Lilith

The only justification for B I could think of would be that the other three options were designed to tempt you out of your scope of practice: i.e. don't diagnose and practice medicine. This is the type of crap they used to do when I was in school. It does not serve you well in the real world, when you need to be able to anticipate urgent interventions. Ofcourse, if that were the correct answer I would have failed - despite my MSN and NP license!

Know how to cross multiply fractions for the ratio/proportion method of determing medication doses, know how to work and convert in the metric system - mostly with regards to measures such as cc (cubic centimeters), ml(milliliters), mg(milligrams),mcg(micrograms), and g(grams). Solving simple algebraic formulas for "x" is important.

You may need to take a break for a year. Take a job in something completely unrelated. Breathe. Have some fun. Make new friends. You may be surprised to find that this might re-affirm your committment to being a nurse. It also may sweep you into a completely new direction. Nursing will always be there as a choice. I think what you are seeing in those "thirty - forty" year olds that are still "chasing" a nursing career is not the age, but the sadness that can come out of a person single-mindedly over fixating on one particular goal. This can lead to overlooking other experiences and opportunities that life holds out to you. I spent many years trying to fruitlessly to climb the corporate managment ladder. That's what my family saw as success. Then I did a "crazy" thing at age 38 - I quit my well paying job I hated and took a job as a nursing assistant on a medical surgical floor at a local community hospital. Now, at age 46 I'm an ANP and I practice in several settings and have prilvileges at several local hospitals. Maybe something like my scenerio awaits you a little further into your future.....or something different, but equally wonderful! I don't care how old you are now, it ain't over 'til you're dead!

I would like advice on how to handle RN's who challenge a new Nurse Practitioner. My nursing background is as an ER RN, and I have just started a new job as an ER NP. I'm finding the role transition difficult. There are a couple of RN's who follow me around letting me know they don't like "midlevels" in the ER and trying to play "pop quiz" medical trivia with me while I am working. I have tried taking the high road and have quietly taken each aside and asked them for their support while praising their knowlege and experience. This has only worked temporarily. This is a different facility than where I developed my RN practice, so there are only a few who know me in my RN role. Those who have worked with me in the past are supporting me wholheartedly. Any suggestions on how to handle the ones who think they know both their job and mine and feel the misguided urge to "supervise" me?

1980 - graduated from high school 1984 - graduated from BA program 1984 - 1999 - almost every job under the sun, seriously lacking direction 2002 - graduated AS nursing, work in ER for three years 2005 - back to school for MSN 2007 - graduated MSN ANP track currently practicing as ANP in a private group carrying both primary care panel and gastroenterology specialty patients

INTP - ER nurse.. Three INTP's in a relatively small sample, curious since we are something like less than 1% of the population and females even rarer (facts from memery, may be alittle off). I would very much like to speak to another INTP, especially in nursing. Nursing is definetely not on the list as a good career for an INTP's...not enough autonomy, too much repitition, etc. Yet, we persist. :wakeneo:

:roll In my hospital, code brown gets you the poop patrol!

Hi, i have occasionally worked for an agency, but I'm in Massachusetts and do critical care. The paperwork is usually little more than standard HIPA and precaution stuff, and a self appraisal of your skills. I usually get about $40 and hour but, again, thats ER and ICU stuff. I've never worked with a homecare vented pt. I'm not sure what you would do other than assess their lungs and general condition, suction the trach, give some meds.....sometimes these patients have other problems that require extensive personal care, turning and such, dressing changes....you'd better get specifics from each individual client before you take an assignment so you can decide if you are being under paid. Good luck!

What you lack in experience, try to make up for in preparedness. Carry the following things on you/in your pocket: tape, trama shears, alcohol wipes, more than one pen, pad of paper, kelly clamp, always have a spare pair of gloves in your size. Sheehy's Emergency Nursing is the reference for ER nursing, but expensive, so you may want to check the library. Ask for the hospitals protocols for specific presenting situations AND LEARN THEM (ex. CHF, ashma, MI etc). If you read only one thing, let it be ACLS guidlines. Good luck. Be willing to admit what you don't know, even if you think it makes you look bad....it will earn you the most respect in the long run.

Regardless of whether you go to an ADN program or BSN program you will get different standards of education depending on how good that individual program is. There are good and bad programs out there, just like anything. Even the best programs have some bad instructors. Education is what you make of it....as someone else said, look into things that interest you yourself via references, ask physicians to educate you (you will be surprised how willing most are), keep seeking learning and you will be an excellent nurse. Personally, my education is all backwards. I attended Mount Holyoke College when I was just out of high school, majored in music and biopsych. Received my nursing degree at age 40 from an ADN program. Now in graduate school for FNP. I was actually pleasantly surprised how well my ADN program prepared me for graduate study.

Again, thanks for sharing.... In today's nursing, more and more, the system sets us up to fail. I know that orienting a new employee, or hosting a student nurse is HARD WORK. Some of the scariest mistakes and near misses I have made have happened when I have been doing just that. Luckily, none have ever harmed anyone. It upsets me that when you are orienting, or hosting a student, you are often given a heavier assignment under the justification that "there are two of you." You really have to do, and think, things over twice when you don't know the real extent of your "shadow's" knowlege and abilities. Its very distracting. Keep the faith....maybe experience really IS just what we have learned from our mistakes!

lalaxton, Good point about already working "holistically and efficiently" as I am one of the "faster" RN's in the ER. at this point, it looks like it would be the physician's group who would hire me, and therefore supervise me, in the ER. If I were to work with the Hospitalists, then I would be hired by the hospital.

Thanks! Your "real life" situation is extremely valuable to me....could you tell me more about how policies are written to allow you to practice in this way? How much MD supervision/cosigning is needed? (I will also send you a private email, if you prefer to correspond in that way).

Hi folks - I'm new to this forum - usually hang our in the ER forum. I am an RN,CEN and will be starting a graduate level FNP program in the summer. I have been trying to "sell" my current employer on the idea of using me as a mid-level practitioner in our ER (I love ER stuff, and want to practice in the ER) they currently do not use NP's or PA's. I had an astonishing conversation with my nurse-manager on this topic - he basically said "if we ever use mid-levels, we will use PA's because nurse practitioners are too holistic, not procedure oriented, and are slower than PA's because they spend too much time with the patients and do not use the medical model." Now, I would not have been surprised if this statement had come from one of the doctors, but hearing that from the mouth of a nurse floored me! Actually, many of the doctor's in the group have responded more optimistically, stating they would rather have an experienced NP at their side than a PA who might be a "kid just out of school with no experience." They are especially fond of the idea of an experienced ER nurse in the NP role, as they already use us to make advanced clinical decisions and order treatments, order meds, etc based on our pt assessment and clinical protocols. Anyone out there have experience with NP's working in the ER environment? Examples where NP's collaborate closely with MD's to perform procedures outside of the traditional FNP scope with MD's? Thanks.

You have done many of the right things. Make sure during the interview that you make it clear that, dispite your many accomplishments, you have the ability to be humble and admit when you don't know something or when you have screwed up. Being cocky, too prideful, and too worried about your ego are the most dangerous and guaranteed failing points of the new grad in the ER. It will make you feel lower than dog s**t some times when you are lacking, or wrong, but it will help you to grow, and gain you respect faster than anything else. Your team mates depend on you to make mature, independent decisions that are in the best interests of your patients...that includes knowing when you are in over your head. I speak from experience....I was the first new grad our ER hired in 15-0 years - and quite a controversial hire! (that was in 2002). I was constantly under the microscope, watched by many sets of eyes, and felt like everybody was just waiting for me to screw up. It doesn't feel good, and it takes alot of self discipline to "throw yourself on the knife" when you are lost. I succeeded, and have helped others to succeed, but also have seen many fail....invariably because they would not follow this one simple rule.

I agree with Needsmore....triage is the scariest job in the ER! In smaller ER's, you are usually the only one out there, and you are responsible for every person in that waiting room from the minute they walk through the door. The sickest people are easy to miss, as they usually quietly sneak in and crash - while the GOMER jerks are screaming at you at the window or creating some other distracting rucus in the WR. Some nights everybody will sign in "chest pain" or "can't breathe" regardless of their real complaint, because they think it will get them seen faster. Trying to thresh out the fake seizures and the drama queens from the truely sick pts. often requires experience with very subtle signs and SX. Again, in my ER you must be an ER NURSE for atleast one year - doesn't matter how long you have been in another field. That "first shift alone in triage" usually leaves the nurse battered and shaken, muttering "I had no idea it was this hard!" All this and, remember, you are supposed to only spend 5-10 minutes assessing these patients and making these critical desicions. The position is NOT akin to being a receptionist...it requires a tremendous amount of advanced clinical judgement, training, experience, and riot control skills. Don't get me wrong, I wish you luck....but I think you should know what a tremendous undertaking this is. It also involves a large risk to your license if you treat it lightly and dive in without proper training and experience. I think your nursing mgmt. is extremely misguided to be thinking it is a good place to stick pool or float nurses. :uhoh21:

Our passions are what give our lives quality! What good is it to live forever if you are bored to tears? My hobby/sport is kickboxing....how strange is that for a nurse? Here I am, studying and practicing ways to intentionally hurt someone else. It is great exercise, and teaches you how to control your body well...and the big, red bag always lets me win. In the ER, I have had opportunity to practice real life blocking and ducking techniques but I have NEVER hit or kicked anybody. Don't even know if I really could overcome the "nurse" and act offensively. Probably not.

:rotfl: WAY too funny....I wonder if she used to list "strong critical thinking skills" on her nursing resume......

How about, "I'm tired of waiting and I'm just here for the morning after pill. Is it okay if I come back some other time?" Um,...define "okay."

The recommended dosage is 0.5-1.0U/kg/day. Toxicity from a hypoglycemic reaction would depend on a number of factors including kidney and liver function, how much the person had to eat, or continued to eat after the injection, rate of absorption relative to percentage of SC fat etc. Also depends on what type of insulin....I'm assuming we're talking about Regular, where a rapid, immediate blood sugar fall could be a problem. IV administration recommends pushing no more that 50U over a 1 minute period....if that gives you an idea of where the danger zone might lie.

Hi! Have had computer problems and haven't been able to post for a while. I'm so happy to be able to participate again! I just wanted to add my testimonial to the group of real life "new grads" that started in the ER. I graduated from nursing school in 2002, at age 40, and started in the ER. Its not what I pictured myself doing when I decided to start a career in nursing, but I have been successful. Its the absolute best "job fit" I have ever had in my life - and I have been continuously employed in various types of business/managment/sales situations since I graduated from college in 1984 with my BA. BUT, I didn't just fall into it right after graduation....I did alot of "field research" first. Before going to nursing school, I quit my well paying job and took a job as a nurses aide on a med/surg floor. Also worked as a "tech" on a Cardiac/tele floor. One day I was "forced" to float to the ER as a nurses aide....and thats when I discovered that it fit. I am one of the first to say that not all new grads belong in a specialty care area. You have to have alot of initiative, maturity, and people skills. Most of all, you have alot of learning to do and that requires alot of hard work above and beyond what may be expected of new grads in some other areas. My hard work started before graduating, as used my employment positions to learn, watch, and acquire as many skills as I could before I hit the floor as an RN. I did not do anything that would be unacceptable for an unlicensed person, but what I couldn't do I watched, questioned, read about, and assisted with whenever possible. After passing my boards and accepting a job in the ER inwhich I had served as a tech, I continued to do my homework and study as if I had not graduated from school. I gained ACLS, ENPC, and TNCC certification within my first year. Next month I will sit for the CEN exam. It takes a special combination of academic preparation (or home study), practical work experience, critical thinking, and humble discipline to succeed in this specialty - in my opinion. Most importantly, "no man is an island unto himself" and you need the support of your team and mentors. If you really want it, go for it! Be prepared that you will never learn all that there is to know, and that you will never be immune to making mistakes. Atleast, thats the way its been for me. By the way, I am moving from a busy level 3 trauma center and starting a new job in a level 1 trauma center this week. So here goes a "new grad" into another level of challenge....facing new unknowns, new fears, new learning, and probably new mistakes. I can only hope it goes as well as my first year has gone. Good luck, all you new grads out there!

We do conscious sedation in our ER all of the time, and the nurse is responsible for the entire process - from pre-assessment, to drug administration, to recovery. Its actually quite a point of controversy in our ER, because the other nurses have to absorb the pt load for the nurse who is tied up, and the physicians always want to rush the process of recovery by using Narcan. God help us if we have more than one pt at a time who needs conscious sedaton! Its quite a problem. Anyone else experiencing these type of problems?