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Perianesthesia RN

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  1. Footballnut

    I want to anticipate needs...but I am also scared....

    You will do great. You should have an orientation and you will have many of your questions answered with that. The orientation will also help you define your role. True, you will not be able to do everything for everyone but if you are willing to help as much as you can and you smile about it that counts for a lot. Even the little things help. For example, just having someone noticing that pts are back in the ED from a diagnostic test elsewhere and hooking them back up to the monitor is a huge help. I'm usually in the middle of five other things and it often takes a few minutes for me even though I know the pt is there. This job sounds like an exciting step for you in your journey. What a great experience for you!
  2. We have a 30 minute goal although it is not a policy.
  3. Footballnut

    Time Management in ER

    Keep a game plan in your head (aka nursing care plan) going for each patient and work it. That way you will know if you are staying on track and moving each patient along. It works amazingly well to remain conscious of your goal for each patient. You can usually pre-plan, stay focused, and readily know what you need from other people who ask if they can help you. For example, a goal for a patient that I have assessed to be some sort of simple gastroenteritis might be that the patient is able to tolerate po fluids by discharge. I will work to get the right diagnostics, control vomiting with anti-emetics, rehydrate the patient, assess my efforts as I go and finally have my patient trial some po fluids to ensure that my patient is ready to go home and recover. All the best! You will only become better and get more confident as you go.
  4. Footballnut

    What is your WORST ER story?

    Wow, big step from no medical experience to life in the ED. I've been there way too long to pinpoint any one situation. I realize that people are more themselves, more anxious and more in crisis than almost anywhere else. It's a whole different reality than most people experience at work and you get to be there helping people through their problems, some very extreme. The situations that have always bothered me the most are the ones that I can personally relate to most easily. Like when I had my baby at the babysitter and a SIDS baby came in from his babysitter's home and died.
  5. Footballnut

    Why I'm sick of the ED

    True, this is one of the most difficult areas you can work in, and there's little thanks in addition to everything else. If you choose to stay in Emergency Nursing keep track of the good people/things that come your way as the result of having practiced your profession in the ED. It might help carry you through some of the difficult times.
  6. Footballnut

    RN driven pain protocols in the ED?

    Does anyone use standing orders for an RN driven/nurse-initiated pain protocol in their ED? How is is working and what does it look like? I can find two articles in JEN, one for pediatric patients not using narcotics (2003), and one for adult patients with extremity injuries (2004) using narcotics along with other measures as appropriate. Does anyone know of any other articles or studies connected with this topic? Also, what do you think about this if you do not do it?
  7. Footballnut

    Questions from a Struggling ER New Grad

    Jennash, Good ideas! It sounds like you are working your way through. In answer to your question, be clear with your preceptor about what your goals are. I would write them down and take 5 minutes before the shift starts to go over them. Perhaps you can ask your preceptor to shadow you as much as possible and give you time management hints based on what you are doing. Be sure and ask for what is working as well as what you need to look at. I often do this for my orientees when they are working on time management. I keep notes on each patient as we go along so I can give specific feedback and the orientee can relate to the situation. The orientees tell me they generally learn a lot from this. Depending on what works for you, go over the time management hints as you go along or go over them when you have time to review. Doing this also gives your preceptor something to do if they need to keep busy. I'm sure they mean well but no ED nurse can stand to let something sit for long. Many time management issues are related to predicting what your patient needs and starting it or setting up to do it. I'm way ahead of the game if I have all my ducks quickly in a row before I have to move on and predicting has a lot to do with it. Other time management issues are often related to bundling tasks. Predicting and bundling both involve doing the nursing process over and over all day. Also, sometimes the order you do things in makes a huge difference. And keep in mind that your preceptor may be under a certain amount of pressure to keep things moving. The department needs may be looming large. It's always a tight line between giving the orientee enough slack and keeping the department gods happy when it comes to time management. All the best, I am sure you will do just fine!
  8. Footballnut

    Questions for ER Triage Nurses

    Our triage nurses are the most experienced ones. Our door to EKG times also need to be less than 10 minutes. Sometimes I have a room in the back, sometimes I don't. I keep a rotation through the triage stretchers for the EKGs when there are no rooms in the back and I read the EKGs. The EKGs are also read by any MD in the department so there are more than one set of eyes on them. If the EKG was normal and I don't have a high index of suspicion the patient waits their turn in the waiting area. However if anything makes me uncomfortable I push for a room. Depending on the flow we start labs, xrays, simple meds, etc. but no IVs in the triage area. Many times these diagnostics shorten the patient's total ED time quite a bit. True, my first priority is addressing new patients as they come in and being sure everyone gets "sorted" to where they need to go but anything I can do to keep the department moving along is appreciated.
  9. Footballnut

    tPA Question

    In answer to your original question, watch for any kind of bleeding or any trend indicating that bleeding may be occurring. Hemorrhagic stroke is only one complication. I had one patient start vomiting bright red blood and he had no GI history before the tPA. He made it through just fine, btw.
  10. Footballnut

    Common practice for any ER??

    I feel the need to clarify. I definitely use pumps when it counts - for titrating many, many meds, almost all antibiotics, infusions on patients with tricky fluid balance issues, when I want to be told by the machine when it is done, when I know the patient will need a pump on admission, etc. I just don't much for blood. Our pumps are considered acceptable for use for blood but still have a statistically significant rate of hemolysis. Most of the time it is easier to use a pump. Sometimes it is not. If I need infuse a couple of bags of fluid on a normally healthy patient who needs a little fluid replacement I generally don't use a pump.
  11. Footballnut

    Common practice for any ER??

    Hemolysis of blood cells varies by the type of pump used, age of blood cells, rate of administration, temperature of blood cells and smoothness of tubings and walls of pumps used. You need to check with your hospital and pump manufacturer to determine whether your pumps and tubings work well in keeping hemolysis at check. Even then, your hospital policy is your guide. In a trauma center I used to give units of O neg RBCs as fast as I could on occasion. We're talking 5-10 minutes or less with tubing systems and IVs the size of a garden hose. A pump would only hinder me. Other times a pump is quite useful. I admit, I rarely use a pump. I do the initial checking for reactions but some of my patients are too critical to wait long for the blood. Faster pump rates create more problems for the cells. There are pumps created specifically for blood. These pumps warm just as the blood is in the last part of its journey and gently move it along. I always treat the little cells like fragile babies whether I am giving them or drawing blood. Strong suction when drawing blood automatically calls for a redraw. If I can't coax them out to me I'm done.
  12. Footballnut

    Inept New Grads?

    It takes a well thought out and directed program for orientation of new grads in the ED. Otherwise you need to plan on a couple of years before they are functioning well or at par in the department. Also, a few new grads will do well in the ED with good selection. Some never will.
  13. Footballnut

    Glimmers of hope for grads

    The nursing job market will change eventually. It won't happen quickly though. I quit my regular nursing job in the early 80's and went resource. Bad timing. It was just before the total reorganization of health care funding and many nursing jobs were lost at the time. I spent a year or so working a couple of days a week before the money ran out. My husband was out of work in a bad economy, we had a new baby, and jobs were scarce at the hospital where I had worked for years. Masters prepared RNs were taking floor jobs that I was well qualified for. Crazy! I prepared myself to work in the areas where it looked like I could get time as a resource nurse. I guessed right and I got enough hours to make it until I was rehired a couple of years later. Most of the time I worked full time as a resource nurse during that waiting period. Anything you do now will help you. Getting certifications, volunteering as a nurse at a free clinic and networking, volunteering at a hospital and keeping your eyes open, or working in any capacity will get you something. Look at the outpatient settings. Healthcare is continuing to swing that direction. I ask the new grads where I am at now and there are still some of them being hired in different places. Some are going out of state, some to settings other than hospitals, some to internships that are still around, some are still working as CNAs. There are going to be a whole bunch of nurses breathing a big sigh of relief as their husbands/wives get jobs and they can let go of having to work/work so much. The jobs will open up. It doesn't pay the bills in the meantime I know. This is just bad timing right now. All the best as you explore your options!
  14. Footballnut

    A really bad day in the ER for a new nurse resident

    Sounds like a really terrible day! Give yourself a hand for doing such a great job. Your preceptor certainly could have given you more guidance. It doesn't sound like he was paying attention at all. What do you like best about your other preceptor?
  15. Footballnut

    Advice for current nursing student

    Spend some time in an ED where you might like to work or one that will give you a recommendation. We see students that do 3-4 month practicums in our ED and we have hired a few of the best. Work with your instructor on choosing a good place and polish up your ED knowledge base before the practicum if you are serious about getting and giving the most. As a quick and easy approach I would recommend Sheehy's text on Emergency Nursing. Amazon.com: Sheehy Good luck!