1EmergencyRN

Altra - sure! We (staff RNs in our dept) have recently found out that we are the only hospital in at least the Western 1/2 of our state that does not have SANE certified RNs performing the exams. Also, in my new job as a Forensic Examiner, I have been reading literature from medical journals that indicates that SANE training is the desired level of training preferred for a proper exam. Also, some of our coworkers were in discussions with an RN who told them of a case where a co-worker in another state was performing ASA kits without SANE training, as we do, and in their case that RN went to court to testify on the ASA kit. The kit was subsequently thrown out due to improper evidence collection and then the victim was murdered shortly after by the alleged assailant. That hospital was sued and the RN performing the kit was personally sued and they both lost. We have been attempting to find out where this case happened so that we could find the literature on it, but have had no luck so far. It has brought up the question of concern over liability in many of our staff RN's eyes, but most concerning is the lack of proper technique, education and care that we are providing to these particular clientele and trying to ensure that we give them every chance to have the correct interventions provided without any further detriment to their being, their safety and to the overall process.

Esme12 - that's my best guess too. Thanks for the comment! I've contacted a lawyer to get a legal perspective now as well, and am curious what they say as to the risk against our licenses. (granted my greatest concern is the quality of care for the patients!)

Hello everyone! Help! I work in an ED where they have any and every ED nurse do ASA kits. It all depends on timing and rotating turns, basically luck of the draw. The ED RNs are given a "once over" on what's in the kit by another ED RN as far as what's in it and how you generally process them. The person doing them never does them side by side with anyone experienced, you basically learn as you go. There are no SANE RNs on staff. I started recently working as a Forensic Examiner and am being thoroughly trained on the exams, additionally I will be completing my SANE course next month. The concern is: Are these ED RNs liable for negligent practice when doing the kits, knowing that the standard is to have SANE training? As far as we know, we are the only hospital in Western WA that does not either have SANE nurses on staff, or that contracts them out. I have been attempting research to see if there are any legal means to support or dismiss this practice, and have even contacted my practice insurance agent for assistance. However in the process, one of my co-workers was just written up for insubordination and immediate suspension for refusing to do an ASA exam, based on her concern for the safety of her license. I am reaching out to all of you to see if you may have any additional perspectives or advice on the matter. Thanks for any help!

June '08

Many people cheated and got away with it in my school. I found it despicable. I NEVER cheated. I feel so strongly that cheating IS cheating yourself... but you know what??? That's selfish! CHEATING IS CHEATING YOUR PATIENTS! It's cheating your patients out of you being the best you can for them, giving every last ounce of what you have to make sure you are on your "A" game in their care. Do you want to be in my ER bed knowing that I work my A$$ off to know my job as well as I can so that I can identify that one thing that tells me when you're going south or do you want the ER (or any other) bed of the nurse who cheated through school and is just satisfied they have a job?

I surveyed ALL hospitals in the western part of the state prior to submitting any applications to nursing schools. They ALL assured me that the location of schooling did not matter as long as it was accredited. I went to a technical college and received my ADN. I was hired straight into the 2nd busiest ER in the state without a blink of an eye. I was also offered ICU positions and 4 other med/surg positions at other hospitals in the area.... point being, I feel strongly that your license stating "Registered Nurse" is sufficient. That being said... always emphasize with employers your desire to continuing your education, after all, that's a very important part of our job, to keep learning and growing! Good luck to you!

Browsing through blogs & just can't help but answer to this one! Nursing is my second career. My first was for corporate america... at a top 500 forbes company, I spent time in management there and hopefully this advice will help, because believe you me, to many even in healthcare, it's still a business when it comes down to it! So... #1... yes, when called by another hiring facility, a manger or HR can not answer certain questions about an employee other than date of hire, if the person is still employed etc. But while HR staff will be quite professional about this; there are ways that many managers work around that. Some hiring managers will take advantage of what others either a) don't know they can't say (it happens!) or b) they'll ask the questions such as "was this person frequently late to work?" and the manager will say something along the lines of "well, I REALLY wish I could answer that for you in this instance, but it would be against the law for me to answer that appropriately for you". They might answer it in an overtly negative tone that implies to the caller that they have disdain for the employee... Point being, calling isn't always fair game. I hope you gave the HR number to your prospective employer vs. your manager's direct line. (By the way, I stuck by the "rules", but on several occasions had other managers tell me things very openly and without prompting about employees that was completely against the law. Now, as far as your approach with recruiters... I have not only used this technique, but found it to be the one I most respected out of potential hires I interviewed... answer with a positive no matter what. You can find ways to get your point across without "blaming". Phrases such as, "their ideas on how scheduling is handled just don't work well for what I need in my employer." Or, "Our ways of handling medication safety weren't aligned." If they ask you to expand you can still take the high road by stating, "I feel all medication errors or potential errors should be reviewed to allow opportunity to be corrected so that future incidents are prevented; however my employer was not in agreement with that". In this way you are clearly showing that you have higher standards than what your current employer/manager was providing to you. Much better than, "my manager wouldn't listen to my requests for change". For some reason if they do call and it ends up in a situation where your manager becomes hostile with you, I would suggest a direct conversation with her, maybe with the assistant manager present or even HR to very directly explain your concerns about how she has handled other employees in this situation, with an emphasis that you are clear as to the laws protecting you from her saying anything negative to any future employers of yours. Unfortunately, when a person marks "do not call" on a resume, it can go either way for prospective employers. Sometimes they think "what's wrong with this employee that they want to hide?" and other times they are able to realize that some managers may not be as unbias or unbegruding as others. You may want to consider giving them a warning that your manager is not fond of giving references (not a blame, but an honest warning). All in all, if it doesn't work out because the hiring manager thinks they've gotten "bad" info on you, then maybe they weren't the right manager for you anyway. Good luck to you, I really hope this new job works out without the headaches of a relentless manager!

Well, yes, I guess that's exactly my point though, I already believe all of what you've said, but how do I go about promoting it? I want to find a way to make it so that the smile I give gets a smile back. I keep giving and giving and hope that at some point it will rub off... sigh....

I feel for you... can't quit? Are you sure? Is there NO WHERE else? Reason I ask is because it seems like you are in jeopardy of your own license (as BRONX_RN mentioned) every time you work. Sounds like there are issues that the state would be interested in as well, reportable items that you should be thinking about. I hope you either find a way out of this one or find a way to help be a part of bringing solutions to the facility. Good luck (I think you need it!)

Rule #1, be prepared! That being said, here's what I found to be helpful when I interviewed (I was offered all 5 of the jobs I did in person interviews with, so hopefully these tips will help you too!). 1) Know what behavioral interviewing is and have some formulated answers based that, do some online research and you'll find plenty of examples. 2) have your answers ready for the standard questions "what are your strengths/weaknesses" (make your weakness a discreet strength!), "why did you pick (insert specialty here)", "why do you wan to work here", "what do you have to offer that is different from the other people we are interviewing". 3) be straight forward, always! If you are nervous on the spot and catch yourself having a hard time responding to a question because of nerves, just be open and say "excuse me, I'm very grateful to be here and really nervous at the moment". You would be surprised, how much grace is provided just from that straight forward honesty. Other standard tips are: dress appropriately, don't be late, be scent neutral, make sure you have and pronounce the name correctly of the person interviewing you, bring extra copies of your resume & other pertinent paperwork and send a thank you card afterward no matter how good or bad you feel the interview went. Hope this helps - Good luck to you!!

Help! I went straight into the ER from nursing school. I had battled between my choice to go into an ICU or the ER, but leaned towards ER the whole time. During nursing school I found a lot of criticism for looking at both as options. "It's either one or the other and they're both very different!" was commonly heard when I was in clinicals. I did my senior practicum in an ICU, mainly because I had not been exposed to it much and knew it would help solidify my choice. Sure enough, as much as I enjoyed the experience, I also confirmed for myself that I am an emergency nurse, no doubt about it. Now, fast forward a year and a half. I am an ER nurse, love my job. Here's what I don't understand though, why do so many ER nurses hate ICU nurses and vice versa?? Every time I've transported to the ICU, I've either been yelled at (it's happened several times!) or I have had a cold shoulder given to me. Only 1 time have I had a smiling face. Now, you may wonder maybe something is lacking in my practice? Well, I wondered that too, but I've asked and asked for feedback, not only from the ICU nurses, but from my peers as well. The responses have been baffling, as no one really seems to say anything solid, just continue to rant, rave and complain about the other. And you know what? I don't get it! Yes, I see that our jobs are totally different, but why can we not just respect our differences and do our job without grumbling? What is it that makes these two specialties dislike each other on such a large scale? Is this type of rivalry common between these two specialties in other hospitals as well? Help me understand, and more importantly, educate me to know what I can do better to make those ICU nurses happy! I want to be a team player and would love to not be viewed as "the evil ER nurse who put an 18 gauge in an ac" (hey, we had to do a CT angio, so I had no choice on the ac placement!) whenever I transport!

Thanks! I'm studying now, just took the ENA online review course, but want to get a book to review at my leisure. As asked by MBARN08, any recommendations on books?

Per Bettysue62's question about credit, many companies, not just hospitals, but corporations are now using credit checks as part of the hiring process because they consider it helpful as a predictor of the longevity of an employee. The theory is something along the lines of: the more stable the credit, the more stable the employee.

It's tough when you aren't sure! I knew I was bound for either ER or ICU, leaned towards ER the whole time, and because of that I completed my senior practicum in an ICU. I wanted to get that exposure to be sure, and it did confirm that I'm an ER girl at heart. Kudos for putting the question out there and searching for your answer. I believe that not only looking in yourself but also, finding as much as you can about different specialties will help, and you may just get to what you love through time and experience. For now, I can at least help you by telling you my view on ER nursing. I love that it is fast paced. If you love adrenaline and thrive on a challenge, it fits that mold! The draw back to me is the lack of time you have to spend with patients. I'm running way too often to have much "social" chatter with them. But also, that can be a pro when dealing with difficult patients. You have your patients who complain a lot, but you have that anywhere you go I'm sure. I love blood and guts, and am exposed to contagiens of all sorts, but that just adds to the excitement of the job. I love the details of how the body works, and miss that with not taking an ICU job, but our ER houses ICU patients frequently, so I do get to dabble in that from time to time. If you can pay great attention to detail, think quick on your feet, and have a lot of self confidence, you might just love emergency nursing.... hope this helps a little. Hope you hear a lot about other specialties too so that you can have a broader view. Good luck in your journey and in your nursing career!

1) 'They' told me to tell you to always use a butterfly (Come on, who is "they", and why are "they" always saying that?) 2) You wont find a vein, no one ever does. (Oh yeah, I'm the IV ninja! Just try me!) 3) Call the nurses who do IVs (HELLOOOOO!!!! I'M THE NURSE WITH THE IV IN MY HAND THAT DOES THIS 15 TIMES A DAY & AM ABOUT TO DO IT AGAIN TO YOU EVEN THOUGH YOU SEEM TO AUTOMATICALLY THINK AN ER NURSE CAN'T DO IT!)