er&obrn

welcome to nursing! your fear is healthy. the new grad without fear is the dangerous one. you can't have possibly learned and retained everything in school so be observant and learn as many valuable lessons as you can on the job. these are the ones that will always always stick out in your mind. remember your abc's and ALWAYS listen to your patients. you may not always like what they have to say, but i've never regretted this motto. and re: "drug seekers" this is a big er issue. one of my seasoned elder nurses once said to me (and i try very hard to live and practice by this) "i would rather give someone medicine they didn't really need than to with hold it from someone who did". even your most frequent flyer may actually present w/ real pain that needs attention. also...i've seen this a hundred times. multiple complaints. whether or not it is trauma. it's not unfathomable for a patient to have 2 major issues re: 2 different body systems...or even more than 2. an old doc i used to work with told a patient " you can only have one complaint per visit". he missed big things more than once and for some reason never learned. don't be that person. advocate for your patient. a family friend lost her stepdad yesterday. he fell 4 ft. from a ladder and severly broke his wrist which required surgery. he was c/o abd pain throught the ordeal and since he couldnt tolerate the po contrast, the abd ct never got done. he died the day after surgery from a lacerated spleen that bled out. like i said..."LISTEN TO YOUR PATIENTS!!". best wishes for a long and happy carreer.

wow! strongly opinionated. i was a new grad that started in the er (er tech experienced). and my er hires new grads often. i work in a very large and busy er in the city (level 2 trauma center, private hospital) and my clinical coordinator has been in her position for almost 2 decades. we run quite smoothly considering the volume that we see. it is her opinion that new grads can succeed in the er and she has proven this opinion time and time again. one of the best er nurses i know graduated a couple of months after i did and started in the er. as for starting iv's on particular patients...our er has protocols in place for "chest pain" and "abd pain" etc. this helps new grads, and seasoned nurses also, to be confident in their "triage" and helps docs to have labs available asap. as for the preceptor that was concerned w/ new grads "knowing it all", my opinion is that you just cant take that personally. each individual has a different personality and some of us have egos. i have watched many many new grads begin their careers in the er and very few have had an ego that was dangerous. i've always heard that "nurses eat their young" and i noticed that while working on a neuro floor as a nurse tech but not in my particular er. my seasoned er nurses take us under their wings and guide us. they give us encouragement and they praise us for a job well done. they give us constructive criticism where it is due. maybe i'm one of the lucky ones but i've never regretted beginning my career in the emergency department and i can't imagine not being employed in the er. i'm almost 3 yrs deep now and i cherish the good times and learn immensely important life and career lessons w/ the tough times.

i didn't read through all of the post re: this issue yet, but since this is near and dear to my heart i wanted to reply. first of all, the homebirth midwife who practices in my hometown is very safe and conservative. when my friend birthed w/ her a year ago, she had been practicing for decades and never had a negative outcome. the reason being...she ONLY accepts patients who are "low risk". she has no problems transporting to the hospital at the very first indication of issues and has never even had to use EMS (knock on wood). if you haven't seen ricki lakes fairly new documentary called "the business of being born", i would highly recommend it. it is quite informative and compares the US to other highly developed countries. only 3% of US births take place at home and i believe we have the 2nd highest infant and maternal mortality rate among other highly developed countries. in the netherlands, 1 of 3 births take place at home and their mortality rates are better than ours. the fact is, and any ob nurse knows this...one intervention cascades into multiple interventions. most women that chose homebirth are aware of this and wish to avoid this slippery slope. when appropriate, and when attended by an experienced and sensible midwife...homebirth is very safe. statistics are available to back this statement up. if you watch ricki lakes documentary, pay close attention to the guy from the W.H.O. (can't remember his name) and to michele odent (french obstetrician). they have profound statements that will really make you think. best wishes in your career! p.s.- i took care of a 32 yr. gravida 1 who is a physician last week. her husband works for a hospital corporation w/ ins. issues and told me "we push for c sections. it's more money for the hospital and doctors dont get sued". these facts certainly are accurate, but how sad that this is what this country has come to!