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awongaemtcc

awongaemtcc

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  1. awongaemtcc

    You are a leader now...

    Transition into new roles has always been challenging, especially in the field of medicine. From the need to increase one's knowledge base, to social norms, to living up to the expectations of those around you; transition is affected by many factors. It is crucial to know your strengths, limitations, and personality to ensure that you can be an effective leader. As a healthcare provider with 18 years of experience, and a strong interest in resuscitation, I thought that I had built a certain level of competency when it came to the active resuscitation of patients who were in extremis. These feelings were validated by those around me. My supervisors, my peers, the provider staff, and my patients and families in my role as a Critical Care Trauma Resuscitation Nurse knew I was a clinically sound, critical thinker, and an integral member of the team. I was considered a leader at the bedside, working amongst many ornery trauma surgeons and being called upon for the sickest of the sickest patients to render care. It wasn't until I became an Emergency Department Nurse Educator where my leadership skills were tested and I learned one of the greatest lessons in leadership. On one of my very first shifts as an Emergency Educator, I responded to a rapid response for a patient in an outpatient infusion center. My heart was racing from the catecholamine response. This was not because I was nervous about resuscitating a patient, but instead, I was delving into a completely different world of practitioners whom I did not know, and I felt the pressure of being expected to be a leader in an environment of people I was not familiar with. The rapid response was called for a patient who was complaining of some dyspnea after receiving an iron infusion for anemia. The team at the bedside suspected a possible anaphylactic reaction. After speaking to a physician on the phone, the nurse manager was preparing to administer a 1 mg IV dose of Epinephrine 1:10,000. After arriving and assessing the situation I noted the chaotic nature of the room with multiple providers standing at the patient's side shouting. I looked over and noted the patient to be awake, alert, with a patent airway and whom did not appear to be in extremis. I paused for about ten seconds whilst standing at the side of the room watching the medical resident argue with the bedside nurse regarding administration of the Epinephrine. The bedside nurse manager at the time was shouting that the attending who was on the phone provided a verbal order to deliver the drug as the team was concerned for anaphylaxis. The medical resident was attempting to assess the situation and had a similar question that I had been pondering: Why would you administer Epinephrine 1:10,000 mg IV to a patient who is awake with a patent airway? During the ten seconds of standing there, I knew that this was the incorrect concentration and route of medication from my years of working in resuscitations. I thought to myself several things quickly: Patient is awake and talking, does not appear to be in any distress, no urticaria. The patient's only complaint was feeling uneasy. As I watched the registered nurse preparing to connect the drug to the patients intravenous line and administer it, I stood there trying to rationalize why this drug was being administered. Was there a new protocol I did not know about? Perhaps the team knew something that I didn't know. What if I'm wrong? How confident am I in my knowledge to put a stop to this? I rationalized my ten seconds of ineptness with the fact that the nurse manager was an advanced practice nurse, and that the medical resident was a physician. I thought that if they were willing to deliver the drug, shouldn't I be ok with it? I recalled fearing that I was going to be looked upon as the "new guy who was trying to take over everything" had I stopped them. In the short time that I stood there, I felt nauseated from the catecholamine's surging in my body. After 18 years of performing resuscitations, here I stood still unsure, even though inside, I was sure this was the incorrect intervention. Instead, I was letting the stature and confidence of others stand in front of me. As I watched the nurse go to connect the bristojet to the port of the IV I shouted, "Hi... I'm sorry, I'm unsure, but can you explain why we're delivering the drug in this manner?" The nurse manager hesitantly restated the fact that they were concerned for anaphylaxis in which I replied that I was concerned that the route of drug and concentration was incorrect. This halted the process and the medical resident agreed with me and the patient was instead given Epinephrine 0.3 mg of 1:1000 concentration intramuscularly. I brought the patient down to the Emergency Department with a lot of self-conflict. I questioned my ability to be a leader as for those ten seconds that I froze. Instead of relying on my gestalt instinctively and placing the patient at the forefront of the situation, I was thinking about all the other bridges I did not want to burn with the in-house staff in those ten seconds. I feared stepping on other people's territory. I feared being wrong. This was a very difficult lesson to learn and I am grateful that I learned the lesson without a poor outcome. My voice in this case, saved a patient from becoming a sentinel event. Over the course of my work I have had a better understanding of my emotional intelligence allowing me to be cognizant of my reactions to situations to prevent this ineptness from occurring again. To be a resonant leader one must embrace this concept and have a good understanding of how our own attributes play into our leadership styles. Having a good understanding of one's own social awareness and emotional intelligence will help build the type of leader they wish to become. In this scenario, I learned the importance of having that awareness. Just because I can be an introvert, I know when I need to turn on the extrovert side to be assertive in a situation. Having that emotional courage allows me to be more effective in leading my teams. One piece of advice that I provide to novice nurses as an educator is that they should learn a little bit from each of their preceptors. My hope is that they take a little bit of every strong characteristic that is emulated and formulate their own nursing practice. To do this, they must have a good understanding of what good nursing practice is and what poor nursing practice is. Just as such, a leader must evaluate their own leadership and personalities and understand what areas are able to be strengthened and what areas that could use improvement.
  2. awongaemtcc

    NYS ER New Grad Stipulation?

    Hello Everyone, I was writing to inquire if anyone knew if there was a 1 year acute care RN experience mandatory for New York State ER working as a RN. I'm graduating from a ADN program with 6 years of experience in EMS as a advanced care AEMT working at multiple busy fire districts. I also worked for several ED's as a AEMT. I have ACLS, PALS, NRP and am a BLS instructor. I have been hearing different stories as you need 1 year of acute care experience and some say no new grads are welcome to the ED, etc. I was told this is a state law but everyone I asked, can't show any documentation on it. Is it more a preference or is there something in writing? If it's in writing can someone show me where to look? Thanks.
  3. awongaemtcc

    In My Prayers

    We do the best for our patients and then we don't try not to take the job home or let it bother us. But I give credit for those floor nurses who are busy taking care of our grandma's, grandpa's, mom's, dad's, siblings and friends because in a way, they become their own family. Their work family. For the most part, they see them every day, day by day. All the things nursing school focuses on care plans and stuff actually matter up there. In the ER not so much. But today, I felt like I connected with a patient. It wasn't a bad night in the ER. We had my first cardiac arrest at Crouse tonight which was definitely different the way it is run at the Brook. But that's a whole other story. I was working at the Acute end of the ER tonight but I thought I'd go help one of the nurses who was drowning with patients. I went to go check on her patient who was hypotensive. I walked into the room and the small frail lady in her 80's sat there in her bed with her son and her daughter at her bedside. I took her BP and asked her how she felt. She said I feel like "crap". Laughing I looked at her BP and it was 70/40. Low. Her son made a comment about saying mom you could've said you felt like ****. And the woman laughed and yelled at her son for cursing in my presence. So we bolused her and I went on my merry way. About 20 minutes later they rush her to the Acute end. Apparently, she went into rapid A-Fib and her pressure kept dropping. She had a positive troponin. Pretty much whatever was bothering her was becoming systemic. The doctor wanted to cardiovert her. All the sudden this frail old lady who laughed and joked looked like a scared child. She kept saying how scared she was. She told me one of her grandson's names were Andrew and that he didn't like being called Andy. I told her she could call me whatever she wanted. We tried to calm her down, had the family step out and gave her some propofol. Once she went out we cardioverted her 3 times. We couldn't get her back into a sinus rhythm. She slowly came around and looked at me and said to me. "Andrew I'm scared. You see, I didn't call you Andy." I felt horrible for the poor old lady who was being shocked over and over. I kneeled on her side and held her hand. I told her exactly what the doctor was doing through each step of the central line. She squeezed my hand and said "I trust you, Andrew. I'm scared... but I trust you." I kept reassuring her that it was going to be ok, we did the central line and I explained each step telling her how great of a job she was doing. I tried to talk to her about her family to get her mind off things. She was a mother of 8 children oldest in his 50's and youngest in his 40's. She had 15 grandchildren and 3 great-grandchildren. She just kept smiling when we talked about them. We started her on pressors to bring her BP up. When the doctor was done, I left the room to attend to another patient. A few minutes later I figured I needed to get something from the room and check on her and she's in the room and the doctor is doing chest compressions and intubating her. I don't know what it was. I've been doing this for so long and I've seen people crash before but I felt like I was connected to her. As if that was a family member on that stretcher. We got her back and she started waking up from the sedation. She had an ET tube in and she just looked at me and tried to mouth words. I just tried to comfort her and tell her it would be ok. She looked at me and I could tell she recognized me. So tonight I pray for her. I hope she gets better. I try not to get too attached but I am only human. So even though I don't know her and probably will never see her again, I hope that I've made all the difference in my hour with her.
  4. One patient sticks out tonight... I felt really bad for this older gentleman I took care of today. He came in 79 year old male with new onset shortness of breath. You could tell he was in CHF. He had edema all over his body, rales, and all that good stuff. What stuck out though was his hygiene. He looked like he hadn't showered in three weeks.. He had this build up in his hair.. he had pus in both eyes which made them red.. His glasses were filthy... One of my coworkers actually cleaned them and he remarked "I can see now." He was a stubborn old man, even though he would get really short of breath and desaturate to the 70's he didn't want help. He had these urine soaked socks on. The ambulance gave him Lasix, a loop diuretic that will make you pee. So he wet himself...I went to go help clean him up and like I said he was stubborn. I asked him if he lived at home and he said he did, alone. One could see that he wasn't able to take care of himself. I went to go take his socks off so that we could put new ones on and he said no... I asked him why. I said, "Your socks are soaked with urine. I don't want you to sit there with them on like that." He said that he was embarrassed because his feet looked "horrible". I reassured him that I've seen it all and nothing would bother me. He insisted on not taking them off. So it led me to wonder, man this guy really has a bad case of Self Care Deficit. Ha, there goes nursing process... Anyway so I told him if he was my family member I would not want him to sit there in his urine soaked socks and that I was going to clean him up and make him feel better. We got him cleaned up and I switched his socks...his feet were bad. There was crusting in between the toes and his nails did not look like they were cut in years. Now yes, it was gross and I'm sure everyone reading it is thinking it. And I'm sure we all as health care providers joke about things like that or the "worst things weave seen". What struck me tonight though was the embarrassment of the older gentleman. I felt bad for him. It must be frustrating to lose your ADL's and your dignity getting older. We all have weakness and something so simple like not wanting to show his feet meant so much more. No patient should ever feel embarrassed. Like I said, I'm someone in healthcare that I've been doing for so long and have joked about the sometimes dirty patients or the silly stuff that comes in. But in another perspective these people have other stories. That man was losing his ability to deal with everyday things. I felt bad for him and it truly gave me a new perspective to bring to my practice. In nursing school they taught us to be non judgmental when it comes to our patients. I hope the patients know that. I want my patients to know that they can ask me anything because if I were in their shoes, I'd want the same care. His feet and the want to cover them represented his vulnerability. I hope that man gets better and finds the appropriate care for him. I asked him if he had family and he told me his daughter was a LPN at another local hospital... I was appalled. And I was kinda upset... but then again, just like my patient who had a reason why he didn't want to take his socks off, I'm sure the daughter had a reason not to take care of her father.
  5. awongaemtcc

    Why nursing was for me...

    Most people grow up having a clear understanding as to what they want to be in life. It is the norm to attend high school, move on to college and pursue these goals. I, on the other hand did not have just one set goal. In elementary school, I wanted to be an engineer, because my dad said that's what I should be. In junior high school, the show Baywatch was always on. I wanted to be a lifeguard because it seemed cool; beautiful people being heroes where everyone looked at them in awe as they saved. High school came around and I was always involved in extracurricular activities. While being the head of three clubs, senior class secretary and running the school's webpage, I developed a knack for management, and organizational skills; which led me to think about computer programming. These dreams however, weren't really my dreams. I never was able to really say, why or how much I wanted to pursue these dreams. They were simply my responses to people asking what I wanted to do with my life. It was not until I was exposed to the field of nursing that I truly understood who I am and what I want to become. My desire to become a nurse was not simply a response but a passion built up through my experiences as a Clinical Assistant at the emergency room at Stony Brook University Hospital. I was very intrigued by how patient care differs in a hospital setting. I have known EMS for over eight years of my life - it simply consisted of stabilizing patients and then dropping them off; my experiences as a C.A. exposed me to a new dimension of medical care. It was however, at the E.R., where I was now seeing the before and after; from EMS activation to patient discharge, I was privy to the whole picture behind a patient's emergency care. The nursing staff had always been the ones who stood out to me. They were the healers, both mentally and physically. I recall one instance where a patient was brought in presenting with chest pain. The thirty year-old man came in with sub-sternal chest pain which radiated to his back. He had a history of cocaine and heroin abuse; and came in requesting Detox. I remember setting the gentleman up on the cardiac monitor and listening to the doctor ask him about his medical history. The doctor ordered an electrocardiogram, Nitroglycerin and continuous monitoring while walking out of the room. While the nurse was starting the patient's intravenous line, she began talking to the patient. It was then that I saw that this patient was not just your thirty year old junkie, but a man who had complex social issues which led to his drug habits, a man who suffered through the tragic death of his wife and who was a father to three children. As a result of the nurse's bedside manner; the patient suddenly became human. He was no longer a case of symptoms. The time the nurse had with the patient and the mere ability for her to sit there and converse with the patient had reassured him. It was one of those moments at his treatment that allowed him to have hope, that he would be better with this visit and be able to see his children the next day. I feel that the field of nursing is one that is differentiated from other healthcare professions. It is a field that allows you to see the whole patient, rather than just bits and pieces of a story. That is why it is my dream and goal to be able to provide that same comfort and care into my future patients. I can't say that my passion for taking care of people all started with the ER. My experience with the Stony Brook Volunteer Ambulance Corps also played a strong role. I remember a call that went out a few minutes before the end of what was a long shift at SBVAC. I responded to at least six ambulance alarms the night before, which ranged from drunk vomiting college kids to people bleeding all over from lacerations while falling out of a second story window. I was looking forward to getting off shift so I could go home to my bed. My pager went off for a mutual aid call to an elderly male respiratory distress at the local Veteran's Home. My initial response was, "great another patient that they're shipping out!" When we got to my patient's bedside however, the response changed. It's Mr. X, a 76 year old male with dementia, aphasia, and a tracheostomy. I have responded to Mr. X's bedside countless numbers of times in the past. Pneumonia is not something new for Mr. X, as he develops it often as a result of his tracheostomy. I went to assess him, listening for the familiar rales that he presented with, and the pitting edema on his legs and arms. Mr. X looked over at me and stared. It was the same stare he always gave; stoic, without any emotion. I always saw something in his eyes that told me that he was thankful for the care we provided to him. Although he seemed emotionless, I could tell when he was sick, sad, glad or content. Whether it was the changing of his sheets or being the only person who is able to successfully establish an IV on him, the feeling of appreciation or need makes all the difference. During his visits to the E.R. I had gotten to know his wife; I could see the gleam in her eyes when we worked on her husband and I was glad to know that I became someone they could trust. I know that becoming a nurse will allow me to provide care to patients like Mr. X on a higher level. Through these experiences, I've have recognized that nursing is what is important to me and what makes me happy. Working in the settings that I have, where patient care should always come first, I have been witness to many styles and philosophies of care. I have seen doctors who truly hate coming to work and complain about their shifts everyday. I have worked with nurses who take out their stress and frustrations on their patients by neglecting them making them wait hours for care. I have interviewed and worked with college students who all said they wanted to do EMS to help people, and saw them leave our agency because they never really loved it. Having been witness to all of these things, I came to realize that doing something that I love is truly all that matters. Nursing is something for which I have a passion. Treating patients has always been something that I respect and can not think of anything else that would make me more content. In the end, I can now say it is my dream to become a nurse. I aspire to work as an Emergency Room Critical Care Transport Nurse, and ultimately pursue a future in teaching nursing. My reasons lies with the patients, the fast paced setting, the autonomy to providing care, the teaching behind nursing, the flexibility, along with the millions of other reasons why nursing is what's for me. I know that with a degree in nursing, I will have the means to make my dreams come true.
  6. awongaemtcc

    Crouse Hospital School of Nursing, Syracuse

    Thanks for the help. First week isn't bad, it's overwhelming though.. I feel like alot of people are being negative about it all. The only person who is real positive is the 110 teacher. But I suppose that's they're way of making us work hard. I'm just worried about test structures right now. I guess we'll have to wait till our first tests to judge!
  7. awongaemtcc

    Crouse Hospital School of Nursing, Syracuse

    Thanks for your help. Start in Tminus 4 days.. Do you need your textbooks the first week? Uniforms? I have'nt prepared any of that, hoping that they'll guide us with some of that stuff during orientation. Also don't want to look like the person whose over prepared lol Also What's the camraderie like? I just moved into Syracuse and I'm getting really bored lol. Does the class study together or hang out together?
  8. awongaemtcc

    Crouse Hospital School of Nursing, Syracuse

    3 weeks... nervous as heck... I've been doing EMS for a long time and worked in a ER for a long time but I'm picking up and leaving everything behind to start a new.. hehe but I'm sure it'll all be fine.
  9. awongaemtcc

    Crouse Hospital School of Nursing, Syracuse

    The reason I ask is because I'm a larger guy and I wanted to get it done myself. Navy blue? what color is the embroidery? One or two lines? Thanks so much for your help!
  10. awongaemtcc

    Crouse Hospital School of Nursing, Syracuse

    Anyone going to Crouse know the uniform? Is it all white with Crouse patches? Do you have to get them at the recommended store?
  11. awongaemtcc

    ER Assigning rooms

    Hello Everyone, I work in a very busy Level One Trauma Center and was wondering what policy's or procedures you have as to how beds are assigned from triage. We have 4 different areas. An Acute area, two main areas, and a IC/Peds area. Each area for the most part of the day is staffed by one attending. The reason we have two main departments is to split the work for the attendings. Also location wise it's split due to construction. Within each of these area's nursing is split too. So we have a CA who is assigning patients to rooms according to whose up. So let's say a patient is going to Main 1 and nurse x, the next patient would be going to main 2 and nurse y, then the next to Main 1 again nurse Z and so on and so on. What does your department do? Is there a system or dedicated assignment person? Thanks!
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