RunnerRN

I definitely wouldn't do any of the things you mentioned - that would be quite unprofessional. But I will say that I am typically an upbeat and smiling RN. I am cheerful, kind, open, and willing to do pretty much anything to make my patients' ER stay more comfortable. BUT when someone starts being ignorant or rude, all that goes out the window, and I tend to give good care without the psychosocial. So I won't miss their first IV only to stick with an 18 the next time, but I will stick and get out. But I would never tell a doc to hold off on seeing the patient in retaliation. I hate when patients say "I'm usually a nice person. I'm not usually like this, only when I'm sick." I truly believe people are fundamentally the same whether they are ill or healthy - nice people don't suddenly become rude and mean just because they have a cellulitis. I know the ED system we have creates anxiety and is chaotic, but to me it all goes back to many people "looking out for number 1." It seems people ignore the fact that there might be someone in the area who is sicker than they, and want what they want when they want it. But I digress.....

It depends on the day. Monday afternoon/evening, we have a wait of up to 4 hrs. Other days/times we can get people into a bed in less than 2 hrs. Sunday is bad for peds with quick times to rooms, but up to 2 hr waits to see the doc. In my ED, your best bet to come in is weekday early mornings by 530, 600. I don't even give those evil starers a second thought. All my brainpower is being consumed by making sure the sick people are being seen....

ER in MO, we do not push Diprivan. We do push Ketamine on peds though.

I have to wear white tops to my job, and have quite a collection of plain tops with 2 bottom pockets. I'm hoping to branch out a bit :) and find some more interesting tops. I found one at my local scrub shop that had a white on white embroidery, and one that had a contrasting color ribbon. There just isn't a huge selection out there. Google searches yield very few options. Any help? Thanks!

You know, we all participate in the "Rules for the ER" and "Stupidest Reasons to come to the ER" threads without a question of our professionalism (by our group....others love to question our professionalism in those threads). I really think this poster was trying to make a joke and a point regarding how often the male nurses seem to get a pass with gyne c/o. We do a team nursing concept in my dept, and I will often already have 4-5 pts, and will get a vag bleed bc "you're the only chick over here." I finally refused last night and told the boys that I would assist on the pelvic, but they had the pt. It wasn't worded the best way, but I take the OP as a funny rib. It can get frustrating. And PS - no one like "crotch rot" no matter how it is worded :) It is just a matter of common sense that if you're going someplace and will have to expose an area, you wash up before going.

I work in a 50 bed Level I, which recently expanded to include a "pediatric ED" having 10 dedicated peds bed in a separate locked unit. It is a truly beautiful area, and the management has put a lot of time into making it nice and doing extra training with nurses. I can honestly say we have grown a lot in the last few years, and our pediatric care has improved greatly. BUT we have been getting a lot of peds arrests/codes lately and it seems that we don't have a specific "dance" like when we have adult codes (I work both adult and peds). For adults, everyone knows we have a med RN, a charting RN, a floating RN, and a CPR RN/tech (if enough people are available). It seems like with peds codes we have a lot of people in the room, but not enough direction for everyone. We had one last week that I ended up throwing people out of the room because they were just standing there. What is your typical pediatric code protocol? Where does your med nurse stand, and your doc? My understanding is that most dedicated children's hospitals have a very specific plan and jobs for people when it comes to codes. I think it is time to put that into motion. Any help is appreciated!!

How awful! This story brought tears to my eyes....then to read that they had lost an infant child last year, well, how many horrible things can one family take? I have no suggestions for gifts, but this family and your community are in my prayers.

When I have a pt who wants to leave AMA, I usually don't say anything about payment. I just tell them the risks of leaving and the benefits to staying, and let them make their own decision. I have on occasion (if it is someone who is AMAing because of the ER being overly swamped, and he/she needs to be seen) that there are some ins companies that won't pay in full if you AMA. I just get so tired of the "Burger King ER" mentality....you'll do what I want when I want it how I want it (have it yooooour way, have it your way.....)

Ewww....you should have been down in the ER getting a Morgan lens and 1-2 liters of NS run through your eye. Even though E. coli may live in the intestines, would you really want to take the chance? This is obviously a chronic sick person who could have really interesting friends growing in her body, even if they weren't picked up on a micro screen. Report!

Best advice? Give yourself an 18 month "contract" after you graduate. Learn as much as you can and get as much experience as possible during nursing school, but don't even entertain the possibility of leaving the field during the first year and a half out of school. It is so stressful and difficult, and it takes some time for you to feel comfortable in what you're doing. Look for a position in a hospital with a fellowship program....they will teach you above and beyond what you learned in school, help you learn your role, and stand over your shoulder until you're competent. I wanted to quit many times during my first year, but my husband kept telling me to hang on. I'm so glad I did!! I love my job, and I love the flexibility of our field. And the perks (both job related and not) and fabulous. You just have to get comfortable!

Thanks for your advice. I have gone to several meetings, have spoken with many union reps, and have made my educated decision. I don't think the union is going to be decertified because the hospital ran off "all the veteran nurses." I think it will be decertified because most people don't see any positive changes from the union. Our wages are still in line with other St. Louis hospitals. Obviously if the NP ratios on the floor are as awful as you state, then the UFCW didn't help much with that either. And I don't want my "union mandated raise" to go to my union dues. With the Nurse Alliance, I have grown very weary of their tactics. I recognize that everything the hospital is putting forth is also propaganda, but St John's administration has never shown up unannounced on my doorstep on my day off, wanting to talk about why SEIU is wonderful and will be the "answer to the problems the hospital nurses are facing." (Exact wording of the union rep who came to my house 2 weeks ago.) If you haven't worked here for awhile, you cannot speak to current admin. There is a new CEO who I feel is trying to make some changes. Yes the organization is still run overall by the SOM, but there is some admin currently there trying to make things better. I never said that the nurse to pt ratios are fabulous all over the hospital. If you read further into my post, I said that I couldn't speak to the ratios in other areas because I do work in the ER. But the ER does have great ratios. We are very well staffed, and usually have at least 2 or 3 float RNs available. And on busy days, my dept's admin calls in extra staff just to relieve other RNs for lunch. The ER is not staffed only with new grads as you stated in another post. We have a number of new grads who went through the Fellowship program, but we also have a large number of veterans and very experienced nurses. When was the last time you worked at St Johns?

Whoa......St John's is not a bad place to work! There were some issues approx 6 years ago when the union was first brought in. The hospital had been taken over by another company that tried to manage it and several other hospitals in the same way, and admin DID treat their nurses not so positively. That is when the union was voted in. Then 3 years ago, the initial contract was expiring and RNs went on strike for several weeks (I want to say 6?). Now, there has been a petition for decertification of the union, and St John's nurses will vote in early August as to whether keep the UFCW, vote in a union called SEIU/Nurse Alliance, or vote "neither" which would mean no union at all. I personally have NEVER felt anything but respect and support from administration. It isn't the place for everyone obviously, but we tend to have good RN/patient ratios, and get a good mix of patient acuity and socioeconomic status. On to your questions :) 1) I believe new grad pay is somewhere between 19-20/hr depending on if you have a BSN or not. They offer a 50 cent BSN diff. I will also say that St Louis hospitals tend to match each other with their hourly rates. I can't recall diffs off the top of my head. 2)I think sign on bonus is around $2000 - $1000 on arrival and $1000 6 months later. 3)They do loan forgiveness of up to $10,000. There is a work requirement for that - I think if you take the full 10 it is 2 years. 4)I can't speak for NP ratio because I work in the ER. The other thing I wanted to say about Johns is that they have great fellowship programs for new grads. You will be in a classroom for 2-3 months, then have a precepted orientation for a varied amount of time depending on which fellowship you choose. I think it goes from 6 weeks (Med Surg) up to 9 months (OR). They also have ICU, ER, OB, NICU, Peds fellowships. I'd encourage you to call HR and make an appointment to just tour the hospital. Also do the same with other area facilities. I worked at BJC hospitals and St Anthony's in school before choosing St Johns. I love it there! Good luck with your decision!

I work ER, so this is all pretty foreign to me, but I have camped a few pts in my day. Is there any chance she's an alcohol abuser having some weird withdrawals? I've had some pts that went through ETOH withdrawals in a very odd fashion. Maybe that combined with a UTI or something else. Just brainstorming here.....

I guess the thing that really struck me about this thread is that it was one person covering himself at the expense of someone else, when it wasn't necessary. There are several docs I work with who I don't trust, but I still wouldn't have charted that exactly. I think something like "Dr Smith aware of pt c/o and hx. Per Dr Smith, no c-collar to be placed. No orders received." would have also worked. The ER is very dependent on teamwork. I'm sure we don't know the whole story of this doc's history, but I try to not do anything that will disrupt the teamwork in my dept unless it is worth it. This didn't seem worth it to me. (And I have told docs no, or talked to another ERMD to clarify an order.....one doc wanted me to give Labetalol to a younger pt who had a documented high BP, but was quickly coming back down to baseline. I took a manual which was 130/90s, and refused to give the med. I talked to another doc who agreed with me. When I told the first doc I wouldn't give the med, he started to yell and told me that I needed to follow his orders. I told him that he could give the med if he wanted, but I would not be giving it. I didn't, however, chart that the doc said "The pt needs this medicine. You will follow my orders." in the chart. There was nothing in the chart about this exchange.) If it WAS worth it to you, then you would have just placed the c-collar after the doc said no. Not tried to cover yourself with his words, because in court that still wouldn't fly.

A few things enter my mind.....first, is there anyone available to help? If not, then think of it this way - first pt has an airway, is breathing, and has an IV. He is not crumping, his pressure has been relieved w Nitro (so you have a higher index of suspicion that this is true angina), and the doc has seen his EKG. Second pt has an airway, is breathing, does not have an EKG, has not had any interventions to help his pain. For pt A, metoprolol and aspirin are not going to acutely change things (unless his HR/BP are off the charts). I would go to pt B, start my IV, then give a NTG if ordered by the doc (our CP protocol does not include nursing giving NTG before being seen by MD). That way, both pts have their ABCs covered. I'm sure you know this, but never give NTG without a good IV line. Otherwise, you run the risk of dropping someone's pressure so greatly that you won't be able to get a line. I've actually seen a pt go asystole for 5 seconds after a NTG was given. Anyway, if you trust your EKG reading skills and the ER MD, you can also triage in your head accordingly....pt A has some PVCs but nothing else, pt B has some ST depression. Obviously, you priority has just become pt B. Hope this helps!

Chew gum (since skanky breath doesn't have anywhere else to go), and don't wear glasses if you can get away with it. It always seem like I wear my glasses to work on days when I have to access a port and wear a mask :)

We have a "zone nursing" format. We have 4 areas to our ED - Acute I, Acute II, Fast Track, and Peds. At peak, we have 5-6 RNs, 1 tech, and 2 docs assigned to each Acute area. We still sign up for patients as they come back, but some people aren't as, shall we say, eager to accept new patients. Which reminds me.....with the whole Anybody/Somebody/Everybody thing (in the end Nobody did it.) Why do I always end up being "Nobody?"

I'll be very interested in the replies - maybe this would be more appropriate in the Psych forum. I too have seen this many times, and each time I'm just as floored as the first. I tend to think that ALL 3 year olds are at least a little bipolar :) Isn't that just the way they're supposed to act?!

I work in the ED, and as a very teamwork oriented environment, we all expect everyone else to look at the computer, realize Nurse X has 6 patients, but Nurse Y has 2 and will then be taking the trauma. We also expect the other nurses to not sit there, looking at the monitor station, and not come into a room when they see a BP of 70/30. When triage calls a pt directly into a room w CP, it is expected that a nurse will go into that room, and if anyone has a minute, he/she will also go into start the IV, put the pt on the monitor, etc. It isn't mind reading, it is just being a good nursing coworker. This nurse (the one who shirked the admit) should have stepped into the room at least and asked the nurse if she needed anything. Like I said, it isn't magic, just good simple cooperation and people skills. Of course, if someone doesn't come in to help and you need help, it is your responsibility to find someone who is available (hmmmm maybe the nurse that has 1 less pt than everyone else?) and get her to help you. With respect to the OP's questions about what to do now, I would try to actively engage her in the coming weeks. If she is sitting at the desk reading a magazine and you need help getting someone up, grab her instead of a tech. Just keep pulling your load and she will eventually get weeded out. Good luck!

Not an OB nurse, but I am in the ER, an area that is also notoriously hard to get into without experience or an "in." Maybe look into a larger hospital that has a fellowship program. My hospital has fellowships for new grads as well as experienced RNs looking to change their specialty. They come with a work requirement - usually around 2 years - but then you can leave and go to your preferred hospital. Just a thought :)

We also just have the defib at the bedside. Might be a smart idea to save a few seconds....but those pads are pretty expensive too.

Well said! Thank you!

Oh my. This is going to catch up to both the hospital and the CNA in the end. The idea that "the hospital wouldn't put me anywhere that I'm not qualified" is akin to saying "the hospital is trying to protect my license" RIIIIIIGHT.

Did you have an orientation when you 1st started at your job? Yes How long was the orienation? June through August was classes and floor work (usually one shift a week on the floor); August through November was strictly precepted time on the floor - 40 hrs/week. On a scale of 1-5 (one being the least and 5 being the best) how well do you think this orientation prepared you for your job? 5 How long have you stayed at this job? 2 yrs on a scale of 1-5 (one being the least and 5 being the best) how do you currently rate your job satisfaction? 4 I work in a large level I trauma center in the ED, and really enjoy my job. My orientation was very flexible in that if I felt shaky on trauma, my preceptor would meet me on a non-scheduled day and all we would do is take traumas that day. In November, I had a meeting with my manager and preceptor, and they actually asked if I felt ready to come off orientation (they do this with everyone). Of course, you never feel ready, but there has to be a point when you jump off and do your thing by yourself. My dept has a pretty good retention rate, and I feel this fellowship program has a big part in that.

1. In which area of nursing are you working (OB, L&D, ICU, ER, Med/Surg, Peds, Hospice, etc.)? ER 2. Do you work at a hospital? If not, in what type of facility do you work? Hospital - Large level I trauma center 3. Are you working as a nurse AND in school at the same time? If so, which scenario fits you: work FT, school FT? work FT, school PT? work PT, school FT? work PT, school PT? Not in school right now; going back for my FNP MSN in January, will be part time schooling. 4. How many hours a week do you work? 36 hrs - 12 hr shifts every Fri, Sat, Sun; usually with at least one extra 6 or 8 hour shift thrown in there, plus meetings 12 hrs a month. 5. What type of shifts do you work? Used to just do 3-3, but now I do everything except 7p-7a. 6. Are you married or single? Married 7. Do you have children? If so, how many? None yet. 8. What age group do you fit in?: 23-27 9. Are you physically fit and eat a healthy diet (all the time, most of the time, sometimes, never)? I run 3-4 times a week, lift weights 3 times a week, eat pretty healthfully. And enjoy chocolate :) 10. What do you believe is the main factor that is causing you to feel burnt out? For me, it is mainly a number of hours a work thing. I used to do a simple Sat/Sun schedule, but I'm now precepting a new grad and need to pick up extra hours to facilitate that. I'm also picking up sicker patients to help her get a good experience (so tired of trauma right now). I'm very involved at work (chairing several committees, on several others), and I've found that can be a blessing or a curse. I get along well with most of my coworkers, so that helps as well. A big problem I've found is that I have ideas as to how things "should" be. Ex: each nurse should take 3-4 patients, if I have 4-5 patients, then I should not be taking a trauma, etc. I get very frustrated when I'm there and completely working, and there are people who are NOT pulling their weight. I'm not a work Nazi, but I feel like if you're at work, you need to be at work. Getting a little rambling here. Hope this helps!