granite109

I would be lying if I said I didn't throw a few back with my colleagues, docs included. I have seen, however, nursing management get absolutely plastered and talk shop with those that he/she supervises. I know there is role definition with CNAs, RNs and docs, but I'm wondering more about true administrative personnel, those who control raises, schedules, promotions, etc. You know, those persons that are no longer a part of the clinical team; their job description is clearly administrative leadership, not clinical team leader.

Congratulations! I remember when I got word. Gives me chills just thinking about it! It's a blast, the bet job ever, oh and nomex makes everyone look good-lol! Best of luck and fly safe!

Just wondering, how does everyone feel about management drinking with staff? I always felt it was bad practice, especially when shop talk came up. Even if the manager doesn't participate, it seems to lend itself to some nepotism and others feeling victimized or left out. Any stories to share, input, opinions?

We've been through a lot of change where I work. We have had some very dynamic leaders and some, well, not so much...I'm not sure how your department is run or structured, but I imagine like most EDs, that it is terribly busy, no one gets breaks on a regular basis, you have boarders for days (many unit players, too), the doctor's offices dump on Friday afternoons, and the staffing stinks. Oh, and let me guess, the floors complain constantly and avoid taking report even though there are 25 inthe WR and an eight hour wait. Been there, still hanging out... Anyway, I have found that the most important thing is that the staff has a voice. The traditional model of nursing and hospital management is not working. At some point, a core charge team was developed and implemented. This gave us some leadership opportunities and skills we had a part in decision making. It's really just an extension of the shared governance model in so many leadership courses. When the medical staff made a decision on how to run the dept without nurse input, they actually got told about it! It didn't solve all of the problems, as there will always be some even in the best of circumstances. What it came down do was that the nurses became empowered to do what it took to get their part of the job done. Bed management and patient flow became an initiative for the entire hospital. We had a manager who gave us a voice and stood up for us. If you have a lousy manger, it's a long road. I feel your pain and wish you luck!

About 3 years ago, our institution initiated the airway cart. It's like a code cart with the drawers and all. All of the RSI meds are in there, the standard ETTs and laryngoscopes; in addition to rescue devices; including the LMA, combitube (or King LT), and a Rhino brand trach tray. We have the lighted laryngoscope and the lighted stylet. They usually go to a trach instead of a cric in the ER; but we do cric in the field. It's certainly less than optimal; as the previous poster stated, hypoxia has usually set in by then and it's badness. On a difficult airway, anesthesia usually gets called if the patient can still be adequatley ventilated, rather than using a rescue device. However, more and more, the literature is supporting less attempts at ET intubation if difficult, and earlier use of the rescue airway. It's a paradigm shift, so it will interesting to see what transpires. When all else fails, a BLS airway still provides oxygen!

Good for you! Wishes for success and satisfaction!

Ugghh! The penalty box of triage is bad enough; when this happens it's a game misconduct! No, it's not just tourists, vacation is just the excuse for not having the info. I have tried to make use of this teachable moment and tell my patients the importance of carrying a med and history list. We started giving out the preprinted cards. If time allows, I fill them out so to make it a little easier and it strokes the patient a little bit, which makes them happy. I agree that it is a public health issue. It would make a great project in Community Health nursing. Not just passing out cards, but maybe a PSA during the local news or something. It would be cool if someone went out the the senior centers and handed out and filled out cards during a BP screening or something. (I know, it's not all seniors, but a lot are and it would hit a lot of people in one shot!) BTW, is anybody's ED involved in community service? I've tried, but no one seems interested here!

You can do this! If it is in your heart, than you must! Your kids will be fine. As a matter of fact, pursuing your dreams and being happy is probably the greatest gift you can give them. Of course, you must make sure their needs are met, but I am sure you will. Kids adapt, and happy parents make happy kids! Please don't fall into the trap of feeling they will suffer if you are not there 24/7. Many successful well adjusted kids and adults had parents who worked or were in school. It's the relationship and investment you have in them that matters. If you value them, they will know it. It is a balance that you and your spouse will have to work out and cater to suit your values as a family. Be confident in what you choose and tweak it as needed. On a practical note, as the other posters stated, speak with an advisor. The CNA is not necessary at this time and would probably just delay your goals. I would HIGHLY recommend taking your prereqs first. Then when the time comes for nursing classes, you can concentrate on them. Many L&D units will then higher you as a second year nursing student. They can get to know you and you can may be able to be hired as a new grad depending on the facility. Also, by taking your prereqs first, you can be a part-time student and the adjustment will be easier on your family. My guess is that your kids will be amazingly proud as they grow older and watch their mommy help others and take care of them. Kids are awesome at that kind of stuff!

This topic, while heated, brings up many important issues. In my experience, ENA has historically been realistic regarding ratios and considering the CC component. On an academic note, it seems the term, 'critical care' is an umbrella term, and therein is the problem. Where I work, we have 9 ICUs. Medical, Surgical, Trauma, Neuro, Acute coronary, Open Heart, Burn, PICU and NICU. With the exception of MICU and SICU, each one is highly individualized. It's highly doubtful that a career NICU nurse can drain a ventric or perform interventions on a Licox reading of 18%, with a pyretic patient who has good sats and an increasing ICP. Conversely, you wouldn't see an Open Heart nurse touching a newborn! When specific skills are named, it excludes everything else. The hospital setting has historically been territorial and competitive. Perhaps the issue here is the lack of teamwork and comaraderie among nurses. Each unit is its own unique place with its own unique skill set. Heck, different ERs have different skill sets. We are a pediatric trauma center, so we see a ton of sick kids. Our sister facility sees a ton of clinic kids. Each one is so unique. It seems to me that CC is less based on specific technological skills, and more on critical thinking and a mindset. Of course, ICU nurses have a depth of knowledge about a specific area that the ER is precluded from due to volume and a diverse patient population. However, to state that it is not a critical or acute care area is ridiculous! It demeans the work that is done and the skills required to function well in a busy ER. No, not all ER nurses can handle those patients, they turf it to the ones that can. Not all unit nurses can handle their patients either. Either you have it or you don't, regardless of the unit title....and I shall extract myself from the floor of my soapbox!

I would recommend the Classis or Classic II also as a starter. They are lightweight and the earpieces are nice. The Cardiology III or Master are excellent but heavy and pricey. Also, they often get stolen!

I work for HUP and they do require a BSN. I am not sure about Pennsylvania Hospital. Considering they are both part of the Univ. of PA Health System, it may be a problem. Jefferson, Temple, Hahnemann, and Einstein do not require a BSN. Starting salaries in the city are hovering around $30+ per hour. Don't forget though, there is a 4% city wage tax if you live outside of the Philly limits, and the parking is exorbitant! Abington pays considerably less because it is in Montgomery County; no wage tax and free parking. However, Abington has one of, if not the busiest L&D unit in the SE PA area. They also have a great NICU. It's a nice hospital with tertiary services. Not sure where you live or if public trans is available to you, but there is a lot to weigh out besides hourly rate. HUP is a world class research facility with deep pockets and has almost every service known to man, plus they are next to CHOP. If you love peds and get into CHOP, you can go anywhere. Also consider what you like about L&D. Do you like high risk? If not, Doylestown Hospital and Grand View Hospital are well financed suburban institutions. They do, however ship out most high risk pregnancies. I know Grand View will even ship out placenta previa's; not sure about Doylestown. St. Mary's in Langhorne is also nice, but they have lost a few services in the past few years. It's a lot to consider, and your first decision may not be the right one, but I'm sure you'll find your way. Best of luck!

Emmanuel- Very, very valid point, thanks.

Best Wishes to you on your final! I have an AAS in Chemical Technology and have found the concepts extremely useful in nursing, especially in cardiology; ie sodium-potassium pump, conductivity, e-lyte imbalances, etc. That being said, I have yet to use those pages of formulas you and I know so well in 7 years of nursing. The concepts are what is important and it sounds like you have a good handle on them. It just stinks that you're GPA will drop a touch. Good luck!

OK, this is an old thread, but I feel a need to clarify, so please indulge me. My first post on this thread was apparently inflammatory. That was the opposite of my intention, so my apologies for my inability to express myself. So....let's take 3 of my described traits and hypothetically theorize. I have noticed that many of my patients are women and homemakers and generally 35-45. (Even if inaccurate, just go with me here for academic purposes) Is it possible that there is an agent in the home that the victims are exposed to, causing the symptoms? For example, let's say that in 1985, Proctor and Gamble, Kraft, or whoever, came up with a new, innovative product. You know, stain remover, tongue tattoos, hand lotion, whatever...this new product is all the rage. Everybody has it. Now, 22 years later, there are a bunch of 47 year old women with fibromyalgia. Is it possible that the common products used by homemakers of the day caused these problems? Maybe it's in the fast food fries or the milk or the bottled water or the pesticides used on the fruit and veggies, who knows? Epidemiologically speaking, similarities MUST be observed and the patient must be described accurately. Trends in symptoms CANNOT be ignored. Why are most FM sufferers women? Is there a hormonal component? Yes, you will proclaim my ignorance again, but we know that PMDD is caused by the hormonal drop just prior to menses. Perhaps all of the female FM sufferers were on the pill and it is a late side effect. Perhaps they all had an epidural an intrapartum. Who knows? Why aren't there an equal number of male sufferers? Is testosterone a factor? My point in my original post was that I have seen a trend. In my small microcosm of the universe, I have seen the same thing over and over again. Maybe it's just a coincidence, but that's what research is for. I have MVP and hypoglycemia (DM runs rampant in my family). However, I feel that the FM diagnosis is inadequately studied, which is a disservice to the patient. A lot of FM symptoms are chicken or the egg issues, and we need to study more. It's the only way to make progress and help our patients. So, I stand by my position on demographic similarites. When diagnosing a patient, we must look at the whole picture and maybe we can perform a root cause analysis and maybe even find a cure! Let's hope!

My sincerest apologies for coming of offensively-that was absolutely not my intent!!! In fact, my intention was just the opposite. There have been studies correlating male pattern baldness to heart disease, apple shaped bodies have higher incidences of MIs, etc. I have noticed a pattern. Is it possible that there is more to the picture and certain traits correlate to certain conditions and symptoms? Mediterranean women actually were the first to have Kaposi's Sarcoma. Not a generalization, but a statistically relevant correlation. Light skinned people get more skin cancer, African Americans have a higher risk for HTN. I am NOT talking about the elusive gay gene, and I take exception to that reference. I am not calling anyone a hypochondriac, as many others have, in fact I am making an apparently weak attempt to advocate. I am merely stating a pattern I have seen where I work-for real. It was not intended to be derogatory. So many people with FM get blown off, perhaps there is more to the story and a new diagnosis is in order. Is it possible that because most sufferers are women that the research is not being done? I have seen similar traits in my patients and I wonder if there is more to the story. Perhaps I did not articulate it properly, but similarities in patients are noteworthy. I am sorry if you disagree.