360joules

Pick up a Paramedic textbook. Seriously. Nursing in the county jail encompasses all walks of life (from serial killer awaiting trail to honest businessman on a DUI bust) "fresh off the streets" with nothing but their story and your basic objective observations to evaluate them with. You have to be able to triage, initially treat, as well as handle the the routine "I need my medicine" type stuff. The hardest skill (for me) was being able to decide who was being a drama queen (post-arrest) and who had legitimate complaints that required outside treatment ASAP. Obvious stuff (bleeding, DIB, etc) is easy to call. Tying up one or two deputies all night in the ER with someone who conned you into thinking he was having DTs quickly loses respect for you with the custody staff. The flip side of that is sometimes you have to "pull rank" to make the wheels turn on a patient's behalf. You don't have to answer call bells, so thats a big plus! :)

Be respectful to everyone, inmates and staff, at all times. Never say anything about anyone (inmates or staff) you wouldn't say directly to their face (at least while inside the wire.) Don't be afraid to write someone up (after proper verbal warning, of course) if they cross any of your verbal or physical boundaries. Never, under any circumstances, for any reason, allow an inmate to seduce you. Many of them can be quite charming, and can sense when you're vulnerable. (It happens. Frequently. Be forewarned.)

It seems to me that this "preceptor" decided she didn't like you for whatever reason, and combined with a weak (lazy too) manager, you got unfairly thrown under the bus. Before being fired you should have been verbally-counseled a few times about their concerns, NOT ambushed with a HR person and shown the door all at once. (A manager should never allow another staff nurse to be sole judge and jury on a hire/fire scenario, but your description seems to indicate this is what happened. At the very least, another preceptor should have been assigned and his/her opinion added to the mix too!) If your preceptor had concerns, a slow day would have been the ideal time to sit down and cover some of the things she felt you were lacking (E.G. explaining how to interpret labs, "prioritizing" scenarios, etc.) -- not sending you home or taking off herself. Thats crap. Period. Problem is, this is all too common. "Preceptors" are assigned often based on seniority. Many of them really do not WANT to teach new grads and it is a "perk" they resent because to do it properly requires genuine effort. Even orienting a seasoned nurse to a new unit requires concern and class. In my personal experience, the trainer often sits at the desk and chats on the phone (or whatever) with an insincere "Let me know if you have any questions." This seems abusive to me, as the trainer seems to be taking an "in-house" vacation day - while everyone else runs their butts off. My guess is you would have represented some actual work and thought to properly precept, perhaps more than she was willing (or capable) of. My opinion is that Critical Care and Pediatric units have a preponderance of these vicious personalities, so I would avoid these type of units until you have a better resume behind you. Also, nurse managers are very risk adverse these days, to the point of paranoia. (More so in an uncertain economy with droves of experienced nurses seeking jobs too.) Hiring a new grad who was fired in a month is a big risk for a manager who might have to explain that decision to higher-ups later on -- with no clear personal benefit to him/her. Easier to just say "no" and CYA. (Learn those initials well -- they define today's healthcare environment.) Therefore, while not directly telling you to falsify your resume to cover this brief period of "negative" employment, you must consider the validity of the above paragraph before you make a final decision about "Plan B". P.S. Consider prison nursing. I've worked some travel contracts in this field, and found it strangely relaxing versus hospital-based nursing. Not for everyone -- there is a forum on Correctional Nursing here on Allnurses.com (The inmates are much more polite and appreciative than patients in the Free World, and Hollywood has greatly exaggerated what prison is actually like.)

Unfortunately, as long as a simple office visit with an x-ray or a blood test can cost the equivilent of a month's wages for the uninsured [CASH UP FRONT PLEASE], or visiting a "public" facility requires a 2-3 month wait, people will use the ER as a walk-in clinic because they have no other options. The only hospital I've ever worked at that "got it" was a small one in rural New York that put about 75% of their resources (staff, rooms, etc.) into the Express Care side of the ER 18 hours a day and charged a reasonable fee for services. This left the ER side free to handle the "big" stuff. During peak periods resources shifted back to the ER if needed. A couple of nurse-practitioners worked in the Express Care, there was no drama if a patient was mis-triaged and needed to be moved to the ER, and every sore throat didn't involved a CT scan and 16 blood tests. Wait times were reasonable, people didn't panic at home because they knew they could get reasonably-priced care, in a reasonable period of time, and everyone was happy. This was accomplished by working in concert with the county, the health department, and some of the other government agencies to create a viable system. The hospital realized the problem of lack of affordable, available healthcare in the region just didn't stop at the edge of their parking lot, and enlisted others to make it work. I can't say how this would translate into other regions, especially where the "my sandbox is the only sandbox" mentality is deep-rooted.

If you buy an expensive stethescope, plan on having it stolen. I lost two Littman Cardiacs and a Classic II before I decided I could hear just as well out of a modest ($22) single tube stethescope. I also bought an ugly green color, and despite leaving it lying around the unit, it NEVER gets stolen. Get the longest length tube you can. Some people you don't want to have lean in too close on. Buying good shoes is a much better investment, as other posters have mentioned. I swear by SKS leather sneakers, which are about $100/pair, but hold up and CLEAN UP well. Good luck. As an ER nurse you'll ALWAYS have interesting stories to tell people. Count on it. :heartbeat

The baseline difference between ICU and ER nursing: Patients coming through the door of the ICU have a diagnosis and everyone has some idea what the plan is, and the nurse can focus on the pertinant clinical details of that patient's case. The ICU nurse typically sees a narrower range of patients and over time can develop a very strong clinical skill set for that range. ER nurses don't get the time for focused contemplation of the patient's needs, and more times than seems possible, we have NO IDEA what's wrong with the patient besides the symptoms. The ER knowledge base is a mile wide, but by circumstances is an inch deep. I do not think the skill sets are directly interchangeable, nor is the stereotypical "personality" of an ICU nurse likely to interact with the "ER" personality well.

I am starting a job in the North Carolina Corrections Department as an RN. I have worked ER for 5 years, Tele for 3 years and Psych for 3 years. Before that I was a Paramedic for 10 years. Oh, I'm male BTW. I have read a good deal of the posts here about inmates and their tricks. I consider myself fairly good at assessment, but want to avoid rookie mistakes. I'm afraid that my 20+ years of prior experience to: (1) accept subjective complaints at face value and to (2) avoid doing anything I wouldn't want to explain to Plaintiff's attorney in open court will leave me open to manipulation until I learn the ropes. Anyone have a "Cliff Notes" or "Top 10" list of tips they could offer to help jumpstart me?