likemike

Drrrrr

From Mike, RN, CEN I passed and so can you. I took a Paragon CEN exam review course. Two days. This after ACLS, PALS, TNCC etc. Then I reviewd the sylabus and used the ENA/BCEN on line test source. One 50 question, one 150 question. I really did not study that hard. I mean, this is what I do as a profession. I took the test, done in 2 hours and am now a CEN. It is doable but you have to have that burning desire. Sadly, the texts supplied are two years out of date. Email Cheryl at Paragon Education. She does small courses, Courses on cruise ships and she saved my bacon. Go for it, ACEP wants us to be CEN's, we want board certified ED Docs..so get on board and good luck.

Wow, That hits a little too close to home. I have been an Emergency Care Practioner for 29 years. EMT, then Paramedic, Navy Hospital Corpsman, LVN in ED and Finally an RN. I work in a knife and gun club level one Trauma Center. I have only been an RN for a little over two years. A CEN for a month. My urban hospital had a great new grad program, a weak contract for two years of service after training. So I finished the training. I finished the contract. In the last two weeks I have had to stop taking public transport and walking to work. DT 8 homicides in an 8 block radius of my hospital. Last noc, another homicide with about a hundred people of color wailing and mourning yet another sensless death. The cycle will not stop. My place has ratios, big deal, we break them all the time, one to one ICU care for 3 hours while your other 3-4 SICK people are not cared for. Scary. I have been ****** on, assaulted verbally and phyiscally and I finally realized my quality of life sucks. So now I have had two interviews in rural hospitals surrounded by scuba diving, surfing and a better quality of life and patients who know how to read. Patients who don't do crack, smack or meth... Do I feel guilty, yup, a little sure, that is my problem. But I need to take care of myself. And if one of my ETOH ers, with a fatty Liver and coags off the chart falls and has yet another SDH, my lisense is at stake and mgt will just remove me like a zit. So right a list of pros and cons, use ENA, network, use this bord and then decide. You may decide that my life is more important than being spit on, harrassed and overworked and run for the ocean. Good luck.

It is the brand name of a rapid infuser, it can warm up fluids to 42 degrees C, ours is labeled a level one, that must be the company name? It is used in all of our trauma rooms and in the OR. Hope that helps, oh yeah, if you unplug the tubing, you can rapidly infuse fluids, it makes a beeping noise as the fluids are at ambient temp. We used it on a tweaker who rather than be arrested, swallowed all of her meth, she had a core temp of 41 and was dry, 70s systolic so we just took off some of the tubing to give her 3 L IVF at room temp. Hope this makes sense

Nope, Good question. A lot of Nurses are afraid to ask a question. The blood is viscous as it is cold, but just put it in the level one, which hopefully is heated, seal the door and pressurize the bag. That is the reason for the level one, to rapidly infuse crystalloids or blood. It works great.

I was recently assaulted (again) at my Level 1 knife and gun club. We have more behavioural emergencies than traumas some nights. I practice in an urban ED, which city is known for it's tolerance of drugs/alcohol and social liberalism. I am also a former Paramedic who spent most of my street time in the ghetto. (No offense, but ghetto Medics know what I speak of) I am also a former Navy Hosptial Corpsman who spent the majority of my two tours with the operating forces on a small combat ship wo a physician and with the Fleet Marine Force. One of my tours was a combat tour during the First Gulf War. I came back from that experience with PTSD and have not had a military flashback for a number of years. In the last bit of my training I was primary for a 3 yo female who had been accidentally run over by her daddy. I had an out of body experience, saw her face in my dreams. Sought help, but not a good fit. Then just sucked it up and soldiered on, relapsed with cigarettes...yech. (thank goodness for nicorette) State ENA president has criticized at a meeting my specific ED for the lack of Critical Incident Debriefings. For instance, he also is an EMS leader and after a 12 yo girl was sqaushed on the freeway, immediately got a Critical Incident Debriefing for PD, CHP, FD, and EMS, when he asked my hospital to send the ED Nurses he was told "...they are too busy and can't come" So I was set up to fail to a degree, part of which is my own lack of self care, part of it instiutional culture. In a period of 3 weeks, I had three "stable and tucked" patients (our population has a long problem list, Axis one and two, with multiple co morbidities). All three of these folks suddenly went south in a matter of seconds, with A, B and C problems. I was alone as they tried to die, and did the appropriate interventions, ie getting help, resusitating them etc. This is not unusual in our setting. Despite ratios, we "must be ready to code a patient on a second's notice, as our patients are so sick, so my kids must be ready to jump in right away" says our Nurse Manager. Then I witnessed a new Nurse get sucker punched in the jaw by a drunken female. All of this within weeks. A female patient was intoxicated at a local sporting event, fought with her girlfriend and assaulted two Police Officers in trying to subdue her. Both Officers were taken out, one with a kick to the knee and ACL tear, one with multiple heel vs testicles and human bite. She went to jail, was refused and ended up in the ED on a BB, c collar, spit mask and four point soft ties. The look on the Paramedics faces was one of abject fear. (I know that feeling all too well) Seriously the worst behavioural emergency in 29 years. She was banging her occiput to the back board with that sickening watermelon like sound and it required the Attending, one resident and four RN's to prevent her from hurting herself. We HAC'd her and were waiting for it to take effect. She spit on the Attending's face shield. Then somehow managed to spit under my face shield and glasses directly into my eye and attempted to sink her fangs into my wrist. I had gloves on and the spit mask prevented a human bite. (Four of us were physically holding her down, no choice) But I then had a flashback to my colleague getting sucker punched and then had like an out of body vision of my dominant hand becoming infected with a rapidly spreading cellulitis. There goes my career..I envisioned. I arrested her and had to leave work as I was unable to safely care for my other patients. Had three days off, did all the right self care things and as soon as I hit the campus had a huge panic attack and again went home. Was off for 5 weeks, saw EAP, and essentially the root cause analysis of my PTSD was RT the little 3 yo girl. No critical incident debriefing in our culture remember, no closure. Started on prozac and a little metop. Also started working out again, huge help. Now I am back to full duty, and am doing quite well thank you. I did some online research and found that up to 10 percent of Critical Care Nurses (ED, ICU, CCU) at some point suffer from PTSD, a higher rate for noc shift. I am thinking of writing my story up in a journal. I would really like to share my story with others so that they can learn just how important self care is. Despite the barriers my house has.. If anyone knows of any good articles on PTSD re Critical Care Nurses and/or wishes to share story, I would be greatful. This is not about me, but rather about us. Our own unique "Band of brothers and sisters" Respectfully, Mike

Ayy Naku, You ask good questions. If you have not practiced for a couple of years you may do well to take a refhresher course in the US. There are a great deal of education sources for such things as IV or phlebotomy in California. I understand your love affair with the ED. If you can afford it join the Emergency Nurses Association. Read the journal, memorize Sheehy's book, go to their excellent web site and see the wonderful books and courses available. My dear friend came to the US with a dream to become an ED Nurse. She could not get a job in acute care right away, had to pay her dues in a SNF, and then MS. But she never gave up on her dream. Now this Pinay is a Certified Emergency Nurse, active in ENA, a charge Nurse who is highly respected. It can be tough coming from the ROP and breaking into the ED, but it is doable. Do not hesitate to contact me for advice. Don't ever forget that were it not for Filipino Nurses our US health care system would fall apart. I am sure some would disagree, but that is their issue. Good luck, Ingat.

ENA. ENA. I joined in my last semester of school. I go to local, state and the national scientific meeting. I read the journal, go to the web site and am very active in ENA. For one thing, you get away from the chaos for a break. Another thing is that knowledge is power, I take what I learn to the bedside and sometimes know more than my colleagues. It makes me far more comfortable. I understand that a lot of colleagues are just tired and do not want to go to these events. Yet I see the same Nurses attending ENA events, and they are excited about learning cutting edge evidence based practice. It is normal to be scared, patients try to die in front of us on a regular basis. So don't stop just cause you finished twelve weeks or whatever of orientation. We are life long students and scientists. And if ED Nursing is not for you, so what. There is life outside the ED, you may just need to find a better unit, or perhaps a different ED. Some colleagues feel that if you are not a rockstar Level 1 trauma Nurse you are nothing. Whether you work in a knife and gun club or in a community ED with a little less chaos, you are still an ED Nurse. Keep studying, work on CEN and please recruit new members to the best Professional Organization in the US. ENA rocks.

I work in a very busy level 1 Trauma Center. I have been an RN for two years, but with 29 years of progressive clinical experience. EMT, then EMT-P when they made Paramedics, a Navy Corpsman and then an LVN when LVN's in CA were able to practice in acute care. So maybe I was not the typical new grad. Having said that, I was in a program (Emergency Nurse Training Program) led by two nationally recognized RNs, the Nurse Educator and CNS. Our program took both new grads as well as Nurses from MS. It is a year of didactic and progressive clinical experience. I can't think of a single Nurse in three cycles of programs who had the afforementioned know it all attitude. Rather the preceptors did... Even if for instance, the preceptee was more knowledgeable than the preceptor.... We all learned to be professional with a modicum of humility. So, new grads can become rock stars, but it is really up to the leadership team, open minded preceptors, and the individual. There is a pretty tough attrition rate, but that is for a reason. Yes, Nurses eat their young. So instead of generalizing about new grads think about how tough it was for you in the stressful environment of the ED. We all make mistakes. I have caught 4 huge med errors from Nurses with over 15 years at my place...According to a study, it is more likely to have the experienced Nurse make a med error. As new Nurses, we are scared to death of harming our patients and most of us are taught to take our time, look up meds and do the right thing. I would suck being a MS Nurse, but do well in the ED. Apples and oranges, I respect MS Nurses as it too is a specialty in my opinion. As long as New Grads have a solid education followed by a wonderful program to nurture them, all is well. I am just a lucky guy to have been trained by a lot of great Nurses. I had to ask to have different preceptors during my program as it was not a good fit. The leadership team accepted this, and the problems with former preceptors dissappeared once I finished the Program and we became professional colleagues. It takes a village to make a good ED Nurse. Cut the newbies a little slack.

Dil Dave/Donna, Um, I cant walk, I need this cane cuz I have a back injury from the war, from the fall from the bridge, from being attacked by a gang, from a GSW, from being a Nurse etc "I am allergic to Toradol, Motrin, Vicodin, Morphine the Doctor usually gives me a couple of millllllagrains...is that the right term? Anyway of this drug called, oh geez, Dil something?" "Was it Dilaudid?" "Yeah, that is the one my Neurologist, Pain Doctor, Surgeon wants me to have, q 15 minutes IV PRN!" "I am sorry the Attending is discharging you with a Rx for Motrin..." At which point the non ambulatory person writhing in pain abruptly stands and swings with the cane like a famous hitter on steroids and when an arrest is attempted sprints out of the ED....

I USED to be JUST an EMT, JUST a paramedic, JUST a Hospital Corpsman, JUST an LVN and now I am per my Manager "A professional Registered Nurse in the Emergency Department." I got a loan in the LVN to RN program. It paid me as a Junior in college despite being in an ADN program. Going full time takes 3-4 years. A BSN 5. I learned so much in my program and am proud to be an RN. It is true though the general public does not know an Associate Degree takes at least 3 years. When folks enquire I tell them about all of the pre reqs, waiting list, GPA requirements and they are blown away. In California there are tons of ADN programs at Community Colleges but a small amount of BSN programs. I just got a job that is helping me from day one to get a BSN. The clinical hours I work now count for 5 units and administration supports us. But truly, all I ever want is to be a bedside Nurse. But I love to learn. Now I am the RN. I hated being referred to as a "just" So I work with ED Techs. They are not "my tech" They are not just a tech or the unit clerk is not JUST a clerk. We do not live in a vacuum, we work as a team. I am sorry when ignorant people do not know the sacrifices we ADN RN's have made. But at least I FINALLY have a college degree :)

My friend sent me a stream like this. The funniest was: You know you are an E.D. Nurse when: You encourage your patients to sign out AMA. LEGAL DISCLAIMER I would never do such a thing.

Nicely stated. But....I spent 8 years in the Navy and had a lot of Pinoy shipmates both in the fleet aboard ship/with the USMC and in a couple of Hospitals. They do tend to group together. Probably for a reason. It used to be if you were a Navy Pinoy you could only be a slave to an Officer, then a cook. Now any rating is open. So there is an inherent racism in the Military and it spills over. I learned from other Nurses from ROP a few words of Tagalog and treated them with the same respect of my other co workers ir respective of race. It was amazing as so few caucasian Nurses took the time to befriend them. In school I found out much to my chagrin, that the "Circle of Filipinos" who always isolated themselves was because they were "taught" ((their words)) to beware of white people particularly men. Again, with a small bit of extending myself to them I was repaid inumerable times by this group in terms of studying and becoming friends with them. To quote Rodney King "Can't we all just get along" A year ago as a student I heard two travelers one from Michigan and African American the other a white lady from the deep south. Change of shift and they covered all the Nursing report. "Ohh he is one of those asian types speaks some language called Tee Ayy Gee Ayy Ohh Ell Gee. "well we dont have any of those types where I come from" "me either" "What the hell is Tagalog" I was steaming as this is the Bay Area and a melting pot. I told them Tagalog was the main non English language of the Philippines and if they needed a translator 50% of the full time staff spoke English and Tagalog fluently. And if you want to work in the Bay Area you need to lose the attitude and my Name is Mike, this is my school, this is my Clin Instructor's name and phone number and here is my school's Nursing Dept. Director's Name and phone number. They were speechless a mere student was so fired up by their rascism over a client. Did it do any good, probably for that one patient who knows. My point is it is a two way street. All cultures here must learn to assimilate. All it takes is a few words, a smile and genuineness. Whatever our culture, race, background, sexual preference, religous preference, gender etc. we are all Nurses and should treat each other like Brothers and Sisters ideally. I know this is a pipe dream but all it takes is one open mind to start. Thanks for your insight.

LOL you got me with my bad Taglish but cut me some slack, I had been up for 14 hours and was checking NCLEX results for a pinay friend. :)

Sorry to put my white nose where it may not belong but I have an affinity for your country and great respect for Pinoy/Pinay Nurses. It is hard to adjust to the brutality of US Nursing for some of my friends. Particularly dt the fact that a great deal of Nurses are racist still in this day and age. Most of my closest Nurse friends are from the ROP. After initial culture shock they adjust and do real well and find indeed the grass is greener. But you must have a + support system. Having said that, if you interview in hospital X and find knowbody knows what lumpia is and Hospital Y has lots of Nurses from back home, you may do better in Hospial Y. Case in point, a rock star L and D nurse just got fired during orientation at Hospital X and is now working at hospital Y and doing well. My friend from Nursing school turned down a well paying job from Hospital X and is happier at hospital Y. I hope this makes sense. Really want to say "Nantindan mo?" but that is against the rules here and for a good reason. English is professional, so do you unterstand? If not, let me know cause I care...

Sorry you witnessed this. As a former Paramedic and Navy Corpsmen Nurses arent trained for rock solid pre hopsital care. I know cause I am one now :) ATLS states, airway with c spine control. I ride a MC as well and there is a right way and wrong way to deal with airway and helmets. If you are not trained to dc a helmet, dont do it. But ABC, ABC etc. In reality if you need to ventilate this patient what are you gonna do, mouth to mouth....yech. Sadly, people die, you did the best you could. You may find it actually fun to take a basic EMT course and never again would you feel self doubt. You would be an asset to the class given your knowlege base and will learn a lot. The MOST important rule of pre hospital care is "Is the scene safe?" Lots of Nurse's get killed doing the Florence thing. No worries if you position your vehicle safely, direct traffic as you put out flares and make the scene safe for the victim and rescuers. Sorry you had this horrible experience.

the difference between a male vs female Nurse is one chromosone. Stop bashing men, the question should be about competency not gender, this is 2006, women fly the shuttle and men can Nurse. With all due respect, get over it.

If your gut feeling is telling you something is wrong, follow your gut. RUNNNNNNNN Listen to all the sage advice above.

3 months, 3 managers and 7 preceptors, sounds like a recipe for disaster as in being set up to fail. Regroup, if your gut tells you after two weeks the unit is dysfunctional RUNNNNNN You just got a bad start it sound like to me. If you can try again.

AFTER you deflate the baloon, have them breathe in and out using belly breathing to relax muscles and at the end of an exhalation pull it out. For men my age, either inserting or dc ing a foley may require a modicum of patience and meditative breathing....

We are all human and humans make mistakes. In the Medical Field Doc's rarely share as it were there Medical Follies. Just is not part of their ethos. Yet as Nurses we are expected to self disclose. Yup, you screwed up. Guess what, we all have at one point. It is only a mistake if you make it again. You will NEVER make a mistake again. What does not kill us makes us stronger. From now on your precious ego will be tossed aside as you advocate for the patient. Better to be a good Nurse who is a thorn in someone's side than to cause harm. Having said that, it sounds like you were OBE (military term) overcome by events and perhaps your unit has a system problem. I used to be quiet and meak as a mouse. I learned the hard way to speak up and "do the right thing" and guess what, folks have greater respect now. Though I am sorry for your suffering, I am not sorry this happened for it was and is such a powerful lesson. You could have easily blown this off, gone home and ignored it. Yet you did the right thing. An experienced compassionate manager might have handled this differently. Reality bite: The Surgeon is gone and you tell them ASAP about the discrep and they get pissed and write you up. The Surgeon is wanting to move on and you messed up the count and they get pissed. A good Surgeon and Nurse Mgr would say, rock on, lets make sure everything is squared away. Chill, learn and soldier on, you have great moral courage.

I had to re learn this issue. At first I used words like angry or depressed and charted swear words. One hopsital was very religous and did not allow profanity in charting. Then I went to a legal seminar. The RN JD stated to chart the patients visual appearance, we can do so as we are trained as well as the verbal comments in quotations. Reason being if it ever comes to adjudication every court in the land will understand. At 1505 pt rapidly approaches nurses station. Fists clenched, pupils dilated, neck veins distended, pressured very loud speech "You motherfucker, get me my fucking dilaudid now or I am gonna kick your fucking ass!" Attempts by three staff members to verbally de escalate patient as security was paged. Dr Smith paged. Emergent orders for Haldol 5 mg IM, Ativan 2 mg IM and behavioral restraints applied as per Dr Smiths orders. Pt restrained as per P and P, medicated, 20 minutes later VS blah blah blah, resting quietly in leahter restraints. Then dont forget restraint checklist and when the attending saw the patient. Nurses getting hurt is a big problem and the lawyer said to protect us by using factual statements, no innuendos, no opinions. Just the facts maam to quote Jack Webb.

I find the term "Male Nurse" discriminatory. If you were stopped by the police for speeding, would you call the police officer "Oh, you are a female police officer!" In taking an order would you identify the attending as a "Female Doctor!" Would you refer to a firefighter or paramedic as a female medic or Firefighter. Try it and see what happens, that is mysoginist. Lets take it a step further. Oh, you are a nurse of color. Is it ok to call a nurse the "African American Nurse or Asian Nurse etc." We are all brothers and sisters in the profession.

I was an LVN in the E.D. of a tertiary University hospital in a wealthy area. An 77 yo female came in dressed to the nines co impaction. The attending, another Vet like me (he was in the Army, I in the Navy) said to give her soap suds. "High, hot and a hell of a lot" I assembled my equipment went into the room and their she was. She took off her gown and was wearing a fredericks of hollywood bustier with stockings. EWWWWWW I kept a stone face, explained what I was going to do and gave her her gown. I returned and did two enemas wo any stool, just stench. The attending told me to attach a BIG foley cath and lube it up and turn on the soap suds as I inserted it. I did so. Lord, I thought that thing was going to come out her nose, she just smiled at me. EWWWWWWWW The smell was so bad and she creeped me out I asked for another nurse to help. We attached another foley and this the fourth time I felt something happen. But no stool until I pulled the foley/enema tube out. I had bored a hole in a 4 inch by 12 inch piece of hard stool with the foley. As I pulled it out the snake like stool came with it. She smiled at me, "I feel so much better sweety" The other nurse and I smiled covered the bed pan and ran out of their.

Yes, a number of times. When it is not a therapeutic relationship either dt a E.D. patient with an Axis two secondary dx who wants to verbally fight or a patient who just physically assaulted me I just tell the CN to re assign me. It is better for the patient and for me. It is just not worth it, but the rest of the team must support you.