debbyed

night shift . i don't deal well with people who wear suits.:bowingpur

Worked for a Union once:crying2: . I paid them alot:twocents: , I got nothing in return:banghead: . Won't do it again:deadhorse .

What's a Break? I work Night Shift in a busy ER. We grab what we can, when we can because there is no float person. If your patients are caught up, you ask a co-worker to cover for awhile. That being said........... We really ate good tonight. Everyone brought something in and we have been picking and munching all night

Let's see:confused: I've been a nurse for over 25 years. Spent a year on a tele. floor:nurse: , a year of ortho:monkeydance: , a year of ccu:smiletea: , a year of hospice:icon_hug: and the rest have all been in Emergency Nursing:yeah: . I've worked alone in a 3 bed ER, worked as the only ER nurse and house supervisor (8 ER beds, 4 CCU, 5PCU, 30 inpatient) and now work in a metropolitan ER with 39 beds. I found my nitch fairly quickly and will stay an ER RN until either my body or my brain gives out. It's pretty much 50/50 odds which goes first.:chair:

Just a thought but....A. the hospital is going back on their work:angryfire ....B. The ER Manager is leaving..... Maybe it might be wise to keep your options open and look elsewhere, Most places would be thrilled to have a nurse with both med/surg experience and the inititive to do all the other things you have done. Somebody will have their:welcome: sign out for you.

I have to agree. Getting out on the floor will give you the best exposure. Once you learn to read a monitor you know it. Check and see if your hospital uses Nursing Students in the ER. Ours does. First year students (Nurse Associates I)are taught to same skills as our ERT's {Emergency Room Tech's}, last year students (Nurse Associate II) spend some of their time shadowing a nurse. It is kinda like a "Grow your own" program. It's working out real well for us, and the student have a job that pay's and tutition reinbursement.

First thing you should learn is Wash your hands, never forget it, it really makes a difference. I work in an Emergency Room and "Knock on Wood" have never taken anything home. Seldom get the "bugs" myself. Good luck in your progrram.

I know that in our state it is mandatory reporting and the hospital I work for reports quickly. It doesn't take that long to check a couple charts and you only need a couple. One might be a mistake, Two carelessness but 3 is unexplainable. If the employee admits to a problem they are offered employee assistance and placed in a program and on administrative leave. If they deny, they are terminated. In either case the BON is notified.

On the same line we have a patient that comes in every once in a while to have something removed from his rectum, You would think by now he would be embarrised :imbar enough to go to different hospitals. His last three abdominal surgeries were to remove a coke bottle, a very large zucuni, and the one that really had us puzzled was the hammer (head first). Everytime we see him come is with that very distinctive walk we all try to guess what he lost now.:spam: :smackingf

After 20+ years of dealing with New Grads I've had plenty of experience with all three kinds. Your type:welcome: I adore. You may start out timid, but you watch, you learn and you grow into terrific ER Nurses. The second type :chair: tend to remove themselves from anything they are unsure of. These you'll find in the bathroom during a code. With an understanding, nurturing preceptor about 60% do succeed. The third type:angryfire ;The "I Know it All " type are dangerous. They don't ask questions, they just speed through things, not even noticing they are making mistakes. They need to be watched constantly. We had one recently that decided he would give PO contrast to a patient with a probable perf'd bowel. An astute new nurse stopped him and called over a preceptor. He immediately started arguing with that nurse who had been a nurse long enought to have delivered him. He just wouldn't shut-up:trout: He was taken off the floor, sat down and made to explain everything that could go wrong with what he intended to do. Than he was told what the worse case senario might be. That would be "DEATH" That humbeled him for about 2 days, Than he was back to being:thankya: his old know it all self. I'm really not sure he is going to make it. Very few of the "Know it all" make it very far. An a few of them end-up with law suits. Many experienced preceptors refuse to precept these folks because of the unacceptal risk associated with their behavior. Take your time, Make sure you understand what you are doing and what the expectations are. You sound like you will be a good, caring, conscious nurse and any hospital would be thrilled to have you.

I believe somewhere in the past the hospital provided cab vouchers for truely needy people. Accident victums with no family, Pt's who arrived via ambo who's significant other was too old to drive at night and our large population of Orthodox Jewish folks who may still get sick on Fridaynight/Saturday day. Now ALL our Frequent flyers, drug seekers, homeless people demand cab vouchers. "It's my right" I tell you I am really tired of it. It just seems like there are so many people out there that think you owe them something whether it be a meal or cab fare. I just have to wonder when the ER became the Hotel, Resturant and free transportation place. We have people who know where each ambo/hospital catchment area is. They'll call 911 to get to our hospital because they live across the street. They come in the ambo door, get put in a room that walk right out the front door. When asked what they're doing they will freely admit "I needed a ride home" Sorry, I'll get off my soap box now. I really should go to bed, cause I'm really, really tired.

Our hospital has always been all private rooms. It's an excellent selling point. And now with HIPPA we have the privacy required. Our hospital aquired infection rates are also below the norm.

I'm in the Baltimore Metro area. We work every 3 rd weekend and it may soon be a little less. I work in a moderate size ER and we just posted and filled 8 weekend option positions. 3=7A-7P 1=11A-11P 1=3A-3P and 3=7P-7A. Day shift option is Saturday and Sunday only, Night shift option is 2 out of 3 Friday through Sunday. The staff who applied were allowed to choose with or without benefits which was about 3 dollars different. Rates went from the high 30's to the mid 40"s per hour depending on shift and benefits. If they work any addition time it is paid at our standard registery rate. If a holiday falls on a weekend they work it. We had all 8 positions filled in less than 2 weeks.

ERnurse04, From past experience using many agency nurses over many years both as charge nurse and Clinical Leader, I have found that the nurses that have had at least 3-4 years experience in a stable ER environment that they are comfortable with and can grow in, adjust to being agency nurses much better. It is very seldom that we get an agency or traveler with less than 2 years experience that works out for us. I'm not saying that no-one can do it, it's just that from an employers point of view the expectation is that an agency or traveling nurse should be able to "hit the floor running". We ask them to come in 1 hour before their first shift to do a computer learning packet (We are phasing in CPOE) and then we buddy them with one of our nurses for 4 hours. After that they are on their own. From a personal view point, I give agency/travelers all the credit in the world. I've been an ER Nurse for over 20 years and could not imagine going into a strange ER with a patient population I don't know and ED Doc's I don't know. I personally could never do it. I need to be comfortable in my surroundings and know which Doc's to completely truat and which to question.

Just a side note. My husband has a very strange side effect to propofol as well as other asesthia agents. He is a "breast man" at heart. The first time he had surgery it was at a very small hospital where I was a supervisor. I was sitting outside Recovery when I heard a nurse scream and yell"Debbye, get in here!" :chair: My husband, still unaware of his surroundings just wanted to hold her breasts. : For his second surgery there we were prepared and I was in the recovery room when he came out. He's a big man 6'4" and about 260# but I have no trouble controlling him. When we moved to a metropolitan area he had some dental work done under sedation. I warned this tiny tiny dental assistant of potential problems and she just brushed me off. (You know the attitude that "That Nurse" thinks she's special") Lo and behold I heard that same scream and she rushed out to get me. He has had 2 further surgeries at my current hospital and they all know me well there and took no chances. I'm always at his bedside when he wakes up. Have to admit It's a little embarrasing :imbar but he truely doesn't remember any of it. You can tell when it wears off because he goes from a very happy feely person to a cranky "Get me out of here" man. So far it has only been hernia's and shoulder repair, he always refuses to spend the night.:trout: What can I say.. He's my man:kiss

I agree with Shammy. Go through the appropriate motions first, even if it means changing preceptors. It is not unusual for new grads to switch preceptors when they are concerned that they are not getting the attention they need. It's possible you preceptor never had a preceptor class and is unaware of your preceptions. With any career, go throught the appropriate motions first, than move on if you can't work things out.

I also work at a non-union hospital. We get paid from the time we punch in till the time we punch out except for 1/2 hour lunch. If we have a busy night and don't get lunch we get paid for that to. If you work more that 40 hours a week you are in overtime. We also have 10/hr. bonuses for any 4 hour shifts you pick up after your 36/week. When we are really, really short staffed we offer double time for specific shifts. You get that regardless of how many hours you have worked.

My licence plate holder is an ENA plate holder. The only people who notice it are our fine county and state police officers. They have helped me several time get around blocked roads so that I could get to work to take care of the wounded they would be sending. I have never acctually seen an accident occur so have never felt the need to stop. EMS was always there. I am not trained in prehospital medicine and Other than a stethoscope have little equipment in my car.

My suggestion {from experience} is to go with her to a community group meeting about Diabetes. Even though our families run to us with every broken nail, when it comes to the big things sometimes they listen to people their own age and to strangers better than they do to family. Remember, they are older and no matter how old or successful we get we are still children and grandchildren {Something my 28 year old son father of one is slowly learning} Just be patient, be there if she needs you, and gently point her in the right direction. She may find people at these meetings she likes and is better able to share her fears of mortality with them than with you. Good Luck Debbye

Just be general in the information you give. There is no need for times, places or names. If it is easier to use name, make them up. John Doe always works

A nurse I worked closely with for many years took on the position as Nurse Manager of our unit. She did interm first and was given a nice boost in her hourly salary because they were hunting for both ER director and ER Nurse Manager. She stayed in that position for about 6 months and did well. HERE COMES THE BUT: She came back into staffing for about 1 1/2 years. During that time a nurse manager came and went, as well as the director. Our new director talked my friend into appling for the job for real. She did and was accepted. At that time she was placed on a salary. If she only worked 36 hours a week it might have been ok, But she averaged between 50 and 60 hours a week. And those Bonuses they talk about---Well lets just say you had to reach some very high goals. She delt with it for 2 years now she is gone. I'd be very careful and get everything in writting, including what happens when you don't make stated goals.

As well as everything below, are you pulling her Lugs for controlled substances she withdrawls and wastes intermittently to make sure the patient was...1} Orderd the Med. and it wasn't given by someone else 2} The the med was taken out of the Pixis (whatever . system you have}, while the patient was still on the unit. 3}Does she always have the same people waste with her, are they inexperienced or agency staff.?

We use a program called "Freedom to Achieve". It is a computer based program that once learned is way more time efficient that the old written ones. It keeps track of the prior evaluationa as well as the prior goals. I do evaluations on about 25 night shift employee's and have had miminal complaint {There is always someone that is not happy}. Prior to evaluation I print out a blank form and give it to the employee. As a leadership Group we also came up with the 6 most important questions for each job clasification and printed them up as Peer reviews. Each person is given two Peer reviews that they can give to anyone in the department and the reviewer also gives these questions to two people of their choice. Those comments are included in the employee's evaluation annonyously. Our raises have also gone from cost of living to Merit raises based on the final evaluation. The staff is now aware that this is the time to sell them selves, To keep track of their education, participation in unit/hospital wide committees, And to keep copies of good things written about them during the year. They also know that we keep tract of their attendance, lateness and any dicipline. It appears that the staff feels these evaluations to be much more represenative of them as a co-worker. Each evaluation is done by a Clinical Leader that works on that persons shift, with imput from both administration and co-workers.

I work on a unit based staffing comm. Our ER is self scheduling. It used to work really well until theybuilt us a larger ER. We had some problems staffing the old one and filled in with staff. Now it is insane. At 7 PM I am supposed to have 12 nurses, I had 6. :angryfire This was after agency had been called and all our nurses were offered DOUBLE TIME, Our staff is just burnt out. We use agency's, we have used travelers, we even import nurses from the Phillipines.{These nurses however take 6-9 months of training, But than They have a 3 year contract that starts after orientation stops.} Our Nursing Director of the ED quit to move higher on the ladder:lol_hitti about this time last year. Our Nurse Manager abruptly quit last week. We have a new director :bowingpur comming in at the end of August :welcome: so we are hoping she has some ideas because we are dying. The light at the end of the tunnell is dimmer that it has ever been, and the administration expect the Clinical Leaders :smackingf to pick up the slack. HOW??? any suggestions. And yes:trout: I'm one of the idiots that just worked almost 60 hours last week. But I can't go on either.:zzzzz