workingforskies

Of course you are right. Let's also ignore the personal responsibility the patient chose to eschew by apparently not taking Tylenol and/or Motrin to manage her pain. Let's also ignore that she had 2 weeks of ear pain. I wonder if she went to a clinic or to her doctors office? But your right. Blame the nurses, blame the staff. The heck with managing a patient load in a code situation. Let's fluff the pillows, give everyone the old "I have the time" speech that we all so heart fully mean through gritted teeth and pasted on smile. :icon_roll

I have been a pediatric nurse for almost 10 years now, mostly in ER’s. Some pediatric IV start tips. -Gather all your equipment and have everything set up on a tray BEFORE you enter the room. Setting up in the room only increases the anxiety time. -Have the child supine on a bed. Never let them be held on a lap. If for no other reason than for safety. It takes away the up and down movement of a pinned down an extremity. -To me, a screaming child is a breathing child so it does not bother me at all. (At least that is how I rationalize it.) -Have a co-worker help you hold down/pin down the child. I still have a slightly broken tooth from getting kicked by a 5 year old whose mom was ‘holding’. -If the child is 4 or under, don’t bother to try to get them to cooperate by explaining. As soon as they see the needle and realize what is about to happen, all bets will be off. -DON’T blind stick. If you see a vein and you think you can do it, go for it. But if you are not reasonably sure, get someone else to do it. In time, as you become more experienced, you will gain the confidence and the skills to be proficient. (And FYI, it usually takes a couple of years to become really good at that.) -There is nothing wrong with allowing parents to be in the room. But if they are going crazier than the child, there is nothing wrong with asking them to leave. -The biggest mistake I see with newer nurses missing pediatric IV’s is when they go through the vein. Go slow. Once you get blood return, advance a little bit further, if you still have blood return then start to advance the catheter only. -If you have any doubt about the integrity of a PIV, take it out and start a new one.

A 20 on an 8 year old is fine. I have, on occasion, used 20g's on dehydrated infants that I knew were going to be admitted for a while when they had the veins for it. An FYI. When starting IV's on babies, if you are right handed, the left, medial saph. will be your best friend. Same for the right saph. if you are left handed.

You mentioned the 3 magic letters. "HCA". Trust me, you will be better off in the long run.

I hope it is just your memory because that is an astonishingly one sided definition. I am an unabashed atheists. That statement implies that my lack of spirituality means that my life has no meaning or purpose. I can assure you that I am FAR from that!.

If this were a male dominated profession, we would be getting paid at least twice as much as we get now, there would be pool tables in every break room, and the free turkey we get every Christmas would have a fat bundle of stock options stuffed in it. In the normal supply and demand market, we nurses, (due to the nursing shortage), should be able to write our own tickets, dictate our salaries, our staffing levels and our perks. If you want proof of this dynamic look no further than the golden tickets that were handed out to all the computer geeks during the 'dot.com' era. But "NO", that is not happening. And, in my opinion, it is due in large part to the estrogen dominance in our field. We don't fight. We do not argue. We don't give an upraised middle finger to a boss as we walk to our next job that WILL pony up the compensation. Instead we, collectively, sell out. We take our low pay, we get ourselves wrapped up in the drama du'jur, we allow our so called leadership to basically prostitute us for the "good of the team". (Insert smiley face icon here) Health care costs have far outstripped the rising pace of inflation over the past 10+ years. Yet nursing pay and compensation has not. I can think of no other time in labor history where a collective group of laborers had such potential power yet absolutely refused to collectively wield it. Imagine if one group of nurses in one single market stood up and told one health care organization to pay them double or they were going to diffuse into the competition and leave them hanging? But no, we can't cut that cord. We have to be loyal to, essentially, a corporate overlord. We don't want to drive an extra 15 minutes, we like our schedule, we work really close to our kids school. WHATEVER! Sorry for the rant but every time I think about this issue, I seriously want to stab myself in the eyes.

Absolutely it would not be inappropriate. You did them a favor by expressing an interest and taking the time of applying to work there. Asking for an honest explanation as to why you were not hired is certainly not unreasonable. Besides, what are they going to do, NOT hire you?

There is a regulatory body in my state, (and I have no idea which one), which has stated in writing that the next 'drink in a unit area' violation at the hospital where I work at will result in a $10,000 fine.

One of my biggest complaints: Drink at the nurses station = $10,000 fine. 7 ER patients for one nurse = nothing.

Empathy, understanding, a smile, a positive attitude, taking a few moments to listen. Things like that are far more effective than a few worthless catch phrases. Also, be VERY careful about blithely saying, "you are going to get better" or things along those lines. There will be times when the pt. will not get petter. They will get worse and they will die. Such is life. To provide false hope when there is none is very poor service IMHO.

Get over it. The drama, the drama....

I was going to reply until I noticed this at the very bottom. " Last edited by SteveRN21 : Today at 11:47 AM. Reason: removed link to business website per site TOS" This is a nursing related discussion board. Please spam somewhere else.

Onyx77 hit it on the head with questions you can be asked during a typical peer interview. Some questions I have learned to ask during an interview for an ER position. -What is the FTE to patient ratio on that unit? (A Full Time Equivalent or FTE is the number of staff hours allotted per patient visit. In other words, if an ER sees 150 patients on a daily basis, with 2.1 FTE’s, they would be allotted 315 staff hours in a 24 hour period. If they used 1.9 FTE’s, they would be allotted 285 staff hours. I would avoid any place that goes below 2.1 FTE’s as it is likely that you will not have a lot of help.) -How many rooms are typically assigned to a typical nurse? If they show you around the unit, a good way to check that is to just peek at the assignment board/assignment sheet. For me personally, 4 non fast track beds is the limit of my professional comfort level. -How long has the current management team been in their current positions? If there has been a wholesale turnover in leadership, I would be leery. -How many open positions are they currently recruiting for? If there has been a large turnover in staff, again, I would be leery. -Are their yearly evaluations performance based or are they weighted? Performance based means that if all the nurses were outstanding, they could all be rated as outstanding. If they are weighted, that usually means that they use a quota system which means that for every 5 nurses, only one can be above average, 3 will be average and 1 will be below average, no matter what. -Is the parking free and convenient? -If you are going to be working nights, is their cafeteria open at night? -Computer or paper charting. If they have paper, ask if they have free Motrin available to the staff for the writer’s cramps you will get on a daily basis. (Just kidding about the Motrin part…..sort of.) If they have computer charting, ask if the doctors use that as well. If the doctors do not, guess who gets to play data entry clerk for all the stuff they write down? Hope this helps. If I can think of anything else, I will post it.

Just a guess mind you... Most deaths from allergic reactions come from decreased O2 exchange from increased airway inflammation. As fetuses get their oxygen from the mother's blood instead of through direct exchange of air, I would not think the effects of a fetal allergic reaction would be quite as profound. But who knows.

It's an interview. It's an absurdly subjective question. Tell them what they want to hear. When I see questions like that, I roll my eyes and break out my creative writing pen. And before all the "tsk tsk'ers" weigh in on my lack of integrity at this stage of the process, remember, they are not showing the person they are interviewing the dirty laundry of the facility either.

Sounds like you and I work at the same place. (Do the initials H.C.A. mean anything to you? LOL) The California staffing law has set the following ratios as an acceptable ER assignment: General ER - 4:1 Critical care. (ie ICU patients.) - 2:1 Trauma - 1:1 My only complaint with that is that I have no problem with having 2, relatively stable ICU patients. But if one patient is unstable such as on a bunch of drips that still have to be titrated to effect, they should be 1:1. It can truly be frightening at times to be professionally placed in situations like that. But fortunately, at least where I work, we have a pretty good team that works together and watches out for each other. If that were not the case, I would have been gone quite some time ago.

If there is a protocol to give it, it is my understanding that is the same as a written medical order. In the sense of being accused of practicing medicine without a license, you would be covered as long as everything was appropriately documented. As far as someone leaving, they are free to come in, they are free to go unless they verbalize or show objective evidence that they are clearly, a threat to themselves or others. What is the alternative? "Sorry sir, even though you now feel better and want to leave, I am going to tie you to this chair until you are seen by the doctor"? Imagine the law suits coming from that. The family can sue all they want. Does not mean they are going to win.

Actually, you can. It's called voting with your feet. The evaluation system at Vanderbilt was one of the (many) reasons I left that hospital. The hospital I work at now has an interesting system. Those that do not meet expectations are dismissed in the normal, progressive discipline process per PnP. The rest are given a 3% raise.

As that could definitely affect your compensation, find a new place to work. It sounds like to me as if they have a quota system. Under that system, you could have the top 5 best nurses who ever lived and 1 will be rated high, 1 would be rated low and the remaining 3 will be rated in the average range. Vanderbilt University Medical Center has, (at least up until the time I left), that crappy eval. system in place and I thought it was dreadfully unfair.

I did not, in any way, find that to be the least bit offensive. I did not find it all that entertaining either. (It's in the comic section. Why would anyone allow themselves to be offended by something so benign in the funny pages?)

A good note. My mother is a PhD RN. When I was in nursing school, she told me that when you write an assessment, assume it is for a jury. What you write on a chart is the picture of that patient as you saw them at that moment. I have never forgotten that, especially with some of the less than stellar charting I see now. My advice to you, learn to abbreviate as much as possible. That will save you a whole lot of time and pen ink/key strokes. Since you are new, I will share with you a typical note I write about 90% of the time in an ER setting. “Mr. Smith AAOX3. No c/o pain. PERRLA. Speaks clearly, answers questions appropriately, obeys commands, MAE. Ambulated with steady, even gait from WR to bed 8. BBS CTA. Resp. even, unlabored. Skin W/D/P. Abd. S/NT/ND (with) + BS. Cap refill Clearly, this is a person with no problems. The reason he came in would be addressed in the note in more detail. I can’t say this is perfect, but I have never gotten a complaint from anyone higher up about it and it has worked just fine for me thus far. 2 things off the top of my head to watch out for. When assessing pupilary response on a baby, write PERRL. NOT PERRLA. You will have a hard time explaining exactly how you got a baby to focus their eyes in order to assess for accommodation. When assessing CMS distal to an injury, say, the base of a finger, don’t chart about pulses distal to the injury. (Unless you pulled out a Doppler.) Those are 2 common charting mistakes I see all the time. My 2 cents.

To expand on this. You are in school to learn how to pass the boards first and be a nurse second. To anyone on that last lap, keep that as your sole focus and the stress about what happens after that will go away. (At least it did for me.) When you get your license, the world will be your oyster. In the real world, your GPA is the last thing anyone in the hiring process will worry about. Seriously, I'll bet 95% of heath care recruiters don't even bother to check.

.............Ummmmmmmmmmmmmmm.........Well, alrighty then.

From an old ER nurse, First sorry for your bad experience. You have every right to expect better treatment. My take on your story is that you are dealing with a bitter, burned out ER MD. You can complain to the administration and exactly ZERO will come of it. (Despite all the the assurances to the contrary that you may see posted later on that say something to the effect of: "Oh it will be taken seriously"). You can also give a bad review on the worthless mail-in survey card you are sure to get and the ER nurses will be blamed for your bad experience for the sins of the ER doc. My advice, take your medicine, pay the portion of the bill that your crappy HMO won't cover and be glad you are at least still alive enough to post an occasional thread on the WWW. Also, next time your feel you require emergency treatment, go to a different ER. Low numbers at one hospital when there are higher numbers at the competition are the ONLY thing a hospital will fret about. Personally and with all sincerity, I do hope you fell better.