BrooklynRN11201

sure, okay, spin it like that. meanwhile, I think it's entirely closed minded and unrealistic to expect to be mother superior to everything that walks through the door. did you get licensed to care for the sick or did you get licensed to help get drug abusers high and then to babysit them to make sure they're still breathing? how on earth is medicating a drug seeker "helping" them? talk to them, educate them, refer them to programs, call social work to assist, etc. - I do that all the time. but the ones who don't want help, who come to the ED to get high for free, who are nasty manipulative liars? yeah, I get that this is their coping mechanism, but I also don't have to be played by them and I believe I can laugh about the sadness of the situation every now and then.

what could you possibly get from a 5 year old? if you didn't puncture your glove or feel anything, you likely did not get stuck. I've had a needle stick and you would definitely know it if it happened. as for HIV, it's an extremely unstable virus that's very VERY difficult to contract outside of sex or needle sharing. I wouldn't be worried about HIV in a 5 year old.

your father is 100% right - I work with two NYU grad RNs and I graduated from a community college - we all work in the same department of the same hospital, and I don't notice them having any more skills or knowledge than me. nobody cares where your nursing degree came from, not for an ASN, not for a BSN. your masters is different if you want to go on to become an NP, but it seriously doesn't matter AT ALL where you get your nursing degree - as long as you pass NCLEX and are able to get a job and get the experience (sometimes this alone takes years).

network network network - doesn't matter at all than you're an NYC employee, if you're applying to an RN job they want you to have experience or to at least KNOW you, know that you're going to be a good nurse, know that you're responsible and professional, etc. sending resumes online or applying in person is 100% useless, I assure you. You have to go out there and network with hospital nursing educators, ADNs and nursing recruiters... reach out to them on LinkedIn, contact your old clinical instructors and have them put in a good word for you at their facilities, etc. volunteering at a facility wouldn't hurt either - you have the chance to prove yourself and develop good relationships with other staff there. I got my current job at an HHC hospital after externing there for 2 months - I developed awesome relationships with my preceptor and other staff, including the chief of the ED (my department) and they offered me the job two months later after I passed my boards. I know that for HHC facilities, they only post jobs online they have trouble filling. When they get the green light to hire, they offer to internal applicants first... if not enough of those, they'll post. I am currently trying to switch to a level 1 trauma center and know of two other HHC facilities that are technically hiring in the ED but there aren't even any postings on the internal HR career board! They want their own people from their own facility first... now you see why it's pointless to just send your resume? anyway, I think with nursing you just need to try harder - reach out and network more. I actually do a lot of networking now through conferences and even NYAS (new york academy of sciences) lectures. and try to get as many certifications possible... it doesn't stop at just your BLS.... go get your ACLS, your PALS, etc. good luck!!

I see a ton of drug seekers in my ED and it is sad, but it is also extremely frustrating and a burden on the whole system. I don't see anything wrong with making fun or talking about these people behind their backs - we do that to plenty of other patients, it makes the job a little easier to harbor a sense of humor about certain situations. I think the OP was curious about specific stories so I'll give him/her exactly that: Out of the umpteen sickle cell crisis patients I've seen come through the ED so far, only ONE was actually in a sickle cell crisis. They always know exactly what they need - dilaudid. Some of them walk around, talk on their cell phones, even go outside for something to eat while their waiting. And we can't do much because "pain is what the patient says it is" - then, when the Dr (rightfully) doesn't want to order anything but oxygen, fluids and maybe one dose of morphine until we get labs back, these people absolutely flip out from threatening to sue to threatening to kill to taking their "business" to another hospital. And I'm sure they do - it's not uncommon for a drug seeker to come in with multiple other hospital bracelets on - so out of it they don't even notice. And don't get me started on the blatant liars! "I'm alergic to ASA, Tylenol and Motrin... they gave me, oh what's that drug called, mor... morph..." yeah right. Or the ones who come in with elaborate stories about how they just had some surgery they can't remember the name of, and they don't even realize we have access to ALL their previous visits and can see how many times they came in for pain in the last month." I've actually had my life threatened before by one of these patients and now am looking over my shoulder when I enter/exit the building and carrying pepper spray. So yeah, these patients and their addictions are VERY sad, but the ER isn't a place to come to get high, and I have no problem making fun and sharing my frustrations about these people.

we have a totally separate ED for psych - but 9 times out of 10 they need to be medically cleared first, so we take care of them, get a psych consult, and try to move them to psych ED ASAP. it mostly works, but I honestly wish it were opposite - have a "regular" Dr and RN in the psych ED for medical clearance - most of the time they just take up space in the acute ED flipping out, traumatizing other pts, and it becomes this huge issue whether or not to medicate them because then psych might not take them if they're so sedated, etc. then you have Drs not wanting to put in orders for restraints and too few PCAs to provide 1 to 1 - it's a mess.

Well for me, we chart the minute things happen - as you know, everything is STAT so times are important. If I can't document it right away, I write the time on my hand. Needless to say, by the end of my shift, I've got some pretty inked up hands and arms. But I typically do - 1) nursing assignment note (who endorsed the pt to me, what time I first saw the pt in my zone, etc.) 2) RN initial assessment (full head to toe) 3) if they're intox, I'll do a CIWA and SAD person's assessment 4) a "receiving note" focus note that gives more detail into my initial assessment 5) anywhere from 1 to 6 additional focus notes covering anything noteworthy that might have happened (I usually include an "IV access" note) 6) a discharge note, or an SBAR if the pt is transferred or admitted. In our critical area we have a separate "Critical Care Note" which combines the initial assessment with any focus notes, critical lab values, etc. mixed in there. We don't have much in the way of care plans, but we do document a lot of restraint and 1 to 1 flow sheets and take photos of ulcers. :)

I work 12 hour shifts 3x a week (and 4x a week one week a month). I work 7:30pm to 8am and the day shift works 7:30am to 8pm. We all have a mutual understanding that we will arrive at 7:30am/pm, get changed/ready in locker room, maybe have a coffee, be on the floor no later than 7:45am/pm to get report and give the last shift a chance to finish documenting. Most times we're able to leave at 8am/pm, but sometimes if things are crazy, you'll see people staying a half hour or so later to finish documenting. It's nice having that half hour for wiggle room to run a tad late or catch up on stuff and tie up loose ends before the next shift. It's also mutually understood that admitted patients with beds before 7:30 must be ready to go up and SBAR done before next shift. The ones without beds (virtuals) are left for the next shift but a detailed report is given and lots of questions usually asked. Any pt just placed past 7:30, assuming they're an ESI 3 or 4 and can reasonably wait a half hour to see a nurse, will wait for the next shift with a "just placed, to be seen." This is the way we all work and I'm thankful for the mutual understanding and supportive nature. Usually when I give and take report, there are a lot of "don't worry, babe, I'll give that/take care of that - go home and sleep." It's pretty rare when people are on the floor later than 7:45-7:50 so I usually get out on time. As for the patients, when we walk around and give report, I introduce the next nurse to my patients and explain that they will be taking care of them from now on and that pretty much does the trick. If I have to stay a bit longer to finish documenting, I find another room - we have a suture room in trauma with a computer that is usually pretty quiet... I could also head over to Fast Track or Peds and pull up to a computer to chart for a few minutes. It's best to remove yourself from the area you just worked completely.

I believe we do labs, IV, NS, Zofran, Zantac, Morphine 4mg (initially), CT, Cipro, Zosyn, Flagyl or combination of those, Sx consult.

I'm a new nurse and have been in the ED for a little over 6 months now. I'm pretty comfortable for the most part and we're a super busy inner city trauma level 2 and we're ALWAYS short staffed (typical RN to pt ratio is 1:12)... but I feel like I'm JUST starting to get a little comfortable. In the beginning, I was constantly stressed out. I suffered hair loss, insomnia and when I could sleep, I had nightmares about work. Even though I don't love my ED and would love to transfer to another facility, I will say it's gotten a lot better for me. After a while you learn to leave the stress at work and wash your hands clean after giving report to the next shift. Remind yourself that it's a job like anything else and just do the best you can while protecting your license. The work NEVER ends... you will never get to the point where you have completed all your work and are surfing the web at the nursing station... that's just not the nature of the ED. You being a little slower but a lot safer is definitely an asset, believe me. It takes all types of nurses to help an ED function, not just adrenalin junkies. I work with plenty of nurses who prefer Fast Track or our observation unit all for different reasons, just like I prefer trauma. hang in there, it gets better :)

my goodness, some of you sound like you work at FANCY facilities! I'm lucky to find a monitor that works in my ED. I usually set the parameters around my pt's baseline for the most part, but I always look when I hear any alarm going off - it only takes a second. Great point about the facility's policy on alarm parameters on monitors! I need to look into that.

your background is the EXACT SAME as mine. I graduated last June, interned in the ED July/August, got licensed in September and started my first nursing job in the same ED in December. I had the same feelings as you too - it's all 100% normal. I can honestly say now, looking back, all you need to be successful in the ED is decent "do no harm" nursing skills and a pure and undeniable interest in emergency nursing. you are new, everyone knows you're new. it is ENCOURAGED for you to ask questions, lots and LOTS of questions. I still ask "what are we giving this for?" or my nursing colleagues "what is 'paresthesia' again?" develop a good rapport with people, don't act like a know-it-all and they will always be there to support you. and now that I'm 6mos into it, I am pretty confident on most days - not cocky but confident and totally certain I'm an ED nurse doing what I love to do. my point is, it will pass - the feelings you're having are GOOD - give it 6mos and you'll look back thinking "why was I so stressed out?"

I 100% agree with this - it's the same at my hospital and I don't see what the big deal is. The provider wants IV contrast for a hard stick? Get the ultrasound and do it yourself - I'm not compromising my pt's safety with your "can't you get a 20g in the hand and just see if they accept the pt?"

I know this is a vent thread and I completely understand and share most of the frustrations you do, but do you have a union? can you refuse to work during understaffed and unsafe conditions?

I work in an inner city ED in a very low income/low education area where we see A LOT of drug seekers. I know every ED has drug seekers, but I mean, we have A LOT! I do think our biases affect our ability to see pain as truly subjective. I know pain is what the patient says it is, but the girl in the corner nodding off and a known methadone patient? I'm not so sure medicating her is a good idea. Believe it or not, we actually had a patient sue our hospital for getting her addicted to dilaudid! However, the pancreatitis pt? You better believe I'm advocating and hounding the provider to medicate that pt properly. The problem here is that it's a very fine line and not so extreme cases most times, right? It's definitely a toughie. I work with providers who give whatever the pt wants just to get them out ASAP and free up the bed. I also work with providers who are very stingy with controlled substances. I guess it depends on your clinical experience more often than some would like to admit. Honestly, sometimes I look in the chart to see how many visits they have and what their past visits consisted of. If I see patterns, I'll notify the provider. Other times I'll straight out ask in a concerned voice "do you have any problems with narcotics?" just to sort of let the pt know I'm cognizant of it.