2muchfun

You need to really think about why you want to work ER. I'm sure you will be asked. The ER environment is a very strange and different subculture of nursing. ER nurses are "different". How do you see yourself fitting in? Teamwork is ESSENTIAL. Very different than the ICU's that are very detaile oriented and therefore slower pacing is necessary not to miss important details. In the ER you must multi-task and prioritize, QUICKLY. Keep the masses moving. You need to be able to delegate to techs and NA's in a respectful manner. If you are asked what qualities you posess that would make you a good ER nurse...remember: TEAM WORKER, PRIORITIZATION SKILLS, MULTI-TASKING SKILLS. Be ready to give examples. If you truley do not feel you have the potential to posess these qualities, steer clear of the ER. Good Luck

Gee, we must work together, same at my ER. And yes, we do miss things from time to time. Had a 48 yom w/ c/o "worst H/A of my life." Reported he sometimes had sz's w/ his h/a's. No other history, no other c/o. Arrested right there in the triage whilst I vitaled him. I have to say, even after all these years, it quite took my by surprise. BIG OLD MI!

Well, all-righty then. I find the first year resident with the dumbest inbred expression on his face and ask him if he wants to start an IV.. :rotfl:

One of our "male nurses" has officially changed his title (taped on badge), "NWP''.. :rotfl:

A group of "residents"' were examining my pt for admission. (i work ER). She was pleasently confused, sitting up, alert affect and mostly appropriate in response. Suddenly, there was a big hoo-ha in the room, the residents franticly trying to find who was her nurse, her BP has dropped to a SBP of 40, OMG we need a fluid bolus stat. So I walk in, look at the pt, whoever put her back on the monitor after XR put a huge cuff on her skinny arm that had loosened all the more. Calmly, I reached in a drawer, got a smaller cuff, tightened it on her arm and cycled the BP again...aha SBP in the 1-teens. I just look at the baby doctors and say, "there you go" and walked out. As a rule, i vital my own pts.

This was one on those situations where the pt had only been admitted to the ECF for aprx 24 hrs. I remember from the telephone incomming report that her medical hx really wasn't ll that bad for a late 80's pt. I fully understand initiating the code. However, most docs, after a couple rounds of meds and defib, would have probably approached the family, while staff continues CPR, advised them of her status and prognosis before making all-out efforts. This happens a lot in these circumstances and the docs are very good at directing the families to make the humane decision.

I sincerely appreciate all the replies. As for the length of time this resident was down, that is questionable since she was A&O at the ECF at the time of the report call, about 40 min prior to arrival. I would like to think that she hadn't coded at the ECf and neither the facility staff nor the squad didn't respond, although...she arrived in arrest and the squad was just rolling her on into a regular bed when our nurse noticed she looked "strange" and got a closer look and said, "I don't think she's breathing." Squad says, "Uh, yeah, don't guess so." Well that's another delemma I guess. Anyway, I missed about the first five minutes of the code, it was in progress when I walked in. The attending that night is one of my favorites, I don't think he even knows what went on unless Dr. Wacko told him, I doubt it. I want to make sure I don't make anyone look bad who might need a heads up before the ethics committee gets hold of this. I plan to talk to my NM, and I think she is out of town this week. Thanks again for the replies and support.

I don't want to give too many details for pt privacy reasons. We had an ECF pt sent to the ER a few nights ago, the nurse calling report said the pt. had sustained a minor injury in a fall. A&Ox4 , late 80's, full code. When she arrived by private squad aprx 40 minutes later she wasn't breathing, had no pulse and CPR was initiated after her arrival to the ER. After intubation and about 3-4 rounds of drugs, no response except an unsustained burst of V-tach before asystole again. Resident MD starts ordering a bunch of crap, XR, blood gasses..you know the routine. Meanwhile, the pt is purple up to her breasts. One of the nurses said to the resident, "no way we need all these tests, she's gone and this just runs up a huge bill for the hospital and the family." Then Dr. Bright-Idea wants to know if we can get an ultrasound...uh no. A few more rounds of drugs, pt is very purple, probably disected the aorta. Anyway, I say to the resident, "even if you save her you are doing her and her family a huge disservice, she is purple to her breasts and no way is she going to have a ny quality of life if you COULD save her." He glares at me and says ..."We'er practicing!! OK?" I nearly shout back at him telling him that is totally unethical. You could have heard a pin drop for about a split second. Then he says, "well, she is a full code, I have to tell her family I did everything I could to save her." I said to him that coding a pt for practice when there is no hope of survival is not ethical. He says he will run the code "till I say stop, if you don't like ityou can leave, this code is going on with or without you.." I say ,"well I don't like it." About that time a PA walks in and asks if she can do anything. I say "Yeah, take my place," and I left. I was later told that he ran that code a good 5 minutes more out of spite. Even the PA was livid and she wasn't even in there for the worst of it. The PA, the other 2 nurses and the RT have all said they will back me if I go to the ethics committee. I am waiting to talk to my NM first, she has been out of town and I want to give her a heads up on this. Plus, I have never gone to this committe before and don't know what to expect. My fears are that he can cause hard feelings between me and the other ER docs, it's a good old boys club, and though I like our docs, I don't know how they would react to me turning in one of their own. AND, she was a full code, so that will be the loop hole he will probably squeeze his slimey ass through. BUT, he did say in a room full of wittnesses that he was practicing. hmmm? About an hour after this happened he apologized to me, but he still doesn't think he did anything wrong as far as the code situation. I told him if that were my family member and I found out what he was doing, I would sue him. YIP, looked him straight in the eye and said it. He was nice the rest of the shift, but I still wanted to twist his balls off. I just don't know I will do next... what would you do?

Why don't you ask some of your instructors? Since they have higher degrees, (and coincidentally hand out your grades), I'm sure they would be happy to oblige you .