KnitWitch

You only have to give someone the Reglan crazies once and I promise you, after that it will always go in a 50ml IVPB to hang. Also, my chronic narc seekers and frequent fliers, your dilaudid/benadryl cocktail has been added to your 1000ml NSS infusion, as allowed by unit protocol. Enjoy.

Our ED techs can perform straight sticks for labs/cultures, but can't start IVs for whatever policy reason. Some of our techs are amazing at the straight sticks, and if I have a particularly hard stick I'll ask them to help me find a tiny something I can at least get a 22g in to get a pt. started -- the large bore can come later once I can get someone who's U/S trained to come take a look. But in the meantime I can get labs and a least a few pushes/slow drips started, even through a 22g (or 24g, if it's dire). Interestingly, at my previous place of employment, techs could do straight caths but not foleys and weren't allowed anything to do with getting bloodwork/access. RNs weren't even allowed to draw labs off the IV line unless it was a pedi patient or a known hard stick -- we had a separate ED lab dept. that handled that. I have no idea what drives these policies but they seem to vary widely by facility.

In the height of croup season I'm giving IV decadron PO more or less every night. I check with parent/caregiver to make sure the kid likes apple juice, draw up and have my decadron double checked, fill the last of the syringe with apple juice and then down the hatch! The only time I actually give the decadron IM is when I have a VERY little one who seems prone to just spitting everything out. Sometimes it's just easier to grab a thigh and do the deed than it is to try and ply them with meds disguised in juice. Interestingly, our pharmacy changed its formulation for oral prednisolone and they actually brought a few syringes worth up to the ED and had a mini tasting party for the staff, so that we could all see that it now tastes... mostly sugary and pretty good (IMO) instead of the old version which tasted like satan's a-hole. So I no longer feel so badly when I have to give a kid the oral prednisolone now, because at least I can say that YES, I HAVE tasted that and it's not so bad. IV Zofran PO I haven't done, but we have the ODT which tastes kind of like candy and I'm not above convincing kids that I'm giving them a hard candy to suck on instead of a med. We do have liquid zofran in our formulary and accudose, but I don't think I've ever given it.

I got six months in my new grad ED program and about half of that of that was classroom (to be fair even the experience nurses had to endure the classroom portion -- good info but a LOT of it in large chunks). When I took a new job closer to home I had a year of experience under my belt and I got somewhere around 12 weeks, I think? Might have been a little less, but only by a week or two. 12 weeks is the standard at my current hospital, regardless of how long you've been a nurse. Some people get cut loose around 10, a few do get a little more but usually everyone hits that 12 week mark and then you're on the schedule solo.

I was very pleased with the ease of EPIC vs. PulseCheck at my last hospital. Some of my change-resistant coworkers had nothing good to say, but I thought EPIC made much more sense from a continuity of care perspective than having multiple different systems for ED/floor/lab/reg/pharm etc. I wish my current hospital would transition. I would even volunteer as a resource/champion, and I NEVER stick my neck out.

I just love when I see 'PAIN OTHER' as the CC, because it's either going to be really good ("I have a ben-wa ball in my lady parts and it's pinching but I can't get it out," "I think I broke my member," etc.) or a complete waste of my time ("I just don't feel right," "It hurts a lot when I bend my fingers all the way back.").

Stick it out. I graduated in Dec. '11, passed my boards in Feb '12, started my first ED job in Sept. '12, and transferred to a different ED (for commuting reasons) in Oct. '13. I have spent A LOT of time being the New Kid. In a lot of ways I am still the New Kid. I'm just now starting to not feel a sick twist of panic when told I'm getting a code into one of my rooms. I'm still a little wobbly on stroke alerts and I've never had to give TPA. Acute MIs throw me into a panic because in my huge hospital I'm still not sure of the fastest path to our cath lab. I'd almost rather an 'unresponsive' with no further info because at least then everyone in the room with me starts off on the same "*** is this?" footing that I do. But that's the thing -- anytime someone super sick or complex rolls through the door, there are always more people in my room to help me than I have tasks to delegate. All I have to do is call out for something, and it's there. If the doc asks for something that I'm not up on, someone else is on it in a flash. The teamwork in my department is on point, and I couldn't do my job without my coworkers. On the flip side, I try to be there as much as I can for my coworkers, even if it's just as spare hands for tasks, fetch n' carry or interfacing with family members. I am working with nurses who are "newer" than I am, but who were techs in my hospital for years before becoming RNs. I'm working with RNs who have worked ICU, home care, and every other unit. I'm working with RNs who have worked 20 years of ED and know nothing else. And every now and then we get a patient who presents legitimately ill and no one (RN or doc) knows what else to try. And that makes me feel a little bit better too. Of course I've made mistakes (nothing makes my stomach drop more than one of those huge inter-office mail envelopes in my work mailbox, signifying that Something Has Happened), and I've tried my best to cop to it when I make a mistake, and to defend myself and my coworkers just as vehemently when the floor or the residents are trying to throw us under a bus. tl;dr: Stick with it. Stick together. Never be afraid to admit you don't know. Never be afraid to ask for help. Help out when you can. Not knowing is NEVER a crime, but not asking could be. Sometimes NO ONE will know *** is going on. Assess, run your ABCs, confer with your coworkers. You'll find your rhythm. Eventually you'll find yourself answering questions and acting on instinct. Don't rest once you get there -- always try to be better -- but take heart that you're doing it and you HAVE gotten better.

You, my friend, unfortunately seem to be stuck in a "nurses eating their young" scenario. This is both unfortunate and frustrating. In my experience there are two things you can do. 1) Try to suss out why the experienced nurses feel threatened by or otherwise dislike you. Ameliorate this, or otherwise strive to make friends among the cannibals. Despite being carnivorous they probably have a lot to teach you. Find a way in to get at that knowledge. 2) Find other nurses on the floor who have 1 or 3 or 5 years experience under their belt and may be working at flying under the radar. To a new nurse, these moderately-experienced colleagues can be gold. They can teach you the ropes and you can work together to solve problems without involving the 30-year veteran cannibals. Other things that are important: 1) Care about your patients. Not just for, about. When you care about your patients you care about your work, and that can increase your patience and tolerance. 2) Learn, learn, learn. Learn everything you can. You never know when an esoteric piece of knowledge pay come in handy. 3) Grow a spine and use it to stand up for yourself and your patients. As a wise RN taught me, the only time you are WRONG is when you fail to act with the safety and best interests of your patients at heart. And in order to protect your patients you first have to protect yourself. The first year+ of nursing is tough no matter where you are. I landed my dream job in a trauma center just out of school and I still questioned every life decision I made that got me there. But it can change and it can get easier. You just have to resign yourself to a bumpy road, and you have to commit to being a better nurse than you were when you started. You can do it.

Nope. As long as you have a strong resume and cover letter to back up your enthusiasm you can never apply for too many jobs. If/when you're called to interview, do make sure you have a strong focus on what you want as a nurse and what you bring to the table, regardless of which particular position you may be interviewing for.

OR RN job, no contest. Working as an OR RN (even in a surgical center as opposed to a hospital) will be a better knowledge base and learning experience than an Epic implementation tech. Trust me. You can take that OR experience (try to get at least one solid year in) anywhere, but the Epic position will pretty much shunt you only into informatics jobs. If that's what you want, by all means stick with Epic. But if you actually want to do some hands on, people-focused nursing, go to the OR and suck up knowledge and experience like a sponge.

I kind of want to put this on a post-it and stick it in our fishbowl. Or maybe just tattoo is on my hand so I can easily flash it to the doc the next time we get someone who is hypotensive, tachycardic and basically septic or heading that way. 5 boluses are not going to help if their vessels are all wide open. It'll just make their heart work harder for no appreciable benefit.

One year is sort of the golden rule of thumb. Emergency nursing looks especially good on your resume because you're expected to deal with a variety of things and be flexible. I'd suggest polishing up your resume and floating some applications out there. The market is opening up nicely in many areas for nurses with experience. Now's a good time to put your feelers out for a more high-traffic position.

Oh man, this question hits so close to home right now. I have a year of experience in the ED, and I still dread having to drop a line in someone. Don't get me wrong -- I will never refuse to TRY, but more times than I'm happy about I try to sticks and get nada. Luckily for me I have my fellow nurses and the paramedics to call on to help me out. And let's be honest -- when THEY also struggle to get a line I feel somewhat vindicated. And then there have been times where I have stuck someone "impossible" and nailed it. The stealth 20ga in the forearm, the miracle 24ga in the hand, sometimes you just see/feel it and go for it and it's there. Other times you can be confronted with PIPES and blow every chance you get. I'm getting better, no doubt. But I'm still frustrated every day when I miss something I feel like I should be able to get. As much as I HATE the answer, I feel that the most accurate response is still, "It just takes time and practice." Even when you blow it. Even when you can't even FIND it. Ask the experienced nurses and medics to let you watch/palpate when they go to stick. Ask them for tips and tricks (use a BP cuff on the elderly to prevent blowouts, or try going in bevel up). People will be more sympathetic when you show a desire to better yourself. IV starts (IME) SUCK, but never turn away an opportunity to try/learn something.

Granola-type bars, nuts, apples with peanut butter or caramel, cheese and pepperoni, hummus with pita chips, potato chips, doritos, m&ms... I try to bring a variety of shelf-stable stuff and stash it at the desk so when I get hungry I can grab whatever satisfies my craving -- which is also a big thing. Sometimes a little bit of "unhealthy" food goes further towards making me feel satisfied than a glut of "healthy" food. E.g. a handful of potato chips will hold me for hours while an entire bag of carrots with light ranch dip just makes me angry and hungrier.

As long as a patient is in possession of at least some of their mental faculties (e.g. not post-ictal, in the throes of a mental health crisis or suffering from dementia) I can make peace and negotiate with just about anyone. ******-off narc seekers in withdrawal, people experiencing their first kidney stone, chest pain patients who have spent 3 hours in the waiting room before being roomed, you name it, I can keep them calm-ish until dispo.