DC Collins

If nurses support this kind of legislation, it MUST include the ED. People ask how this can be done if an emergency comes in, especially when the worst emergencies sometimes involve more than one nurse: 1) Enough float nurses to cover the emergencies (and breaks, to include the 15 minute breaks, while we are at it - no more "buddy breaks", which would then violate any such ratios). 2) Eliminate "Pull Till Full" protocols where every room is filled regardless of staff availability. When an ED RN is tied up in an emergency, no more of that nurse's rooms are filled with non-emergent patients until that emergency is cleared. 2A) What if another emergency presents itself in the waiting room and that nurse's room is the only open room? See #1 3) Have a Triage RN at All Times. If there are no patients in the waiting room, the triage RN can help with tasks (clean rooms, medicate existing nurses' patients, etc.) until another pt shows up. 4) Have an "Ambulance Triage Nurse" (Whether that be the Charge Nurse, one of the floats, etc.) Just because a patient comes in by ambulance does not mean they cannot wait in the Waiting Room right along with all the other pts. Many times pts come to the ED via ambulance just to avoid the waiting room, and there are patients in the waiting room who are sicker than the ambulance patient. These are just a few changes which can and should be made. I am sure others who have more.

Yes, it sounds to me like you are getting as much of a full patient load as you can, without access to the chart (which I don't understand). DC :-)

After thinking about it, I am not sure any of these numbers have a lot of meaning. While, as I posted above, our 'standard' is three, often with a fourth 'hallway appropriate' patient, we are expected to get our patients out within 2 hours in most cases (admitted or discharged). So we are just as busy as those with 'up to 12+' each, I would *assume*. I can't imagine moving those patients very quickly when, as the math calls for, you only get to spend 5 minutes per patient per hour. YIKES! DC :)

Teams of two RNs, each has a 'standard' of three rooms, but often get one additional 'hallway bed'. While we keep our own pts, if one of us is swamped and the other isn't, we 'inherit' anywhere from a few aspects of the teammate's pt care to an entire pt or more. DC :-)

I knew someone else who had it prescribed for sleep, so I asked my doc. Doc said ok. DC :-)

Because, anecdotally, that has not been the norm, though such things do happen. I was referring, however (while failing to mention it), to more emergent things like cancer screenings when other diagnostics point toward it, organ failures, and the like. And chest pain will get me a room right away. I don't know about where you live / work, but in my ED, if I go in with the worst headache of my life, I get an immediate head CT. If something shows, and immediate MRI. Same with bad abdominal pain - CT. They find a brain bleed or clot, immediate surgery. They find seriously blocked small intestine, immediate admit and treatment. I remember reading a few years back (may have changed by now) that *all* of Canada had only as many MRIs as Detroit. /shrug YMMV. I can only go off of my experiences and those with whom I communicate / read about. DC :-)

There is something to be said for working up good relationships with family and friends and community. People in the US are some of the most generous people on the planet. Asking for help is great! Getting it even better. *Stealing* the help, is immoral, whether or not the term 'government' is involved. DC :-)

I don't find waiting 16 hours in an ED (socialized) a better system. And we do have one of the most advanced / more equipment per capita systems in the world. Waiting several months for a CT because there are fewer machines per capita is, IMHO, *not* at better system, though yes, it is cheaper. Plus, the main reason so many other nations' citizens have longer life spans is because of better health *choices* made, not because of better health 'care'. Again, IMHO. DC :-)

How old are the kids? If the school has an athletics program, encourage the kids to join = free showers? DC :-)

1) In other words, they feel it is okay to keep stealing from others because it is easier to do so than not. Anyone else doing this would go to jail. 2) But good point! Let's make the costs outweigh the benefits, or simply remove the benefits. Funny how people find a way to lift themselves up by their own bootstraps when nobody else is doing it. DC :-)

The key word highlighted above is "shouldn't". Is it smart to help your neighbor? Is it smart to encourage someone who is trying to make it? Yes to both. But "shouldn't" implies authority to *force* others to pay for it. Theft is theft, whether under the guise of government or not. If *you* believe it helping with others' healthcare, pay more of your own money. And along the way, feel free to wheedle, cajole, and even guilt me into doing so as well. But do *not* steal from others to make it happen...to do so is immoral. DC :-)

The problem is, if I understand it correctly, that *you* saw the MAR. If you have a co-signer, the co-signer *must* always see the MAR (or orders, or whatever you are working from) as well. They are signing saying that the order is correct with what you are going to be giving. There is a reason for co-signing. In cases of students, its obvious. But in my ED, there are several meds that require co-signers (Insulin, certain cardiac drugs, any peds IV meds, etc.). These co-signers, if they value their careers, must look at the order to make sure it is correct. It certainly is for the pts' saftey. Not knowing your Exact circumstances, I can't put you *or* the instructor at fault. But as for the generality, you Always check the orders, whether you are giving the med yourself, or are a co-signer. DC :-)

2 DC :)

As said above, your time-management skills will be useful. But if you get a chance, watch an ED nurse do a quick *focused* assessment. And watch one d/c a pt. Even better is if you can shadow (ask the manager(s) if you can do so on your own time) and ED nurse to get a sense of it before you even start. DC :-)

I was a fresh hire into the ED 2 years ago. Did I struggle a little? Sure. But we have had m/s nurses transfer in, some who have both done better than I did and some who struggled a lot more. ED is an entirely different world than m/s, and the m/s nurses have to have a lot of 'bad habits' (which are important habits in the m/s world) trained out of them...quickly - this is where most struggle. I know one m/s nurse who has been in our ED for a year now, and just can't get out of the 15-20 minutes head-to-toe / complete *detailed* medical history first assessment mode. This nurse also takes about 15-20 minutes to d/c pts (including d/c instructions). This nurse also charts every detail as well, such as pillow given, ice water provided, lights reduced, etc., even when not medically relevant to that particular visit. So while it isn't easy jumping in feet first, it is certainly possible! DC :)

Hear, hear! DC :-)

maverickemt is correct. EDs do hire fresh graduates (like I was), and with ACLS and TNCC you are already ahead of the game. Add in 5 years as an nurse. As long as there are openings, you should have little trouble. DC :-)

CEN is hard even for experienced ED nurses for one main reason. Each ED has its own policies, procedures, and most important, favorite drug list. I am studying for CEN now at 2 years experience and I could not pass the test yet based on the many sample tests I take. Problem is, for example, we use one set of drugs for each type of complaint. There are many drugs in the sample questions I have never heard of, and others that I learned about in school that I just can't remember enough about due to lack of using them. There are also lab questions I can't yet answer because as the ED nurse, with the doctor right there, and our computers telling us when those labs are out of normal range, that I just don't have to remember. Plus things like ABG's: the RTs hand the results directly to the doctor, and the doc writes orders based on those results before I ever get to see them. And I rarely have time to go back and look at them. So, imho, go ahead and start studying for CEN now, but only take the test once you can pass the sample tests easily, whether that's next week or two years from now. DC :-)

I agree with starting with TNCC. Its a little easier but good prep for CEN. DC :-)

*If* you have the time and money, go for it. Would it be Easier with some experience? Sure. But it should help the employment prospects if you have them out of the way. DC :-)

Love it! DC :-)

Can't deny any of that. But, pts don't always tell you everything, and, until you know those things above are Not happening... DC :-)

A lot depends on the size and type of hospital. In our case, our group has 5 hospitals in our particular region. While they all do elective surgeries, the central, larger hospital does most of the emergency surgeries, has the cath lab, etc. My particular hospital has an ED with 18 main ED rooms + up to five hallway beds, two 'fast track' rooms with a number of chairs where these pts once examined can sit and wait for diagnostic procedures or discharge. Oh, and the main ED also has five other recliner type situations where pts can be pulled from main ED rooms once initial workup is done if the main ED bed is needed for something else. This is a smaller ED than our central, trauma ED (with cath lab) is. Our ICU has, I can't remember for sure, 9 or 10 beds. I guess my main point is, small hospital with small staff. There is no 24/7 surgery so no 24/7 anesthesiologist. And, our ED is small enough that approx 1/3 of the day we only have 2 ED docs, and 1/3 we only have 1 ED doc. If that one ED doc is swamped... DC :-)

I don't deny your points have merit. But the reality is that the ED is 'the best of our resources'. Just knowing someone is having a-fib with rvr doesn't mean there is a resource available the minute the pt hits the door, whether brought in by family to the triage desk or by ambulance. DC :-)