Azzurri

You know this statement you said about critcal care nurses annoys the **** out of me. I work in an extremely busy ED/Trauma and the ICU nurses almost 98% of the time always have something to complain about. There are days when i'm working the trauma assignment that also includes 3 other critical rooms and we'll be getting hit with trauma after trauma on top of the 3 other vented/ICU pts and I'll call report on one of he ICU pts(and I might add I give an excellent report and always get compliments from CC nurses especially for my neuro exams sec. to neuro icu hx) and when I finally get the pt situated to go up and resp on their way as well as pt escort, another trauma will be called. At this point I can't go up yet because myself and resp have to goto the trauma and this same issue will keep repeating itself for an hour or so and we end up taking the pt up at near change of shift and get reemed out by one of the nurses in the icu. I understand their frustration since I have experienced this first hand working in an icu and as the original poster said it happens in the ed all to frequently. But what the icu nurses fail to understand or realize is the **** we deal with in the ED and that I can't leave my assignment partners alone with new traumas or even wait until after change of shift to take the pts up because then we would be unneccesarily be holding the pt in one of our critcal care rooms that could be used for a code/CPR, trauma or some other unstable pt just to make the icu nurses happy. Regarding the OP statement. There r numerous times when pts just show up and you'll hear overhead trauma alert or trauma code pt is here because they were too lazy to call it in or they were so close to the hospital that it wouldn't have made a difference. These unexpected arrival **** me off on occassion but working in this type of enviroment the level 1 ed is, I feel as if I'm trained to handle almost anything, don't get me wrong, I'm not saying that I'm o the smartest or strongest rn in my er or that I know everything and have nothing else to learn but I do feel relatively comfortable n my ability to adapt situations. What really tends to **** me off about EMS on occassion is when ALS will show up with a really sick or very hemodynamically unstable pt without even an attempt to place an IV because they thought the pt was a hard stick or the best line I ever heard from a medic is "I was gonna put in a line but thought I'd let u do it", for no other reason than they didn't feel like it and this turned out to be a very sick and unstable pt.

I understand where you're coming from and all but I hope you are not mad at me because I'm working out of state. If you are that is sad, you're just bitter that you're not getting hired at this time and taking it out on others. I gave my history because others were asking questions about requirements. I'm the only person who really answered the question asked. At the present time, ALL STATES are not hiring like they were when I graduated. There are numerous nurses that work with me that aren't from Delaware, eg. MD, NJ, PA, etc. I didn't take anyone's job. I think I'm very qualified for my job and do a damn good job at it. I didn't have a ****** GPA, it wasn't perfect but it wasn't far from it around 3.5. I just want to clue you in on something, just because you have a BSN, doesn't mean you know more than someone with a ASN or will be a better nurse. We all take the same nursing classes and clinicals, you guys just have more nursing theory classes. I have taken all the sciences that BSN courses require in the past, it just wasn't a good time in my life to get a BSN. I think I'm alot more skillful than alot of the nurses I work with that have higher degrees. I'm not being cocky, just honest. The job market in nursing isn't good right now so its not my fault you're not getting a job. I'm not going to just work at any hospital because in my home state or PA because someone from DE can't find a position. I'm sorry for you, but I graduated 2 years ago and should not be affecting whats going on now.

I have been working in the Christiana ED for 1.5 years now and went through the ED Internship. I was the only one in my internship who never even stepped foot inside Christiana besides for my interview. I grew up in central-north NJ and have been living in PA the past 5 years with my wife. I went to school in PA and all my clinicals were in Philly and the surrounding area's. I started applying for nursing jobs in the beginning of February 2007 and was offered a position at Einsteins CVICU and accepted it but changed my mind when Jefferson offered me a position. I worked as a tech at Lankenau Hospital for 1 year. After graduating in May of 2007 I worked in the Neuro ICU at Jefferson Hospital for Neuroscience for 4 months and left prior to finishing my 20 week orientation because I did not like my coworkers that made the working enviroment very uncomfortable. I applied for the Christiana ED Internship in October of 2007 online and had not 1 single reference of an employee to give and was interviewed in the beginning of November 2007 and was offered the position at the end of my interview unofficially but got a call 2 days later from the recruiter asking me if I would accept the position. Out of the 8 people in my internship only me and this one girl had prior experience, hers being 10 years in the OR and me with alittle ICU experience. I didn't have a BSN, which alot of places like. My graduating GPA wasn't perfect. When I applied they were still hiring alot of people into the internships. After my internship the next group had like 10 people in it and now the groups are getting smaller and smaller. I know for fact that the ED is on a hiring freeze and are very overstaffed so don't take offense if you weren't picked for the internship. If they are even hiring, they're probably only taking 1 to 2 people on. JerzeyGirl, I don't know about where you work but we still get OT down in the ED, although its not as pleantiful as it used to be. And even though we are overstaffed, we are constantly short on the weekends even though everyone is required to work 1 weekend per schedule shell.

I just want to mention to people, it's really not necessary to use tourniquets if you can see the vein. You will blow veins with tourniquets. You can always use one temporarily, in order to mark two points on the skin as targets, but really, you have more luck on these old folks without a tourniquet. Tourniquets help lab people, of course, because they create more pressure, causing the blood to flow for the lab draw. But they will definately contribute to blown veins in the elderly. Well where I work we use tournequets because we get labs from the IV when we place it. I've done IV's without the tournequet before but veins that are very small and hardly palpatable they work better for. I'm not gonna put an IV in and then stick them a 2nd time to get bloods via a butterfly unless I can't anything from an IV. I would also like to say we don't take blood off IV's after for repeat labs or new labs that we didn't get the first time, those instances we'll use a butterfly. Even in trauma's, we keep the tournequets on to get trauma labs, but if its a serious trauma and we need immediate access, we'll get bloods later on. I agree that a tournequet can lead to blown veins in the elderly but I don't think that's neccessarily true for all ages.

I used to work there in '07 in the Neuro ICU in the Neuroscience building. I also had my critical care clinical rotation there and I was in the SICU and Neuro Trauma ICU(main building) the most and loved it. It's a great hospital to work at. The nurse recruiter is a total *****(excuse my language) but its true. I didn't interview with her thank god but I interviewed with the nurse manager of the neuro ICU who was really nice. I really wanted to work in the neuro trauma icu on the 9th floor of the main building but there was a waiting list so I took the other neuro icu to get my foot in the door. I also liked the SICU but they didn't hire new grads at the time. The one thing that sucks about Jefferson, is you have to pay full price for parking most of the time. You can buy tickets at the book store for different garages in the city around Jeff but they only take off like $3. The other thing that sucked was the city wage tax that was taking approx $500 out of every paycheck but thats anywhere in the city. You may start off at $30 or so per hour but you have to factor in city wage tax, parking, and gas too. I didn't think it was really worth it.

I hate when pts say "I'm a hard stick, and you can only use butterflys or a baby IV or a 22G or 24G IV or my veins roll, etc". I'd say that 98% of the pts that say that aren't really hard sticks, they just had unexperienced nurses stick them before. There are ways to get veins that seem small pop up better that I've learned. For example, putting 2 tournequets on or putting a tournequet up near the bicep and then one above where you're sticking. I'm a very confident person when it comes to starting IV's for my own pts or even others. I would even venture to say that on occasion, I am almost cocky about it. Like when another nurse asks me to get a tough stick and I go in there and get an 18G like it was nothing or when my pts say they're a tough stick I'll do the same. Those instances will make you cocky about IV starts. The funny thing is I'm not an overly confident person either, except when I'm at work. I find that if a pt asks me if I'm good and I say yes I sometimes jinx myself and miss. So usually unless I'm asked by a pt multiple times, I just keep telling myself I'm gonna get it. Every nurse has their bad days. Some shifts I'll miss every single IV or every vein I blow. It sucks and puts me in a bad mood but it happens. Like I said before, just practice alot and you'll get your skills.

"My nursing school didn't stress IV skills. They told us that was the least of our worries. It's merely a technical skill, even EMTs start IVs. They wanted us to understand things, the mechanical skills come later." Actually EMT's don't start IV's, paramedics do. EMT's work for the fire company and all they basically do is transport pts. Medics are the one's that can start IV's, give meds, and even intubate.

I work in one of the largest/busiest ED Trauma centers on the East Coast and I honestly feel that IV's are one of the easiest parts of my job. We never use the IV team unless we have multiple unsuccessful attempts by a couple nurses only because its hospital policy to call them. We do as many IV starts if not more than IV nurses and I believe we're better at it. There really isn't a shift that I don't do atleast 5 IV's and I've done in the upwards of 20+ IV starts in some shifts where I'm extremely busy. I get more annoyed having to do my own EKG's than IV's. Most ED's don't hire you with a contigency you know how to start an IV. Alot of people in my orientation group had never done an IV before and are good now. I can't speak for all ED's but the one I work at, I'm not always in the assignment with the trauma's. We have 2 designated trauma bays and 3 critical care rooms next to they bays and that whole assignment has 3 RN's working it per shift, one of them being a trauma clinical leader. So what I'm saying is I can go a couple of weeks and not be assigned to the trauma assignment because we have almost 200 nurses in our ED alone. Of course I've gotten trauma's in less acute area's when we're full but most of the time it doesn't work that way. If you need practice, start off with 20G IV's..they're not so big where its hard to advance but they're still stiff enough where they're not going to bend too much. I hate 22G for that reason, they're too damn flimsy. And I've never even used a 24G, not even for a newborn. I'd say that probably 95% of my IV starts are 18G. Some people think 18G should only be used for trauma's or critical situations but in critical situations, I'm using a 16G or 14G. And you never know how serious a pts situation is. There are people that you think just have a cold or indigestion and they end up coding. I've seen it multiple times, so I rather have atleast 18G for those circumstances. I will say that I've been putting in a few 16G IV's per week and alot of nurses look to me when they can't get large bore IV access. Just this past weekend I put in 3 16G and a 14G on top of numerous 18G. Don't worry, you just need to practice. During our orientation they made us practice on each other. One piece of advice I'll give you is, in the beginning during you first few weeks, don't tell pts you're new to starting IV's. It makes the pts nervous and less likely to let you stick them and in turn makes you nervous and anxious starting IV's.

Thanks for the info. I just found this on the website: Terry DiNarrdo, R.N., M.S.N., C.C.R.N. Nurse Manager, 6th Shock Trauma Acute Care and Intermediate Care Units and Mike Knapp, R.N., M.S.N., C.N.A., B.C. Nurse Manager, Trauma Resuscitation Unit But the page was last updated on July 31, 2007 so things could have changed in over a year since. Either way, I'm going to email her to see what happens. The worst that can happen if she isn't the TRU nurse manager is she can give me TRU nm's email. Thankyou for looking. I appreciate it.

zahryia I may do that if I can't find an email. I'd rather email him for now since I'm not going to be applying for another 2 years or so. ujones00 Thank you, I'd really appreciate it if you could find an email or # for me. Thanks.

Thanks for the reply. It seems impossible to find this guys email or phone number. The Multi Trauma Unit would definately be the unit I'd want to work on if I were doing ICU but I tried working in an ICU and though it was a great learning experience, I just always wanted to work in a trauma ED. The reason I want to work in TRU is because I like working with trauma's. I like the ED aspect of working with trauma's, like when they first come in and unstable and you're still trying to figure out whats going on. Very frequently where I work we take care of trauma pts in the ED for hours until they get an ICU bed and we're doing the same job as an ICU nurse. I really love taking care of critical pts post-trauma in the ED and even though I like taking care of them as they would in the ICU, I wouldn't want to take care of the same pts for days and days. I also think ED experience from a level 1 trauma center would be more suited as a prerequisite to working in the TRU because ICU nurses aren't used to taking care of the pts when they first arrive and everything is a shitstorm and hectic. That's not to say ICU nurses aren't capable or don't deal with crazy unexpected issues but I think that ED nurses are more equipped to deal with a trauma pt that has just rolled in the trauma bay by the medics. There are occassions when SICU or MICU nurses are pulled to the ED, not very often but it does happen and they always say that they don't understand how ED nurses take care of trauma's because everything is not as organized as they're used to and everything is a mess, etc. Thanks for the reply and suggestion.

They're called Licox and they've been around for a few years now. I work in a level 1 trauma ED and one of the neurosurgeons placed a Licox in one of my trauma pts in the ED last week, which is odd because they usually wait until the pts get upto the SICU to put in ventrics or Licox bolts. They're pretty cool. I used to work at Jefferson's Neuro ICU in Philly and they were used very often, along with tunnel ventrics.

I work in a large teaching hospital in the ED and I don't shy away from doing any of pt care just because the pt is female. But there are some circumstances where a female nurse needs to be present with female pts. For instance if the doctor wants to do a pelvic exam and that doctor is male, then a female nurse has to be in the room with the pt, but if its a female doctor, then I can be in the room. This isn't just my beliefs its our ED's policy to ensure no false accusations are made about inappropiate behavior from the doctor during the lady partsl exam, and its more so just a witness. Sure a male nurse can be a witness to a male doctor, but our hospital doesn't want to take any chances with how malpractice suits are going these days. Another example and this one is just something alot of the male nurses in the ED believe in, not neccessarily a policy but alot of us guys feel this way because of the example in the last paragraph...and that is when the female pt is in her pubescent teen years or early 20's, we sometimes ask a female nurse to either be present or perform the EKG on the pt or when placing a foley. Now there is an exception to this, for example a trauma pt or anything critical but for most routine EKG's this is how we practice with that age group. Some may disagree with the last comment but that's just how I was taught by other male nurses that have been there for a while.

Hello, I wanted to know if anyone knew the nurse manager at Shock Trauma's TRU contact information?? His name is listed on the website but there is no link to his email address. I currently work at Christiana ED, Level 1 Trauma Center in DE for about a year now and wanted to contact the STC TRU nurse manager to get info on the requirements to working there someday. I know that I don't have enough experience right now but it is a goal of mine to someday work there. I see alot of trauma where I presently work due to the extremely close proximity to I95 and Wilmington but I would like to eventually work at STC TRU. I also plan on taking the CEN and ATCN in the next year or so and I'm working on going back for my BSN or possibly RN to MSN. I presently have BLS, ACLS, PALS, and TNCC certs which most RN's in trauma centers have. If anyone has any information(email, phone #, etc) of the nurse manager at STC TRU or any other way of contacting human resources, I'd greatly apprectiate it. Thanks.

I don't know they have an ED-internship program which orients new grads and nurses with little experience for months to prepare them for their ED. I'm sure you're not gonna be a master and will probably still be overwhelmed but I've heard great things about it. In fact I start the program in February. I'm not a new grad neccessarily but I have 3 months critical care experience.