RJ 55

Hi So I have been a ER and trauma nurse for about 10 years. Here is what I have on hand.... 1. Pens 2. Sharpie 3. Trauma shears 4. Stethoscope 5. Scrubs that have lots of pockets 6. Good attitude 7. Flexible mind set 8. Open heart. 9. My listening ears on Advice.... So as new nurse on the unit about a decade ago I learned how to break down some barriers...and they are relatively simple. ER and trauma nurses are sometimes hard to relate to. We have seen the worse that humanity has to offer. Offer to help. Even if it is something as easy as assisting a patient that needs to be turned or cleaned. Responding to a beeping alarm when the primary is on the phone with a doctor is helpful as well. We notice who is helpful and who is not. ER nursing and trauma nursing is a team effort. So come prepared to be part of a team. If you don't know how to do something.....ask! We don't expect you to know everything. Be an advocate for your patient. Sometimes the ER docs are distracted. You are your patient's voice. Speak up when something doesn't seem right.

I feel grateful that I can pay my bills. When I started working as a RN, my husband I bought a house that we got a great deal on because it was in foreclosure. Many of my friends bought newer homes for 100s k thousands more. My home isn't fancy but you can't beat the location. I don't stress about providing my kids with things they need. Such as braces and medical care. I can afford to give them extracurricular activities and we go on family trips at least twice a year. My husband and I both work. He works in sales and we both make pretty good money. Our vehicles aren't "luxury" items but they are relatively new and reliable. We are able to eat out without feeling stress or guilt. A large amount of ou ur money goes to retirement as we don't want to be a burden on our children. The second big amount goes to our children's college funds. Many nurses that I work with have luxury vehicles because that is what they want to spend their money on. Everyone has different priorities. I work in the ER on nights. My job is so physically and mentally exhausting that I plan my finances accordingly. It takes one bad night to produce an injury, whether by assault or just repetitive movements to put a nurse out of commission. I'm extremely careful bit realistic. My finances reflect that and gives me a cushion. Like every good nurse, I like to think I'm thinking three steps ahead.

You are right. I, like your husband is happiest when I can stabilize them and then send them to their next destination. I feel for our patients that are Tele holds on portable monitors in the hallway and on our crappy gurneys for ten plus hours. Holding icu patients too on our resuscitation bay is less than ideal when we have traumas that keep rolliing in that need the space. The other day we treated a full arrest on the ems stretcher because we had no beds to put the patient on. Working in triage is a disaster because you have older people with legitimate complaints and comorbidities waiting hours to be treated. Patients are rightfully upset. Diagnostics are taking forever (xrs, cts) because of the amount of people. People who shouldnt be in the ER are flooding us too. It is so frustrating and scary and exhausting.

Thanks so much. I really appreciate it. I am scheduled tonight. I will take your advice and keep my chin up. I work with a great team and I think we are just getting tired of always being in internal disaster. I feel bad for our patients and it isn't a safe work environment.

I have been having a difficult time at work. We have been understaffed and have a large influx of patients in the Emergency department. The large number of patients is also impacting the inpatient side of the hospital. The hospital is full so we are holding a large amount of admitted patients in the Emergency department. The negative attitude from both patients and staff has really got me down. I feel like a failure even before I hit the floor. How do I combat this? It feels like a no win situation.

1. Once after a particularly grueling night I stumbled to my new car in utter exhaustion. I swiped my work badge against the door handle repeatedly. A good friend who was parked next me and to point out that it wasn't my car key. 2. As a new nurse on orientation, I started an IV on a confused and combative patient. We needed labs and I proudly obtained them while half the ER staff was holding him down. I was in such a hurry to dispose of my sharps that I ended up throwing the tubes in the sharp bin as well. I got glares and the silent treatment when I told everyone what happened. They did help hold him down for a second time. 3. I had a very cantankerous patient who I had to start an IV on. He suspiciously asked me if I was any good at starting Ivs and he was only going to give me on shot. His wife and daughter were there as well, equally as cantankerous. I confidently told him that I have successfully started IVs many times. I grabbed my equipment and placed it on his bed. I misjudged how far the rolling stool was to my bottom. I crashed and landed on my back and had the air knocked out of me. Needless to say it didn't invoke much confidence in my abilities. 4. I was irrigating a three way catheter. My preceptor told me not to be afraid of using force when pulling back clots. I vigorously tried my best. As the attending came in to check on my progress the tip of the syringe slipped from the Foley and sprayed urine and clots all over her and I, ruining her white coat. We just stopped and stared at each other. I managed an apology, but I was completely mortified. 5. New to the trauma room at the time I meticulously set up a chest tube and trauma tray and trocar and dressing supplies for the doctor in preparation for a sick trauma coming in by air. Being extremely nervous (and exhausted) I also downed not one but two red bulls before the patient landed. Time came for me to hold the lidocaine so the doc could pull the med out without breaking sterile field. My hand was dancing and shaking all over the place and the trauma surgeon just looked at me like I was crazy. He kept telling me to hold my hand still because he didn't want to stick me. The more he told me to hold still the more I couldn't. We got through it but my manager told me to lay off the red bulls. 6. New grad...just off orientation. Was relieved that I was taking report from my former preceptor. She tells me about patients in beds 1, 2, and 3. I ask her if anybody is in bed 4. She says no...it's empty. So beds 1,2,3 are divided by curtains and bed 4 is an actual room with a door. I assess by three patients and then hurry to room 4 to make sure it's clean since we are getting multiple ambulance patients. I walk in and there is a man who is on clearly rigor mortis. I start to hyperventilate and my vision starts going hazy. Overhead I hear that someone is on the phone for me. I manage to make my way out of the room and go to the phone. It's my preceptor, asking if I went into bed 4. I burst out into tears and am incoherent. She tells me she is so very sorry. She forgot that they moved the body in her section because they had to make room for more patients in the trauma bay. They were just waiting on the coroner and that the trauma nurse (who was a midshift) and who was still there would handle it. Not a great way to start of your first day on your own...thinking that your negligence murdered a patient. I'm sure there is more...these are just the ones off the top of my head.

Hi! Whenever I have a patient that has an existing NG or OG in the Emergency department (usually from a transfer) I will check placement of the tube. Or if I am receiving report from another nurse and I am concerned that it may not be placed correctly or if my patient had a change in position. I first check by auscultation. Also, when you pull back on the syringe you should see gastric content. You can pH test the content if your facility has the testing strips. You can also verify placement by XR or CT (usually patients that need a NG or OG will have further diagnostics ordered). I once had a patient who was a trauma transfer. I auscultated to confirm OG placement (he was intubated with poor oxygen saturation). XR tech swooped in on our trauma code and the XR showed the OG tube was in the lung. Once we pulled it out he began ventilating and perfusing much better. Hope that helps!

I'm sorry you are going through this. I have taken care of many combative patients and it is never easy. The patient you are describing takes me back to a memory (before I was nurse). My sister had woken up from a coma after being in a bad car accident. She had to have a ventriculostomy because of the swelling in her brain. My sister has always been sassy and a little impulsive but always sweet and gentle. She was a completely different person....swinging, biting, spitting and swearing. It was terrifying. We didn't know if she was going to stay like that forever. Fast forward....over a decade later she tells us that she did remember behaving that way. She thought that were aliens and we were trying to do medical tests on her. I remember one night walking into her room she.had her hand wrapped around her throat and said she wanted to die. She didn't want to leave like this. It broke my heart. We eventually got her back but after her TBI she is just a different person. She isn't violent but she is different. When I have a patient like this, it reminds me of my sister. It reminds me that there is a person in there and they aren't behaving this way I order to make my life hell. They are living their hell and it's my job to help them. It helps me to focus and not become frustrated. I have gotten hurt over the years. I have had my head slammed in walls. I have gotten choked and my wrist twisted. So I make sure I have resources and I do things safely. I tell them and their family what I am doing." I'm restraining you because I don't want you hurting yourself or anyone else". "I will take off these restraints when you stop xyz". Or "I'm giving you this medication to help you relax, so you don't hurt yourself or anyone here". I reiterate that I'm here to help and not hurt them and they are in a safe space. Working with patients like this is challenging and sometimes scary. Just know that they need your help.

When I was a new grad RN I started my career in a residency program in the ER. At that time we had ER techs (that were crosstrained as CNAs). We also had a handful of LVNs. I learned so much from them and developed do much respect. Many of these professionals don't get the respect they deserve. I learned tasks such as splinting, ekgs, drawing blood to talking down psych patients. In my early years I asked so many questions that one of the managers tool me aside and said that I was doing fine but I needed to stop asking so many questions. Well, I didn't really listen to that advice. You see, asking questions has gotten me out of doing things that could harm a patient or is out of my scope of practice. Now I'm seen as a leader in my unit. I precept many nurses. I not only teach that it is ok to have a question, I encourage it. You always need to know your resources. Maybe he shouldn't be using you as a resource. Some people don't like teaching and that's ok. I would talk to him and tell him to stop asking you questions. As a RN I don't look at my title as outranking anyone. Maybe we work a little different in the ER/Trauma unit but we are a team. I value everyone's work. Maybe you don't work in an environment like I do and people are hypersensitive under which rank they are. Maybe it would be helpful to find a new environment or new position where this mentality of rank isn't so profound. I wish you the best.

The only time that I am not able to clock out from work on time is when management asks me to stay. Managemrbt has asked me to stay over due to staffing issues (someone has called in sick and they do not have enough nurses). Management asks me to stay to call report on a critical patient (when the room is posted at the change of shift). Or during the time a critical patient (such as a full arrest or bad trauma) rolls in at a change of shift.

I understand your frustration. I am a nurse and I have had family members repeatedly call to check on their loved ones and ensure quality standards of care. I have found that my designating one family member to be the recipient of information and the communicator to the rest of the family it does cut down on phone calls and questions that I have to repeatedly answer. I think that the family response isn't an attack on you or your nursing skills bit rather from the fear and stress of their loved one being in ICU. Maybe it is their only way to feel a sense of control in this situation. Usually I will encourage family to come and visit with their loved ones. When my sister was in a coma in ICU after a bad car accident, my mom and I would stay with her in shifts so that she would never be without one of us. It gave us a sense of control and peace in a terrifying time. I was not a nurse then but my mom was a medical professional. I was so grateful to her nurses that kept her alive and gave us information on her condition. It was heartbreaking for our family. The nurses would give us "jobs" such as rubbing lotion on my sister's feet or reading her favorite books or braiding her hair. It gave us some form of purpose and control.

I think that if a staff nurse has communicated that they have no interest in teaching or precepting new nurses on the unit they should not be given that responsibility. It sets up the newer nurses up for failure. I have precepted many new nurses in the course of my career. I enjoy teaching. I find it challenging and rewarding. Also, I work in the Emergency department and in Trauma resuscitation. I think that this type of nursing depends heavily on teamwork. When I am teaching someone, I am making the team stronger and better. It improves our patient outcomes and frankly makes everyone's job easier when we are all proficient and confident in our skill level. I love my job. I found there are a few things though that you can't teach people. This are personal characteristics such as integrity, empathy, grit and respect. It's much easier to teach skills and develop critical thinking skills than instill these characteristics. Most of my preceptees have gone on and been successful but some have not. Preceptees must take ownership for their learning and be able to accept constructive criticism. I have run across a few that are only it for the paycheck. To them my response is there are much easier ways to earn a paycheck. There have been some that leave the department and even nursing because they realize that their expectation and the reality of nursing does not match. I have met wonderful nurses that I would trust with the life of my loved ones not want to teach new nurses. I think that it is admirable to voice that you would not be an effective teacher than take on a role that you know you would not do well in. Looking back when in was a new grad I wish some of my precepters would have spoke up and said they didn't want to be in that role. I had a very inconsistent and negative experience. I was hazed and mocked. I was put in situations that were dangerous just to see if I would drown or if I could handle it. I would cry on my way to work and on my way home. I made it through but I cannot say that I am a better nurse because of it. It took a more experienced nurse (who was not assigned as my preceptor) to show me kindness and the ropes and tell me that although I had a lot to learn, I was on the right track. I vowed to be that beacon of light when I was in a position to. We have to stop hazing and thinking that it is ok for nurses to eat their young. It is definitely not ok. It's not good for anyone, especially the patients that we are caring for. Our patients' lives depend on it.

When we are on leave we are unable to sign in to access our work email or anything work relates. The hold on our account is lifted when we return from leave per human resources.

I absolutely love my job as a nurse. When I started nursing school, I had a toddler and a newborn at home and I worked full time. It was a struggle and often times I wondered if it would be worth it. I landed a position right out of nursing school in a ER/Trauma. Nursing as a career isn't easy. You have people's lives in your hand. It is a great privilege and honor but also a huge responsibility. I make a good living with good benefits for my family. Nursing is stressful. Even after almost ten years of ER/Trauma experience I am challenged daily. It is an exhilarating experience. No two patients are alike. No situation is the same. One night can be calm and quiet and the next can be a bus crash with multiple casualties that overwhelm an already busy ER. One day we can be fully staffed with everyone able to take their lunch breaks. The next day we can have nurses that call off because illness and we work short and no one is able to take a break. There are many uncertainties in this profession, just like life and you have to be able to adapt. There will be sacrifices that you will be forced to make. For me the reward of caring for patients outweighs the negative. Good luck!

I think many people use this forum as a way to express (sometimes vent) their feelings. It is a way to connect with others that are in similar situations. As a trauma and ER nurse (for almost a decade), I can honestly say that anxiety for me coincides with my daily nursing practice. I think it makes me a better nurse. Far too often I see nurses become too comfortable on the job that they miss early signs of a patient decompensating or take dangerous short cuts. I go into work motivated to do my best, knowing that the ER patient flow and acuity can change quickly. I think anxiety is a natural feeling and the way you harness it is the key.