JDougRN

I work in a small Emergency Department and I'm reaching out for information. Specifically, I'm looking for ED policies in giving IN Ketamine to pediatric patients for procedures. I know the literature shows that it is a safe and effective way to help our small patients, but my hospital has nothing in place to use it as light sedation vs. moderate sedation, and I need guidance so I can try to educate our providers and advocate for the littles. I appreciate you all.

Well then let me educate you. I just left work as a full time day charge nurse. I got PTO at 7 ish hours of accrued time per 2 weeks. They did away with sick time, so any time you are ill you have to use your vacation time. I'm an RN with 27 years of experience, have my BSN. I pay my own certifications and do them on my own time, with no extra money paid for the BSN or any of the many certs I hold. When I left there I was making 27.00 an hour...plus a grand .75 cents and hour to take on the charge position. I had to pay 300+ every 2 weeks for my health care, with a 5 THOUSAND dollar premium to pay before they started to cover things. I was supposed to have 11 nurses staggered through until 3pm. AT NO TIME in the last 2 years did I ever have full staff. I was often down up to 5 nurses. The nurses I had were often float pool or temp nurses who's primary skill set was NOT the ED. We are a certified stroke center, so fairly frequently we get TPA patients that require 1:1 nursing for at least 2-4 hours. We also had to auto accept any STEMIs from our sister hospitals. They start new grads at 18.00 an hour. They frequently bring in travelers....I was a traveler there on and off for a few years, and was TOLD by upper management that it was cheaper for the hospital to pay for travelers than to pay their own nurses adequate money to ensure retention. I'm betting that the CEO and the other numerous upper management who make the MILLIONS of dollars a year aren't losing any sleep over the issues I raised above. SO now I'm going back to traveling....raking in that money....BUT. Getting through the ton of crap needed to onboard with a travel company is time consuming and can be expensive. I had to drive a total of 6 hours unpaid to get paperwork and labs done. Then I have to worry about my contract being cancelled if the facility doesn't need me. Then I get to drive 17 hours away from my husband and home to work a 13 week assignment in a hospital where I don't know anybody. I usually get less than a shift to learn the charting system and get familiar with the policies and how things are done. Travel nursing is often lonely- you are never really "One of the family." You have to work with Docs you don't know. With the situation happening now, there will be no site seeing on a day off. I will spend 13 weeks working or sitting in a hotel or Air BNB. I won't get to see my family at all during that time because of Covid. THAT is why we get paid a premium thank you very much.

Hey all, hope you are all staying safe during this insanity. I was wondering if anybody has started to see crisis/high rate jobs posted yet? If so, post the specialty and company.

I actually am an Excelsior graduate. I don't think it's an easy fix/program but I was looking into it for people who want to go into nursing who already have an associates degree and are working as Paramedics.

So I've been with a travel company for the last 4 years. I've always worked my butt off- Every facility I've worked at through them has offered me a job. I've sent fellow nurses in their direction. I love my recruiter, I think she's awesome. HOWEVER- I've had ongoing issues with them not getting things- Part is because a lot of the certs, paperwork, ect are sent via email or text. I take a picture of the document they need and send it. The area I live and work has questionable reception. I worked out the last of my contract and sent my time in. I never was contacted by the company- they claim they never got my time. I noticed my check never went in and contacted them. They stated that because it was more than 20 days, the company they work through refuses to pay them, so they are refusing to pay me. 1. Nothing in any of the contracts was there anything about having to send time in within x amount of days. 2. After much back and forth, they generously said they'd pay me for the hourly wage (18.00 and hour) but are refusing to pay me the meal and housing stipends- that's what brings your salary up to a decent level. I'm thinking what they are doing is illegal, certainly immoral. I can't believe they'd care so little about an employee. I can't believe they'd risk losing a damn good traveler, not to mention the bad press. I specifically chose a big company so things like this wouldn't happen. I'm disgusted.

Does anyone know if Excelsior stopped their Paramedic to RN bridge program? I was telling a Medic friend about it but I can't find info on the site?

Ouch. It's too bad the medical culture discourages self reporting of incidents like this. People are scared of losing their license and their jobs, so things like this get covered up. Hang in there.

I'm reviewing to take the CEN for the first time, and bought "CEN Examination Review" put out by JB test prep. I've found several questions that I think are wrong and was wondering if anybody else had used their book? The last question I disagreed with was- A possible cause of Thrombocytopenia? I chose Alcoholism, they said Portal Hypertension. I've found several different sites that ID ETOH as a causative factor, but none that include their answer. Another involved an uncompensated shock pt.sent from a tertiary care center. They are getting TPN/Lipids and Dopamine together in a peripheral IV. You get an order for IV Bicarb and AMpicillin, should you shut off the TPN/Lipids and run the other meds together? ask the MD for a central line for additional access? Insert another peripheral line to run the other meds, or push the bicarb in another peripheral IV while waiting for the pharmacy to send the Ampicillin? I chose MD placed central line, if they are in uncompensated shock peripheral IVs might be difficult and time consuming. They said start an additional line, push the bicarb while waiting for pharmacy to send the Ampicillin. What do you all think? Lastly, what type/brand of prep books/sites did you all use to prepare that most resembled the actual test? I've found some review sites that have very easy questions, and others that are naming off obscure questions about disease processes I've never even heard of in the 26 years I've been a nurse.

I JUST went through this same issue in TN. I work with FNP's that just graduated and are working in clinics. Walden University told me I had to have an Geriatric/Acute care NP- This makes no sense to me because they aren't allowed to care for anyone under the age of 12- A LOT of what mid-levels see are simple peds cases. The lady at Walden told me that the BONs are changing their regulations and soon FNPs will be considered working out of their scope if they are in EDs or clinics. This makes no sense to me at all either, and I was actually going to talk to the TN BON.

I just recently began trying to decide what school and certification I'm going to do. I'm an ED nurse now, and I'd like to stay in emergency medicine, possibly transition into EMS flight care. Does anybody know what, if any, capacity NPs can function in that area? I seem to remember working a trauma that got diverted to our ED when the pt. coded. The NP on the flight team was very impressive, and threw in a central line while we were working on the patient. I'm wondering how to get to do that when I grow up? :) I spoke with a counselor this week who told me that in order to work in the ED, I would need my AGPCNP cert, that I would only be able to take care of patients age 12 and up. I explained to her that where I live (Eastern TN) that EDs and minute clinics seem to be hiring FNPs who see a fair amount of pediatric patients. She told me that they were acting outside of their scope, that FNPs were trained for primary care in an office type setting. I always thought FNPs were able to do emergent/critical/emergent care for the entire life span? I'm a travel nurse, and I've never worked in a place where the midlevel couldn't care for peds patients. Could someone please shed some light on this for me please?

Ok, I'm gonna be the voice of the crusty old bat-meanie nurse. I do believe that most nurses do NEED to learn on a med-surg floor. If you can't handle where you are now, because you are still trying to learn your time management skills, you should NOT look to go somewhere where you need more skills (ICU/CCU/OR). New nurses look at the amount of patients they have, on a particular floor, not the acuity. It's not fun, but you just did something HUGE- You got through nursing school, passed your boards, landed a job- That is an accomplishment to be proud of. This is part of the learning process. I agree with those who are telling you to hang in there and give it some time- It does get better with more experience. I'd suggest talking to your fellow nurses, and explain that you feel like the weakest link. Ask for suggestions on your time management. Make sure you are trying to get as much experience with different things as you can. New experiences and situations are very stressful as a new nurse. Good luck, and I hope it all works out for you.

We won again on the 28th- empty for almost a full hour!

Studentnurse418 and Racer15- Congrats! If you are willing, email me an address and we here at CRMC will send you a little something in the mail. Tootsie pops for everybody!

WOOHOO! 21 Carpuject salute, that ROCKS!

We WON! We beat the universe! On 4/1 at 0640, our 37 bed ER cleared it's very last patient up to the floor, bringing our pt. census to 0!!! This hardly ever happens, so we did a bit of a celebratory "Happy happy Joy Joy" dance, and seranaded the day shift that came in at 0650 with our rousing rendition of "We are the CHAMPIONS......." So I'm starting a tag thread to all of our fellow ED's- When you beat the game, come on here and brag. The first ED who can add their "Win" to this thread will get our applause- heck, I'll even promise to send you a card and a "Prize" if you are willing to give me a contact name and address for your ED. Lets foster some intra-ED camradery! Rules to enter the game 1. You must have at least a 30 bed ED. Smaller ERs are welcome to add their accomplishment, but I've worked in small, 6 bed EDs, and clearing the board is a fairly frequent occurance. 2. If you accept the card of congrats that I send, you have to be willing to forward it to the next ED after adding your hospital and names. Come on ya'll- Us wonderful peeps from CRMC are waiting to hear from you!

I read the OP, and I'm not sure if I'm missing something? I'm not sure exactly what (Laughing?) the Nurses did that upset you. You are in a difficult place, being a graduate nurse, so you know how things SHOULD be, in your opinion....unfortunatly, I think your views on what constitutes rude might change a bit once you have worked in nursing. I hope your Dad is feeling better.FYI- In the ED, a lot of people do come in with a multitude of complaints, but always throw in the "And I have chest pain" because they know it will get them bumped. Also, I have had my fair share of triaging patients....asking questions about history and sx....only to have them turn right around and tell the provider something TOTALLY different. It makes us look really stupid, and can really affect the course of treatment. I'm sort of fuzzy on how chest pain can get accidentally put down as a complaint? I guess you can always take it as a lesson learned....make sure you know exactly what complaints your own patients have. Good luck! :)

Saved from what? To the OP- Hang in there- Nursing is difficult to adjust to as a newbie, and nights can be very difficult as well. Try to remember that as nurses, we can't always change the outcome, but we can make a horrible experience for a patient/family just a little bit easier to bear. I believe this is a good message no matter what faith you follow.Also- there is another wonderful thought- All paths up the mountain lead to the same place. They may be different paths, but each person finds their correct path....except the person running around the mountain telling everyone else that only HER/HIS path is right and everyone else is wrong. (I'm NOT saying the OP was doing this, btw!) I've been lucky to have been privelaged to take care of a number of wonderful patients of different religions, and I always love being able to speak to people about their spirituality. I've learned so much, another of the perks of being a nurse.

Like what? Please supportyour claims, asI'dbe very interested to see any posts that have information that could be considered a HIPPA violation?

Ya know, there are times on this site where I honestly feel like people will argue about ANYTHING. Seriously? A flu swab shouldn't hurt- they aren't pleasant, but they aren't the same as getting a chest tube. Come on now people

Well, that's your perogative. I've had flu swabs, as well as done numerous, and I've never had anybody complain. Perhaps the person who did yours was a bit rough, but that doesn't need to be the case. As I said earlier, I don't ever lie to my patients about the "Boo-boo" potential.

I didn't call you anything- it was used as a verb, and you were insinuating i was being untruthful with my peds patients- you don't ever lie to any patient about the probability of causing them pain.

Yes I have, and no, it didn't hurt-

As nurses, we can't always change an outcome, but we can make most situations, even the most painful and horrific...just a little bit easier to bear with our compassion and how we care. Nurses rock, and most of my most intense "I am a DAMN good nurse" moments come from helping the patient and family cope.

Flu swabs are explained as "I'm gonna get a boogie on a stick, but it won't hurt." 3 yo and up think the idea of a grown up picking their boogers is HILARIOUS! Follow by the standard joke- "How do you make a hanky dance? Put a little boogie in it!" Urine specs with little boys- draw a crayon smiley face on the back of the hat and make a game of him seeing if he can pee on it. I actually wore a urine hat on my head last night (A clean one!) If you can get them to laugh, it's half the battle. BRIBE them! Popsickles and crayons and coloring books are WONDERFUL!

I guess it would depend- If both of your patients were level 1 or 2- active bleed, acute MI- something really sick and time consuming then yes, they are being unreasonable. But if it was something failry common like abd pain, ect- 2 patients really isn't a lot. Unfortunatly, ED nursing tends to be very fast paced and autonomous. Hang in there, ask questions, and always be willing to learn something new. ED nursing isn't for everybody, but if it's something you want, I'd suggest getting an ER education book and reading up- also, there is a lot of good information on these boards to new ED people giving aadvice on how to streamline the process. Good luck and congrats on your enterance to the "PIT"