubiti, fungal infections, VRE, MRSA, flu and eye and ear infections). We also handle factures, dehydration (big issue), behavioral issues and deal with families a great deal, measures, sensory and perceptual problems, failure to thrive issues, gastro-intestinal issues, DNRs, death pronouncements, referrals, consults, skin assessments, respiratory assessments, trach care, ROM, patient safety (big issue), many, many new meds, perotonial dialysis and others. This why Med/Surg practice is important. Medication reactions is always an issue because these patients are taking so many meds which may interfere with each other, and allergies. We do a lot. Hygiene issues are something we are fanatical about. Prevention is huge. And we are the most scrutinized part of Nursing there is.
Backside: Medicare and Medicae costs and the current Nursing reimbusement caps keep salaries low and the nursing shortage hits us maybe the hardest. Added to that, most LTC companies are 'for profit' and can play very dirty supply, pay and staffing games.
Psychologically, many nurses feel that LTC is "bottom of the barrel" and most nurses don't particularly want to be presented everyday with their own oncoming or projected infirmities. I don't find it a problem, but would fight like hell to keep myself out of one of these facilities. (Maybe I'd just, when the time comes and my Cherokee blood overtakes me, just walk out into the winter woods to let nature have me. some family members have done it.)
The spiritual issue is very large. Understanding that helps. Only in hospice and palliative care have I found like issues. The nurse can participate if he or she is careful and respectful.
Cultural issues are also big. Gypsies can die in our sun room or, if it is feasible, outside. Jews want the Kiddush. Moslems want the Suraic rites. Catholics want Communion and unction, etc. You will want to know them all.
No more room.