PedsER-RN

the way i look at it is, they are no better than anyone else. ignore it. if it gets excessive, confront him/her, write it up, or tell your nm. i'll never forget the time i had a trauma pt that came with 2 non-functioning ej's. it's pretty much protocol here that for a trauma, they get 2 iv's. we started one and while it flushed great, it wouldn't draw. so i popped in another and was in the process of drawing blood off it when the trauma surgeon blew up "i told you to draw off the ej!!!! didn't i??? take out the damn iv now!" so i just calmly stood there, looked him in the eye, and said, "do you want me to finish drawing the blood for the trauma panel first, or do you not want that either?" so i finished drawing the blood and dc'd the 2nd iv. i didn't really care that he had yelled. he just made himself look stupid. funny thing, later he came up to my when i was cleaning the room after the kid was transferred and apologized: "i'm sorry i yelled at you; that wasn't right of me to do that". i accepted his apology and we both moved on. it hasn't happened since. i know it's hard when you first start out b/c you're already scared and unsure of yourself. thick skin comes with time; i used to be super-sensitive, and still am outside of work, to a degree. something my mom told me years ago: "don't ever let someone make you think they're better than you are. they sit on the pot and take a crap just like everyone else". kind of gross, but it puts into perspective that everyone's human. good luck. it'll get better.

i completed my bsn while working nights (7p-7a) full time. i attended school full time; my semesters ranged from 12 hours to 18 hours. while i managed the 18 hour semester ok and made good grades, it was stressful ( between working at night and going to school during the day, i didn't get much sleep) and i would recommend taking a max of 15 hours if it's possible for you. the program i was in took 12 months to complete. at the time it seemed like it took forever but looking back, it reallly did go by quickly. good luck.

tonight (which was eerily slow) it was approx. 30 to 45 min., but on busy nights it's 1-3 hours, and nights during peak season when we're slammed it can be anywhere from 4-7 hours. i really don't care if they give me the evil eye. the ones that need to be seen are brought back, and the other non-emergent pseudo-illnesses can wait til the cows come home. it's an er, not a clinic. we have signs posted everywhere that the sickest child is seen first, and if they don't like that, they can go to the county hospital where the wait is usually 10+ hours.

we do this alot. we usually mix it with sweet-ease.

:rotfl::rotfl::rotfl::rotfl::rotfl:

working in a pedi er, i draw my blood from the iv if possible, and i put my iv's wherever i can get it on the 1st stick. if an iv won't draw, then i'll do a butterfly on the ac of the opposite arm or a heelstick if it's a newborn. i don't have too many that come back hemolyzed; if they are, sometimes the lab results it anyway depending on the acuity of the pt. and the docs take that into consideration.

ditto. this is exactly what i was thinking. thanks for a great post.

we fax. we call the floor, let them know we're faxing report and orders, then wait 15 minutes, and take the pt up. seems like a good plan until they call down, "can you give us more time/did you start my fluids/etc." or like the other night "there's no bed". i agreed to wait, waited nearly 30 min., called again, was told, still no bed, housekeeper had to go to main hospital, we'll call you. lo and behold housekeeping was down in the er, so i questioned her, and yes, she had already taken the bed up. so when i called to tell them, hey we're coming up now, i was told "oh, sorry, we must not have seen it". what?!? are you blind?!?! how can you not see a bed?!!?! do they really think we're that dumb? anyway, i let my boss know about it, so hopefully something will happen. i should mention that this incident involved a nurse who is notorious for being lazy and postponing everything possible (although i actually was foolish enough to buy into her story of the missing bed); there are some nurses that are great and actually say "ok, thanks" when we send them report. in those instances the faxing works fine.

we have sane on call 24/7, but before we had them, the er docs did the exams with one of us assisting.

in our er it depends on the time between the alleged abuse and when the pt presents to the er. if it's been >72 hours, they are referred to the care center (a seperate clinic that performs culposcopic exams on kids); if it's been to answer your 1st questions: we do not do virgin exams. period. drug testing will be performed on an individual basis and at the discretion of the md. if he feels there's a need for it, then it's done. being a pedi er, we don't get too many homeless that come in, and none have stated hunger as their c/c. if they did, of course we'd get them something.

i think one of the big reasons is that we live in a society where people don't want to wait, they want what they want when they want it, and they feel as if they're entitled to it. why call your pcp for an appointment in a few days for a cold when you can run to the er and have it taken care of (usually for free, at least for them)? another poster said we encourage these people to come back. not me. if the child is legitimately sick, i'll go over the home tx plan, stress the importance of a pcp follow up, and mention returning if the prescribed tx isn't working and the condition worsens. if it's for something dumb like a cold or otitis, they're educated on the fact that yes, the child will run a fever, yes, it's ok, and no, it doesn't mean you need to come back. the healthcare system is partially to blame. with all the regulations that are slapped on us we aren't allowed to say, hey, this ingrown toenail/runny nose/earache/sore throat/etc. does not constitute an emergency room visit-go home and see your pcp or go to a clinic. we're required to see them, bend over backwards at their every whim, and we get reprimanded if we don't give them what they want. it's absurd. the majority of the people that are using ers for stupid reasons are frequent flyers and know the system as well as we do, and know how to (at least try) to work it to their advantage. sorry for the rant, this is a huge sore spot for me.

we're supposed to be doing this, too. the only problem is, management doesn't seem to acknowledge that if you're in triage on a busy night (and our dept has 1 triage nurse), there's abosolutely no way you can keep up with your triage list and still find time to do hourly, or even q2-3h vitals. it just isn't going to happen, unless they allow for more staff, which they won't. what i try to do is with the ones that are semi-sick/injured, but aren't acute enough to be bumped, i'll warn them that there's going to be a wait (and probably a long one), but if anything changes while they're waiting (ex: loc in a head injury pt), let me know. i'll then do a quick assessment, and if warranted, they'll get bumped. if i do get a break, i'll go around and recheck vs and do a focused reassessment.

yes, it does help. we've been doing this for a couple years now. when we used to call report, it was always, "can you call back?", or "the nurse taking the report is busy". now, we call and let someone know we're faxing, send it up, and 15 minutes later the pt goes up. they call us if the fax didn't go through and we resend, or copy it and send it through the tube system. we hated doing report by fax at first, but it has really eliminated problems for us, the main one being the floors avoiding taking report so they don't get the pt.

the lack of routine, the autonomy, the relationships with co-workers and the docs, and i love the fact that if my pt's status changes, i don't have to waste time paging docs and talking on the phone. they're right there. i love that if i have a pt/family that's high maintenance, i don't have to deal with them the next time i work. i like the variety of things we see and having a knowledge base broad enough to care for everything from a clinic pt to an icu status. i like not knowing what's going to walk in next!

given my choices, yes i would.....the other hosps in town are downright scary! i had a knee scope last year and everything went fine. now, if it were for my younger siblings, i'd be a little more picky (ex: wouldn't want one of the pedi surgeons....he has a pretty high post-op infection rate), and if it were anything cardio related, we'd go oot. [color=#483d8b]

our peds er requires: bls, pals, acls, tncc, and enpc. i think the floor just requires bls and pals. not sure about your 2nd question....sorry!

from the schools that are around here (including the one i graduated from), the level of competency (of the students) is pretty low. then again, it's not really the students' fault, b/c (at least at my school), most students aren't allowed to do procedures on kids. our instructors allowed us to start iv's *if* and only if the pt was an adolescent with decent looking veins. we had lots of skills labs on dummies and such, but other than that, not a whole lot. i got most of my experience pre-graduation by working as a tech in the pedi er where i still work nearly 3 years later. we got a lot of book knowledge but like some of the others have said, there's such a wide range of norms for peds, even the book knowledge can only go so far.

i'm not familiar with the 'abbocath' system, but she might have hit a valve and decided to try to float the iv in with the first stick. there's many occasions when i put the torniquet on and then set up.....it lets the veins fill. saying your instructor said you're one of the best iv starters in clinicals doesn't say a whole lot.....it takes dozens of sticks to be considered competent, at least imo. it doesn't matter how 'nice' your dad's veins are. depending on medications, illness, hydration, and many other factors, they can be more fragile and make it harder to start an iv. i think it's pretty sad that you've judged a nurse simply on her ability to start an iv. she was pretty patient with you; while i feel sorry your dad had to be stuck more than once, i feel more sorry for her for having to put up with your attitude through the whole thing. and yes, i know how it feels to have a family member stuck more than once. that's no excuse.

i've asked docs i work with for a script before, but then again i work in an er and know them pretty well. i got sick at work one night and the doc offered me a phenergan rx. i certainly wouldn't ask a doc i don't know well. the cn should have sent the sick nurse home, esp. if she worked in a nursery. that's wrong to knowingly expose babies to a sick person.

don't come in expecting to (or acting like) you know everything (not an attack against you personally, just a general rule for anyone new to a unit). if you don't know, ask someone. if you're unsure of a procedure, talk about it, watch/assist another nurse, then try it! i precepted a float nurse the other night (who also works peds, just another dept.) and even after watching me do several straight caths, when i offered to let her do one, her reply was "oh, i think i'll just watch". almost as bad as the nurse who "knows" everything is the nurse who won't do anything. :angryfire [color=#483d8b] [color=#483d8b]it's perfectly fine to look up meds (shoot, i still do from time to time)-we all do. [color=#483d8b] [color=#483d8b]if you feel overwhelmed, say so. your preceptor might have some suggestions for things to go smoother. [color=#483d8b] [color=#483d8b]if you're unsure of your charting, ask someone to read it (hey-it is a legal document....can't hurt to have another set of eyes). [color=#483d8b] [color=#483d8b]don't expect to get the most critical/interesting case right off the bat. everyone starts with something more basic and works up to something more complex. [color=#483d8b] [color=#483d8b]if you have down time, offer to help the nurses, aids, secretary, anyone (same goes for experienced nurses). [color=#483d8b] [color=#483d8b]as far as new grads lacking something, the majority of the ones i've dealt with recently (3 out of 4) have lacked a strong work ethic. they dawdle, don't jump in and help others, have to be constantly reminded what to do, and basically lack common sense. this is soooo frustrating. i'm guessing you won't have this problem since you're on here asking for help! :nuke: [color=#483d8b] [color=#483d8b]pretty much if you show a strong interest in what you're doing and are actively seeking opportunities to learn, you'll do fine. be proactive! in my area (er), if we've got a trauma or an ems, for example, i like to see the new grads at least jump in and get the patient on the monitors. it gets them a feel for what's going on and gets them used to people bumping in to them and 20 things going on at once. then from there they can work their way up to starting iv's, getting ekgs, bagging, assessing, etc. [color=#483d8b] [color=#483d8b]good luck. hope this helps, and sorry it's so long. :typing

one of the best was a bilat leg amputation of a toddler-an older sibling had shot her with a shotgun. when we were moving her to the stretcher for or i had the job of holding the bandaged legs and it was the weirdest feeling to feel where the amputation was (the remaining part of the legs were still bandaged up with her legs). the most amazing part is a couple months later she walked out of the hospital on both of her own legs. this happened a couple years ago and just the other night at work we were talking about it. a tough little girl and an awesome surgeon. i'm still amazed.

so i guess if a kid has no airway, they just bag away and hope for the best? sounds like whoever told you that was talking out of their @ss. some of our transfers come intubated, and some scene calls do. if they come in and they're not, then we do it. sounds like they need a pals refresher.

I didn't read all the posts, so some may be repeats: Don't chat us up and then 6 weeks later write complaint letters full of lies. We have copies of your chart-we know what time everything happened and what was done. We're not stupid. Don't withold tylenol/motrin b/c you wanted us to see you child really does have a fever. Do you take something when you have a headache? Good, how about sharing some with your kid when he/she has one. Kids feel pain too, you know. Just because your quack of a doctor sent you here after diagnosing you with strep or an ear infection doesn't mean we'll do anything different. And yes, you will run fever. Don't call us and ask for someone to come pick you up to take you to the hospital. Call a cab. Better yet, stay home. Demanding plastics for a 1/2 cm lac won't go over too well-better to just shut up and let the er doc do his/her job. Diarrhea/vomiting x1 does not = emergency. Don't come in for a work excuse. If you get me for your nurse, chances are good you won't get one. Don't bring your kid in for rlq ap and then leave ama b/c you don't "have time to wait" for lab results. Glaring at me from the doorway will not make me move any faster. In fact, you'll only wait longer. If your kid(s) can chow down on big red and cheetos then they probably aren't too sick. No, you can't give your baby her bottle since she just threw up. Sorry you have to wait for xrays. They just don't teach us how to operate the machines in nursing school. No, i don't know how long the wait will be. Longer if you keep asking. No, pain for x months isn't an emergency. Coming by ambulance won't always get you back quicker. If you bring your child in b/c he "won't talk" and then whines about taking some medicine, there's a clue that he might be pulling your leg. If you see a car marked "medical examiner" outside the er, maybe you should reconsider if you really have an emergency. If you decide to stay, don't ask how long it will be, and don't ask what happened. It's none of your business. When I ask your child to rate his/her pain, don't point to the 10 on the chart and say "you feel like this one, don't you?" it doesn't work with me. If you do that then i'll rate his/her pain myself. There's a reason i direct questions at certain people. I'm sure there's more to come....

yes, 1.4 ml is correct. that's how we calculate at my facility, also. say you have a 500 mg vial and you want 400 and reconstitute with 1.5 ml lido. then you would draw up 1.2 ml (1.5 x 400 / 500 = 1.2). if you ever have doubts check with pharmacy.

i started in the peds er during the beginning of my senior year as a nurse tech. when i graduated i was hired as a gn and have been an rn there ever since. i'd say either icu or step-down/tele would be a good place to work since your hosp. doesn't hire new grads in the er. work somewhere that will allow you to gain organizational skills and a good foundation with a wide variety of patients/diseases. preferably a busy unit, so you can also develop good time management.