TraumaJunkieRN

I agree with what others have stated that the most "challenging" department is different from person to person based on personality, coping skills, and personal preference. For me, however, it is definitely flight nursing on a helicopter. To start, I did my preceptorship in periop (pre, peri, post-op) and intermediate ICU (progressive care). My challenges with those departments were mostly boredom and mundanity. The most excitement I had that got me through the day was starting an IV, helping nurses complete their crossword puzzles, or calling the occasional rapid response. I then worked in an ER/Trauma setting for 4 years after I got my RN. It has it's own type of challenges, some of them being dealing with pts who feel entitled, working fast enough to keep up with the busyness of the dept, managing 4 needy pts while understaffed. For example: 1. A walk-in STEMI as your reward for discharging your last pt 30 seconds ago and freeing up the only available bed in the department. 2. The total care C. Diff pt who needs to be changed constantly. Gown, gloves, mask before every room entry. 3. The drug seeker screaming at the top of their lungs and hitting the call light every two minutes, yet is ambulating around the dept demanding to get a taxi voucher home. 4. The combative psychiatric hold who security is having trouble controlling. And the kicker is you have new orders for all of them at the same time! Not to mention the other 20 patients in the waiting room and 4 ambulances waiting for your next free bed. Even with the excitement of trauma codes, medical codes, stroke codes, and STEMI, it soon lacked mental and intellectual stimulation for me. Everything was pretty routine and you learned to be fast and efficient. I've been a flight nurse for about 3 months now and I still feel years off before becoming close to proficiency. Not only do we have to transport critical adult, pediatric, and high-risk OB pts, we also have to transport neonates since we have a neonatal program. Basically, you have to be an ICU nurse, a PICU nurse, a NICU nurse, an L&D nurse, and a paramedic for scene calls. Unlike nurses in hospitals, there is no doctor present with you so you are required to make all medication and dosing decisions. Then there are procedures like pleural decompression, intubation, and cricothyrotomy we may need to perform. If that's not enough, there are operational and logistical challenges too. There's also a whole realm of aviation, navigation, night-vision goggle use, and radio work we have to learn since we play a large role in the safety of our team. Death is a real risk. To add insult to injury, there is the physical side. Wearing our flight suits/gear in 100 degree weather, and hauling heavy bags/equipment. We work 24 hour shifts too so if there's a scene call or interfacility transfer request in the late night or early morning (which happens regularly), there goes your sleep. All in all, it seems pretty challenging but rewarding to me :)

Me 1. State: CA (San Francisco East Bay) 2. Years experience: 3 3. Specialty/unit and work setting: ER/Trauma, 130-bed hospital and designated stroke and trauma center 4. Hourly Pay (base rate): $58.59 5. Differentials (if any): PM's - 12%, Nights - 16%, weekends - $30 flat rate 6. California Nurses Association Wife (works at different hospital) 1. State: CA (San Francisco East Bay) 2. Years experience: 8 3. Specialty/unit and work setting: ER, 389-bed hospital and designated stroke and STEMI center 4. Hourly Pay (base rate): $61.82 5. Differentials (if any): PM's - 12%, Nights - 17%, weekends - 5% 6. California Nurses Association Sales tax here is 8-9.5%, gasoline as of today at our local Costco is $3.69/gallon. We live in San Ramon/Danville (one of the wealthiest cities in America per Huffington post). Mortgage for our 2,000 sq ft, 4-bed, 2.5-bath home on a 5,500 sq foot lot is $2,200/month. Our gas/electric bill is $38-42/month including summer and winter. Internet/TV/home phone/cell phone bill for family of 3 is about $250/month. Neither of us have premiums for our medical or dental insurance.

Lol. Here is mine.

Great, now when will we know when to start CPR? At least we won't have to chart BP, HR, heart sounds, and pulse ox. But how are we going to get ABGs?!

Just finished taking the revised exam and I passed! I am so relieved. It was not as hard as people make it out to be. I found it easy to eliminate wrong answers. The hardest part for me was sitting for 175 questions! I was so sick of answering questions that by the end, I didn't care whether I passed or failed. I just wanted to get out of that place and finished the test without checking my answers. I have been a nurse for about 1 year (all of which in a basic ER, no trauma). The method I used was taking the 150 question CEN online practice test before studying. I barely passed by 4 points. Then I got 'Pass CEN' by Dennison and took all the online practice tests provided by that book. Didn't read a page out of the book (too much content). Then I took the practice tests from the CEN Review Manual (4th edition) I borrowed from a friend. Took the 150 question CEN online practice test again the night before the test as a final assessment. Don't waste your non-refundable $75 by taking that practice test again because it was the same exact test I took the first time! I crammed all this in about 10 days over 2 weeks. Probably could've taken it sooner because all that studying didn't improve my score dramatically. However, I found the information I learned to be extremely helpful for my future. Good Luck!

I have created a thread regarding the new test. I believe mwboswell is taking the test today and am curious of his experience.

Our meter reads "HI" whenever a value is over 600. The 1,257 mg/dl is an actual reading from our lab after sending off her blood.

THANKS MWBOSWELL! Your resources and knowledge in this subject is unparalleled. I actually responded to a previous thread which you answered and was hoping you would share your experience of the new exam here. I started this new thread in hopes of easing others and my own anxiety about the new test. Hope this thread will consolidate plenty of resources regarding the revised exam.

should've seen my other patient last week, hemoglobin=2.1, hematocrit=7.3 and she was alert and talking. i've been having some patients with labs that are incompatible with life and still kicking recently.

Thanks. I been to their website already and looked at the new content changes. Also, the test rolls out today and any test taker should get their results at the end of the test from what I understand.

I work at a basic ER and my I had two drunk patients under involuntary psychiatric holds, a 50-year old woman who still cries "i want my mama" for a miniscule kidney stone, a lady with DKA (pH=6.8, Bicarb=3.3, glucose=1,257), a child who blew a hole into her thigh with 6cm of tunneling, full of soot, smelled of BBQ flesh, and was bubbling out water like a witches brew. Those were just my patients.

Supposedly the new test has rolled out today (being 7/5/11). 1. Anybody take and passed the test? 2. How was the test different? 3. How did you study? 4. What resources did you use to study and date of publications? 5. Any recommendations?

Great tips above mwboswell. What are some ways you recommend studying for the revised CEN exam? Will you be providing an update on your experience on the new July exam? I just registered to take my exam. My goal is to obtain my CEN before I start my new job at a trauma center in August. Thanks!

If i remember correctly, pH was 7.101, bicarb was around 6.3, BGL was 544 mg/dl. Dr. ordered 100mEq of sodium bicarb.

Here are the tuition figures for Samuel Merritt University in Oakland, California: 2010-2011 Tuition and Fees | Samuel Merritt University Here is a flyer I got from one of the informational meetings