tomjones200824

In desperate need of assistance... I am a new bachelors educated nurse, graduated in late 2011. Am certified in ACLS, PALS, BLS, and LNC-csp (legal nurse consultant). I am currently investigating clinical risk management certification to add. My pre-RN experience is mainly assisting in nature (cna, tech, etc..), approximately 3 years in this role. As an RN 2 years in a level I, II, and III ER and now 8 months as an RN supervisor at an LTAC facility. Let me state, I love nursing, but management is my main interest. Unfortunately, secondary to today's economic difficulties, higher paying positions are my objectives. Please do not confuse this with greed. Question: what more can I do to maximize my chances of getting that higher paying management position? Getting a MSN is not currently an option. I understand experience is crucial and the main driving factor... Since I don't have much experience I am supplementing my resume' with certifications (as described above). I live in the Lehigh Valley area of Pennsylvania. I am appreciative of any thoughts or suggestions:yes:

I worked in the ER for about 6 years and I truly loved what I did and thoroughly enjoyed the satisfaction of helping those in need. That "feeling", I'm getting goose bumps now even thinking about it, that you get when those doors open up or that stretcher comes rolling into your room and you know you have to act NOW or risk losing someone. That teamwork/family/love relationship with your colleagues in an emergent situation is priceless and I terribly miss it. That critical thinking that you have to do within seconds or risk undesired outcomes. That drive that keeps you hungry to learn more and be better. I miss those days walking out feeling exhausted but content that I made a BIG difference in someones life. Unfortunately, I cant do it anymore. I couldn't keep risking my license day in and day out. That love for the ER did not supersede my license. I could no longer accept the unsafe practices of having 3 vented vaso-drip patients and have an additional 4-5 patients on top of that, with no assistance (often "tubed" a person and helped stabilize with just one doc and no other staff). I could no longer tolerate the unpractical belief that you have 6-8 beds and regardless of what you have in there, you must take another. Obviously an emergency is an emergency but not offering sufficient assistance and expecting perfection is a quagmire to me. Risking safety for dollars is crazy and i could no longer do it. Has anyone felt this way so badly you had to walk away from your love? I terribly miss my "love", but I felt I had to to leave to maintain my license and sanity- went into management now. Mixed feelings..... God do I miss those code red (ER/OR come together) situations....

Professionally i function as nurse facility supervisor for off coverage hours. Currently, i do this for a 210 bed nursing home. I am interviewing soon for a similar position in a hospital with approximately 500-700 beds, including an ER and ICU units. The facility is not far off a drive but requires twenty five additional minutes of driving time... Question: I earn roughly 63k at the current location, hourly position. The potential new position is salaried. Given the above informanton, is it inappropriate/far fetched to request a 10% increase to current pay? As OT hourly rate increase is not possible and accrued OT will never be compensated for?

Congrats on your new position. Hope you are liking it so far. You pretty much hit the nail on the head- it takes time. When I first started using T-system as an RN I found it a mess and blessing all at once. Now, I have come to love T-system because it is very well laid out. A recommendation I can make to assist you in faster triage is to type the medication names, dosing and frequency rather than clicking and clicking- such as, Metoprolol 25mg BID. I find this approach saves much time of looking up at the screen and down on the paper the information is written on. You can also expedite your entry by focusing on only entering what you need to. If you are concerned of getting the info in for the provider to see, if the provider even looks at your notes, enter only the C/C, pain, vitals, PMH and medications- that is all they really care about. Social history, assessment, and interventions can be added later if your busy with the late entry or manual clock entry feature. I use the following process when I'm getting my butt kicked- prepare the gown, turn on and ready the monitor, pull out all IV equipment and have pen and paper ready for EMS report. As report shouldn't take more than 2minutes at most, immediately use the following time to undress, place on monitor, dress and IV your patient. This can all be done in 10minutes with preparation for EKG. If your patient is a tough stick and can wait a few minutes, enter your info and come back for blood- literally:) Orders are a big deal because all ER stuff is *STAT*, but that does not mean each order carries the same level of urgency. You mentioned you had a NSTEMI, resp distress/COPD and pneumonia. Use your nursing judgement to pick your most urgent. I'm assuming the NSTEMI was "stabilized" since she/he could be transferred. The NSTEMI is of priority, but can wait if stable. The pneumonia person will probably get placed on the monitor, blood and cultures gathered, given antipyretics if applicable, and placed on abx, xrayed, CT'd, and admitted. O2, antipyretics and abx are the most beneficial thing for this patient. Get blood, give tylenol, and wait for abx to come up. This person can wait also. I would probably focused all my efforts on the respiratory distress person and worried about getting back to others when my resp distress was "stable." Hope that helps, Regards.

Is administration of abx centrally more favorable then peripherally peripherally? Me and a coworker were discussing this earlier. A pt. had a port and a peripheral iv. Vanco wad being given. She questioned why the port wasn't utilzed for the administration. My thought was the central line could be better utulized for more emergent purposes. what are the clinical benefits of centrally administereof abx vs peripheral? Sorry for misspellings, using phone to type.Thoughts and experiences are welcome.

I'm a recently new graduate nurse with approximately 6 months of experience. I plan on working at my current location, which is level I trauma center with average of 100K+ visits per year, for another 6-12months. I'm wondering what the average income is for an ER RN in Virginia. I will most likely be applying to Sentara Norfolk General Hospital. According to salary averages visible online 60-65k seems to be the average. I'm just wondering how true these figures are. Any input is welcome and appreciated.

I am new to nursing, but worked as a tech for 3+yrs in the ED-place of nursing hire. I have worked as a new RN for about 7 weeks now. I am functioning well and have received positive recognition from colleagues, even the ones that are considered "unapproachable and mean." Anyway, long story short, my preceptors, including charge nurses, feel I'm able to provide complete patient care- start to end. I started out with 1-2 patients for the first week or two then picked up 3rd and picked up a 4th more so recently. Fortunately, I remain able to provide quality care, but I am missing out on witnessing those "special things" a nurse does that makes him/her exceptional, as I am mostly functioning alone. I have learned about maintaining a clean room for my patients and their family. I have learned to look up all medications I have yet to push before I do it. I have learned to provide dignified care to my patients and their family. I have learned to explain all procedures and follow up with my patients before they go for any imaging or after a physician informs them of something that may be new to them. Without me going on and on, these are some of the things I picked up and practice. But I do not feel this is enough. I am a firm believer if you do something be the best or give it your best . So what are those things you try to do or practice that you think provides "the best quality care."

Question: i'm a newly licensed RN that just started in a level I trauma center ER and i'm considering future certifications. I'm planning on getting my CEN but i'm also considering a CCRN. historically ccrn was only for ICU type units. Is this still true today? Is there a way I can find out if a level I trauma center is considered critical care also for CCRN purposes . Not sure if it matters but the center I work in has a connected ER & OR- separated by 2 doors. Also, the ER and OR staff also work together in code room which its in ER.Any info regarding CCRN and level I Trauma centers relation is appreciated...

Sorry. New to the forum posting and to the cite. Unaware there is an ER section...

Question: i'm a newly licensed RN that just started in a level I trauma center ER and i'm considering future certifications. I'm planning on getting my CEN but i'm also considering a CCRN. historically ccrn was only for ICU type units. Is this still true today? Is there a way I can find out if a level I trauma center is considered critical care also for CCRN purposes . Not sure if it matters but the center I work in has a connected ER & OR- separated by 2 doors. Also, the ER and OR staff also work together in code room which its in ER.Any info regarding CCRN and level I Trauma centers relation is appreciated...