Crocuta

In our ED, it functions as a sign in sheet. Registration then uses that to generate a patient account in the computer. That account is needed to sticker charts, or in an 100% electronic environment to much of any charting at all.

I'm hoping to get a little input from the community here. Just fire away - all responses are good responses! I've been out of nursing school for a few years and now find myself in the position of frequently mentoring nursing students and recent graduates. I am interested in what you find yourself in need of that you can't find (or doesn't make any sense) in the usual provided resources or online. What are the holes in information or resources that you struggle with regularly? Are the resources in the right format, or is there a better way of presenting it? Thanks!

Here's your answer from the California Board of Nursing: http://www.rn.ca.gov/pdfs/regulations/npr-i-02.pdf Just remember, should something happen, you cannot claim "I was only the CNA." While your scope of practice will be limited by your job description, if you ever have to stand in front of the Board and defend your actions, they will hold you to the standards of your RN licensure, and that is what you can lose if you are found to have not acted appropriately. Hope you find an RN job soon.

Dexamethasone for N/V falls under that great catch all of pharm books - "Exact mechanism of action not known." Several mechanisms have been proposed. It is believed that it acts as an prostaglandin antagonist, as well as causing some direct action on the CNS. Regardless of the actual action, a number of studies have been undertaken which have demonstrated prophylaxis for PONV. I've listed a couple references below to get you started. Dexamethasone is an appealing medication because in the doses and frequency used for PONV, there are minimal documented side effects. http://www.anesthesia-analgesia.org/content/95/1/229.full Log In Problems

A report sheet was invaluable to keeping me organized when I was on med-surg. I developed one over a couple years, slowly changing it as I got better ideas of how to organize. I've uploaded my report sheet to my Google Docs account and I'd like anyone who can benefit from it to feel free to use it as a template, but you need to customize to your practice and your facility. http://docs.google.com/fileview?id=0B4GOm4zHWoKiYTE3NDg1MGUtYTFmMC00YjRkLTliYzEtOWQ4NTMxOTQxNDMx&hl=en&authkey=CJOntUU I'd keep a stack of these in my clipboard and fill them out at the beginning of each shift. General info is at the top, information from the previous shift went on the left side, and I'd fill out new information as I obtained it during my shift on the right. Then when report time comes, it's just a matter of reading off report. Good luck!

This is just a passing thought, but I think you should go make an appointment with your college's Student Services department and perhaps one with the Disability Support services before you commit to transfering. Allowances and accommodations are made all the time for various reasons. Be sure and drop the "multicultural" word during your talk. Colleges don't want to be seen (and there are some legal grounds here) as excluding students just because they aren't native born. Stop in, talk about how well you did on the other parts of the test, tell them how much you want to be a nurse, and see what comes of it. It might not get you anywhere, but you'd only be out time. Who knows? You might even find a sympathetic ear.

I'm glad that you're nervous. It means you know your limitations. It's cocky new grads that scare me. I've had the privilege of orienting several new grads to my ED. Toward the end, most are feeling the same way you do. I tell each of them the same thing - you're going to feel like that for the first full year that you're in the ED. I did too - I came in every day thinking that I didn't know what I was doing. An amazing thing happens, though. So slowly that you don't even notice it, the anxiety drops away. The realization usually happens after the fact. "I just realized that I was running that code." "I knew when that guy walked in that he had a neck fracture." "The doctor listened to my advice and it was an MI and not just indigestion." Relax, ask lots of questions, listen to the nurses that know what they're talking about. I also encourage my new grads to go in and listen while the doctor interviews and examines the patient. I still do this. It helps get you and the doctor on the same track, you'll pick up a ton of great tips for physical exams, and you'll learn how each of your doctors thinks and you'll be better able to anticipate which direction they'll head in which will help with your time management. Good luck - and did I mention relax? ;-)

http://answers.hrsa.gov/cgi-bin/hrsa.cfg/php/enduser/std_adp.php?p_faqid=1465&p_created=1209990666 (emphasis mine) the nursing scholarship program does not decide where participants fulfill their service obligation to the program. scholars are free to select any facility, in any u.s. state, district of columbia or u.s. territory, that is one of the following: federally qualified health center (including look alike health center) rural health clinic indian health service health center native hawaiian health center hospital nursing home home health agency hospice program state or local public health department including public health clinic within the department skilled nursing facility ambulatory surgical center for the purposes of the nursing scholarship program, all of these types of facilities have critical shortages of nurses and are eligible health facilities where nursing scholarship recipients can fulfill their minimum two-year service obligations. nursing scholarship recipients are responsible for finding their own employment site and confirming its eligibility with the program. the nsp reserves the right of final approval to ensure a scholar's compliance with statutory requirements related to the service obligation. -------- be sure that you: contact the scholar support branch of the division of scholar and clinician support at 1-800-221-9393 prior to accepting employment to assure facility/position eligibility.

...during your lunch break, you describe your latest trauma code to your colleagues using your food as a visual aid.

Speaking of peppermint, a couple of drops on a face mask covers nearly everything, and no one will look sideways at you for wearing a mask while doing stinky patient care. And if they do, heck with em. Almost nothing bothers me - except homeless swamp foot. Wow. I've had one recently that I honestly didn't know how I was going to deal with it. I'm not talking about "I'm going to puke if I go in there." That I can choke down every time. We were well into "I'm honestly afraid that I'm going to end up asphyxiating." That man probably smelt of peppermint for weeks.

I've been trying to get traction for a patient completed med rec for a while. How long have you been doing this, and how did you make the transition? How do you deal with crummy writing? We also use the T-system. Do you just fill out the left hand side of the front (Triage section) or do you also do the Initial Assessment section?

Our system consists of four "bays": a sign-in booth, two triage bays, and a registration bay. During peak times, flow goes like this: Patient presents to the sign-in booth which is manned by a member of the registration department. They sign in on a form which gathers the basics - name, DOB, C/C. Reg clerk assembles a chart and places it in a basket. Pt then waits to be called (goal 20 minutes or less.) Pt is called to one of two triage bays by an ED tech who gathers vitals, allergies, meds, bands the patient, and field dresses anything dripping blood. Nurse takes over Patient #1 while ED Tech gets next patient into the other bay. Nurse completes triage and returns the patient to the waiting room. Chart goes in a needs to be registered box. If registration gets to them, they'll call the patient to the registration bay and complete insurance, L&I paperwork, etc. Sometimes I'll have registration just come over to my triage bay and do registration if in my estimation it would be a burden to keep moving the patient around. When reg is done, they put the chart in a "fully registered" basket. We do not hold in the waiting room for registration, though. We have bedside registration folks, and if there are rooms, we just bypass the front reg people. With the right ED tech and the right patients (i.e. none who try to tell their whole life story in triage) I can see one patient every five minutes during peak times by the tech and myself alternating back and forth between the two triage bays and directing them to return to the waiting room. If rooms are available, we can triage and room a patient every 7-10 minutes. If the tech is just starting with the next patient, I'll take the patient I just finished with back to the room myself. If it sounds like the tech is nearly complete, I'll go jump on the next patient while the tech rooms the previous one. We also do quick triage during periods where patients are coming in faster than I can see them. Sometimes we do it ourselves, but often we can get another nurse or the charge to grab the entire stack of waiting to be triaged charts out to the waiting room and we see everyone for 30-60 seconds right where they're at. We just find out why they are there and do a quick eyeball assessment. That time gets noted on the chart along with the c/c and major symptoms. We're able to keep our time to RN under 20 minutes this way. That's how we do it. As I said, and you know, it all depends on the staff assigned to triage. Triage has one point: to decide who needs to be seen and who can wait. That can be done in less than five minutes for most patients. It's not about full assessments. Prolonged triages in my experience usually come from nurses who have anxiety about missing something and sending a critical patient back to the waiting room. Now where it really gets rough is when our waits start hitting 2-3 hours, then I add in a whole component of blood draws, EKG's, radiology studies and preemptive lab work. Those are the times I'd love to have a second tech and another curtained bay available. Then I could really process some patients. Hope this helps - good luck!

The CEN review sample video of Laura's available at Great Nurses seems quite dated. Would those of you who have it and have taken the CEN recently say that the information is all still valid and current? The CCRN video looks more recent. The material in the CCRN review should have quite a bit of overlap with the CEN, no?

Congratulations on your move! I find the idea of not doing head to toe assessments an amusing one. Consider that when you are an ER nurse, you get a patient without a neat and tidy diagnosis. You'll get the patient without having any idea what's wrong. A vauge and not very helpful complaint sometimes, other times, a complaint that doesn't really have much to do with the real reason they've presented. We do some of the fastest and most critical head to toe assessments of any department. You have a very short time to get a total assessment so you can start running your possible differentials in your head to figure out what direction you'll be going in - is it an MI? A dissection? GERD? Does that trauma patient have any other ominous findings that no one else sees because they're focused on the mangled foot? You'll see many of the same conditions that you see on the floor, but you get them when they're still scary and unstable and undiagnosed. It rocks. Good luck!

AHA certifications are valid anywhere. It just depends on what the individual facility accepts. You won't need to redo BLS as long as you have a valid card. Crocuta AHA BLS Instructor

Have you tried contacting the Emergency Nurses Association? Don't try to reinvent ED triage - other people have already done the work for you. I'd suggest starting with the research department at [email protected] . I also note that there does not appear to be a professional emergency nurses group in your country - it sounds like it's time to start one! Good luck!

Working in an ED, I think of a couple things: The way this was presented, it sounds like she just showed up, was screened and shown the door. It doesn't address if or how many times she has been seen in that department for the same or similar complaints. If she has been evaluated for "severe pain in her side" a dozen times in the past month with no significant findings, then there isn't a great deal more that will be served by yet another workup. The ED can keep prescribing narcotic analgesics, but long term drug therapy should be overseen by a PMD. It's not medically appropriate for long term therapy to be overseen by an emergency department. The continuity of care just doesn't exist. No emergency department physician who plans to stay out of court and keep practicing medicine will medically screen and boot someone with "severe pain in her side" who hasn't ever been seen in that department in the past. It's just not going to happen. They'll at least get lab work done and radiology studies as appropriate. There's more to this story than was presented. I saw one of my regulars lately (chronic pain). As I was triaging him, I asked if he had seen his doctor at the local community health center recently. He stated that those people were all idiots and he "fired" them as his doctor and he couldn't go back there. This is a patient with multiple comorbidities that requires ongoing lab evaluation for dosage adjustments. Basically, he expected us to manage his multiple conditions from now on since he fired the only doctors in town that would see him. We have a system coming down that I expect to start rolling out in the next year. We'll be building an interdisciplinary team that will review ED records and look for our major offenders and attempt to get them tied into more appropriate resources including PMD coverage. Part of it will be holding the line on narcotics and more aggressive use of medical screening exams for frequent fliers. Partly it's being diven by the state, as our state pubic aid department has started tracking use of ED vs PMD and we're getting letters about specific patients (the patient also gets a copy) that state that they are overusing the ED (costing the state too much money) and that they must go to their PMD for non-emergent issues. We'll see how it works. Oh, and Oramar - most of our docs wouldn't have the first clue where to look to determine if a patient has insurance or not. I don't see it as an issue, and woe be to the facility that gets caught doing such.

Wow. Nurses (and CNA's, techs, and any nursing students who were in the building) at my hospital were served lunch or dinner by senior management. They converted a conference room into a cafe and served sit down meals (nice ones too) to all the staff. It was pretty classy. All managers from department level up to our CEO were there serving meals. This is the second year they've done this. I never thought I'd spend a whole career in one place, but if that's what the rest of you have to look forward to, I may end up staying right where I am. :loveya:

Are you looking for something for training purposes? The appearance of packaging will change depending on the supplier used by a given facility. Every few months I'll reach into a crash cart and find out that things are packaged slightly differently than the last time. Keeps you on your toes and double checking what you're about to push. If you are just looking for pictures in general, you can find them on Google image search pretty readily.

I am working on putting together a float evaluation form for my hospital. We are a smaller facility of around 100 inpatient beds. Due to our size, we cannot justify a separate float pool at this time and so during times of fluctuating census we occasionally float staff who would otherwise be sent home to higher census units for a shift. We recognize that floating can be a stressful experience for staff and we are looking to develop an evaluation form to provide feedback to our hospital staffing committee and unit managers regarding both how the receiving unit treated the floating staff member and how the float performed. It is our commitment that feedback on these forms will not be used in any punitive fashion. Does anyone have any experience with these types of evaluations? I am interested in knowing what percentage of evaluations were actually completed, how the results were used (or not used) and perhaps what questions were asked. Thanks!

I would. Chlorhexidine is the active ingredient in several healthcare products including Biopatch (for central lines) and Chloraprep (for starting IV's). Even as a patient, you have a fairly high chance of being exposed.

Don't be a wallflower. Make sure you're in rooms where you can get a good view. I've seen too many student nurses come through recently either sitting at the desk, or heading in the other direction when something scary looking shows up. Don't think that if you happen to be standing there when the ca-ca hits the fan that anyone is going to be upset that you don't know what to do. Put on gloves and say to whoever is in charge "What can I do?" Here's a tip: You're BLS certified, at least. Volunteer to do compressions. You don't get any closer to the good stuff than that. If you're lucky enough to be with someone who really likes having a student around, you'll get a great experience. If you don't, or the experience is less than organized, it's up to you to make it the best experience you can. Just ask the busiest looking nurse, or the one with the sickest looking patient if you can follow them for a while. Hope you have a great time!

NAC 632.165 Procedure for writing examination after initial attempt. (NRS 632.120, 632.305) 1. An applicant for licensing as a registered nurse or as a practical nurse may write the examination four times. 2. If the applicant is unsuccessful on the second attempt, before he may write the examination for the third time, he must present to the Board a plan of study, acceptable to the Board, for preparation to write the examination. 3. If the applicant is unsuccessful on the third attempt, he must repeat courses in nursing theory in a nursing program approved by the Board before he may write the examination for the fourth time.

First of all, don't ever lie about previous employment. At virtually all facilities, discovery that you lied on an application is grounds for immediate termination. That will earn you a black mark for sure. Even more importantly, the lie goes straight to your character - and I'm not talking here about how other people view you. Start lying now, and it will become easier with each passing day, if the guilt doesn't gnaw away at your self-esteem first. There's nothing shameful about admitting honestly that you were in a situation that was more than you could handle. Everyone has strengths and weaknesses. The real take-home point is "what did you learn from it?" You haven't ruined anything unless you let this experience dominate your life. Personally, I'd take it as a tremendous sign of growth and potential if I was interviewing someone and they said exactly what you've said here. Accepting your own part (attitude) in the outcome of your previous situation and taking ownership and responsibility for it makes you a better nurse and human being, not a worse one. Good luck with your search.

As a word of caution, be careful about thinking about medications in terms of what "sounds like a big dose." Use a nursing drug reference and study individual medications. Every drug is different. Take metformin and glyburide for example. One has a common dosing of 2000mg/day. The other is 20mg/day. Both treat the same condition, but are very different chemically. Given the info provided, I'll start by assuming the drug in question is venlafaxine (Effexor), a very common SNRI. It comes in the 37.5mg dosage. A dose of 300 mg divided bid is not out of the question - studies have been done with doses up to 375mg/day for major depressive disorder. (This is for the instant release form - XR has different dosing.) Thinking in terms of paroxetine (Paxil), that would be a large and inappropriate dose. Max dosing for paroxetine is in the 50-60 mg/day range. The real problem is not the dosing, but the concerns about gradually increasing the dose. I would perhaps ask nicely to see the orders and MAR's to ensure that there was not actually a gradual increase (sometimes it's best to go to the source rather than someone's recollection.) The nursing manager might be a good source to work with to determine what happened.