cccnurse

Our ER is a small critical access facility with 7 beds, 2 nurses and 1 doc. We only allow 1 visitor with adults and maybe 2 with peds. We simply do not have the room and/or the people to play all the games the visitors want to play. Of course we usually get at least 1 nastygram a week in regards to our visitor policy. Fortunately for us our manager also works along beside us, and doesn't just push paper. This and one of our docs is the medical director for the facility, so these nastygrams usually get chuckled at and deposited in the proper plastic bag lined file.

When it comes to kids it never gets easier, after awhile you will be able handle the sting a little better. Myself personally, in the case of a pediatric demise, when I can't feel the sting anymore I will need to get out. I hope that day never comes. How I start to cope is, when I get a minute, I take a step outside, look up to the sky, and ask the Great Spirit to care for the child until it's time for their parents to arrive. Then I put my head down, go inside and get back to work.

All of the above advise and more... Take care of the ones with breathing troubles first, then chest pain or bleeding, you'll have to assess which one of those is worse. Put the rash X's 2 weeks in the waiting room, they may itch for a while but it's fun to watch on the security monitors. Go buy a big bag of marbles... Every time you learn something new, throw out a marble. Every time a drunk or drug addict wants pain meds, throw out a marble. Every time you get called a ***** throw out a marble. Every time you get written up by the ancillary staff for wanting them to do their job and actually care for the patient, throw out a marble. When you look in your bag and find that you have lost all your marbles.... Laugh hystericly so people think you need a mental health eval, and welcome yourself to our club.

Avelox Shears!!! Oh man am I jealous. All we get from Avelox is boxes of antibiotics, and an occasional banana bread from Tim Horton's. Well I can't talk too bad about the banana bread... I almost got to see a smackdown over the banana bread once between the nurses and the doc... that was fun.

OK... Just wanted to get in here before the "righteous" did and start bashing us "bad" ER nurses because we also have the ability to assess BS. I agree with everybody so far. My experience has been that they don't think they are actually getting what they want if they can't feel the burn. My reply to them in this IM vs IV situation would be that... IM administration of this medication is safer than IV, this is the way it was ordered by the doctor, if you don't want it IM you are refusing treatment and may now leave. I usually hear some crap about how I am refusing to care for the pt, but I don't bite. I just calmly explain that they had been seen, treated and released by the doctor, this is the treatment he ordered. You have the right to refuse this treatment and may still be on your way. I've found out that AMA paper work is just as easy to fill out as discharge instructions.

I work in a small rural ER 1 doctor and 2 nurses for both day shift and night shift. After midnight the RN isn't only the ER Nurse, we are also needed to be the code team, trauma team, IV team, triage nurse, lab tech, maintenance, security, pharmacy, supply room stewards, assist with Gift of Life procurements, AND...... Unit Secretary. Take what you are doing and use it as a learning experience, because you are going to find out as your nursing career gets further along, not only does your responsibility gets bigger, so does the hoops you have to jump through. You also won't know in the future when you might need to fall back on these skills to get your patient what they need.

I have seen several different ways to draw ABG's I'll try to explain how I was taught to draw ABG's by a very respected Pediatric Intensivist, I almost never miss (not that I'm the best by no means) it's just this way seems to work. First locate a good Radial pulse. (don't forget to check your Ulnar pulse) Once you find a good pulse point your index finger of your non dominant hand toward the palm of your patients hand and locate the pulse again. Place a towel roll under the patients wrist and slightly hyper extend the hand. you don't need much... Just enough to hold slight traction. Take your time while feeling the pulse and try to visualize a straight line through your finger where you feel the pulse, and to where the Patients pulse originates. Hold the ABG needle directly over your finger nail where you visualized the line... pull your finger back (proximal to the patient) and insert the ABG needle slowly just passed the tip of your finger. Watch the hub for flash, when you start to get flash stop and let the syringe fill to 1ml. (don't forget to run your syringe plunger back and forth once and have your plunger at 1-1.5 ml first) Keep your finger on the patient to be able to recheck the pulse if you go all the way to the radius and didn't hit your target, this way you can slightly retract the needle and re-visualize the target and take another go. My biggest advise is to take your time... take a deep breath and have confidence in yourself. When I raced dirtbikes in the woods the best advise I received from an old veteran was... Sometimes slower is faster. Good luck, you will be ok.

I wanted to be like Hef... I mean; come on... What other job allows/requires you to come to work wearing pajama's

Sal, nursemike nailed it. If I was to add anything, or anything that I feel helped me, was to loose any apprehensions about being a male in healthcare. I don't go to work thinking I'm a male nurse, I go to work KNOWING I am an RN, I received the same education, had to pass the same exams as the female RN's. I'm a nurse by choice, I'm male by default. When you enter the room to do your job act professional, look at how your female co-workers handle the same situations that are reversed, act accordingly. For me it always worked out.. For every female pt that preferred a female care provider, there would be a male pt who was being a pig to the female staff. In these cases it was a no-brainer, I would readily take any of these types. I also wouldn't allow them to talk to me about my coworkers that way. It's all about confidence and competence, you need both to do your job effectively. You have to work to gain each, it doesn't matter what your gender is. An incompetent nurse is an incompetent nurse, it doesn't matter what their confidence in their abilities are. A confident and conscious nurse, usually becomes a very competent nurse. It's a long road to hike on. Just remember to hang in there... Because hanging out of there is pretty embarrassing.

You have to talk some of this stuff over with your co workers. Other nurses don't quite understand our sense of humor or frustrations. I have been lucky enough to have been able to swing my leg over the seat of a dirtbike since I was 6 years old. To me there is no better way to forget about the rest of the world when I get to jump on my 525, ride Michigan's back country roads and trails and get a good look at the natural world the Great Spirit created. For those days when I just can't take off and get in a ride, I try to play a musical instrument. I'm not very good at it, but the distraction and the need to focus on something different helps a lot. Hang in there... It's not as embarrassing as hanging out of there!

I still say the best thing any "new" nurse can do is use "confidence" and "competence". All your co-workers know your a new nurse so fortunately for you they don't expect a lot from you at this point. So be confident in the procedures you have learned so far, and be competent enough to know when you are over your head and ask for help for those you haven't learned. Lend a hand and someone will lend you one, but don't rely on them to help you get your work done. There are still a few things you need to do yourself. Dig in on those codes!!! How the heck are you supposed to learn if your not in the room when the pooh hits the fan. Don't be known as the nurse who heads the other way or the one who only grabs the clip board. Food is always good but you shouldn't make it obvious that your trying to win over your co-workers. What ever you bring in make sure about 1/4 of it is missing and tell everybody that it was left over from some family gathering. Or better yet bring in somethings left over from a family gathering. This shows you were thinking of your co-workers when you were not at work. I have a daughter who can bake one heck of a pie. The first time my ER doc met her he asked her if she was the "keeper of the pies!" Now a pie has become a monthly necessity. Most of all.. be yourself, ER nurses have a sixth sense for someone faking it and can sniff them out in a second.

Only you know what is best for you to do. Not that I don't want to give you a straight forward answer, it's just that I personally don't work with you. As far as feeling out of place in a certain situation; we all have at some point and still do at times. This is what keeps you on your toes, when you loose that feeling completely it's likely you will become dangerous because you will become complacent or burn out. When it comes to your co-workers... Competence and Confidence I would imagine that it's been 5 months and you haven't been run off yet so I would say you must be some what competent. Now you just have to show those 25 year nurses that you are confident. The person you really need to ask this question to is your Manager. Trust me... If your co-workers have anything bad to say about you, your manager has been told about it already.

Pushing Narcan, killing their buzz. Pushing Versed, waiting for the snore. (then push the buttons to cardiovert) Watching an 80 year old man recover from Ketamine. Getting a hug from the little peanuts after giving them an injection.

We as ER nurses do not need to justify ourselves. If your facility doesn't consider you a Critical Care Giver they are misguided. I don't care how many gadgets are attached or who attached them. Without us up front they don't get a chance to play with the expensive toys. We save lives on a daily basis, we don't just maintain life. What more justification is actually needed?

Hazinski was almost considered a bible at the PICU I worked at.

I must rephrase what I meant I said. Or something like that. I didn't mean not to chart "Dr. Aware" after re-reading what I wrote that was what I said. I meant that you should not put in the pt's chart that you notified nursing supervision or Risk Management. I did this once and it had me sitting across the table with administration and almost had a reverse effect from what I was trying to gain.

The "game" is a trap your not trained well enough to play in and you never will be. Ignore the looks, be jovial in your conversations, DO NOT go near the flirting line. That line is crossed faster than you can ever realize. Once it is crossed, it is nursing supervision for you. Once there a lecture will be mandatory then soon after comes the target painting for your back. Concentrate on your nursing skills you will be expected to know more and be better, especially with basic nursing. Go to lunch with whoever you please.

Document,Document,Document. I know you have heard all of this before, but it works. Do Not put any of this documentation in the patients charts you will be looked down upon. Talk this over with your ER manager then talk to your Risk Management division. Keep a copy of everything for yourself just to CYA in case your investigated by nursing for "not doing anything about it". It can be amazing how some paper work comes up missing at times. I work in a small rural ER, this is how we managed to get rid of one, we convinced administration that this doctors actions was out of line and was a lawsuit waiting to happen. It took several months to make it happen but it happened just as well. A "code white" also works very well, just be sure that during the "code white" that you do not become the one that puts the patient at risk and that the rest of your department is on board. This works in our ER because there is only 2 nurses and 1 doc a shift anyway. Good luck and hang in there, because hanging out of there is more embarrassing.

It does get easier; it doesn't get better. What helped me cope was becoming more comfortable with the thought of my own death and becoming comfortable with knowing that someday it's going to happen to me. I fully plan on a lot of kicking and screaming on my part first, but some day it will happen. When this day comes I too will have family members who will be sad, with this in mind I treat the family of these patients with the same respect I would want my family treated. Then when I have completed all the tasks and paper work required, I take a break, step outside, take a deep breath, look at the sky, and thank my Great Spirit for letting me have that one more breath and the sky above my head. Then I step back inside and go back for more, because that is what we do, we are ER nurses.