NoMoreStudying

I'm in the Baltimore metro area, if that matters. I met with an agency here that has a good reputation from it's nurses and hospitals. She said I would have no problem scheduling three 12's per week. I do 11a-11p ER and most people don't like that shift. But the idea of being canceled worries me. I figured out what I need to make in a year and then divided by 50 weeks, to account for 2 weeks per year of issues. My goal being to set aside money in case of illness, cancellations, etc. Should I expect cancellations in the summer and holiday times? Are we talking the entire summer or just partial? Do I try to arrange a contract prior to those times? I don't want to stay at my current position, but I'm considering transferring to the float pool PRN just in case.

I've read all of the Davita posts, but they seem to be all related to chronic. How do people feel about Davita with acute positions? I'm an ER RN, interviewing with them for an Acute position.

My first day with patients... I was just trying to get everything done in time. You can't focus on being more proactive, seeing the big picture, etc. You are completely task focused; "get it done and done right." It's been a year and I go through varying degrees of comfort. Like plateaus or summits. I try to give myself a goal each week. One week I focus on printing my monitor strips. Next I focus on better skin assessments. I&O's. And so on. It's usually task oriented, but it helps me to think of the whole picture. For example when my pt came back from the cath lab this week, I felt spot on with my care and my documentation actually reflected it. I really felt like I addressed all of the possible problems and what I did for them.

wait, are you talking about the boat comment? many initial vietnamese refugees came here on long unsanitary boat rides, rationing what little food was provided. my family is one of them, by choice of course. so when i have regular people complain that i don't understand how hard it is, it always makes me chuckle that they think i was born into a nice middle class lifestyle. i wasn't talking about slavery. which, yes, would be quite offensive.

exactly why is it extremely offensive? i think it's important to dwell in fact rather than topics so emotional. particularly when there are more important topics at hand. it also lets people know that you have the same real goals as them, not side items. the majority of the time, people will see you actually care about what happens to their loved one. an "i'm sorry you feel that way" never hurts either, sugar rather than vinegar. in some ways, yes i'm being a bit lighthearted in my comments. on the other hand, i've grown up biracial in this country and with two poor families, so i can see both sides. on other topics posted, i think there have been documented studies that minorities or disadvantaged (it's so easy to lump the two unnecessarily) tend to be distrusting of the medical community. there is a history of unequal treatment or poor explanations and involvement in care. it's almost expected and it's part of the image and practice change to make medicine more holistic.

It used to bother me. It happens a lot in triage, for one. i always bring it back to fact in one short sentence, so we both know it's the end of that discussion. Nothing further needed and no more will be entertained. Works when anyone decides we're "not fair." B/c really, there's no arguing with people so we might as well discuss what's really appropriate. I've had to tell a few people that I won't be discussing anything besides their care from that point forward. "My priority is to assist your child at this moment." "I need to see the most acute patient first." "I was tied up with a complex patient but I will help you shortly." "I'm sorry, that person got a chair in the hall b/c they aren't vomiting like you. You would prefer a bed, correct?" "No, it's not b/c you're black. It's because you're drunk, sedated from your own drugs and so lethargic from that concussion that you don't need any more pain medication. You need a CT scan." I also really enjoy getting called racist or told that I don't give good care to minorities or the poor. B/c a) I'm Asian and b) I grew up dirt poor with intermittent housing and basic needs. It always makes me smile to myself. "You don't know what it's like to have nothing!" I'm sorry, did you come here secured in the bottom of a boat, too? Although, I'm always sympathetic unless people are ridiculous. Even then I can get by with some coffee in me.

I always think of that commercial "Depression hurts." I know when I feel depressed, I'm very achy, don't sleep well, all over pains. And then it clears with the depression. I always see fibromyalgia as being similar but more chronic or poorly managed. Twice I had hugely swollen joints with it and all of the autoimmune studies were negative. A male friend of mine was severely depressed, no mental health history and not ackowledging it. He was in chronic pain, too, which he did acknowledge. No relief from pain meds. Finally he saw his doc and antidepressants resolved everything. If he were a woman, though, he would have been a perfect candidate for the dx. After, he kept saying "I can't believe depression can cause so much pain!" Of course, he still chooses to focus on the pains as the problem more than the depression, probably b/c of the stigma.

I'm 6ft tall and Urbane fits me best. They have tall pants. I like the bootcut and cargo. I do wish the tops had more than one pocket. The length of the top is great also. I've never exposed anything, had trouble bending and lifting, etc. In fact, they're the only ones that move with me and look good. No trying to fit into unisex and having pulling or tugging at the breast, arm, crotch or elsewhere. I order online to get the talls. I have yet to find any other brand that fits well and looks nice. Also, the fabric is softer. Like Dickies, however, I'm between a M and L top. Dickies tall pants are too short. Cherokee is scratchy and the proportions of the pants are off. I found Peaches unreliable in their sizing. In fact, the only problem I've had with Urbane is the sleeves are a little short on the jacket, but that's my world and I roll them up an inch anyway.

It's usually generated by the dx or chief complaint. So I get several boxes to fill in on the computer and it may also prompt things like a neuro, neurovascular, etc assessment, or treatments like elevate HOB. But yes, it's all about teaching you how to think. Most of it is in your head. As tedious as they are, it's worth it. Say you get an abd pain with n/v. Well, you need to remember to assess not just pain and nausea, but bowel sounds and habits, po tolerance, output, hydration status, etc. Taking that extra step. Then maybe even farther. Are they an SBO that's on the verge of septic shock and now we need to be even more diligent, where as pain and nausea are a little lower on the priority list. And the biggest part it teaches you? what are you doing (meds and beyond) and is it helping? B/c you can document all day long but if you aren't showing how they respond to treatment, good and bad, we might as well go home. I always think of it as where they are in the progression of their disease, and what is one step worse or better. Then I have my framework to work with. If it's an elderly person with a UTI, is their mental status clearing, is their urine output adequate and what does it look like, is their BP holding. Right there I can give a pretty good picture and someone can tell how they are progressing. Then I can go into decubs, etc if I need. As much as I hated writing them, you'll be able to tell which people didn't pay any attention to them when you get out and start practicing. They don't show the whole picture.

I remember one more now. Getting report from a new nurse for whom english is second language. Still her english is as good as any college graduate. So she says "the pt, he stood up from the sofa, he passed away. later, he went to the bathroom, he passed away again." I was trying not to laugh, but it was too funny. She looked horrified when I told her the difference.

nope, she truly say "an ammonia." :chuckle

My mother, who has a master's degree, still says people "catch an ammonia." Also, the Taliban is in "Afaghanistan." Like the blankets people crochet, "af-a-ghans." My favorite triage slip was simply, "lage." Luckily, he still had both of them. I just had a young guy tell me he didn't remember the MVC b/c he was unconscious. We explained he called his dad and was walking at the scene. Still, he insisted he was unconscious after the accident. Fine. Later, I ask him if he's remembering anything yet. "No, I'm still unconscious." :roll

When the machines are being difficult and taking forever, only to yield the dreaded (###), I could certainly do all of my vitals manually a lot quicker. But I've rechecked some manually that originally came up very high or low on the machine and it was pretty close, within 5-10.

I'm not experienced but my favorite is the people who come back 1-2 hours later. lo and behold, they still have gastroenteritis! No, they haven't tried any of the meds, but it won't go away! Charge says, so seriously, "That's it! who didn't use their magic wand?!" I also love the people that come to you in triage and say "Fine, I'll go out to the curb and call 911." "Okay, but they'll bring you right back here and now you'll be at the back of the line wasting the 1(2,3,4) hours you've already waited."

mmmm, giant burritos..... I had someone come in n/v after eating Chipotle. I had to block it out b/c I do love the pork.

"I'm pregnant" or "we're expecting a baby." Although, I can tolerate "we're pregnant" more from the men than the women. It's endearing from men, but from women it reminds me of the "today I marry my best friend" crowd. > Can we all agree to get rid of "He's babysitting the kids today." Also, "actually" gets me. I can't tell you how many sentences start with "actually," even when they're correcting with the same exact thing. It sounds pretentious.

Nope, but I learned something interesting at a lecture. The band is considered less drastic, but you can "eat around it." That is, if you're someone who grazes or snacks all day, you won't lose as much weight. Eat a little bit, it passes, eat some more, it passes, and so on. Whereas a bypass makes that more difficult as you are forced to change your eating style. This guy said he didn't even do bands anymore b/c people weren't as happy with them. Often, they're able to not change a thing with their lifestyle and they lose some, but not as much, so it's a waste. I've seen bad complications. Plenty of sepsis, some deaths, some chronic immunocompromised and chronic malnourished. But I don't know their whole stories. I'm sure I meet plenty of people out there that have had great outcomes that I just don't hear about it. I do have to ask: You know how Al Roker, Star Jones, and a few other celebrities still have chubby heads? Most regular bypass patients don't seem to have that. I think maybe it's the size of the pouch? I imagine people in the public eye get the really small pouches.

$10K sounds about right. I've never heard much more, although, I'm sure there are some programs. How much are you talking? Is this something you researched prior to taking out loans? It seems a lot of students don't consider how they will pay back their education (not just nursing students.) I think it's something we do a really poor job of when preparing kids for college. It's like everyone thinks they have a right to an education, but that doesn't mean they can afford it. Not saying you, but a peeve of mine in general.

EMTALA requires that all patients who come to an ER must receive an MSE. We can't send them elsewhere b/c of their insurance status. A doc has to see them. And as far as coming in by EMS, unless we're on reroute, they come in regardless of insurance. In general, I think the difference in care has more to do with socioeconomic status and the image put forth, than insurance. Plenty of young professionals are w/o insurance anymore. But people who come in a certain dress, act a certain way, frequent flyer, etc , can be brushed off by the unethical, and no one knows if they have insuance (it's an assumption.) Our docs don't even pick up the registration folder that lists it. I do see on call docs trying to tell us "I don't take uninsured patients or patients with xxyy." Well, you're taking the money to be on call, so you take this patient. Of course, we complain and some of them are still around. It really pisses me off. "Don't call me at 3 am, i don't take uninsured patients!" Let us go over the definition of 'on call' again, at 3 am.

Remember, everything isn't just sitting on top of that tissue. Everything is also connected from the sides. Think of surgery and everything thing they have to get through just to get to the organ in question. Humor me, but I keep thinking of the commercial with the wet paper towel and the bowling ball.

A saline bullet is a little squirty bulb of saline. You squeeze it down the trach and then suction it back out. Depending who you ask, you get rationale for either side. Older thought is that it would liquify secretions, making them easier to suction. Like drinking fluids would. Newer though is that it doesn't do that and you're causing aspiration. I don't do it and our policy doesn't allow for it. another topic could be wet to dry dressings, foley usage.

I got a job as a ER tech halfway through nursing school. I didn't need a CNA b/c I had completed Fundamentals. Although, that may vary by state. I was hired upon graduation as a new grad RN. Actually, the last 8 months of nursing school I only heard "when do you graduate? did you graduate yet? can you graduate early?" It was very good experience. A good rule of thumb I learned in orientation though: You have to care for 90% of the regular patients to get to the 10% of really sick, exciting ones. Oh yeah, and don't forget, the pts in the ED still poo and pee. Some people always seem to think we don't have to deal with that.

I will run errands in them. I'm no more germy than anyone else. Even negative air flow rooms vent the TB-infested air to the outside world. There is a guy who come to my gym in his denim scrubs. I hate nothing more than to see him on the elliptical working up a sweat in those things.

We were told by employee health that as long as you are up to date on vaccinations and follow infection precautions, it's only TB and Shingles you need to avoid. Staffing is difficult enough, I would take the rest and follow the precautions as usual.

At least you can leave work at work and come home for a relaxing evening. Except when one of your patients takes a turn for the worst, a family member screams at you, you reealize how quickly you could make an error in any given day if you aren't careful, you leave work and know you forgot something but you just can't place it, or you feel like you just didn't do enough for someones pain/nausea/depression/overall health. Okay, so most days you don't have to go home and think about nursing. I still found the first half of orientation to be pretty tiring. You have to be on top of everything at first b/c it's all new and it's a lot to learn. You have to transition form being task-oriented to managing care. School uses your brain to memorize and teach you the routines. Now you have to multitask more than they could ever have you do in school and you're expected to already know how to do all of the tasks and understand all of the patho. A good orientation will prepare you well, though. I think it's impossible to know what it's like until you do it, though. It feels exhilirating and exciting, but can be overwhelming.