AndyLyn

Well, this won't be popular, but a lot of the problem comes with the assumption that "pain is what the patient says it is." That statement completely leaves out the practioners' leeway in negating so much of what is common sense. When a patient is texting, watching TV, and eating cheetos, why are we giving them narcs for a reported 10 out of 10 migraine? It doesn't make any sense.

Do you KNOW that you're going to be happy being a nurse? Nurses, especially new nurses, work crazy hours and crazy shifts, weekends, holidays. It's stressful, and hard not to take the bad moods home. I'd seriously consider things before I left a 9-5 job that I was able to pay the bills with. Only you know if it will be worth it to you and your family.

I had an 8 month old last night that couldn't breathe. Both parents smoke. Both grandparents that help care for the baby smoke. They all love the baby very, very much. Until I spent a good 15 minutes talking with them about how harmful second hand smoke is to a baby, they claimed (and from their expressions I believe them) they had no idea just how harmful it would be to the little one that they loved so much. We need to do a better job of making an impact on smoking parents of how damaging smoking around their children can be. Not everyone has the same knowledge we do, and I make it a personal mission while I'm triaging or doing bedside care to make sure that every parent knows when they leave that their smoking is hurting their baby. What they do with that knowledge after they are discharged or transferred is up to them.

I work in a small, rural ED and love it. It's the best job I've ever had. We take good care of our patients, and it's like a big family there. I know all the docs, all their little quirks, and what I can order to help speed things along. No job is worth a 2 hour drive, especially if it's more stressful while you're there! Plus, working in an ED is sooo good for your nursing skills. They get used and used until they shine.

Congratulations! Welcome to the club!

I agree with you 100%. I get tired of all the Debbie Downers posting on here, about how much they hate everything... it's nice to know there's people who love their work as much as I love mine!

It's not just family, tho! We had a weird thing happen one night, so administration called a little meeting to discuss what had happened - and they scheduled it during the day! Really?

Respectfully disagreeing... I'm proud of my ever-expanding skill set. Love my work. I'm happy to help train new nurses. Even declined to apply to a MSN program, because being a nurse practitioner isn't on my list of things to do with my life. I learn something new every shift. My instincts become stronger, my people skills more polished, and my desire to get better only increases. Even if I'm just a plain-ole' nurse. Good luck in your career though, I hope you find your niche soon.

Don't try and be SuperNurse. Ask for help if you need it. Any experienced nurse worth a hoot can tell when a coworker needs help, and knows how to ask for it herself. We never try and work a cardiac patient alone - I've been a nurse for 12 years and have no problem asking someone to help me get all those drips going, extra lines, labwork. It only benefits the patient to have a second set of eyes on them, anyway. Docs - as lovely as they are - have a skewed concept re:timelines, and procedures. Work as quickly as you can, but don't get shook up if somethings not done as soon as they think it should be. Things take time. Learn to prioritize. What needs to be done right now? Next? Continually re-shuffle and re-prioritize. Keep notes if you need to about what you did when. Take time to eat and pee. Cut yourself a little slack. You're learning just as quickly as you can, and the experience only comes with time.

Our patients are met by a registration clerk who does a "quick reg", gives the stickered chart to the triage nurse who does a "quick assessment", and places the patient in a room, if possible. Then the patient is "full reg'd", the chart is up for the doctor or nurse (whoever gets to it first), for either the doctor to see, or the nurse to complete the H&P and do the med rec. It's a new system for us, about a month old, but seems to be working OK. There was a lot of complaining at first, because the bedside nurses were used to having the H&P and the med rec done by the triage nurse, but we're getting over that.

Are we having the discussion of is it OK to smoke pot and care for patients? I'll give you a choice. Nurse A: Well qualified, experienced, intelligent, caring. Nurse B: Well quallified, experienced, intelligent, caring, stoned. Who you gonna let titrate your drips or manage your vent? Really?

Congratulations! It's a great feeling, isn't it?

Ours is similar in size, we have one nurse that does triage, and then 3-4 in the back. We do have assignments, tho. The chart can be picked up by any one of the nurses if there's a med or treatment that needs to be done, and we'll discharge each other's patients, too. The important part is communication, and keeping the charting up to date. Our pyxis also tells us when the patient last had "that" medication, so it's fairly easy to keep track of who still needs what.

Our current design is a plexi-glass windowed room, where the triage nurse is the first person an incoming visitor/patient sees. However, we're in the process of moving triage into a more private area, with registration being the first person they see when they enter. It was hard to triage when the nurse was being constantly interrupted - and there was no privacy for assessments at all, we had complaints from parents that we did pedi rectal temps on, and it was hard to get a good mental health assessment completed. The new room, though, will make it harder to keep an eye on the waiting room, so I don't know what the solution is.

Ours have the patient's name, birthdate, reason for visit and primary care dr.'s name. Registration takes the sheet and generates a "short form" from it that produces all the stickered pieces of the chart for the triage nurse. We're in the process of doing some ED redesign, and I'm wondering if anyone uses the half sheets for a quick, patient produced medical/medication history, kind of like what they do in the doctor's office.

Going into the meetings, I didn't know what the direction of the changes were going to be. But, this week, we've talked about resurrecting our Fast Track system, pulling those minor emergency patients out of the regular flow and using a smaller "care team" consisting of a PA/NP, RN and tech to focus on moving those patient through the system in 90 minutes or less, with a goal of 60 minutes or less. Has anyone done anything like this? What were your biggest hurdles? We have both the designated space and staff to do it. Thanks!

So, I'm on a committee that's going to be making some changes in our ED. I was wondering what kinds of changes (small or big) have other departments made that have actually HELPED, and have been integrated into the department without causing alot of difficulties for staff. Thanks!

I don't understand why you WOULDN'T use a filter needed. You have to draw it out with a needle, it's just as easy to grab a filter needle out as a standard one. Not using one is just being stubborn. It's saying that just cuz I can't SEE the glass, they aren't there... hmmmm... I wonder if those germies are real, too? PS. Using the docs as a point of reference can be a slippery slope. We need to use our best NURSING judgement, and that means protecting my patients from harm the best way I can.

I just took (and passed! Hooray!) the exam on Wednesday, and used both the Emergency Nurse Core Curriculum and the CEN Exam Review book that has 5 written exams and then 2 more you can take online. I took the tests over and over again, really studied the rationales behind each question, and then read and took notes on the core curriculum. It worked, and I feel like I really learned a lot. Good Luck!

I took the class in June and really felt like it helped alot. It focuses on an ABCDEFGH method of trauma assessment, so if you can get the book ahead of time, spend some time studying the early chapter that talks about that specificially. The tests consist of a written exam (which our proctors focused their lectures on what we really needed to know) and then a practicum (alot like ACLS) where it was one-on-one with an instructor, going through a trauma situation. You should try it!

Could your blood sugar be low?

I hear ya. I work in a similar situation, although we do get our fair share of critically ill patients. I joined ENA and have been studying to take the CEN exam. It's given me lots to think about, and I try to work in what I've been learning with my real life patients.

It's hard when you're new. It takes a while for people to warm up to you, both when you're working and in your personal life. I wouldn't take it personally. I don't mind switching with nurses that I trust, it's just that we've all been burned by the "help me out this time and I'll help you out next time that never happens" person at one time or another.

Med Recs. Every patient that comes through our ED needs to have a computerized med rec done, with spots for last doses, too. It's a ridiculous time-sucker that aggravates me to no end. Double charting. If the computer is so magical, why can't I put the info in once and have it appear all over the freaking place? And if I put in the the computer, why do I have to write it on a paper record too?

That's ridiculous. Not only have they not had their MSE, they're not monitored, med recs haven't been done, and I bet you a billion kazillion they elope with their saline locks intact! No thanks, no matter how much admin thinks it'll improve patient satisfaction! (and we all know that's the real reason!)