TraceyRN_CEN

Love, love, love my Dansko's!! Been wearing them for over a year and they are the best shoes I have ever worn. I have very flat feet and my ankles tend to roll inward, creating strain on my knees, hips and back. The Dansko's hold my ankles in alignment.

I feel your pain. There is nothing that will suck the life right out of an ER nurse like the type of patient you describe. It never fails that truly sick people that need nursing care do not get the care they need because of the time it takes to deal with the actual situation and then the added charting required whenever a patient is in restraints. I have seen many patients, once realizing they were facing jail time, say the magic words 'I think I am going to harm myself". In real life, how many people use that particular phrase when truly contemplating suicide? The ones who know the system are the ones who use it. I realize I didn't solve your problem... sorry, I just needed to rant with you!

I think it totally depends on the person. We have some new nurses only a few months who have taken and passed, and some others that have been ER nurses for years and have failed. One train of thought I have heard is to take it "before you learn things the "wrong" way." I think that studying for it definitely helps to become a better nurse, and the practice tests are a good tool to gauge when a person is "ready" to be tested.

3:1 is the norm in my ED, with an occasional 4:1 ratio. I consider myself to be good at what I do, but I don't feel that I could sustain a 5:1+ patient load safely if they had high acuity. At one time, we had a "clinical decision unit" where once you got a patient started with IV fluids and labs,if they were stable, they were transferred there to await lab results and get hydrated, etc. Those nurses had a higher ratio, understandably. Our facility is all about Press Gainey scores and we usually rank in the 90 percentile. Lower ratio translated to higher satisfaction score. This is instance where the surveys have worked to the nurses advantage.

In my ED, we put in EJ's all the time. I have numerous patients who actually say 'you are going to have to put in my neck" because they have experienced multiple unsuccessful sticks. I have only been an ER nurse for 3+ years, but in that time, I have never used a pedal vein for access. I don't understand why your charge nurse preferred the pedal to the EJ. IMO, you were on the right track.

When I was a nursing student, I was doing clinicals in a local hospital and I had 3 patients to do FBSB's on. The first two were males with thick skin that I had to really try hard to prick. The last was an elderly lady with delicate feminine fingers. Right as I stuck her, I realized I used a bit more force than necessary. She graciously waited until I was finished before stating in her southern belle drawl... "Deah, that was just fine, but next time you might want to just prick it a little - you don't need to get a runnin' start and jab it like a spear!" What a trooper!