Scis

Erin: No, maybe I didn't make myself clear. I was a GN (graduate nurse) for three months before sitting for the state boards. I graduated at the time when the boards were paper and pencil tests, twice a year, so you had to wait to "sit" for them, then wait for the results. I was an RN prior to taking ACLS and TNCC. Anyone can "take" the TNCC but I am unclear as to whether you need to be an RN. There are no medications administered, however mastering the skills stations requires pretty intense knowledge of anatomy and physiology. Maybe a TNCC instructor can offer advice on that area.... ACLS is another matter. Remember, medications are administered in the protocols, and one must have pharmaceutical knowledge of the indications for administering certain drugs and the potential reactions to look for to see if what is done is appropriate. An RN license or paramedic certification is required to push meds. in a cardiac arrest situation. Scis

C'mon guys! You all have valid points, but the hostility is corrupting the board. We are all professionals and of course as individuals have a right to our opinions and to voice them on the site, but let's not get downright vindictive. We're ALL above that, am I right? Scis RN CEN

Pabrid: I concur. Well said. Scis, RN, CEN;)

I don't believe an ER nurse can ever "look stupid" by asking a question, especially when patient care and safety are at stake. Let's face it, sometimes our actions can "make or break" a situation (or life or death, literally). What does "look stupid" are mistakes done when they could have been avoided. I think in the ER, one should never be seduced into thinking they "know it all". Just when you get to that point, BAM! something will catch you off guard! Trick is to stay current, keep knowledgeable, and double-check your actions if necessary. In the words of ol' Flo Nightingale: "A woman (or man nowadays) who thinks of herself, "Now I am a full nurse, a skilled nurse. I have learnt all there is to be learned", take my word for it, she does not know what a nurse is, and she will never know: she has gone back already."

ER's are ER's. No amount of med/surg. prep will prepare one to be proficient in the emergency room, anymore than thinking that OB/GYN floor experience is necessary due to the amount of "outside" deliveries that happen in the ER. It is a specialty area that requires much expertise, however, I do not agree that there is no place for eager, willing new graduates. Let's face it, "tasks" like mentioned in one of the posts are just that, "tasks". With training, ANYONE can perform those tasks. You don't have to be an experienced RN to do them. What is necessary in an ER, especially a busy one such as the Level I, Level II trauma centers are nurses that are eager to learn and are not afraid to ask questions of seasoned ER veterans. The attitudes posted don't seem like new grads would be comfortable with asking for assistance from them. The new nurses must be aware that they can ask for help with anything, and those managing the nurses need to know their capabilities at the present time and what they need for the future. Don't "eat the young", help them mature into the specialty they feel fits them. I started in a Level I urban trauma center right after I graduated from nursing school as a GN, before I even sat for the state boards. I was hired because I told them that was the only area I wanted to work in the best hospital in the area. I learned all I could to specialize right from the start, ACLS certified by one year, PALS by two, along with Trauma Nurse Cert., then sat for the Emergency Nurses exam two years after being in ER Nursing. I knew it was what I wanted, I went for it, I had excellent mentors who I felt comfortable asking anything I needed to ensure patient safety, and succeeded. I wouldn't want to see anyone discouraged from what they feel they want to do. I've been at it for ten years now, just accepted a Clinical Coordinator position in a slightly less busy ER, but I could not envision working in any other specialty area.

RNangelER: Thanks for the tip on Tenet. You mean they actually post their indiscretions? I'll check it out. Love to be informed. Happy New Year Scis

The responsibility lies with the registration clerk, however, if the patient is acutely ill or a trauma, the band comes attached to the chart and the RN usually applies it after verifying that it is the correct patient, especially important since the sickest patients usually can't acknowledge who they are so they REALLY need the name band.

lizz: Thanks. 'nuf said.

Guys: Hate to sound naive, but what exactly is "Tenet"? I'm from northeast NJ and have never heard the name? Thanks!:)

Rayrae: Beautiful tribute. Your grandmother was very lucky to have you. Thanks for sharing. :kiss

kate930 That "expert" certainly does not work in an ER!

I don't know about you guys, but if I had the flu, the LAST thing I'd want to do is bundle myself up and go out in the cold to sit in an ER waiting room along with others who had the flu also, maybe even worse than me! I don't get it. I guess they think we have a magic wand to wave over them to help them be cured spontaneously! I would take Tylenol/Motrin, drink plenty of fluids, wrap myself up in bed, and stay there until I felt better! I try to tell my patients that as they arrive in triage, but the STILL choose to wait for hours! Unbelievably, in the northern NJ ER I work in, the waits can be up to 8 hours or more during peak times! I guess I blame the media for the mass influx. It has been all over the news about the flu deaths, so people panic. Yes, this season may be worse than some others, but if everyone tries to stay out of crowds, stay home if not feeling well, and treats their flu symptoms at home rather than go out infecting everyone in their paths, maybe we could avoid some casualties!

nurse51RN: Of course we would have also referred the patient to a cardiology clinic or PMD (I assumed they had one since they were a direct admit) to find out why they've had chest pain for 2-3 months! In the hospitals I have worked in, no one gets directly admitted to any specialty unit without an ER workup. The beds are too scarce nowadays! Good Luck to you in the ER! ScisRNCEN :)

See, now if that direct admit had gone through the ER, they could have ruled out the cardiac dispo and the patient could have been given food and discharged! ScisRNCEN

sabRN2b05: Only have a second, but I had to comment! Yes, I went straight to a level I trauma center upon nursing school graduation and never looked back! The hospital is located in a very poor, very urban center in Newark, NJ, but is a teaching hospital as well, associated with the state medical school; I have learned much during my ten years here. I sat for the emergency nurses certification test 2 years after nursing school graduation and have remained certified. I love emergency nursing and have seen many people come through, try it, and leave, and I'm telling you, YOU HAVE WHAT IT TAKES!!!!! There are emergency rooms that treat solely pediatrics, along with separate areas for adult emergency and traumas. You have such a unique handle on all aspects of the ER route, from registration to hanging around waiting during treatment, to discharge. C'mon. Give it some thought! Maybe the stint as an ER tech will change your mind.! Good Luck in whatever you do, you sound like you are going to be great in nursing! Scis RN CEN

sabRNtobe05: Sounds like you are very good at multi-tasking and keeping up with the hectic flow of ER registration, which makes me think you would be a likely candidate for the ER upon graduation. Why would you not consider it? You are already used to the types of patients, the idea of priority management, the need to keep focused no matter who/or what is trying to sidetrack you from the task at hand. Please reconsider. You sound like a great fit for emergency nursing! ScisRN,CEN

Sounds like you've got a group of great minds working together! I concur with all of you. Sounds like a great plan!

jt- I wholeheartedly agree with your postings. If more nurses would educate themselves on the history of nursing they would realize that Florence Nightingale, one of the first and foremost, went to all kinds of measures to get what she wanted to achieve for her patients on the battlefields! That is what frustrates me most about the majority of nurses in our profession---they want to complain and moan over what is, realizing we are not getting the professional respect we deserve, but ask them to put their moans and groans into action, and you get silence and inaction from them! C'mon guys, it's clear some change is needed, and it is not going to happen without major action. Nurses are the backbone of the healthcare profession! When enough of us get together ,we can't help but get attention! Without enough of us, the nurses advocating the change look like a bunch of disgruntled rebels! Maybe it's the term "union" that some nurses object to, since it does have a blue-collar connotation. I prefer to call it a move toward professional organizations of nurses. "Strike" as a job action. Whatever makes you comfortable, but something must be done, and now is as good a time as any!

I think the families and friends of these critically ill patients try to act as if nothing is changed. That their family member/friend is the same person as they are used to, with the same interests. You, as a nurse, realize that if someone has a life-threatening illness, or a fresh MI, their lives are nowhere near what they used to be, but rather are drastically changed. The patient probably does not have the realization or energy to express his/her feelings to the family/friends. That's why we're there..to do what is needed for the patient at this unusual, critical time. Never doubt your priorities as long as the best interest of the patient is in the forefront. It's also good to keep a sense of humor!

It's obvious that the nursing profession does not get the respect that it deserves. Obvious, also, is that major change is needed within the profession. Nurses must take a united stand in order to effect the changes we need for ourselves and our patients. The working environment in all healthcare facilities is unsafe at this point in time, with nurses and their licenses being placed in jeopardy at the front lines. It takes all of us to unite together to get the point across, and if striking gets the attention, so be it! It's just unfortunate that the pioneers willing to put themselves out to effect change will pave the way for a brighter future for all nurses, even those who sit on the sidelines afraid to make a move! It's time for nurses to "think outside the box".

Maybe the patient did not WANT to be with the family on Thanksgiving, maybe that's what provoked the high anxiety level prompting her to need the medication. You did what was required to adequately care for the patient. Whatever the complaints of the family, they were probably more due to the fact that they went out of their way to spend Thanksgiving with her, and now she would not realize it. You could have reminded them gently that there are other days during the year they could visit and maybe the patient would not be so overwhelmed with everyone converging on one day.

Don't forget the price tag for the ambulance ride. Most of these ER abusers do not drive either, so they call 911 for these bogus complaints. In NJ, ambulances must transport these calls!!!!! A charge of $5.00 for the ambulance would eliminate these excursions! Then they want transport home when they're done being seen! Amazing!

Calling the PMD and making the appt. may work in some areas of the country and with some complaints, but it does open up the RN triage officer to liability in the event that the "bul_sh_t" complaint does turn out to be something serious, which does happen quite frequently in emergency medicine. Wouldn't want to be the RN on the other end if a negative event resulted because of this type of unofficial "referral" to the PMD. Legally speaking, once the patient presents to an emergency room triage area, they are entitled to a "medical evaluation" including, but not limited to, an evaluation by a triage RN. Of course you can still call the PMD's office, tell them the patient is there, and then tell the patient that the PMD suggested making an office appt. rather than waiting hours in the ER for a "non-acute" illness. The decision then rests on the patient, lessening the liability for the nurse in the event of a negative outcome. Unfortunately, we are a very litigenous society!!!! Also, this idea would not work in the many urban area ER's that see patients who have no PMD's and use the ER as their primary care physician. The complaints illicited by this type of clientele are usually those that can be seen in a doctor's office or clinic, but present to the ER simply due to convenience or no other option. ScisRNCEN

Wow. A year and a half? What kind of contract did you sign? Are they paying your nursing school bills? What's up? Now you know why you were contracted for so long, apparently staffing that insititution is next to near impossible with the antics going on there! My advice to you would be to lie low, do what you have to do in order to provide safe, professional care to your patients, and try to stay out of any altercations if possible. Sounds like the management there will hang nurses like you out to dry when push comes to shove. Also, take all the sick time and vacation time due to you in the next year and a half. You'll need it to stay sane! Also, make sure you start applying for new positions to line one up so you can get out as soon as your contract expires. Best of Luck! Scis RN CEN:rolleyes:

Semen???? I've been in the ER for ten-plus years, and, thankfully, never been "splashed" with semen. Nor have I been splashed with lady partsl secretions.... I must be lucky!I guess these two would probably freak me out a little bit..