jotond

Thank you TraumaRUs, I appreciate your kind words...

I think you covered all the possible imaging, but just wanted to mention always have bladder CA in your differential. My father was treated for chronic prostatitis for 3.5 months by his primary and urology as well before they decided to image him. Found several tumors. His only symptoms were UTI type symptoms, he did not have gross hematuria. I wish we had found it sooner. He's sustained a lot of damage to his bladder.

I had to give Penicillin G IM 600,000 units to a 7 year old in the ED for suspected Group A strep and scarlet fever. I had never given it before and was also surprised at how thick it was! I used a 23 gauge 1 inch needle and gave in the gluteus, but it felt very difficult to inject, and seemed to take forever as the kid was screaming. Should I have used a bigger gauge needle? Any recommendations for how to give this medication more easily and efficiently?

Hi there, I'm assuming this is your first baby? I am in a full-time FNP program and I have a 20 month old. When I started he had just turned one, and it was a tough decision for me to return to school at that point. Prior to starting school I was working part time and enjoying life just getting to know my little one. It was a wonderful time. I think those precious quiet moments of having a new baby are so amazing and wonderful, life became something I hadn't really imagined. It's an experience you only get to have once. The thought of rushing back to my program after giving birth seems crazy to me now that I have lived both. But that is my own personal experience and you won't really know how you will feel. My thought is if you have an option to take a leave from school, you may want to explore it, and then when you do return to school, you will know your child, and will have some childcare set up. All of those firsts won't be occurring around the stress of school. First time leaving them with a caregiver, first time trying to give a bottle, first time they are sick… etc. Anyway - it's hard to be torn. But if your heart is in pursuing your education, you will be excited to go back when the time comes. Good luck to you and enjoy your pregnancy!

Thanks LunahRN! It's a good feeling to have it done!

I passed the CEN yesterday (85%) and wanted to recommend the Med-Ed Seminars that someone else here mentioned. Was a huge help as there were no live seminars going on in my area before test time. Jeff Solheim is super knowledgeable and presents the material in a very clear manner. I would recommend buying the DVDs instead of watching online review so that you have something to keep (if you want to watch it again, I think I would as it is a great review of some core concepts). Also he provides excellent materials to study from. You get 16 CEUs and there is a pass guarantee. Med-Ed > I also did all of the practice tests from the BCEN book, which I think were slightly harder than the actual test, but many of the questions from the test are covered in this book. I used Sheehy's as reference and read a fair amount from that too. I would also advise give yourself lots of time to prepare, don't try to cram as it is a lot of material. I studied hard the last 2 weeks, and sporadically for about 6 weeks before that. I ended up watching all of the Med-Ed in about 8 days because I didn't discover it until close to my test time. In retrospect I would have given myself about 6 weeks of serious study, watching DVDs at a bit more leisurely pace. Good luck to everyone!

I was an ICU RN for 10 years (CVICU and CCU mostly) who was ready for more variety. It took a solid year of looking and applying avidly to make the switch to ER. I'm in No. CA where the jobs are tight, and it is difficult to change specialties. But hang in there because someone will give you a chance eventually! Persistence will pay off. My husband and I always say that if you have a goal, you have to keep trying until you've exhausted everything, until every possible avenue has been explored. Don't give yourself the option to stop trying until you've done everything you can to make it happen! ER nursing is great - some days the stress is too much but at the end of the day, I feel satisfied and challenged in ways I never did before. I think all kinds of personalities can thrive in the ER. The most important qualities are flexibility and resilience - you have to be able to let things roll off (ie - difficult family members, stressed out coworkers). It's fine to be sensitive, which is a great quality for a nurse, keeps you in touch with your patients, but you cannot take things personally, and you have to keep things in perspective. It's a dynamic place. Overall I think it can be a great environment to grow professionally and personally. Now and again I'll help out in ICU but am happy to say that ER is definitely where I belong! Good luck to you!

Thanks everyone. Never saw such a reaction to these meds before and I've been an RN for several years. Although mostly in ICU before ED so maybe I'm just used to my patients being sedated!

Hello everyone, long time reader, thanks in advance for your input! I had two situations this week that I'd like some feedback on. First, was administering two units of platelets to a cancer patient. First one was infused and shortly after, before I hung the second, patient stated that she felt a nasal congestion all of a sudden, with a slight sinus type of headache. Her vitals were unchanged, temp remained in the 36 C range, no shortness of breath or other symptoms. I asked another nurse what she thought and she didn't think it was a reaction. I researched blood transfusion reactions in our policies, and headache was listed as a possible reaction, but I didn't think on its own it was truly a reaction without VS change, or other symptom. However with the stuffy nose? At any rate, the second units of platelets was infused and her symptoms remained the same. I reported off to the next RN and went home, end of story. Also, she had been premedicated with tylenol and benadryl. Second situation, working in the ED and patient definitely did have an allergic reaction to IV contrast following return from CT scan with profound angioedema. No SOB, difficulty swallowing, VSS, patient seeming ok. MD notified and rec'd orders for solumedrol 125, benadryl 50 and zantac 150 - IV for all 3 of course. Shortly after I gave solumedrol and benadryl (was waiting on zantac from pharm but that's another story...) patient became very agitated, tachy up to 148, yelling she can't breathe, diaphoretic. We put her on a nonrebreather, no other meds given, her heart rate returned to NSR and her anxiety lessened after a couple of minutes. No stridor or wheezing, SaO2 never less than 95%. Do you think this was an escalation of sorts of the allergic reaction? It seemed to happen RIGHT AFTER I gave benadryl and solumedrol. Perhaps a reaction to either of these medications? Also, this ED situation was happening concurrently while I had a crying baby in another room (who was fine but still, the crying...), another patient needing to go to OR.... my coworkers were helping me obviously but I could feel my stress level shooting through the roof. Any suggestions on how to physically calm myself, any techniques you may utilize to stay focused and not feel like it is all on you? I know it can't be good for me to get so wound up and stressed out, nor is it good for my patients! Thanks so much!

Hi everyone, After a long job hunt I finally got my first ER position after years in ICU. I'm still on orientation. I really enjoy it when things are going well! But I am finding that time gets sucked up troubleshooting computers, meds in pyxis not be loaded properly, blah blah blah. The inefficiencies that just make the job crazy when you have back to back admissions etc. I'm trying to adjust to the pace of it all, and sometimes it seems that my patients are being discharged and I'm never told, the order just shows up in my computer and I have no idea how long it has been there. Last night my patient was discharged and I realized later that urine was never sent and it was a stat order - don't the MDs look for results of full work up or is it up to me to say we still don't have all test results back? Or if they are ok to send the patient home I guess they don't care about UA results anyway and I shouldn't worry about it? I realize a UA is not always the highest priority test...

Ouch! I had two interviews for an ER job, and no call back. Not a call to say thanks, but no thanks. Just - - nothing, no response. How many of you have had this happen? Anyone to commiserate? I'm having a very difficult time trying to change specialties (ICU to ER) in this economy, and I know they had some reservations about the amount of training I might need. I would appreciate any words of encouragement, thoughts or other??? I'm trying not to harp on the rejection...

I had a similar experience when I started nursing. I first worked in an ICU that was small and fairly limited. I was mostly interested in cardiology but that was a small segment of our patient population. I was there for about 8 months when I got hired for a residency program in a CVICU at a large teaching institution that had a large volume of open heart surgery patients. It was a great move, and I never regretted not sticking it out at the first place. I learned a lot more than I would have had I stayed. I agree with other posters - figure out specifically what it is that makes you unhappy at your current job. I would also start looking around to see what else is out there, but these days I know that's not much. But I don't think you should stay in a job just for the sake of staying, if there are other opportunities that you think will be more enriching to your experience. But at the same time, the one year of ICU will be invaluable for your next adventure. Good luck!

Hi Gest1971 - I am in the same boat as you, worked CVICU for years and CCU prior to that, moved into clinical research (which is what I am doing now) and thinking of NP school! I also applied to several EDs to broaden my skills and possibly prepare for school, and I was told the same, no ER experience, no job. I applied for a per diem position at another hospital in their medical ICU and trauma ICU, so at least I will be with patients instead of completing paperwork all the time. Did you find out about school yet? Or did you get a different job? -Niccole

When I did my new grad training in TX in 1996 I was paid a reduced salary until I completed my training (8$/ hour!!) and then we started as an RN I. But to not get paid at all?! That seems crazy, as tempting as it might be to get the experience and just start working already... I think it's exploitative of your time. It's not like there are so many jobs for experienced nurses (I've been looking, and there really aren't) that you are going to get up and leave after 3 months of training? After you've done everything to get this job in the first place? I think they are just looking for every way possible to cut costs, and if this is indicative of how they feel about their nurses' time then I think you should look elsewhere. I mean you WILL be providing care, not just sitting in a classroom! I think it's a dangerous precedent. If other hospitals see Sutter recruiting successfully in this way, then maybe all hospitals will try to move toward unpaid new grad RNs. Can I ask which hospital this is? I can't imagine that CNA would be ok with this. Good luck to you - your job is out there!!

ANC33 makes some good points, you definitely want to know if they have someone to handle all of the regulatory requirements (some jobs have staff for this and some don't), as well as how many studies you would be responsible for. My hesitation for you would be to leave acute care - it would be difficult for you to go back without a full year of experience. If you stick it out for the year, then go to research - you have a back up in case the research thing doesn't work out for you. In this job market I would think twice about leaving the hospital as a new grad, might be tough to get back in... Good luck!