neneRN

I understand your rationale of watching to get a feel for things...but best advice I can give is to learn this line "What can I do to help?" Every time you're in that situation where you're maybe not sure what to do or are trying to learn how to handle things, say this to the nurse in charge of that patient. Trust me, they'll give you something to do to help! Gets you in there actually doing hands on, getting the experience, and nothing gets you accepted faster by your co-workers than being always willing to pitch in.

I'm a Trauma Program Manager, previously an ER nurse...setting up trauma policies and protocols is a big part of what I do and would be happy to help in any way. Shands hospital (not where I work) actually posts all of their trauma policies/protocols online and is a great resource if you're just getting started...huge wealth of information...link is: http://www.shands.org/hospitals/UF/professionals/Trauma/guidelines08.asp

I would say something with anxiety or even depression; single mom living with pain for 2 years, trouble sleeping, not eating, warm baths help...

My quickest meals revolve around the rotisserie chickens from Publix...I just pair it with refrigerated mashed potatoes and a big salad...or shred it and mix with Frank's hot sauce and shredded cheeses and make buffalo quesadillas...or cut up and mix together with that 90 second microwaveable wild grain rice, thawed chopped spinach, and some feta or goat cheese. Another quickie is to use those bobolli pizza crusts and make your own pizza, we like to top with spinach and tomatoes or just pepperoni for the kids; takes only 10 minutes to cook.

Probably less than 4 miles, about 10 minutes...

Watching friends struggle through this has actually changed my mind about going the ARNP route...one works 3 part time NP jobs as can't find a great full time one, 2 have been out of school over a year and still work as RNs, 1 found a full time in a specialty she loves, but hospital pays barely more for an NP than it does for an RN. I will say, though, that the NPs who have been around for a while have some great spots and they wouldn't give them up...I think its a matter of toughing it out for a few years while you get NP experience, and then the better jobs open up to you...FL isn't a great state for NPs in general.

If you have found an area that you love, go for it! Med-surg is a good foundation, but just like any other specialty, it has its own mindset...do Med-surg if that's where you want to stay or if you haven't found a niche, it is a good starting point. I went right into ED as a new grad and never regretted it...stayed for almost 8 years until I was ready for a change.

Always go with Airway, Breathing, and Circulation to prioritize. Beyond that, in prioritizing what you can do for the patient: assessing first is always a big thing. Also, the NCLEX tends to want you to perform a nursing action if that is an option, don't assume you have a doctor's order if it isn't stated in the question. Those ones are tricky, always seems like you can narrow it down to two good answers:(

What type of facility do you work in? Hospital What unit? Trauma Program Manager Do you work part-time or full time? Full time What type of shifts do you work? Usually 7-3:30, but hours are flexible as long as I do 40. What do you generally do? Ensure we meet State Standards for Trauma Center Accreditation through performance improvement, injury prevention, education. Work with all staff and docs involved in trauma care, EMS, outside agencies for injury prevention.

Yes, I work in Polk County...and I think a certain amount of weeding out (the TV show wannabes!) is required...

Graduated from PCC in 2001...excellent program, in my opinion graduates come out much better prepared than other local programs. Yes, a large portion don't make it past Nursing I, but you get back what you are willing to put into it...

Actually, we have a huge supply in our ER! (Hand them out to those Dx with STDs, etc)

The almighty patient satisfaction campaign and Press Gainey surveys... Higher ups that treat staff members differently according to who the "pets" are... Pts coming in that haven't bathed in weeks and need foleys....

We ALWAYS order a CXR before we can use the line...

Same as above poster except Phenergan (its no longer used in the facility)... and I would add Cardizem, Levaquin, Solumedrol, Td, insulin, ASA...

Had a little old lady yesterday who stated "I stopped breathing for 3 seconds last night"...um, if you are waiting 3 seconds between breaths, you are breathing 20 resps/min...??!?!?

I'm in FL...have 85 beds and saw 142,000 pts last year.

I've given it IV only once or twice, when a pt was truly unstable and had critical lab values...otherwise IM or SQ.

A FAST exam is a bedside ultrasound, typically of the abdomen, that is standard for all trauma patients.

As long as you documented that all risks were explained and understood by the pattient and that he was mentally clear, you'll be fine.

We assign our nurses to a room or block of rooms and the charge nurses places them as they come in. I think our ER is too big and spread out to self assign. We have several different areas...bear with me, its a complicated set up! Our ER is divided into 4 sections that each have their own staff and management: Fastrac (which is a separate building and is staffed by an RN and 2 LPNs) Intermediate care (OB/Gyn, Ortho, Psych, abd pain, minor MVCs, minor c/o that are too sick for Fastrac) is separated into blocks of 6 rooms staffed by an RN and an LPN for each block. Pedi ED is separate from adults, I don't know how they staff, I never go over there! Critical care: We have three rooms for our sickest patients that have 2 beds each. One RN is assigned to each of these rooms, so its a 2:1 ratio, although 90% of the time, each of these rooms also has 2 hall patients, so really 4:1; these are our MIs, vents, strokes, sepsis, DKAs, etc...all of our ICU type patients. During our busiest hours, 1p-1a, we have an RN that assists in these 3 rooms. Then we have three blocks of rooms for patients still considered critical care, but not unstable (routine chest pains, NH pts, COPDers, CHFers, AMS, etc.) These are staffed: (5 beds and 4 halls to an RN, LPN, and tech), (8 beds and 2 halls to 2 RNs and an LPN), and (8 beds and 3 halls to 2 RNs, an LPN, and a tech). We also have a Chest Pain Screening Area staffed by one RN; as patients come in through triage (they get their EKG out there), as long as they're not an acute or unstable pt, they go through the CPSA, where the RN starts a line, draws labs, does bedside Chem 7 and Troponin, gives ASA, completes a risk factor assessment, and then sends them over to the critical care side. Triage is staffed by 3 RNs and 1-2 techs. They have their own staff, we don't rotate through triage. Our Trauma nurses are two of the RNs from the blocks of rooms; they are pulled from their assignment when we get a Trauma Alert. The assignments are rotated daily, but within your own area; you're rotated through different sections of critical care if you're critical care staff, rotated through intermediate assignments if you're intermediate staff, etc. We're hired for each specific area. There is a charge RN for each of the four areas, and charge does not take an assignment. On the critical care side, the charge sits at a desk to watch monitors, place pts, take admit orders, answer EMS calls, etc., so she is stationary where she can't really be out on the floor. The other charges are more mobile. There are also always 2 clinical supervisors on shift; one is over triage, peds, and intermediate and the other is over Fastrac and Critical Care. They are usually on the floor to help with the sickest patients, handle staff and pt complaints, etc.

ST elevation is "above the line" and indicates myocardial injury. This is an acute MI (heart attack). ST depression is "below the line" and indicates myocardial ischemia. If this isn't treated, it can worsen to injury (MI). You can see ischemia for a variety of reasons so the underlying cause needs to be addressed to prevent injury. For example, an anemic patient with a very low hemoglobin may have ischemia on an EKG because not enough oxygen is getting to tissues; this patient needs blood. Another example is a cardiac patient that may have a blockage, but has developed enough collateral flow to the heart muscle that an MI has not yet occurred. Lots of different scenerios. Remember that ELEVATION equals INJURY and DEPRESSION equals ISCHEMIA. (There are some exceptions; pts with pericarditis may have slight elevation all throughout their EKG, but not be having an MI. Also might see diffuse elevation in younger pts with early repolarization and this isn't an MI either. But these are fairly rare occurances and an MI is suspected with elevation until otherwise ruled out)

General rules for HIPAA: Do you need to disclose/access this info to do your job? NO! Is it in the best interest of the patient? NO! Why don't you do as the previous poster suggested and make a call when you see your neighbor is at home?

There has to be more to the story than this....your license just doesn't get taken away over one med error.

We also keep the daily assignment sheets with staff names and assigned area for 4 years. Not only is it important for the legal stuff, but how else would you keep track of who's working where? i.e., so the same nurse isn't always stuck with the same assignment...