PeakRN

Just for perspective I have found essential hypertension in otherwise healthy 2 and 3 year olds several times in the ED. While the ED is not the kid's primary care, that may be the only medical provider they see for months or years. These kids could easily end up with long term kidney disease if they weren't completely evaluated during their visit.

When we hire in my center we typically favor critical care over floor pediatric experience. Unfortunately adult med/surg is unlikely to give you either experience, but you also have to start with the job you can get. If you are willing to relocate there are often programs where you can start as a new grad in a large ICU.

The ICU book. The Ventilator book.

Query: Professionalism.

One of our PICU intensivists loves giving haircuts to the long term kids.

Reducing dislocations. Instantaneous gratification.

While I agee with some of this I would like to clarify a bit. I was a messy medic. The floor and bench of my bus were a disaster by the end of my call. That was because we thoroughly cleaned the back after every call. Also since we only us a few calls a day it want a big deal to clean after the call, had I run a 911 system that is constantly churning volume I’m sure that would have been different. Cleaning your workspace type habits were a big change for me.

You seem to have a bit of a chip on your shoulder. Why did EDs start hiring paramedics? Simply put they are cheaper labor than registered nurses. Paramedic and nursing education is not the same, I’ve done both. Paramedics are taught the technical skills in order to manage patients outside of the hospital. They perform high risk interventions with less training than those who would typically be performing them in the hospital because the risk is outweighed by the benefit on the street. In the hospital we can lower that risk though by having specialty trained staff perform those interventions. Nurses are instead taught a general basis of care across many care environments and then specialize when they start working in a specific area. The shortest paramedic course is 3 months in the US, the shortest RN are about 16 months but requires a prior bachelors and prerequisites.

In my opinion your ED has not provided adequate training. All of our new grads must have ACLS, PALS, TNCC, ENPC, NIHSS as well as complete their online ED modules and all of their staged orientation (which would include things like gastric tube placement, sedation management, invasive line management, vasoactive drug titrations, et cetera) before we allow them to come off of orientation. If my new grads can’t get the appropriate learning opportunities in the ED by the end of their orientation I will send them to one of our adult or pediatric ICUs to get that experience.

We never furloughed anyone, but we did cancel every traveler and PRNs have been removed from the schedule. We did rotate a lot of nurses with adult experience back to the adult world. PICU nurses back to adult ICU, peds onc to adult onc, peds floor to med/surg, et cetera.

I’ve taken care of more famous people and their families than I can count. Professional athletes, national media reporters, politicians, several heirs to european monarchies, CEOs who’s names are nationally known, and so on. We are a bit well known amongst those circles for not caring about anyone’s celebrity status, and treating everyone equally.

No offense but if you have nothing to do as a nurse on a peds unit for several hour you aren't really a peds nurse. There is always a kid that needs help with homework, another disease to be studied, an infant that would benefit from holding, and so on.

For something like a glucose check I don't understand why you would really need to use the limb alert arm. In the unit we stick patients every hour when on IV insulin, often (repeatedly) on the finger of their choosing.

I'm fortunate to have the perspective of having worked with adults and peds in EDs and the units. Life is unpredictable, it isn't fair, and not everyone gets dealt a good hand. I've had plenty of kids with poor outcomes from heart disease, the flu, and just about every other thing possible. It exists in adults too. It exists in the EDs, adult ICUs, NICUs, floors, and so on. I think that in order to survive critical care you have to come to terms that a lot of patients are going to have poor outcomes, and be able to not take it home. We are able to recover many more patients, and give lifetimes back to so many of our kids and their families. Over the years I've worked with a lot of nurses who don't ever really handle the stress well, and ended up leaving the units or EDs. It isn't natural to see death and suffering like we do everyday, and they found that another care environment ended up being much better for them. If you do choose to leave the PICU don't think of it as a failure or weakness.

I think that it's just part of the business for hospitals that have unions. There is probably variation based on union contracts and state laws, but if your union has the right to strike then is it egregious that the hospital has the right to hire temporary workers? That's kind of the point though, you hope that you are valuable enough that the hospital will take you seriously and the you use that as negotiation leverage. But if the ask is too great or the value compared to temps isn't worth it then it is up to the hospital to decide whether to keep or fire the union nurses.