magicman

I currently provide a podcast that can be used for CE. While many listen, few take advantage of the CE option (as yet). I think this is due, in part, to a few things. first, the general age of the nursing population is a bit older than those who regularly use iPods, etc. Second, the culture of nursing is one of more "brick and mortar" type courses (even with home study, many I think still want a "book" to study from). The culture IS changing though. It's interesting to note that physicians have been using recordings for CE for well over 25+ years and it has done well as an option for them. It's quick, it's time effective (you can listen any time you want), it's timely (it takes less time to put out an audio than to write and publish a new text), and it's inexpensive. If you'd like to know more of what I'm doing, drop me a line and I'll share it with you. Paul

You most CERTAINLY may disagree! That's the beauty of the forums. :) As for bending, I've never, in 28 years, seen a 20 guage bend upon intorduction into a vein. The type of patients your ED sees has to be taken into account also. We see a LOT of elderly patients, so 18 guage's wouldn't fly as easily (smaller, less straight veins, etc.). As for CT's, our radiology dept. doesn't have a problem with 20's for any CT. They seem to work just fine for all of them. Now, hemolysis is another story. But I've had just as many draws hemolyze (per lab) with 16's and 18's as with 20's. It's all in the technique I guess. :) I DO know from firsthand experience that a 20 guage is MUCH less painful (traumatic) than an 18 guage (and I have great veins.....called ropes!). I looked for flow rates before and couldn't find specific volumes, but again, it would depend on the size of the catheter (18 guage double lumen vs. triple lumen, etc.). But they're finding more and more that there are fewer trauma patients who actually need large volume replacement (i.e. not in open thoracic of head injuries unless profoundly hypotensive....... One other thing to consider is the amount of time you have to spend starting the IV. Now, I know much of this is repitition, but still.........you have a better chance of starting a 20 guage on the first shot than an 18 (again, depending on the size of the veins, age of the pt., etc.). I'm thinking much of it comes down to personal preference. I've used 20 guage's for years with little problems and have heard all of these arguements over and over again. And in the end, the 20 guage cath has continued to work (policies have changed, restrictions loosened, etc.). Just my

I didn't think the ENA had that many credit hours available! I'll have to take a look. I usually get 30 - 40/year.....Florida requires 28 now (I think. They keep increasing it). But I need 100 in 4 years for my CEN, so I always have extra. I'm not sure about "all" states, but I know of many that require a minimum number for recertification. And although you don't have to tell them how many you have, they have the option to audit you and THEN you have to prove it.

Way to go Mare!!!! Welcome to the club! Again congrats and good luck!!

While I can understand wanting to use larger bors catheters for trauma and surgical patients, in practical application, it's much less traumatic to the patient, quicker, and you have a higher success rate with 20 guage than with 16 or even 18 guage caths. They (20 guage) work just as well and can take the higher pressures for IV contrast, plus you can give blood through them essentially as well as 18 guages. If the pt. needs large bore, a central line might be a better choice. Now, this is all predicated on the size of the pt's veins to begin with. If they have large veins, then a larger catheter can be placed easily (although if their veins are that engorged with blood, do they really need a large bore angio?). In practice, I use 20 guage catheters on alomst everyone with no problems.....trauma patients excluded. TRUE trauma patients should have large bore, but depending on the type of trauma, they may or may not need large volumes of fluids. But as previously stated, a central line would be preferable. Just my

The answers to this are numerous. First, there's the lack of true preparation in nursing school to perform the job of a nurse in real life (i.e. managing multiple patients, time management, skills you may not have gotten much practice on, etc.). Second, there's the orientation, or maybe the lack there of. In the E..D. (I'm an E.D. nurse), the recommended orientation is at LEAST six months (that's from our national specialty organization). I would say ANY orientation should be at least that long. It takes some time to get your feet under you as a nurse and feel like you're actually doing the job well. Look at physicians...........they do three years in a residency! Now, I know that's apples and oranges, but even still............3 years to, say 6 weeks!?!?!? The heavy load for newbies is bad too. If it doesn't make someone turn tail and run, it makes them anxious and skiddish and puts them in a position to make mistakes that can ruin many lives. And should they make it through this gauntlet, they become the same way as the other nurses. They turn on newbies, dump on each other, and generally stab their coworkers in the back. Great line of work huh? With all that said, my suggestion would be to find someone to be a mentor to you. Someone who can be a sounding board for your frustrations and that you can turn to for help and guidance. It doesn't need to be someone you work with necessarily, but someone with experience and who is willing to spend some time with you. I wish you all the best!

I too think the ICN nurse was WAY out of line. Everything the other two responders said is how I feel also. You're a team as a nursing department in the hospital and should work together. With that said, taking an NRP course (or similar) would be a good idea. Also, trying to get your hospital to sponosr one, based on this incident, would be better. As an ED nurse for 17 years and a paramedic for 12 before that, I can tell you that unless you work on peds all the time, it scares ALL of us. But, in doing it (working on peds) more, you become less anxious and more willing to do things. While 2 years in the ED is a good base, the longer you do it, the more comfortable you become (as with ANY line of work). But don't think you were wrong for requesting help. You were right in knowing your limitations and that you needed backup. I commend you for that. Now take that knowledge and make it a positive. Get some pediatric training (PALS, NRP, etc.), and talk with your department director about getting the same for the entire department and maybe even joint education with the NICU.

Not only taking report, but even getting a bed assignment can be worse than pulling teeth! It can take upwards of an hour or more to even get an assignment when there are beds available! And yes, there are almost ALWAYS attitudes from the floor toward the ED. They also try to nit pick and find reasons to write us up on almost every pt. Been like that for years now.

I started as a medic also and hadn't done any other nursing before starting in the ED also. Your background in pre hospital care gives you some of the skillsets that are needed to be a good, quality ED nurse. I say go for it!

Are there no other Florida E.D. nurses here? I'd really like to get some input on this.

I have a request from my fellow Florida nurses. We were told at our last staff meeting that our staffing ratio was one of the best in the state at 5:1, and that the average in the state was more like 7:1 or worse. We were "dared" by our department director to find a better ratio in the state for an ED. I KNOW there have GOT to be better ratios than 5:1 (I mean being EXPECTED to start out with that ratio, not what ends up happening with holds, etc.). Please help me show this. I need the hospital name and the scheduled ratio, nurse to patient and/or nurse to bed amount. Or, if anyone knows of where I can find this information already posted, either here or another site, please let me know. Thanks in advance!

I was an EMT and a paramedic for 12 years before going to nursing school. That 12 years was invaluable then as it is now. I would highly recommend not only finishing your EMT, but putting it to use in the field for a while. THAT'S where the REAL learning happens. You get to understand how to look at patients, how to assess better and quicker, make decisions faster, etc. That all comes with working in the streets and isn't something that can be taught. It's definitely NOT taught in nursing schools. Just my 2 cents. Best wishes

First, I feel I must correct something here. The correct terminology is mute, not dumb. That's (dumb) an antiquated way of saying things. AFA the GCS itself, it might need to be up to policy. Im my facility, the GCS is always based on a max score of 15, but specified to be to the PATIENT'S normal ability. Thus, in this case, the score would be 15, but with the stipulation that the patient is mute , but responds and interacts correctly.

Could we please get away from the statement that the ANA is a "union". It is not, nor does it act as one. It is a PAC and a loose association just as the ENA or any other "association" is. It (the ANA) has no legal right to bargain for ANY nurses working anywhere in this country (that I know of), nor does it make any contracts with any hospital to bargain for their nursing employees. AFA joining, dues is prohibitively high for the people working the front line of nursing to be given so little back for it. The powers that be in the ANA have their own political agenda that has very little to do with the nursing profession, and they (IMHO) are truly out of touch with what nursing is and does from a practical standpont. They deal more with the "theoretical framework" of nursing. And (again IMHO) they have made some poor choices in what they have spoken out in favor of. Just my 2 cents.

AFA your question, the minimum 30 day time frame sounds pretty good overall (although longer might be better depending on your daily census). The certs you want nurses to have are good, but requiring them before being hired will diminsh the pool of available nurses to choose from. you might want to make it that they obtain those certs within a certain time frame once hired (i.e. one year, 6 months, etc.). Although a minimum of ACLS wouldn't be too stringent IMHO. I Do however have a few questions. First, why is a PA pulling a nurse from anywhere to do orientation? Is that not the nursing departments function? Second, if the PA pulls a nurse in to do orientation, does that not count against the nursing departments budget? How can someone outside of the nursing department do this without any consequence? It sounds as though either the department manager (I'm guessing that's not you) and/or the DON of the facility need to do something official (i.e. incident report, disciplinary action, official discussion with the medical director, etc.) based on your facility's policies. The PA should have NO control over nursing staffing or scheduling whatsoever. Again, IMHO. :) Good luck and I hope you get this sticky problem solved soon! :)