BeachyRNn08

I agree with others, you're only young once and you have dreamed about this, do it. I am curious, this was a few months back did you end up doing it?

Yes, it was horrid!!! I felt so sorry for this poor man. The family consented to the intubation. I've never been in with this particular MD for an intubation, he seemed frazzled, even said to the family (who happened to somehow be let in during the procedure) "He's not going to make it............" After a long pause "without intubation"........... This was so wrong in so many ways.....

I haven't been on here in forever, but I had to vent about this!!! Today I was involved with a rapid sequence intubation of a COPD'er whose CO2 was 136 (I know, impressive right??) The doctor rushes into the room, the patient is lethargic but alert and his eyes are wide open. The MD immediately runs to the head of the bed laryngoscope and tube in hand..... I am taking over this patient from another nurse, and I immediately ask if the patient has received any sedatives at all? His response is "No" :uhoh3: Another nurse runs to the pyxis and grabs out a RSI kit (has succs, etomidate, etc in it) The nurse runs back into the room and is holding up the bag of meds "Are you going to order RSI meds????" We stand back in sheer shock and disbelief as the doctor rams the laryngoscope down the patients throat as he is wide awake now and GAGGING!!!! He does not answer the nurse and continues to try to tube the patient, the patient is choking, gagging and fighting the tube as best he can. He desats to the 70s and finally the doctor stops. :smackingf We ask AGAIN "Doc, what do you want to give this patient to sedate him??" As we're bagging the patient back up to the 90s, he states "I want to try it again" And starts attempting intubation AGAIN, with the patient choking and gagging.... One nurse walking out of the room, mumbling something like "this is BS" Finally, the doctor gets the tube in place, hands it to RT to get on the vent, I start bagging and the MD immediately starts heading for the door........ At this point I'm LIVID, I'm bagging the patient and I cannot even ventilate him because he is choking on the tube and the patient starts grabbing at it "Doc, we gotta knock this guy down, quick, this isn't right" The MD states "We got the airway, that's what's important" :confused: Is this seriously happening I'm thinking??? This is someones grandfather, someones father, Would you want this done to your family member???? "DOC, it doesn't matter if he has an airway, I CANNOT ventilate him, he's choking! And he's gonna pull this thing out!" He finally mumbles "Fine, I'll order some propofol...." He orders a measly 30mg bolus for a patient of 113kg and tells me to start slow with the drip because he's worried about his pressure (which is 160s systolic at this point)....... Get my bolus given, throw the gtt up at 20 mcg's, and titrate it all the way up to 50mcg's, (while monitoring his pressure of course) until FINALLY this poor man is sedated.... This seriously ripped my heart out of my chest....... Would I want my mother treated in this manner???? As I'm titrating the gtt and the poor guy is still choking on the tube, I tell him "I'm going to get you comfortable as quickly as I can" Is there any excuse for this??? Is there any reason at all that there could be no meds given prior to the intubation? Nothing?? This seriously ruined my day.... Thanks for letting me vent....

Hey Queens, Congrats on your first job in the ER! I too, have always wanted to work in the ER. I worked about a year in ICU-stepdown before I could finally get my foot in the ER door. I've been in the ER 7 months. Here's my advice to you, as a new ER nurse myself. Your confidence is an asset. Assert your confidence, but like the previous poster has mentioned, also realize when your need help and ask for it. Compared to the floor I worked on, ER nurses have tougher personalities. You will learn who you can go to for help, and who you should probably avoid if at all possible, lol! Good luck starting your first job in the ER, there's so much to learn, but guaranteed to be anything but boring! :)

Below is a rant regarding "hiring freezes" and inappropriate nurse staffing proceed with caution! :angryfire All around me, I hear about new graduate nurses unable to find employment and about local hospitals having "hiring freezes"... HOWEVER, at my hospital we could use a couple (dozen) RNs!!! I work in the ER. Time after time, I have an admission that is "stuck" for hours down in the ER due to inappropriate staffing! I'm told by nursing supervisors that "I don't have a bed". But that is not the case at all. There's plenty of beds, if you want to just roll them upstairs and let them lie in it! There are not enough nurses to care for the patients. It does not make any since at all to me that there are nurses out there, ready and willing to work, and these kind of situations persist!!! These "cutbacks" are not only bothersome, but dangerous for patient care. Train these new nurses (or hire experienced, whatever!) and put them to work for their sake, ours and the patients'! :) Vent over

Yeah I prob would have passed out right about where your bladder came out of your body... :) Glad you had a great nurse and you are okay!!

I'm glad to know I'm not alone, I've got shaky hands too, I'm just a nervous person that drinks a lot of caffeine, bad combo, haha. Somehow I manage to stabilize right before I stick for blood/IVs. Just gotta figure out what works for you. Medications isn't always the answer. Though for me it prob wouldn't hurt :)

When I worked on a cardiac floor it was difficult for me to keep up with my I & 0s 100% accurately. Sure, you can tell your patients that we are keeping up with "what goes in and what comes out" or however you want to explain it and many still don't get it. Family members or ancillary staff will bring in drinks that you never see. The urinal/hat will get emptied, or they might not use it at all! There's a million different reasons you can't get an accurate I and O. For me it was just a very good estimate. Unless they've got a foley, on TPN and/or IVF only. Gotta do the best you can!

I would never do L&D. I don't have any children of my own, and the thought of labor honestly scares me. I wouldn't be an effective nurse, as I would prob pass out assisting in a vag delivery!:eek:

I've only been a nurse for a year 1/2, and it's been a stressful one to say the least.. several times I have questioned what the heck I was thinking becoming a nurse. The stress is hard to bear sometimes. But there's special moments that remind me of why I became a nurse, and why despite the stress I absolutely love being a nurse. I work in a busy ER, which I'm new to, and was asked by a co worker to medicate a patient with a couple tylenol. No problem, i can handle that! Little did I know, this patient had a traumatic brain injury in the past, unable to swallow. She required her medications to be crushed and put into pudding. I sat at her bedside for about 10-15 minutes assisting her to take her tylenol and talking to her and her family. Afterward, I came back to discharge her, and though she was unable to talk, texted into her phone "you are a VERY SWEET lady" and gave me a big hug. And, our amazing ER doctor wrote on her discharge papers "good luck, he's (her boyfriend) a lucky man to be with a beautiful girl like you) Was one of the best moments in nursing to me, and that makes all the stress, all the BS and frustration that comes along in nursing worth every second. I just wanted to share a happy nursing moment, as we all know they're very few and far between!

Virgo, I'm in the exact same boat as you. I start orientation in the ER tomorrow (yay) after working on a cardiac floor. I'm nervous, scared, but most of all excited to get off the floor and make the move to the ER! I'm ready for a change of scenery so to speak, and I can't wait to start!! Good luck to you!!

Our Department "Educator" reads our charting, nit picks it apart for things like remembering to chart "prn pain med effectiveness" or charting that we are educating our patients. Fun!

Don't give up yet! I felt the same way when I first started nursing. I started work on a cardiac intermediate care unit from h**l, and absolutely hated it in the beginning. I felt like I had worked my butt off for 4 years, for a job that I hated! Granted, I don't love it now, but as I get more experience, I seemed to hate it less and less. But I've always kept my eyes out for another position, because my heart's always been in the ER. And it's given me something to look forward to. And I just got hired to the ER, so stoked!! Please don't give up so soon, a lot of people feel the same way as you! You'll find your niche!

A hot bubble bath and a glass of wine, or two.. :wink2:!

I totally agree w/ you there!! I work day shift now, and usually only get about 3-4 hours of sleep, and sometimes less... People think I'm crazy that I can't go to bed early, but we're all wired differently, I'm just a night owl!! I live on 5 hour energy shots at work! Thank goodness I'm starting a new job soon, 1p-1a! Finally, I'll be able to get some sleep!