Neferet

It is a good idea to place my Rn license on inactive status due to illness? I live in California. I've already read the California BRN's information on it, but want to know what you guys think. I've recently experienced a lot of medical problems, leading to me being unable to fulfill the requirements, so I quit my job recently. I cannot focus or concentrate or multitask anymore like I usually do. Doctors don't really know what's going on, and we're still waiting and testing. It may be months or years until I can fully function. I don't know. I planned to renew to active status initially. I already have the book for my CEs, but cannot study due to poor concentration and symptoms. Will it hurt my RN license or career if my license is on inactive? And if I decide activate it, will it be an easy process based on what you know? And does it require more than what the website actually states? I have the money to pay for the renewal, just not the health and strength to do the CEs. And one last question. Do you have to practice as an RN to actually keep your license? I've heard once that you can loose your license if you do not work as a nurse. Is it true?

ALL4NURSINGRN I agree with you completely. I think a lot of time we were taught a whole bunch of stuff that was not really what we faced in the real world. One good example is we were always taught too much on "nursing interventions," but that never included knowing what are the stable/unstable conditions and lab values, vitals. It was mostly tasks, tasks, tasks, and not alot on diagnoses and critical thinking on diagnoses and what to do, what to expect...yaddi yadda. In nursing school we were always taught that the normal blood pressure is 120/80. Well, it was a wake-up call to learn that most people in the hospital did not have that perfect blood pressure, and I did not have to panic if they didn't. We were taught what is the "norm" but not taught what was too low, too high, urgent, critical, and need to call the doctor. What we got in nursing school was text book stuff, and totally not what we encountered in the real world. I understand that nursing has completely advanced, and nurses have so much more knowledge and autonomy now. But where does the line stop? Sometimes I feel like nursing is getting to be almost like being a doctor. Most of the time we find ourselves having to make the same judgments like doctors. EVEN though we don't act upon it as a doctor would...we would call the doctor so that he/she could order something. We are expected to know the acceptable, and not acceptable. We don't have all the medical training that doctors do, but we are expected to know so much as to make an initiation to call the doctor and anticipate what labs, or orders are needed. And if something is missed, or ordered in error, we are expected to catch it. And why? Since we are not "medically" trained as doctors, why are we expected to catch such orders that only a doctor has the knowledge to make???? Doctors have extensive medical knowledge and training in these parts, and we don't. But we are expected to alert them at the right time, and for the right reasons. Maybe we lack all the education needed for that. RNs are taking up more responsibilities. I think the standards and roles of nursing should either be decreased, or increase the training and level of medical knowledge in nursing school. I go for the latter. RNs need to be better prepared. By the way, I looked in a career book the other day and tried to find nursing under "medical" careers. I found it under "social." And then I went to the nursing section to look for a book that will help nurses in certain situations, testing skills, and knowledge of lab values and tests combined with nursing practice....and found very little. Most of the books are on How to pass the NCLEX... ay ya yay! Some of those continuing education class books needs to be out there.

Depends on the pt. Some patients need to hear it out straight. Some patients are more anxious, nervous and would probably prefer another way. By the way, was the pt on O2 mask or NC? I had the same problem with a pt on a mask, and we switched to NC and she didn't take it off anymore.

I pre-prime all my flushes. When I prime my lines, I cannot stand any bubbles. I will stand there and flick it until there is none. I really hate it when I step out the door and the IV pump is beeping already! Watching people eat chips in the nurses' station makes me wanna vomit. Oh yeah, and especially after they just came back from a code brown. I seriously have to force myself to eat anything with my hands even in the cafeteria. Most times, I eat things that can be eaten with the fork or spoon, and refuse finger foods. Even though I've washed my hands...sometimes I have to wash them 2 to 3 times before I'll go to the cafeteria. The ICU monitors right next door drive me NUTS! And I will always keep peek my head out the hall just to make sure it's none of mines. Nurses who come to work with a cough. What the? I try not to breath, and pretend to be done charting, and walk out. Even if someone sneezes, it's like my nostrils know that there are little germy particles out to attack them. I don't like standing alone in a room with a dead person. Gives me the willies too. I don't like shortcuts. I stick to the protocols, and go through the steps. OCD at times...lol. I wash my hands before using the restroom. Hey, you never know what you'll be wiping yourself with. Here's a weird one. I can't stand the smell of some people with Hep C and liver dysfunction. Makes me nauseous. I can smell it in their sweat, breath, skin, and poop. I've seen this in two of my patients, and it's the same smell.

ConfusedRN123, I was in your shoes, two years ago. Just take a deep breath. Starting a foley and taking out stitches and staples are the least of your worries. I used to be sooo stressed over those procedures, but after I watch someone do them, and have done them myself, they were sooo simple! Don't be afraid to use every chance you get to watch someone perform a procedure or do it yourself! I think the hardest thing is the staff. If you have great co-workers that are willing to help, even if you think they think you're stupid, you can do it! It takes team work. Of course people will be annoyed if you ask them to show you how to do one thing many times, that's why you get your paper and pen out and write notes for yourself. Show them that you're a fast learner, and also that you're thankful that they could be of good help to you. Basically, just get out your procedures book, read through what it says on a procedure and make sure you understand, and then get your materials ready, grab a co-worker and go do it! My first 6 months was like that too. I always wondered why I always came home late. When I started my job, I was dead scared of starting IVs and hanging them. But now I start IVs every day, and I love doing the IV stuff! It just takes practice, practice, practice....and pretty soon, you'll know more than others. I am still inexperienced in things like trachs, EKGs, tubes, and wound vacs, because we don't have those much on our floor. Sit down, and make sure you have a plan before you go off to work. Make sure you have time management down. Do things right the first time, so you won't have to go back and fix it again. One thing that is helping me right now is to do something when I see it. Get it done now if I have time, so that I won't be stuck doing it later. Also try to bunch all the things you need to do together in groups. For example, you can bunch room 27's pain meds, scheduled meds, and wound care together so you won't have to go back at a different time. I've learned that I'm not like those geniuses in my class. There were those students that seemed like they knew everything, and some of them sat around bored while I was running by butt off. They caught on easily and were so confident. But I'm not like that. And I can't be confident just for the sake of being confident. That's when I learned that I'm really a hands on person. I need to do things and evaluated them, practice them in order to remember. I'm very meticulous, and like being thorough in my chartings, procedures and assessments. And that's why I spend more time staying behind. But with time it will get easier and easier. What helped me is to differentiate between what's important and what's not. Prioritize. Throw out excess information that you don't need, and keep what's important. And then delegation. Things that you can have others do, delegate it to others. And you're not supposed to know everything! For the first one year, you'll be overloaded with so much information, you'd think your brain will not hold. But more and more, you'll learn them, and erase them out of your notes. It's better to be honest and say, "I need help doing this, I've never done it before." Than to pretend you've done it before, and make a fool out of yourself. Take a deep breath, and keep on fighting. Tell yourself that you worked hard to get where you're at and you won't quit. Tomorrow is another day, another challenge. Do some relaxation and breathing excercises! And pat yourself in the back after you've succeeded doing anything! Give yourself some credit!

I don't have any references for this..but just practice. This is all just from my experience. Kinking tubing when flushing seems like a good idea at first, if you're short of time and do not want to take time to unattach and reattach infusing line while you flush a med. But kinking can ruin the infusing line, causing the machine to beep and the infusing to run slow or even stop. Which is not a good idea if you think about it. And it may cause the patient to not get the amount of IV fluids they need. So what I do is stop infusion, press the line tightly between my fingers near the saline lock and then flush (not kinking the line). It's important to stop machine before you push the med or else after you let go of the pressure, the pt with get a rush of IV fluids that is building up in the line. You must know if the med and the infusion solution is compatible. If you know that the med you are pushing are not compatible with infusing med. Stop infusing, disconnect from saline lock. Flush with NS, push med, flush with NS, and then reconnect. And this doesn't work with blood, TPN, etc...which are not suppose to be mix with other meds. Yes, hanging flush bag should run at the same rate. It makes a really big difference, for example if the MD is trying to balance out pt's fluids in CHF cases. This has happened before where CHF pts were getting too much fluids because of flush rates, ABX, etc. With ABX, you can't really help it, because a certain amt has to be mixed with a certain amt of solution...but you can control the flush bag more. Yes, I would set it at he same rate. So that when the MD sees the input and output, he's not surprise that the pt got more input than what he had ordered...and it may effect the pt's health. Also you have to be careful if the pt is getting k+ in their primary bag, but you are flushing a lot of ABXs with a NS bag...and throughout the day the pt has been getting mostly NS...then that will also effect their K+ levels....and if the doc is unaware, he/she think that the pt has been getting K+ all day, and it's not helping..and maybe he/she will order more k+. Which can be dangerous...just a thought. When we have this kind of problem, we just update the docs on the IV infusion probs so that they are aware of actually how many hrs did the pt receive K+ or etc. However, I don't think you'll have to worry much if the pt has IVs in two different sites.... Sorry no literature for you.

I've seen the "K-riders" ordered all the time for unstable pts..either with high INR or very low K+. Well, we don't like to give it anyways because of the risks, and it just is very painful for the pt, and not good for the vein that the IV is infusing in. Never ever give K+ as an IV push. You can cause someone a cardiac arrest. This is always what we are taught in school, it's in the book, and it should be in your hospital protocols. I've heard of a bad story of a student/Rn pushing K+ in a kid, kid died. Check K+ levels before you give, and pt should be on tele.

I remember hanging this. Was my first time, and it was a pain in the butt. Tubing comes from the pharmacy. Special tubing for albumin...it's not the primary or secondary...but a different one. The reason is that the albumin is so thick...that the special tubing has a little opening valve to open and let air through so that the line can be primed and the fluids will flow. Then hook it up to the pump. Doesn't work well with regular IV tubing at all, because you can see it's a hard container with no positive pressure. With this special one, it flows really nice, and primed in less than a minute.

What bugs me the most right now is new and experienced nurses and CNAs wiping pts from back to front! And most of these times, there is poop! Grrrrrrrrrrrrrrrrrrrrrrrr! What can be harder than wiping pts from front to back?. Easiest way to avoid UTIs and for some reason "trained" professionals can't even do this itsy bitsy thing to keep pts safe from infection! Wipe front to back okay?! Reduce the risks and complications of UTIs, money and ABXs to treat it, and decreases risks of systemic infection that can lead to death of a pt. Same for foley caths....wipe "away" from the urethra....wipe the poop way...not towards. I can't believe this! I mean do these people do this to themselves too or just the pts? I seriously doubt that they wipe themselves from back to front, spreading poop into the lady parts and urethra. I'm really annoyed by this, so please....be nice to your patients who can't wipe themselves. Info for new nurses: A low grade fever is normal after post-op. I agree with Jlmb214rn on this one. But however, if higher, doc should be made aware, and meds ordered for it or blood cultures done if the doc wants. Never hurts to do cooling measures for low grade fever. I too, don't treat the first temps, unless indicated. At our hospital we don't treat until 100.5 or higher with Tylenol. And you don't want to treat temps anyways until the doc knows, and you know that they don't want a blood culture before you give the Tylenol. After surgery encourage pt to TCDB and us Incentive spirometer. Make sure pt voids within 6hrs after getting general anesthesia. We usually give ice chips post -op but make sure pt is awake before bringing it in the room. Our hospital I/Os are done in every 8 hrs....11-7, 7-3, 3-11 again. Say for example if you are there at 3pm, and doing I/O's.....Start like at 2:30pm so you can get it all done in time. Pour all the water that is left in the pt's cup back into the pitcher liner (because they did not drink it) and then measure what is left in the pitcher liner. Subtract that amount from what was originally in the pitcher, and you will get the amount that they drank. If they drank other fluids, add this to the total too. Whatever they did not drink, you shouldn't add it. For example if they spilt 800ccs at 12am, and you know they only drank 100cc. 100ccs will go on the I/O's sheet and then just refill their pitcher back to 800cc (or the total). And at time of I/O's you'll be able to calculate how much they drank from the new 800ccs in the pitcher, and then add it to the 100cc that they drank earlier....So that will be the total they drank from 7-3pm. At this time also you will go to the volume history on the IV pump and see how much was infused. The last shift was suppose to clear it before they left...from 11-7. So whatever total left should be the total for your shift. For example if the pt is getting 100cc/hr, it should be around almost 800cc for your shift, and you will take down this number and write the IV intake on the pt's beside. Press "clear" to clear it from the pump because you've already recorded it. At this time you will empty their catheter bag and also record the amount on the I/O's sheet. If they have draining bags, you should check on them at the beginning of your shift and empty them as necessary and chart the amounts when you do. And empty and chart these also at this time for the 3pm I/Os. And then, you can chart how many times they voided. After all this is done, make sure you calculate the total. That is from 7-3pm how much was in or out. ...and then these number are what you will report to the next shift. If you don't have a running IV bag, just clear the pump after every time you run an antibiotic or something, and chart it in somewhere in the right time slot. Then you can total it at 3pm. Every time you turn off a pump, pt's IV should be flushed, and the clip closed. No blood should be seen in IV lock if possible. Put a cap on the IV tubing if you're planning to use it again. Piccs, and Central lines flush with a 10cc NS, and flush regular locks with a 5cc NS (some facilities use heparin, follow your hospital's protocol). IV tubing should be thrown away if they were opened more than 72 hrs. Make sure stools are charted correctly with description: 1x med loose stool, 1 xtra-large hard formed, 1 x med loose stool ....and then the total will be,......2x med loose stools and 1 xtra-lard formed. Check if pt had BM for past three days....check for abdominal s/s... If pt states that stool is difficult to pass, but they have an urge to poop and feels like it is right there, usually doing a digital will help if there are no serious s/s of distress or colon obstruction, or bleeding, etc. Check orders for bowel care, and give if pt has it if no BM within 3 days or so depending on your hospital. When hanging IV,'s set the volume a little lower than what's in the bag. For example I always set a 1000ml bag with an infusion volume of 950ml. That way it won't run dry. Different amt for different pumps, so get used to the pumps you use. Also for kids, should never hang a bag of 1000ml, if you could hang a bag of 500mls...because kids overload easily. If you are running and IV for a kid at 50cc/hr, you may want to set the volume at 100ccs. That way the pump will stop and beep in two hours, and prevents overloading risks. If pt is allowed to have reg diet without fluid restrictions, family can bring drinks. All they have to do is leave container in the room or alert you how much was dranked. Same for I/O's. If they don't have a catheter, place a hat in the bathroom or a urinal, or commode and have the pt pee in it. When you come into the room, you can always check on it, empty it, chart it....and then at I/O's time you can total it. With restricted fluids, alert family not to bring pts anything because they are on restricted fluids, and nurse must be the one to allow them how much water to drink in a certain time period. I hope that when you guys are transferring pts, you guys are getting help. No need to hurt your backs on heavy ones. Sometimes I will hook the catheter bag to the chair they are transferring to if it's long enough and won't pull. Other times I'd have someone help me transfer, and I can hold the bag in one hand. If they are getting onto the commode, sometimes I hook it onto there instead... and make sure that they get on the commode safe without tugging on the cath. Everything dirty and used goes into the dirty utility room. Every new and unused is in the clean utility. Anytime you hang an IV medication ..Say for example a antibiotic...make sure you know what it's for. If not, look it up in the IV book, and write the med and page number down. See the book tells you to check any labs, or VS, etc, before giving the IV. Also sometime there will be labs that show if an organism is susceptible to this med or not. And if it's not, you have to alert the doc. On this page it should also tell you the what fluids to dilute with, what rate to give it, what to side effects to watch for, parameters on when not to give it....etc.... Then look under the "dilution" area in the book. Here you will find which fluids it can mix with. And check the MAR to see what fluids are running in the pt's primary line. If they're compatible in the book, then it should be okay. If you're running K+ in the primary line, and the secondary (for example the antibiotic) is not compatible with the primary fluids. Then I usually use a "primary line" tubing to prepare the antibiotic, pause the primary line, infuse the antibiotic first, and then hook up the primary solution again after the antibiotic is done. If you have two IVs that need to be infusing at the same time...for example if you need to hang the ABX, but also the pt's K+ is low and needs to be infusing...then I would sometimes start another IV in the other arm and run two IVs at once. If this happens then you just have to know their effects on the body. Check your dilution, push rates, etc. If you do an IV push or secondary IV and you see precipitation or the fluids in the IV tubing turning a different color, then they are probably not compatible. Must stop the IV immediately. When priming IV line...make sure you close the valve first. Squeeze fluids into the drip chamber....and then open the valve, and then take off the cap at the end of the tip.....and run it until a few drops come out at the end. Place the cap back on, making sure you don't touch the end tip. Sometimes you will have trouble getting it to run faster, just press on the bag a little and that should help. Always do a visual...look at your tubing to see that it doesn't have any bubbles. If you do it right, there won't be. There is no such thing as giving meds without orders.....know your state laws. Some hospitals will have protocol orders...and those are okay. But if you don't have an order for something that is not a standing order, or protocol order......get one. You will forget a lot of stuff...but perfect makes practice. You can only put yourself down where you are slob and too lazy to study and learn. But we're your willing to learn and when you are learning day by day, then that's how it is. Be assertive, but don't brag about what you know to the more experienced nurses. If there is an error, address it professionally with the coworker alone, but don't accuse. If you are a new nurse, you will not know everything, so don't feel bad. Get as much training, and ask as much questions as possible, because when you become a nurse longer, you'll feel more stupid asking questions that you should have known years ago...trust me... Asking questions is expected of you. Take a deep breath, it will get better, and sooner or later...all this IV, basic care stuff will be so easy...you'll need time to get it done, but you won't even have to think hard about it. The critical thinking is the importance focus under all of this.

thank you everyone who replied to the, "what do you love about nicu" thread. you've helped me to figure out my passion in nursing and what i have been yearning to do for years! i've been contemplating lately about going to work in the newborn well nursery. i knew that one day i will work there. i knew it the first time i walked onto the floor. it just fitted my style so much, the environment and the patients. i loved nursery, but there was only one problem. it was a piece of cake, it was too easy. not to say being a nurse there is easy, but what i meant was it was too easy for me because i enjoyed it too much. i don't know, might be sounding silly, but i wanted to do something more advance. i just don't believe that i went through 4 years of nursing school to do something that was a piece of cake. it was too sweet for me and i wanted myself to be more challenged. i needed to use that potential to the max. but i also dreamed to go overseas as a nurse and help the poor. so i decided that i needed to get a few years of med/surg under my belt, and save the nursery dream for later. yeah, i'm hard on myself sometimes, but i guess that's what you have to do if you have dreams that you want to achieve. i hated med/surg. i hated it so much when i was in school that just the smell of the med/surg floor would make me want to vomit as i came through the doors onto the floor. i forced myself to spend my last year of clinical in med/surg, forcing myself to learn and know. then i applied for a job for med/surg, and saved my nursery plans for later. med/surg was nice due to the hospital and staff i worked with. they are great and loving people. but my hospital is not a high acute hospital, so now i'm left wondering what to do. beginning in m/s i freaked out during emergencies, but more only because i don't know something, or haven't experienced it. in med/surg you don't have the time to look over every single patient's charts to a degree of satisfaction. and i hate that! just as some of you felt, i needed to be in control. i needed to know, so that i could prepare. i want to know the ins and outs of all my patients, so that i can do the best i can. i like critical care because you can focus on the whole well being of a patient. on med/surg i get sad sometimes when i spend the whole day running around, passing meds, and doing tasks. i really want to spend more time thinking about what is happening inside of them. it's true, i get sad when i spend half my nights turning, cleaning, wiping poop, and doing paperwork. i love helping my patients by doing these things, but i didn't go to nursing school for this. i want more knowledge, more thinking, more saving people's life. i just now realized that it's nicu that fits me. initially my plan wasn't to go to nicu. i was too afraid to handle nicu babies because they looked so fragile. i didn't get to be in nicu much in school. i love nursery, but want something more challenging in that field, then it is definitely nicu. saving little people in nicu is different than saving older people. i don't feel as rewarded from saving older people. most of the older people on my floor are dying and they want to die. and some of them refuse to take care of themselves and they die. it's near the end of their life, so it's a different satisfaction than saving someone who is at the beginning of their life. saving someone at the beginning of their life? now that's something that gets my heart pounding and willing, wanting to do. one thing that i just found about nicu was that the doctors are around most of the time. yep, that's the place for me, i just know it. i want to be in a place that is critical, but where i would have access to a doctor. er is that too, but i am definitely not an adrenaline addict and can't operate on excitement all day. remember? most of the time i actually want to know what's going on.....not to be surprised all the time when patients fly through the door. nicu is perfect, because there are only so much that can afflict to newborns. it's limited to that age, so you don't get the plethora of disease and conditions in med/surg. seeing the beginning of a problem and then outcome of my nursing interventions makes me a really happy nurse. i knew i wanted to see and know a patient from start to finish, but i just couldn't imagine doing this with adults. seeing the results of my care is the reward that fulfills my dreams of why i am a nurse. another thing i love about nicu when i hear you guys talk about it. is that you don't have to be running all over the hospital to take care of your patients. there are many hallways in my hospital, and i am constantly running/walking back and forth. it's good exercise, but it isn't funny when it's at the expense of the patient's health or your health. last but not least, i'd like to take care of babies. i think i've done my share taking care of older folks. i don't mind, but i getting tired of being nice and patient with adults who complain they can't pour their own drink, wipe their own butts, reach their own tv remote, eat their own food, when they really can. it's not like this with everyone, but it's very common. and i would love to do these things for babies who can't do it themselves. one really weird thing i found out about myself is that i like to intensively monitor things. i was taking care of some newborn kittens that had lost their mother before they were weaned. some of them died of starvation. i just wanted to watch them, feed them, clean and attend to them every 30 mins. and it's weird, but i really enjoyed it. the weakest, smallest, unattractive one of all was the only one that survived. and now he is a beautiful, playful, and healthy little kitty. and i just feel so good about it. nothing compared to a newborn, but it's good to get the point out. this is the end of my rant. but let me tell you something. i've spent at least three different summers taking care of newborn baby siblings and cousins. and can tell you that it changes a person's life. in some ways it makes you really at peace and humble. i guess you can say that some people go on life experiences where they go to some solitary place to find purpose or peace. during those summers spent with the newborns, i felt like i've experienced something like that. i think that you've missed out on a part of life, if you've spent some time caring for a newborn. thanks you guys! :heartbeat

thank you everyone for all of your help. i've been doing med/surg now for 2 years. it's doable, but not my passion. i get stressed sometimes because of the lack of time on medsurg that does not allow me to know all the things that i'd like to know about my patients. this medsurg worked for me. i prayed very hard for god to find me a great hospital to work in. and i found the perfect one, all the staff i work with are so helpful and we work together as a team all the time. i've finally found what i would like to do in nursing now. it's nicu nursing. i didn't know until i stepped onto the nicu page on allnurses. i knew i liked nursery, but didn't actually spend much time in nicu during clinical. nicu nursing allows me to be close to my patients, not running around crazy on the floor like on medsurg. it allows me to know all my patients in dept and know their ins and outs. it allows me to deal with emergencies with help from the docs and other nurses who work as a team. and i found that on the nicu site, some of those nurses have that same need of knowing mostly everything about their patients. and i am so glad, because i was frustrated about not knowing everything about all my med/surg patients. it was impossible to on a med/surg floor, because time does not allow for it. i used to be so stressed, but this was only because i didn’t know much. i’m a person who likes to be control, and know what i’m doing to be confident. and with nicu being specialized to a specific age, that narrows it down. i’m hard on myself, but only because i know you have to know what you’re doing in these areas. my confidence has grown greatly due to my experience on med/surg, and greatly due to the great staff there. i know that taking care of babies will help me to value my work more. that’s because most older people on my floor is dying or wants to die. people say just let them die, and they are dying. but that’s not why i became a nurse. i wanted to save people who do not want to die, who still have purposes in their lives that they wanted to live out. and i think babies are perfect for this, because they are at the start of their life, with everything ahead of them. when i think of it, it makes me very excited. i found that i didn’t learn much from clinical, and it was hard to apply book knowledge to the real thing. but once i started medsurg, i started to understand more of why this?, and why that?, or how?. i’m glad i didn’t do er. i know that i get stressed with too much emergencies that are “unexpected.” and i like adrenal sometimes, but definitely not addicted to it. i like how nicu has it’s fast and slow times. i still dislike med/surg nursing. it’s only bearable, i know, because i like taking care of the patients, and my co-workers are a joy to work with. i think i will love and feel so rewarded by being an nicu nurse. because then i will know that i am saving a life that is not meant to die, or is not it’s time to die. and that’s the reason i went into nursing.

Don't quote if you're just here to put me down, in order to exalt yourself.....

Sorry, you got the wrong idea....I'm definitely not a "princess." I find that I'm those nurses who slave over their patients and I do it because I love them and care for them. And it does make me feel good to do things for them. Med/surg just isn't for me. Your post seemed rude to me. Ummm....why would I tell all this to my interviewers? I'm just letting everything out so those who know about ER or have advice can give it. [are you always so scattered? I am not sure how old you are, but you have an awful lot of opinions that you have expressed during your short posting.] Ummm..thanks for making me feel like bird-brain....that was exactly what I've come here for! I'm not a child if that's what you think.... I said above I'm done with school and have taken the boards.... [keep your past knowledge how things should be done to yourself] --wow, I guess ER nurses do not have their own outspoken opinions... I don't know what more to say...I've already said it.

maybe you can start by desensitizing... for example looking at pictures of vomit everyday and trying to get used to it....testing on smelling vomit..and so forth....

i think icu is too boring…too much intense focused….it’s just not me……i don’t know…i enjoyed tele though….i love tele but the tele floor at the hospital that i was once at was a mistake waiting to happen….everyday i’d walk into to take reports and find that every morning i check meds…there’s always mistakes…somehow every nurse before me has not cross out dc’d meds from one-two days before….they were still being given…..it just throws me into a panic…because they’re heart patients….poor me….i felt so sorry for myself because it was difficult trying to learn new meds, and time management…and there i was….wasting time every morning fumbling through all the old physician’s orders to see when the meds were actually dc’d…..that was me every single morning….it just drove me crazy! i’d find dc’d orders that was crossed off as “dc’d”…but in the mar they’d still be there…and most times were still being given last shift….arrgggg! yep…i couldn’t deal with that. too bad i really liked that place. other hospitals are too far…and i don’t know if i want to go that far. carachel2…..i know, nurses don’t really do that in er…but i kind of like that kind of “skilled” environment…. i know that some emergency nurses out in the middle of nowhere do it sometimes. and they’ve had some kind of emergency training. i just kind of like the way the er nurses know what to do when someone codes or something. they’ve faced it so much that it has actually become good skill. emtb2rn………yeah, i don’t think i’ll be flying on my own…but some rns in the er do expect you to know everything….even though you’re new. what i meant by an emergency sending me into the books thing was that i get excited when learning how to deal with emergencies (people bleeding, coding, unable to breath, snake bites, anything that causes the nurse to act fast)…….so that i’d be prepared when it comes…….all the other things i do…but it doesn’t excite me…. mlos….lol…i’m an liscensed rn new grad. [lack of confidence is pretty common for brand-new nurses. my preceptors routinely told me it would take a year to feel competent and another 1-2 to feel confident.] yeah…tell that to the preceptor that i’ve had. [not sure i understand this at all. you're saying you want to work in an er environment but an *emergency* sends you ... to your books, and not to your patient?] no, no…what i meant is that it actually makes me excited and want to be prepared for it….i want to be able to know what to do in case of an emergency…not going to my books in a middle of an emergency…that’ll be a disaster. ["surgery" in the er is limited to suturing (which you will not be doing as a nurse), chest tube insertion, and, in my experience in a level i trauma center, very, very occasional thoracotomies and chrics. there are things you'll do to assist with these procedures, but you will not do them yourself.] yeah i know….but i can at least see some of the exciting stuff. [i think confidence is gained from providing great care to the best of your (gradually increasing) ability day in and day out, more so than the occasional moments of "glory."] this is so true. i feel that if i want to be an emergency nurse in some third world country or serving victims in a mass casualty or something, i at least should do some er nursing to prepare for it. [my suggestion: try to set up a shadowing experience with an er nurse. think through specifically why you think you are better suited to the er than a med-surg unit.] uhmmm….i’ve been on med/surg for two semester of clinical, and forced myself to do a third clinical rotation there because i knew i hated it, but needed the skills. i don’t know what drives me crazy about it….i just hated it. not really hating the care of the patients, but just everything else that goes with the environment….most of the time i feel like a robot just filling out paper work instead of being with my patients. medsurg is soo stressful….no, not really because of the care…something in the environment is just not healthy….one thing that gets me the most is co-workers who are unwilling to help eachother….. i’d rather work in a real stressful, busy place and be supported by co-workers and know that my team has my back and know that they know what they’re doing…….than be in medsurg with 5+ patients and know that i am alone. i’ve been there three semesters…and i think it almost ruined my career. shadowing is a great idea. gilarn….. [as far as lack of self esteem, i cannot help you on that one. you need to take a look inside and find out what keeps holding you back. just like many others posted, you will need a couple of years of nursing experience before you start to put it all together.] you’re right…med/surg has left scars….i was a young and i got eaten…. jjjoy….thanks for your post, you know exactly what i’ve been through.. [then. boom, you graduate, and are confronted with being responsible for everything: several patients with competing needs, rushed mds, a ton of paperwork, etc. the newbie can see that the experienced nurses are barely getting everything done, though they're not even sure what 'everything' is. so the newbie is trying to figure out all that, and also has to juggle competing patient needs and yet doesn't yet have the experience to really be able to recognize how to prioritize.] exactly! trudyrn…..[you have an understandable fear of rudeness from teachers/mentors but the er pace requires more of a tougher skin, i think.] uhhh…that’s because my worst nightmare of the hospital had come true…working with nurses that don’t just eat their young…they swallow them whole… i don’t blame myself, because they were rude and fearful. but you’re right when you say the er requires more tougher skin…. [maybe you're just not quite strong enough mentally/emotionally to deal with that right now and would be better off in a slower-paced setting, where people are more likely to take time to teach you slowly, courteously.] yeah, true……i just wish they’d do that in er too, so that i can at least have a chance to see if i it’s really my nitch. jjjoy….. [what setting is that? i must ask because the low-acuity settings tend to give more patients to the nurses (eg 30 patients in ltc) and thus the pace isn't really any slower and the nurses aren't any more likely to have the time, patience or inclination to teach slowly and courteously. when a newbie is having trouble adjusting, the advice is often to find something "slower." perhaps when people say that they really mean "less acute" because passing med to 30 patients, each of whom have many meds, may have dementia, can't swallow well, etc, in two hours, charting on those patients, checking notes, and running yet another med pass is not slow.] yep, i agree….less acuity places sometimes mean death….even in medsurg they expected me to know everything. one thing i hate is when i ask a question and my preceptor is unable to tell me what the answer is. it’s not really their fault because maybe they weren’t train well either….but i need to know what i should know… most of the things that screwed with my time management were not even medical related….they were just things like: how do you work this stupid machine, where are all the vs carts?, how the heck should i know how to program the blood glucose machine without being taught or given the secret code needed?, how am i suppose to give 2o po meds to a patient without overloading him with water? cuz he/she can only swallow a pill at a time with a cup of water…..and still i have to worry about my other 4 patients and possibly the lvn’s patients too…..and some patients are missing meds that are not up from pharmacy yet….and then i have to be away from my patients to chart on them 5+ patients….and there are still new orders coming in….and i have to check the charts again because we’re suppose to check or write something within a period of time…… blah blah blah i know that nurses on medsurg have to spend more time on these other things than direct patient contact…..….i hate that medsurg life....it may be a good place for others, but not for me… i can’t believe i paid so much money in nursing school…..thanks for all your comments...they really helped....