maydaymalone

I hear ya! No kiddos for me either. After my first week of pediatrics in nursing school, I came home and snipped my own vas deferens.

You did fine. Don’t beat yourself up, people that have to lose sleep over not ordering the right lab test are called doctors. You were working your butt off, and I have a sneaking suspicion this wasn’t your only patient while all this was going on : ) No matter what else was going on, nothing was going to change 87. Next time you can add on a mag, but as the other poster said, I'd be surprised if an 87-year old didn't have some PVCs. Any time your pt has AMS you should check a blood sugar, but I’m sure the ER did that before he got to you. Don’t worry about nasty nurses, they are like bad drivers—everywhere, nobody has enough time to worry about all of ‘em. Be good at your job and be a nice person. With no evidence of a bleed and labs WNL there was no reason not to give Lovenox. As the other poster mentioned, the head CT without contrast that is done during a code stroke is only to rule out a hemorrhagic stroke…it will not “show” an ischemic stroke. The reason it is done is two-fold, one to look for the bleed, and two, as part of the tPa ‘checklist’. If the pt has a bleed (hemorrhagic) of course tPa is not an option, the pt needs neurosurgery. If the CT does not show a bleed, then the neurologist has to determine if the pt exhibits significant enough deficits to warrant the tPa, and the pt also has to meet a number of other criteria…what time were they last known well, etc. Example tPa checklist: https://www.apexinnovations.com/Classroom/docs/tPA_Ischemic_Stroke_Protocol_Eligibility_Checklist.pdf Regarding the MONA, as you’ve heard, it’s no longer a package deal… If a pt still has AMS, a lot of times they don’t want you giving narcs because they can’t tell if LOC changes are due to meds or their condition, so they may not let you give morphine. Supplemental oxygen? Only if needed, if the pt is 94% or better, no need. Nitro? Well, that depends on the situation…in this case (since you’re in-hospital) I’m getting the EKG stat, then a troponin. If the EKG does not show STEMI, you can slow your roll. You can try a nitro while waiting on the troponin as long as the pt’s BP is above 100 systolic. (Do you have I-stat machines for troponin, or do you have to send them to your lab?) Make sure they have a patent IV (two is better), because if the nitro improves the stenosis and causes hypotension, you’ll be needing a NS bolus stat. Some docs worry about giving nitro for an inferior MI and some don’t—again, have the IV and NS ready BEFORE giving nitro. Inferior MIs are very sensitive to preload—need to fill the tank. https://pubmed.ncbi.nlm.nih.gov/26024432/ How do you know if it’s an “inferior” MI…that will come with practice at reading EKGs. If your facility offers an in-person EKG course, I recommend taking it for any bedside nurse. And it WILL be confusing the first time. I found it helpful to take it with a different instructor (I was at another hospital by then) because different teaching styles work better for different people and more things will start to sink in. I'm sure there are good on-line courses too, I just prefer in person learning. While there is some overlap, the rule of thumb is Leads II, III, aVF inferior leads right coronary artery Leads I, aVL, V5, V6 lateral leads circumflex artery Leads V1 – V4 anterior-septal leads left anterior descending artery Specifically, V1 & V2 are “septal” leads…septum between the ventricles, and septal perforators are smaller arteries coming off the LAD; V3 & V4 are anterior. If the Left Main coronary artery is affected, then you will see changes in lateral and anterior-septal leads, because the LAD and circumflex artery branch off from the Left Main Coronary Artery. Aspirin? Well, again it depends on the EKG and troponin. Assuming no aspirin allergy…EKG show STEMI? Then yes aspirin…325mg is okay, but 4x81mg baby aspirin are better because they are chewable and will start to work faster. EKG show STEMI? No…what's the trop? If EKG neg, but positive troponin, then yes aspirin because you have a non-STEMI and they will be going to the cath lab. If EKG negative and troponin neg, then no need for aspirin—but realistically you would probably give the aspirin while waiting on the troponin result. Why aspirin? In case the patient receives a drug-eluting stent during their heart cath, this prevents our body from attacking the ‘foreign body’ (stent) and causing re-stenosis. Keep up the good work!

I work for the VA and would highly recommend it. This is my 4th nursing job / different hospitals, and this is the best job I've had. I do work at a VA hospital and not a clinic, but I can confirm it has the best pay and benefits of any of the jobs I've had. I work 12-hr shifts because I want to, but our dept has 8, 10 and 12 hour shifts which is nice because then almost everyone gets what suits them best. Those that work 5-eights seem to like them--usually because of having younger children at home, but not always. Once you get started at the VA, it is easy to switch jobs too, so if you don't like it you can transfer much easier than in the 'public sector' and not lose any time. I will caution you that actually starting can take awhile (several months in some cases) due to the extra background checks etc. so don't put in your notice until you have officially been hired and given a start date. Good luck!

Forgive, but never forget the lesson...healthcare management does not care about us. Ever. We are just a means to an end. Do not bad mouth anyone, do a great job while you have it, and be a great coworker to your fellow nurses and a great nurse to your patients. Keep your resume updated and ready, and be looking for a new job while you already have one--whether that is the temp manager position or when you return to your bedside position. Looking for a job WHILE YOU HAVE A JOB is the way to do it. Besides, switching hospitals is unfortunately the only way to get a significant raise in my experience. I have taken a new job every 2-3 years since '13, doubled my pay with my original degree (BSN), and have found a job and hospital I really like. Good luck!

Oh, hell yeah! You can adopt me every week! Free lunch, Amazon gift card, sex, drugs, rock n' roll. I would accept cash donations from Osama Bin Laden knowing he made the money from selling cigarettes to grade school kids through the fence at recess...daddy needs a new pair of shoes!

I would recommend looking into nursing for the VA. In addition to getting to serve Veterans, it's the best nursing job I've had (4 hospitals). More leave, better patient ratios and as a fed, we NEVER get sent home without pay due to census. usajobs.gov Good luck!

From what experience I have, and what l've read from your post, I would 100% recommend the position at the magnet hospital... I have worked at a HCA hospital and it was miserable. For whoever asked, it stands for Hospital Corporation of American and it is a for-profit corporation with healthcare facilities all over the U.S. My experience with HCA was awful (nurse:patio ratios, staffing, pay, culture, lack of management support, poor training) and would never recommend another nurse look for employment there. The rest of my two cents: You've already stated you love the magnet hospital--don't overlook the day to day happiness/joy factor in any job. It took me a couple of tries, but have found a great spot now. The commute will be a factor--an hour difference EVERY DAY will wear on you. Delaying your ICU start (and therefore CRNA school) will be a blessing in disguise. Your first nursing job is hard enough, to learn ICU on top of that takes an incredible preceptor (or several), an understanding team and a lot of luck--being put out on your own too early will sabotage your confidence and everything else that follows. A year on Med-Surg or Tele will FLY BY...it will take you a year to learn the door codes, phone extensions, printer codes and other people's name just on your floor, let alone coworkers from housekeeping, MDs, radiology, RT, ER, and surgery that you will interact with. Learn everything you can about your job, and how the hospital runs in general--it will benefit you the rest of your career. Once you're off orientation and have a few months on your own, try and pick up some OT by floating to another floor to see what they do different/better and expand your learning. Your hospital should also have a lot of online learning opportunities and classes you can attend--you'll need to know your cardiac rhythms (and what to do about them) down pat. Then in 12-18 months you'll be coveted by ICU managers--DON'T mention your CRNA goal. It takes a lot of time (and therefore $$$) to train an ICU nurse, and if they think you will be there for 12 months then off to CRNA school, most would be less likely to hire you (although they realize this is a goal for several ICU nurses.) In the mean time, you might decide you like where you're at (either the first job or ICU) too much to go back to school. Either way you'll be kicking butt at your current job and a great resource for the next group of new nurses to learn from. Good luck, and welcome to the show!

We got cash!!! Our company loves us...$100 per year of service with the company : ) Just kidding, I stole some Rice Krispies treats from the cafeteria, though.

Congrats on your job! That's exciting and such a relief to have a position lined up prior to graduation. I too worked ED as a new graduate, and was glad I did. You will find there is a lot of teaching with each patient discharge, about what they can and can't do, when to follow up, teaching regarding medications, etc. I encourage you to have thorough discharge instructions because many patients are not well informed about what is next—you will be helping them tremendously while also preventing some repeat customers. I have also had a brief stint in the ICU, and in both positions there was rarely any down time (to study the patho)—too busy. In ED by the time you were caught up, the patient was getting discharged or admitted and it was time for the next patient (not to mention your other 2-3 rooms). In ICU you had four times as many meds (because you're also giving patients their daily meds on top of anything they need r/t why there are admitted), then hourly vitals, I&Os, turning and oral care q2h for vented patients, dealing with family, setting up meals, ambulating patients, leaving the floor for swallow study or CT, calling outside providers, intensivists, etc. In ICU it helped a great deal when you worked back-to-back and had the same patients on day two, because you were already familiar with their situation/plan of care. As others have mentioned, you will have every opportunity to cross train…put in your one year of ED and then look for PRN jobs in the ICU (that's assuming you're still enjoying ED—if not you can just apply for full time ICU / other). I found doctors both in ED and in ICU that loved to teach when both they and I had the time. You will also find several that don't want to take the time to teach you—but you will figure out which is which very quickly. With your community health nurse goal in mind, I would say that ED is a better fit because of the variety and types of things you will be exposed to. ICU is a great learning environment as well, but when you are running your community health clinic in 6 years you won't need to teach them vent settings and ABGs, but it will be very helpful to know how to speak with a 19 year old that came in for a preg test and STD diagnosis—and you'll get plenty of that in ED, along with everything else under the sun. The longer you are in any position, the easier it will get and that will free up more time to get further into the patho, etc. When you first start any job/department there are many little things that take up your brain space as you have to learn them, but then 3 months later those are routine and you're on to other things. Hopefully your ED has a good new grad training program—it can make a world of difference. In addition to the other great suggestions of podcasts, journals, etc. you will find lots of info online with a quick google search—youtube, animated videos discussing a disease process, etc. I like your idea of a journal, that is something similar I started back in school. Basically I started a big 3-ring binder and divided it into sections as you would when you get report on patient…neuro, cardiac, respiratory, GI/GU, pysch, etc. Before you know it the binder is overflowing and you have to get a separate binder for each section. When I started in the ED, I made an extra copy of discharge instructions—ripped off all patient identifiers, and took the copy home for my personal information/education. Good luck!

I have left two RN jobs due to low pay. This is a second career, and with HR only paying for years of experience and not based on ability, the extra hours I pick up, my self-perceived value to the department etc. and yes the joke of annual review (usually no increase, sometimes $0.05 - $0.15) I keep the resume current. In my past experiences my direct managers have had no say in whether or not I receive a raise--strictly an HR decision, and they wouldn't know me from any other nurse in the department, they just use the chart...years of experience, degree, any market adjustment or competition and that's that. If you don't like it, pack your bags...so I have, and have increased my pay each time. Unfortunately taking another position is my only bargaining chip, so I've had to use it. Good luck in your decision. I would certainly keep the position until you've investigated other opportunities--alot less pressure to get a job if you're looking for one while you're still employed.

This is an email I recently sent to my family and friends in order to start the conversation regarding organ donation and end of life decisions. If you are looking to have the same discussion with your family and friends, feel free to use any or all of this and modify as necessary. Hello All, I'm on call at the hospital this weekend and thought I'd share one of my experiences with you... Although I have watched a few surgeries in my tenure, the majority of the time we cannot leave the PACU to go into the OR (there are 12 OperatingRooms and a GI lab where I work) because we might be getting a patient from a different operating room, and we need to be present to recover that patient. Well, during non-peak times (nights and weekends) we only run 1 or 2 operating rooms, so it is much easier to predict when you need to be in the PACU. In fact, if there is only one surgery going, then (if surgeon, et. al. is okay with it) you can go observe what is going on. Towards the end of the day on Friday it was known that a patient (who had come in as a trauma) was near death and the transplant team was called in to do an organ retrieval. Since we were down to one other case, and I have never been part of that experience I asked to observe the process.Feel free to continue, I am not going into details regarding the actual surgery. The patient (a man in his 50s) had suffered a fall down a big, steep flight of stairs and was not going to survive due to bleeding in his brain. It was not known whether the patient had a stroke and then fell down the stairs, or fell down the stairs and everything else happened due to the trauma. This patient was on record as wanting to be an organ donor, and as a result when a patient meets certain criteria, the transplant team is notified. (Technically any time a patient meets certain criteria the transplant team will be notified because at that time specially trained professionals can initiate conversations with the patient's family regarding the possibility of organ donation. This is only done by people with the transplant team who are trained for this situation. Any questions brought to the (hospital) nurses or doctors will be referred to the specialists.) Once it is either known the patient wanted to be an organ donor, or the transplant team and the family have made the determination that organ donation is something the patient would have wanted, the transplant team can start making the necessary preparations. The most critical elements at this point are time, and the past medical history of the patient, to determine which organs might be a possibility for another patient to receive that desperately needs them. There are different situations depending on what has happened to the patient and what the cause of death is (particularly a cardiac vs other event). Those differences are complex and not really the purpose of this email. Regarding the element of time, from an organ viability standpoint, you only have so much time once the (patient's heartbeat, and therefore) blood perfusion has stopped. With that in mind, the patient, who is technically still alive at this point, is brought down to the pre-op area just feet away from the operating room. The patient's family members had the option of saying their goodbyes in the patient's ICU room (the patient had come in via ambulance, to ER, then to ICU) or they could come down and sit with him until he passed. This family decided that they would say their goodbyes in the ICU room, so the only people at the bedside in pre-op were other medical professionals. From my standpoint that was lucky for me. I would be perfectly fine with whatever the family decided, but even back in my ER days, it was much easier to focus on the job (during a code) with just the patient. It is common in the ER in today's day and age to allow the family in the room even during a "code" if they insist, because if the family truly wanted to be there and they were not allowed and the patient passes away, the results are not good for anyone involved. Most people cannot / choose not to be in the room when CPR, etc. is being performed on their loved one, but in the cases where they are, some people understandably get very emotional and that can get to me. As an aside, I've had family members come back in the room after codes to sit with their family member, some of which survived and some of which didn't,and you will see the full range of emotions-from family AND hospital staff. With this in mind, I was thankful there were not family members present simply because I'm sure without having medical responsibilities(since I was just observing) I would have been more focused on what the family was experiencing, than anything going on with the patient and transplant team. Once the patient has passed away, the (organ transplant)clock starts ticking and things move very quickly-this is why the patient is brought as close to the OR as possible before they actually pass. As soon as the patient passed away, the doctor pronounced the time of death, then the patient was immediately taken to the operating room where the surgery was initiated. In addition to the surgeon there were two surgical assistants (not really sure what their titles were), two operating room nurses-one to chart and one that was scrubbed in to help with equipment, one patient care technician who can assist in a variety of ways, and three more members of the transplant team to help prepare the donor organs for transport. There was also still a member of the transplant team upstairs with the patient's family to attend to any of their needs and questions. I am not going to speak about the actual surgery (with one exception) because this email is going to a variety of family members, some of whom may not want any details. If you care to know more regarding the actual procedure I would be happy to talk to you or I'm sure there are a number of resources online. The only thing I will mention about the surgery is that immediately before the surgeon made the cut between the major blood vessel and the heart, he asked everyone in the room to pause and observe a 5-second moment of silence on behalf of the patient, their life, and the good that they were doing by being an organ donor. There are a number of factors considered when determining who will actually receive the donated organs. Generally speaking organ donation is first considered geographically (assuming there is a match with blood type, antibodies, etc.) Organs are donated locally, then regionally,then nationally with some exceptions made to recipients who are either kids,difficult matches, or living previous donors (for example, if a person had donated one of their two kidneys and then their remaining kidney failed, it is my understanding they are moved up to some extent.) Of course the whole purpose of sharing this story is to have you consider if you would like to be an organ donor. If you would like to, or would like to at least know more about it, the time to act is now, because we never know what lies ahead of us. And here's a point I cannot emphasize enough-something I've experienced first-hand from my days in theER...whatever you decide, PLEASE make your end of life wishes known to your closest family members! This is very important to do now-when you are healthy, because this is not an easy topic to discuss at any point for most people, and the situation gets much more difficult during times of acute medical conditions and the emotional stress that comes with it. I truly am not trying to 'make' you an organ donor, but I would ask these two things: Think about it, then make your intentions known. And if you would like to be an organ donor, take action-make the declaration on your driver's license, and you can visit the Donate Life website for more informationThe medical care you receive is NOT affected by your donor status (some people mistakenly assume if they are a donor, there may be an instance in which something might not be done for you). These and other questions are answered in the frequently asked questions section: The entire process was sad, but beautiful. It was sad what had happened to this gentleman. At this point, nothing anyone could do was going to change his outcome. It was beautiful to think about the reaction that other patients and their family members would have when they received word that an organ transplant was now a possibility. Love & Prayers

I'm not sure what every abbreviation meant, but I've ordered my first book and my Google machine is on fire! (It will be a busy semester break.) Thanks everyone for your replies, I appreciate you taking the time!

Hello all, I'm a Level I (of IV) nursing student in a BSN program interested in working in an Emergency Department. Obviously I've got a long way to go before graduation (May '13), but I was hoping some of you who already have experience working in the ED could give me a few topics that I can research on my own time to advance my learning. I realize you see everything from bunions to brain damage, but I was specifically looking for the most common critical cases you encounter. For example, if someone presents with chest pain, you would do X, Y, and Z and I need to know about drugs A, B, and C. What are the most common, but critical cases you see regularly, and what drugs do you administer frequently? Chest pain, trouble breathing, stroke, MI, gunshot or stabbing, other? Thanks for your time and replies.

Most patients either refer to me as nurse or male nurse, but my good friends still call me Steel Balls Magillacutty.