bodhisattvya

Seriously? No mention of a Foley during the "Trauma Nursing Process?" Receiving report from EMS during the Secondary Survey? Not just a bad idea, but disrespectful to our EMS Colleagues! Is the Nursing Echo Chamber on the Ivory Tower now so loud that it is now drowning out common sense? Thanks ENA! Next time it's going to be ATCN re-certification & skip TNCC!

The reviewer at forusdocs didn't think that Spragues were that bad. In fact the Omron model won the "Best Buy" award. I don't know what allnurses forum's rules are about "hot links" so I posted a link of this review below without the www. P.S. I have no financial interest in the website or Omron. forusdocs.com/reviews/Acoustic_Stethoscope_Review_page7.htm Bested only by the Littmann Cardiology III. The authors of this review were very complementary of the Omron Sprague-Rappaport. Truth of the matter is that the Sprague-Rappaport by Hewlett Packard was the Littmann Master Cardiology of its' time. If you are using one, you're just kickin' it old school. Use what works best for you. It's a pet peeve of mine that healthcare professionals feel that they need to spend $160-170 to get a top of the line Master Cardiology when a stethoscope that costs less than $20.00 will do. P.S.- If you prefer the Sprague-Rappaport style. MDF Instruments has a deal where they will give you free replacement parts to your stethoscope for life. They are a little more spendy ($25.00-35.00 range) however the cost of replacement eartips can add up. Helpful & inexpensive stethoscope modifications: P.P.S. - If the eartips on your stethoscope are not staying on, wrap Teflon Plumbers Tape around the threads once or twice prior to putting the eartips on the binaurals. This will keep them snugly on the binaurals & help prevent them from falling off. P.P.P.S - If the diaphragm ring on your Sprague Rappaport keeps coming loose & is falling off. Use a little moderate-strength (blue) thread-lock,(e.g. Loctite) on the threads of the diaphragm ring. This will keep the diaphragm ring firmly on the stethoscope & if you need to remove it, you can with a wrench or vise-grips.

I have been an ED nurse since 1995 in all sizes & levels of hospitals. Patients that abuse the ED for drugs really frustrate me also. However, please be careful about how you respond to said drug seekers. At one small community hospital I worked at, we had a 30-40 y/o woman coming in constantly for Demerol injections for Migraines. Then, one day I got called to the Med/Surg. floor to start an I.V. in a young girl with Cerebral Palsy & Spina Bifida. Lo & behold, this girl's mother was the lady always coming in for Demerol injections. An effective coping mechanism, no. However, it made me realize that I only see a small facet of a person's life & that I should not be so hasty to rush to judging said person. At another hospital I worked at, A young mid-30's male kept coming to the ED for c/o rectal pain. As far as I am aware, the doctor never even examined his rectal area. He just wrote this gentleman off as a drug seeker,(I don't know about you but I've never had a drug seeker come in complaining of rectal pain.) Well, to make a long story short, about 6 months down the road the gentleman comes back in with a diagnosis of terminal rectal cancer & he was very angry that the ED doc had not listened to him & rightfully so.

re:#2: I don't know where you live. However, I live in a county in a Western State that is bigger than the entire State of Connecticut. It takes two hours driving time to go from the western end of the county to the eastern end. I get what you are saying in principle however & agree with the rest of your post.

I have found that the use of a topical nasal spray about 5-15 minutes before NGT insertion, such as Afrin or Neo-Synephrine helps shrink the nasal mucous membranes, aids insertion & minimizes the risk of nose bleeds from the procedure. I also see a lot of folks want to guide the NGT up "aiming" towards the top of the head. Instead, you want the tube to go straight back towards the pt's Occiput along the bottom of the nasopharynx. Good luck the more you do & are successful at, the more confident you will become.

IF your pt. isn't intubated, or other medical interventions aren't done prior to arriving to ICU. Most likely, it has to do with the ER Physician not being willing to do it. I often time run into this in the ED. However, I will tell the ICU RN that I'm giving report to that I've made the request & it has been shot down by the ER Physician. Please remember ICU folks, the rules don't change in the ED. Just because you have a request that seems like common-sense to you as the ICU nurse & most likely me as the ER nurse, ER Doc's often exercise their perogative & shoot down our requests for orders quite frequently. So, please keep this in mind.

Does anyone have any experience with Excelsior's Clinical Systems Mgmt. program? It sounds intriguing. I would love to hear about the program from someone currently enrolled.

Sorry I don't have NYC experience. However, the best is a rather subjective question. My advice is to establish a relationship with a recruiter from a Traveling Nurse Staffng Agency. Tell your recruiter what you are looking for in an assignment & have at it. P.S.- You're probably going to learn exponentially more about ED nursing at the toughest ED in the city than you would at a posher institution. After all, you are going to New York for a reason, right?

No,not nursing. However, you could become a Respiratory Therapist!

PinoyNP & CraigB-RN: Thank you for your responses, I appreciate your insight! PinoyNP, I would like to respond to a portion of your reply: "Another factor to consider too is whether the "dream job" you are aspiring for is actually realistic in the area where you live. At times, NP's are trained to do a lot of stuff while in school but once they start their actual job, they find that they are restrained in what they can do by the collabortaive agreement set by the physicians they work with. As an example, I know some NP's working in some of the ED's and urgent care centers here but many tell me that for the most part, they are only seeing urgent care types and no traumas and codes even when they work in the actual ED's." This is the reason why I am willing to relocate to some rural area;(such as remote Alaska) where Nurse Practitioners have the potential to do more. Having my whole worklife based around Fast Track patients sounds like hell to me. PinoyNP, could you tell me more about your job & what it entails? I know that there are ACNP's that function in a Trauma Nurse Practitioner role. I also forgot to mention that I also do have a CCU/ICU background. CraigB-RN: The second thing to consider is that only 10% of the ER patients need those specific advanced skills you mentioned. Most are family practice/Internal medicine problems. headaches, flu symptoms etc. Patients that after 15 years as an ER nurse you could probably do most of yourself now. I understand that the skills I've listed are not the bread & butter of ED Nurse Practitioner work,(with the exception of suturing.) A CRNA once told me that his job was 98% boredom & 2% sheer terror. I consider the ED to be a similar environment. This is not to say that I'm scared of acute presentations, I live for real sick pt's. But I want to feel competent in those lesser-used skills. Your personality & background sounds very similar to mine. Could you tell me more about pursuing both an FNP & ACNP. Are you doing this through the same institution? It appears your from Georgia. I believe that Emory has both of these programs. Is this where you are attending? I appreciate your time regarding this subject.

I am an ED nurse with 15 years experience in ED/ICU that is interested in becoming a Nurse Practitioner with a primary focus of working in a rural ED that would allow me to work as autonomously as the role allows. For NP's that practice in this environment, I have seen both ACNP programs that claim to prepare the student to work in the ED & FNP programs that claim the same. I know that FNP allows you to care for all ages, what are the other differences? How do FNP grad's of programs that train you to be an Emergency Nurse Practitoner feel about the advanced skills training you received;(e.g, suturing, chest tubes, central lines & such?) Thank you for taking the time to ponder my post & responding.

Karrie: May I suggest that you go to the following website: http://forums.delphiforums.com/TNTRecruiting/start & ask travel nursing recruiters about assignments in the area. It has been a few months, but there were contracts available for the Salem VA Medical Center,(right next door to Roanoke.) You also might check into assignments @ Lewis-Gale Clinic in Salem,(I dunno if it still is, but used to be an HCA facility if this matters to you.) Martinsville is also not to terribly far away. I hope this helps you out. I started my nursing career at Carilion Roanoke Community Hospital.I am now in Oregon, but still miss it. In fact, I have a picture of downtown Roanoke as my screensaver at work. Good Luck. -Toby.