Maggie09

And that, ladies and gentleman, is why so many nurses are dealing with depression, anger, regret, sadness, and absolutely hating their jobs. I can say without a doubt tele is one of the absolute toughest places to work. I started there for my first few years of nursing, and towards the end I hated every minute of it. Many times the patients were ICU material, but the ICU was full. Thus, you ended up with multiple patients who have the potential for going down the drain. But, by golly, you'd BETTER make sure they all were bathed (even the walky talkies), fluffed and puffed. and heaven forbid the CNAs get off of their cell phones and quit rolling their eyes long enough to pitch in. It blows my mind that day shift charge nurses never (and I mean EVER) took an assignment, but the night shift nurses had a full load. It makes no sense. The charge nurses on days didn't do jack, but they were more than happy to tell the staff nurses how poorly they did their work. Ok, so that's my rant. This topic just hits a nerve with me. M/S and tele patients are so much sicker than people realize. Even sometimes the ICU and ER didn't understand how high the acuity could be in those departments. And the lack of support from management and charge nurses...Lord have mercy. I'm sure these experiences aren't the case on every tele floor...and I know there are some good, decent, hardworking charge nurses out there. My experience in tele made me want to get the you-know-what out of Dodge. Hence why I moved to the ED. Much better teamwork, more exciting, and in a lot of ways...less stressful. Don't stay somewhere that makes you completely miserable unless you absolutely HAVE to for other reasons. It's not worth the stress, tears, and frustration!

If you have a tubed ESI 1 patient circling the drain, there is no way that you should have three other patients that aren't stable. That is completely ridiculous, and I would have probably raised heck and refused the unsafe assignment...then I would've gone to upper management if anyone gave me any crap about it. Especially since it's obvious that other nurses don't have that problem. It sounds like you're a good, solid worker. There might be some jealousy going on, or it might just be that there are a few key people there that are nasty as all get-out and will never improve. Regardless, I would be having a talk with the charge nurse ASAP. Call her out on her partiality. I am so sick of nurses having to sit back and put up with cruddy conditions just because they're being "tested" by the higher-ups. While it is perfectly fine (and appropriate) to "challenge" someone, it is ridiculous to give someone the assignment from Hades and watch them while they drown. Approach the CN and management (if necessary) in a polite but firm way. Tell them you want to provide great care, but there is no way a nurse can safely and effectively care for the kind of assignments you're getting. I would also be sure to document any patients you don't receive report on. Heck, I'd be filling out incident reports. If you don't see changes and the working conditions are consistently cruddy--MOVE ON. I wish you the best. I'm a newer ED person as well. I have my rough days, but for the most part I never feel like I'm put in completely unsafe situations. Coworkers can be a bear anywhere you go, but at the end of the day it is essential that the majority of people have your back if for no other reason than patient safety, otherwise you're just going to be S.O.L.

I love, love LOVE working in the ER. Transferred there in May after 2 years cardiac/tele and have never looked back. I think it took awhile to get used to the completely different prioritization that occurs in the ER. No AM meds, no checking off a bazillion orders, treatments upon treatments, dressing changes, etc. It's all about stabilizing the patients and moving on. Being able to think very quickly on your feet, absorbing everything around you, and always being prepared are essential. The squads don't care if you already have one vented pt and another on multiple drips--they keep bringing patients! Rascals, ha ha. I found Critical Care Nursing Made Incredibly Easy to be quite helpful in terms of mastering some of the more ICU-related issues that can occur. Brushing up on your arrhythmias and interventions for each one would be helpful. That will help you anticipate what drips you need to be thinking about. Also, each ER is different, so finding out the most common complaints you see on a daily basis and then getting a good feel for the typical protocols would be really helpful. Example--a patient comes in with abd. pain, I have a good idea of the workup the Doc/NP is going to order, what meds will be utilized, the consulting MDs, etc. etc. In orientation I kept a list of each of the major complaints--chest pain, abd pain, headache, stroke, gyn complaints, psych, and then kept notes on each topic--what tests were usually ordered, protocols, meds. One thing about the ER...we do OB/Gyn/Peds/Neuro/Ortho/Psych/ICU/Tele/MedSurg/Onc...and that's the short list. You have to be a bit of a Jack (or Jill) of all trades to an extent. Good luck!

Hi Beeker, Granted, some nursing units are just inherently tougher than others when it comes to coworkers. I work in the ED, and our ED and ICUs have notorious reps for being "tough crowds" to break into. When I transferred from tele to the ED they were supportive of me as a new ED nurse. Nobody expects (or even wants) to be "best buds" with all of their coworkers, but I would flat-out refuse to work in an environment where I felt completely thrown to the wolves. While it takes awhile to feel camaraderie in any group, I would be very leery of accepting a position where the manager is acknowledging that the staff and your future coworkers are not supportive and helpful. Another note--4 weeks of orientation? That would be tough if you had the best coworkers on earth--I can't imagine 4 weeks of orientation then "out you go" to be left on your own without adequate support from coworkers. You'll have to follow your heart...is there any way you can spend a shift or two on the unit shadowing? Maybe get a feel for how things go?

Good grief, where were you all when I was a staff nurse on the floor??? Kudos for chipping in and being USEFUL instead of a nice, well-manicured "ornament." Hence why I now work in the ED...a lot more teamwork there than on the majority of the floors. At least in my hospital, lol.

The ICU and ER are two totally separate worlds. If you feel like you would rather work in an ICU over the long haul, then stay in the ICU. In the ER where I work and most ERs around the area, new grads are not very welcome at all...and it's pretty much the same in the ICUs...although I will say that critical care opportunities are more common for new grads than in the ER. But every region is different. If you feel the pull towards ICU, stick it out and get as much experience in it while you're finishing up school. ER experience as a student wouldn't necessarily do much for you with regards to getting a job in an ICU...at least in my hospital.

I had a peer interview at the first job I interviewed for a few years ago. I was not at all impressed, and glad I didn't end up working on that unit. It IS like a sorority "rush," kind of BS in my opinion. I want a manager who has a good enough feel for the unit to pick out his/her own employees without pawning it off on those who already work there. On a different note, I think shadowing is a good thing, because it lets you get a feel for how things actually go on a unit, and is a lot more productive than just seeing if you "fit in with the cool crowd," I work in an ER now that requires shadowing prior to hiring, and I felt like it was a good thing.

Hi Issey, The ED would definitely be a tough switch from the OR, but I'm sure you could do it. I don't know if they would go for someone with no ED experience, but they very well might--you never know until you try. When I graduated I did cardiac stepdown/tele for a couple of years, then moved to the ED. Even being somewhat "used" to having a variety of patients at one time, nothing really prepares you for the craziness that is the ED. It's a blast, but it's definitely a learning curve. Talk to the nurse recruiter and see what he/she has to say. With five years nursing experience, you definitely have some pull. If all else fails, switch to an ICU or tele unit for a little while and gain some more experience, then try the switch again.

I have the utmost respect for nurses in LTC. You guys and gals are absolutely amazing! I work in a busy, city ER which can be tough in its own right...but I know full well I couldn't handle LTC. The nurse/patient ratios and lack of support would have me freaked out from day one. The idea of having to deal with 25-50 patients...good grief, there's absolutely no way I could function. Too much responsibility and not enough security. Ok, that's my rant Regarding new grads, I think it would be a very, very tough place to start just on the basis of time management. It's hard enough to get used to taking care of 4+ patients in an acute care setting where there's always some form of support in the way of other nurses and doctors...to have double digit numbers of patients and all of the responsibility would likely overwhelm most new grads. Heck, it would overwhelm me and I've been a nurse for a little while now. But to each his/her own, and kudos to those who can do it!

You're not delusional at all, and please don't sell yourself short! I worked a couple years of cardiac/tele and am now in the ER, which I love...but there is no way I could handle mother-baby. It would scare the living daylights out of me. I'm afraid I might break the babies, lol. Kidding. While it might be "easy" in some ways, if something should go wrong you need to know your stuff and be able to act just as much as I would in the ER with a really "sick puppy." Feel free to branch out into other areas of nursing, but don't feel like you're not doing a great job as a nurse just because you're finding the job "easy"--did you ever think, you just might be really good at it and a quick learner?

AJPV, I'm in an MSN program right now, as are many of my friends/coworkers. From what I (and they) have experienced, there is a lot more nursing research and theory in grad programs than anything else. Even in the practitioner program (which I and my friends are in, and we all go to different universities) there is very little about diagnostic/medical reasoning. This seems to be the general rule. When this has been brought up to the "higher ups" in the universities, they said "If you want to diagnose and be a doctor, go to medical school. We're nurses." So in a lot of cases, that is the mindset. I completely agree with you that there needs to be a strong medical foundation for nurses, but unfortunately the nursing profession feels like to "be a profession" they need to be totally separate from the medical profession. I think that's a joke...but hey, what do I know...I'm just a nurse! Ha. I think the MSN--nurse practitioner/CNS programs need to be mostly clinically based, and leave the majority of theory/research to the nurse researchers/PhD tracks. I don't care WHAT the universities say, as a nurse practitioner I might in many cases be practicing in a situation where I will be making clinical decisions without much, if any, physician back-up/contact (depending on the state and practicing laws of course), so I'd BETTER have a good idea of how to clinically diagnose someone...and it sure as heck better not involve a daggone energy field! Ok, I'm off my high horse!!! :lol2: To some of the other posters regarding physician/nurse relationships: In a perfect world, doctors and nurses would get along and have respect for each other 24/7/365 and realize that it's the collaboration between them that helps heal the patient (and disease) as a whole. That may be preached more in medical school than it was years ago, but there are still many, many nurses who feel inferior to doctors and/or doctors that feel superior to nurses. I think when you're in nursing or med school you don't always get a clear picture of "how it really is." I think it's a case-by-case basis. It depends on the hospital, the nurses, and the doctors who practice there. I hate generalizations and stereotypes, but they are most definitely out there. I think the best thing anyone of us can do is to be as knowledgeable as possible in our chosen profession, be it medicine or nursing, and therefore have a strong base from which to draw on and contribute to the patient's care. I have no problem working with docs and med students...some of my best friends at work are a few of the residents I work with, and we hang out outside of the hospital frequently. Word to the wise: don't ever let anyone look down on you for your position or work. Demand respect, and most of the time you'll get it. To the OP of the thread: Good for you for pursuing a medical education, I think that's fantastic! That being said, if I was going to go to med school, I would not go with a nursing degree unless I could absolutely breeze through it...which would be very, very difficult for many people, especially someone who wasn't really devoted to pursuing nursing as a profession. I do think nurses can make great doctors...my family doc was a paramedic, then a nurse, then went to med school. Very sharp person. But if I was going to pursue a degree and go towards med school, I'd try to find something I could complete without a lot of trouble, with the credits you already have instead of going down the nursing path....a BSN isn't easy to obtain and it'll suck the life and soul out of you in the process sometimes. Good luck with whatever you decide to do! :)

I am so stinking SICK of childish behavior! Whatever happened to accountability and getting your butt called on something when you screw up? Augh, this makes me want to scream! Ok now I feel better. I had a bit of a rough day myself, so I needed to get that out. I don't think you were wrong at all in filling out the incident report. Hypothetically, if it'd been me, I would have tried to contact the nurse prior. But I have seen incident reports filled out for much "stupider" things than actual dangers such as failing to administer a med. This is one reason I kind of like bedside reporting--gives the oncoming nurse the chance to ask questions, look at IVF and IV sites, etc. And you'd better believe I'd raise bloody h*** if there's something in question and the off-going nurse is trying to play off a situation. Find a more supportive unit and a manager that has the you-know-whats to call people on their mistakes and shortcomings. No need to be punitive--anyone of us can and likely has done something similar, but I'll be danged if I'd stay on a unit that penalized ME for looking out for my patient's safety and let the nurse who made the mistake off the hook (and free to key cars! what a joke!).

I've had some wise people in the health care field tell me that anyone who has a problem with someone who is "over-efficient" or "on-the-ball" is jealous. Like you, I pride myself in busting my butt too. On a lot of days, I have my 9 am meds passed on four patients, as well as all my documentation done by 9am--and we have 4 VERY sick cardiac step-down patients on a "good day." I get "kidded" all the time. But if my work ethic makes someone else look bad, tough you-know-what. The difference is, I don't worry about anybody else. I know the situation is different in the OR, but I say do your job--and your job only. Long as the patient is safe and cases get done, let the others mess around and hang themselves on their own rope. Don't cover for anybody but yourself.

Yeah, it definitely sounds like the typical nursing school...but here's a thought--how about approaching the instructor in a polite, "un-defensive" manner and asking her for some tips in studying for her exams? I had quite a few classes where I approached the instructor and said something like, "I find this material very interesting and I've put in quite a bit of time into studying for exams...yet the results (ie grades) aren't what I expected. Do you have any suggestions for me to improve my performance?" I never ran into an instructor who didn't give me some tips and suggestions. Worst case scenario, you're back at square one. But in any case, I would definitely seek out the instructor for some assistance...then it won't just look like you're trying to "take the easy way out." I can guarantee you that if everyone "gangs up" on the professor, it won't have a good outcome. I've seen it in my own nursing school experience. Good luck with everything.

I'm a relatively new nurse, and my unit has been doing walking rounds for over a year. I much, much prefer walking rounds to taped report because I like being able to pause the conversation and ask questions instead of having to hunt down the nurse or give them a call if they've already left. Anyway, to answer your questions: 1. How do I go about it- I work day/eve rotation, but I always try to get to work around 30 minutes ahead of time. We utilize kardexes that have patient information (hx, dx, meds, nursing interventions, lab results, and nursing updates from every previous shift). So...I look through the 3-4 pt kardexes, highlight important information and meds due my shift. As soon as I'm done, I find the night shift nurses who had my pts overnight and proceed to get report. We go right outside the pt's room where there are shelves that we keep the medical charts. I get the majority report right outside the room where the pt's can't overhear every little thing. We look through the chart, I have a minute to ask questions, then we go in the room, and I introduce myself, and we discuss any last minute issues (that was one long run-on sentence but I'm tired, ha ha). 2. What if a pt needs something- Since we aren't directly in the room while giving the majority of report, this usually isn't an issue. Should the pt need something when we go in the room, we either call the PCA or tell them it will be addressed in about 15 minutes (as long as it isn't something urgent). 3. How do charge nurses handle it- The night shift and day shift nurses do verbal report at the nurse's station. 4. Do patient's like it- I think so...I think they like meeting the oncoming nurse and get a sense of "continuity." 5. If a nurse is running late- The night shift tapes if the person is going to be more than 15 minutes late. 6. More day shift than night shift nurses- Most of us on day shift get are "crud" together a little early and get a head start so that the night shift doesn't have to wait around. It usually isn't an issue.