veetach

you must work for the same company that I work for!! where do you live in Colorado? I live in Colorado too, in our area you would still be considered a "new grad" but the hospitals are stepping up and providing great training opportunities to help new grads break into critical care areas. I went to CN after 17 years of Emergency room nursing, so I had to have ACLS and all of the rest of the alphabet soup to work in the ER. I think taking ACLS would should a good effort towards learning and it sure wouldn't hurt a bit. Have you applied for any OB jobs yet?

I work in a county jail and we NEVER pass meds unattended. It is our jail policy for our pod deputies to actually observe the inmates taking the meds... do you carry a duress alarm or radio?

yep. I have been spit at, hit, kicked, punched, pinched, you name it. Finally the ENA is lobbying for stronger laws regarding assaulting medical staff members.

I think you have been given some excellent advice already. One of the things I see new nurses freak out over, is the order in which to give RSI meds. You do not want your patient to be paralyzed and NOT sedated!!! Talk to the doc, find out what meds he/she will want and make sure you know which one is the sedative and which one is the paralytic.

In our hospital we have a policy that no one goes from inpatient status to outpatient status. The solution to this problem would have been to transfer this patient out to a facility who could care for him.

I work night shift and all of our CTs are read by Rads in Australia, but they usually get the readings to us fairly quickly. In my opinion, 90 minutes for a head CT is preposterous! Especially if the pt has a head bleed! Are there not enough rad techs to handle the flow of the dept? Does this happen on every shift or one in particular? I know at our facility, night shift in radiology is staffed very thin. In fact the CT tech is on an on-call basis. They ALWAYS get called in, I dont know why they dont just staff the position on nights instead of paying all of that call back pay... but we cant complain about turn around time on scans.... good luck! Do you have any kind of computerized system that can track turn around times? that might be a good way to document your problem.

Never heard of this. We use SOB or dyspnea.

Our Rad Techs Bring over the PO contrast, but it usually only takes them a few minutes after the order is entered into the computer. Do you have a 90 minute wait on all patients? We have rapid CTs on traumas and those suspected of having a AAA.

great call! Your hospital is lucky to have you! Give yourself a pat on the back, and be proud that you made a difference to that mans life. I know several triage nurses who would not be able to identify that he was unstable.

Its funny you should mention this, I have worked in Emergency Rooms in several different states and CEN was never required or even given a consideration....I always wondered why.

Ha! you beat me to the post, I was just about to say the same thing.

Valium has been removed from the list of drugs to give down the tube...

learn the acronyms for example: when I first took ACLS about 6 times ago, we had acronyms for lots of the stuff... symptomatic Bradycardia=a trip down every Isle. (atropine, transcutaneous pacing, dopamine, epinephrine, Isoproteronal) meds down the tube used to be ONAVEL (Oxygen, narcan, atropine, valium, epi and lidocaine)and now its something else, I forget. LOLOLOl PEA=push epi and atropine, and of course the shock, shock, shock, everybody (epi) shock, littlem(lido/amio) shock, big (bretyllium-forget this we dont use it any more) shock, everybody shock. ON second thought dont let me confuse you :chuckle ACLS is not pass fail anymore, I am sure many people have already told you that. Dont freak, pay attention and take not when your instructor says "this is important and you might need to know it for the test" good luck!

LMAO Tom... It does sound like you had a pretty awful day. This profession of ours is not glamorous at all, is it? I work in a 24 bed ER, we see between 150-200 people per day, usually holding anywhere from 6-12 patients per day. We do get a lunch break though, we take care of each other, its definately not because management comes out of their office to take our team so we can go though.... Hang in there, I would demand some help if I were you. A couple of days of the "blue flu" might drive the problem home. Someone out there has convinced these MD's that UA's turn up more transient disclosed problems than they can imagine. We have a doc who orders a UA on every pt too. I tell him he is flagging himself for a medicare audit! :chuckle

we have both kinds. Usually those patients with IV's get the gowns with snaps.

I have only used it once in 11 yrs. It made no difference with the progress of the pt, she was only 55 yrs old too. Sad situation.

I was just about to mention the ENA 5 level triage system. No matter what triage system you use, though, a fb in the eye is an urgent situation. He should have been triaged above non urgents. Now, as a bit of a disclaimer, I have seen ER's where the urgent patients have to wait 3 hours because there are so many emergent patients that they bump the urgents back.

this is what i am begging to have happen in our ed. we get no help.i believe that nurses from the perspective departments should come in and take care of these patients. the problem is not lack of staff, it is lack of space... we hold patients every day, sometimes we have 12 or more holds and we have had situations where 10 of those were ccu/icu patients. after 1:00am our staffing goes down to 3 rn's. this does not equal 2 patients to 1 nurse. it is becoming a problem that management is very aware of, but are not doing anything about. i dont know what the answer is, but i do know that if i have 3 critical care holds and 6-7 er patients, then i am gravely endangering my patients. i used to work critical care, so i do have an advantage on a lot of my coworkers who are either new grads or just have 1 yr or less of med surg experience under their belt. it is a sad and scary situation.

ahhhh the old "team nursing" approach. Our ED just abandoned this approach after using it for several years. This structure of care does not allow for any kind of accountability. The strong nurses end up doing most of the work and the weak/lazy nurses get to coast along. Things were missed and no one was accountable for making sure they got done. When I first started working with this type of approach to nursing back in 1999, It was difficult to get used to. But I am glad we dont do it anymore. The one bad thing about our current total care nursing though is that if I have a really bad patient, I cannot leave their bedside to keep an eye on my 7 other patients, and usually my coworkers who worked team nursing with me, end up bailing me out and I do the same for them.

If this pt had an inferior wall MI I can see why he didnt want a nitro gtt. On the other hand, The sublinqual nitro is much more potent than IV nitro, just because she went hypotensive with S-L nitro does not mean she cant handle an IV gtt. of Nitro.

I am also a SANE nurse, member of IAFN and working towards a SANE-A certification. There are many avenues available for nurses in the world of forensic nursing you just have to find your niche. Unfortunately, the jobs are not as plentiful as the number of nurses wanting to fill them. With the introduction of CSI Miami, and Law and Order SVU on tv lots of people have the bug. Good luck and hang in there!

Go, ERNurse, Go!!

I agree. I am a SANE and I have never had a problem obtaining consent for photographs. Light seems to be an issue when we take photos, usually our exam rooms have fluorescent lighting and it can really be a problem. of course you will want to have sufficient measuring landmarks and when it comes to technique, quick and concise are very important. Hope this helps.

we will be moving into a brand new ER in March of 2005. Every single room has a door. No more curtained areas. We will have 15 monitored beds, 2 gyn beds, and when the remodel of the old ER is complete we will have I think 20 other beds, (ortho, psych etc).

Every new grad is different. If you had experience in the field of emergency medicine like CEN35 did, I would say go ahead and hop into the ER. But... if you dont have that background, it would be much easier on you to work in another area first. The ER is not a controlled environment, and we work with so many unstable patients that it can be overwhelming on a new nurse. Our ED hired 4 new grad nurses last may, after graduation. One of them dropped out immediately and out of the other three only one has transitioned smoothly. That is after 16 weeks of intense orientation, precepted time and classroom instruction in emergency care...