ER_JEN_RN

Breakfast: nonfat greek yogurt and way too much coffee Lunch: Left over chili made with extra lean ground turkey, reheated and eaten 2 bites at a time as I made a point of passing by the break room Dinner: Most likely more left over turkey chili with some tortilla chips. Snack: I keep a large bag of pretzels in my locker at work and when I find even 30 seconds I grab a small handful and much before anyone realizes..... I cook large quantities of soups, chili, healty casseroles, enchilitas etc, portion and freeze in single servings whenever possible. If not I end up living on burger king, ick.

I dropped out of 10th grade and got my GED. I am currently an Emergency Department RN. Alot of the 4 year BSN programs will not accept you because you cannot meet their admission requirements. However, I went the community college route for my Associates, RN and than transfered to an RN-BSN program without difficulty. For entrance to a community college, the ONLY requirements are that you have completed your GED. You will have to take an entrance exam so they know what level to place you for math, reading etc. Complete the nursing program pre-reqs and than you may apply for their nursing program. At my nursing school, they didnt care AT ALL if you got your GED or HS diploma. What they DID care about was your nursing pre-req GPA and entrance exam scores. I had a 4.0 GPA and decent entrance exam scores and got into the program immediately without being waitlisted. For the RN-BSN program they require that you have a valid RN license and certain core courses that you most likely would have completed prior to getting in to nursing school such as Microbiology, Math, English etc. Their entrance critera is typically based on your nursing school GPA and instructor references only. Please dont feel that having a GED limits you in life. You may have to take a different route to get where you want, but in no way will it prevent you from getting there. My BSN is the same as any ones elses BSN. Go for it!

WOW! I am so thankful for the many replies I have received from this post. The support and different perspectives offered have been amazing. I have t o honestly say that the simple act of posting how I felt about this and reading all the responses has helped greatly. (Okay, plus a 10 day vacation on the beach...:-) I have to say that although the case is still sad, I certainly feel as though I've been able to move on and continue to care for my patients and their families in a caring and effective manner. Thanks so much for the support you are all wonderful!

I graduated in May of 2009 from a rural nursing school, than moved back to my hometown of Tucson, AZ. During nursing school, I worked as a tech in an ICU for 6 months during my first semester, and worked as a paid extern for a few months during my last year of nursing school in a cardiac cath lab. I also worked fulltime as a LPN in a ltc facility during my last year of school. Basically I got every single ounce of nursing experience I could during my 2 years of school, even though I was exhausted almost always. Upon graduation, I sent out approximately 100 resumes throughout the country, with approx 50% of my resumes going to the banner health system in phoenix and alaska. I did have a few phone interviews here and there, but ultimately was consistently passed up for nurses with more experience. I also applied for several new grad programs throughout the country but was not accepted. Finally, 6 months after graduation, I called one of the hospitals I did a ton of clinical hours at during school and spoke with the emergency department director personally. She remembered me because my preceptor gave me absolutely fantastic reviews and offered me a job on the spot. The catch was, I had to move to a very rural part of Arizona. I accepted the position and have been in the ED for the last 8 months. Although its certainly not a town that I enjoy living in, I am eternally greatful for my first chance as an RN in a critical care setting and absolutely realize how fortunate I am. I am the ONLY person in my entire graduating class to be offered a specialty position. So, the moral of the story is: 1. Make as many connections in nursing school as you can. 2. Be prepared to apply for every position in every location you can imagine. Even ones you dont really consider ideal. 3. It may exhaust you, but get as much direct patient care experience as you can, even if its only a PRN position as a CNA while in school. It does help. 4. Just keep applying, and applying, and applying, and applying (you get the point here right?) SOMETHING will come along eventually.

No, this is not a smell associated with detox. I see alot of etoh w/d patients in my particular ED and none have a smell that a serious bath wouldnt fix. If you smell something this severe, I hope you have checked labs for any signs of infection, glucose levels for ketones etc. If your patient smells like they are rotting from the inside out and a bath wont fix it, they really might be literally rotting. The one thing I can tell you is that I regularly see etoh patients who have chronic illness related to their lack of ability/desire to care for themselves. Infection is a huge part of that.

I admit as a new ED nurse, I definately have that rush when the EMS call comes over the radio that they are a few minutes out with a good trauma, but one recent call is more than I know how to let go of. Im not going to go into a lot of details about the incident, but there was a 25 year old kid who was involved with a freak accident with a cement mixer. Needless to say, he did not survive. This was one of those cases where death was so much more merciful than survival would have been, and my saddness and grief are not so much related to his death, but I cant stop thinking about the absolute terror that this poor kid must have felt in the last few seconds of his life. It nearly brings me to tears when I do think about it. So my question is this; when you have that patient whose story just rips your heart out, how have you dealt with it? How do you learn to let go of the hard cases so you can move on to help the next person who walks through the door? During nursing school, it was always a joke with my clinical group that if there was a trauma somewhere, I was probably near by and standing in the middle of it trying to help. I love what I do, and I honestly feel that the ED is where I am meant to be, but for the past week I havent been able to stop thinking about this patient. I actually had to choke back tears today when I started thinking about it.

Initial PTT and INR of *comment* -meaning it wouldnt clot AT ALL. Redraw after FFP, vit K, blood was INR 37.5, PTT >600. Dialysis patient on coumadin who was given an accidental OD of heparin during dialysis than sent to us. Shes actually doing just fine believe it or not. Super scary though!

We do them in our ED as well. We observe 1 (or more if you would like), than are observed doing 3 and signed off by another RN. They can be a life saver (literally) with a patient who is a difficult stick. Lol, just make sure there's no pulse and then poke! ;-)

I work for IHS and we are salaried as well. We do have 4 hours of mandatory OT per pay period (2 weeks) but we get paid time and a half for anything over 80 in a pay period. We also get double time for holidays worked (or the first shift worked post holiday if you didnt work the actual holiday). It actually works out pretty well for us, but if the OT was not paid at a higher rate, I agree that it would be a problem.

Well, I worked at a sub acute LTC about 80 miles north of Phoenix as an LPN while I was in school :-) Not sure if its the same facility but I am willing to bet theres a good chance it is since there isnt much up that way. As an LPN I made 24 an hour, and even though I left after graduating with my RN, a few of my classmates stayed and were making about 30 as charge. RNs in that facility are almost always working as charge after graduation because most of the med passes are done by LPN's. Charge RN did PICC dressing changes, CNA assignments, IV antibiotics etc. The rule was, if you were charge, you made 30-31 as an RN. If you were working the floor and not yet assigned as charge it was a few dollars an hour less. I forget how much shift dif was, with no differentials for weekends. This was 2008-2009. I image wages are very similar still.

Lol sorry for my typos, its early in the morning still :-) I meant to say I can see how you might not think to check blood suger if you DONT have a large diabetic population in your area :-)

NO stat labs with a blood glucose included? I work for IHS so our ER serves 99% native american population, for this reason accuchecks are a first line check during code situations, we've had people come in full arrest with a BS of 11 AFTER an amp of D50.....I can see how it might not be first thought during a code if you have a large diabetic population, and no doubt he had many other significant problems leading to his situation, but ACLS does mention reversible factors and blood sugar is one of them. Easy to miss though.

The reason your friends can only dream of getting the experience you are getting right now, is because these opportunities are few and far between for RN's without 1-2 years experience. You stuck it out through however many years it took you to finish nursing school, you can handle 6 more months cant you? I know its tough, Im a new grad and the ER I work in in not NG friendly, but Im going to survive my 12 months, than move on. IF you absolutely CANNOT endure finishing out one year, at least make sure you have a secure offer from this other hospital BEFORE giving notice at your current job. The last thing you want to do is assume you will get hired and find yourself trying to plan a wedding with one less income.

So, I totally agree that medics and EMTs are a HUGE asset to the ER. However, one poster commented that he has been hired as a medic to write orders, prescribe meds, etc and he cant wait to "see the face on the RN's" when they find this out? Sounds like someone is on a power trip here...... EMTs kick butt and are a huge help in our ER. They start IV's, do 12 leads, hang fluids, splinting, wound care, transport, etc. This is wonderful especially when things get hectic. However, we all have a scope of practice regardless of our title, and have been trained to work within that scope. Its for the safety of everyone involved.

Lunah-Thanks so much for the book reference. I will make a point of picking it up ASAP! I dont mean to say I dont meet a minimum level of competence, I just often wonder if I am truly on par with where I should be. Hopefully studying that text will help. I think one of the only aspects of working here that has made any level of success possible is the "team" nursing approach. We dont have assigned beds or patients. For each patient, there is an assigned RN, however we all pitch in and pick up med orders, assessments, etc as needed. It seldom happens that a patient comes in to our ER and doesnt end up seeing each of our nursing staff at least once during their stay. I think this only works because we arent huge. We have 13 beds, 2 trauma bays, and 1 isolation room. We usually staff 5 or 6 nurses per shift with 1 being dedicated to triage. I have had critical patients, some immediately post code, some on vents waiting to be shipped to another facility, septic and on pressers etc, and do fine as long as I am able to focus solely on them. Fortunately we are staffed well enough that when any RN has a patient that critical, they are a 1:1 until they are sent to the floor or another hospital. PetiteOP-GREAT idea!!! Im going home tonight and creating something like this to post as well. I think it would be a huge benefit. Although most of our nurses are very friendly, I am sure some will take a snarky approach to things and maybe post some not so nice comments, but as long as I keep an open mind and view these things as constructive, Im sure it will be a great benefit.! So most of all, I dont want to sound like I am whining because I KNOW how fortunate I am to have a job as a new grad, especially in ED. I just want to be the best nurse possible.