ACRN06

You did your job, carry on. Tough love. Its easier not to say anything but they need to hear it. Granted there are definately ways you can buffer the blow... body language, phrasing, and instead of saying "YOU shouldn't do this, YOU shouldn't do that" simply keep it factual. "When the blood pressure stays high untreated for prolonged times it leads to bla bla bla..." Maybe she would feel less "targetted" that way. The trick is to try to make them feel that they came to the same conclusion as you on their own. Make them want it for themselves (I realize as I write what an uphill battle this can be, trust me). Don't stress too much over it. Do what you can and carry on.

I was you a couple years ago. Tele experience, some travel nursing, wanted to get into ER. I just put in applications to ER positions, some of them don't specify that it has to be "ER" experience. They're posted as "RNII" or whatever. They just want an experienced nurse. Even if it does, it never hurts to throw your name in the hat. Email the recruiters. Granted, looking back I do realize it's not the norm and I was lucky I got it....I think they were just hurting for nurses? Dunno. Whatever it was, they hired me on. The best time to apply is in June and December with all the new grads and when they're doing most of their training programs. Thats when the nurse resident slots open up and those are technically the jobs you should be applying for. You'll be hired on with new grads and other nurses who are wanting to change specialties. Some would rather an experienced RN over a new grad. I got hired on to an ER, 6 weeks of training (this was in September), and that was it. Good luck!

Here's another vote for TED hose! Or compression socks...whatever you wanna call em. They do wonders!

Man, people wanna make the tube more rigid??!!? That was new to me!! The tube already holds its shape easily! Well except for those baby NG tubes, I've started IVs in adults a larger size than those! I'm the opposite.... I soak the end of it in warm water while I'm getting the rest of the prep ready to make it more pliable so that it can more easily bend it's way thru the nasal canal, down the throat, etc.. Never missed one yet!

Short answer: yes Long answer: I've been thru 6 interviews in 3 and a half years but 5 of those were for travel nurse positions which are a different in ways but similar in many others... However generally speaking, yes, I pretty much knew if the interview went well and if the deal was closed. Most of them offered a job at the end of the interview. The one of those 5 travel interviews that I didn't get the manager was up front with me that she had someone to interview after me who had experience with peds (I didn't at that point) and that they are looking for that ideally but that she would let me know if they didn't work out for whatever other reason.

Short answer: yes Long answer: I've been thru 6 interviews in 3 and a half years but 5 of those were for travel nurse positions which are a different in ways but similar in many others... However generally speaking, yes, I pretty much knew if the interview went well and if the deal was closed. Most of them offered a job at the end of the interview. The one of those 5 travel interviews that I didn't get the manager was up front with me that she had someone to interview after me who had experience with peds (I didn't at that point) and that they are looking for that ideally but that she would let me know if they didn't work out for whatever other reason.

#1 all the way Many studies suggest the increase in thyroid cancer could be partly due to pediatricians’ increased use of CT-scans. If it were my asymptomatic kid, theres no way in heck I'd let them CT him.

No. It should not be mandatory. As far as pple who are comparing this to other vaccinations, we are not talking about those vaccinations, we are talking about this brand-spankin-new H1N1 vaccine.

I recommend buying some books about ER nursing. Your questions are very broad and are the same ones I had when making the transition into the ER setting. Its good to want to be prepared, theres just no way you're gonna get all your answers on here. Buy a book. One of my faves is the CEN Review Manual. Even if you don't plan on taking the CEN for years and years it has a boat-load of wonderful information, and the rationales to explain WHY you do certain things. There are lots of other ones too... I have at least 5 or so. Do some research and find one that seems to cover what you're looking for.

Oh, and one thing thats annoying about working the floors after working ER... You know all that little stuff that you're allowed to blow off cuz...well... its the ER and your prioritization skills tell you ''that can wait'' because...it can? Well it all gets to be addressed and attended to up on the floors cuz...well.. you have that pt for the next 12 freakin hours...and its not the ER anymore. They're admitted, time to iron out those wrinkles. It drove...me....CRAZY! I picked up a M/S travel assignment after working ER and all I could keep thinking was ''this doesn't matter! this doesn't matter! doing this affects your health/recovery in NO WAY! why am i wasting my time with this?!'' All those little things pt's love to have you do for them to make them more comfortable, their stay better, etc are all wonderful and, yes, important (in the pt's eyes...and Press Ganey's). And the nurse that does them is a saint.... I admire them truly. It takes a great deal of patience, and a whole new kind of prioritization. You'll be busy, but a different kind of busy. Some love it, some hate it. Good luck!

You'll be fine. Totally do-able. Especially if your ER is anything like mine and backed up with inpatients waiting on beds and you BECOME an inpatient nurse in the ER setting.

Yes some ERs hire new grads Yes in your case (though not all cases) I'd personally recommend some floor experience first (for debates on whether floor experience is necessary, see other threads where this is debated ad nauseum) Yes I think the ER could stilll totally be for you. There is indeed a stereotypical personality type that people picture an ER nurse to have. Type A, loud, assertive, confident, no-BS attitude, etc. And the people who fit that are amazing, no doubt. Its a powerful personality but it also has its fallbacks just like any other. I've worked in the ER for awhile and I've seen ALL types of personalities thrive there! You'll also find that you BECOME more assertive, confident, etc with good old fashioned time and experience. Good luck!

And just to add, I just wanna make sure you understand it right. Don't worry if you haven't done everything on those checklists. Its not a "checklist" in the sense of "you must have completed all these skills before travel nursing", it's more just to see where you are. I've never been asked about information on those things. I haven't done all the skills on my checklists either (having been at a Level II), it never held me back from travel jobs. Just FYI :)

Q 6-8 hrs x 3 sets Wish I could be more specific on the "6-8" part but that really can vary from doc to doc. I wanna say I've seen it Q8 more often than 6 though.

Interesting, just about everyone has said they rarely get sick. Wonder if there is any correlation between our jobs and our super-immunity! I too haven't been sick since.... nursing school, where my immune system was terribly suppressed from a combination of STRESS from fulltime work and fulltime job and the coping mechanisms I used to relieve it: ETOH and cigs:smokin:... Finally quit the smoking. Don't take a MVI. So yeah, no serious illness apart from a cold in 4 years. Not bad.

That cracks me up, so basically your radiology department doesn't want you to transport actual SICK patients to them. Just the healthy ones that don't need monitors, drips, and can sit up in a wheelchair. Riiiiiight...... Um, well, I'll tell you what we do at my ER, Level II Trauma, 52 beds -Basically you start with ER techs to transport your non-monitored type patient, if they're busy you can get an EMT as well. These are your primary transporters -If the pt needs to be on a monitor, pt STAYS ON MONITOR, and is transported by a paramedic. -Of course if time and the ER gods allow, you can transport the patient yourself, I've done that a few times when its possible. Sometimes theres a nurse floating around helping pple that can. But really, the RN is the only one with patients assigned to him/her that they're responsible for watching and caring for. The RN isn't expected to leave their 4-5 other patients. Thats just not safe. But thats the jist of it ER tech/EMT for non-monitored pt Paramedic/RN for monitored pt Whoever takes them there brings them back as well. I disconnect IVF on a lot of pts that just have KVO type IVF running, just to keep things easy. If they don't technically need to be on a monitor (the ones I just throw on the monitor to keep a closer eye for whatever reason) its a judgment call and you can take them off for the procedure. Your ER sounds like a nightmare to work in! No resources! No team of help around you! YOU're running the ER! You're making me count my blessings here.... Good luck!

1mg/min is an easy rule of thumb to go by

Our unit used that peppermint oil stuff that really just makes whatever the smell was a MINTY-worst-smell-of-your-life...doesn't really "mask" it very well, just adds another element.... ...Christmas has never been the same:candy:

oops...double-entered a post... so here's editing it out since I can't delete it.....

All that talking and I didn't even answer your questions... 1. Travelling is fairly popular among those who have few enough obligations to be able to do it. 2. See above 3. BSN/ADN whatever, doesn't matter, as long as you're an RN, they prefer 2 years of experience of whatever specialty you travel under. Some prefer "travel experience" already so sometimes it can be a little more tough to get that first assigment. Getting assignments depends a lot on what your specialty is too... ICU nurses are the highest in demand. Any specialty really. Med/Surg is just a little more difficult because its a specialty that an ICU nurse could be qualified for as well, so there are more canidates for the job competing against you.

It's a bit more difficult to get assignments now than it was before "The Recession!" (so sick of this "recession"..) Let me rephrase that, you can't be as PICKY as before. When I started a year ago I could take my sweet time deciding between contracts, the hospitals fought over me! Now there's so much less that you gotta jump on them when you see one that fits your needs/wants, and you're fighting against all the other out-of-work travellers for jobs. Hospitals have cut back, and the travellers were the first thing to be cut....understandably really. Pros: 1. More money, same job 2. Travel, see different places, adventure! Cons: 1. Instability, ever-changing environment, just when you get the swing of things at one place, you're off to another and start at the bottom again 2. SOME places/nurses (not all, dare I say the minority in my experience) are a little discriminating against the travellers, give them the sh*tty assignments, make em float everywhere first, etc (due to anger for you being paid more and "taking their jobs" when you're actually HELPING them and definately NOT taking their jobs because you're TEMPORARY until they find someone to fill it) I very much enjoyed my year travelling around the country. If you have someone that can go with you (friend/spouse/whatever) it definately helps, especially for your first assignment. However it can also be done alone successfully if you're a sociable, pleasant person that "makes friends easily". The fewer your home-life responsibilities the easier. This including of course children, other dependents, even pets. Travel light. Be flexible. I stopped because I'm ready to grow some roots again and "settle down". I discovered that deep beyond my adventurous side was a home-body who still wants to travel, but wants to be able to come HOME afterwards. I'll just vacation more :)

Wow. I was seriously just thinking about this.. maybe i worked too much OT this week and am getting a little burned out but yeah... i've thought a LOT about this actually... *sigh* elementary school teacher (love kids, love being creative, maybe elem art teacher?) Open my own daycare? (again, love kids) flight attendant (discounted/free travel) interpreter (fun to know multiple languages fluently, useful) Instead I'm a nurse (I actually love my job 90% of the time I swear), who has hobbies including painting, drawing playing with/hanging out with my younger siblings/nephews travelling/vacationing learned one language, going on two ha.

Wait... so which ICU specialty do you think would best prepare one for ER? MICU? SICU? TICU? CVICU?.....

I definately don't think the "floors before ER" thing applies to everyone. It looks like you were an EMT before becoming a nurse. That experience alone gave you a huge advantage in your transition to an RN. I wouldn't expect you'd need the floor time as much as I did. I had never worked in a hospital before I was a nurse and had never had to set foot in an ER! (still have never been a patient other than docs office visits *knock on wood*) The time on the floor was good for me. I agree that the ER is a totally different animal. Thats the beauty of it! But because of the diverse patient population it requires you to have a diverse proficiency base as well. Its not that you have to spend years specializing in everything before coming to ER, doing time with peds, then m/s, then caridac, then renal, neuro, whatever.... but I think critical care is different. Perhaps its the limited exposure I've gotten in a Level II, but it would take YEARS and YEARS for me to REALLY become competent in all critical care management. I like to be self-sufficient. I don't want to always have to rely on someone to be there to teach me for years to come, I want to know it on my own, ask questions every so often when something comes up. I want to know it in and out like I do other stuff...then when they hit me in the ER, I know exactly what to do and what to anticipate. I think that its totally and completely possible to never work anywhere else and be an amazing ER nurse, I guess it varies from each individual how comfortable they are with it. I feel the need to get to know it more thoroughly than I do in the ER. See the whole picture as one of the other posters put it. I just may do this... wow... never thought I'd go to ICU... I just think of the floors and shudder. But its not the floors, its the ICU! Hopefully it'll be more of a rush than I give it credit for. I think I'm gonna listen to my instincts and go for it... Holy cow... I may have just switched specialties!

I'm losing sleep (literally) over something so I'm on allnurses.com at 2am begging for some insight! I'm gonna try to cut to the point and not drag the quesiton out with unnecessary details.. Basically I LOVE ER, always have, always will. I KNOW ER is where I ultimately wanna be. However. I came to the ER after a few years on the floors, so the vast majority of ER patients from fast track to acute to step-down unit-ish I totally picked up and handled no problemo. What I'm lacking is experience in the critical care department. Traumas. ICU players. I just don't that experience behind me. And its really been bugging me lately. The hospital I'm at didn't do any special training classes. They stuck me with someone for a few weeks then I'm on my own! Its all learn-as-you-go. Its frustrating. I WANT to learn this stuff back and forth but when you only have a critical patient for a few hours before handing them off, its hard to get the experience enough to feel totally comfortable, to know what it means when that vent alarm goes off and how to fix the problem, to know the usual dosing on various drips, which ones work better than others, what you can expect with different ones, etc etc... blah blah, you just can't get that when you only have the patient for a couple hours before shipping em off! Plus you only get assigned to the trauma rooms every so often so your chance for experience is totally just luck of the draw. What I've been tempted to do...and here's where my big question lies... Would it be a good idea to work in the ICU for a year or two, then come back to ER after getting in-depth critical care experience?? Go somewhere with a concentration of criticals and learn it back and forth, work with all the different pumps, lines, situations, see what happens AFTER the ER stabilizes them, etc... Maybe I'm just impatient... maybe I'd be miserable being back in the non-ER environment and regret it. I really love ER, and I learn something new every day, but its like you're EXPECTED to know all this stuff to care for the patient, but I haven't been trained in it or ever had experience with it, but HERE YOU GO! HERE'S YOUR PATIENT! What do you think? I'm moving soon, and changing jobs at the same time... so now would be the time to do it if I did... Should I apply for ICU or ER positions? Was my last hospital just crappy at training and I should go somewhere with a better training program? Or would it be beneficial to go and get that experience? Or should I just keep learning as I go? Thanks!!!