five_apples

Where I work there actually a few "fresh" docs who do a very focused, "custom build" workup for pts. I like it b/c it saves time, but I keep saying - they practice like s/o who's never been sued...

On the question of how long, I would give it at least 6 months, if not a year. Where I work: 2 triage nurses if fully staffed, with EMT if fully staffed. If not enough staff might have 1 nurse 1 EMT or just 2 nurses. At worst, just 1 nurse & no one to greet incoming pts. Beds; 20 in main ED, 10 more in obs (also for psych/ETOH), 2 trauma/code bays (3rd level), 5 beds in fast track. One nurse in fast track, 1:3 in highest acuity level area in main ER, 1:4 in moderate, 1:5-6 in obs. 2 docs & 2 midlevels during the day (until 11pm), 1 doc 1 midlevel at night. Anyone takes EMS radio calls, triage nurse assigns beds to external pts, charge assigns to ambulance, so it really depend on how good the triage and charge nurse are individually, and how well they work together. Not rare to get 2 pts at same time, sometimes ambulance & triage, a lot of times multiple triage pts come into assignment at once. Rarely is there an extra nurse with now assignment just helping around with ambulances. Help with criticals is not anchored by any protocols or hard rules, really depends on who you're working with. EMTs 1:6 if staffed, but could be 1:8 and even 1:12.

I was a new grad when started ED. Had a 6 month orientation and still didn't feel ready when I got off it. Only way to learn ER is do ER. Books will only take you so far, but this is on the job training. The biggest challenge was prioritizing, and the only time I really learned that was when I was finally off orientation & on my own. Orienting in the ED can be distressing. Take these feeling and use them to build yourself up. Ask question and read about things you're not sure about. Give yourself time (it took me a full year to feel like I have this ting down and I can really do it), and be gentle with yourself!

Where I work, it really varies, depending on the charge. Some are better in helping you when you have a critical, 1:1 pt, some are not so great. With some you don't even need to ask, others if you don't ask for help they'll just assume you got it (which is stupid. assume I don't have time to come asking for help!). It could be really frustrating when there's no standard behavior.

We have a holding/obs area and use it for both medical pts waiting for results & dispo and for psych/ETOH waiting for placement/sober. Each have their own room & sitter. If no beds in this area pt has to stay in big ER. Stopped having hallway spots long time ago. Thank you, Joint Commission, LOL

This used to be the practice where I work before I started there. They stopped doing it and switched to IV since foley comes with risk for UTI, and you're just creating a whole new problem for your pt. Some pts still ask for it, it's their right. BTW, in my experience, if you can't get a super great IV, bladder will take 2 hrs to fill and even longer for some ppl, also think some ppl are slightly dehydrated as baseline. And they're taking up a bed all this time...

You could kindly hint to the person that they're probably not getting a Dilaudid & a script for Norco for their CC, and that their CC isn't really an emergency, and that there's a 3 hr wait time. Be like "choice is yours"...

Oh, I saw what you added at the end of your reply to everyone - what to call on: your floor experience is valuable! Trust your gut. If a person "just doesn't look right" to you, go get the doc. If it's been 30 minutes with this pt and you still can't leave the room to go deal with your other pts, ask your charge for help. It's better to over-communicate at first, and you can tweak it with time...

One foot in front of the other. There's only one you and you can only be one place at a time. Speed comes with experience, as does the ability to quickly assess someone and decide if they need you right now or can wait. Work a patient up start to end, don't count on having time "later" - there's never later in the ED. If they're breathing, not bleeding & talking to you you covered your ABCD's. Put a quick note in the chart to prove that you eyeballed the pt and that they're alive and well and go back to your most urgent case. Explain to you other 2-3 pts that as soon as you're done working on this other person you'll be with them - and do that! Give them a time frame, if you could, and try to stick to it. It'll get better! Good luck! D.

Well, we already know that some bosses are jerks. Your story just stresses that point even more :) I hope you found a better unit w/ better attitudes in the management level & that you're happy!

It depends... After working in the ER for a few months I can tell you, the answer for you Q has to do a lot w/ the specific place you work at & the organization's culture. You're right, there are other people that can help you get IV access, but on a busy day, when the sickest of sick roll in through those doors, sometimes you work almost alone, your paramedic/tech caught up helping some other nurse that might need it more than you. If your pt needs an IV now, you're the one that has to do it. I understand the passion for working in the ER, but If you can't do IV's, why not just go to a different specialty that can accommodate that? (I understand this Q was posted a while back, but thought other ppl might still benefit reading more answers to it...) Good luck!

I've been in the ED for a little over 3 months now. I had the same thing happen to me, when I hanged the ABx before culturing the pt. It was when I was in orientation for less than a month, and like you, I felt my heart plumet. I felt so bad!!! I have to agree with what's already been told here - it's not the end of the world. what's most important is that you treated the pt, right?! And I totally agree with you - after something like this happens once, you're conditioned for life... This will not happen again. little mistakes will happen, and there's nothing you can do about it. We're all human, and we're working under crazy conditions. All we can do is try our best. Don't worry about it!

Hi, I'm a newly licensed RN. I graduated 9 months ago abroad and came to the U.S. b/c of my husband's studies. I was licensed 3 weeks ago, and started looking for a job in our area a month ago, but have failed to get ANY call-backs. I'm really trying to keep an open mind about the positions I'm willing to take for my first job as a nurse. My only red line is that I won't do night exclusively (rotation is OK) and I prefer not to apply for "pure" medical wards for now, just b/c there are things that interest me more. I think that in the past month I have applied to about 20 position in three different hospitals, and still - no call-back. What am I doing wrong? I started to think that perhaps my C.V. isn't doing me a good service. I have lots of non-nursing experience, in customer service and such. should I leave it out? Plus, I'm 28 - how long back should I go? My current c.v. consists of 2 paged, 3 if you count the cover letter... I feel like it's to long but don't want to leave anything important out. Help please! Thanks :)

thank you all for you kind words! as I'm time passes and the stress defuses, I'm starting to remember more and more questions and I think I did pretty well (knock on wood). I now remember I had lots of Qs on infection control, too. I would say around 7-10. not that much pharmacology... I don't think I'll wait for the results on the BON b/c that means I'll have to wait for Monday. and if the quick results are on time I should be able to see it as soon as Saturday afternoon... I'll keep you posted, thanks so much for you support!

Yes - SATA means select all that apply. Didn't take a course, just used the saunders review book and the CD that comes with it, plus nclex 4000 & Kaplan Q-trainer.

Hi guys! So I finally took my exam today at 12:00 pm. Finished with 75 Qs at 1 hour and 20 mins approximately. It was sooooooo hard! I think that almost 50% of the questions I got was SATAs. What's up with that? So I decided not too try the PVT and just wait for the quick results (I'm in Michigan). I really hope I passed. Anyways, I'm so happy this is behind me. Good luck to us all!

Hi y'all! I'm taking my exam on Thursday. I did the second 150 questions practice exam in the Kaplan CD today and it was HELL! I'm telling you, half the time I felt like I really didn't know what I was doing. At the end it turned out fine, I scored 71%, but I was left with such a crappy feeling... I'm starting to get all anxious about my fluids ans electrolytes, too... I guess most of it is just normal pre-exam jitters, but oh lord! I really feel I'm losing it! I really hope that 3 days from today everything goes well and I can forget all about this time... grrrrrr.

Hey y'all I'm just reviewing a practice exam I took with NCLEX-4000. I had a SATA question about a female client who's labor isn't progressing so she has a c-sec. the question asks what should the nurse assess for in this client, and the optional answers are: infection, hemorrhage, hematuria, mastitis, endometritis. according to the CD, the first 3 options are correct (infection, hemorrhage, hematuria). My question - I actually have two issues with this question. First, why should the nurse watch for hematuria? is it b/c the client is at risk for injury to the bladder during the c-sec? Second, isn't endometritis a complication of c-sections? or do you think it's not one of the correct answer b/c it's a late complication and nothing to watch for in the immediate postoperative period..? I would love you input on this! thank you & Good luck :)

I'm taking the exam in less than a week - next Thursday. For me, this is my plan for relaxing in the time left, a day before, the day of and during: 1. I go to a yoga class every other day this week. Helps get my mind off studying for an hour or so, promotes concentration, relaxation and deep breathing. 2. For the days I don't do yoga, I go for a long walk with my dear husband. We talk about whatever, but try not to obsess about the exam - "Que sera, sera". 3. The day before, I'm planning on starting my day with reading the notes I took while practicing (every time I got a question wrong, I looked it up and wrote a short sentence about it). 4. After reviewing my notes, I'll get my ATT an ID ready, along with anything else I need (directions to get to the text center, etc.) Then I plan to do the following: go to the mall - get a pedicure, get a massage, do some shopping. 5. In the evening, taking a good long bath with relaxing music. Maybe watch a chick flick w/ a glass of good red wine. Meditate & go to bed early. 6. On the day of the exam - my exam in on 12pm and I have about 45-60 min. drive up to the test center, plus you need to be there 30 min early. I plan to wake up so I have an hour to spend at home before having to leave for the exam. Take a shower, eat a nutritional, but not heavy, breakfast. Take some snacks & drinks for the road and just before the exam. 7. After checking in to the test center - find my seat. Sit with my eyes closed, take a deep breath and say to my self - I can do this! 8. Each time I'm not sure about something - do the same. breath-breath-breath. And keep a SMILE on my face. It projects a certain mood and self confidence. o... I have a plan :) In a few days I could tell you how it worked for me ;-)

Haven't taken the exam yet, but as logic would tell me, potassium has pretty "clean" values. I would say that anything under 3.5 is low, anything over 5.0 (or 5.1 in some cases) is high. clean cut, not reading into it for more then it is... that's my opinion...

oh my dear god! Well, all I can do is hope for best.

Hi y'all! I just finished a 100 question practice exam with my Saunders CD. I had one question about the daily maintenance dosage for Dantrolene... and I just had to guess. lucky for me, I guessed right, but - do they really get so specific? I know we need to remember therapeutic ranges for some meds, like Digoxin and lithium and stuff. and some peds dosages... but really? this? do they really give these in the real exam? if they do, I'm gonna have to guess for the most part two weeks to go for me!

Cool :) I'm in MI.

Same here - I feel ready but can't shake the nervousness all together. ho well, they say that some tension keeps you alert, right?! Where are you taking you exam?

Hi guys! I'm taking my exam 17 or so days from today. Sounds kinda scary when I put it like that... So - on march 17 I started reading my Saunders review book, it took me about six weeks to finish that, including all the questions at the end of each chapter. Scored 75% on the CD pretest. Last Friday was my last day of work before going out for a pre-exam break. I intend to give all my attention to studying in the coming three or so weeks, just up to the exam. After finishing my book, I now focus mainly on doing questions from the Saunders and NCLEX 4000 CDs, and I plan to start doing practice exams from the Kaplan CD about 10 days before my actual exam. Anyone else taking the exam end of May- beginning of June? How do you study? Good luck to us all! :)