The_Squid

As far as the travel thing, like I posted before, I think I'd be better off getting an actual position to have a proper orientation. I would like to know what hospitals I should avoid and which ones are excellent. I figured this message board might be a good way to get a true first hand opinion on this. Suzanne, that's a good idea and I'll plan on doing that once I know which hospitals I might be interested in. Boston is definitely an option too, I have more friends there than in NYC (unfortunately none in nursing). I'm up to the challenge of the big city though. I never thought I'd be working as an ER nurse when I was younger, and I'm doing it successfully now in this small institution.

Sounds like you have a lot to say. Anything helpful?

I know what you're saying regarding the toughest. I know I'll learn the most but I don't want to end up in a situation that could be dangerous for my patients. I've got to be aware of my limitations. I'm leaning more now towards taking a staff position rather than a travel position. Just because I'd rather a more thorough orientation. I've been doing some research, Bellevue looks awesome.

Anyone (echo, echo, echo)

I've been working in the ER at a small community hospital in western massachusetts for 1 1/2 years. I'm looking to make the plunge and work in an ER in New York City. I would really prefer Manhattan or Brooklyn. I don't have any real trauma experience other than quickly setting up a patient that rolls in our doors to get transferred to a hospital with trauma services. I think I'm accomplished for my years of experience and a fast learner but I don't want to go to the toughest ER in the City. Any recommendations?

7a to 7p definitely, you get to wake up before it gets too crazy (depending on the hospital), if you're new, then you'll have more resources like your manager present, and the education dept. present. 11a-11p is cool because you can sleep in but that is peak flow (excuse my unintentional pun) in the ER and can be exhausting.

As far as actual policies, I don't think there would be a black and white one on any of these.

1. Why would you not want to start the vasopressors before the central line? I'm still fairly new and have only had a dozen or so situations like this but I think I would want to start the pressors asap if they're hypotensive enough to warrant them. 2. Rarely, we use nurses aides to hold unless the procedure is going to take a very long time. 3. Any time I use anything in that class, the airway could be compromised, I would want the official stamp of conscious sedation on that procedure with respiratory present. 4. Never given propofol for anything other than vented patients.

We just started having pt's list their complaints, we were triaging backwards before, registration taking cheif complaint and insurance then seeing triage. I laugh mostly at the spelling so far "Vomintin"

From the ER I definitely give them instructions, basic ones to follow up with pcp and return if worse, watch for s/s of infection, etc.. Honestly can anyone say they just silently have them sign the AMA form? I can identify with half of the people that leave AMA from the ER, they're certainly not critical and they can follow up if they need to.

"It is almost as though Nurses LOVE to see a co-worker fail....and the constant criticism, continual sarcastic "questions", non-stop correcting of silly things. It is so weird. I agree 100% with your observations and advice. Even when people are correcting you in a constructive way (at least intended to be constructive) they try to make you feel stupid and stressed which helps no one I know perform well. "I've learned the hard way that it is best to share as little as possible about myself. Keep the talk small." I'm a 26 y.o. male musician/music lover/outdoors lover and I only reveal this to people that have an interest in these things otherwise some people label me. One doctor listened to my cd and said "this is some serious pot head stuff." Whatever, keep listening to John Denver!

Because they know that acting like a jerk could virtually never impair the treatment they or their family receive, it's not like a restaurant where they could spit in your food or a garage where they don't fix your car right. Plus they're bored. They also want to seem like their advocation for their family member is actually doing something to help them because they are totally out of control of the situation. Also they're making sure there isn't going to be anyway you will forget about them. Honestly have you ever forgotten to get the patient to xray, or have the orderly get them a blanket, if that patient or the family is aggressive and harrassing. I hate to defend them. My personal tactic is to kill them with false kindness, as long as it's somewhere between over the top and obviously not genuine you will get your anger across without giving them a legitimate complaint.

Guy thought he had a tick on his butt, turned out it was a worther's original stuck to his ass crack hairs.

Psych patient who od'd on a bottle of herbal supplements of some sort "I'm in cardiac arrest...now I'm back...I'm arresting again now." His male friend was wearing a grass skirt.

I've also had the virginity verification request once.