ERGirl83

In an ED with lots of frequently visiting friends, I see my share of patients who are clearly not in the department for actual medical emergencies, but for an acute narcotic deficiency. And the nursing theorists can pretty much shove their "pain is whatever the patient says it is," hoity toity crap. When a patient's DOPL is longer than the last book they read, with twice as many authors (prescribers), and they've been in my ED more often than I have in a given month, it isn't hard to put two and two together. It used to bother me too, and not just in an altruistic sense, either. The waste of resources, use of a bed, staff time, it really got to me. I used to be furious with the docs for pandering to their demands. But, now, I figure that the longer I drag my feet and cajole the doc into ordering Toradol or Nubain instead, the longer this song and dance goes on. Not to mention the more work for me. Now, I look at Dilaudid like my diamond, a girl's best friend. Because I can give it, they shut up, and after a thirty minute narc watch, they are out of my hair, off that bed and not continuing to waste any more of my resources. One visit with me was never going to solve their problem anyway, no matter how many community resource sheets I hand out or crisis Evals I recommend. Might as well treat 'em, street 'em and move on to someone who actually needs the help. That's not to say I won't stand up and hold my ground when the doc holds his, or helpfully inform a busy doc that this is a patient's fourth visit this week, and the last doc clearly put a no further narcs order in his/her chart, but I no longer fight a losing battle, or waste any more of my time worrying about my contribution to their addiction. I didn't prescribe it, and as long as they are clinically stable I have no reason to argue about the order. If I don't give it another nurse, either in this facility or any of the other ones nearby will. The sad truth is, you can't win 'em all. Now, that being said, if someone truly wants help, I'm happy to oblige. And I do all of this with my best nurse face and impeccable customer service. There are no throw away people and everyone gets the same courteous care from me, regardless of what I really think of their motives or life choices, lest you believe I'm one of those...

Pregnancy shouldn't be a get out stinky jobs card by any means. But transferring a bariatric patient? Yeah I'd probably decline that too. I work in a busy ED. I worked up until I delivered at 37.5 weeks. I did virtually all of my duties, but I declined to participate in reductions with fluoro or transferring/repositioning obese patients. I also stopped seeing rashes as many turned out to be shingles. I had supportive coworkers who were more than happy to step in. But if I had used it as a trump card or some sort of excuse, I wouldn't have expected such kind responses.

Concealed carry? Ha! I'd be happy if our facility just implemented on campus security 24/7. They open carry, and that seems much more effective. I am a proponent of concealed and open carry (when done responsibly), but don't personally own guns. I just don't trust myself to own and carry a loaded weapon in a safe responsible manner. I'm sure I'm more likely to kill myself than defend myself. But, as an ED nurse working all over shifts in an understaffed department, I recognjze how unsafe we really are (even if admin does not) and if I found out another staff member was carrying, I'd be more likely to thank them than report them.

I hate these. I get a different temp every time I use it. A variance of 1-3 degrees. A huge deal. If I have a patient I'm really worried about I use another method no matter what.

I voted ER (and not just vecause I'm biased ��), but man, 2100-0900 is an AWFUL shift. I work a lot of Noc but shift change has always been 0500 or 0600. I've even heard of 0700, but never 0900. It's so far into the next day that it would be very difficult for me to get to sleep at all. I definitely wouldn't like that shift. In my experience (and yes, I'm biased), the ED is really a great jumping off point to ANY floor, and especially the ICU. You get your foot in the door in every department of the hospital, you take care of a little of everything from primary care to critical care, from newborn to geriatrics. You interact with virtually every department in the hospital from radiology to lab to all of the inpatient units, respiratory. At this point in my career, I could probably get a job on any floor in my hospital. The only exception might be L&D simply because the ER shuns all real preggos! Although I think ER skills would translate well to a busy L&D unit, it's just the unit we interact with the least in the hospital (and obviously Mother Baby as well). The ER has been a closed department at every facility I've worked, but we will often be asked (never forced) to float up and cross train to ICU when they are short staffed. And when we are drowning and they are slow, ICU RN's come and help us out. ICU is the department we are closest to, so it's very realistic to expect that a start in the ED would help you transition to ICU at some point. At least in my experience.

Today's shift was 13,882. And that was a day shift. Swings are way more!

I'm not sure what kind of facility or department you are in, but I would absolutely not tolerate being treated inappropriately for any reason, least of all patient satisfaction. I work in a busy ER. People are not at their best. Even the best of people can be rude. And the worst are downright belligerent. When it gets to that point I simply say something along the lines of "I am happy to give you the best care possible, but the way you are speaking to me is unacceptable and will not be tolerated." If it escalates from there, I contact security. My manager has our backs on this one. And so do the docs. You aren't required to be anyone's punching bag.

Oh, and yeah pay is much lower here than many expect. Expect to start around $21-22 an hour.

Utah is still a tough market for new grads but it has opened up quite a bit since I graduated 2.5 years ago. If you want a hospital job, unfortunately a lot can ride on "who you know," but it's not impossible either, just highly competitive. There are plenty of home health, LTC and LTAC options too.

I licensed in June, and got my first job (in my desired specialty) in October. And that was with 1.5 years of tech experience and 1.5 years of EMS experience. The market here was really saturated with nurses and there are still some underemployed RN's from my class over two years later. The market seems to be loosening up for new grads around here, but still tough. Keep on trying though, be persistent and don't give up!

I'm an ED nurse. We give telephone report to the nurse on the floor. In my current facility, we personally transport ICU pts to the floor so they get a short bedside handoff too. We also print off an SBAR sheet which is kind of a visual snapshot of important data. I'm a big fan of a good verbal report. I think it fosters patient safety and ensures continuity of care. Especially if your charting system is crap. Not providing a verbal report with the chance to ask and answer questions seems dangerous to me. That being said, what I'm NOT a fan of is getting the run around from floor nurses who sometimes act like they are my boss and many times don't really understand what we do down here either. I try to give a thorough report, hitting everything pertinent to patient care and transfer of care. Even if it's in the chart. CC, Allergies, IV access and fluid status, pertinent lab and imaging results, meds given in the ED, any important miscellaneous info like if it's going to take three people to get them out of bed or that you may want to 1:1 this person if their family leaves, oxygen status, etc. I absolutely don't mind being asked a few questions. We are all colleagues, trying to take the best care of our patients. But, please for the love of all that's holy don't ask me about a skin assessment. Don't know. Didn't do one. Not going to do one. The skin I saw was fine, if it wasn't I would have told you otherwise. It's focused assessments down here. Chest Pain does not equal get naked and let me inspect your skin. Pain control? Their pain is as controlled as I can get it with the orders I have. Will you have to give some meds when they get up there? Maybe. Am I going to park them down here until they are sitting at a two when I have a full house and 10 people in the lobby? Again, no. While we are on the subject of orders, let's go over them, at my facility, at least, ED nurses are responsible for ED orders. That is, orders placed by the ED Physician. In fact, I can't even see most of the orders the hospitalist puts in from my screen, nor can I pull any meds from my Acudose once the patient has been officially admitted to the floor. Getting snotty with me that he ordered something that's not done doesn't help anyone. If a specialist consultant puts in or gives me a verbal stat order I do that. But, beyond that, ED orders are my orders and admitting orders are floor orders. I do try to anticipate common and obvious orders, though, and ask my doc for them. Femur fracture? Hey doc, I'm gonna place a foley, ok? But, sometimes we are busy, and I have two other critical patients, the patient didn't have to pee, I didn't have an order or even a second to think about it and yes, they are coming up without one. I'm sorry they aren't as nearly packaged as you would like. They are much better than when they came to me. And the delays on taking report kill me too. Don't get me wrong. I get it, you have 4 other patients and may have stepped into a room, maybe you're doing a procedure. No biggie, call me back. Only, really, call me back. Not in 45 minutes either. Just got an admit 35 minutes ago? Sorry, that sucks. By the time I get back downstairs from dropping this guy off, and break down my chart I'll have one too, oh and two more at the exact same time since I had two dispo'd while I was upstairs. It's just life. We have to roll with it sometimes. If we are (by some miracle) slow and I have extra beds, I am more than happy to sit on a patient for a half hour or so, but if we have people stacked to the hilt? Sorry, I've got to come up. And again, because I can't access meds or orders for an admitted pt, this would not be good for any of us to happen long term. Also, shift change admissions. We all hate them. I get that it sucks for you to take report on a pt you will have for less than 30 min. It sucks for me more when I agree to wait for the new nurse who is supposed to take ED report first, but instead takes floor report first and refuses to take ED report until damn near 1945. And then gets annoyed that they are getting report from a nurse that's literally never met this patient because I've gone home. For the most part I get along great with the nurses upstairs. I try to do my part to make the transition of care as easy on the patient and the nurse as possible. Code brown in the elevator? I'm happy to stay upstairs and help you clean it up even when I'm busy. IV blew right before we came up? Happy to help start another. Even when you have two techs and I've none. It's just the courteous thing to do. As such, I don't have too many issues. But, occasionally I get attitude from nurses during report, demanding details we simply don't delve into down here and then being downright condescending when I explain why I either don't know or haven't done something. It's frustrating, rude and doesn't help anyone. As as far as some of the previous posts, I cannot imagine a pt being admitted without baseline labs, and IV access of some kind. What kind of work up or treatment can have been done to even determine a need for admission without it? But again, some of that is on the providers as well. We can only do procedures we have orders for. I hope though, that most of us are assertive enough to say, Hey doc, I'm going to put in a CBC and CMP on this guy. Anything else you want? I firmly believe doing three shifts with a nurse from another floor would help the animosity that accompanies report sometimes. A facility I used to work for required ED nurses to spend three shifts upstairs and floor nurses to spend three in the ED. This way each nurse had an appreciation and a basic understanding of what the other goes through and why things might be the way they are. It helped morale and report issues A TON

Actually, chare, I did take the final exam and complete the skills practical as a student. I received a completion certificate but not a certification card.

You can audit the course as a student, but you cannot certify. I audited it my last year of school because it was fun (I'm weird), but I still had to retake the course after graduating and passing NCLEX.

Maybe I'm the minority in this post, but I don't think you can ever have too much education, and I don't think you should have to apologize for your drive and ambition. If you've got the time, and you're investing it in learning something you are passionate about, more power to you. Passionate, proactive people are (or should be) a manager's dream. I do agree that each resume you submit should be specifically tailored to that position and should include only certifications relevant to that position. But that is easy to do and shouldn't stop you from pursuing your interests either. I think you and I are kindred spirits. I audited TNCC while still in nursing school, and attended a CEN review course during my final year of nursing school too. I paid for them out of my own pocket because I was interested, excited and had a drive to do more. I can't tell you how exciting it felt to walk out of my regular nursing school courses, which were so boring and barely grazed the surface and to walk into a class and spend hours learning sometime I was passionate about. I was so energized after each experience. I knew I found my niche and I was hungry for any learning I could get my hands on pertaining to it. It didn't make me less of a student because of it. If anything, it made me a better student because I found my passion, what was worth working towards for me. Because I was EMS prior to nursing school, I had ACLS, and PALS on graduation. I also included my TNCC audit and CEN course on my ED resumes as well. I landed an ED job as my first job out of school and I am positive (because my manager told me so) that my proactive investments in ED specific education despite my lack of RN experience landed me the job, over nurses with some years of med surg experience. I work in a suburban ED with very little trauma. I likely won't leave this department for a very long time. I still plan to take ATLS and CATN when time permits. For the simple fact that it fascinates me and I love it. I say find what you love and go after it. If it's something you have time for, and you can afford, you'll never regret the extra knowledge. And at some point that drive and ambition will help differentiate you and land you your dream job. Sometimes it seems as though ambition is a dirty word in nursing. This should not be the case. Sure, do a great job in your current role, but keep doing what you need to to get where you want to be. No shame in that.

This post makes me grateful to work in a closed unit!