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

allnurses.com :) haha in addition to that, wikipedia, pubmed, epocrates, and use your school library subscriptions for online database. I use uptodate and lexicomp at work.

Wow, I wonder who tweeted this thread as "Scary that RN in ER without sufficient knowledge of DKA is asking on the internet how to manage!" I guess this is the hazing I get as the new grad :) Just to be clarify, the purpose of this thread is not address the management of DKA but the technical details of priming an insulin drip and any evidence-based practice or experience surrounding the issue. Sorry if that was unclear.

Trying to manually disimpact himself huh? Don't you just hate it when patients are caught masturbating and say it's something else? LOL. If I was the receiving nurse, I am so not shaking his hand upon introducing myself and I'd be better off putting the pulse oximeter elsewhere.

This is exactly the evidence-based practice I was looking for. Too bad I only have access to the abstracts. Do you happen to have access to the full article? Thanks! Don't get me wrong, the patient had been stabilized in the ER with an insulin bolus, bicarb, fluids, etc. She was being admitted to ICU with orders for an insulin drip to start there. We just decided to do ICU a favor and start it in the ER since I needed to learn about insulin drips anyway. The new protocols had been discussed but every once in a while, you get the veteran nurses who question the validity of protocol changes since the old ones always worked for them.

At least you can put "WNL" for your GI assessment without having to go in :)

Thanks for checking Tait. It seems like a lot of other hospitals prime it normally. I got to thinking, if the rationale for the "old" method was true, wouldn't there be a lot of DKA patients with unchanging blood sugars? I just feel bad pouring insulin down the drain (no pun intended).

I'm a recent new grad to the ER (today was my 7th day) and got my first DKA patient. Here's a quick run down of the story: Patient brought in by ambulance with DKA secondary to running out of insulin and not eating for 2 days (pt decided to spend the money on meth instead). An insulin drip was ordered. In our department, we mix our own insulin with 100 units in a 100ml bag of NS. A disagreement arose between nurses in teaching me how to prime the bag. The old protocol was to mix the insulin in 100ml of NS, and drain the entire bag. Then mix another bag, spike it, and run it. The rationale is insulin sticks to the plastic of the tubing and therefore, the patient does not receive the intended dose of insulin. Coating the tubing with insulin will allow the rest of the insulin to flow through better. The current protocol is to address wasting insulin and NS. The procedure is to mix the insulin in NS and drain the first 20ml. How do you guys mix it and is there any evidence-based research to substantiate this? I tried searching Pubmed and Google but couldn't find anything. Maybe someone here will have a better idea.

I was grilled for 1.5 hours in my interview! I've heard some interviews in other departments were simple conversations but this was totally different. It was a panel of the department managers. The general personality questions are a given (i.e. tell me about yourself, why do you want to work here, why should we hire you, what can you contribute, 3 words to describe yourself, etc.) This made up about 20% of the questions in my interview in the beginning. The last 80% were scenarios and questions to expose my critical thinking skills and weaknesses. I was given different emergency scenarios in which I had to list what nursing actions I would do, what medications to expect the doctor to order, what are the dosages of those medications, and what is the diagnosis of the patient. Then I was given prioritization questions for different situations. Things were pulled out of the air to make the questions more difficult once I got them right. For example, the question may be what you would do for a patient who is in 10/10 pain and all non-pharmacological measures have failed. You say the patient needs an IV push of an ordered pain medication after checking against any contraindications (which is the correct answer). Then the scenario changes to "what if the patient is an IV drug user, the only line he has is a central line but he pulls it out due to agitation, becomes combative, and wants to leave AMA so he can sue you because you won't give him pain meds?" Definitely not the easiest interview when the questions are biased against you from the start lol. Luckily, I was already an employee of the hospital and had some advice prior to going into the interview about what to expect. Thus, I read up on a couple of things relating to emergency medicine. However, that almost lead to my downfall which I will explain later. The best thing I can recommend is to be honest. I would not have gotten my job without honesty and a job would not be worth doing for me if honesty was not important. One of the first questions was if I ever made a medication error. I answered yes (I had given a PRN dose of Zofran early once). They thanked me for my honesty and said, if I said I have never made a medication error, that would have been a red flag because virtually ever nurse has made an medication. When you come to those questions, it's better to err on the side of honesty in case it is a test of your integrity. Throughout the interview, if I did not know the answer, I didn't BS and trying to force the answer. I just simply said I didn't know the answer but I would know where to find it and moved on. Now the juicy part. Couple of days after my interview, I received a call from the manager. I was asked if I received help for my interview. I answered yes, that I was given advice prior to my interview (thought I shot myself in the foot with that answer). The manager said something like no interviewer can possibly have done as good as me and that I was able to answer some questions before they were even asked, and that it was considered cheating (now i thought I really didn't get the job). But then the manager said that my honesty was appreciated and that I would be hired or terminated based on my answer to that question. Since I answered yes, I was offered the position. Therefore, the biggest lesson I learned from my interview was to be honest lol.

Hi I am curious about how the training and routine is working now. Did you guys find anything that works for you? I used to be a road cyclist who raced and did several centuries a year. I stopped because school got too busy. Now that I graduated, I want to get back into it but will probably have night shifts. I plan to commute to work by bicycle to rack up the mileage lol.

Calif. Nursing Grads Having Trouble Finding Jobs - cbs5.com Hi everyone! I have been monitoring the threads on allnurses.com for quite a while now. What a great forum! I was fortunate enough to land a new grad position and I finally feel I have done something right, which means I finally have something useful to contribute here lol. A bit of background. I graduated on 3/19. Took the NCLEX on 4/12. Received a call to interview 4/13. Interviewed on 4/15, 7 hours after my results came out. On 4/19, I was offered a full time position in the Emergency Department. I start 5/3. I hope this gives an ounce of hope to the new grads out there. Here are the applicable details I have obtained by working in 3 different hospitals and networking with people in virtually every major hospital in Alameda County and Stanford Hospital: lperkrn mentioned Kaiser Oakland's ED hiring 5-6 positions which were filled before posting. These were filled by SMU graduates in the Winter of 2009 who did preceptorship there. I've heard from a student that a little less than a dozen of them were interviewed and narrowed down to 5-6. Kaiser Hayward's ED hired about 4-5 positions last month. These were students from different schools who took the SMU sponsored program mentioned earlier (Transition to Professional Nursing Practice | Samuel Merritt University). This is probably the best bet in landing a job even though it is no guarantee because you get to know and work with people on the inside. However, SMU does the program exclusively through Kaisers even though they're working with other hospitals like Alta Bates to sponsor some positions. Kaiser has been on a new-grad hiring freeze for quite some time due to an internal alignment issue where a bunch of managers sat down at regional and figured out there are more nurses in some units than others, so they are realigning those units to have a more proportionate number of nurses. Until they get those issued solved (which rolled out in March), they will not be hiring new grads though there are some exceptions such as the ED which are usually short on staff. Some schools have also adapted the SMU transition program such as CSUEB which is basically like preceptorship all over again. The problem with these residency programs is that they contribute to our own problem. The hospitals get "free workers" working their butt off under the impression that they "might" be able to get hired. That means they get to rely on less travelers and don't need to hire new grads if they get RNs working for free. Even though this system does work, the chances are slim but it's better than nothing and allows you to practice your skills and get ahead of the competition. On my last day of my preceptorship at Stanford Hospital which was early March, I spoke with the manager who said units D2/G2S (a step-down unit) will be hiring about 2 new grads in June or July. I am not sure if the applications have posted or if the deadline is over. Best to call and personally talk with a manager to find out. John Muir is planning another new grad program and I heard probably Washington Hospital in Fremont. I also have a source that tells me a budget for training new grads have been submitted at Highland Hospital which starts in the summer. No word yet on if that budget was approved. The best chance to get a job now is if you know somebody on the inside. Your odds decrease once the postings goes public and everybody applies. I recommend personally visiting managers (bribe if you have to and checking in periodically after. I hope the information listed here helps you decide which hospitals are worth applying for and which is a waste of time. It's a cutthroat economy out there and I am very saddened to see my colleagues having so much trouble after all the hard work they've put in. As if nursing school was not hard enough to get into, they have to make finding a job almost impossible!