WonderRN

Thank you to everyone who responded. I took this to Leadership, expressed my concerns and they agreed we should not be staffing LPNs in triage/comms.

I work in a very busy ED with high EMS volume that is a stroke, stemi and trauma center. We are trialing LPNs in the ED but nobody has been able to define their role for me. They are utilizing LPNs in triage, and having them be the primary point person to answer and triage EMS calls. We have both high volume and high acuity patients that arrive via EMS and this is concerning to me. I thought this was outside of their scope of practice? Curious if anyone had any more insight into this? Are you currently using LPNs in your emergency department and in what capacity?

I am creating an escape room experience for trauma education and I was wondering if anyone has done this before and has any suggestions for successful puzzles. I have several puzzles already that generate a number or alpha code which will be used as a combo for a lock. For example, I have a photo of a trauma room and want them to pick the 4 things that are missing from the room. There will be a word bank of options. They will pick the correct items and put them in alphabetical order; the first letter of each word will be the combo for the lock. Like if the four things that were missing were Airway Cart, Monitor, Suction, Crash cart- the code for the lock would be ACMS. This lock will open a cart or lockbox which will have the next clue. I am using this same kind of thing a few times, at least once with an number code. My issue is that I don't want spend a lot of time on intricate puzzles that have no bearing on the actual scenario or contribute to the learning itself. Decoding ciphers etc may be too time consuming. Any suggestions are appreciated! Thanks!

I would encourage you to keep your head up and work hard. Learn on the job. Look up stuff you don't know. Find a mentor and ask questions. Look stuff up in detail when you get home. Review patho of certain disease processes that you weren't fully comfortable with that day. The fact that you desire to immerse yourself in knowledge and get up to speed shows that you can make it. Perhaps you expect too much of yourself too soon- I did. it was almost my downfall.

1) This is not an ICU forum 2) What is your contribution to the OP's question?

You should jump on in. You'll never know if you're ready until you do it! Skills come with practice and experience!

whoops, I just read that its not an advanced practice program. Well, I don't really know that much about it..... but would just wonder in the end, if there would be any real difference in the amount of money you make with a Master's verses a Bachelor's degree. Even with a specialty degree, will you be hired with no experience, to be an expert in your field and lead others in this higher paying role? Is it worth the extra time in school and extra tuition spent? after reading the brochure about it, I do see the potential there, and see that they are trying to elevate the nursing profession, guarantee quality care, etc But real life is real life, and sometimes you just wish you didn't have all that debt, especially when you are working alongside a damn good diploma prepared RN who knows her stuff and makes just as much money as you do :) Cheers!

There was no AGMSN program in 2008 when I did the ABSN. If there was, I just might have done it! Just thinking about it, i would be intimidated by the idea of going from knowing next to nothing about nursing and being an advanced practice nurse in only 21 mos time. But I guess thats what a lot of PAs do! Good luck to you.

I know I am a little late to the party, but I just wanted to add.... Perhaps she charted "pt taken off the bedpan" to indicate she was in the room and provided care to that pt during that hour? I often chart things like that because there is nothing else eventful to chart and it shows that I have done my hourly rounding duty....haven't been ignoring my patient, etc. And I have done my part to feed/water/toilet them. And i don't chart the color and contents of stool unless it is unchanged from my initial assessment. And perhaps she didn't chart it because it wasn't anything too striking (like c diff, melena, bright red blood etc). AND if someone ran off to lunch without telling me the patient was on the bedpan, I seriously wouldn't scoff. That is small potatoes to me. If they made it a habit to do stuff like that, then, well maybe. Things that get me mad .... handing off a patient that has a ready bed upstairs and they don't have an IV (actually has happened), giving me a CHF patient who cannot toilet his/herself who we are diuresing and you failed to put in the foley that was ordered 2 hours ago (that has happened)..... {NOTE: these people did not get away with these things} you know, that kind of stuff. Don't worry to much about things like that. you will burn out WAY fast.

They can call a ride and wait in the waiting room. Or we will call a cab for them and the cab can take them by an ATM on the way home. If they are really belligerent I will call the charge nurse and let them deal with it. Thats why they get paid the big bucks. Then they MIGHT get a bus pass.

OH, YEAH- He also orders.... 2.5 mg of morphine on EVERYONE- we only have 5mg and 10mg vials. So i have to waste 2.5mg on EVERYONE..... and then I have to go back in there in an hour and give another 2.5mg because whaddya know, the first 2.5mg didnt work! 500mg bolus on everyone then 100ml/hr infusion- NOT A LITER, god forbid. (And these are all people that DONT have renal failure or CHF.) SO if I am going to be anal, then i will hang a half liter, and then gotta go BACK in and hang another bag in 20 mins. Its all this little stuff that takes up time that I don't have! just venting....

She did have CKD (no dialysis), and for that reason probably lives above 5.1. She had EDEMA everywhere (CHF) and used to be on lasix everyday but was taken off (dont know why). Lungs were clear. This doc happens to be the medical director of our ED. He treats every little abnormal lab. A person with a potassium of 3.3 (normal, young, 25 year old patient) must get PO potassium. Its just a little annoying. (Mostly its annoying because he gives you admission orders, you start to get the patient ready to go up, and he orders 5 more things. Don't get me wrong, i will always do whats right for my patients, but he is a little order happy)

oh, no. She was giving the 300mg as a IVPB. We then did a drip. I have given this drug several times in codes, always as an Iv push. I am at a new facility now and they are driving me batty. Causing me to second guess everything i have learned...... For example: all IV infusions must be put on a pump. Even a NS bolus They expect us to do this with an insufficient amount of pumps. A doc today ordered for me to give kayexalate and an albuterol neb to a patient who was "hyperkalemic", her K was 5.7 (3.6-5.1 is normal at our facility) AND she was being diuresed with Lasix. Where I come from, we don't treat anything less than 6, ESPECIALLY if we are diuresing them. BUT, the ratio here is 3:1 most days during our busy hours, so I guess, in the end, I can't really complain.

Thanks, Lunah. I have pushed the Amio myself before in a code, different facility. Just wanted to check with y'all, make sure I wasn't missing something.

Documenting a code today. Full arrest, kept going into pulseless vtach, vfib. Drug pusher mixed the 300mg of amio to hang PB over a few minutes...... ?!? Don't you just push this in a code situation?

I posted a similar thread in the ambulatory care area of this site, but its been 24 hours with no replies..... I have been offered a Nurse Manager position at a fledgling urgent care system in the midwest. It consists of 2 locations at this time, one is well established and the second location is newer, still becoming established. I would be the Nurse Manager over both locations. Up to this time, I have been working PRN as a staff nurse for this urgent care system. I did not interview for this position, I am essentially being pursued, I guess because those in charge are happy with my performance and leadership. I have been an ED nurse for the past 2 years, my only 2 years as an RN. Before that I worked at an urgent care (different one), for 4 years as a tech. I know urgent care well. I work really hard to educate myself, am studying to be a certified emergency nurse, and have precepted new grads in the ED. I feel competent I could DO the job, but I don't know if it will be worth it in the end. We still have to talk money. It would be 40 hours/week, salary. I would have to work if noone else could. I would be on call... I have a family with 2 small children and a husband. I am concerned that it will be way more work that its worth in the end. I would also be giving up a 401K and tuition reimbursement, and the stability of working for a hospital system. I have a pretty sweet shift in a well staffed ED. However, I am getting pretty burned out in the ED. I feel the stress. I take it home with me. I feel overworked and under appreciated. I know I am the only one (with my husband) that can make my decision, but I guess I am hoping to have ambulatory care/ ED nurses weigh in here. What would you do? And I know pay is specific to parts of the country, even within the same state- but HOW MUCH $ SHOULD I ASK FOR? Like % more than I make now? Say is I make $20/hour at the ED (i don't- I make more), should I ask for 25% more? 50%? Thanks in advance

I have been offered a Nurse Manager position at a fledgling urgent care system in the midwest. It consists of 2 locations at this time, one is well established and the second location is newer, still becoming established. I would be the Nurse Manager over both locations. Up to this time, I have been working PRN as a staff nurse for this urgent care system. I did not interview for this position, I am essentially being pursued, I guess because those in charge are happy with my performance and leadership. I have been an ED nurse for the past 2 years, my only 2 years as an RN. Before that I worked at an urgent care (different one), for 4 years as a tech. I know urgent care well. I work really hard to educate myself, am studying to be a certified emergency nurse, and have precepted new grads in the ED. I feel competent I could DO the job, but I don't know if it will be worth it in the end. We still have to talk money. It would be 40 hours/week, salary. I would have to work if noone else could. I would be on call... I have a family with 2 small children and a husband. I am concerned that it will be way more work that its worth in the end. I would also be giving up a 401K and tuition reimbursement, and the stability of working for a hospital system. I have a pretty sweet shift in a well staffed ED. However, I am getting pretty burned out in the ED. I feel the stress. I take it home with me. I feel overworked and under appreciated. I know I am the only one (with my husband) that can make my decision, but I guess I am hoping to have ambulatory care/ ED nurses weigh in here. What would you do? And I know pay is specific to parts of the country, even within the same state- but HOW MUCH $ SHOULD I ASK FOR? Like % more than I make now? Say is I make $20/hour at the ED (i don't- I make more), should I ask for 25% more? 50%? Thanks in advance

I have felt the same way....... I just moved to a new ED. The docs i worked with at the old ED learned to trust my judgement/assessment, with some exceptions (some docs just don't care what nurses have to say). At this new facility, the docs don't know me yet and I can tell. And it bothers me a lot. I had to argue with a doc the other day about a nursing home patient that should be NPO because she didn't pass the swallow test. She very clearly aspirated the small amount of water I gave her......eventually he gave in. But he made a big deal about it and tried to embarrass me in the work area. Doesn't matter. But I digress...... I don't want to be just a work horse. I want my assessment to matter. Sometimes I don't think they appreciate it what it takes to PULL information out of patients to get it on the triage sheet. Or make a med list. And even if the doctor does do his/her own triage after you, you have helped to pull out important information in the patients mind and the information flows easier for the doc when they get in there. But there are other times, I don't get in the room until after the doc does. And I am just chasing after him/her and trying to keep up. In those times, I tell myself that my role as an RN is to keep the patient safe, keep the patient comfortable, educate them, translate, and fill in the gaps for the MD/notify them for any change in pt condition. While I am getting my orders done. I am sick of the tech issue as well. There are some really good ones and I let them know how much i love them. The others, well, I tell the charge nurse about when I have a problem. And hope that eventually, with enough complaints, they will leave or be fired. Because in the end, the suits do care about productivity, and when productivity is halted by lazy techs, well, they'll do something about it. In the end, I believe ED nurses have more independence than floor nurses. I know my critical thinking skills remain sharp because of the revolving door and varying levels of patient acuity and my technical skills are pretty good too, because of the frequency in which I use them. Those things are important to me, and that is why I stay. Also, I work PRN at an urgent care. I love it, it helps me not burn out because there I can actually talk to my patients, educate them, not feel slammed. And generally, patients love you because you help them feel better fast. I also have learned a lot there, like how to take a fishhook out with a string, how to reduce a nursemaids elbow, the tricks to irrigating an ear, etc. Like the others said, maybe go part time and work part time somewhere else too, to change it up? Keep the faith. Keep doing whats right for the patient and you'll be able to sleep at night.

You are doing fine. I was a new grad in ED, and I hit a slump too. It is partially because my preceptor was watching the computer for orders and would intervene when she became impatient instead of letting me work it out. I don't think you REALLY learn how to manage 4 patients until you are on your own and figure out how to manage by yourself. My preceptor was a little frustrated with me at the end. In fact, my manager pulled me into the office and told me that they were afraid "the ED was not the right fit for me" my first day off of orientation. Not because of anything I did persay, just it seemed like i was overwhelmed. I told her to give me 2 weeks and I would show her I could do it, and I did. I was one of first new grads they hired, so I don't think they knew quite what a new grad needed. BTW, 1 year later I was pulled into the office and told that i was being nominated for the Rising Star award because as a new grad, I was thinking critically and intervening for my patients. I established a rapport with the docs and would clarify orders that I thought were questionable or make suggestions that made a positive difference for the patient. They could tell by my charting that I got it. I was also helping others when I had the time and starting hard sticks- I was becoming an asset to the ED. Things come together with time. I think that it is super important that you maintain a cautious confidence. The overconfident new grads you work with WILL crash and burn: there were a bunch of those at the hospital I just left. In fact, when several of them were on their own, they were pulled BACK on orientation because they didnt know WHY there were doing what they were doing. They were just checking off orders. For example, one of them was going to give nitro to a pt who was hypotensive, and another was SUPER late on giving her hyperkalemic cocktail meds- she didn't even know what they were for..... As a new grad, I went home and studied commonly used meds to learn them better (but WILL always look up one i don't know BEFORE i give it) I would try to better educate myself on the nursing interventions for a certain disease process and what orders to expect. This helps for a few reasons because 1) less time spent looking it up a work/asking other folks about it, 2) less time redoing something, 3) it inspires confidence in you that your are capable. For example, if you know that a pt with a small bowel obstruction will need a NG, you will have all the stuff ready at the BS when the order comes along- the appropriate supplies etc- because you set up for yourself when you had 5 minutes down time. My best suggestion to you is this, Get your iv and labs drawn ASAP. It puts you ahead of the game. That is, as long as there is a culture that allows nurses to do this before the official orders are in. If I am behind, I talk to my patients while I place their line, and document when i get done. I at least get my line, a systems focused assessment, and a short note done before i leave the room. I usually come back and hit the systems that I missed before (as necessary)- get more details-, do meds lists, etc when I hang meds. If the doc orders a whole slew of things at once, I do it piece mail in order of importance. Like blood first, come back and hang my AB in 15 mins after I go see the next one. That way I don't get stuck in a room for too long. And like others have said, prioritization is key. Some things just have to wait. It is sometimes an hour or two before I can cath the little old lady from the NH. Find a buddy on your shift that will help you when you get behind, and do the same for him/her. Call your charge nurse if you need help and are not able to find it. Don't let floor nurses get to you. When you give report, don't let them chew you out because the line is in the AC or because there is no foley in the incontinent patient or because the line was put in by EMS. Some of them have NO idea what the ED is like. i let stuff like this bother me for entirely too long, until finally my skin became thick enough, i guess. If you have any more questions, just let me know. I have survived for nearly 2 years now :)

I've been a nurse for 1 1/2 years. I have worked in the ED the entire time. I think I was decent after 6 mos, and after a year, colleagues would ask for help on hard sticks. I would get the hard sticks, say 75% of the time, within 2 sticks. But everyone has off days. I just switched facilities and this new place has totally different J loops and securing supplies, I was having a hard time my first two weeks. I also had been drawing blood for a while as a tech before i became a nurse. Tricks I have learned: Two tourniquets on really hard sticks, have them hang their arm down off the stretcher for a minute, wrap the arm in a warm blanket. Feel for the springy-ness. I sometimes have to close my eyes, it helps me feel it better for some reason (haha, sometimes patients think I am cuckoo :) My last 2 spots I look are on the back of the forearm (esp on the dominant hand for IV drug users, they often can't get to that one) and the bicep, just above the AC. Don't be afraid to look in the shoulder region (as your facility allows), you can often see them there on fair skinned folks and hit them with a 22g. If you are getting in the vein and having trouble cannulating, I often pull back slightly and try to advance the catheter again. It sometimes works. When I was on orientation as a new grad, I had a HORRIBLE time at first. When I was finally on my own, my preceptor told me, "you are getting pretty good, I was worried about you at first." (she was serious). Haha. Confidence is key. REALLY.

I think you were prudent to wait for the redraw. We don't do the K cocktail unless the K is over 6. Esp in a dialysis patient.

I work in the ED: Love: 1. Learning new things every day 2. Using my knowledge to make a suggestion to the doctor that in the end, makes the patient feel better 3. Being part of the most trusted profession 4. Making a decent paycheck 5. Saving lives (and yes, I am very proud to say, there are things that I did, I initiated, that directly saved a patient's life/livelihood- very gratifying) Hate: 1. Seeing the same patients for the same things OVER and OVER because they just refuse to do what it takes to stay out of the hospital 2. Patients that use the ED for their next hit 3. Patients that think I'm a waitress and not a professional with a degree and critical thinking skills 4. Doctors that... (see above) 5. ED-Critical Care rivalry, and nurse-nurse rivalry in general (we all are in it to make people better, so lets quit rolling our eyes at each other and get 'er done)

I was about 6 mos pregnant when I started interviewing for nursing jobs. I was a few mos from graduating with my BSN. I couldn't get anyone to hire me because I was very obviously pregnant. I kept working as a tech until I was ready to have my son, took boards ASAP, and enjoyed my family. (There were no nurse openings where I worked at the time, or I would have been hired on there) I started interviewing for a job at around 4 weeks postpartum with the plan to start work at around 8 weeks postpartum. I got a job in the field of my choice (emergency medicine) at that time. Another thing to consider is, you do not qualify for FMLA when you have worked somewhere for less than a year. This means that they could hire you not knowing that you are pregnant, but when you go out on maternity leave, they technically do not have to hold your job for you. HOWEVER, I have a friend who was pregnant at the same time as me in nursing school. I was about 10 weeks farther along then her. She had a job as a Student Nurse in L&D. They found out she was pregnant while she was still a student, hired her to work there, and assured her they would hold her job for her during maternity leave. Everything worked out fine for her.

\ Yeah, not sure. No ST elevation. Didn't have much time to look at it for obvious reasons. It was actually a mess. He was a super hard intubation. Had to call a second doc in to try. Then he vomited everywhere during the whole thing- ended up with aspiration pneumonia. I know the pt will be coming back for a CABG sometime in the future. I will find out more in the coming weeks. He supposed to come in and see us.

Ok, I'll bite...... What is crumping !?!? I know what krumping (with a K) is.... and I'm pretty sure you don't mean beckoning providers to the bedside of pt's that are hip-hop dancing....