kimmie4476

Thanks for a starting place, I was getting no where

Hi all, I am trying to find some peer review articles or any data on the safe minimum number of nurses in an ER. My ER is a 22 bed level 3 trauma center with an average census of 80-100 per day. We have no policy stating the minimum number of nurses needed to be present at all times, and as charge, I'm pressured every day by administration to put nurses on call. I feel ok with 3-4 nurses (including myself) at all times, but they are wanting me to work with less (when I started, we had 5 nurses and 2 techs at all times) most of the time we no longer have a tech and are working with less than 4 (including myself) I'd like to present my director with some evidence to suggest what is safe. I'd also like to know what you guys are working with and consider safe even if you don't have a peer reviewed article or statistics thanks!

If I have someone who tells me they are feeling faint, or that they normally faint with blood draws, the first thing I do is whip out an alcohol pad and stick it under their nose and tell them to take slow deep breaths. This also helps wake them up if they do faint.

Make sure you know the assessment process and practice saying it OUT LOUD. They will go over most of the book in class, so you can take good notes there, but KNOW THE TRAUMA ASSESSMENT. You will only get about 30 minutes the first day of class to practice it and then tested at the end of the second day. There are assessments in the back of your book along with interventions, study those

I can answer some of these questions. A little background....I got my LPN in 07 and my RN in 09. I have worked the same hospital as both an LPN and through school for my RN. 1) In my hospital, when I was an LPN, it was 1RN and 1LPN for up to 12 acute care patients. I did all my own assessments and meds, the RN did all my pushes. All my partner RN said to me after I got my RN was "you get all the blood transfusions for the next couple of months lol, you owe me :) 2) My advice to a new RN, "you are not too good to empty the bedpan. Never say "that's not my job" because teamwork is imperative to being able to take great care of your patients and I prefer to lead by example. Look up all your meds. 3) The hardest part for me was even though I had been managing my own patient for 2 years, all of a sudden "I" was the RN and I was scared to death. It was the same job, the same people, but all of a sudden I was a scared rabbit 4) I absolutely feel that I had a "leg up" by having my LPN while going through school for my RN. I was already the IV and Foley queen, most nursing tasks I was already really good at, so I could focus on the learning and really enjoy lectures and clinicals instead of fighting other students for skills opportunities 5) Responsibility 6) The same as above 7) Just kept swimming :) Sorry, can't answer the rest, have to get back to work :)

Wow, this is great! I for one am horrible at interviews because I am so shy. On the positive side it keeps me in the same position for many years which looks good on my resume :)

It really doesn't matter what anyone else does. You are responsible for what you do and for holding yourself up to your own standards. You have to find a way to keep your full assessment and fit it into the time constraints you will be under. Now, it might take me an entire shift to do a full assessment, as I also do it in bits and pieces (heart lungs belly edema at the beginning of shift, then skin when you help them to the bathroom, pupils whenever you are talking to the patient etc.), but they get the full assessment. I don't chart on anything I haven't seen, instead I chart "Have not witnessed at this time" or "unable to assess", then when I do actually assess that part, I go back and chart it.

Yes, it wasn't requests that they were calling me for, it was because they were critical and in addition...anxious about it so the thank you was for getting her through the anxiety...talking her down etc. No, I'm not a new nurse and it's not a honeymoon period....thanks people for taking a positive thought from me and turning it negative.

Had a really rough night at work...one patient in particular ran me ragged all night...so much so that I was begging the other nurse to just answer their call light once. Then, just as I'm about to leave, there goes their call light..."okay, just one more time" The patient grabs my hand and says "I just wanted to say thank you for everything you've done for me tonight, you've made this much better for me" awwwwww, okay, I guess I'll go back tonight :redbeathe

Take away the "That's not MY patient/job" mentality. Everyone where I work answers call lights regardless of whose pt. it is including the ward clerk and DON. It only takes a second of your time to see what the patient wants/needs and relay that to their nurse/CNA. This isn't a directive from above, it's just the mentality our staff has here. I know that whenever I am precepting someone I always instill this into them, and even if we get "seasoned" nurses that are used to letting someone else answer their call lights, we "guilt" them into participating "Oh, YOUR pts call light was going off for quite some time, I stopped what I was doing to check on them and they would like pain medicine now."

I'm lucky in that our hospital uses the disposable kind and we have an abundance of them. Our DON who is extremely budget conscious (tight with the money lol) Says they are actually cheaper than trying to sanitize the reusable ones. We encourage pts to take them home and if they don't, we save them (unofficially) for the homeless shelter

I started as an LPN on my floor then became an RN on the same floor...no one had a problem with it but me lol, I was the only one having to make the change from an LPN mentality to an RN mentality. (That and the fact that I didn't get any orientation or preceptership afterwards)

Thanks for posting this, everywhere it says that the cover letter is the most important part of the resume, but all I've ever been able to find are generic ones that never really fit me...yours has given me ideas of what a really great one looks like! Kudos!!!

My In addition to studying content, maybe try reading up on test taking skills. I think that a lot of times when a person has taken the same test over and over again, it has to be something with the WAY THEY TAKE THE TEST. After all, you passed nursing school the same as everyone else did, learned the same stuff that everyone else did, but yet when you take the same test on the same stuff as everyone else did, you failed. Try going over test taking strategies really well before taking the NCLEX again, or before even doing practice questions from your study guides again and I bet you get more questions right on your practice questions than before. There are numerous resources on the internet for test taking skills and in the Kaplan's NCLEX-PN study guide, there is a chapter titled "there's more than one way to skin the CAT" that was one of the first things I read in nursing school and it helped me immensely even though I was already a really good "test-taker"

regardless of what the other nurses say, always assume your patient can hear you. I had a nursing instructor who developed sepsis and was coded 3 times, was in ICU for awhile unconscious, but she heard and remembered everyone who took care of her, the good ones and the bad ones. She was sure to let administration know who were the good ones and who were the bad ones. I always picture myself lying there, helpless while someone is roughly pulling me this way and that way, talking about how I am worthless etc. and imagine how that would feel.

I think maybe there are different degrees and types of photographic memory, I too can "see the page", I can also remember every single word of conversations, picture exactly where everyone was standing and who said what which my husband HATES (you stood in that corner and said HFUFUFYU and I answered back KJIGIVUFUfgy, then you said IGUIGGGY, etc.) lol, I can also "see" the steps to procedures after I have done them once, but tell me your name and I will forget it 2 seconds later (I guess there's just not enough room in there lol) I've always been this way, but there ARE books that will teach you how to visualize. (most of them are metaphysical though) Maybe you could buy one and try it out, if nothing else it will teach you to relax and meditate

I worked as a waitress after school and on weekends during pre-reqs and the first year of nursing school (lets you make the max amt of cash in the fewest hours and truthfully the skills will come in handy lol), then got my LPN and worked days Fri Sat Sun (12hr shifts) during my RN year. Not working was not an option for me. By working only the weekend, I was able to get all of my schoolwork completed during the week. Even though I didn't have a day off (except during holidays) I learned to take my time in hours, like I have 3 hours free right now, so I'm going to do something for myself, THEN get those dishes done. I woke up early and stayed up late. I told my family that they would have to pick up the housework slack ( and then you have to let it go if your house is not perfect) and not to bother me if I was on the computer unless it was an emergency, then I would spend a couple of free hours with them. I carried my books with me everywhere I went and grabbed all free chances I could find to study. I taped lectures and listened to them while driving. It's hard, and you will envy your classmates that live at home with their parents talking about what they did on the weekend to relax lol, but so worth it when you are done.

I don't understand.. the patient was holding a medicine cup and syringe when the first nurse arrived on scene... what was the student nurse doing in there? was the student nurse the one that called for rapid response? How did the pt get the syringe, and what was in the medicine cup? was it empty? any residue?. From what you say, it appears that the pt may have "self medicated" or did the student nurse give the pt anything? So, yeah, the pt may have given themselves an air embolus while self medicating, but maybe what they self medicated with caused them to code. There is just too many questions in this scenario to answer as to what went wrong. I think it would need autopsy results to know what really happened.

The character of the nurse is as important as the knowledge she possesses." ~Jarvis, 1996

My hospital is wanting to begin holding a skills fair yearly and since it will be new to us, I was wondering if you all could give me some ideas as to what your skills fairs are like? Things like what the stations are like, what you review every year etc. Any resources would be greatly appreciated also! Thank you in advance :heartbeat

PLEASE come to work at my hospital! We don't have sitters and on night shift we don't even have a CNA, so all those pt's that normally require a sitter are the responsibility of myself and one other nurse. Let's see one of THOSE nurses handle that! They'd certainly be changing their tune.....maybe even bring you flowers the next time you showed up for work lol

Document, document, document! Is there someone above your manager that you can talk to? Like the DON? This girl obviously does not be on a step down unit, sounds like she has no common sense and needs to start somewhere with lesser acuity patients. Those examples you gave are extremely scary!

I'm going to agree with everyone else about questions, questions, questions! Ask your classmates if you still keep in touch with them for their review books and do those questions. Search the internet for test taking skills. When I was in nursing school, in my study group there were several people who grasped concepts better than me, but I would do better on the test because I have always, luckily, been a good "test-taker" and have never had test anxiety (until I took the NCLEX-RN however) The good news is that being a good "test-taker" CAN be learned. Do a practice test then do some research on test-taking skills and then take another practice exam (a different one) and see if you do better, then you'll know if it is knowledge or test-taking ability/anxiety. When I studied for both the NCLEX-PN and then the NCLEX-RN, all I did was questions, then on the ones I missed, I would read the rational to see why that answer was more correct Above all, PLEASE don't quit! You have the knowledge it takes to be a nurse...it's in your head and we just need to figure out how you can access it while you are sitting in that chair taking the exam!

my bad on the first one, it's been a long night shift! This is why when you are working and tired, you always have someone double check your calculations! but the object was to show how you get rid of all the extra words around the problem that you don't need.

Maybe you are just over thinking these as is the case a lot of times with reconstitution problems. There are a lot of extra words there you don't need. For example number 1, the dose needed is 250mg the dose on hand is 100mg per 5 ml and that is all you need to know to answer the question. Answer is 2.5ml Example 2 All you need is the dose needed 300mg dose on hand 20mg/ml hope this helps some!