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I received my CEN in April. Congrats on going for it. It is a VERY hard test but I think you learn a lot studying for it. I bough the CEN study guide from ENA. The book also gives you 2 or 3 online practice tests so you can get a comfort level with the way the actual test is given. I would advise taking the practice tests, look at the items you missed and read the rationale. If you don't understand then research further. The test will have questions based on your knowledge. Good Luck.

Virgo, I feel your pain! The mess the prior shift leaves the room and the pt in is UNACCEPTABLE! I think it is totally unprofessional. Sure, sometimes the shift is totally nuts.....but a dirty commode? no IV even attempted? garbage can full and overflowing to the floor? Then you get the computer up and see that the initital assessment was never done! SOB pt without monitors on...grrrr. I did not write it up but I have promised myself if it happens again I will ask the offender to clean it up before they leave. If that goes badly then I will have to try another approach. I hate to be labeled the "rat" but I hate the mess even more. If the face-to-face doesn't work then you ahve to try soemthing else. If you don't address it---it will never change. Good Luck. Let us know how it works out.

I agree hherrn and gardengal. So what do you say to the staff that want to change the process to raise scores? I do the best job I can do every day....people that have a genuine NEED to be in the ER are very appreciative. The rest of them will never be happy no matter how many warm blankets and fluffed pillows we provide. Perhaps if we tucked some extra Percocet in the pillow case that would make them happy!!

The ED I work in generally asks the pt if they have transportation arrangements prior to narcs. Albeit, some do lie. Once the ride arrives we require that the driver come into the ED, show the whites of their eyes and the pt is dc'd. This policy that states "detaining the pt" is not been enacted at this time and most ED staff are smart enough to ignore this!! Personally I will NEVER put a hand on a pt that wants to leave. The ED staff does not have the right to detain a narcotically impaired (by the staff) person. Would everyone like to have them have a ride home, you bet. Does it always happen? No. Who has the time to watch the elopers or will stand in their way???

Great idea elkpark! I will pursue that angle. I just can't imagine it would be legal. Thanks

The search I have done is unanimous. Detaining patients is illegal. Since I do not have an outfit for court I will not be doing any detaining!!

erlissy--we do check if patients have a ride but patients do lie, We ask them to have their rides come into the ED so we can see them.....I am talking about the pt who has lied and then when we insist on a ride they bolt. Do you "detain" them?

You love your droid, huh??? As much as I love my iphone. Do you have any thoughts about detaining patients??? Legal nightmare??

That is totally ridiculous!!! The technology is making us better informed with an easier process. How could this be anything but good. Does the hospital provide another fast option for getting the information?

There is a policy in development for our ED that deals with nurses physically detaining patients that want to leave after receiving narcotics. The tentative wording is that nurses are to.....physically detain them. I see this as battery and/or kidnapping and certainly not legal. What are your ED's doing? There is a degree of liability when an impaired person leaves the ED. The risk of injury when physically restraining someone against their will is a given. Security on our campus are not to ever touch anyone with the intent to stop them. So why would the nurses? What do you think?

I agree totally with the ED personalities. Most are Type A, and that is ok. It is the narcissistic overbearing nurses that can make a 12 hour shift feel like an eternity!! You know the type; they know more than anyone--especially more than the MD's and not afraid to tell them how wrong they are. How do they get away with that??

You are so right! Administration seems to have overlooked that option. A happy nurse can provide the best care in a very compassionate manner. Wonder why that never seems to be the focus?

The risk of pts leaving the waiting room with intact IV's or meds on board opens up a whole new issue of liability. I do think the RN in the front to evaluate pts prn during the stay in the waiting room is a good one. The concept of "rounding every hour" in the waiting room by RN's trying to keep up with the flow of the pts in rooms is a bit scary! Folks waiting for their "urgent needs" are rarely pleasant. To present yourself and ask them how they are doing is like waving a flag in front of an angry bull. Does anyone out there do this? How about bedside report? These are some concepts that are proposed. I see the value in a bedside report in ICU, maybe even Med-Surg but in the ED?? The area I work in has had layoffs of clinical nurses, so the option of adding another staff member is not feasible. I do think the Frequent Flier Card should be presented to senior leadership though!

Thanks Rickbos! We a looking at a fast-track process but need to finish an expansion project to create the rooms. A lot of our "clients" expect instant service, as their issue is the "most urgent"; it is easy to see that the dysuria they have had for 2 years is much more important than the evolving MI in the next room!!! So who will be most likely to respond to the survey? Yes, indeed, it will be that poor soul with dysuria.

Ours is only 8 beds!! The only other hospital in town has a 26 bed ER and is a Level 2 Trauma Center. It is big and impersonal. Ours is the one "everyone" likes because of the care and the personal attention you can give on the units. The ER is a whole new ball game. The whole world has this entitlement attitude. The motto seems to be "Its not my fault I am a drug addict and you must give me narcotics!"