muesli

My grandmother just retired and she is 83. My husband's grandmother works and is 88! I anticipate working a while although probably not in something so physically demanding. That's part of why I want to expand my skills now. I want to have more opportunities available to me in the future.

Retired by 53? My goodness I hope you have a great retirement plan or a rich spouse! I will be working until I'm 80. *sigh*

By that time, assuming you are a nurse now, you will be in a much better spot than many young nurses. You will have years of experience, and in nursing that is what matters. I am trying to tailor my career to get good experience when I am still relatively young (I am about your age I think). I am being more aggressive about my job experience and education and certification now so that I can have more options in the future. Also, I get bored easily :). Remember they were saying there was going to be a mass shortage of nurses this past decade, and it hasn't been as drastic as they predicted.

Thank you. :)

It's that time again to update my resume, fluff my little feathers, and put in as many uppercase letters after my name as possible to get someone to notice me lol. Which credentials do you include? It can really get out of control. I was going to put RN, BSN; but since I was thinking of applying to another level 1 trauma center I was thinking about including TNCC. But is this considered a credential to put in your title? I wouldn't, for example, include ACLS or BLS after my name.

Now that it is in the US... we all have a responsibility to get answers to this question!

Thanks! This was very helpful.

I'm not saying people hired into a job shouldn't do their job, but it seems to me that paramedics are a little over qualified to be hired to stock rooms and simply take vitals, similar to a nurse's aid with no formal training. Why don't they hire nurses aids instead who have a tradition of working well alongside nurses and have a passion for bedside care? Most paramedics I know are skill oriented and like to work independently. Nurses aids make awesome team players.

No, except for students. I don't know why they would want to, although I'm not a paramedic so I can't speak to that. Paramedics are very qualified and can intubate, give meds according to protocol and assess. Why would they want to share duties with a nurse and let the residents handle the intubations? Seems to me that takes away all the fun. In our facility BTW, paramedic students intubate during their rotation in the OR.

I am looking to build my credentials and education, and am wondering which of these to do first? I don't work with pediatrics very often in my ED which has pedi specific nurses. That is one reason the ENPC appeals to me though, so I can be stronger in pedi. Both credentials seem to be an application requirement in many ED job postings I've seen as I consider relocating, so I will likely have to get both eventually. Anybody done both? Which is harder? I've been told the CEN is more challenging than the NCLEX. How long did you study for? Thanks

With your experience in ICU honing your assessment skills with critical patients you would probably do very well if you felt drawn to the fast pace of a level one. The only credential you should consider is TNCC. Other emergency-specific credentials like CEN are recommended to be taken later after a few years of ED, but the place I'm at won't even put you in the trauma room until you have TNCC.

Weatherck, get your TNCC as soon as you can. I found it very informative and helpful.

Things that end up being treated in the trauma room must meet certain criteria, but they typically include car wrecks, gunshots, stabbings, or falls or other accidents with suspicion for serious and emergent internal injury. Depending on the injury, these patients may go directly to the OR or they may be assessed, stabilized and sent to the main ED for continued monitoring. Pregnant patients who are imminently delivering who don't have time to be sent over to labor and delivery may also end up in the trauma room. That doesn't mean that the main ED never sees sick patients. Patients with open fractures without massive hemorrhage, heart attacks including STEMIs, strokes, patients in septic shock, heart dysrhthmias, cardiac arrest and patients in respiratory distress needing intubation are all examples of sick patients that would come to the main ED, but not the trauma room. I work at a Level 1 trauma center; other facilities may vary in what ends up in their trauma room.

Is staffing and acuity different in your new job? Perhaps it's unreasonable to assume people are going to help you with routine tasks, but hopefully when the poop hits the fan in your assignment and someone else is less slammed with acuity, they will step in. The ED where I work has a layout which is not conducive to team nursing, but somewhat isolates nurses with their assignments. You really rely on your ancillary staff. With an average patient assignment of 6 in a busy level one trauma center people don't always have time to help on a routine level, but they are great at stepping in when acuity strikes, i.e. intubation, STEMI, code, etc. I've always believed you have to promote a culture of teamwork. I try to offer people help whenever I can in hopes that what goes around comes around.

Anyone get into CRNA school with ED, not ICU, experience?

What are some reputable CRNA programs? Can anyone recommend a school in New England from personal experience or reputation? It seems there are not many NA schools in the US; I also would like to get a sense for how competitive they are. How likely would it be that I would be accepted into a program with only 1 year of critical care experience and a BSN but no other certifications? Thank you in advance.

What ACRNO6 described is right on the money. You focus on more of the comfort things, the less critical aspects of care. But in that don't underestimate your impact on patient outcomes. Sure, it's humble work, but you have time to educate, turn and reposition, think about the big picture, and affect the psycho social component affecting health maintenance. And honestly i like being able to do the little things to make people more comfortable. And because often you have more time and patients are not as stressed, people tend to like you a little better lol. It's not as stressful, but the pace is more routine and a little more boring, despite being busy. But as an ED nurse with varied assessment and acute/critical care skills, you'll certainly be able to handle it. It may just bug you the things that people focus on (like how long you scrub a hub, or the frequent q5 minute vital sign monitoring after giving a med no one would really flinch at in the ED), but in a way it's good to get an appreciation for best practice for the little things because they do matter. You may though feel like you're not allowed to be part of the fun in a true emergency. A med surg nurse is not always allowed to participate in a code where I'm at, and there's usually like a hundred people at the bedside just staring. And I'm talking about staff.

I'm still shaking my head at the young guy who came in c/o chest pain after a speedball, was found to be in bigeminy but eloped because his girlfriend needed a ride to work and he was "fine." Did I mention he was driving. Oh, and then he says to me, "how could the doctor tell me that if I walked out of here I could drop dead? That's f___d up." Wasn't really sure how to respond to that one... Sorry to hurt your feelings?

As a new ED nurse, though not a new nurse, I feel the stress of having to meet extremely high standards under a lot of pressure. Recently I received a warning for not recording restraints on the paper flowsheet, but online the way the med surg floors do, because I scoured the entire ED, every pod and paper cabinet (meanwhile delaying care for all of my patients), but was unable to obtain this flowsheet. I spoke to my charge RN, supervisor, and checked the psych department at the time and was told that we were just out. Even though I had an online order and documentation, and didn't have the resources to do my job up to ED standards, it still counted against me. It's tiring to feel some nights that you work so hard and feel like you're giving so much of yourself to the job, only to receive negative feedback and to have a constant, slow simmering fear of making a mistake, losing your job or your license.

I love the fast pace of the ED. I love never being bored, and how quickly the night goes by. I love solving mysteries and curing problems and not having to worry about crushing my five patients' ninety different stool softeners in applesauce and scanning each one at a time. However, how in this fast paced environment are you able to have those moments with patients where you really take a moment to care about them, empathize with them, and see them as they might be seen outside of a Johnny in the foreign environment of the ED? What are ways you find to connect with your patients?

It seems there are many different hospitals in Portland. What are some of the better places to work? What are the best paying? Which ones are level one trauma and experience the highest acuity? And finally, is it feasible to commute from the Vancouver area? Thanks!

Metropolitan, level 1 trauma center. 1:4 unless we have poor staffing and then 1:6. Honestly the flow coordinator and pod lead seems to try to even out the acuity and staff patients based on nurse experience level so I don't often feel overwhelmed. Many people on my shift help one another out. Trauma patients are seen in dedicated trauma rooms with trauma nurses before being absorbed by the general ED. You would, however, see less than level two traumas, codes, strokes and STEMIs in the general ED.

I'm new to the night shift (3 twelves 7p to 7a). I have someone watching my three little ones in the morning after I work so I can sleep. But how should I manage my days off? My plan was not to do daycare on my days off but here it is 1:30 in the morning and I'm wide awake and am expected to get up to take care if the little ones at 7 am! What does everyone else do? At least when preschool starts in the fall, my two oldest will be there until noon. But I will to get up early to drive them there. I need a solid schedule, but I'm not sure what that would look like! I just can't afford five days/week daycare right now.

I disagree that honesty won't win. Great interviews involve being honest, but knowing how to tailor your answer to be compatible with what they want in a candidate. What you just said is not anything bad to say in an interview, although I might tweak it a bit: "I am a new nurse, and as a student nurse I enjoyed all of my clinical experiences. I am excited to put my knowledge to use and begin my career working as a team and taking care of patients. I believe that this med/surg job will give me the foundational experience that I need to succeed as a novice nurse." Etc. if it is a medical/surgical/oncology floor or whatever, talk about what in particular you think might interest you in that specialty and try to relate it to an experience you had in nursing school caring for that type of patient. There's nothing wrong with saying any of that IMO. Everyone knows new grads are just trying to get their foot in the door. I have done several peer interviews of new grads, since my department is one of the only ones that hires new grads. I can tell you that many people have lied - as I have found out. I have spoken to many interviewees who talk about how excited they are to join this department, and how they are committed to working here at least a year, and then the a lot of them leave the department once getting off of orientation for a job on a different nursing floor! It's annoying as a staff nurse because you try to develop relationships with these people and then they're gone in a couple months. One recent peer interview involved a nurse who couldn't really give one reason why this particular department appealed to her. She didn't have any questions at all about the department and when being honest with her about the particular challenges of the department, seemed disappointed and unable to suggest that she was confident that she could take on those challenges, or that she felt that they would provide good learning opportunities (which they did for me, as someone who went through it as a new grad). She just kind of sat there looking disappointed about the whole thing (and I wasn't really breaking some horrible news to her). I wasn't the hiring manager, but if I was (and I had any clue), she would not be first on my hiring list. Even if you don't know what specialty you ultimately want to get into, at least research the particular place you are applying for and try to find some positives about it - and convey those in the interview. If I were a hiring manager, I would want to know that you were a good fit for the department because I would want you to stick around as long as possible. But I would encourage you to stay positive about the interview process. It's likely not your honesty, but the stumbling block of being without experience which has stalled the process so far. Eventually you will get a break. I've always felt in my interviews (which is totally a learned art - I've been through so many interviews in my life and really sucked at first), that speaking from the heart is more effective than memorizing scripted answers. Anyhoo good luck!

Thank you! I love unpredictability, shifting modes. It keeps me excited about my job. However, I want to pursue a specialty where I can learn a lot, and be intellectually challenged. I feel I could learn much in either job, but I'm less convinced that Ed nurses become "experts"about certain conditions like a specialty ICU nurse could. But maybe I'm wrong?