MesaRN

If your ultimate goal is flight nursing your initial goal should be to aim for a critical care or ER position. From your list above I would vote for cardiology as a placement. This assumes that by cardiology it is a unit that deals with acute as well as chronic cardiac conditions. A typical progression is cardiac (aka telemetry) unit, critical care unit, ER, then flight. Depending on the program and its emphasis this change of course (a pediatric program would obviously desire greater peds experience). General speaking in a RN/ Paramedic program the RN is expected to bring hospital based critical care expertise to the table.

This question nearly always results in the following replies: 1. Don't rely on your employer's coverage as it is designed to cover them not yourself. Some may offer to pay for your individual insurance, but it needs to be a individual policy for you, not a group coverage. 2. Some will say there is a risk of insurance as you now become a target for malpractice since you have insurance money to go after. This argument is often cited for RN's but is not as valid for NPs. As an NP you are assuming the same risks as a physician in many instances. Policies for NP are more than RN but far (far far far) less than physicians. RNs can often get liability insurance via there homeowners insurance, but I have not heard of this yet for NPs. Two companies that come well recommend are Proliabilty and NSO. My recommendation is that I would look to the physician world for guidance on liability insurance as the liability of the NP compared to an RN is very different.

Wanted to ask those with recent experience with the CFRN as to how "new" (or old) are the questions you had. All the recommended study materials (Holleran's Patient Transport, Wingfield's ACE SAT, Lopez Back to Basics) are 2011 or older. Baur's FAST is 2014, but with more mixed reviews. As we all know medicine is not a buy the book sport, but exams are. I am under the impression the test is still largely based on the 4th ed (2009) of Holleran's book. I wanted to see if anyone was have a different experience with the test. Thanks!

I am currently helping to develop a chest pain response team in our hospital.We are a 36 bed ER and regional medical center with interventional cardiology. Specifically I am looking at the role a Cardiovascular ICU nurse would play as part of the CP response team. This means that anytime there is a STEMI verified by EKG or EMS a page goes out to the "chest pain team". RT, CVICU RN, Lab, Cardiology, and Cath lab are all notified. Does your hospital utilize such a team in the ER? Does that team use a CVICU RN? If it does, what is the role of the CVICU RN? Thanks for your time! (I will also post this in ER section)

This among the worst post I have ever seen anyone make, please do not take this seriously. It seems to say that if you knew the pt was going to get up themselves you should just let them do it when your not there, and then its not your fault. As the primary nurse you ARE responsible for a pt fall, even if they do it when you are not in the room. You were doing what you though was in the pts. best interest and trying to keep them safe. If the pt fell without you present, it would have likely been a much worse fall. Keep in mind that the post fall head CT was negative. This pt was in the hospital for a coagulation issue and may have developed a spontaneous bleed completely unrelated to the bathroom incident. Talk with your charge nurse or the docs and let them know your concerns. Don't let uniformed snap judgments weigh on you, its difficult enough just to think you might have been responsible. As someone already said, don't assume responsibility for this, especially without the rest of the story.

I have to say +1 one for the "we did it this way" folks. There is a time and place for improvement, but generally these comments are not exactly in helpful situations. My biggest per peeve as a preceptor is the "I already know how to do this" attitude. Take a beginners mindset when heading to a new place. The new nurses who scare me are the ones who do not ask questions and seem to have something to prove. Humble down and ask questions. I feel safer with a new nurses who knows when to ask for help then the one who doesn't even know there are over their head.

The reason for your preceptorship is to help you understand how complex the question you just asked really is. Your preceptor is there to help you figure out the questions to ask and focused assessment needed based on the answers to those questions. An example is that we had a 70 yr old female who was having dinner with her friends, she had an onset of ABD/ epigastric pain. Pretty healthy otherwise other than HTN. An hour after registration to the ER she unzipped her arota and died within two min. While there is not much a nurse could have done assessment, my point is that there is no 1-2-3 step by step in the ER, or things we must automatically rule out first (there are a few examples such as CP, but the majority of patients require more assessment and questions before starting r/o. r ABD pain alone can range from viral syndrome, to appendicitis, to SBO, to ecoptic preg, to a bad gallbag, to AAA, and on and on. Do not be eager to break away from your preceptor, use every minute they give you despite that it may seem to get boring and routine. Its those moments when your preceptor points out something from there experience that you very heard of before that make the difference. Like the 58 yr who had a onset of "something stuck in my throat", after a few pointed questions the first thing my preceptor did was get an EKG, sure enough STEMI, only symptom was choking. Try to never get complacent, the worst nurse I have seen or those who always say "its just another ABD pain" before ever seeing the pt. Treat each one individual, that one biased judgement can make you miss something important!

I second the don't bother to save texts. Most text are out of date by the time there are printed. DO NOT buy a med dictionary, the web is quicker and with more info. Also it saves money to buy the later edition than the "newest" when it comes to texts. This stuff is not changing by leaps and bounds every 2 years. I know the feeling of being in school and wanting to have every reference. I now teach students and don't go anywhere near a text book. Best reference I actually use now is a drug book on my iphone (its epocrates and its free). Net is full of free up to date info as long as you know how to distill it.

Nope. Unless your aiming for director or CNO, RN is an RN. Most of the time even the BS part doesn't matter a bit. You can go to a private school and pay a lot more to make the same pay as those who so the state schools.

This is what I send out to our senior students before their ER rotation: Items to Review Skills Whether you have done a lot of IV starts or none at all, don't worry!! Learning is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills: IV starts Venipucture NG tube placement OG tube placement (with a ventilated patient) EKG lead placement 3 lead (red, white, black) 12 lead placement Foley catheter placement Straight catheter placement ABG collection Medications: Remember, just a few important points about each. Why would it be used it in the ER?: Morphine Ativan (lorazepam) Epinephrine Haldol (haloperidol) Benadryl (diphenhydramine) Solumedral Metoprolol (Lopressor) Nitroglycerine Versed (midazolam) Albuterol Magnesium (what type of dysrhythmia is it used to treat?) Zofran (ondonstrone) Phenergan (promethazine) Cardizem (diltizem) Dilaudid (hydromorphone) Compazine Protonix Xanax (alprazolam) Valium (diazepam) Pepcid Lidocaine Amiadorone Adenosine Atropine Dopamine Propofal (diprivan) Normal Saline Dexamethasone (decadron) Heparin Lovenox Vicodin Percocet Tordal (ketoralac) Ancef Rocephin (ceftriaxone) Activate Charcoal What drug do you use to reverse opioid overdose? What drugs on this list are narcs? What drug do you use to reverse benzodiazepine overdose? What drugs on this list are benzos? Systems Review Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER. Cardiac: Common signs of an MI Remember MONA?? What is Troponin? What does it mean if it’s elevated? Be familiar with the following rhythms: Atrial fibrillation What does supraventricular tachycardia (SVT) mean? Normal Sinus Rhythm Ventricular Tachycardia Ventricular Fibrillation Sinus Tachycardia Cardiovascular: What is shock? What are the four (major) types of shock? What is anaphylaxis? Renal: How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less) Common signs of a kidney stone Hepatic: How does the liver effect clotting (in 10 words or less!) GI/ Abdomen: Common signs of appendicitis Common signs of cholecystitis Endocrine: What is DKA? What are the common sign and symptoms? Neuro: Common signs of a stroke Differences in treatment of hematic stroke vs ischemic stroke Common signs of herniation What is involved in a nuero assessment? What is a Glasgow Coma Score? Respiratory: Common signs of pneumonia Common signs upper respiratory tract infection Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

We use separate bins that are color coded to the Braslow. The bins contain larger items like ET tubes and OG/NG tubes, ect. that are appropriate for the weight group. The core cart itself holds the larygoscope blades, IO kit, IV kit and meds.

We are required to have 18G in a great vein (AC or better) for R/O PE (which I assume was the reason for the chest CT). This rule is so ingrained that even if you have a 20 in the AC they will not take it and require a central if no 18 can be established. Typically we do deep brachial with Ultrasound guidance as a last resort. This is due to the pressure necessary for CT angio of head/neck/chest as it must reach the organs at the same time as the scan. For abd ct and gauge will do. Our go to IV size is 18 or greater. Only time we use a smaller guage is if we just can't get an 18.

I am preceptor for students and nurses new to the ER. I have been giving my students this handout before thier rotation to help get them ready: Items to Review Skills Whether you have done a lot of IV starts or none at all, don't worry!! Learning is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills: IV starts Venipucture NG tube placement OG tube placement (with a ventilated patient) EKG lead placement 3 lead (red, white, black) 12 lead placement Foley catheter placement Straight catheter placement ABG collection Medications: Remember, just a few important points about each. Why would it be used it in the ER?: Morphine Ativan (lorazepam) Epinephrine Haldol (haloperidol) Benadryl (diphenhydramine) Solumedral Metoprolol (Lopressor) Nitroglycerine Versed (midazolam) Albuterol Magnesium (what type of dysrhythmia is it used to treat?) Zofran (ondonstrone) Phenergan (promethazine) Cardizem (diltizem) Dilaudid (hydromorphone) Compazine Protonix Xanax (alprazolam) Valium (diazepam) Pepcid Lidocaine Amiadorone Adenosine Atropine Dopamine Propofal (diprivan) Normal Saline Dexamethasone (decadron) Heparin Lovenox Vicodin Percocet Tordal (ketoralac) Ancef Rocephin (ceftriaxone) Activate Charcoal What drug do you use to reverse opioid overdose? What drugs on this list are narcs? What drug do you use to reverse benzodiazepine overdose? What drugs on this list are benzos? Systems Review Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER. Cardiac: Common signs of an MI Remember MONA?? What is Troponin? What does it mean if it’s elevated? Be familiar with the following rhythms: Atrial fibrillation What does supraventricular tachycardia (SVT) mean? Normal Sinus Rhythm Ventricular Tachycardia Ventricular Fibrillation Sinus Tachycardia Cardiovascular: What is shock? What are the four (major) types of shock? What is anaphylaxis? Renal: How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less) Common signs of a kidney stone Hepatic: How does the liver effect clotting (in 10 words or less!) GI/ Abdomen: Common signs of appendicitis Common signs of cholecystitis Endocrine: What is DKA? What are the common sign and symptoms? Neuro: Common signs of a stroke Differences in treatment of hematic stroke vs ischemic stroke Common signs of herniation What is involved in a nuero assessment? What is a Glasgow Coma Score? Respiratory: Common signs of pneumonia Common signs upper respiratory tract infection Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

We are paid to use our nursing judgment and to be patient advocates. According to your post you were using your best judgment in order to obtain the best outcome for the patient. In retrospect the best way to have handle the situation would be to communicate with the EDP (or admitting doc) about wanting to get the pt to the floor before carrying out the order. I have found more often than not the docs are very open and receptive to these idea as they are the experts in pt care but not necessarily in hospital flow. Under this specific situation and without further details of the order it sounds very unlikely that it would be a terminable offense. An ER nurse faces situations like this on a daily basis. Communication with the ordering physician, an EDP or other doc, can greatly reduce these conflicts. These types of situations can result in sleepless nights. Talk with your manager ASAP for your own benefit. Usually we make a situation worse in our minds than it is in reality.

I would second the poster above. Especially the Kayexalate. In the ER setting we tend to focus on intracellular K/NA exchange of K+ to decrease serum levels, but that it is only a temp fix, you still need to get rid of it via the GI tract with Kayexalate. As far as the order of meds though, I believe the above poster stated it well. Albuteral is also sometimes used to aid in intracellular exchange aswell.