oliveralways

I've thought about ways to get more training, however, as I said the experienced nurses are leaving. The nurse that oriented me was not a good teacher and the orientation was not very defined. What is the average orientation for ER nurses (new grads, experienced ED nurse, or nurses coming with no ICU or ED experience)?

Hello All: I am working in a 20 bed ER at a community hospital that stays steady with the typical cough, n/v, etc complaints and a good number of traumas and other emergent patients. I started about 3 months ago after a 7 week orientation (with only 3 years of med-surg experience). I am concerned b/c I don't think that I have been adequately trained and oriented to the position. Honestly, I feel as though I'm a new grad. I have learned that nursing on the floor is VERY different than nursing in the ED. I'm concerned for several reasons: 1. I was asked to triage after my 2nd day off orientation. However, my preceptor told me that the triage nurse needs to have about 6 months of ED experience. In this hospital, there is only one nurse and a tech in the triage area. 2. In a recent event, I received a patient from EMS for AMS, when I got the patient in the room, in less than 5 minutes, the patient seized and it was just me and EMS. At the exact same time we got two other traumas, so there were no other nurses available to help. We got a doctor in the room immediately, moved the patient to a trauma room, intubated and flew the patient out. However, the worst feeling was I had no idea what to do for those first few minutes. The worst part was while I was in the room, the doctor repeatedly requested that he needed a nurse in the room, when I'm standing there looking at him and he knows I'm a nurse. I'm concerned b/c I didn't know what to do in the situation for this patient and the doctor repeatedly called for another nurse. Since I have been working, I've been reading ED material, I attempt to help and be present in other nurse's trauma so that I can learn. However, what can I do to better prepare myself or is it hopeless? I'm concerned for my patient's safety and also for my license. 3. My other concern is that the majority of the seasoned nurses are leaving and all that is left if new experienced ED nurses and travelers. Any advice?? Thanks

I just want to clarify that I was not asking her to falsify documents. I told her that she can check the dosage/attempt logs to find the attempts and dosages from 0000-0400 and correct it. She refused to do that.

Could I get some feedback on these scenerios: Just some background: This is my first year orienting (3.5 years experience in med-surg). I have a regular new grad that I'm orienting, but the other night I was assigned another new grad that is about 16 weeks into her 18 week program. It was my first night with her and I had not received any information about her progression. 1. When I was coming on shift, she was helping to transport another patient. I waited for her to return to receive report together and when she gets there she asks why are we waiting on her, we could have started report without her. 2. After report, I ask her how many patients she is taking, does she have any questions, what is her routine. I inform her that I want to do assessments/rounding with her. And to please feel free to ask any questions. But just as we are about to go into one of the patients rooms, another nurse stops to ask me a question and she goes off starts the assessment. 3. I am checking her charting with her. One of her patients has a PCA pump and therefore needs to be charted on every 4 hours. However, she has a 0000 assessment and 0500 assessment. I have re-inforced to her several times that the PCA and pain is every 4 hours. She states that she didn't get in there until almost five and that is when she is going to chart it. I tell her that she can go back into the machine and find the dosage and attempts from 0000-0400 to correct it. She tells me she's not going to do that, that the other nurses told her to chart it when she did it. I explain that accurate assessment and charting of pain is important to patient safety, hospital policy, and JACHO standards (beside the point the unit just got seriously docked by JACHO for sub-par pain charting). She says I'm not trying to argue with you, but I'm not doing that. I tell her she needs to understand the needs for these assessments and charting, but she doesn't seem to understand that this isn't what you want to do, but what needs to be done. I spoke to the Orientation Coordinator about the situation and said I would attempt to orient again and re-assess from there... What is your feedback and /or advice?

Thanks and the same to you...

Hello Everyone, I browsed through the New ED Grad post, but wanted to get some feedback anyway. I have been a nurse for 3 years. First two years on an ortho/trauma/medsurg floor and the last year on a renal/medsurg floor both at Level I trauma centers/teaching hospitals. I have interviewed and received an offer today to a ED at a small community hospital and am 99.9% sure that I am going to accept it. Do you have any advice for this change? Any resources that I can read/study to become more prepared? Thanks in advance...

Hello- I've been a nurse for almost 3 years and have worked in orthopedics, trauma, and renal (in the acute care setting). There have been many instances when a patient has taken a turn for the worse and I have had to call the Emergency/Rapid Response team. The team consist of a critical care trained RN. I admire their level of skill in assessing the patient and realize that I want to learn more than what I've learn in acute care. However, I'm not sure which path to go: MICU, NICU,CCU, CIU, etc. Currently, I am on a travel assignment in an acute care setting. How would I go about transitioning? Also, is it a hard transition? Thanks

I'm not sure of any websites (it would have helped while I was in school), but there are few books the Memory Notebook of Nursing that are very, very good. http://search.barnesandnoble.com/booksearch/results.asp?WRD=memory+notebook+of+nursing Hopefully this link will work and take you to info about them.

I'll have to use the I'm a highly educated health care professional line next time.

Hey, I came out of Nursing school and went to an ortho/trauma floor, in hindsight, it was the best move. I gain a good med/surg background (a lot of patients come in with various complications) and gain a speciality (ortho) and learned a LOT about pain management. I also feel that I was more independent on the ortho floor as opposed to other floors I worked on. You get to know the ortho-pods and build a positive relationship and over time they listen. I got the position b/c I expressed an interest in wounds and research. Good luck oh, by the way...I have more than 1 year of experience...need to up date the profile :)

Hello, How do you handle that situation. I work on a renal/med-surg floor and I have a patient with left flank pain. Her and her husband are frustrated as to why the doctors haven't found the cause for the pain. He is certain it is kidney stones. I'm attempting to explain to the husband that tests are being done to verify the exact cause for the pain to ensure the best treatment. The wife says: "She's just a nurse, she doesn't know anything about kidneys." Okay, this is my fourth night with the woman. She has been demanding, rude to everyone (including her husband). I just smile, look at her and say "Thank you for telling me what I do and do not know" The patient responds by crying out that her pain just got worse. Have you heard this comment and if so, how do you respond, if at all?

Thanks for the responses everyone, at this point and in the short hind-sight, I know that I did everything correctly. I was contracted to the hospital, so the following morning, when I did go to occupational/employee health, I was told that they(occupation health) could not see me or do anything for me. I did immediately call my agency and they filed me on their worker's comp. If I hadn't gone to the ED immediately, I would have to have gone about 12 hours after the incident to the ED or find a clinic/doctor in a the area. As far as my assignments, I gave my 5 patients to the charge who had no patients. I had assessed the patients and ensured that they were in no acute distress. As nurses we should support each other,not become ****** when another nurse is injured, however slight it might appear. Have you ever seen cellulitis and MRSA wounds that take weeks of IV antibiotic treatment, that came from a scratch? It's very serious. I know that a nurses we provide a service, but have to protect ourselves just as much. Thank you

Here is the situation: During my 7p-7a shift, confused pt becomes combative when myself and care partner are trying to help her to the BSC. I reached out to help her and she grabs both my arms and scratchs me (took off the skin, small bleeding). After the patient is safe per security, family, and doctor intervention, I become concerned about myself b/c then it dawns on me that this is a VRE and MRSA positive patient with a history of alcholol and drug abuse. I've only been at this hosptial for 2 months, so I start asking how do I fill out an incident report. Everyone gives me the blank stare. I eventually get an incident report. I call the charge nurses giving end of shift report, they tell me that they have to page the house supervisor and they'll be out in about 20 minutes, but to wash my arm. I believe that is too long, therefore I call the house manager and report it, then go to the charge tell them what has happen, give my 5 patients to the charge and go to the ED. I'm in ED for about 4 hours, return to the floor and take my patients back. Was a scratch worth the report and ED visit? Also, during this event the charges never stop report to assist (the patient became very combative needing security, a call to family who rushed in and the md)

Hey, I don't know much about Norton or Jewish. I just left an assignment in Louisville at Baptist East. It wasn't bad, they (Baptist East) are moving into a new tower, lot of growth there. Good luck

Hey, I just started traveling after about two years of med/surg/ortho experience. I haven't had the offers that some of my fellow nurses with more diverse experience. I have accepted one more assignment and afterwards am going back to the floor for more experience. More experience does work in your favor and gives your more opportunities. Also, as a traveler, you are hired to know, not to be taught. I would get more med/surg experience. Good luck