ReWritten

It's doable while on night shift, as I know people who have done it, but when it comes time to do clinical hours, it's going to be far easier to do it while on dayshift, given most of your clinicals will be held during regular office hours. I'm about to start my final year this fall and I'm working mid-shift and I'm dreading it, since I get off around midnight.

I'm not at UTA, but I have heard similar complaints from coworkers in their master's programs. At least we are all in the same metaphorical boat.

Thank you for you reply, CocoaLover. My BSN was all on-campus school, and this is the first time I've ever really taken online courses, and I'm really not enjoying the lack of face time. I've only had 2 professors bother to really put forth interacting with the class by way of providing youtube links for extra info, or even making videos themselves. I feel like most just provide the syllabus and bluntly state "follow this", and I won't hear from them again for another few weeks to check in. Is it common to feel like I'm teaching myself to be a nurse practitioner? I'm all about adult learning and self motivation, but it makes me anxious that the only support I feel are only from the physicians/fellow nurses I work with in the ER and not my own professors.

I am currently at a local state school's FNP program, going more or less at a part time rate as I work full time. The school is mostly online, though I've yet to go to campus for anything. Anyhow, I suppose I'm looking for encouragement and voices from others out there. Do you enjoy your program? I find mine quite frustrating with little to no interaction from professors and very minimal feedback. Currently I am in a summer class that will finish in 15 days. I've submitted a total of 4 discussion board posts, 2 papers (one is due tomorrow), and various CE certificates of completion, but have only received grades for 2 discussion boards. I feel like there is a lack of guidance in nearly all of my classes from the professors and am feeling very discouraged and debating whether I really want to continue onwards. Is this a common experience for online FNP schools? My undergraduate experience was the exact opposite with professors always willing to chat and responded fairly promptly to e-mails. I just feel a huge lack of guidance or caring, but can't figure out if it's just me, my school, or what. Thank you for any feedback!

It depends on the level of trust you have with your ED physician and your skills/experiences. It also depends on who you work for. I've worked out in a rural hospital where the midlevels could pretty much see and do everything the physician was. I've also heard of rural areas having EDs run by midlevels. I've worked in large urban hospitals where the midlevels only saw level 4-5, and rarely a level 3. Again, it just depends. I'm currently an ER RN going to FNP school, and have been approached to join the ER practice after I graduated and it was explained to me there was different levels of functioning of the midlevel depending on your experience and comfort (both yours and the physician).

Brand new - focus on assessment skills and time management (including priorities). Don't be afraid to ask questions. If you don't know how to do something/unsure/not confident doing it on your own - ASK. Your coworkers would rather you ask questions/ask help before you do potential harm. Same goes with doctors and even with experienced nurses. If I don't know how to do something/am unsure/not confident - I ask. Learn drugs. Don't be afraid to take time to research in the IV drug book for meds or look up something you might not know. It takes time to learn the common ones. If you don't know what a prescription is, again, ask. I still do this on the surprise script I'm unsure about. Work in a big ER teaching facility? You might get new drugs. Don't be afraid to ask the doctor or call pharmacy about it.

It definitely depends on the applicant pool. I'll let you know my GPA was in the gutter (around a 2.9) and I did mediocre on the GRE. I applied to a couple schools and in my letter of intent, addressed my low GPA (in my case, horrible test anxiety), and even discussed it when I interviewed for my NP program with the director. She was very kind and understanding about it... I was actually accepted into the program minutes after my interview. Don't let your GPA discourage you (I know it's hard, trust me). Gain some real world experience, perhaps take some classes to help you and show intention of taking things seriously.

I started in a 15-bed rural ED, and the PAs and NPs saw everything - fast track and if the MD was busy, pick up other patients. When I went to a major city ED, they didn't even hire NPs until recently (and she used to work there as an ED nurse, which is how she got in) and I never saw them take on a level 3 or higher. I'm now back in a smaller ED just within the metroplex and the midlevels see everything, so I think it really depends on the system. However, my personal feelings are that the smaller EDs are a little more lax in the rules of how things work.

Unfortunately it is very confusing. I've worked in ERs where the NPs are FNP and I've worked where they're ACNP. It really depends on the system. I've also worked in setting where I've never see the midlevels take on level 3's and higher, but in rural settings, they can do anything/everything. I think it really depends on the hospital system. I've been kind of debating this myself and unfortunately it's very confusing.

Dallas! But of course I'm a bit biased as I live here. Apply to all, interview, and decide from there based off their interview/tour you're given.

Low 30's sounds about right. You also have to remember the cost of living in the Dallas area is very reasonable, I think, and you can live comfortably at this salary. You'll have to ask the hospitals what they do about having your CEN. Some may pay you a little bonus each year, some might offer you a little more, it's just something you can ask. I highly recommend you touring these facilities (which you'll get to do during interview process) before making your decision. Baylor and Parkland are the big trauma centers in the city, and if you want to go a little north, Medical Center Plano is a level 2. Presbyterian is not, although there are rumors they might become one next summer. Like anywhere, there's pros and cons to each place. Do you research. I'd offer you my opinions, but I'd rather you to make your own decisions :) Good luck!

Plenty of nurses move from the floor to the ER. I did and very thankful for my time on the floor. I learned about medications and prioritization, and got my assessment skills down. You will have an advantage over a new grad coming to the ER. Good luck!

In a smaller ER. We report at the nurses' station. I think bedside reporting would work in ours, but I don't see any of my coworkers agreeing to it. Plus, the fear of HIPAA violation. We had AIDET too. What a waste of time, the hospital should've spent money somewhere else (like working equipment) rather than teaching us how to introduce ourselves. And I agree with thelema, I'm not going to put a timeframe on labwork and such. Our lab is worthless and takes forever or screws up, and all that depends how busy we are. I also got scolded for saying "busy" instead I should say "it's a popular time right now". Really? Ok, rant over.

I always wanted to do critical care/ICU during nursing school. I did not have a good experience in my ER rotation during nursing school, so I was no interested or impressed with it. After 8 months of not landing an ICU job, but on med-surg, I made ALOT of connections with the ER staff in my hospital and they coaxed me into coming downstairs. I've been there for 6 months and can't imagine going back to the floor. I LOVE it! However, I'm very thankful for my med-surg background. I consider myself a quick learner, but med-surg really helped me in terms of medication administration and good assessment skills. I work in a rural community hospital and had only 4 weeks of orientation in the ER, so you expected to know your stuff from the beginning. All that being said, I'm always learning something and my coworkers are a delight to work with and have no problems showing/explaining things to me.

I graduated May 2010, never worked in healthcare before. I was a cashier at Target... I was hired on a med-surg/tele floor with no problem.

Unfortunately I don't have any advice for you, but I wish you luck in the interview! I'm curious to know how it goes for you. I'd like to work for MSF one day.

I've only been in the ER for 2 months, but curious to other's reply to this. In my ER, we're required to do preg tests on all females (unless they've had a hyst) before giving Toradol. Does anyone else do this? Last week I had a pt come in with alot of pain, and my doc ordered Toradol for her. I decided to go ahead and draw it up, but my coworkers argued with me stating I absolutely couldn't give it until we ran a preg test, my doctor overheard the argument and stated to go ahead and give it and that he's never heard of this rule. Thoughts? Comments?

According to nearly every weekend in the Dallas Morning Newspaper, Parkland is under alot of fire recently between Medicare funding possibly being denied and questionable overseeing of UT-SW practicing med students. In an article maybe a month ago was talking about how Parkland hired many agency nurses to staff their ER until December (I don't quite remember, I'm going off of memory) because there was a mass exodus of ER nurses -- that right there sounds quite fishy to me. What was going on to make so many nurses leave, maybe not all at once but over a short period of time? I work in a rural hospital and I actually know a coworker of mine who did take Parkland's offer to temporarily work there. I don't know her that well to know how it's going for her. But the hospital is looking to hire new ER nurses. I don't know if I'd want to work there given all the negative publicity the hospital has been receiving the last few months, but then again articles could be biased and I've never worked there to have personal experience to say otherwise.

I work in a hospital in rural Texas, just a preface to my replies. 15 bed ER, 3 bed fast track. We probably see around 200 patients a day. 1) What is your standard nurse to patient ratio? 1:4 2)How receptive is management to staff going back to school? Some of my coworkers are working on their MSNs. I think the hospital is reimbursing them if they go part time. But honestly, I'm not sure. 3)What shifts do you guys work? This has been kind of an ongoing battle in my ER recently. Everyone works 12's. The manager wants 7a, 10a, 3p, 7p... but finding people to work the 10's and 3's is pretty difficult so he rotates people through them (only dayshift nurses will do 10's, and only nightshift nurses will do 3's). 4) What are the requirements to work ur traumas? We're not a trauma center, but we do have 2 trauma rooms. Everyone takes turns rotating through these room assignments. 5) What certs are required and how soon? ACLS, PALS or ENPC (you can have 1 or the other, or both, but required to have at least 1 of the 2), and TNCC. I believe all of them have to be obtained within 6mo of hire. 6) Do you have midlevels (NPs and PAs ) in your ED? Yes, but they only work midday shifts. The latest they'll possibly stay is 1am. (they typically only work 11a-11p, 10a-8p, 3p-1a) 7) What do you wish someone told you about ur ED before you started working there?? I worked on the floor and lived with some ER nurses. They're the ones that convinced me to transfer, so I know what I was getting into beforehand. 8) I know no one like to talk about $$, but what is ur base pay rate.... $20-23/hr, $24-27/hr, $27-30/hr../ >$30/hr??? I'm in the $20-$23 range. Most of my ER coworkers started out as travel nurses to my hospital and received very nice sign-on bonuses. Also, they have many years of experience compared to me so their pay scale is much higher than mine. 9) How long have you been an RN?? 1 year and a few month's worth. I worked Med-Surg for 9 months before transferring to my ER in June. I'm very thankful for my amazing coworkers who all of them have years of experience compared to me and have taught me ALOT since coming. Also, my manager didn't want new nurses in the ER, but they argued for me to come stating it'll be easy to train me brand new than someone "stuck in their ways".

Been in the ER only a couple months now, but we don't. We might test to give us an idea of they're actually on something or to help us determine how to treat them, but other than that, we could care less. If their alcohol level is too high, they're stuck with us until it goes down before discharge unless they have a ride.

two pens, paper and plastic tape, pen light, alcohol pads, 1 or 2 NS flushes, scissors, hemostats

I have just transferred to the ER, and on one of my first nights, we had a pt come in with an OD. EMS was called by his wife due to his decreased response and hard to wake up. When we asked where the wife was at this time, they replied "She said she was too tired to come and stayed at the hotel". Guess it was a good thing the pt didn't die! My roommate, an ER nurse, showed me a sign-in sheet he had saved. The time written was around 5am. On the Reason for Visit line, a woman wrote she needed a wrist band to show her husband to avoid a fight for being out so late with her boyfriend. Needless to say, she didn't get a bracelet. A doctor who wanted to make his patient a DNR, and had asked me if I had talked to him about it or if the patient had said anything about it. I reminded him that was his job if he really wanted to do that, and when I asked for parameters for a rapid response so I didn't have to keep calling him (the pt was asymptomatic), he replied, "Well, I guess if he stops breathing you'd have to code him..." talk about insensitive! This patient is A&Ox3, and yes, he's quite sick, but he wasn't anywhere near death. Everyone at work knows our pharmacy is absolutely horrible. Even my manager stated quite seriously in a meeting, "Don't trust pharmacy to have things correct...". My coworker had a patient on Zosyn and pharmacy seriously timed the medicines q30 minutes on their MAR. Needless to say, we had a good laugh with that one. But at least our medicine inventory was well stocked for all that zosyn!

My coworkers and I have this theory that when people are admitted to the hospital, they suddenly become invalids. There's been plenty of times we've lectured our patients, "Who does this for you when you're home?" And that often will motivate them to do it on their own. I think the best story I have of this, I actually had a patient call me in his room to scratch his butt, where he's well capable of doing it himself! (He asked me AND my coworker to do this!). I've also had my fair share of pts requesting to be turned in their beds, when they were just up and walking around in the hallway. Really, I don't know what gets in people's heads when they come to the hospital. I understand you're sick and feel awful, but if you're well capable of doing things on your own, DO IT!

I feel very fortunate that I passed my NCLEX the very first time I took it, and obtained a job 2 months after graduating last year. (Not in the specialty/hospital/location that I wanted, but I was just thrilled to get a job so quickly). I feel very fortunate that I have amazing coworkers that didn't mind training a new grad (me). They encouraged me to ask questions no matter how dumb they may have seemed, because they rather have me ask and be sure than to risk harming my patients. I feel very fortunate that despite the hospital's many faults (poor admin, often times poor staffing) my coworkers know what team work is, and will help out without questions asked.

I have almost 8 months of experience. My very first code ever was my own patient, and I know exactly how you felt! When you're not ACLS certified, the only thing you'd be asked to do is compressions or being the recorder. What prepared me/gave me more confidence in the situation was getting ACLS certified. (It's a requirement on my floor). If you're in that situation again, it is best to just observe and learn. Maybe obtain the patient's chart for the nurse in case questions are asked.