MAL, RN

Wow. Its sad that this is your response and alot of others responses. Someone is asking for help and instead you scold them, and after not having read the entire post where she address this! She feels terrible about it and still does. A more productive response would be to give advice on time management or maybe not say anything if you dont know the answer. Think about that next time you make a mistake. Im sure your a ball to work with.

Good luck OP. Hopefully this child is OK and im sure it will never be a mistake you make again. Thankyou for sharing your experience as it reminds all of us to stay focused at work.

I agree-- the CEN seemed more difficult than the CCRN despite that I also work in the ER. There was so much psychosocial on the CCRN that I found to be very easy.

I didnt have any ICU experience before taking the CCRN. I had 4 years of PRN ER experience. I spent 3 months of studying 3-4 days a week for 2 hours a day. I passed with a 90%. The test in general is really not that hard, but you'll need to review specific things about SWANS, IABPs, Vent's, etc that are all covered in the review books. I used the Laura V-G DVD's, the AACN High Acuity Critical Care question bank, and the Pass CCRN question bank. If you do those, read the rationale, you'll get enough to pass the test. I found it much easier than the CEN

Moving to Ventura with 4 years ER experience. Im looking at potential hospitals for a job, and Los Robles looks like the closest trauma center. Anyone have any insight into pay/work conditions for this hospital or any other hospitals in the area? Havent decided which area we'll live in. Ive been told to be cautious in Oxnard but everywhere else is game. Also, anyone know if per diem pays more in these hospitals? I heard they are union and that can affect pay sometimes. Its been a struggle trying to learn the area through the internet. -californiaboundRN

Federal RN positions at Tripler start around 59k-low 60's and go up from there a year depending on the position and candidates experience.

I've chatted with some other nurses from the area, and it basically comes down to knowing someone. They WILL hire new grads, but you can't go through the recruiter (Im referring to Straub), because she will deny your application based on hospital policy which is out of her control. But its hard to meet people when your always moving, so obviously the locals will get these jobs.

Hi all, Im disappoined thus far in my experience looking for RN positions on Oahu and looking for advice on getting a job at Straub or Queens. I am moving to Oahu with my military husband, and forced to leave my current (and first) job with only 9 months of experience as an Emergency Room RN. I have EMS experience, GREAT references, internship in a level-1 trauma, my bachelors and even my CEN! Yet, yesterday I was told, by Straub nursing recruiter, that she simply cannot forward any of my applications to ANY department because Straub has a "non-negotiable" 12 month experience policy. Her advice was "stay behind for 4 more months" and then she can get me a job..? They currently have several ER positions listed, all night shifts, which I have and am able to work. I have worked so much overtime in the past 9 months that Im sure I come close to one year! I think Im an excellent candidate for these positions. Why are managers not looking at an entire candidates profile? and probably the hardest fact-- I have a friend who worked at Straub, and said that some of the managers actually LIKE "new graduates"...so it once again comes down to who you know. The recruiter at queens said something similar. Im looking for any advice on how to get some contacts at Straub, Queens or another area hospital. My passion is in ER nursing , but I am a nurse first, and enjoy my profession regardless of the department . Thanks in advance..Any advice is welcome..

Ive been applying to several jobs and talking with lots of recruiters. As long as you have 2 years of experience, you will not have a problem finding a job (in your current specialty). Sometimes SNF is not weighed as heavily as acute care, but with even 12 months of acute care experience you will have decent odds of finding a job. I have yet to complete my application for Tripler--the USAjobs website has some ridiculous requirements for RN positions (print and scan and submit in addition to fill-in online). Good luck! I am also moving to Oahu with my husband next month and hoping to find a job that I like (im pickey). Hit me up in a month or so and I'll update you :)

Thanks so much for the link! Anything that surprised you on the test? Did it meet your expectations? What were your scores on practice tests?

Which practice tests are you referring too? Im assuming you took the BCEN prep exam and got a 68-71 ? I dont think Im going to pay for the practice exam from BCEN. Do you think it will help, as far as learning content? I am taking the 5 practice exams from the ENA CEN book and feel like that should be sufficient as far as practice exams go---thats over 700 practice questions!!! ..

Im in the same boat as you--studying nearly everyday for the past month and also took Jeff Solheim seminar, which, I think is very informative. They offer a refund for the seminar if you fail the CEN, as long as you take it within 60 days of finishing the seminar. My average test scores are b/w 68-72 right now...But still 2 weeks out and have to review alot of material. When do you take your test???

Please tell us your experience!! What questions were the hardest? Any content that surprised you?? Im taking my test in two weeks...Averaging 68-72 percent on my practice tests now. Still have alot of studying to do...

Recent graduate with 10 months RN ER experience, 1 year experience as an EMT, and 3 month preceptorship in the ED, ACLS/PALS/CERN. Whats my outlook for an ER position? I have an undying passion for the ED and am not sure I would enjoy anything other than that, or maybe a CC floor. I have excellent reccomendations and an impressive academic profile (as if anyone cares what you did in college, haha). What ER's are in the Honolulu area? (Ill be living between there an Honolulu). Any magnet/training hospitals? Any advice/comments about getting interviews/talking with recruiters? I will begin applying this week. I see that many have posted how difficult it is to find a job in HI, but I personally know a nurse who has recruiters calling her asking her to come to HI for work. These might be agency jobs but hey--they are jobs and they're offering 50/hr! Thanks for any advice! I am super excited to expand my nursing career into OAHU!

Agreed. Im not so much questioning what insulin can be piggy backed with, but the pump piggybacked into a gravity drip.

Thanks!! Never thought of that. Im going to look into the volume of our extension set. Great advice.

Yes. Seriously. In the ED we dump Liters in as fast as we can. And of course, we can always ask for an EJ or a PICC but if a patient comes in DKA/Hypotensive we need to do what we can with what we have until further access is established.

And if the NS needs to be WIDE open, as in, 1 liter/hr or so? I dont think I could eyeball 8mls from a bag

You have only one IV access. (For whatever reason). You have two IV medications to give. They are compatible. Lets say one is Insulin at 8ml/hr, the other NS wide open. 1--If you put the insulin gtt on a pump at 8ml/hr and the NS via gravity, can you piggy back the insulin into the NS tubing, or is there a risk that the insulin could back up into the saline? Either during the tandem infusion, or when the NS is finished? Or 2-- what if you had two IV solutions- neither need pumps. Say one is NS, the other an ABX that can be given over roughly 20-40 mins. If you dont want to stop your fluids, can they both be hung via gravity and infusing in tandem? Thanks.. I worry that with such a small amount infusing, such as in the case of insulin, that some may back up and not reach the patient. 3-- when you hang a medication that infuses slowly, are there any tricks to get it through the connection tubing without bolusing it? (or a safe way to bolus it) The connection tubing between the cannula and IV tubing has been flushed with a saline flish, so saline is sitting in the connection tubing. Im thinking in the case of Nitro at 3ml/hr, where it would literally take an hour to flush out the saline. 4-If a drip such as insulin or nitro is finished and you need to flush the line for a new medication, do you aspirate from the connection tubing to prevent bolusing? Or in a similar scenerio, if you needed to give a push medication while a patient is recieving a drip such as insulin or nitro (in other words, a carefully titrated drip). Im sure this is addressed on this website already SOMEWHERE, so sorry in advance. So far, Ive just been starting a second IV site. But in some of these dialysis patients, its impossible.

I agree with you!! Its hard to stop what Im doing to take orders, and I have a tendency to want to finish something if it only takes a few minutes, even if there is something higher on my priority list..Its definetly something to get use too..

Its really a relief to hear everyones comments, especially that even seasoned ER nurses get frazzled. I like the analog about running on a treadmill but not getting any where!!

Hi All, Im on of those "Forbidden" new-grad's in the ER. I wasn't given very good training, but nonetheless learned alot during my weeks of orientation. My concern is adjusting to the fast-pace in the ER. Im on my first few days by myself, and the challenge of learning to handle 5 patient rooms of documentation/orders/etc is overwhelming. I work with a great team, but they are all so busy too that its hard to ask them for help! I'm just not sure if its because Im a new graduate or just new to the ER. Any insight on this? Tips/suggestions on how to keep my head above water these first few weeks of orientation?? How long until you ER nurses became comfortable with your workload?? I just dont want to get fired because I am drowning in my workload from poor time management!! Thanks Evereyone!

This is so true. MANY of our nurses are prior techs. Our hospital however, requires techs to be paramedics of military coreman.

Ya, I have mentioned it..But thats a big burden for someone who isnt getting extra pay for precepting. Not all hospitals are like mine though. Everyone is so busy! I'm very proactive about getting experience/explainations so I've been delegating more lately... The level-1 trauma I precepted at paid mentor's an extra 3 dollars an hour! SO everyone was down to precept and they were all great! I have pushed for the same few preceptors though, and I come to work with a list, literally, of things I want to work on.

My orientation is 11 wks...sometimes I work 5-8's, sometimes 3- 12's... Im sure that, by 8-15 pts, they mean over the course of the day (unless your fast-track). Otherwise, that's more than the floor nurses and unsafe for the ED. I have 5 pt rooms, and at least 2 pts come thru the rooms in a shift so a minimum of 10 ..I did a 200 hr preceptorship in level 1-trauma before and if your assigned to the trauma bay you usually have less rooms (but not always). Thats usually an extra certification that takes time to get before they assign you to the trauma bay..No rush on that though, you still get to jump in there and help!! Since you have some time to study, and of course theres SO much to study, I recc going over some of the things you know to expect right off the bat, like IV push meds/cardiac meds you know youll be giving alot..Morphine/dilaudid/Zofran/Lasix/Solumederol/Cardene drip/Nitro drip, etc..And start learning the dosages and how fast you can push...We give them alot and its helpful to be refreshed on them..Also, the "rainbow" for blood draws and what each color tube is designated for at the lab...It helps to know this when MD orders lactate, etc..and the colors can vary by hospital