acuariaRN

Christy, I think I would refer to Tsystem as a type of EMR program... it's where all the charting gets done in the ED. We have a rapid assessment unit in the ED where most of the triages take place prior to being sent back to the main ED --- however ambulances usually get placed in the rooms in the main ED and it is the responsibility of the primary RN (or the pod leader, if there is one) to complete the triage assessment in a timely manner. Yesterday I had a productive 12 hr shift, I got to manage several ambulances & post-rapid assessment pts back in the main ED (9 total)... I got to try to keep up the pace between assessing, treating & even managed to do a stable ambulance triage (took me forever haha... still clumsy with T system... gotta practice practice practice!) I've learned so much in the past two weeks... and so much more to learn! Despite the sometimes overwhelming simultaneous demands, I am truly enjoying myself thus far... So happy I made the change! :)

Thank you all SO much for the input! :redbeathe Looking forward to having a go at another 12 hr shift tomorrow... Bring it on! hahah! And I'll do my best to take it easy on myself.... :-P

Sorry to hear you're having a tough time... depression sucks the life out of you! I think that sometimes change can put us into a long, drawn out funk. Anyway, what kind of nursing do you do? Any chance you could try a different specialty or see if your employer has an EAP program? They might be able to help. Best, M

So, after 6.5 yrs as RN/shift charge on a step down unit, I moved to the ED! Very excited to work with the excellent team! Though I know how to be a nurse, being an ER nurse is a whole new world to me... different processes, different resources, and different expectations. These things are stressing me a little bit... I hope that I eventually adjust to the process... like what is expected and when... Last night in the last 30 mins of my shift, I had a stable NSTEMI admitted (needed to transport her to floor), and back to back ambulances (relatively stable COPD resp distress/tachy & a pneumonia with god knows what drugs in her system).... I decided to try my hand and triaging the COPDer... I was halfway through getting my quick history and trying to enter it in T system when the pneumonia came in. I hadn't gotten labs or checked orders on COPD by the time the next pt was in her room, needing triage/assessment. Went to pneumonia patient's room, let my preceptor triage her as I collected blood/hooked her up to monitor, etc. Got that done and tried to call report on admitted pt so I could take her up since the next shift was already there and I didn't want to dump a transport on them... meanwhile COPD lady is climbing all over the stretcher bc she has to pee! (not to mention, I still haven't collected labs on her... by then I think I had forgotten!)... oncoming RN got her off the bedpan and I kind of mentally checked out... a little bit of shell shock? maybe. I had a sudden and overwhelming feeling of incompetence! I do realize some situations are just overwhelming, no matter how experienced you are... So I'm wondering... how do you guys prioritize these things? Triage has to go into the computer right away... but I'm inclined to line/lab/problem solve before getting to the computer. I get that this will come with time, especially as I get better at charting in Tsystem... but.... woah. I guess that's what orientation is for... How long did it take you to get used to the flow/process/your resources? Any words of wisdom? I know I am an ED nurse at heart and I look forward to getting the hang of it... I just hope it doesn't take me too long... :-P

I just got an interview!!!!!! :w00t:

I've been an RN for about 7 yrs on a progressive care unit... I decided it's time for a change of scenery and have applied for a position in our ED. I am beyond excited to hear back... hoping beyond hope that they'll hire me and it'll be a smooth(ish) transition... fingers are crossed! Please wish me luck! I am looking forward to working with the cool kids! :heartbeat Just for fun, what are some of your best memories working in the ED - be it patient care, teamwork, or otherwise? :) ~Melissa

I cannot. Stop. LAUGHING!!!!!! HAHAHAHA!!!!!!!! :rotfl:

1. what is your age? 25 2. how long have you been a nurse? 4 years 3. did you work as a cna before becoming a nurse? yes 4. if yes to #3, how long did you work as a cna before becoming a nurse? yes 5. if no to #3, do you wish that you had? n/a 6. regardless of whether you worked as a cna prior to becoming a nurse, do you believe working as a cna prior to nursing better prepares you to be a nurse? feel free to elaborate on your response. i began nursing school with no clinical experience. clinicals felt awkward and i had no idea how hospitals operated. after a year of nursing school i became a nurses' aid. i felt the experience helped me become more comfortable with interacting with patients, gave me an opportunity to practice my critical thinking and basic skills, and it helped me to better understand the hospital hierarchy and politics. it was a shock, i had no idea what i was getting myself into. i do not regret going into nursing, but i wish i had been a cna before applying for nursing school. perhaps i would have had enough experiences under my belt to really "get" what the instructors were talking about in nursing 101.

Don't be lazy, do your assessments, be aware of relevant vital signs (make sure your check blood pressure/pulse before giving cardiac meds for example, when in doubt, ASK!)... and chart/fill out whatever paperwork is required of your shift. Look at the big picture, make sure your patients pee (especially the post ops) and get used to figuring out what your priorities are for your shift. Your coworkers/mentors should be able to help you do this. Be confident but not reckless. I cannot stress enough that if you don't know something, don't pretend you do just to save face. If you make a mistake come clean and try to figure out how to prevent a repeat performance. Believe me you'll sleep better in the end and you will command much more respect. Do your discharges/transfers in a timely manner. Communicate with your charge nurse. Find your support system. Don't try to blame everyone else for the difficulties you might encounter. Most nurses will do their best to help you, but are sometimes very busy... appearing to not care about you... don't take it personally. If you feel unsupported and faced with a difficult decision, call your nursing supervisor. Keep a good attitude... pretty soon you'll be precepting! :)

I have been a nurse 7p-7a on my unit for 4 yrs, having the coveted weekend night position (3 day weekends, 3 weekends a month = 9 days a month) with no sick time or paid vacation time for the past 2.5 yrs. I love the pace on night shift and the people I work with, but after 4 years I feel that night shift is taking its toll on me. I try to stay awake all night when I have off, but there really isn't much to do at night but sit around and eat (when I'm off that is...). I've gained about 25 lbs since I started, feel like my IQ and attention span are not what they used to be and I miss the sun! I've decided to apply for a day shift position that just opened up. It's 13 days a week 7a-7p with sick and vaca time. Of course, the days won't be all in a row... but at least I'll be awake at approx the same time every day and hopefully be able to enjoy the outdoors more often. I'm just terribly apprehensive about the change of pace between the shifts. I equate day shift to spinning plates while running around on roller skates... I'm a good nurse, I'm just hoping I don't crack under the pressure! Also, my partner is going to school for radiography and currently works night shift... Working opposite shifts will be tough as we don't live together :-( To all you dayshift nurses out there (or anyone who has worked both shifts)... any words of wisdom to help make the transition easier? lol... I don't know why I'm so worried...

I agree with BabyLady that nurses generally have a working knowledge of the drugs they encounter routinely in their area of care. I'd like to add to my previous post that although nurses should not be expected to be an encyclopedia of irrelevant drugs, I have seen some less than professional attitudes regarding personal responsibility for one's area of expertise. I am a progressive care nurse on a unit with many cardiac patients. I've seen nurses give cardizem with a HR of 45 at midnight and then wonder why their patient needed atropine at 3 am. Why give the cardizem? Because the doctor didn't order any holds. Yeah. Because it was the doctor's responsibility to tell us robots (note sarcasm) when a drug should be held because it could kill a person (cardizem is a very common drug to our unit). That "it's not my job to know that" attitude can be fatal when a situation like that arises. I would love to see the nurse in the above situation realize the relevance of at least striving for mastery of their specialty... but attitudes aren't always so easily changed. Some people are jaded from the start and don't care... don't see that their actions are very very consequential. It matters that the nurse takes the extra step to make sure that their patient on a narcotic drip has narcan in the room, that their patient on an insulin drip has an amp or two of D50 in the room... that their patient with a recent MI has a 30lb wt gain over 4 days has a nurse on their side to remind the doctor to do something about it before they go home. . . And doctors losing respect for nurses because they call about a patient on a Nitro drip who is having dull chest pain, asking for morphine or nitro paste instead of titrating the drip up! (nitro= very common on our floor, peice of cake... read convo: "she's on a nitro drip right?" "yeah..." "what rate?" "20" "are you serious?!" ***snickers and the story spreads like wildfire among the new residents that nurses indeed cannot be trusted***) ...i could go on.. My point is... i suppose... that it doesn't matter what they teach you in nursing school, you are responsible for what you are expected to know. In the OP's story, that person could very well have been kidding when they said "that's the doctor's job" and they very well could have no experience with administering diphenhydramine... but be forewarned, you WILL come across nurses who don't know what they should know (which is excusable for an inexperienced nurse, believe me I understand, I'm far from arrogant) and worse, actively don't care that they don't know things that they should know. I apologize for the rant... i talk a lot when I'm sleepy... it's just a pet peeve of mine. I'm a shift charge nurse and I see a lot of the strange things that nurses do and I shake my head in disbelief. Apathetic/cynical personalities cross over into nursing practice and it can get a little scary. I'm not talking about innocent novice ignorance.. i'm talking about people who should know better. I'm also not one of those nursing-must-be-done-by-the-book snobs either. People just scare me sometimes. lol. ok. i'm done now. :-P off to bed...

I've noticed it's pretty much the same no matter what you study.. you only get from a program what you are willing to put in to it. Some people see nursing as a job. They have very little interest in expanding their knowledge to improve their overall delivery of care... they self-identify as med-passers and bedpan cleaners... for some people that is enough. unfortunately, when the time comes to testify in a lawsuit, the quote "it's the doctor's job" won't cut it. I know too many nurses like that. I don't think you could possibly care about your patients' safety and not care about the "whys" behind your interventions. . . my ...

Good morning to you all... I apologize in advance, I worked a 12 hr night and I'm sleepy, so forgive any lapses in logic here... :) I had an admission last night. 89 y/o F with h/o Parkinson's disease, admitted for an acute MI and SVT. She was a great admission, sweet as pie! Took her to the bathroom and noticed bright blood in the toilet. I told her what I saw and she agreed to have me examine her further to identify the source of bleeding. She denies scratching, pain, irritation, etc. No hemorrhoids. Alert and oriented x3. I found a small, non-painful bleeding ulcer (about the size of a grain of rice?) on her labia.. looking at the whole picture, it looked like she had others which had healed. She denied tenderness or pain while I was cleaning the area. She also denied knowledge of anything unusual going on down there.. I did order an ET consult, and I communicated this info to the docs... I hope they care enough to check it out or at least ask her PCP to run an STI panel... anyway... What do you guys think it could have been? my guesses were HSV and syphilis... except I would expect HSV to cause some type of discomfort... also, she denies being "with" anyone since her husband died over 10 yrs ago, and I doubt late stage or latent syphilis would cause ulcerations... but the parkinsonian neuromuscular issues and the heart disease do fit... or maybe i'm just making connections that aren't there because I'm so amazingly sleepy :-P My overactive brain has been pondering this all night... Any of you see STI/STDs in your elderly population? This is the first time I've seen this, although I know it's been a pressing issue for the elderly population as of late. Thanks. Sorry for the odd topic. G'night to the nightshift folk! :)

PICNICRN: "One day I was watching the girl at the GAP fold shirts with that cardboard thing and I thought.... wow how peaceful... I could do that!! Seriously, I can relate, as most of us can. I'm sorry you are having such a hard time! like others have said- maybe another department would be better. Or maybe an urgent care or docs office? Try and change it up..... and hang in there!:nurse:" lmao - there was a story going around my unit when I was a new grad about a girl who came to us fresh out of nursing school and quit during orientation because it was so stressful... she left us to work at the GAP. :chuckle

Oh dear lord! That's great... how bout when the lab calls the unit insisting that we did not send the blue tube down for the PTT/PTP... even though I sent it myself! How is it that they always get every other tube I sent down except for the glass one??? Yaknow, if you'd just admit to dropping the damned thing I wouldn't care so much.. but to lie to me!? Pshaw!