stunner127

The OR has been helping us cover call but now they are fighting against it because they just had 5 nurses quit. They are more burned out than we are. They hate covering our call which I do understand. They get called in a lot more than we do and have to stay a lot longer doing back to back cases. Unfortunately we don't have a cath lab. We are tracking our call-in cases for the next 3 months and then taking a look at what we can do. Does anyone work in a small hospital that doesn't have 24 hour GI call coverage? Even if we stopped call at 11pm and resumed at say, 5 or 6, that would help us a lot because at least we could SLEEP! And our "emergency" add ons during the day typically wait several hours to follow our outpatients anyway. I like the idea of a slot to add in an emergency before our first outpatient. I appreciate all input!

I work in a small community hospital GI unit, we have 6 staff members. We typically run 1 endo room on week days, occasionally we open a second room. Half of our staff members have less than 1.5 years of experience. We currently have 24 hour call coverage which we split among our staff. Our staff is burned out from call, and we have had problems with staff turnover and morale. Management has asked for our input and ideas on how to improve our call situation. I was wondering how other facilities cover their call, how much call you do in a typical week, and what staffing ratios are maintained. Do other small GI units have 24 hour coverage? Thanks for for any input!

i just passed cen about a month ago. less experienced than you - icu as a new grad, 2 years er nursing. i found the actual test much easier than the review books. they throw you some bizarre questions on the test but the vast majority on my test were what i would consider common er nursing knowledge. you only need a 75 to pass so don't sweat the weirdo questions. the ena review book and especially their online tests (you get a code for those with the book) were most helpful to me. some of the questions on my test were very similar to the online test.

I had started an IV on a stable er patient tonight and she claimed to be "Severely allergic" to tegaderm, refusing to let me put a dressing on the site. I had no idea how else to dress the IV site so I just got the labs and took it out, thankfully she needed no meds and went home. Any other appropriate dressings for an IV site? This patient said "The other nurses just put paper tape on it, that's all you can use on me" well to me that seems like a risk of infection plus it would make it impossible to see and assess the site. What do all you experienced nurses think I should do if this comes up again?

Hi everyone, I'm a little Yankee girl that fell in love with a travel nurse from TN a year ago. Now it's time for one of us to make a move and put a stop to this long distance nonsense. I really have enjoyed my many visits to Nashville and I know there are about a million hospitals in the area I could potentially work in, but I'm pretty much lost in terms of where to start looking! I guess I'm looking for a hospital ER that's medium or larger, that isn't horrifically understaffed, has competitive pay for the area, decent benefits, and that doesn't treat the nurses entirely like crap. Little or no pedi is a plus. My experience, if it matters: Community hospital ER. No trauma, no cath lab, approx 100 visits/day. Generally lower acuity, the sick ones are sent out. I have almost 2 years ER experience, ACLS, PALS, but not TNCC (my hospital doesn't offer it). $33/hour with diff on night shift. Looking for a good learning experience to make me a "real ER nurse." If anyone works somewhere awesome that they can recommend or has any horror stories, either would be helpful. Thanks for any info :) I'm not totally sure what kind of advice I'm looking for that I can't find elsewhere, but I figured maybe I could narrow my search a bit!

The other day I saw something strange and I was wondering if anyone here has seen anything like this before and can give me any info. The patient was a baby in the ER. A nurse had placed an IV on the previous shift and IV fluids were infusing. I went in to assess the patient, unwrapped the arm to check the IV site and noticed the entire arm where the IV was was a purplish red color and there was a ring of petechiae on the upper arm where I assume the tourniquet had been placed. The discoloration went all the way down the arm and there was definitely a really defined line between the normally colored skin and the discolored skin. There was no infiltrate and no tourniquet was left on the arm. There was good capillary refill, a strong radial pulse and his hand was warm. It looked awful and the mom was really upset. The entire arm looked like one big bruise. Of course I had the doc come in and check it out and he had never seen anything like that either. Does this happen when the tourniquet is left on too long or is applied too tightly? Are babies particularly vulnerable? I have never seen this before even on patients who have mistakenly had tourniquets left on them for an hour or more. Does elevating the arm or applying cold or heat help in this type of situation? Should I have d/c'd the IV (it was flushing fine and the doc said it was ok to leave it). Any info would be appreciated especially on how to prevent this!

Not to get into the whole "should ICU's take new grads" debate...but having recently quit my job as a new grad in an ICU (and currently working in med surg) I just feel like I want to emphasize that anyone considering ICU as a new grad really look into the orientation and training the hospital provides. At my job I was told during the interview process that orientation was 6 months for new grads and this was also stated on the nursing recruitment portion of the hospital web site. In reality I was on my own after 3 months and due to a high census (and not enough nurses) barely had the opportunity to get a question answered if I had one. I can't believe I lasted a month on my own without killing anyone. 3 of the 4 new grads I started with also quit, 2 didn't even finish the orientation. Even when I was still on orientation, my preceptor frequently had her own assignment and I was kind of fending for myself. I absolutely think with a longer orientation, or a little more support after the 3 months, I could have been successful. On the other hand my time spent in the ICU really made me think critically all the time and developed my assessment skills...so I bet that externship would be great! I guess my story could really apply to any area of nursing and not just ICU so maybe I typed it out for nothing, but just thought I'd throw in my 2 cents. Good luck :)