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Med Surg, ER, OR
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mcknis specializes in Med Surg, ER, OR.

mcknis's Latest Activity

  1. mcknis

    Helpful Tips for New OR Nurses

    Such a great post to share! I have no experience in the OR but will be starting Monday. It is scary to think of everything I don't know as I am coming from a 5 year stent in the ER. I can swim in the ER but I hope to not sink in the OR. Always scary going from comfort to change, but time will tell how it will all go. Thanks again for sharing this!
  2. mcknis

    My New Life as a Transport Nurse

    Thats great to hear! I, too, am hopeful that I am able to do MICU one day and keep up my critical thinking skills all along the way. Keep enjoying!
  3. mcknis

    New MICU and Employment...

    Thanks for your advice Flyingscot! I definitely don't think that joining a new MICU is the best decision as I would be the first that would be eliminated/accused if something were to go awry. I have accepted a position with the company that will have me rendezvous with their ALS unit and provide me with a decent orientation period. They are already established and have nurses who have been working in this environment for a while longer than the 3 years I had been told previously. Any tips or tricks for working in this environment that is new to me? Any sites out there that provide good reading info or policies/procedures I could read that would give me some additional insight?
  4. mcknis

    Satisfaction scores

    Anonymous, most of us do understand the role that the PG/Patient satisfaction surveys play in the financial makeup to an organization and we do understand that patients do occasionally have bad circumstances and/or poor care. This forum is designed to allow those in the profession, and those outside of it, to have a glimpse into this realm and help to share in its' growth. The majority of the nurses/healthcare staff on here are good people who desire to provide the best care possible for their patients, no matter the are of healthcare they serve in. The ED setting, however, is one of the more challenging areas and many of us get defensive when someone speaks negatively or positively regarding our neck of the woods. It is not meant to be bashing or upsetting towards any one individual, but it is just a callous many of us build up after working in this setting for a few years. The ED, as you have seen, gets knocked down by all department and patients because of the front sidewalk not being pretty, or the meal tray not having enough options. These are things nursing is not able to control, but the powers that be feel financially it is easier to decrease (or eliminate) wages to frontline staff regarding any complaint. PG unfortunately is around for the long haul, and like the others have stated, it's yet another game that we, frontline staff, must play in order to get our raises and ensure patients have a voice. PG shouldn't be related to finances although it is, but associate opinion surveys (of management and physicians) shouldn't be either, however they are. That's a rant for another day...
  5. mcknis

    New MICU and Employment...

    Have been interested in CCT for some time and have already done some ride time with a large company in my region that does ground and flight transport. However, I am not able to work for them due to the travel requirements (1.5 hour drive for a 12 hour shift on ground and up to 2.5hrs for a 24hr on flight). There is another company in my area that has already been doing MICU (ground) for 3 years but are only interested in doing on-call (unpaid) and having the nurse rendevous at the transferring hospital with the ALS crew to then be paid for their transport time only. Since I live about 40 minutes from some of the hospitals they are wanting me to rendevous at, I am leaning away from this option. This company had discussed with me about applying yesterday but just prior to that, another company (10 minutes away) informed me of their plans to start a MICU... This ALS company in my town (fairly new to the area, but in business about 20 years) is talking about starting up a new MICU. This is just in the talks right now, but am curious to know what everyone's thoughts are regarding new MICUs. I know everyone must start somewhere, but what are the pros/cons, risks/benefits, etc. with joining a company just starting out? Anyone been there and done that? What are your thoughts? Also, any policies & procedures/tips & tricks floating around out there that are MICU specific that would be able to help me learn some more of the ropes in this environment if I were to take a position with this company or another? Any advice/help/knowledge/wisdom is definitely appreciated! Thanks all!
  6. mcknis

    Things you'd like to say to....

    I love the dilaudid comment as Im sure we have all heard it...if nothing else "just give me the one with a d. it makes everything just disappear." To management: just because you get to take a break at your lunch, and enjoy it...and by lunch I mean eat an entire meal in one sitting 9/10 times, should mean that we are entitled to a BREAK and a LUNCH. Unfortunately my breaks come when I can find time to pee and my lunch is a few packs of crackers at random times. Not what I call a break or lunch...
  7. mcknis

    Can NP's self prescribe?

    I know an NP who self prescribes her warfarin. Has a POC PT/INR machine and then self-adjusts her dosing. Just like others have mentioned, have never heard of legal barriers, but ethically it isn't wise.
  8. mcknis

    Best snack food

    I try to always pack my lunch so that I can grab and go. PB/J or just PB is a great little pick me up. Granola and/or granola bars. Yogurt with granola. Trail mix. Really just anything that is going to provide some protein while getting some other nutrients in is good. I used to bring apples, carrots and other veggies, but i found that not much long term benefit with fruits/veggies. One of our medics always has a jar of peanut butter and protein powder drinks. Whatever works.
  9. mcknis

    CEN and the ENA

    I have read through the posts on here about obtaining certification (CEN) and the need for this as a professional. I do realize the need and desire to obtain this. I have a question though about the cost of the exam. By choosing to be a member with the ENA, there is significant savings when taking the CEN exam. So, if I were to choose to be a member with the ENA ONLY at years for the initial certification and then recertification, would this be a possibility in order to save a bit on funds? Of course, this would be a lot less money out of my pocket, but not sure if there is any stipulation that you must remain a member of the ENA in order to recoup the savings on CEN recertification. Thanks!
  10. mcknis

    Non-Littman Stethoscope Recommendations

    I will continue to reiterate the same as I have said before in other posts, any brand will work, but yes there are some that are proven to be better. I have used some really cheap scopes and have liked them more than more expensive scopes (littmann CII). Although I dislike the Littmann Classic II, I really have liked the knockoff versions of the same design, like the Prestige Clinical I (not Clinical Lite (or other "lite" models), as I found the head is too lightweight to pick up good sounds unless on a healthy individual);or ADC 603. I have used sprague-type stethoscopes and have found that the quality of these vary from one brand to the next. ADC, Omron, or anyone else for that matter making them right now seem to have a pretty poor design going on. I do, however, like the sprague from Prestige. I think Prestige is a good brand to look at and have been in business for a while, but unlike Littmann, they do NOT use the floating diaphragm design. It is for this reason (the floating diaphragm) that most find Littmann stethoscopes difficult to hear with. I have had to go through and replace the diaphragm on my Littmann stethoscopes in order to hear the best out of them. I have liked the Littmann Select stethoscope, but after using the Littmann Cardiology III for the past 7 years, it is hard to turn it away. I figured I will keep using it until something major happens to it. BTW, the tubing has already cracked and i had to replace it. Many said to send it back to Littmann and let them take care of it, but I chose to just buy replacement "look-a-like" tubing from China on eBay. It still works equally well and no problems at all. One other brand, besides Prestige, to consider is that of MDF. This company has a lifetime warranty and lifetime of replacement parts for the life of your stethoscope. We have about a dozen staff in the ER who have switched to MDF after their scopes have grown legs and they have nothing but positive reviews to boast. Good luck on whatever you decide!
  11. mcknis

    Supplies a new grad ER Nurse should carry

    Stethoscope, tape, pens (usually lose one or give one to "unclean" patients to keep), trauma shears, Vocera (required, or else it wouldn't be around), ammonia inhalant taped to back of badge. Everything else is in the cabinets in the pt rooms. Do have some hemostats, tweezers and bandage and iris scissors in a backpack in the locker room. Other than that, nothing else is needed.
  12. mcknis

    Male Nurse Hair Styles

    It definitely depends on where you work/go to school/part of the country/etc. I went to a fairly strict nursing school with former "military-nun" grade instructors. If they didn't like you, you didn't make it, no matter how well you knew your stuff. For them, looks mattered. Now working in the ER, many years later, the staff truly don't care what you look like, as long as your are clean and smell clean. Other than that, no big deal. I keep my hair short all the time, but that is just me. Quick buzz cut and I do it myself. Maintenance free! While you are in school, do as they tell you to do, not how the other students tell you to do. Just my 2 cents.
  13. mcknis

    Ring Cutter used in Your ER

    Regarding ring cutters...VICE GRIPS or for TUNGSTEN ONLY!!!!! Tungsten rings do break under extreme force. They are unable to be cut through, except for with a laser cutter, and you would never use this on a human being as the heat is too extreme. Titanium rings bend. We do use the GEM cutter for difficulty to cut rings, i.e. cobalt and higher grade titanium. You must use lubrication (water, or other recommended lubricant) as the amount of friction can cause first degree burns, even with the finger guard. We don't use it often, but it is nice to have when the manual ring cutters dont work too well.
  14. mcknis

    Getting burnt out with non urgent patients

    I completely agree and there are many times where the jaded and cynical feeling creeps up throughout a day. "I have severe abdominal pains and need that medicine that begins with a D-------." As they sit there eating their Cheetos and soda from the snack machine in the lobby. Oh, and when they leave... "We will need a cab slip because we have no money to pay for it. We used it all on the snack machine." Ugh...it's times like these that get under our skin as ER nurses, but keep us coming back anticipating our next code. Like VICEDRN stated, we learn so many valuable skills that make us better people and help us be better nurses. Cynical? At times yes, but I would choose our nurses in a trauma or code over our ICU and other critical care nurses. Do we do better than others? Of course not, but when fight or flight hits the fan, we can usually remain more calm than others. Keep on working and smiling! Even if we must grin and bear it :)
  15. mcknis

    Earning potential

    Yes the figure that he quoted you sounds high for a NP, but definitely doable for CRNAs. CRNAs, from my research, enter around $130-150k. They are definitely higher paid than NPs and yes, I assume, if NPs want to work their tail off with call and OT, this figure is possible. Many, however, I would presume like to have a life out of work.
  16. mcknis

    What's the inside scoop?

    Like hella mentioned above, speed is very important. If you do anything, make sure to stay caught up. That is probably the best information I could provide. I can attest that if a tech, nurse, medic, provider (doc, NP, PA) is behind, everyone feels it. But, yes anticipation of orders is important. We do the same as far as obtaining urine, labs, EKG, etc., and it can really get you behind if you do not fulfill this. Believe me, triage nurses expect the nurses in the "back" to be anticipating orders and completing them before the provider gets to them. If you don't act on these "pre-filled" orders, you will have more and more patients sent to you while you attempt to get caught back up. Also, once you start in the ED, try to do most of the work yourself and only delegate what you don't have time for. Everyone will love you for it, including your other nursing staff who are trying to pick up slack left from your care. Sorry for this being a little rant in itself, but have had some challenges lately with my department staff. Each department/facility is different, however.