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  1. Larry77

    Epic Charting System

    I've used both computerized Tsystem and now Epic, you will hate Epic at first. It is not nearly as straight forward as Tsystem but after awhile you will get used to it and have a new normal. There is nothing like left clicking for circling and right clicking for slashing as well as the great chart summary you get from Tsystem. The good part about Epic to me is it is commonly the same system that the inpatient world uses so you don' t have the issue with inpatient staff unable to easily see or understand your Tsystem charting. Epic is a little different, it is an inpatient system that has been altered to do ED charting as well. Tsystem was designed for the ED and it shows. Epic is very customizable so even if you are familiar with the system and you go to another hospital you will still have a slight learning curve.
  2. Larry77

    Are all these certifications worth it?

    To me it depends on what your long term goals are. Do you plan on staying in the ED? If so, you probably do not need to maintain your cardiac specific certs. In the ED we have plenty of courses to maintain (TNCC, BLS, ACLS, PALS, ENPC) plus our own cert (CEN). So adding other specific courses/certs would just add to your time and expense without giving you much benefit. After moving to Management I am having to live with not having ACLS, TNCC, ENPC, PALS but I plan on keeping up my CEN for as long as I can (need to set an example).
  3. Larry77

    difficult ETOH pt

    I would talk to your Medical Director and come up with an ED care plan, you do not need a PCP for that. On some of ours over the years we would have a plan in place to only treat objective findings (i.e. withdrawal s/s). We would have a plan to NOT feed them, to NOT give them a treatment room. If they were SI the plan would be to put them in a hold room with nothing but a mattress. Some of this may seem extreme but the only way to decrease the abuse is to take away what the reason they are coming to your department. As far as for you, please be careful to not let your frustration show in your care, and do everything you can to not bring it home. I feel sorry for someone like the person you describe and feel that it must be sad to be killing yourself just to escape whatever he/she is trying to escape. Many cases came to mind in my own experience that are nearly identical to what you describe, the last I can remember died in an ally after passing out drunk in the winter. She was 26 and in our department at least twice a week, never wanting help just angry that someone called the cops to land her in our department. Just keep swimming and really appreciate those cases where you can make a difference. Drug and alcohol addiction is an illness in my opinion and your patient is afflicted. If you think about it in that sense it might be a little easier to handle. L
  4. Larry77

    Protecting yourself from disgruntled patients

    It was an uncomfortable change for me because I also came from the Inpatient Psych world, but I have not run into any issues. Usually I'm one degree away from what the patients are "disgruntled" about. Most of the complaints I deal with are patients that are unhappy with the MD or the bill but not me. I feel like when I was the one restraining them, or the one not giving them meds, or not allowing them to leave, I was more at risk than now that I'm the one dealing with their complaint days later. When I give my business card (which is not every time), it even has my work cell number on it...that was also scary to me, but I have had no issues thus far. Larry
  5. Larry77

    Job interview

    Most facilities are going with "Behavior Based" questions like, "Tell me about a time when...". I would have a few stories in mind that happened to you, a touching one, one involving conflict (possibly with another staff member), and one where you made a mistake. Be prepared to talk about your weaknesses (strengths are usually easier to think of). Go in confident and friendly...some nerves are expected and you shouldn't be punished for them so just relax, breath and try to have a conversation with them. Basically they are looking to get a sense of your personality. Leaders realize they can teach skills but can't change someone's character. Good luck! Larry
  6. Larry77

    BSN or CEN?

    I look at both but I am strongly encouraged to only hire BSN prepared RN's. We are on the "Magnet" journey so we are required to have 80% BSN RN's house-wide. That being said I would not discourage you from sitting for your CEN as well. I would look into doing your BSN online, if you are enrolled that would be enough for me to hire you, especially if you already have your CEN. There is a lot of advice on how to pass the CEN on here but basically I would suggest you order the book from ENA and start studying your weak areas (that you discover during practice testing)--then schedule a date and go for it! Good Luck, Larry
  7. Larry77

    After the Evidence

    Your statement, "staff want to be managed" I find is not true. I feel like that translates to micromanaging and I do not think staff appreciates that at all. I think staff need a strong leader yes, and one that does act on unresolved issues. When I note an issue or one is brought to my attention I first bring it to the CN's because they are the frontline leaders and should have a chance to resolve it before I get involved. If they are unable or if they are the ones bringing forth the issue then I help them come up with a plan and we track it's progress and adjust the plan as needed. I do not normally need to act on small issues except to make sure they have been resolved. I like to build up my frontline leaders (CN's) and my Associate Manager...let them attempt to resolve because it builds respect from their team and the staff doesn't feel like I'm needed to solve every day-to-day issue. That way when I do have to act directly it makes for a feel of escalation. I'm curious of what brought on your statement...more to the story, what evidence? Larry
  8. This question is very specific to the type of facility and/or the organization. I can give you a quick hospital answer but even that is variable depending on the organization. In a hospital you usually have, in order: Staff Nurse ---responsible for the patients under their care Charge Nurse ---responsible for minute by minute department operations, ultimately responsible for all the patients in the department Associate Nurse Manager (can be called: Assistant Nurse Manager, Shift Manager, Shift Supervisor etc) ---Very site specific responsibilities, could be schedule, could be patient flow, could be responsible for the "shift", reports to Manager Nurse Manager (sometimes more than one depending on the size of the department) ---Has responsibility for whole department, budget, benchmarks, hospital initiatives, usually signs off on all hiring/firing with the assistance of Associate (and usually input from Charge Nurses). Reports to Director. Director (can have multiple departments under them if smaller hospital) ---Larger initiative responsibilities, ultimate responsibility for all departments under them, usually spends most of time in meetings, answers to "region" rather than site specific, reports to Chief Nursing Officer Chief Nursing Officer (CNO) ---Responsible for all nursing departments, reports to CEO, regional/national leadership, direct reports are the Directors for each area of specialty Chief Operating Officer (COO) ---Responsible for all non-nursing departments and usually building etc, also reports to CEO, regional/national leadership Chief Financial Officer (CFO) ---Obvious responsibilities, works with CNO, COO, Directors and sometimes Managers on budgetary goals and department flex/fixed budget measures. Reports to CEO, regional/national leadership. Again this is just a generality of some hospital's org chart. If you were a new Manager coming into a new job one of the first things you would ask for is the Org Chart...you want to know who reports to who and how the hospital is structured because it is so different depending on your company. Hope this helps a little... Larry
  9. Larry77

    Help with college paper

    FYI, requests like this do not usually go over well on this site. Most of us are here to see how things are done in other facilities, to vent, to get advice, but not to help others with homework. That is why schools have websites and chat rooms... I do wish you luck and like others suggest speaking with a manager in person, if you don't know one I'm sure you know someone who does. I have helped with requests like this in person, if you want to fly out to Oregon and buy me coffee I'll do your interview ;-) Larry
  10. Larry77

    8-vs-12 hour shifts?

    Almost all 12
  11. Larry77

    Team nursing in the ED

    Primary nursing is the direction most of the country will probably be going because patient satisfaction is so important. Patient's give better scores if they have the same nurse and are not passed around to whoever has time in that moment. I agree that team nursing is more efficient but we need to think about courtesy as well as efficiency more and more in the ED. We used to think we were doing a good job by saving lives or getting you through the department fast but it has been shown over and over that patients actually want to have some of the touchy feely care that ED's have been extremely unsuccessful in providing. "I'm here to save your ass, not kiss it" needs to retire...
  12. Larry77

    Anyone using Q-CPR?

    Our code committee is changing our policy to include the use of the Q-CPR device on all of our codes and I'm just wondering if anyone has used it before? I played with it a little yesterday but I'm not really sold on another device to either critic post code or another device to take the attention away from the patient (treat the patient, not the monitor). I do like some of the real time feedback you get, but having your hand an inch off the chest feels awkward. Thoughts? http://www.healthcare.philips.com/us_en/products/resuscitation/products/mrx/qcpr.wpd
  13. Larry77

    how to deal with management?

    I'm used to promotions or opportunities (like working in trauma) coming after hard work, not after someone asks for it. If you put your head down, show up to work, and get along with your coworkers great opportunities will come. I was asked to apply to a charge position years ago, and asked to apply to management, I did not have to muscle my way in. I have promoted many a hard working nurse that didn't ask or insist on it. Work hard, repair your relationship with the said charge nurse and see what happens in the next 4 months. If you still are unhappy there look at other options because you will have a year under your belt and will be a little more appealing to other dept's. Also I would look at yourself more than you seem to be looking at others. Instead of saying, "Suzy got to go to trauma and I didn't" say things like, "What can I do to prove myself and show I'm a great asset to this dept?" Just my 2 cents...good luck.
  14. Larry77

    Hindrance to professional growth

    Wow, I've never heard of this as a policy. What part of the country is this in? I've been wearing scrubs for 20 years and have worked in many hospitals in the NW as agency and I have never been told I couldn't do peri-care or cath a female. I have always looked for a female RN to do my cath's when possible but there are times when that is not available and if the patient is sick enough, young enough (baby), or old enough to not understand what is going on I have never hesitated and I think my female peers have always appreciated that. Also I have always jumped in to take care of the unruly drunk or psych patient for them...as well as cath their young men that would sometimes ask for a female (in a creepy way). We are all a team and I have never been offended when a female seemed uncomfortable with me seeing them naked, it most likely has nothing to do with me personally and I'm here to make them feel better not force them to see that I'm a descent person. I and my coworkers know I'm not a creep and that's enough for me. This feels a little like all the threads about guys being offended by the whole "male nurse" label...personally I have more important things to fret about :-)
  15. Larry77

    Being an ER Nurse, is it worth it?

    I'm curious why the ED Manager is looking for you to apply, do you know him/her or someone from that dept? If so, what do you know about the department, are people happy there? I ask because the good department's I have been involved in don't really need to recruit new grads...new grads and experienced RN's were applying in droves. I agree with the other advice above. It used to be that I recommended a year on Med/Surg but lately it has become so difficult to break into the ED that I would never advise turning down an opportunity if you believe the ED is for you. I do believe you should do anything you can to get into a hospital because that can be another very difficult hurdle, but once you are in the hospital world you can more easily move to different, more acute departments. It's very uncommon to come from subacute care and land a job in the ED or ICU. Good luck!