amarilla

I am leaving nursing for another health profession and it is the ONLY reason I'd leave the ER, *laugh. I could never go back to floor nursing and have no desire to work for a doctor's fiefdom in ambulatory care. I've worked in same day surgery and pre-admission testing/OR holding, which was fair (because of the pace - hustle all day!) and awful at the same time (unit culture of misery). Returning to school this fall, I'm wondering whether I should try for a per diem ED job to keep one foot in or just give it up entirely. It just feels too weird to not do anything at all.

Hmm. While I may not be one of the more eloquent posters here, I'll try to be succinct: I triage people in danger of dying or nearly dead as '1', indicating immediate lifesaving intervention needed, i.e., arrests brought in in progress. Emergent treatment - like reviving an altered hypoglycemic patient with D50 - I would still triage a 2. Urgent with many resources a 3 and so on. In your example, I would triage the hypoglycemic patient who has already received interventions based on my assessment when I receive them. If that second finger stick on arrival is now 180 (from the D50) and they are awake/alert, they are a 3 and will be roomed accordingly unless there was a fall, LOC or some other issue at play dictating more immediate care (found down? poor vital signs?). I don't usually care how they looked an hour ago unless it's something like head injury or trauma which could have other implications, (internal injuries, shock etc) that may impact patient's status and resulting treatment going forward. Just my opinion and will look forward to reading others'.

I think the best thing to do may be to look up your local hospitals to take a look at the job descriptions posted for ED techs. It will tell you exactly what they want in terms of experience, certifications and the like. The few EDs I've worked for have varied in terms of what they want; of the two per diem places I work now, one hires EMTs and the other seems to prefer nursing assistants who have phleb experience. As for what recruiters are looking for, I can't say but I do know what my ED managers and peers look for: willingness to help and work as a team. Many things in the ED aren't an emergency and sometimes new employees sour on setting up that 13th abdominal painer of the day, dipping urines, putting grippy socks on our fall risks etc. It won't be adrenaline all the time and sometimes is mundane and even annoying. If you can keep the patient's best interest in mind - getting them treated and dispo'd - you won't have that problem but there are those days that even your last nerve will be stepped on. Just being honest. Duties vary by facility policy, I imagine. In both my jobs, ED techs usually help us set up the patient (move to stretcher, get vital signs, change and set up monitor, collect urine or straight draw blood) and respond to needs as they occur, (EKGs, dip urine, urine pregs, throat swabs, transport, pick up blood/meds, compressions in codes, move equipment to rooms where it's needed, help clean up pts, etc.) The ED is a great place to work and I wish you luck on your search. Cast your net far and wide and don't be picky - experience is experience and you can always move on.

Oh, so many things here that irritate me on a regular basis (and now I've been reminded of them on my day off!). Here are mine: Cosign the many who have posted about the cutesy cartoons and cut-outs that are posted on the walls. Just no. This is not elementary school! I don't want a sticker next to my name - maybe a raise or use that $ to hire more staff? In my ED: -I cringe every time the phone is ringing nonstop (we all pick it up) and someone sitting at a computer says "SOMEONE PICK THAT UP!". I always think in my head, (usually because I'm already on the phone), why don't YOU?? -Please don't tell me that you can't help or do something I've asked for a patient because you're doing something ridiculous like stringing Christmas lights, writing out your bills or downloading an app. "In a minute, it's almost done, okay?" Really? REALLY?? -Can we please stop being nice to one another's faces and then start talking about them the minute they walk away? Some of us really don't care. Just stop. Thank you for the vent....refreshing!

Hi all, I'm relocating to Buffalo in a few months and would appreciate any insight into where to apply (or not apply) for a per diem ER job in the area. I am an ADN with nearly five years experience - several years of float, almost 2 years in ED. I have all the expected education (BLS/ACLS/PALS/TNCC/etc) and will hopefully also have CEN in hand (testing next month.) Would also consider correctional but am seeing mostly ads for LPNs. Any advice appreciated! Thank you.

Please take this gently, OP, but sometimes we aren't always doing as well as we think we are. A month on med-surg to work on your skills may just mean that you're lacking the assessment skills and time management of your more experienced ED peers at this time. It's just something that comes with time. No knock on you, but I can't tell you how many clogged NGs, missing or overlooked labs and unfinished stats I've received from new(er) nurses who handed them off to me without even mentioning what was undone. While I try to mention these things as they come up, not everyone does and I've seen new(er) nurses blindsided by complaints later on when they otherwise thought they were doing well. Sometimes you just don't know what you don't know. Not saying this is the issue in your case, but try maybe to get some specifics to work on from your manager before you go to the floor? Last thought: make contacts while you're on the floor, in case this isn't just for a month. You'll want to be able to keep a job - even if it's not the ED - rather than be let go entirely. Best of luck.

When you put it that way, definitely! I suppose it's just been surreal that none of the other nurses there seem to be bothered by the way things are there. I come home and feel bad about the care some of the patients have received because I couldn't do any better for them, given my role. On a brighter note, I received another offer last week elsewhere. Hoping for greener pastures!

ICURNmaggie, I feel like a number of my free text entries in the chart are 'pt ______. Vital signs now _____. MD ____ made aware. No further orders at this time.' You can actually see the situation deteriorate through my notes. Ugghhh

Hi TLC, Thank you for your reply. Perhaps I should give a few examples to better illustrate the scenario? Let's say you go up to one of the docs with an update and as you open your mouth to speak, you get a finger held up to your face and then a 'WHAT?'. As you tumble the words out - pt is vomiting / febrile / etc- the doc says 'fine'. That's it. There isn't discussion; that's part of my problem. Yes, I understand I'm 'only' a nurse, but I am a team member and don't deserve to be shushed like a child or ignored when I speak on behalf of the patient. Your suggestion of breaking the ice with question/teaching is something I've already tried; it got me a doc asking the charge nurse to assign him nurses who aren't so chatty. Charge told me 'don't ask the docs anything and don't make suggestions; they don't want to hear from us. Watch the EMR for their orders.' It feels really silly. They don't want to engage. There isn't a relationship other than 'they order, you do it', and it's been made clear that's what they want. Does that change anything?

You might not always need consent to disclose to law enforcement though; know your state laws and hospital policy first. JME. Another link, this one specific to LE from HHS: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/final_hipaa_guide_law_enforcement.pdf

We get these - call them 'detainers'. For whatever reason, the police place the detainer and make us aware when we accept the patient into the ED. They leave and we treat the patient. When dispo approaches, we call and advise same and two officers arrive to take the patient into custody. If the patient figures this out and decides to elope, we don't stop them but we do call the police immediately to advise.

I feel your pain, OP, and yes, I would LOVE to have a discharge specialist to coordinate rides home! My regular job does not give out vouchers or bus passes, (we're nearly bankrupt as is), but my pd job will do so if the patient isn't on the usual offender list. I agree with others that it only seems to encourage bad behavior, unfortunately.

Hi all, I could really use some advice. I've been a nurse four years or so; a few years on the floors and about 18 months in the ED. I started a second job a few months ago for more hours and am contemplating whether to stay or to go - help me decide? Hospital is suburban and much less busy than my current inner-city job. Flow is good, patients are nice enough. Problem: the nursing culture here is so subservient to the docs; I've really never experienced such a thing, especially in the ED! Docs want nurses to wait for orders, won't hear suggestions and sometimes seem to plain refuse to act, even when patient or family is standing right there at the desk. I've witnessed a few situations already that resulted in poor outcomes and am wondering how I can do my job if we're not on the same team. Before anyone asks, yes - management is painfully aware. Any advice appreciated.

Agree with the previous posters to ask yourself why you want off the floor and what you're looking for. I started in med-surg, went into float pool and pursued an ED position for about six months before one finally gave me a chance. Like you, OP, I 'wanted off the floor.....NOW', *laugh. Mostly: I wanted to be challenged, to advance my skills and learn new ones, to turn and burn patients and have some variety in my day. JME. I cosign Stargazer 100%: every ED is different when it comes to staffing, teamwork, acuity, autonomy, etc, but I too would be concerned with a department with high turnover. The department which gave me my chance also was one of those 'challenged' units; I received less than two weeks orientation and was one of the only three nurses in *four* hiring cycles to stay through probation. The experienced ED nurses I met in my hiring cycle and the subsequent ones quit on their first or second shift. I should've bolted as well given this but didn't want to start over in the job search, still with no 'real' ED experience to offer. I stayed almost eight months and secured another position elsewhere, but the experience has been really rough. I'm not sure I would do it this way again, honestly - learn the right way with a supportive orientation because these patients NEED you to know what you're doing. Regarding acuity and teamwork, specifically: my first department tied nurses' hands. You triaged at bedside, MD on your heels, and you had to literally stand there and wait for initial orders - IV, labs, diagnostics, etc. It was frustrating as all get out but it was the department's protocol. One of the day MDs would write all his orders and you basically could not touch that patient until he was finished; one of the night MDs expected you 'to do the important things', (sometimes without orders), and would be upset if you didn't start that line or draw a certain lab. Total miscommunication and total mess. My new job: mostly order sets that can be nurse-initiated, thank God. Biggest thing that I've noticed different than the floor: teamwork. On the floor, we all had our assignments and when we could help each other, we did, but mostly it was every man for themselves. In the ED, I can't tell you how many times we grab labs for one another, transport a patient up, call a report and so on - it's like we all share the load so no one gets buried. It was very welcome but hard to adjust to - at first, I wondered if they were helping me because I was too slow or 'not getting it'. Personality types: I've met so many different types of nurses, so not sure there is any one type. As a previous poster said - you can be any type of nurse but you have to be able to 1/ move and 2/ be assertive when necessary. Things change very quickly and there have been a couple instances that I never saw coming - like the walky-talky fast track patient with the visitor who all of a sudden dropped to the floor. @&^@^!%% There really is no routine and getting used to things changing all the time - taking over patients for others who are swamped, having patients elope, being forever interrupted and having to quickly change priority while dealing with the inevitable complaints those changing priorities create...THAT is what I had to adjust to. Oh - and knowing nothing other than '45, male, c/o stomach pain x 2 days' when trying to set that patient up, assess him and get moving while managing my others with the doc on my heels already asking 'what's this guy's story?'. For me? Totally worth it. For you? You'll have to try it on for size. Good luck!

1. NJ 2. 3 3. ED 4. 34.00 5. 2.50 for nights 6. Non-union