FiduciaRN

For those who criticized my lack of paragraphs I'd like to say a big thank you! I am adept at writing properly. As I was writing from my phone bc my computer is broken, I didn't realize that it went on so long. I am human, as I assume you who have critized are too. To those of you who had encouraging words, I thank you. There is a way to word things as to not sound totally pompus. I didn't realize that my lack of spacing or paragraphs was so offensive. Again, this won't have the proper spacing as well bc my phone is not equipped for that. I do hope that those of you who had neary a kind word don't experience a day like I have had. We should support each other and not tear one another down. Much like my place of employment, I see that politics and how loud your voice is and your bullying raise your self esteem! It upset me greatly, that after a horrendous shift, with lazy unsupportive co-workers, that I come and post here and am made to feel worse. I love my pts, and the little things that I do that make them happy. Thank you very much to all of you who supported and encouraged me, with one long rant and all!!!!!!!

hello all, i am in need of encouragement, as i get none from work. i was a float nurse at a small local hospital for a year. i learned a lot while i was there, but there was only so much to learn because it wasn't a trauma center and a majority of the pts were in the geriatric population and i basically saw the same things over and over again. i decided to branch out and get a job in the emergency department at a level one trauma center. i feel as though a made the biggest mistake of my life and wanna quit nursing all together. my orientation was three months. the way this ed is broken up is that there is a main ed, non crit pts, a peds ed, an urgent care ed similar to a walk in clinic and the trauma/crit ed. i have been on my own about 3 wks right now and it has been nothing short of a disaster. there is no team work. a lot of laziness. tons of favoritism. i have been relugated mainly to the main ed which is fine, but i always seem to get pts that don't belong in that area. i thought i was doing a good job. my pts like me, i am pretty good at anticipating what the pts dx is gonna be. so i set up accordingly for the docs. the last three shifts have really had me not wanting to go back. infact i have been trying to get a job at my old hospital. i know the day shift is busy and we just converted to a computerized system, but the things that i have been walking into. have totally left me disgusted. i take report on 5 pts. the previous rn has left me everything to do on these pts. out of the five, four had to be lined and labbed. some weren't even assessed and they had been there atleast four hours. no excuse. i let it go, did what needed to be done and that was that. the next night, i walked in and started off fresh. yet again i pick up 5 ppl immediately and have to totally work them up. as i am still pretty new to all this it took me a little time, but i knew who needed to be treated first etc. about an hour into my shift the night manager tells me that i need to pick up my pace bc i'm to slow. too slow? the four other nurses on my side had 3 pts each and they were all admitted already. i was so upset, i took a minute to gather myself and tried to explain the situation and he didn't care. so i then pick up 5 more pts to get him off my back. still i was the only one running around like a chicken without a head. noone communicates. i get a call from the or asking for report on my pt who was going for emergency sx. ummmmmm what?????? the er attending never even told me. he gave me the impression she was going home. so now i look like a jerk to the or. great!!!!! i rush to draw the type and screen, do the pre op check list and send her off. at 630am some ppl feel as tho they don't need to pick up pts anymore. so yes i pick up the last two. i assess them, line/lab them and make sure that my relief has little to do bc i am giving off 8 pts to start their day. even if i was giving off just one i would make sure everything was done. i hate leaving things unfinished. it is not right and just plain lazy. i am in noway saying i am a super nurse, bc quite frankly i think i am a terrible nurse. the only thing i know i rock at is my relationship with my pts. they all seem to like me. idk what to do? i am going to leave this job as soon as humanly possible. i go to work to work, not to socialize with my co-workers. i am there for my pts and their families bottom line. i try to make friends with the ppl i work with and they are so cliquey i feel like i am in hs. i cry everyday when i have to go in. sometimes i am made to feel like i am useless there. i hear people talk about me. i am usually a hot head, but i choose to ignore them bc again my pts matter, not these ppl who just wanna bash every new person who starts there. bottom line, one of the floors i used to float to at my old job wants me to work there. problem is, as much as i loved the team work, my co-workers etc, i won't learn much, and will lose a lot of my rn skills bc it is a behavioral science floor. i am so torn. i love the work and learning in the er, just not the ppl i work with. i never realized that that is what can make or break you. it has broken me to the point that i want to give up nursing all together. sorry for the extra long post, just needed to vent. thanks to all in advance!!!!! ; ) staff note: paragraphs have been added for easier reading.

On the pumps we use where I work, if you want two solutions to run at the same time, we set the pump to run concurrently. That way if I am running say heparin and nitro it will run in together. Hope this helps.

When we get orders at the hosp I work at, all BP meds are written with parameters. ( Ex. Hold for systolic less than 100, or Heart rate less than 60). I always call the doc to let him know I held the med and why, but some ppl I have worked with don't bc they say well we have the permission to hold it anyway. As for the insulin, I never mess around with that either. Some docs will have you give the Lantus at night even if the fsbs is 85. Some will write for half the dose, while others want it held completely. I always call to make sure. I have noticed that some RNs I worked with will play dr and decide to do whatever they want, which is a huge pet peeve of mine. We have RN after our name, not DR before it!!!!

Wow. All those orientations seem so short, especially for a new grad. New grads at my ER get six months of orientation. When I started this job, I had been a nurse for a year and my orientation was 3 months. I felt like that wasn't enough. My ED sees sometimes upwards of 250+ pts a day. Mondays and tuesdays sometimes 300. I feel like 3 months wasn't enough. I've been on my own for almost a month and still freak out. I know what I'm doing in my head, but I am severly lacking in confidence. My job has failed people on orientation. They even have sent back people to the units they came from. They sent a guy back to the ICU. I found that odd. I'm glad all you new grads have been finding jobs. It took me almost 7 months to find one. Xoxoxoxoxoxo my fellow nurses. Keep on keepin on!

Yes, we all do make mistakes and just need to use it as a lesson learned. I've made a few silly mistakes, but I've also caught mistakes by seasoned nurses. One night at my old job, I went to pull captopril 12.5. I notice as I'm about to open it, that is says carvedilol 12.5. So I called pharm to get the right med brought up. The pharm informs me that there is noway she sent up the wrong drug, and that it must be my mistake. It wasn't. I'm very anal as well when it comes to passing my meds. I couldn't say for sure if any other nurse prior to me gave the wrong drug. So unfortunately I couldn't report it, and it made me feel like crap. One day I hung up the wrong dose of Vanco. I didn't even notice it until my relief pointed it out to my preceptor. It seems as the RN prior never gave him his first dose, so that's the dose I hung. I wanted to cry bc it was my first week in the ED. The docs there can't stand me. I never give a med unless I see the order with my own two eyes and they get mad. I do this, because I don't like taking verbal orders at all. The reason for this is bc one night a doc told me to push 40 of Lasix. I repeated back 3x to make sure I heard him. Well when I asked him to write the order he said, why did u push it. Ummmmm bc u told me too. He said I will write the order anyway, but I realized he shouldn't have gotten it. Gee thanks.

Awwww. I miss going to Martha's Vineyard every summer. I miss being a kid. Now I am an ED nurse @ a very busy one in NY. I will switch with you!!!! Lol. I haven't seen a lull here. It seems like all the crazies come out of the woodwork in the heat and humidity.

Wow, I feel like the OP read my mind exactly. I just came off orientation in the ER and hate it. I cry everyday before I go in. I'm totally miserable. I feel inept there. I thought I hated being a float, but the ER is a totally different beast. My hospital is always booming. Last night, I walked into a mess and instantly went into freak out mode. I couldn't get a line to save my life, was behind on everything. I had a hard time picking up pts. It seemed like every 3 minutes a new pt came by ambulance, one worse than the next. All night critical pts were put in the main instead of the crit area. I wish I never left my old jo and now I am stuck. I have to stay in the same spot for a year before I could transfer. Ugggggh. I may have a breakdown by then. To the OP, I really feel your pain, and wish you all the best and keep on keepin on.

I hate that new grads can't find jobs, when the ER that I work with is constantly understaffed. It is to the point that people often protest their assignments. How can you possibly work in an ER and have up to 12 pts. It is just not feasable. It makes me sick. The care you are giving no matter how good of a nurse you are is sub par @ best. I am a newbie, just off orientation and I can tell you, that there is no way that I can handle that many pts. I know a hospital is a business, but this business has a severe outcome on peoples lives. Something needs to be done about this. If I knew then what I know now, I would have stayed at my old job.

Thanks guys for all of your advice. Its not my night co-workers who scare me. They were so good to me last night on my first night alone. They kept asking if I need help and such. The one time I did, they all ran to help me. I couldn't get an iv in to draw blood. They were all a hugw help. There are some ppl at night who will watch you drown. Also, who won't pick up any pts. I had the most pts last nighr. It just got my goat that I kept pickin ppl up while they had one or two pts while I had 5 or 6. I feel like I am way to new to say anything. I feel like I should have never left my old job!

Hey all! Last night was my first night on my on in the ER. I was scared out of my wits. I feel like I'm not ready. Everyone else seems to think I am. My managers, my preceptors, my co-workers. I think my problem is that I have zero confidence. The ER I work in is always a zoo. It is always crowded beyond belief. I'm not a new nurse per sae, but I was a float and really didn't float to the med floor that often. I thought I'd never get the hang of putting in ivs, which I have. I'm just terrified to be in the peds or trauma area. I know if they didn't think I'd cut it, I never would have passed orientation. What is a could way to build up your confidence? Next week I'm in on the two busiest days and I am already super anxious. I put too much pressure on myself and wanna be super nurse right away. Help please....TIA

Thanks for all the advice. It was something that has piqued my interest since day one. The salary doesn't sound all that hot. I wanna finish my year out in the ED anyway, then that would give me about 2 1/2 yrs exp total. My biggest fear is losing out on pay since I work in the nyc area, plus I'd be terrified of what my accomodations would be. It is just a thought for now. I need a change bc I just don't like ny, never have. Thanks all!!!!

I wasn't overly sensitive to the comment, it ****** me off bc, even after her snide remark I still went in there with a big ol smile on my face. I wish I could have shown her how my whole back was done. Lol. She treated me like a maid like she was at the Hilton. Funny thing is when most pts see that tat they comment how nice it is that I am close enough with my family to want to remember them like that. People can judge me how I look, that's fine. I like my tats, my short stacked hair with pink highlights. Me looking one way doesn't define who I am as a nurse and how I care for my pts. People are never gonna change and some will always be ignorant. I will still treat them as a family member and do all I can to help them despite their oppossiton to how I look!!!!

I've been a RN for about 15 months. I started as a float, and moved to the ER 3 months ago. I have depending on what the manager says either one day left on orientation or two wks. I'm scared outta my bird. My night manager and preceptor think I'm ready and I sooooo don't. The learning curve is sooo steep. There are things I do now, that I could never do on the floor. It seems just like me, you have some confidence issues. I try my best. Never let my pts see my anxiety, although on the inside I'm dying. I had a pt recently whose niece was a pa there. I went in assessed her, drew labs, lined her, and the pa said wow, where did you come fron? She new I was new there, but she said you came in here so confident you must be a nurse forever. Lol. I just laughed to myself. That day made me realize, its all about the pts and families perception of your confidence!!!!! Hang in there.

Hello all, I have been an RN for almost two yrs. After I finish out my first year in the ED, I would love to try travel nursing. I have had a bug in my bonnet about possibly thr US Virgin Islands. Does anyone out there have any experience or info regarding this? All comments/suggestions would so be appreciated. TIA

So the another night I taking care of a pt in the ed where I work. She noticed the tats on my wrist and went on a tangent. Why would you do that. Theyare so ugly. They are five small stars with my families birth stones and it says thanks be to God in Latin. She then said how does the hosp feel about them. I said very nicely as long as I take great care of my pts it doesn't matter. Some ppl just really are terrible. Bad enough I was being treated like her slave, all the while I smiled. Her son was like we don't mean any disrespect, I said that was rude, but evryone is entitled to their own opinion

I am having the worst anxiety lately when it comes to starting a line. I'm extra stressed because my orientation in the ED is almost over and I am freaking out. I was having no problem but now as it is getting closer to being by myself I feel like a huge failure and that I won't be able to get an iv esp in a trauma situation. The other night I had a good line, just not good to get the labs and the doc is telling me its not good and trying to fluster me. It flushed no problem no infiltrating, he was like all over me about while his resident was on the other side mangling this poor girls arm. Lately I'm either getting in 16s or nothing. I feel like I keep hitting valves. IDK. I hope its in my head bc this ER is level 1 trauma, plus always packed. I feel like I made a mistake leaving my previous job that I was so comfortable in. I'm looking for another job just incase this doesn't work out. I need to build my confidence ASAP!!!! I feel like such a joke. I always wanted this and now I regret it. The people that work there aren't too welcoming. Any encouragement will be great!!!! Thanks

Previously, I've only given it SQ. When the dr said iv, I looked @ my preceptor like he had ten heads. Because I come from basically med/surg, I really haven't dealt with such a critical level as I did last night.

I actually had two pts leveled in the ER last d/t falls and being on coumadin. One dude had a inr of 8.6, he got 4 units of FFP and 10 vit k iv bc he had a retroperitoneal bleed and he tore a vessel in his chest he was young 47. The other man with the 17.9, I'm gonna suspect had a bleed that wasn't found initially bc he was hypotensive after many boluses, ffp, platelets, and the vit k iv, plus he needed factor 7 I believe. He was a mess the poor guy. I swear there was a dang full moon last night in the ER.

PO? I know they have it po, and I've seen it, but if a pt needs the vitamin k stat for a high inr I would think sq, or now iv as I have learned would be the best bet. Unless the po is given in a non emergent situation.

Hello All, just a quick question or two...what is the highest INR you have seen, without any outward or inward evidence of bleeding? Last night I had a pt who had an INR of 17.9!!!!!! OMG, I was terrified. He got 2 units of FFP one unit of platelets, and 10 of Vitamin K IV. Eeeeep. Also, since I am an ER newbie, I didn't know that you can give the vitamin K iv. I thought you can only give it SQ.

What I find funny, is that when I enter the room to line and lab someone who comes into the ED,and they tell me they are a hard stick, I often get it on the first attempt with a large gauge. I often miss on the person with pipes!!!! Super annoying to say the least!

I try 2-3x. Then ask for help. Working in the ED has helped me tenfold with ivs. When I was a float, I only floated to one med/surg floor and most were elderly pts with no veins, so I either put in a 24 or 22 if I could get one in @ all. Now I usually can get an 18 in. Most docs want an 18 minimum. Argggh. When its a trauma, usually a 16 or 14. I've only gotten 1 14 successfully. 16s quite a bit. It just is nerve wracking when there are a zillion ppl in the room, my confidence goes down the drain quick.

I think I too am frustrated because nursing isn't what I thought it was going to be! Not one floor I have worked on is what I imagined. I really enjoyed psych as a student. When I graduated I wanted to go into psych. Haaaaa. Not anymore. As a float, I went to psych quite a bit. I thought I would be able to help people. Nope, not so much. The drs over medicated pts or under medicated, there were no groups, nothing constructive, it was like a movie on that floor. Sad. Detox wasn't people who wanted to get clean, it was people who didn't have enough money to get high, and would try and bully you into giving extra meth or xanax to them. I frequently heard, my medicaid pays your salary. No sweetie its the other way around. my salary gets whacked with taxes to pay for you to cheat the system. When I tried to offer other meds for s/s of w/d I was called every name in the book! Frustrating. Even on the med floors it was a joke. Tell me how a dr prescribes a pt who comes in the hospital to get a broken needle taken out from in between her toes Dilaudid 2mg every 3 hrs IVP, Dilaudid 1mg Q hour for breathrough pain, percocet 2 tabs Q 6 for mild pain and xanax 2mg Q 6 for anxiety. This girl had stickies next to her bed with the times she was supposed to get her pain meds. She was soooo doped up, she would get mad that I didn't give her everything she was due. I told her firmly that I am not losing my liscense which I worked hard for, when she went into resp arrest. I had a pt with end stage pancreatic ca, that had 2mg of morphine Q 6 for pain. This man was in such severe pain, to even move him broke my heart. It took me 4 hrs to convince the same dr who prescribed that cocktail to that girl, to give this dying man 2mg of dilaudid. *****???? I fought him for it. I told him to come upstairs stat and look at both pts and tell me the problem with the picture. He gave in, but was angry and said I am not his boss. No, no I am not. BUT, I will not let a person suffer like he was an animal in the street!!!!! This is why I hate nursing!!!!!!

I too feel the same way as the OP. I graduated in May 2008. I really procrastinated looking for a job, and finally landed a job in Feb 09. I never really wanted to work at this hospital, but needed a job, so I took the job as a float. I figured that would be ok, because I wouldn't be stuck on med surg every night. Well no matter what floor I went to I hated it. I cried every night on my way into work. Then we got a new manager, who I didn't get along with, and that was it. I got another job at a different hospital as an ER nurse. I started there in April. I thought to myself, this is a great change, a great job to learn a lot in. Well, I still cry everytime I have to go in. Now, I can't even sleep before I have to work. I want to quit so bad, but I'm in debt, and my parents would be so disappointed. They keep saying, oh you will find your niche. What they don't get is that I truly hate it. Idk what it is I hate. A lot perhaps has to do with my confidence. I have none. I am so scared to be on my own. I have like 3 wks left of orientation, and am soooooo scared of being on my own, that I feel like I'm gonna have a nervous breakdown. I think the best thing to do is to be honest with yourself. Can you really see yourself doing this job for the rest of your working life? I don't. What is it that you dislike? I am wayyyy to sensitive, and take everything to heart. I feel so bad for people and I hate seeing people in pain. If I could find a new job tomorrow, I would quit this one in a NY minute.