Catch22Personified

Hi All, I'm going to be taking the NR661 post predictor exam in Chamberlain next week. I'm s cared to death because I would need roughly at 70% to pass the course. Are the questions in the predictor the same as the QBank ones? I've been doing okay in them but I'm scared at how hard those questions are in the predictor exam. Also, what were your experiences taking the exam?

I work at a Level 1 Trauma Center's ED for the past 3 years going on 4. But for the past 8 months I've noticed I've been getting more irritated with the physicians whining and acting like divas/being more verbally abusive to me in general whenever I'm in triage or charge. My coworkers have gotten cliquier and I feel more and more excluded, to the point I feel like people talk **** about me. They 2nd guess my triage, get on my case when staffing is **** and think I have a magic wand that can fix things. Leadership things I do an excellent job and tell me the moment you get put into those situations because of the position I've been assigned. For being there for only 3 years I've become one of the more senior nurses, for some reason the nurses more senior than me no longer take charge anymore. When I'm not in charge, I just don't have that passion to take care of patients anymore. I'm not getting the satisfaction of making them feel better and taking care of them. When I get floated out of the ED to the observation section, where it's like floor nursing I still have the same problem. I feel like I've lost my passion/place in nursing and I'm nearly a year away from finishing my MSN to become an NP. I can't leave my job due to tuition reimbursement plus I have bills to play like many others. I have no idea what do do with myself. I've always believed the moment you don't feel like you have that enthusiasm or drive to take care of patients, it's time to step away because that sense is important to take care of patients. What should I do? Strangely working 3 days a week plus clinicals from school is enough for me to start breaking down. I can't drop to part time because there's no openings.

Thanks, tomorrow is going to be my first day. What should I be doing to get my E-Logs and Case Presentations ready weekly?

So I'm starting Clinicals (hopefully) I'm having issues with the preceptor already on week 1. I'm going under the assumption I'll be able to start this week. Getting a preceptor was difficult, took me 8 months so I wasn't in class for a long time. Now that I have a preceptor...what am I supposed to do in clinicals? I feel completely lost, I'm getting nervous thinking about it.

I work in a Level 1 Trauma Center in a growing urban area. Our nurses can be separated into two groups: Newer nurses (Less than 3 years of ER/Nursing Experience) and Experienced Nurses. Our manager has this belief that that newer nurses should be exposed to the harder assignments like Charge, Triage, and Psych. I fall into the newer nurse category, I've worked in that department for 2 years and before that I worked on Tele/Long Term Care for 2 years. None of my experience prepared me for this. However, management keeps assigning me to Charge or Triage and my peers/management keep saying I'm doing a good job. I don't feel like that at all, every day I come back mentally exhausted looking back at every choice I made thinking I could have done it better. Every time I have to assign one of my nurses their 5th or 6th Patient it kills me inside because I know it's unsafe but we simply have no nurses. I've at times taken an assignment only for upper management to tell me I can't take an assignment as ER charge (bizzare as hell). I try rounding on all my nurses to make sure they aren't drowning but sometimes I can't leave the high acuity section because the staff need me there to make sure things don't fall apart. Two questions for the folks that managed to get through my little rant there: 1. How do you improve as being a charge nurse? 2. This is a scenario I dealt with as a triage nurse. I had a 37 y/o Male no prior medical history come in with a complaint of left arm numbess/chest pain with an onset of 1 hour prior to arrival with no causative event. On examination he totally had paresthesias on the left arm along with a decreased grip/shrug. But his chest pain wasn't chest pain, but a left shoulder pain with no real aggravating factor. I ask one of the ER attendings to screen the patient to rule out calling the stroke team, my gut instinct was leaning towards a shoulder impingement due to the pain with a lingering possibility being a stroke. The attending flat up told me, up to you to call the stroke alert, because of the lingering doubt I called it. The stroke team after their workup wrote it off as a radiculopathy. If you were in my shoes, would you have called the stroke team at that time?

When I was doing my TNCC it was taught to us that it was encouraged to give the family the option to be present during resuscitation attempts. And in my practice we always gave the family the option. Families that took that opportunity were very grateful and at times were actually afraid to be too close, due to concerns of being in the way of staff during taking care of their loved one. I think the only time we don't let family be close to watch is during central line insertions. Personally, I get very nervous when family is around due to pressure but I will respect their wishes. When my grandmother was ill I wasn't even allowed to visit her even when she was dying due to "flu season" visitation restrictions. I do not want any family be deprived of see in their family, sometimes seeing everyone work their hardest save their loved one gives a sense of closure.

Oh man I'm almost the complete opposite of this, but I still chose to work in an ED of a level 1 trauma center. I'm pretty much reserved, don't mind sitting around to an extent,and the opposite of an adrenaline junkie. Though I have the sarcastic wit, treat'em and street em mentality, and am flexible. The ED to me was my entry into critical care nursing. As much as I would love to work on the Unit the ED affords me flexibility. Don't feel like taking care of ESI 1's and 2's? I can always go to fast-track. Also, the floor nurse in me doesn't mind taking care of chest pain patients.

Go the next best thing, Valium Gas in the ambulance bays and psych holding areas. It worked in Moscow, though a bit too effectively.

Hi everyone, Back again so it's been like 7 Months working at the Level 1 Trauma Center and basically now I've been an ER Nurse for nearly 14 months now. I like working in the higher acuity areas as part of the reason I transferred to the ER (besides the fact my Tele position was cut and my transfer to the ER was my only choice) was to give me critical care experience, I have less patients but can focus on them. I don't mind dealing with chest pains, chf, and copd patient's, and SAH's. I still absolutely cannot stand abdominal pain patients and lady partsl bleeds due to the abdominal pain workup and for lady partsl bleeds I'm a dude so I cannot even witness the pelvic exam due to the patient population(I'm going for my FNP and my classmates tell me get ready to do a lot of them). Maybe it's the floor nurse in me that still loves having structure and predictability but still being flexible. I'm not an adrenaline junkie and sometimes when crap hits the fan I still freeze up. I get horribly nervous when Trauma patient's come in especially when they don't have IV access. The trauma team can't survey the patient's back until I establish access the line, so I'm all nervous with that as well. I get a sign of relief as horrible as it sounds when the trauma is a high acuity/transfer where ALS/other facility 95% of the time puts in some form of access. I don't mind helping out in these situations but I'm always nervous when I'm the primary RN. A week ago though I felt like a complete idiot, we had a patient that got hit by a semi but somehow survived so the trauma team wanted basically a mass transfusion of blood products, uncrossed and all that. The patient was so severe my charge nurse sent in another nurse to back me up. I always check the blood tags to make sure the donor ID's are the same/info and the other nurse was like: "You don't have time to do that, you have to transfuse now!" and she refused to even cross check the blood with me so I had no choice to transfuse without checking. These kind of situations I'm not experienced in but I felt like I was doing the wrong thing. I'm studying for the TNCC thats coming up in November. If I pass it I'm going to take the CEN will these two things further help my competence in the ER?

Thanks for the encouragement everyone, there was a slight ray of hope the other week. I happen to work in the same hospital as my mother does but she's in a different department. I took care of a patient that ended up going to the OR during his stay and at the PACU the patient started asking the nurses: "Oh do you have a child that works in the ER?" so her coworkers asked my mom to come in and the patient's wife mentioned my name and said: "Oh you have such a nice kid, he's a great nurse in the ER" she gave her a hug and stuff. It made me feel better about myself. I wish I knew how to be more assertive though.

I'm going to tough it out for now. But damn I get so nervous when I go there.

Vent alarm (you may wish to silence due to high pressure): I went from a small community hospital ER after 8 months to a level 1 Trauma center since it was a closer commute and allowed for greater career growth. My coworkers at the smaller hospital all told me I was a great nurse and would do well there. Most of our patients in the smaller hospital are ESI 3-5's though a lot of our nursing home trainwrecks we classify as 3 that end up being admitted to tele for sepsis. 5 months later in the new place I don't feel like a real ER nurse anymore. The new place is just sensory overload with alarms going everywhere. The moment I turn around when I'm charting on a computer a resident just pops up and takes the computer WHILE I'm sitting down! This happens so many times! The floor nurses there give me so much flak about taking report and are flat out rude to me. As a floor nurse I never gave the ER an attitude about report and even said just send me an SBAR and send them up. Sometimes even taking care of 5 belly achers and one of them being admitted is overwhelming me now. In my other job I could take care of 7 of them with 2 of them admitted with similar acuities. I feel so overwhelmed there that one of the days I got so busy I felt like I killed a patient. The patient presented SOB and possibly septic so we put her on bipap to help with the respiratory effort and it took an eternity and a half to get IV access. I was getting back from CT scan for a r/o new onset cva then I see a bunch of nurses RUNNING in, I don't remember how but the patient evetually developed a pneumothorax and got a chest tube. Later on the patient coded and the family decided on comfort measures only. During the code however I got so overwhelmed while charting and had to walk out, only for someone else telling me I had to go back in. What also bothers me is that my preceptor beats me to detecting any changes in a patient's status before I can, which worries me if I'm watching my patients enough. I swear on my other job if I had that same patient, I would be monitoring that one extremely aggressively and would have caught the changes/hung the abx within an hour. I'm so busy just doing tasks I feel like I don't have time to learn. Also there seems to be a personality clash. A coworker told me I'm way too nice and I have to be a bit more assertive. Another coworker I get along with said he was happy that management hired a personality like me since everyone there is all Type-A and gungho while I'm a little more reserved and rather just get work done. I'm surprised I didn't fail out of orientation after that whole fiasco with the septic patient. Now I feel like the nurses there think I'm a terrible nurse and are keeping me in the lower acuity areas. I've never come across a job so difficult and part of me wanted to work in that hospital since I got out of nursing school since it was close, paid well, allowed for career growth, and had potential for learning opportunities. But now there is a part of me thinking I can't do this and that even nursing is the right career choice for me.

Pediatrics and Obstetrics. I'm a guy so it feels weird for me. Yet OB was the class I had the best grades in during my nursing school days.

I sometimes feel how you do OP but I try to be as professional as possible. If the patient is asking for pain medication, I will relay their concerns to the primary and nothing more. If both the primary and me both know the patient is a pain seeker, I still will relay the patient's request. If it's ordered I will give it if I find it safe.

A friend and myself moved to a new hospital in the emergency dept. He came from a large university hospital ER and I came from a very small community hospital ER both of us had less than a year of ER experience before moving to this hospital. This hospital is the only level 1 trauma center in like a 50 mile radius so it gets really busy. My friend has been doing well and basically thriving, but I'm doing terrible. In less critical areas I was doing fine since it's like my old job dealing with abdominal pains/flank pains with the occasional nursing home patient that had something wrong with them. But as soon as they put me in their critical care area hit I felt completely useless. They start me out with a chest pain which is fine then the charge nurse goes take this MVA coming up. So in the trauma bay I completely choke and fail to get the IV (the vein was so huge too you could probably put a 14 in it!). Patient is stabilized and then I gotta chart. I go to lunch so my preceptor is covering for me, when I come back a patient that was assigned to me was showing stroke like symptoms, CT scan him and he resolves so its probably a TIA. During most of this time I keep just freezing up/spinning my wheels not getting anything done. More happened that day but getting new patients while monitoring these critical ones basically killed me. When I had a TPA patient, I was basically 2 hours behind since I can't leave the patient for the first hour. And when I get so overwhelmed my nursing judgement just disappears, BP on one of my patient's is 80/42 and I'm about to hang fluids and call the doc. Little did I know the patient is being admitted for this problem, the patient is asymptomatic, and the patient's pressure has been trending like this. I rarely felt like this at my old job. But at this new one I feel like I know nothing and all I do is get nervous/freeze up. Any tips to suppress the freezing up/getting overwhelmed part? On the floor when I had so much crap to do, I knew I could prioritize it a lot easier because I knew my patients were stable, but here all my patients are sick so prioritizing is even harder to me now.

I'm starting at a level 1 Trauma center as an ER nurse next week, I'm somewhat excited but most of all very nervous. I'm coming from a small community hospital's ER after only like 6-7 months, I've only participated three codes in my whole career as a nurse and only one of them was in actually in the ER. The other two were on the floor and nursing home I used to work at. The job was close to home (20 minutes vs 1.5-2 hours) to home and at the same time I wanted to see more and learn more as I'm not getting any younger. Any tips on how to adjust to the changes?

I think of it as the same as how floor nurses hate ER nurses, because as ER nurses we are giving them patients. In this regard medics give us patients therefore we have to work. That's just me though.

I agree with this. Rich or poor, educated or uneducated; a jackass is a jackass.

I don't see a single abdominal pain patient at all! This is must be some kind of fantasy land.

I just do the best I can for the patient and that's all. I've only been annoyed to the point where I said: "Go ahead and leave! Your insurance won't pay if you leave. It's a free market, so go ahead."

I'm moving from a small community hospital (like less than 100 inpatient beds) to a level 1 Trauma center/University Hospital. I'm wondering what kind of differences will I see and expect. I've only been an ED nurse for about 6 months and before that I was in tele for 18 months. Also, would it be advisable to take the TNCC or the CEN first? Thanks!

I don't want to burn my bridges, the place has been really good to me. I'm going back to work tomorrow so it's gonna be rough. How do I tell my other coworkers that I took the position or do I act like nothing happened?

I transferred from Tele 9 months ago to emergency almost 10 months ago and the department has been great to me however the place is far away. I applied to local hospitals with no real conviction. However the one hospital I wanted to work for actually gave me an offer and out of sheer awe I accepted. The new place is one of the biggest learning hospitals in the region and I live less than 30 minutes away. Now I'm in my current predicament. I'm so nervous to tell my director/HR about me stepping down (I want to drop to per diem, I still like working there) due to like 7-8 nurses have left in the past two months and they hired only like 3 nurses. Maybe it's weird I have this sense of loyalty to an employer that probably could care less about me, but I still feel like that. The hospital gave me a chance when many others did not, so I feel like I'm stabbing them in the back leaving so soon. Is there a way I could phrase my notice where it's still gracious? And how do I even talk to my director about it?

Nurse's Note: Productive cough with thick green sputum

When I was on the floor I never got report from the ED unless the patient was getting blood, actively suicidal, or getting a drip. I was fine with that I read the SBAR. When I moved to the ER I try to make the transition as painless as possible. Every single time I call to the floor the nurses are asking for report. Our new computer system automatically fills up the SBAR. I will call the floor when the patient is a trainwreck, getting drips, and if I actually have to come up with the patient. I still work on the floors sometimes so I know if the nurses there are pulling my leg when they are dragging on report. The hospital's policy I work at when it comes to ER transfers we are only obligated to give nurse report to: Facility to Facility Transfers ICU Transfers ER Observation transfers (this report is basically here for this, we did this, they need this to leave) Psych/Crisis Unit OR Patients What I do not like is the hospital I work will transfer patients at change of shift without regard.