pockunit

I would assume that a catheter was taken out and used if one was ordered and charted. If a pt got a neb, it seems to follow that neb treatment should be charged. That seems easy enough to figure out and charge for. My beef is that we end up double charting because EPIC doesn't drop charges when we chart. It's incredibly annoying. I have to chart the assessment; that should trigger a charge just like when I hang blood. On top of that, we receive very spotty education on how to charge for infusions/injections (if your preceptor thinks to do it, you might get some training). Facilities that want to be paid the max should have people trained to capture those charges. Since they don't offer that training, they lose a ton of money. When it becomes a priority, they'll staff accordingly. Until then, they get what they get and if it's crazy busy, I'm a lot less careful and thoughtful in how I charge, because patient care and all that silliness.

I can have anywhere from 1 to 12+, depending on acuity and how fast rooms turn over. I worked a double yesterday and had 3 rooms but that probably only turned into 10 or so pts because of bed space and holding pending discharge or admission (one was serial trops to see if she trended up or down, which dictated would dictate disposition). One was a roll-over accident who needed a bunch of imaging before he could be sewn up. He was probably there for 5-6 hours. I had someone in DTs, but no beds, so he just sat there waiting on admission. Other days I'll work our UC hall and have 20+ pts if we aren't boarding BH pts in those rooms. CSB: it all depends on the day.

I am almost aggressively upbeat and I have found that it wins people over in spite of themselves. It can be exhausting on some days, but it's generally worth it in the long run.

I worked a year in community health out of school, then started as a med-surg float at a small hospital, moved to a bigger hospital (same organization) as MS float, then took a turn with Mother-Child. All of it has been helpful in the ER, from educating people on STIs, dealing with heart failure, to helping a woman through a miscarriage. ANY experience you get can be applied in the ER.

I got my position because I had Peds/Maternal experience, which I had gotten *because* I wanted to move to ED and figured it would be good to be not scared of kids/pregnant ladies. Med-surg is a fine, fine base, but anything extra you can add on is only gravy.

MILK & MOLASSES, BABY. Pink elephant if we're feeling frisky.

Windows.

I assume your friend has never been a patient in the ER or they probably wouldn't have this crappy attitude. If they have, they might have rolled up with one of our bread and butter complaints, like "flu sx X 3 days" and gotten minimal interventions because really, you honestly probably just need to suck it up and feel sick for a few days until you get better. People who have NEEDED our services know that we do so, so much more than IVs.

WELL. The other day I cardioverted someone, got someone prepped for Ortho surgery after a nasty fracture, treated a pt for presumptive STDs, prepped for an eye exam for someone with a probable corneal abrasion (confirmed), Sent IDK how many people home after rule-out MI, and yeah, sent people to the floor. ER sees it all. Some stay, some go home, some die. It's not just starting IVs and turfing to the floor.

We are generally 1:4 from 0300- 0900 1:3 on days and afternoons. NOCs are 1:3 until 0300 unless we're short. Floats take ECG, hall pts, and if we have a trauma they generally take that pt. So it can be UG.LY for a float if there are pts in ECG and the hall and we get a trauma alert. We're working on how to divvy that up better. Ideally, we have a float for each zone, and one overall float, but they're the first spot to go if we're short. If someone has a heavy pt, we'll all get together in that zone and cover their other rooms for them. I love how people just jump in and GSD in our unit. We have a pretty good crew rn.

NYT published a story about an ER going mostly narc-free. It was pretty interesting. I'd like it if we gave it a try, but I don't think management would go for it.

Our pharmacists draw up meds for RSI and other stat situations. It's part of our process. I won't just take a random syringe from another nurse if I didn't see them draw it up, but refusing to take a drawn syringe in a code is going to go badly.

Volunteer to be the recorder in codes and sketchy situations. You will learn what the standard procedures are, what drugs are used, see people doing compressions and intubations, and get a good idea of how codes are run.

No, she knows. But you coming in asking for a definition without providing what you THINK it is is kind of a hallmark "do my homework for me" ploy. Also, google is a thing.

Do you choose to drive? Do you ever consume raw milk cheese? Do you eat raw cookie dough? All examples of activities that are acknowledged to be potentially dangerous but people still decide to engage in because they are terrible at judging risk. Also see: refusing vaccination. GB is an acknowledged risk, but it is far less likely to occur than the risk of complications from influenza.

I go by the $100 test. Would you bend over to pick up a hundred bucks? If so, probably not influenza.

That's some pretty incredible biofeedback control you've got there.

So I guess my question, especially for the new grads, is: why on earth would you expect NOT to feel out of your depth and be drowning? This is all new to you. You just graduated and this is your first nursing job. You haven't even had stable med-surg patients, let alone people trying hard to die on you. OF COURSE you feel overwhelmed. And you SHOULD. There is **so much to learn** in nursing, whether it's inpatient, outpatient, ER, wherever. I am amazed that people seem to feel that they should know more than they do when they've literally never done this work before. IT. IS. OK. NOT. TO. KNOW. THINGS. That's what orientation is for. That's what your coworkers are for. This is why we have (endless) ongoing education. When you don't know how to do something, you find out. Then some day you teach someone else who doesn't know. You are not a failure for feeling overwhelmed. You're not a a bad nurse for being slow.

Yep. Do the things, and speed will come. Just know that as soon as you feel like you have a handle on the things you see regularly, something that totally rocks your boat is going to come into one of your rooms.

I tend to do heart/lungs/belly on everyone just to CMA. Then I'll do a focused assessment based on their chief complaint. So chest pain clearly gets heart/lungs, but I'll also ask about musculoskeletal in case it's a strain. Rash? I think ticks along with diet/contact/meds/etc. It'll all fall into place. I like to hang around for the doc's assessment if I can, so I get to know what they ask with each kind of admission. Don't be afraid to ask them what they like to know, and then you can focus your questions. Also, we use index cards in our ER, so I just put a pile in my pocket at the start of the shift, then put a pt sticker on each one. I can keep track of things that way. Mostly, though, I've moved away from a brain and use the computer since it's all there in our system.

Transport teams for non-critical pts. Anyone monitored or going to a unit gets RN transport. Behavioral gets transport team or aide and security.

"I'll be back to check on you in 15 hospital minutes."

We are supposed to ask for the pt's shift goal (shower, take a walk, etc), but the care plan itself is still based on nursing assessments and ADPIE. Most people don't ask about the shift goal or just chose an obvious one like pain control for post-op pts.

How did your test go, do you think?

Can you not apply on a different floor in your facility? Nothing wrong with being honest and saying you were over your head and want to go back to what you were doing before.