alkaleidi

I wish our charge nurse did half of that! At this point in time, our charge nurse is responsible for staffing if someone calls in sick, being a resource, "knowing what is going on in the entire ER" (which makes me laugh hysterically being that our ER has 6 beds and 1 trauma room), and floating/helping the primary nurses. A different nurse is assigned to triage. Our average population we see a day is probably 20-40 patients. I will just say... the charge nurse does a lot of sitting, checking email, texting on cell phone, checking their bank accounts online, etc. Pretending to be busy, yes. All that responsibility and an extra $ .50 an hour for the added workload.

Do parents have the ultimate say when it comes to a teen taking medication? And if they do, what happens when the teen continues to be belligerent and refuse? If the situation is not life-threatening, but has the potential to become more critical (aka "if it goes untreated, it could become something far worse"), how far does this go? Right now these parents and the MD have enlisted an agency to come in and administer meds. What if the patient refuses from the agency? Is this something that has to be forced, or is it as simple as, "Ok, I will document your refusal." I am confused as to why an agency is being used to simply administer a medication. Why the parents don't have the initiative to not GIVE the child a choice is beyond me, but that's not something I can fix. I am just leary about becoming involved because I don't know the legal policy when it comes to this. I hope you can follow me -- if you couldn't tell, I'm trying to be really vague. But, if anyone can offer insight, please respond or PM me. Thanks! A

Hahahahahahahahahahaha... When people say, "You're a nurse, so you should know better," I reply with something like... "You're right. I am a nurse. I know better, and I am making a conscious decision to be human." Or... something relating to the fact that I am a nurse, therefore I know how to fix whatever could possibly go wrong. Broken bones, cuts and scrapes, etc etc etc. I am a nurse and I smoke. Yes, I know the consequences of smoking -- I teach my patients about smoking cessation. I drink alcohol on occasion too. I know all about the damage it does to the liver, and I educate my patients on that as well. I make human choices despite the knowledge I have. I figure we're some of the most knowledgeable and know the ins and outs, tricks and secrets, and can probably get away with the most in the world. :) If I can't fix it, I'll at least solve the immediate problem and make do until we can get to someone who can. For God's sake, I save lives -- I think I can handle my kid falling out of a tree, off his skateboard, off his dirtbike, and I'm sure I could manage if his shoulder got dislocated or if he ended up with nursemaid's elbow from playing freaking Red Rover. Shake it off. :) What everyone else doesn't know won't hurt them!

In my experience, you get out of those programs what you put into them. The best way to learn whether you take a course through a bookstore-bought program or through a university/college is to actually USE it. You will do this at work because you have many spanish-speaking patients. Having both taken high school and college spanish courses as well as purchased MANY books to continue to learn on my own, here is my personal advice: Take a college course to learn the basics. Not just the conversational hi, bye, how are you, but also verb conjugation, sentence structure, etc. THEN, purchase medical-specific books to broaden your vocabulary. I think that is the way to be best disciplined when starting out... you will remember the basics, and you will be able to read and say anything, even if you don't know what it means! :) Just my

I've always given it with lido. Of course, it generally has to be ordered that way because lido is a medication. But, what doc wouldn't give the go-ahead for that?

LOL. I don't think I would have told anyone that. I even have a special bra I wear -- a super supportive Champion sports bra that has been donned the name "The Code Bra." No bouncing no matter HOW vigorous your chest compressions are. Unless you can get away with duct tape, bras are non-negotiable.

I am 27. Female. Four... hit a deer twice (2 different times) in the country, rear-ended once, and lost control on ice/snow/white-out, ended up in ditch.

What suburbish area are you in? (I'm south of Chicago.) If you are that passionate about going right into an ER, I would apply at all of the local ERs that you are interested in, within a decent driving distance. (Sorry, addendum to my previous response.) :)

Going into the ER as a new grad is completely doable -- just keep in mind you are learning 2 things: 1) how to be a nurse, and 2) how to be an ER nurse. Make sure you are VERY well-orientated on general nursing assessment, etc, in addition to the ER-specific skills and processes. Get your hands on policy and procedure manuals and actually READ them. It seems like everywhere I have work at kind of views the P&P's as "you can read them (wink wink) and sign here saying you have read them and are familiar with them all," but as a new grad it's actually good to read them. Also, as a new grad and for ANY ER nurse, get a copy of all of the protocols, both the basic ones (sore throat, abdominal pain, toothache, etc) as well as the big ones (stroke, chest pain, etc). It is harder because you are a new grad, but it's definitely something that has been done and will continue to be done. Not every new grad works out (though few ERs tend to utilize the 90-day probationary period)... but many do. For example, the ER I work in right now is just finishing orientating 4 new-grad RNs. 2 of 4 are doing GREAT. 1 of the other 2 is doing alright. The other 1 is doing poor to fair. If it's something you are passionate about, and you are willing to learn, no, ABSORB, and adapt to a new way of thinking as a nurse, then GO for it... it's an exciting place to be! :) Good luck and welcome!

In a hospital setting, we nurses quickly get used to seeing "sick" people. Especially when it comes to aging and older adults, we typically don't get to see the ones that are aging gracefully. One thing you must keep in mind is that not ever 65+ person has HTN, DM, CHF, and a history of at least 1 MI or CVA. It's so refreshing to take care of a 90 year old patient that has NO medical history, and the most serious surgery they've had might have been a tonsillectomy or an appendectomy way back in the day. Don't let your view of health get distorted by your role as a nurse. We take care of sick people in the hospital. I live with my boyfriend too. I'm 27... but if I had found him at age 22, you bet I'd be under the same roof. My grandma is 79 and flies to TX every winter to stay in her summer home -- they ride their bikes across the border several days a week.. go to the beach.. she walks at least a mile several times a week when she's home here in IL. Not every old person is sick and unable to care for themselves. Don't get discouraged!!!

http://www.facelake.com/md300-c1.html this is similar to the ones we ordered. And it's affordable. :)

I just ordered a couple for our health dept's new home nursing program -- they were about $78 each, and are accurate yet VERY small and handy. I honestly have no idea what the company was, but if you want I can ask the woman that does the ordering and PM you. You can find them Good luck!

Our ER docs take naps when there's down time (yeah, what's that, right!). We occasionally have a little break from 3am-5am, and from like 7am-9am. I know they're tired, and most of them drive a good distance (at least 40min, some more like 1.5hrs) to get there, and none of them work a consistent schedule (they are ALL bounced from 8a-8p to 8p-8a -- no one works strictly days or nights). So... if they're resting (sleeping or just resting in the Dr's room), I have no problem working up a patient and waiting for some results to come back if the "emergent complaint" is completely non-urgent (i.e. sore throat, UTI sx, etc). So yes, our docs do take naps on occasion. And if a co-worker wants to try to nap for 20-30min during their lunch break, I have no problem giving them a wake-up reminder so they can catch a snooze. :)

I also have never given a flu shot subq. Always IM. At the health dept we use 1" 25G needles... pinch up for smaller people, smooth out for bigger people. Like someone else said, if you stop abruptly at the bone, pull back a tad and inject. I personally think people miscalculate needle size too small most of the time. At a pediatrician's office I worked at, we rarely used anything less than 1" for IM immunizations. And giving usually 50+ shots a day, never hit bone in a kid. I think it was 5/8" only if the kids were

Same as most of the other people who responded... if I stop at the gas station or Walmart or somewhere else on my way home from work I am good for an OOPS about once a month... A Xxxx RN Never on purpose. Too many people think you are the go-to person for medical questions, I think, if they know you're a nurse. The cashier in the McDonald's drive thru asked me about some medical issues his pregnant girlfriend was having... all I wanted was a cheeseburger and a sweet tea! Sheesh.

1: A preceptor should be a position that is APPLIED for. It should be a position that a staff nurse CHOSES to do because they enjoy teaching. It should NOT be a position that someone is ASSIGNED to. That would be nursing's first mistake. 2: The transition of a new grad in any field should start with a 1-on-1 preceptor. You should start at a point where your preceptor is doing ALL the care, explaining everything and answering questions, while you as a new grad are asking questions, observing, and absorbing everything. You should transition from there to you taking half, your preceptor taking half, you relying less and less but your preceptor ALWAYS being available to help. The end point being where you are doing EVERYTHING and needing NO help whatsoever. In the ED that I started in, for example, the preceptor I had would be assigned usually 2 patients to start. We would go through the entire process, etc, and eventually I was taking 2. The max patient/nurse ratio was 4:1, so even as I was taking 3-4 patients, my preceptor was not assigned any so that in the event I needed her, she was available. The preceptors in the ED were chosen after expressing interest IN precepting, and we also had 2 mentors that were our go-to people to voice concerns, etc. If you and your preceptor didn't get along, you could discuss that with your mentor. Anything you said was in confidence and in a very non-threatening manner, you could be reassigned to a different preceptor. Does that help? I think a preceptor should also be a mentor. Deal with the actual role you are learning as well as be able to discuss personal issues, stress, etc. Just my opinion and my positive experience being able to have that.

Just a suggestion... Post your resume on hotjobs and monster. Be very honest about your experience (little or none, new grad, etc) and also honest about your eagerness to obtain full-time RN employment. Check out the job listings on there as well. Go to google and type "hospitals near philadelphia, PA" -- check out ALL of their websites (job listings) -- submit applications to all of them. As a new grad you can't be too picky. Also consider what specialties you are willing to work in. Prisons hire nurses, doctors offices, local health departments, dialysis centers, nursing homes, the list goes on and on. I can't believe you aren't able to find a job! Keep looking -- they are out there! I do have experience, but I can tell you that I posted my resume online and the next day I had 6-7 voice mails from nursing recruiters. Also, are you willing to travel or relocate? Are you stuck in PA or willing to move? As a new grad I was offered a 6-month contract on a med/surg unit (willing to hire new grads due to a combination of the facility being expanded, an anticipated long-term need for travel nurses, etc). Get your resume on the internet -- it could be the key to your first job. :) Good luck!!!

No one? No help? Please -- would love some input!

Lengthy post warning! We are "restarting" a home nursing program with the health dept -- I know these questions would generally fall under "public health" due to it being a health dept program, but the program itself is more home health in essence without the 24/7 responsibility, on-call, etc. (Kind of a simplistic home health program, for those that fall thru the cracks.) Here are some things that came up at our last meeting: 1: revamping charts - could any of you email me chart forms so that I could compare ours with yours? Ours seem a little outdated (ok, a lot), and I would like to streamline and condense, streamline, but still include all info necessary. ALSO... along with a main chart, do you keep a more simplistic home chart? Kind of like a flow sheet of the main things that family wants to be kept informed of (i.e. current medication list, allergies, ongoing vitals flow sheet, etc)? 2: is there official word on prefilling insulin syringes? I checked some websites and couldn't find a definitive (and recent) answer. looking for if and WHICH insulins can be drawn up say, 1 week in advance? 3: do any of you use portable vein finders? such as a transilluminator, veinlite, etc? the administrator was interested in purchasing one for the program, and I've never used a portable one (only the huge, $20K ones at hospitals). I *have* searched online and found several, but would love input from people with actual experience using them. 4: promotional medisets? We would like to purchase some medisets to be able to give to patients in the program. I have found hundreds online but was wondering if any of you hand them out, and if so, have you found any that are very senior citizen user-friendly? Something that is easy to read, follow, and, easy to open with arthritic hands. 5: the bag of tricks. a few things -- for blood pressure cuffs to be used in the home, I'd like to order something that is very easy to clean -- haven't found anything despite the hundreds of med supply books I've looked through. also looking for the "perfect thermometer" -- easy to use, fast, easily applied covers, etc. aside from the usual (alcohol wipes, dressing supplies, blood draw supplies, extra chart forms, medisets, etc), what... "unique" things do you always carry with you into the home? and suggestions for anything else I mentioned? Again, I would appreciate everyone's input -- thanks in advance! -A

I had to actually look up "fidelity" and "veracity" because I wasn't sure in terms of needle exchange what those words meant or how they applied. I'm still not sure, actually. Those two words sound like they were quoted directly from a book or an assignment -- maybe you need to put the assignment into terms you understand, or clarify with your instructor on what they are looking for? If you are asking for information as to the effectiveness of needle exchange programs, or if you are asking for the pro's and con's, or why on earth people would support, and be opposed to, the programs, I think we could better answer this question. In short, needle exchange programs are to public health as sex ed (NOT the abstinence-only sex ed) is to high school students. They are not, by any means, out there condone illegal drug use/abuse. They are there for those who are using and either (a) don't plan to quit or (b) are on a long wait list for a detox/rehab program, which is unfortunately a real-life problem. I like to think of the programs like sex ed because of the following scenario. You go into a junior high or high school and do the George W. Abstinence-Only sex ed speech, and tell everyone that they only way that they won't contract STDs or become pregnant is by NOT having sex. Very effective, right? Well, some of those people are still going to have sex. And a lot of them aren't going to have the balls to go to the local drug store (that their aunt, parent, or family friend probably work at) to purchase condoms. So the health dept hands out free condoms without questions, to help prevent the spread of STDs and unplanned pregnancies. In the same way, there are SOME people that are just going to inject drugs into themselves. No matter how many laws are passed, or how hard the government tries to control the import of drugs into the country, or how many times the DARE program is preached at kids, they are STILL going to use. So the needle exchange programs hand out free needles (and usually cotton, metal caps, alcohol wipes, sharps containers, etc) to help prevent the spread of blood-borne diseases -- hep C and HIV being the biggies. Does that answer your question at all? Have you done any research on this topic? If you google "needle exchange program" you can find over 400K websites -- I'm sure you will find plenty more info from there. Good luck!

I work at 2 hospitals. Hospital #1 is a large level 2 trauma center. ED scheduling is done online via boomerang (icsboomerang.com). An ED-wide email is sent out when the next schedule is available for full-time employees (FTE's) to fill in their desired hours (self-scheduling). All of the nurses "request" for the days they want to work. At the date of the schedule being "locked," any FTE that has not signed up is filled in by the assistant manager that does the schedule. The schedule is also modified if needed to spread the staff evenly (i.e. if 10 nurses sign up for a tuesday and only 2 sign up for monday, they change the schedule of some of the people to appropriately staff). After the FTE's are all filled in, that portion of the schedule is locked (all of the shifts that people are signed up for change from a "requested" shift to a "confirmed" shift) and a calendar is posted online of "available shifts/shift needs" for the schedule -- all PRNs and registry staff can then request to work whatever shifts are open. As people sign up for hours, the assistant manager confirms people, usually first come first serve. We fortunately have enough PRN & registry staff as well as regular FTE's that want overtime on occasion that holes are almost always covered. After that, the remainder of shifts are slowly posted for time & 1/2 or double time if they are having a hard time filling holes. It seems really confusing but it really works, and is nice to be able to pull up your schedule at home or go online if you have plans that are cancelled and sign up to work. The other hospital I work at is smaller but still busy. The schedule is paper and written in -- they also do self-scheduling, and after people have signed up for hours, the schedule is copied and signed by the director of the ED as "master" -- from there, PRN & registry staff are able to sign up for hours. After they have signed up for what they want, the charge nurses start making calls, trying to cover holes. They don't seem to have a lot of registry/PRN staff that want to go above and beyond their requirements, and a lot of the PRN staff don't seem to want to work much at all. For the most part it works. The first come, first serve policy is a little irritating when you work midnights and get stuck with working every other day all week, if you are someone who prefers to work a few on then a few off. But, in terms of coverage, it's ok. Nurses are sometimes pulled from M/S or ICU to cover the ED (they usually function as techs that pass meds once in awhile). At the larger hospital, the ED is a closed unit that does not float elsewhere in the hospital, and does not receive staff from other units for help. Long long post -- but hope that helps? Maybe suggest self-scheduling to your current nurse manager? Or have her notify you of all days available once the full-time schedule is done, and ask to choose days instead? Don't know... sounds like your manager might be kind of micro-managing OR giving the rest of the PRN/registry staff pick over the available hours before she calls you.

I feel for you... I don't know exactly what you are feeling because I didn't feel that way initially. But, once I was in, I realized I should have taken some prereq's because one semester of nursing school I was taking 19 credit hours and another semester I was taking 18. I was irritable, had canker sores like you wouldn't believe (viscous lidocaine was my friend -- I had a bottle in my backpack), and having mental breakdowns left and right. I got pulled over mid-19-credit-hour semester for not wearing a seatbelt when in actuality I *did* have my seatbelt on, I had just put the thing under my left arm so I could lean forward and try to get whatever had blown into my eye out. The idiot cop called me back to his car instead of just coming up to mine, and had me sit in the back seat while he went through the paperwork BS and I bawled the entire time -- about everything except the fact that he was giving me a petty ticket! After all that, 12-14hr semesters were cake, and I felt invincible. I actually got a monster scholarship to DeVry 3 years prior to starting nursing school, and the day of registration was horrible. Minus all the details, I ended up going home the next day, with a supportive mom, and knew I made the right decision. Mulled it over the entire previous day and all night. I think the fact that you started shows that you had a genuine interest, and you made the right choice. If you truly feel like you want out, don't waste your time doing something that you don't want to do. But, if you want to stick it out, you will end up with a degree in a profession that can take you anywhere in the country, and to many other countries as well. And, you don't *have* to work in a "clinical" setting... there are SO many fields of nursing outside the hospital, and even positions on the outskirts or completely outside of healthcare, that you can work in that don't require you to even do patient care. In a nutshell, if you stick it out and get your license, at the LEAST you will have a guaranteed good-paying job and, worse case scenario, you can afford to go back to school and get a degree in something else. If you feel like talking in private, send me a PM -- I hope you make a decision you're happy with!! Good luck with whatever you decide.

I agree that patients need to be spared from radiation when at all possible, but do you currently work in the ED? I know that where I work, people demand an explanation for the slightest ache, and anymore, are flat out requesting a CT "just to be sure." If they aren't, the docs are generally forced to CT just to further rule out any possible obscure diagnosis. (It's all about getting those positive Press Ganeys! ) And... if they don't get a CT, the docs are chewed out by administration for not pleasing the patients. I don't know that patient advocacy has anything to do with it. We discharged a woman with the recurrent "abdominal pain" diagnosis (aka med-seeking) who has had >20 CT's this year. The doc was hesitant to scan her, and wrote out very specific discharge instructions re: the # of scans she's had, and the damage that radiation can do, and educated her as well. Still, she wanted to be scanned because "something has to be wrong." Who is getting lax? Maybe you are in the wrong profession -- should be educating emergency physicians re: treating and diagnosing their patients. :)

LOL. That's funny, because the nurse educator in the first ED I worked in told us that "anything smaller than an 18g is unacceptable, so anyone who needs to brush up on their IV skills needs to start now!" And, the director of the ED supported that statement. Cruel or not, I guess my first thought is, "You are here for an EMERGENCY visit. I will treat you as if you are having an emergency." I would prefer someone be "cruel" and possibly save my life, than try to be "nice" and be scrambling at the last minute to get a large bore IV in me while someone is doing compressions. Yes, that sounds extreme, and maybe unrealistic in most cases, but a stick is a stick, small or large they don't tickle, so I don't see what the big deal is!

To avoid getting off topic, my answer to the original question: Within the EDs I've worked, the expectation is for all ED patients to have an 18g or larger. If unable to obtain access with an 18g, or if an 18g is not realistic (which pretty much only translates into having a pediatric patient with veins that are not compatible with an 18g IV), then something smaller is used. When starting an IV on a patient that is remotely ill and they have large veins, I may insert a 16g. 14's and 16's on acute MI, trauma, overdose, CVA, arrests, etc. On a monthly basis, I might insert 3-5 20g IV's, and maybe one or two smaller IVs if I have an infant/child.