NurseDawgJess

I've been a floor nurse and I'm currently an ER Nurse so I do see both sides to this debate. However, I want to point out that when a patient comes up to your unit with an IV in the AC site, please keep in mind that the medics often start the IV's while en route to the ER. More often than not, I find that to be their site of choice, not ours. I don't fault them for that though because I'm thankful to have IV access of any kind and it just makes my job that much easier- sorry it doesn't help you in that aspect. In their defense, I can't imagine how hard it would be to start an IV with the squad speeding down the road hitting bumps and dodging traffic. I hardly ever see ER nurses picking an AC as the preferred IV site unless that is the only thing they have left or, like another poster mentioned, they need to have a larger vein to dump fluids in. I do understand the frustration of the positional IV and running down that hall every few minutes to reset the pump. A lot of times I propped the patient's arm up on a pillow, secured it to an arm board or casually mentioned to them that I may need to obtain access elsewhere if the two of us couldn't come up with a good plan to keep that IV infusing properly. Usually, the fear of being re-stuck often motivated my patient to make a conscious effort to keep the site from occluding.

We use it at my hospital and I love it. However, I came from home health a little over a year ago and was so burned out on paperwork, any computer charting program was welcomed by me with open arms. It seems overwhelming at first but eventually, you'll catch on and you'll do fine. Good luck with the transition.

Thank you for your help. Coming from homecare and a med surg floor, I haven't had much experience with monitors and EKG's. I think they are fascinating to learn about. Looking forward to taking my 12 lead class soon.

I see nothing wrong with using a nurse "tool belt". I like the Nurse Pro Pack bags. I initially started out with their EMT pack because it was smaller and kept everything more contained because the flap velcros shut. Once I moved to the ER, I needed something larger and now I use their Nurse Pack which is roomier and it's easier to get to the supplies I need when I'm pressed for time. It's not really that noticable since I leave my scrub shirt untucked. It's a little heavy but I would be lost without it and I'm much more efficient having it. Sure, lots of supplies are in the patient rooms but it never fails when I need something, the stock has ran dry and I waste too much time hunting down what I need. Plus, I can't stand to have my pockets bulging out. That looks much nerdier than my tool belt in my opinion. Good luck with whatever you decide.

I have heard that phrase as well but I'm unclear about what exactly that rhythm is or looks like. Any insight on that would be appreciated.

I noticed that AFTER I made my post, my bad, lol. I plan to get a pair of those. They look like that have better arch support also. Thanks for the feedback.

A coworker recommended placing a piece of tape (plastic tape) towards the toe on the bottom of each of my crocs to prevent Croc Stop. It actually works well but my Crocs are Pearl colored and the tape quickly turns a nasty black which looks cruddy if you look at the bottom of your shoe. I usually only notice it when I'm on the phone waiting to give report but it still bothers me seeing it. :uhoh21: I just change the tape frequently between washings but I'm curious to try the new Crocs for Professionals since another poster remarked that they don't give you the dreaded sudden stop. I noticed the even newest version of Crocs for nurses have closed heels in addition to the closed toes and they conform to your foot similar to how Danskos do. I also notice they have extra tread gripping toward the toe. I would think that would make Croc Stop even worse. Has anyone tried any of the new designs listed on this website below? I don't remember the Professional Crocs having the toe tread. They aren't listed in this link: http://www.uniformadvantage.com/pages/dpt/crocs.asp

I'm new to ER and work in a Level 1 trauma hosptial. My preceptor used to be an ICU nurse. So far she's been a great teacher and her experience is highly respected and appreciated by the doctors and nurses. Good luck in your new endeavors.

that's awesome, sounds like you work for a great organization. that will make or break you in homecare. good luck taz.

I did home health for several years before going back to the hospital. I loved it for a while but I did get burned out on the paperwork aspect. I was always buried and felt like I was in college again with that never ending nag of "homework" aka, paperwork. It was so redundant at times and bored me to tears. Felt like it was busy work. I loved the flexibility, the autonomy and the quality time and care I could give to my patients; however, the wear and tear on my vehicle, not to mention the climbing gas prices, just made it another hassle. Our company gave us gas card every month which was a nice perk but it still didn't take the mileage off my car. Seeing peeps in incliment weather was no fun either. And of course, dodging bullets and stray hostile dogs in dangerous neighborhoods became a risk not worth taking. I also felt so isolated at times with no fellow nurses to vent to. I love working in the ER now and hopefully I stay happy. It's nice to have coworkers to interact with and I really love just doing my job, clocking out and coming home. Good luck to you Taz and try to learn to say "no" to burdensome assignments if you can. I know it's easier said than done. Also try to remember to set aside time each day for phone calls to doctors, labs, pharmacies and your homecare company if needed. That was something I often forgot to consider when taking on extra "New Admits" . Those phone calls can really eat up a lot of your time. Do you have a fax machine at home? If not, that might help save you some time also instead of making extra trips to the agency. Are you full-time and if so, how many patients a week are you seeing? I found that if I saw 30 patients/week and of those visits did about 3 Oasis (including recerts) I was ok. Once I hit the 35 mark and the 5 Oasis mark I started to get fried and buried in paper. I briefly worked for a company that did computer charting. It sounds like a blessing but it was even worse- total nightmare. We had these teeny little screens on a hand held computer and I would get horrible neck cramps from looking down all the time. The amount of questions on the assessments was ridiculous and so many questions didn't even apply- yet you couldn't skip sections either. I hated it! It was a sytem through McKesson so beware if that name comes up when you switch to computer charting. I say "when" because eventually all agencies will be required to do computerized charting for billing purposes- at least that was the info I was relayed. On the up side, I heard there are other computer systems that are very user-friendly. Hopefully you'll be blessed with that opportunity once it arrives. Contact me anytime for feedback or someone to vent to. Hopefully I can turn to you for ER/Trauma feedback as well.

Our hospital offers a two day "ride-along" with the Care Flight crew in the spring and I would love an opportunity to do that and learn more about the prehospital system in that aspect. Thanks for the support and feedback. :wink2:

Congrats, I too have recently joined the ER ranks. I've been a nurse for 11 years, mainly in Peds and home care but I feel like I'm starting school all over again, LOTS to learn and very humbling. I have no critical care experience so that's been my main challenge so far- especially with monitors. I take ACLS the end of this month and some critical care classes. I'm working in a level I trauma unit and have briefly seen some juicy traumas which really boosted my adrenaline. I was told by my preceptor to tackle trauma later after I've had more experience with the other stuff. She said it never hurts to peek in if there's room and if I stay out of the way. She said later I'll get to jump in which sounds exciting. Thanks for the input about the text book NREMT-P/RN. I've been wondering what good resource to invest in to help with my transition.

I too just shadowed in the ER. I've been a nurse for 11 years but my hospital experience has been pretty limited. I've been a floor nurse on a post surgical floor for the past six months but most of my experience has been with Peds and homecare. After my experience today, I'm certain ER is where I belong. The staff I worked with was so supportive and enjoyable. I will work 3p-3a in a busy Level I trauma inner city hospital so I'm sure I'll be exposed to any and everything. I've always dreamed about being in the ER but feared my lack of experience would hinder my chances of ever working there. This forum and the feedback you fine nurses have provided has helped give me the confidence and insight I needed to open my mind to the field of ER nursing. I plan to give notice on my unit tomorrow and in 2 weeks, I too will be in the ER. Thanks again to Tazzi and the others for your helpful posts. Even though I hardly post on these forums, I frequent them a lot and I want to thank you all for sharing your experiences and advice. :)

I used to be a homecare nurse and have had my share of leaky ostomies with limited supplies at the homes so hopefully my tips can help. After removing the old ostomy dressing and cleaning off any remaining stool or adhesive from the skin, make sure the skin is as dry as possible. I found that gently blotting the area with paper towels worked great. Then, apply your skin prep- yes, non-sting is best but use whatever you can get because using skin prep is one step that must always be followed to get an adequate hold in my opinion. After applying your wafer, use the warmth of your hand to press it against the skin for several seconds to facilitate the bonding. Once your dressing is applied and seems secure, take Tegaderm (or something similar such as wound vac transparent dressings; they work great when cut in strips) and apply it in a window pane fashion around the wafer. I've done this for years and it works very well- especially if you overlap the Tegaderm at least 1/2 inch or more over the wafer. I hope this helps.