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  1. KeeperMom

    CEN as a new grad ABSN?

    I totally agree! while you probably have the knowledge and ability to pass this exam, I think it goes beyond being able to study and know how to answer the questions. Having two years of experience will help you to better understand why the answers are the correct ones. I've seen so many new grads take TNCC and pass but barely know how to apply that to his/her everyday practice. I have both my CEN and TNCC and I think I had a better understanding after a year of experience. Studying was much easier with some experience and I knew the "whys" of my answers. You may also find that your facility will pay for some classes and may even reimburse for testing if you pass. Our department does so that was a big help for me!
  2. KeeperMom

    New grad nurse in Emergency Department

    Do a search on new grad in ER and there are tons and tons of posts. You should find loads of info. My best advice is to ask questions. Don't act like you know everything and certainly do not be a know-it-all.
  3. KeeperMom

    ER patient wanting pain Meds

    We don't require a signature of a responsible party but we do have to lay eyes on the person coming to pick the patient up after receiving narcotic pain meds. We don't even prescribe it until the ride is seen IN the patient's room. Not "on their way," not "in the parking lot." The ride must be seen in the department at least.
  4. KeeperMom

    Botox - nurse practitioner

    NPs are not permitted to do botox in every state while there are some states that allow RNs to administer Botox. Sadly, I live in a MD-only state.
  5. KeeperMom

    New Trauma Nurse Help

    In our L1 facility, it takes at least a year to be assigned big beds and another year before you can even apply to be on the trauma team pathway. That takes another 6 months to a year before you can actually be on the L1 team. Be patient, grasshopper. Don't rush into traumas until you are really comfortable taking care of a really sick patient on your own. You gotta walk before you can run! As far as learning more, try to see if you can find a more experienced nurse to help teach you. Maybe go in as many of her codes and traumas as you can. Also ask you educator about more learning opportunities. My ER has critical care classes taught by more experienced RNs. These are never required but usually pretty helpful.
  6. "Patient drove self to ED." "Pt reports "severe" vomiting x12 hours with approximately 20 episodes of emesis since onset of s/s. Pt actively / not actively vomiting at this time." For kids, I chart something like "Pt does not appear to be in in any acute distress / discomfort. Breathing is even and non-labored."
  7. It never ceases to amaze me what people think is an emergency!!! early 20f....signs in for "sleepy" It is almost midnight. She says her mom told her to come in because she is falling asleep while driving and she is 10-ish weeks pregnant and it isn't normal to be that sleepy while pregnant. Wait.... WHUT? I kinda went tough love with her and said that maybe she should be at home sleeping at 11:30 at night and not driving tonight or when she is too drowsy. She drove herself by the way. She also said she had to drive herself to work. I asked her if driving sleepy is a risk worth taking to put her life, my life and that of her unborn child in danger. I was probably a bit snarky and definitely in "mom mode" but this girl wanted us to do something so she wasn't so sleepy. That's pretty much allllll up to you, sweetie. All you!
  8. KeeperMom

    Driving drowsy

    I'd would push for 0730 meetings! My previous ED was huge and would have a 0730 meeting and a 1800 meeting to cover both shifts. We also worked in crews so the manager would often have four meetings per week to cover everyone's schedule. There was no way a night shifter should be required to come in at 1100 AM just to come to a meeting just like a day shifter shouldn't be required to come in at 2300 for a meeting.
  9. KeeperMom

    Fast Track Education

    I think your idea of an info card is a good start. In my experience, however, no one reads them and they end up on the floor. If they do read it, they will have 8000 questions about why they don't get a "bed" in the back. There is a weird perception that if they aren't getting a BED they aren't been properly seen. Not all patients feel this way but we all know there is always that "one guy." I think having a personal conversation with the patient while he/she is still in triage is best. I say something like, "We are going get an X-ray / XYZ test while you are waiting to get the process started. From there, we will work on getting you a chair in our Fast Track area and can get you seen and treated and out the door a bit quicker. Sound good?" In our ED, the FT area is run by the NPs but a doc still has to lay eyes on the patient. While a priority 4 patient is usually a FT'er, someone needing suture or an I&D may go on our "procedure" bed but still treated like a FT chair. Clear as mud?
  10. Recording?! Oh hell no!! Security would have been in that room in seconds and that pt made to delete any video. It is a posted policy so if they get all butthurt PD gets involved. And I am alll about some "sir" and "ma'am" like my mama raised me to be. You have to establish boundaries. If the first thing a patient or family member asks for is a warm blanket and coffee I politely remind them that all medical needs will be addressed before any comfort needs. Setting a boundary and a level of expectation is essential to our work! I had a priority 1 pt... vent, art line, central line, 4-5 drips, warming, blood on hotline...the whole nine yards. Difficult intubation too and we had to bougie the pt. Alarms going off, tittering drips or changing bags, I'm continually in the room or getting meds for this guy. I haven't sat down in like two hours because we were constantly hands on w this patient at the BS. I walk across the room to sit down to chart. Wife comes and pats me on the arm and says "honey, I'll take a cup of coffee just as soon as you make a fresh pot." I kid you not. I am about to explode at this point. It took all I had to not rip her a new one. I did tell her that making coffee was not a top priority for me today but being the one thing that stoood between her husband and the grave was my priority. She looked at me like I had three heads. Even crazier was the pt's daughter was an OR nurse at our outpatient facility and she got bent outta shape because the ETT was pulling on the side of his mouth. I nearly bit my tongue right in two. I hate that we are in the business to please folks and our reimbursements are based on an unrealistic expectation of what is actual patient care.
  11. KeeperMom

    Best stethoscope for an ER Nurse?

    I realize I was a bit snarky last night. Long, long shift and came home angry. Anyway.... I strongly suggest you walk before you run w any tool or equipment. It is like buying a super expensive set of golf clubs before you bet hit the green. You have no idea how you hear yet or even what your listening for. Build your listening skills before you buy that expensive scope. Plus, you really don't need it. You can hear rubs, murmurs and just about anything else you need to hear w a $50 scope. Even as an NP I don't really *need* anything fancy. I can get everything I need out of my III. Also, weight is a factor for me. Those big scopes can be heavy around your neck. I am constantly having to take my scope off to do tasks. Let that bell hit you in the face just one time...you'll see. Plus, a good scope is an excellent gift your parents or someone can get you after you graduate. My daughter bought me one when I graduated. She was 8 and picked it out all by herself. Asked her dad to take her to get it and he said she even tried to pay for it w her birthday money. Even tho it was broken, I still have that thing. Now isn't that a pretty sweet memory of my first "real" stethoscope? I would not have had that if I had gone out and pitched a super fancy one right out of the chute. The Littmann Classic II is a great little scope and will serve you very well thru school and beyond.
  12. KeeperMom

    Best stethoscope for an ER Nurse?

    It appears you want us to validate you in getting a fancy Card 5000. If that is what you want, get it. I personally don't think you need it. We ALL say we keep up with our things but it just takes one co-worker borrowing your scope for it to walk away. You can't wear it around your neck all day every day and there is always a chance you will leave it in a patient's room, the bathroom or break room. It happens. As soon as you say, "It will never happen....," it will happen. No amount of engraving or tagging the s'scope will guarantee its safe return. I successfully used my $100 s'scope for over ten years in the ER until an MD borrowed it and bent it in half and broke the tubing. You think he offered to replace it? I replaced it with a Classic III and it is serving me very well now. I know plenty of RNs that have been using $50 s'scopes for years with no complaints. Really, there is no ONE best s'scope for any job with the exception of a NICU/peds nurse. I always suggest a student get a very basic s'scope until you know for sure where you will land in your career and how you hear best.
  13. KeeperMom

    Best stethoscope for an ER Nurse?

    I would get one you don't mind having stolen or misplaced during school. You can upgrade based on what you need / want later. Honestly, the expensive s'scopes are nice but I can hear just was well with my old Littmann SE II or whatever the heck it is.
  14. KeeperMom

    being fired by patient's family member

    Awww.... You had your "I got fired" cherry popped. You should be celebrating!! I have been fired more times than I can count for my "tone." I have never ONCE been fired for my abilities or level of care. I'm in a position now that I can say to the fire-e, "I'm sure it gives you great pleasure to think you are firing me but I don't take it personally and I hope you find the perfect nurse that can provide you as great of medical care that I can with a more pleasant tone that suits you." In my previous ER, if the family tried to fire a nurse, we would get the CN involved. Patients weren't really allowed to fire nurses if it was just a personality conflict. The CNs would remind the patient that we have a job to do and treat the patient medically. They couldn't fire docs either so their choice was to either stay in that room with that nurse or they could sign out AMA and sign back in to be seen. They usually opted to stay. If the family pushed the issue we would swap nurses but we'd usually try to get the nurse with the flattest affect or was over-the-top bubbly to turn on the charm. Don't take this stuff personally. A lot of times family members are exhausted and the most minute detail will set him or her off and you are there to take the brunt of that frustration. Consider it a blessing in disguise.
  15. KeeperMom

    Why do some practices prefer PAs to NPs?

    Yep. This is what I was going to say. In most states, a PA is 100% billable. As always, it comes down to the dollar.