widi96

I second Solheim's class if you have the opportunity. He has high pass rates for those who attend. I took his course for my TCRN along with two others from our facility and all three passed. For my CEN I used the ENA's CEN Review. It offers videos to watch which I didn't find overly helpful but it did have printouts on each category that I studied and was able to make note cards from and was successful with that. I liked the printouts much better than the videos. It all depends on what your learning style is. Good Luck on your test!

Hi All! I don't know if anyone is interested but the Kansas Emergency Nurses Association is sponsoring a TCRN Review class on Nov 11 and 12 at Stormont Vail in Topeka, KS. It will be taught by Jeff Solheim (President of Solheim Enterprises and the past president of National ENA). Class is $150 for ENA members, $250 for non-members. Everyone who has taken his courses seem to love them and say they are very valuable. Registration is available on Eventbrite (search TCRN); or if you prefer to print and mail in registration the form is available on the website at https://connect.ena.org/ks/home - you just have to click on the 'upcoming events' to find the actual registration form.

We currently only have one protocol that includes pain medication and that is flank pain for possible kidney stone and we can give IV Toradol after a negative preg test. I don't believe it is our physicians that are causing this problem - this is much more of a ED size issue. We've added more rooms and still have 4+ hour wait times frequently for our level 3s. We're trying to get things started in triage prior to seeing a physician. The pt who complains about a twisted ankle that is doing ok may have to wait awhile then find out they have a non-displaced fracture vs the patient with obvious deformity who would go right back. We're trying to improve the situation until they can get to see the provider.

For those who have protocols for pain medication in (actual and potential) long bone fractures - what do they look like? What medications are you using? What contraindications are listed in the protocol for administering the medication? We are looking to add pain medication to our protocol and want to see what others are doing. Wanting to see if there are better options or something we aren't thinking of.

You did the exact right thing. The patient had a complaint that was concerning - you did what you could in your facility with no improvement and notified the physician who made the decision to send them to the ED. I'm an ED nurse and can tell you that about 95% of the time we can't find a cause for a patient's chest pain - it happens all the time. But I'd rather work up all of those patients than miss it when they are having an acute cardiac event. The only thing that you might've been able to try (if the physician was agreeable) would be if they would order something for anxiety and see if that improved her pain/HR. But again, your actions were appropriate.

Hello all. I am wondering if anyone has had success in decreasing falls within the ED, and if so, how did you go about doing it? Is is a difference in the fall score, equipment, etc? Our Practice Council will be working on attempting to decrease falls within the ED and unfortunately there is not an overabundance of research specific to the ED - and what works on the floor does not necessarily work in the ED. Would greatly appreciate anyones input.

For anyone who has been to the conference before - do you know what the 'general assembly' is? Not sure what to expect from this portion.

Hi all, I am just wondering if anyone on here is involved in their ED Practice Council. I have been in the ED for a year now and our PC has been pretty much non-existent since I started. We do have additional committees of Emergency Preparedness, Trauma and Triage. I am just wondering what are some of the goals and projects other practice councils have taken on. Thinking of attempting to revitalize the committee, but need a direction to go in. Any ideas would be great. (This is for a Level 1 Trauma Center at an Academic Institution)

Everything I think of would require additional education - but have you thought about becoming a nurse educator? If you don't want to go the route of teaching nursing students - do you have large hospitals in your area? The hospital I work at has an education department, plus every unit has their own educator. You could keep up with critical care without the stress of the 1:1 interaction.

Here are my thoughts - when I was looking for a new job but nervous to give up my comfort zone I applied for a PRN job at another hospital. Didn't have to give up my seniority or anything at the previous job and instead of picking up OT there, worked extra at the PRN job. Lasted 6 months before I quit the previous job and went full time at the PRN job. Doing the PRN thing let me know if I was going to like it there without having to risk my comfort at the old job.

I will be there. Unfortunately, so far I have been very disappointed with their organization and communication. There were very few details published when they wanted my money for the conference - the interactive part being the main thing - then adding the dinner at Epcot. Now, after I paid for the conference in January, we find out that none of what is already organized and advertised is included in what I have paid for. While I will be there this year, I doubt I will ever go again.

Our iStats are wonderful - we have 6 and need more. Use them all the time. We recently also got a machine similar to the iStat that will do POC INR.

I do have the book and have actually already read it from cover to cover. Since the blood sugar was an example our educator had given in class in regards to someone who had walked in the front door - then experiencing the patient via EMS who had already been treated - wasn't something I had previously thought about - EMS treatment changing the triage level.

Hi all. I am working on our ED's testing and training for performing the role as a triage nurse. Since I am in the process of the education/testing, it has made me think a little more about some of the patients I see and triage. (Completing the triage testing, etc means we can work IN triage for those who walk in the front door - all ED nurses help check in ambulances and therefor triage those patients.) My question is . . . our educator is emphasizing that anything that requires immediate intervention is ESI 1 - which would include things like mental status changes secondary to low blood sugar. The immediate intervention being the administration of D50. So my question is . . . if this is a patient who was transported by EMS and they treated the hypoglycemia per their protocols - is the patient triaged based on report from EMS or the patient's presentation upon arrival to the ED? Had the patient been brought in the front door and ED staff were the first to see them - it would be a 1, however if the patient's glucose was improved and they were more with it upon arrival to the ED - is it based on what we first see? Despite already receiving the intervention?

I have charms on my stethoscope - I do like the cutesy stuff and it helps me differentiate my stethoscope from others. Mine is actually a floating charm bracelet that I tied around the intersection of the tubing. I have not once had a problem with hearing excess noise from the charms. And I have never had another nurse, administrator or patient say a negative thing about them - however, several patients have commented on liking it and several asked where I got it. Bottom line - if you like it and your nursing school will allow it - go for it. And if the nursing school won't - hold onto them - nursing schools seem to be much stricter than many places of employment.

I'm glad someone brought up that this is more than a med error where the child was okay from the medication. It is also an exposure - so insisting the child is find without the follow up is not necessarily accurate. There are going to be repercussions - the original owner of the pen needs a new one because of the cross contamination (which insurance may not cover), the kid who received the wrong injection will need a workup similar to a needle stick injury (although the risks are very low, they are still there). Has someone brought that up to the parents or had them seek the advice of their physician? Having said that - this whole situation seems like a terrible system failure that needs addressed. No, I don't think you should quit nursing or your school nursing job. There will be a fine line when addressing the powers that be between accepting responsibility for your actions while indicating the other failures within the system that lead to the error. No labeling will lead to further errors - especially if you are no longer there and it is someone who has not gone through this experience. You have certainly learned from your experience and while non-nursing individuals may be deciding your fate for working at the school - I hope that they can see that the SYSTEM needs changed to help protect the safety of the students.

Unfortunately, I am not a fan of the ENA's website or organization. I had asked a friend of mine about going and she forwarded me an email she received about an early bird special where we put down a deposit in December and had to pay the balance by mid-January. But finding the registration stuff online is difficult, especially finding out any of the costs.

Hi all! I have enrolled in the ENA Conference in Orlando for Sept./Oct. and was just wondering if anyone else is going? Also, if you have been to one before - what are your thoughts. Anything I need to take with me, be prepared for, etc? Still months away, but getting very excited to go. :)

At my facility anything less than 2 weeks automatically puts someone on the 'disqualified for rehire' list, meaning the facility will not allow them to ever be rehired. Anything 2 weeks or over is considered professionally appropriate. If you are wanting to stay on managements good side (because you never know when you will need a glowing reference or will run into them in the future), being flexible with your ending date through the possible end of the schedule will look good on you (If this is feasible with your new job, if not, managers do understand as long as it is communicated). Managers remember those who try to help them out in the end, not leave them in a lurch.

It would probably help if we knew what region you are looking in. I work in a KC area hospital with no school affiliation and they offer $1500 a year and require you to work one year after the completion of the course. This was enough to cover around 1/3 of my classes for my Master's Program.

I work in a Northwest Missouri area hospital - we get $3/hr night differential; day shift and night shift get $2/hr weekend differential for Friday night through Monday morning.

I know it's not as nursing related, but I would say a nice little potted plant with a thank you card.

It does sound like you might need to discuss this with the physician (if allowed by your grandmother). If her hgb is that low, I would suspect there would be signs if it was a GI bleed - if there is no signs of bleeding and / or they have performed an OB stool on her that was negative, the chances that there is a severe bleed in the GI tract seems very minimal, making a colonoscopy an unnecessary, uncomfortable procedure your loved one would have to go through.

The charge nurse on our floor usually does not know about each and every patient. If a patient is having problems, they should be notified. They know about why pts are in isolation or if there are any immediately acute medical or behavioral issues. The charge nurse has a full patient load and is responsible for delegating admits, assisting other nurses, pyxis counts, etc. It is not feasible with a charge nurse having a full patient load themselves, to know all about the other 15 patients on the floor. But I work nights - we do have a 7am-3pm CRL who does management type stuff and works as the charge nurse during the day. She knows far more about the patients and goings-on of the unit than we do on nights.

I would suggest telling any potential employer about your pregnancy. It is illegal for them to discriminate against you because of it (although I'm sure it does probably happen, and far too frequently). But I would want a manager to feel that I was honest, and starting out by not telling them the truth will not look good on you once you have obtained a job. Good Luck and Congratulations!!!