emergencyrn06

Good for you for deciding to enter the rewarding field of nursing! Now, for the bad news. You can't just "specialize" in trauma nursing in school. Nursing school is meant to give you the general knowledge base for entrance into the nursing field. You can get different certifications post-graduation like CEN, TNCC, ACLS, PALS, ENPC, etc. Most of those you have to have even to work in the ER. And yes, if you work in an ER you will have more than just "trauma" patients. A common misconception is that emergency nursing is "as seen on TV." Yes you can get your GSWs, and MVCs, and assualts, etc. And it is an adreneline rush to be hands on in trauma cases. However, your cardiac emergencies and respiratory emergencies can be just as exciting and "action packed." I've always liked psych cases too - especially paranoid schizophrenics or bipolars with psychosis.....absolutely fascinating. And there is no typical time a trauma patient will be on the ER. It depends on what kind of trauma it is, what kind of services are offered in your facility, how the patient responds to treatment, medical history of the patient, and so much more I can't even list here! The ER is multi-fascited. You have to have some skill in all areas with patients across the life span in order to be successful. And you have to realize you will never know everything and almost nothing is as it is in a textbook. And I'm not trying to discourage you by any means. Many ERs have internships and new grad positions that have an orientation period to help you "learn the ropes." But you will not walk into the ER fresh out of school and be assigned to Trauma rooms. You have to be proficient in sooo much to take the lead in a trauma. You have to get your feet wet first because the choices you make and actions you take can very well be the difference between life or death. Now, ICU is NOT the same as ER. In the ICU you don't go through the intial triage and stabalize phase. Don't get me wrong - any aspect of critical care nursing takes a lot of skill. Sometimes it is just a little different or modified from one unit to the next. Many of my friends are ICU nurses and there have been many times they have made comments about the ER nurses and "how do you all do it? " and "I don't think I would like not knowing what was wrong and having nothing to go on." It's called teamwork and it is absolutely essential. I highly recommend that you do some sort of precptorship/internship while you're in school to help you decide which area of nursing better suits you. And you always have to remember that it takes all disciplines to make a difference. I can't tell you how many times we've called the nurses down from the dialysis unit to help us troubleshoot a few things with dialysis patients. And they are always very helpful and skilled in their area. Just don't go into emergency nursing or critical care if all you want is to be a hero - that's the wrong reason. Good luck in your venture and I wish all the success in the world!

We do have a high turnover rate at our facility, which is hard on the nursing staff as well as the clients. Maybe I'm just an OCD control freak and that's why I feel the way I do. But at the same time, our facility is compromised of several different buildings with varying levels of MR. The majority of our campus is comprised of lower functioning individuals with various medical conditions and most are completely dependent requiring multiple medications (some are on 10+ multiple times per day - NO LIE), tube feedings, etc. We are in the midst of transitioning from ICF to skilled nursing for these vary reasons. And you know, if the client to nurse ratio wasn't so high (15+:1) I'd be all for total care nursing. To me, a medication pass is more than that - it's a prime time to assess your clients on a regular/more frequent basis.

2 times in 2 years is NOTHING! It's good to know there are still some people that don't use the ER primary care. :yeah:Of course, frequent flyers (especially those who lack any insurance) show how horrific the economic strain is on our society. And you know, the real kicker is I have seen a physician check the demographics for insurance before deciding on how to treat a patient. And I'm not talking about before prescribing a medication that they may or may not be able to afford. I was appalled! Ridiculously unethical, immoral, and illegal.

We had a frequent flyer that came a bare minimum of 2x/day per EMS with multiple complaints, usually the same complaints (indigestion, sore throat, non-specific abd. pain) each time. She always got a GI cocktail (Maalox, viscous lidocaine, and Donagel). We finally got to the point that when we heard the call coming over the radio we would just pull the meds and mix them up so she could get treated right after we triaged her and it wouldn't tie up a bed. Now, take note we did ALWAYS thoroughly triage and if needed she got a room. That lady has had so many x-rays now she probably glows in the dark!!! Gotta love job security! :chuckle

Basically, I think that if a Medic has enough training to scrape your butt off the asphalt and keep you alive on the way to the hospital then they can triage anything that walks through or is dumped at the ER door. I also agree somewhat with the post that said an EMT-B would be like having a CNA triaging. Yes, some basics are really good and know their stuff, same goes for some CNAs with ER experience. But come crunch time I'd rather have someone with more training on my team. Granted maybe there should be a short course the Medics should take to learn the ropes for triage in the hospital setting, but other than that I would be fine with it.

For trauma victims the ENA recommends a 16g or 14g. This is according to the TNCC which I took in 2006 so if it has changed since then I'm unaware. A 20g is the bare minimum for PRBCs or OR candidates at our facility. I am also guilty for throwing a 16g (in the AC of course) on a hungover 20 y/o male who was yelling and screaming in the lobby because he had to wait an hour. (We had a multi-victim MVC two of which we were trying to get loaded to fly out.) He continued to yell, scream, and use foul language after we brought him back. The department was packed and we had EMS rolling in like crazy with cardiac and respiratory patients. He was just really nasty to everyone and we just wanted to get the IVF in ASAP so he could go home. (And I know it sounds bad, but we needed the bed for more serious patients than someone who is more than stable, under the legal drinking age in our state, hungover, and disruptive.)

In NC you can become certified as a med tech as well. From a nursing point of view I think this is unsafe. I just can't undertstand how anyone can gain enough knowledge in an 8-14 hour course to safely administer medications when I took an entire semester (12 weeks) of Pharmacology. I still have to look up some medications in the reference book before I give them because I'm not familiar with them and need to know side effects to look for, effective response, labs to monitor, etc. And new medications are discovered every year! I'm just not comfortable letting my license ride on someone who doesn't have the education of experience to properly assess a patient before adminstering a medication. The key word here being ASSESS! The last time I checked assessment was not a task that could or should be delegated to non-licensed personnel.