RunnerRN

How sad. I work in a large Level I ER, and absolutely love my job. My bosses are very involved, and we have the best staffing of any ED in my area, or that I know of. I work my tail off, but it is worth it. Did you get enough education in ER when you started? My hospital has a great fellowship program....6 months of classes and precepted floor work. Good luck finding something that satisfies you.

I too think that you were out of line. If you thought the pt needed to be collared, then you should have done it. A simple "MD aware, no new orders received" would have been sufficient. I also agree that an apology is in order the next time you see this doc. You were pretty much covering your orifice by exposing his. ETA: His response wasn't exactly the most mature. Sounds like a jerk.

It depends on how your dept works. Mine won't allow you to go PT unless there is a PT position open. Sounds dumb, but that's how it is. Check with your manager and find out what the rules are.

We do this as well, but generally mix it with Tylenol. Can't imagine it tastes good at all! Agreed - beats giving a kiddo a shot!!!

Blood tubing, and infuse over 20-30 min max. This is in the ED, and I think we tend to infuse it a little faster than other units.

I work evenings, so I do a little with days and a lot with nights. You're right - night shifters in the ED are very team oriented and a little cliquey. I like the idea of making cookies, but mainly you just need to jump in and do what you can. If there is a trauma coming into someone's room, ask them to tell you about their other patients so you can keep an eye on them. Let your personality shine through - you're obviously an upbeat and funny person! They're also looking to see if they can trust you when the poo starts flying. Ask questions. Every shift has unspoken leaders. Find out who is good at what, and ask them for help. I'd also talk with your preceptor and ask if there's anyone you can look to as a mentor on your shift. Good luck!

My $0.02....there is no shortage of nurses, but there is an awful shortage of nurses willing to work in the hospital conditions. This shortage is not going to end anytime soon, so assuming you can get through nursing school you'll be fine.

Had to cath a toddler, 2 or 3 years old at the most, whose mother was a psychiatrist we all knew and disliked. As I'm prepping, I hear mom tell her daughter "she's going to put that thing in your va-jay-jay." Um, hello? Anatomy lession? Or do psychs get to miss that day? I just let it go. I know we use some euphemisms for that "area" with kids, but why not say privates? Va-jay-jay is a pretty advanced and ridiculous euphemism for the genitals.

YMCAs offer the class as well. My nursing school offered it the week before classes started, just because it was a requirement and so few students had the certification. You may want to check with your school before paying for it yourself.

I don't know the physiology behind the medication, but I'm sure it has been tested and tested and tested. I doubt they arrived at their timings for administration lightly.

I do 3pm-3am weekend option, and love it!! I am young, no kids yet, and have a hubby who works a lot of odd shifts too. We've actually been able to work it out so he works every weekend most of the time, and has a lot of the weekdays off. I don't plan on leaving this position for a long time! I've thought a lot as to why it works for me, and there are many reasons. First, the no kids thing. We only have 2 schedules to figure out. I don't think it works for people whose spouses work a traditional schedule....you'd never see each other. I also socialize mostly with other nurses, so we work around each others' schedules to hang out. My parents own their own businesses and are very flexible in when we can see each other. My manager is incredibly flexible-I can work any hours between 3pm on Friday and 7am on Monday. I have several weddings this summer, so I will work Friday 3-3, off Sat, work Sun 3-3. No problem!! I pick up shifts during the week as I want to, and (here's the best part!) I make more working 2 shifts than I ever did working 3!!! You really just have to look at your family and priorities and decide if it will work for you :)

Proper training? I believe that is called NP/PA/Med school. And the reason triage is staffed with RNs and not MDs is all about resource allocation. Why would an ED want to take a doc away from the back where they can see pts and get them out of the department to just triage people? I do not do an EMTALA screen in triage. I use my nursing judgment to determine if this patient can wait for the MD eval, or if they need to be seen emergently.

I have 2 thoughts (I'm too ADD right now to read all the replies, so apologies if these have been hit already) 1) When the pt is registered, have several "ER Hold" labels printed off. In our dept, you can either order specific tests, or you can order an ER hold. Either way, labels print off which are affixed to the tubes and send. We have found that having the labels available when you go into the room can decrease mislabeling. 2) The other thing we have available is a Typenex band. I'm sure every facility has something similar - it is a yellow band that has a number and a carbon copy label for pt name, and a bunch of stickers with the same number. These are hand-labeled at the bedside, and placed on the pt. Then when blood is given, you double check the specimen TnX # with the armband #. Well, we started using the stickers that come attached to the band to label any blood that is drawn before labels are available. That way, the TnX # on the tube is also on the armband. Interesting note - we had a scary mixup last year with mislabeled blood for a Type and Cross. A pt ended up getting several transfusions of wrong type blood due to a labeling error. After we had a whole process change with the Typenex bands, we noticed that more nurses were printing off the ER hold labels and taking them into the room with them, instead of being forced to write out a Typenex band. If any of the above doesn't make sense, let me know. I haven't slept much the last few days, so my verbal skills aren't the best!! I will say that knowing the severe repercussions that could result from having mislabeled specimens changes many a nurses practice in my dept.

Deep breaths? That's truly the only way I know of to handle these people! There will always be those self-centered patients who don't understand that anyone but them is having pain. And there will also forever be those people who don't understand what nurses REALLY do. I guess next time that person would rather their family member sit in the WR until the doc can get them back, put in that IV, and find time to push those meds PLUS be compassionate and understanding. RIGHT. We were incredibly busy last weekend, and I had several of the same situation. I just explain again and again that this is an ER, we have 25 people waiting in the WR with an over 4 hr wait, so the simple fact that "you" are in the treatment area in less than an hour is pretty amazing. I also have no problem explaining that because we are so busy, there are a lot of very critical patients, which means if we aren't getting to you really fast it is a GOOD THING. Same thing if we put you in the hallway beds....95% of the time it means we don't think that pt is critical (the other 5% of the time we're just screwed because we have no beds!!!). This is getting long. Mainly, I remind myself that I only work 12 hrs, so in x number of hours I'll be going home. That's when it becomes less of a passion and more of "just a job." Those difficult pts get the bare minimun of my energy. (I don't deny any aspect of care to anyone, I just do what I need to do and leave the room). Plus, every ER patient has to go someplace sometime! Either they get admitted or sent home. And then I remind myself why I don't work on the floor :) I think floor RNs are wonderful people, but I could NEVER do that.

Just remember that you're going to experience a certain level of discomfort (mental) as you learn how to do your new job. BUT there is a big difference from being uncomfortable with a patient because you are new, and having that gut reaction go off when a patient is not doing well. Trust your gut, and never be afraid to grab one of the more experienced nurses to double check your assessment. I still do it occasionally. Good luck and congrats!

We started doing this sometime last yr. We have a page that has a carbon copy, and we have to write something on every patient, even if it is just "unk BP med" etc. I'm really good at doing that. The problem comes when people are d/c'd. We are supposed to write out any changes (in "real person language" - no prn, tid, bid) and add any meds that have been Rx'd that day. Then we keep the top sheet and give the carbon copy to the patient. We do not have comp charting, and it is a big pain in the you know what.

We do it much the same way that pkapple does. The admitting doc has the option of coming down to the ED (or sending a resident) to do an admitting assess and write orders. If they don't get there before the room is ready and the pt is going up, the ER doc will write basic orders (we have a basic orders sheet, so it is generally just circling) and send the pt up. We also have several hospitalist teams, and many patients are admitted to them. If that is the case, then no orders are written. The only big problem we run into is if the admitting doc/resident is there when we are waiting on transport to the floor. With the high number of patients we have, I don't hold a bed for anyone :) even a doc!

I also despise the pain scale. I think it can be good for reassessment of pn after an intervention, but it is generally useless. I chart 2 pain scores - 1 is the required numeric, but I also do a Wong Baker....even if I don't write "pt states pn 10/10, Wong Baker score of 2" I will chart "pt states pn 10/10, sitting up in bed laughing with friends, eating Fritos and drinking Coke. BP 120/80, HR 66." etc etc. Just for fun, I try to pain score myself when I'm having issues. I've never been able to get over a 4/10. Menstrual cramps? 4/10. Gas pain? 4/10. Falling down the hill while gardening? 4/10. Kicked in the chest by an unruly toddler while trying to start an IV? 4/10. Dealing with the drug seeker who is allergic to everything but the "D" drug, who is on the call light as soon as I leave the room, insists she has a ride who will be here just as soon as I give her the narc and her d/c papers? That is my 10/10.

Most urban areas self regulate in terms of salary. I live in a pretty average sized city - we have 3 Level 1 trauma centers, a few 2s and lots of community hospitals. If one hospital raises starting pay, the others do so as well to compensate. The only exception is the hospital that is horrible to work for. Their management company is constantly increasing sign on bonuses (currently at almost $10,000 for a 4 yr committmenr, vs. $2000 for a 2 yr committment where I work). You wouldn't be able to pay me enough to work at that hospital - poor care, not enough resources, etc. Hospitals take on quite a liability when they hire new grads. Yes, we need to get more young people in our profession, but they have to pay extra for preceptors, fellowships, etc. Take your $21/hr (unless it is completely out of whack with other hospitals in the area) and smile. Get some experience, then you'll be in a position to bargain.

Here's my method on this....I take the time the I have the patient in my triage booth as a chance to update them on the procedure (I've found that a lot of people just dont' get the processes in the ER). Explain the length of time that is our longest wait at that time, and explain that if their sxs worsen, they need to let us know. I also explain that in about an hour or two, if they are still waiting in the WR, they will be recalled to the triage booth so we can check their BP again and make sure nothing has changed. This lets them know that we're still thinking of them even though they're stuck in the WR for hours at a time. Now the logistics of actually getting someone back into the triage booth when you're backed up like most of us usually are.....we've scheduled an extra RN and tech to triage when we're most busy, and pull them into our "mini room". It seems to work pretty well. No we don't ALWAYS get our second sets of VS, but try really hard to get them on medical c/o, abd pn, chest pain, etc.

Wow....I would not want to work or be a pt in Pelican's ER! As was stated above, the nurses in my ED are EXPECTED to get an IV going, order the appropriate labs, and get appropriate dx tests going (CXR, head CT, extremity injury xrays, EKG). Even if there is a 2 1/2 hr wait to see a doc, you will see that all of my patients are lined, have at least a CBC and CMP in the lab, and have had dx tests. If they're in pain or nauseated, I will get an order from a doc for some Toradol/MS/Zofran. The idea of an RN being responsible for a pt they have never laid eyes on until DC is very scary.

I've never even thought of this!! I'd be afraid to have my husband on your floor!!!! So how did these relationships end? Are the patients and RNs still together? Does the nurse still have a job?

Obviously it differs on the patient. If onset is definitely less than 3 hrs PTA, and no bleed on the scan (or other contraindicating factors) then we will give tPA. Many of our strokes are already resolving by the time they get into us, so no tPA and just supportive care. This reminds me of a very interesting case from a few weeks ago. 70ish man, cardiac hx. He woke up with chest pressure, wife gave him Ntg SL x 3. The pressure went away, but then he started acting confused and had L sided weakness. So what happened? The Ntg dropped his pressure which caused the infarct. The doc referred to it as a "watershed" stroke. I had never seen that before, and found it fascinating - but so sad. There was nothing we could do....couldn't give Beta blockers to treat the MI bc that would drop his pressure and extend his CVA, couldn't give tPA because he'd had surgery pretty recently. I just hope no one ever explained all this to the wife. I thought it was a really interesting teaching case.

I actually enjoy triage quite a bit. It never fails to amaze me what people assume is an emergency. Plus, you only have to deal with the annoying crazy people for 5 minutes, then they're out of your room. I have also found that my skills have improved the more I work in triage - you really have to assess well and make sure that you really know what's going on. I like the "what's your emergency" question. I also have no problem asking family members to step out of the triage booth for a moment, or pulling one of our very protective security guards over to my area. And while I don't let people pull any crap with me, I also have a caring attitude instead of being a ***** all the time. Don't get me wrong, I have no problem being short with people who deserve it, but I am friendly, cheerful, and caring to those who don't. It makes them stare at you a lot less when they're in the waiting room 2 hours later.

We're doing something slightly different (this is just a pilot program, but will probably go fully live within the next few months because it is working great). ER nurse doesn't get a bed number until the bed is clean (no occupied, dirty, or next to be cleaned beds). Each unit has a point person who takes report on all patients, we call their phone and hopefully can give report. Sometimes this person is busy, so we are just told to ask if someone else can take report. If not, then we have a fax form and we fill it out and fax, let the house sup know we're doing this. The interesting thing about this is that the hospital transporter has 30 min to come get the patient, and we often haven't even called report when they come (if the transporters aren't busy). This policy has been great; we still get some floor nurses who complain when we say "okay, we'll just fax the report then." They think we're being vindictive, when really we're just following policy. It only takes a few moments to call report and make sure everyone is on the right page, but it takes a lot longer to write the report and fax and call the sup.