phlebitis

I had a patient not long ago sign out AMA after he was diagnosed with a new esophageal mass causing tracheal deviation. You could see it protruding out of his neck and could hear the stridor. Pt refused to believe it was possibly cancer because he was only SOB and had throat pain for a few days. MD wanted to admit him for further evaluation and he refused. I still wonder about him...

I was hired into the ED out of nursing school with an ADN. I had three months orientation, no classroom time, the last month was on night shift which was what I was hired for. I was terrified my first shift alone, although I just had to realized that I wasn't alone. I often asked questions of my pod-mate, I called the pharmacy A LOT, and I just took things one step at a time until I figured out how I was going to practice nursing in a way that I felt good about. We have up to 6,7,8 patients a piece where I work. When someone has an ICU patient, the pod mate handles the rest of the pod the best they can until that nurse gets the patient upstairs. If there is a code, everyone helps, and the rest of the patients in the ED just have to wait, because they aren't dying. Take control of your assignment, prioritize, and ask for help. Ask other nurses how they chart, take advice from everyone and develop your own practice that allows you to sleep at night. Learn how to maximize your time and try to be as efficient as possible. This comes with time. And I think the most important thing is to know what you don't know.

Not everyone with abdominal pain gets a CT scan. It depends on labs, physical exam (tenderness), other symptoms, etc. I'm not giving medical advice, just speaking generally. The ED rules out and treats life-threatening illness and injury, we often discharge people without finding the cause for abdominal or chest pain, etc to follow up with their regular doctors. Additional testing if warranted can be scheduled on an outpatient basis.

I agree with other posters, get certifications. Yes, they are expensive but your application will stand out and they are great skills to have. Driving an hour to work is not unreasonable. Try following up with a phone call to each facility. I had a hard time being aggressive with my job search. I learned that nobody is going to come looking for me even though I had a 4.0 and great references. I applied to every facility within one hour of my home (single mom with kids, or I would probably have gone anywhere). I then began to follow up with a phone call, I'm sure HR was annoyed with me, I went to open houses at SNF's. I took ACLS and a cardiac interpretation course through the AHA. Eventually I got really brave and mailed my resume and cover letter to one of the directors of the ED I had clinical at. She called me back and offered me a position because she remembered me. (I wish schools would reiterate to students to network during clinicals, many people got jobs that way). Also, be wiling to work any shift. You just have to get your foot in the door. Best of luck.

I haven't posted for a couple years, but have been a lingerer on this site.....I work in the ED and have had some training on Ebola/MERS. Our triage note has a required field asking about recent travel in the past 21 days, if they answer yes, more questions pop up, we had training on donning/doffing PPE which includes hazmat suit with hood, N95, Plastic face shield, booties (if the hazmat suit is footless, there are two kinds) and double gloves taped on. It is very uncomfortable and I found myself pouring sweat and panic setting in, I felt like I couldn't breathe, I am sure I will pass out if I have to wear this. Other nurses felt the same claustrophobia. The patient will be assigned one nurse, doctor, and room monitor (PCT). The room monitor is required to sit outside the door and record names of everyone entering/exiting the room and to gown up and assist the nurse/doctor to remove the PPE. The will watch for any breaches. We were told to simply insert an IV if needed and administer medications if ordered and if they meet certain criteria, will be transported to a larger hospital prepared to admit them. We were told to not draw any blood as our lab is not equipped to handle it. Despite this training, I am terrified of removing the PPE. What if something goes wrong? I will have to really trust in the PCT to do it correctly for both of our safety. We all just did it once. I do not feel prepared and I am uncertain. I do feel better that we have the right equipment, I'm just not so sure that we are all confident and ready to use it correctly.

I think I wrote the post where I stated that my preceptor told me I would make it because she can usually tell as she has had students before. I just wanted to clarify that her statement wasn't made on day one. It was made after a couple of shifts and she also told me at the time that I am independent (not afraid to jump in and try something; even though I am on the inside :) and a quick learner. I think she was talking mainly about my willingness to learn and that I know I have so much to learn, I'm humble. I also ask 4million questions every shift. I don't think my preceptor thinks her opinion is the be all end all of my ability to make it in the ED. It was just something she told me while she was talking to me about working in the ED. I hope she is right and that I end up being a great ED nurse, because I really love it and I want to be good at it. So don't worry too much about hearing those words or not, they are just words. We have the ability in ourselves to make it.

Thank you all for the replies! I was so surprised to log on here today and see that so many nurses had taken the time to offer support. I will try and be more patient with myself and remember that I am a "student" with an RN after my name. I still have 3 months of orientation left so I have a lot of time (sort of) to keep soaking it all in. Thanks for the support guys :)

Thanks for the replies. I am a perfectionist and am my own worst critic. I am sensitive and want so much to feel like a good nurse as much as actually being one. I'm scared to make a mistake, but I know that nobody is perfect. I am giving myself a year to at least feel not so stupid even though it will take much longer than that to be truly competent and experienced. I am happy to hear that many have gone through this and came out just fine.

I am a new grad RN working my first nursing job ever in the ED of a community hospital. I have worked 5 12 hour shifts so far. My preceptor is amazing and extremely supportive. She says I will be great, she says she can tell on the first day if someone will make it or not. I have been taking 2 patients on my own (with her having full knowledge of what is going on and being there for any questions I have and making sure I don't miss orders, etc). I also help her with her patients. I love it and I am very lucky to have been offered my dream job right out of the gate. It is just so hard. I graduated at the top of my class and am currently in an RN-to-BSN program, but I feel like I forgot everything I learned in nursing school. It is busy all the time and I am struggling to keep up with 2 patients. I have to adjust to each doctors personalities (one doc is sensitive to sounds so she gets annoyed when she hears monitors all the time so we have to turn off the respirations, but I like using it right now because I am so new and this same doc wants orders completed immediately so I feel pressure to not screw up and miss something as soon as it comes up) I just feel intimidated by the doctors, everyone calls them by their first names, but I don't know if I should too. I guess I just hate being a newbie and am scared I am going to screw up. I feel like everyone thinks I don't know anything because not only am I new to the dept., I am a new grad. Can anyone relate or advise?

I have the same problem. I get really nervous around fine motor skills and unfortunately it manifests in my hands and they shake pretty obviously. After a few times of this happening, it was really starting to effect my confidence and self-esteem and I was afraid to even go to skills lab where I thought people would notice and gossip about me. I went to my instructor and she advised me to see my doctor since it was sort of a big deal and effecting my performance in the program. She told me she wasn't afraid of me hurting a patient and that it sometimes happens to people. My NP prescribed a beta-blocker to take 1-2 hours before I needed it. Since then, I have been a whole different person. They will shake ever so slightly sometimes, but it has been a huge improvement. I feel so much better about myself and my skills. If this is something that is really bothering you and possibly holding you back mentally, then go see your doc. Over time with practice, it may go away on it's own as well. Good Luck!