Psqrd

I am an ED nurse as well and see only a couple of issues, yes that is a high dose of morphine but the flip side is that if you go over it is easily rectified with narcan..however your patient being alert, oriented and ambulatory tells me that he has a high tolerance to morphine and thus I would have been looking for something else..the other issue to consider is that if his pain was that extreme..this would have been a huge red flag and I would have been pullng a doc in and calling the OR to expedite as this is an indication that something is turning real bad for this patient. A two hour wait for a ruptured appy is WAY too long and I certainly hope you were dumping antibiotics in this guy fast. I think of q10 minute pain meds and I know i have at least 2 or 3 other patients that wont be getting any care at all as all I would be doing is running from the pyxis to this guy and back again.

I have to smile at your post as I recently was grilled by a patients' family member about why I didn't want to be a physician and appeared bewildered when I explained that I loved being a nurse! P2

Darknights, I admire nurses like yourself that everyday despite poor conditions continue to do the best they can every day for their patients. To second guess what you could have done different in this situation is very tough indeed, as you were only thinking of what was best for the patient. In my own experiences I have learned to move or disturb a patient as minimally as possible at end of life. Faced with your situation I believe you did the best thing possible which was to cover the blood on the linens and wipe the patient as best you could...the only other thing if possible would have been maybe move the patient to clean room if available. You did the best you could for your patient to move from this life to the next as easy and respectfully as possible and no fault can be found in that. Keep up the good work your doing down under, and know for what it's worth, I would be proud to work with you any day! Psqrd.

I would remind the family member that the injury is of the brain not the arm itself. I have seen some edema in the affected arm but this is usually after a long time following the stroke. Not all strokes are the same...with my grandmother she feels pain/sensation in her weak arm but has no muscle control. If the family insists that they don't want the BP or blood draws on the weak arm then I guess you will have to comply.

I was a phlebotomist before I was an RN...I have one word for this practice..LAZY! As I know that most of these sticks are brachial or femoral..if they clot off or damage the artery do they have a plan for re-vascularizing the limb...if this was my child trust me that heads would roll if I found out about it. P2

I have taken care of several individuals with stroke symptoms and I can see no reason why you can't draw blood or start IV's on the weak side. In fact, a good argument could be made that starting the IV on the weak side would be the better choice as that would keep the strong side free as that is the arm they will be using for everything from eating to personal hygiene. The stroke is a brain injury not an injury of the body... I hope this helps. P2

Anytime a medication is held, document observations and notify physician. Not notifying the physician of a held medication can get you in trouble. P2

Well I would certainly list the job or you will have trouble explaining the gap in employment and as most employers are doing credit checks it would most certainly pop up there. As far as how to talk about the job I would just say that you left seeking opportunities that better fit your career goals and leave it at that. Its truthful and sounds professional and people leave jobs all the time trying to find a better fit for themselves. It used to be that the someone seeking reference could ask if you were eligible for rehire and that the former employer would give that information but now most wont even give that. If they do say your not eligible I would say that you fell short of a full two week notice because of vacation plans or something. Don't stress about it..I would be more worried about them reporting it to your license that you delayed care. P2

I too will be starting in the ED here in Sacramento in January and similar to you have 1 and half years of experience on a cardiac unit. I don't have any advice but wanted to let you know that you are not alone in starting this ED adventure and wanted to wish you luck on your endeavor. P2

I had a patient that wanted to go AMA, I pushed the elevator button for him and asked him while he was waiting if he would sign this little form I had entitled "AMA". When the elevator came I said see ya later.. and we was back before I came back on shift. I agree with everyone in regards to having a sense of humor with your patients so as to not let them get to you. Once they get to you then they have won, plain and simple and thus have power over you. The one thing that I always suggest is that they don't have to leave...they are allowed to refuse parts of the treatment regimen...I think in your situation I would have asked if he wanted t refuse the vent...got the AMA form signed with at least 2 witnesses to the AMA advisement and signature. Called the MD left a message that the patient was refusing the vent as he wouldn't call back and call RT to remove it. At least your clear as being able to monitor him and if he got bad again you can say "told you so". I think nurses often forget that patients are allowed to refuse a medication but accept other meds or they can refuse certain treatments and I will even remind the patient thay they have the right to refusal. I had a patient refuse a med then continued to apologize for refusing it...I reminded her that it was her body and thus she was still the boss of it. No skin off my nose!

It's not good enough just to have the license as the competition is heating up for the few new grad jobs that become available. My manager speaks with the clinical instructors and asks who is the best and that is who she is recruiting. The other issue at hand when I graduated a year and a half ago is that new grad positions are seasonal...what I mean by that is the people in my class that started applying about a month from graduation got jobs..the ones that decided to wait didn't. So my advice is try and do the best that you can...while working floors make those contacts with managers and get your name and face known to them. Try and work as many floors as you can, even if it's not the floor you want to work on... you can do it for a year and then move on to what you want. Good luck, P2

I took ACLS as a fourth semester student about 2 months before graduation and because of it ended up on a Cardiovascular intervention floor. You are correct that it gives you a bit more confidence and increases your marketability if you ever want to move to tele or higher acuity floor. My advice is don't wait...go for it! Do your pre-reading before the course and you should have no problem as they teach you all that you need to know to pass. P2 my

I am sure I am not the originator of the term "Jenny Craig" assignment of one patient at one end and another patient at the opposit end of the unit but I love the term.

On my unit we do the assignments for our shift. I having worked with the nurses on a regular basis take into account whether the nurse had a bad assignment the night before as to not give them heavy patients again..I also consider isolation as I try an spread them out so one nurse does not have all the isolation patients. I also consider the nurses ability...I try not to dog out floats as it can be tough enough on a floor that you don't know where everything is and I don't want our nurses to get dogged when they go to their floor... I'm not sure but maybe your charge did not know how heavy those patients were and if that is the case I would bring it up with them to make sure they don't pass that assignment on. The other thing that needs to be addressed is the lack of teamwork on your floor...no one should be sitting on their duffs while you run crazy...if this is going on then I would definately bring that up with charge and if nothing happens then take it up with your manager. The other thing to consider is of course is your perception that you are the only one with a bad assignment. I have had nurses come to me and ask why they got such a bad assignment...In one situation I explained that everyone had bad assignments as it was just a heavy floor that night...it was quickly confirmed by another nurse walking/running by who asked if she would like to trade assignments...she got the picture. Alot goes into it...in fact I consider it to be the biggest challenge of being charge and always feel guilty when someone gets the "bad" assignment. I had to the day shift assignment once (i work nights) as the charge was going to be late and I have to tell you I don't envy them with all the discharges and admits from surgery or cath lab...that one is a total crap shoot sometimes. P2

I have heard that cover up makeup works really well...use that for the interview then when you are hired..it's to late. I work with nurses that have tattoos that show piercings too...no problem that I have seen. Just my 2 cents. P2

As far as nurses with BSN getting preference over ADN, I have not seen that. In fact in my unit ADNs outnumber by far the BSNs. I used to hear that the BSN would be the person to get the charge nurse role but I haven't seen that either. I have been a nurse a little over 16 months and they have me stepping into charge nurse. I believe at least on my unit that they look at the individual not just at the initials after their name. It certainly can not hurt you to have the degree as with the competition for jobs is heating up any and all cards play so to speak. Good luck, P2

Your question is a tough one to answer as it would depend upon specialty and length of experience. I however can give you a range that one could possibly expect....A new grad in a acute care hospital can expect around 38-40 dollars per hour. I have heard of nurses in the area with experience getting per diem jobs that payes well over 60 dollars an hour at another very large HMO in the area that don't want to name directly but sounds like phiser...I hope this helps. As far as the number of jobs around, I have heard from many new grads that are having trouble getting hired but it is a slightly easier situation if you have experience. P2

Pretty much like Lovingnurse said but in addition..with the H and P I try and learn just a bit more about the patients history and pass it on to dayshift as they never have the time to that kind of reading. P2

when they put me in charge nurse. P2

I was once involved in an altercation with a fellow employee that hurled something at me and almost hit me...an assault...I did not call the police but rather let the managment take the reigns...he continued to work there. They thanked me for allowing them to handle it but hind site tells me that they did nothing. I should have called the police and pressed charges. I wonder what they would have done then...if you feel that you are still under threat go to the police and fill out a police report and specify that the individual made "terrorist threats". You will not be violating hippa as the patient is protected not the family. Let your employer figure out how to sweep that one under the rug when an investigator from the police shows up. Unfortunately this does kill a potential career at this facility but sounds like you should not be working there if they treat these situations like this, remember its not just you at risk but your family. This is the interent age and it does not take much more than a credit card to get all the info that you need on someone. It is a common misconception that because they are patients that they can say or do anything they want to us..it needs to stop and it stops only with us and our not taking this BS anymore! I know at my hospital their is a line at the door for a bed so let them find health care elsewhere. It will be only a matter of time before no one will take care of their loved one. Good luck P2

Well, I actually do understand as I was a Super B as an E4 and thus had more training than most of the NCO's that I worked for. I was often put in charge of the "my" ED at Fort McClellan Alabama as I had more training and experience then the NCO's that I was working with. This often led to conflicts as some had trouble understanding that I was in charge of patient care. I tell nurses that I work with that kind of look down on me as I have only been a RN for about 9 months about having to go through goat lab at fort sam and just look dumbfounded as they realize not to judge a book by its cover. I will tell you however that nursing is very unique. I breazed through the first year but the second was a bit of a challenge and led to many late night test prep sessions. My experience was invaluable when it came to actual hands on patient care. The patients always think that I have been a nurse for a long time...its the confidence in you interactions (careful not to be cocky) that will give you a supreme edge. As far as your military training and education, I found that it wasn't worth much as far as credit for or towards nursing. I did have my education evaluated and received college credit for it but as you will realize most of the nursing education is based on pre-reqs. What I mean by that is that they wont tell you that you need the credit but that you need the class in order to satisify the requirments to advance into the next class. I know it sucks but the only place that you can get the credit is towards an LVN license and trust me when I tell you that if you go that route that you will be extremely bored as it may not get you doing what you want as it sounds like you probably should be looking at either ED or ICU. I currently work as an Cardiovasc interventional RN and recently took to being charge nurse looking for more of a challenge. (yes charge after only 9months but that is what you will be looking for as well) Your experience will definately help you land the job that you want...you did not say where you want to work but out here in Cali it is getting tougher to find jobs in the northern Cal region as there are tons of schools pumping out nurses. I actually took my ACLS while on spring break from RN school just trying to give myself and advantage for the job hunt and my manager told me that is what put my app on top. I was lucky as I was hired before graduation, its nice to know that a job is waiting for you as I did not work during nursing school. If you are however looking for the quick get to work fast track read my earlier post on challenging the boards. I know that all states are different but I believe all of them have some form of challenging the LVN boards. If you have any other questions feel free to email me through this website as it seems you and I are very similar in regards to our background and good luck to you. 1986-90 2nd General Hospital Landstuhl Germany Ambulance/ER EMT MOS 91A 90-92 Fort McClellan Alabama Noble Army Hospital ER MOS 91B10Y100 (school trained Advanced medic)

Help with what? as in what is your question or are you asking about LVN training? It sounds like you need to be an RN and will be bored to death with anything less. P2

I work on a cardiac floor but have dreams of working in the ED one day. What I suggest is for new grads to make sure that you get your 1 year of experience in Medical surgical floor. This experience will prepare you for whatever specialty that you may want. I also recognize the value of the advice already given to you, to not make those decisions prior to school as you may discover that you may want something else. I actually considered post partum following school, as I thoroughly enjoyed the joy that is felt as a child is brought into the world. Keep an open mind and enjoy nursing school. P2

I am not sure that I have info that can help you decide but I did enter nursing at the age of 40 but I already had been working in health care for over 20 years. I did not work through nursing school as I knew the challenge of balancing nursing school and family would be just about all that I could handle. As far as finances at the time I went through school the interest rates on student loans were terrible so we set up lines of credit on our home equity. This worked out well especially since part of the interest paid becomes tax deductible. I have say it is the best job in the world, I suggest that before you make your final decision that maybe consider some volunteer work in a hospital to help you decide whether it is right for you . Good luck P2

I would not list the license but if you list the work experience from former jobs that you worked as an LPN I think it would be apparent that you were an LPN. I was a Certified Phlebotomist here in CA, it expired a couple of months before I took my RN boards...you read my resume you know what my skills were. P2