tech1000

I never draw a med with the needle I give it with. Piercing the top can slightly dull the needle. I pull all the med in with a smart tip, then put on my needle, then "prime" the needle.

Figs are definitely not needed for ER nursing. ER nursing doesn't require more expensive scrubs than any other type of nursing. I wear a t-shirt and regular old scrub pants. No extra pockets or anything. I have a stethoscope and that's about it. If I need a pen light, I use the otoscope in the room. I keep trauma sheers in my bag at the desk and grab them if I need them- same with my stethoscope. I only walk around with a pen and my phone. Less things for people to grab on me.

If the child is fine, I feel like 24 hours is a lot. The germs spread long before the kid got a fever, so does it really matter? And some parents could face losing their jobs if they call out every time their kid gets sick. If their kid is feeling well enough to go to school, fine.

You aren't a failure! So many people change majors in college! If all 18 year olds knew what they wanted to do for the rest of their life, well, colleges wouldn't make nearly as much money from all of us :) There really is absolutely nothing wrong with realizing that nursing may not be for you. If you really suffer from anxiety that bad though, you definitely need to seek out some help. One of my friends had severe anxiety and had great progress with a behavioral therapist. She's like a whole new person! Although, nursing is very stressful and even I feel anxious at times (giving a new med for the first time, when patients have a bad reaction to a med, whatever) and I'm a low anxiety type of a girl. So, while your anxiety may improve with some therapy, it still may not be the best choice for you. If nursing school is causing you this much grief, I'd say it's time to explore some other options.

My school had a 97% NCLEX pass rate. I felt good about that :) I knew a lot of other grads from private colleges who paid big money for their degrees and failed the NCLEX multiple times, and multiple people came from the same program.

Travel nursing locally isn't all it's made out to be. First of all, not all cities are big on local contracts. (Portland was, my hometown is not.) A lot of places looking for travel nurses also actually require you to be outside of 50 miles from the hospital, so when I was home between assignments, I couldn't take an "assignment" close to home. I traveled and loved it, but then I got pregnant (by my husband!) so I'm home now for good. California I've heard can be super rough, despite the ratio laws. I stayed in rooms I rent off Craiglist and sent the rest of my stipend paying my mortgage at home (since my husband was still at home). It was somewhat lucrative, but nothing I'd say I could retire early off of. Also, if you quit traveling, you have to remember that your taxable income was low, so getting loans for houses may be harder. I'd also recommend AT LEAST 2 years of nursing experience. I got to one job and had 6 hours of orientation total before I was on my own in a whole new hospital, and I wasn't even familiar with the charting. LOVED the assignment and I did just fine, but there's no way I could have survived had I been a newer nurse.

We had people cheat in nursing school and they got kicked out of the program for good. No chance of reacceptance.

Don't fret. Those are observation days usually. No other nurse wants to be responsible for your actions :)

I never get it when nurses come out of school with major debt. Nursing isn't that lucrative to start with, but if you really want to do it, then do it. But find a way around it. My hospital paid employees $3000 annually for school but they have to stay a year after it's paid. I did that. It at least paid for one semester of my BSN every year! I'd also try to pay some of your loans down first...

You could discuss phenergan since it is caustic but still routinely given IVP. We also give it IM on patients who are quite large and I always wonder if it ends up more subq than IM in those patients. Also, you could discuss something like beta blockers since bradycardia can be common. Epi, since 1:1000 and 1:10000 can be easily confused in a code situation and can also be given in the wrong concentration. Calcium gluconate is usually ordered IVP for hyperkalemia but can also cause adverse reactions and no policy has ever been in place in at any hospital I've been in regarding administration....

Well, use that EMT experience to get a job as an ER tech in a hospital. If you can't immediately with the experience you have, you usually qualify to get tech jobs after a semester of nursing experience. Once you're in an ER as a tech, it's pretty easy to get hired on when you finish school if you have a good record at the hospital. I had military experience, was in nursing school, and working as a tech on a med-surg floor, which was how I got in as an ED tech. Then I got hired right out of school for days in the ER residency. Almost every tech who graduates comes to work in the ED as a nurse.

No, it will not get better. I've been in the ER for 5 years now and it hasn't changed at all. While I am burnt out, I don't think I have quite that negative of an outlook. It is unreasonable to expect that you can be a nurse, but not to have to tolerate things in your professional life as you would your personal life. You work with the general public. I would expect that you are respected by your employer and wouldn't tolerate that from your employer, but the fact of the matter is that in ANY job working with the public, you WILL be treated in a matter that is at times extremely unacceptable. It will probably be worse in the ER because some patients are actually sick, some families are actually worried, and some people are actually drug addicts who are just angry about their drugs. If you are this jaded, find a different area of nursing.

If it's an adult patient, we have a monitor tech who is watching all ED monitors and also takes the EMS calls. On our children's side, any nurse or paramedic takes it. Techs aren't allowed to take the calls unless they're also a monitor tech.

Just out of curiosity, why did you go to nursing school if you weren't interested in bedside care? What is it that you saw yourself doing with with a degree in nursing if you weren't willing to actually work as a nurse? This question isn't meant to be rude at all, I'm just curious what took you down that route if it doesn't seem like you want to actually do it.

Our ED docs order meds ALL THE TIME (as in, every single time they order an infusion, aside from potassium for some reason, which automatically enters that it's 10mEq/hr) with no infusion rate. Not a single order says how long to infuse the meds over. But, you can easily look up how long meds infuse over or call pharmacy if you aren't sure what rate to infuse at. That said, I hang certain meds instead of pushing. Not too often, but I do.

In the amount of time you spent typing that out, you could have googled the answer.

I have given SL nitro a ton of times in my time being a nurse. Yesterday I gave a woman one dose of SL ntg. About a minute after giving it, she said she didn't fell well at all and felt like passing out. I tried to lay her back thinking it was just from an initial drop in BP because of the vasodilation, but she said she felt worse laying and sat right back up. Her HR was about 100 when I first gave it and then I noticed her HR trending down. It was in the 80s and I went to ask the MD to come in the room (she was just down the hall). In the 5 seconds I was gone, the husband asked another nurse to come in cause she had convulsions. Her HR when I got back to the room right after was 57, she was diaphoretic and pale, but she said she felt better already. Her HR went right back to 100 and she was totally fine. The only thing I could find about this was somebody saying it could be Bezold-Jarisch reflex. I had a BRAND NEW doc with me and all she said was "oh, it's cause she has the flu. Give her some fluids." I know that wasn't it though. Aside from having the flu (and she had been sitting up the whole time if it could be the Bezold-Jarisch reflex, but I can't find a ton of info on that other than articles that I have to pay to read), she had T wave inversion, which she said was not new, and upper back pain. She was admitted before ever having a stress test, so no idea what came back, but her cardiac enzymes were normal. Also, her back pain totally resolved after this incident. And she had no other history that I can recall. Has anybody ever had this happen or have input on it? I may check with one of our more seasoned docs tomorrow when I go back, but it was just really strange. (And I added NTG to her allergy list under adverse reaction- not doing that again!)

Tegaderm doesn't stick to wet skin (ever have a diaphoretic patient?! those things fall right off) and if that comes off, out comes the IV.

Perhaps it's time to push for the change where you all don't have to have nurses go with tele patients. Our nurses only go with ICU/PCU or patients on cardiac drips to the floor. It's our policy. If you feel a new policy would be better suited for times and is safe, then I'd say you need to really push for that. There is no reason to use up resources when it's not actually needed.

We do! I LOVE THEM! They typically are more task-y people, but they tend to put in our IVs and give meds. Sometimes they have to cath patients or just get VS and do more "tech" tasks. They don't tend to chart any sort of assessments on patients, although they are allowed to- as long as I do my primary. But it has really made my job easier to do. Some areas we just get slammed and our PMs really help us out with handling some of the meds and IVs!

Typically, when a bed is assigned, we HAVE to get the patient up due to the hospital tracking our time from bed assignment to the time the patient goes to the floor. If I give report to the floor on a patient I have barely seen, that report is going to be complete sh*t. I don't know a thing about the patient and I don't retain a ton of info from the nurse giving report, since we typically do our own assessment on patients we keep. As the nurse going off shift, I try to call report to help out the nurse who is coming on shift. If you won't take report and the patient clearly has to get upstairs as we have 50 people in our waiting room, it'd be nice if you'd just take it and relay that message so you don't get a terrible report. It takes less than 5 minutes to give report on a patient coming from the ER. If you want a good report, taking 5 minutes out of your hour long report would be much appreciated. I get patients ALL THE TIME in the ER. I can have a patient going downhill and get another patient in the room. I've had patients in my room for an hour before laying eyes on them. I mean, sorry you get patients during an inconvenient hour, but I get patients that are inconveniently timed ALL DAY LONG. Thankfully, at my home job, we don't give report other than on ICU/PCU so this has remedied this a lot. I will only call to give a heads up on something necessary (something regarding meds or patient status if I am unable to take care of something in the ER that needs to be addressed). But really... There is ZERO REASON to have attitude if an ER nurse calls to give report when it's inconvenient for you. I have never ever eeeever been rude to a floor nurse no matter how many times I want to ("the doctor is in the ER, can't you address it down there?" THE HOSPITALIST DOES NOT LIVE IN THE ER and our ER physicians DO NOT give orders on admitted patients! AHHHH!- and do you REALLY need to know your IV access? won't you assess the patient as soon as they get there???), so it'd be appreciated that when a nurse calls during shift change because we get so much slack from our supervisor if we don't (and it's not like we aren't trying to get things together at shift change in the ER), that we don't get attitude.

I have found that a lot of hospitals don't just want your experience at home but want a YEAR of TRAVEL experience! AZ is a big state that wants prior travel experience. Some jobs want TWO years of prior travel. I haven't looked at big name hospitals because quite frankly, I am traveling because I want to see the US, not work for Yale and Johns Hopkins. If you worked at a level 1 for awhile and THEN traveled, I think that'd speak for yourself more than just going as a traveler and wanting to extend. It was easier for me to get my first new grad job in an ER than it was to get some of these dang travel jobs.

Your IV skills will come when you start putting them in EVERY SINGLE PATIENT that walks through the door. So trust me, you'll learn in the ER! We don't expect that a newer floor nurse is even going to be anywhere close to good at IVs. That's just how it is. Take the job! You will learn and be fine and the floor isn't going to prepare you for everything anyway!

Your first one is so similar to my job that I wonder if we're at the same place. I'm traveling now though and am finding that I was SPOILED at that job!

I don't think you can learn it from a textbook or somebody teaching you. You just start realizing when somebody looks bad. I sometimes go grab the doc and say, "I don't have a clue what is going on, but SOMETHING isn't right and I want a doc to lay eyes on this pt." Sometimes the doctor is less than excited, sometimes the room ends up full. I used to not know for sure or just think everything must be serious if the patient said so or that its was more serious than I thought, but I tend to pick them up fairly quickly now.