JD228

i hate anyone who acts like they are entitled!!!!

I have been involved with the hiring on our unit for the past year, we prefer previous ER or EMS experience, can you volunteer for EMS work in your area to get some ER experience??? Another idea would be to see if the ER Director for the ER you are looking at would meet with you. You could explain your desire to work in the ER and ask them what steps you could take to make it happen. It would show initiative and might get you some answers. Good Luck!!

[color=#0000ff][color=#800080] i feel lucky that i work in an er that has an officer assigned- who would step in if the patient behavior escalated and i work with physicians who i have actually heard tell patients that they would not tolerate them talking to the staff badly. i think that all the staff should be on the same page and not tolerate such behavior. i understand trying to de-escalate the situation but your charge nurse should have supported you by telling the patient that his behavior would not be acceptable. while we might be expected to deliver patient care- we should not be expected to be verbally abused in the process.

EMS called in the pt "looks bad and is getting worse"......um...ok....that leaves a lot open for interpretation.

We get runs of different complaints but I have noticed we get more kidney stones when its been dry and a storm front is coming in. I think the barometric pressure change affects them. But they are a lot like potato chips.......you never get just one of em.

my dog is a sock monster, i am constantly finding half eaten socks in the yard. How the heck she smuggles them out of the house, I don't know. I mean unless she figured out how to let herself out too.

Yelling back may make you feel better in the short term, it isn't worth the long term consequences. We have police in our ED that are great about intervening as needed. Also, our physicians will step in and tell them that they can not treat our staff that way. Support from others usually helps. If it just seems like a personality conflict, sometimes switching with another nurse is the way to go. Unfortunately, a lot of our patients don't have good coping skills and it is easier for them to take out their frustrations on us than on dealing with the real problem (s).

i am going to differ from everyone else's advice, I think you spend so much time at work, you should enjoy it while you are there. These are just two units that you have worked at, perhaps you can find another unit or hospital that would work with you on your schedule or perhaps your old job would now have prn position available. I think most managers would understand that you are trying to do what works best for your family. We have had several people leave and return to work after they found out the grass isn't always greener. Just a thought, no reason why you shouldn't be able to have both. Good luck!!!

I have actually worked some shifts at Spotsylvania and it isn't too bad, very nice facilities. what You need to call the department that you are interested in working in, speak to the person who hires people for that department as well as talking to Human resources. DO NOT depend solely on putting in your application to HR, they take months to forward applications to directors. Also, if you are interested in working in an ER, EMS experience would improve your chances of being hired with out previous ER experience. Also in Virginia there are many EMS agencies where you can volunteer and you don't have to have your EMT to start, in fact they may have classes available at the agency you volunteer at. If you decide you are interested in coming to the Richmond area, let me know, I can give you some info on the area hospitals. As for being a new grad and starting in the ER- I do not think it is necessary to work elsewhere first. We have plenty of nurses that are great and all they have ever done is ER. You just need to work somewhere that supports new grads and mentors them instead of throwing you in to sink or swim. Goodluck in the job search.

The hospital I am at (in Virginia) only the MD, PA and NP apply it, officially. I don't know if it is a hospital policy or just what.

VA, 1:4 or 5, varying acuity but usually medium to low, pt length of stay is average 150 minutes, Can vary from 65 patients a day to 120 patients, depending. Patient safety is usually adequate, security however, could be better, more of a locked down unit. Most days I feel I can provide adequate care but some days, I feel like I am having to neglect one or two patients in order to care for a higher acuity patient. I do think people in general expect too much of a "warm and cozy experience" versus emergency treatment of ill and injured. So a lot of time is spent getting blankets, pillows, drinks, food, etc, etc. I mean let a TV not work and you would think it was the end of the world. Most days I like my job, others I don't. I am lucky in that I like 90% of the people I work with.

It sounds like the size of our ER is comparable. We have a tech and RN at triage. The tech gets the info and does a quick register in the computer and the RN can ask the chief complaint, allergies and a short history of events. Tech does VS and takes the pt to the room or releases to waiting room if no bed available. We work on the 5 level acuity system and have the level 4 and 5- lower acuity patients go to one area and the level 1,2,3 to the other rooms. It really helped us that we developed a rapid triage form that the top section was sign in information i.e. name, dob, ssn, physician, lmp....etc. So you can allow the patient or family to fill this out if you are backed up and then the triage sheet is below that- you fill in a few key info pieces. The primary care nurse is required to ask the past medical history and medication list. The thought here is that your primary care nurse needs to know the meds and past medical history and wasn't always reviewing that info on the chart before caring for the patient- so it forced the nurses to acknowledge that info. It also helps that we have 2 security monitors so we can see what is going on in triage from the back- most of the staff is really good about going out front and getting peopl to bring to available beds, esp when backed up. Hope that helps!

The ER I work in employes Police officers for security, but they expect them to leave the ER and do rounds around the hospital, checking doors and locking and unlocking doors. Seriously? I don't think the administrators have a clue as to the real danger we face every day in the ER. We are on the outskirts of the city but all kinds of patients get "dropped off" in the ER. We have been asking for hospital wide access to be restricted, especially at night as well. But to no avail. I agree with other posts, nothing will happen until something major happens. Unfortunate.

Can I suggest that should something like that arise again, you call 911. They should be able to provide oxygen and breathing treatment enroute to the ER. Not that, that excuses the way you were treated during your visit. Glad your son is okay now

1. we use the large bore peripheral veins until a central line can be established. 2.depends on the doctor ...we use ketamine a fair amount for lacerations. 3.versed = conscious sedation paperwork, unfortunately. 4. propofol is pushed by the mds (er) but drips are maintained by the nurses.

i personally have not been pregnant and working in the ed but have several co-workers who have worked up to the day they went into labor. they did triage if needed, they got help from their co-workers with lifting/contagious patients. i think they went into it with the attitude that they were going to do it and everything was going to be fine. other nurses have been pregnant and you would have thought they were the only person to ever go through it. i think it is really your attitude and out-look. i am sure you will be fine, what ever choice you make.

Congrats... hope you reach all your goals. Good luck.

i agree with the other posts. the worst shift is 11a to 11p. the other shifts just depend on your personal internal clock. i worked days when i started and hated every minute of it, because i was sooo tired all the time. nights just fits my schedule better and so i am happier. he could always ask for a trial run of the times and see what works better.

In the ER my patients are not stable until after I have done all the work to get them that way. I usually have at least 2 of the 6 that are at least chest pains/abd pain/septic nursing home, etc. These require the full work up. So why should I leave those patients in order to transport the ICU pt to you? Meanwhile your other ICU patient may have been there a day or so. I am not saying you aren't busy and you shouldn't have to leave your patients but you should not think you or your work is so much more important than what the ER staff is doing and that was how your response came across.

ER nurses have been transporting patients up to the ICU for years, why is it so appalling for you to go to the ER to get a patient? ER nurses often have to leave their 6 other patients to bring you the ICU patient, usually with out having another person to really cover and watch the patients being left. So is that safe?

i am moving to Canada :)

Trying to feel a vein usually doesn't work in the little kids, like several people have suggested, you pretty much have to go for the blue lines. A lot of kids have veins in their dorsal wrist, if you bend their hand down, like you are trying to push the wrist up. (Hard to describe) Usually around the middle you will see a vein. The tip prev posted about having everything you need, in abundance is true, it helps decrease the pt (if they are old enough) anxiety as well as the family's anxiety. Sometimes the anticipation is worse than the actual stick. If you have parents that you think maybe more of a hinderance than a help, you can always try this approach I picked up from a doc. Tell the parents that in order to focus all your attention on the patient and what you are doing, they need to step out for a few minutes. That is they are there, than part of your attention and focus is directed on them and in order to do your very best job, you need them to step out. Sometimes it works, I think some parents would prefer not to be there but feel like it would look bad if they didn't. I don't know how I would feel, if it were my child. It does add some pressure and certainly some are better than others.

-almost forgot- the self-mutilator that was in jail who would hide razor blades- in his mouth, under his scrotum, in his rectum, etc..... he would cut himself and then after he got stitched and went back to jail, he'd rip the stitches out, we tried staples, he pulled them out too......

I am a CCEMTP and an ER RN. It is rare to find someone who really understands what is like to be pre-hospital if you've never done it before and vice versa. I think you may have just been rubbed wrong by a person who is perhaps a "know-it-all"..... all fields of medicine, and life, have people like this, not fair to generalize like that.

that was too funny-red cell.......thank you for that post