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.

from Jan 2014, not sure if it's been posted yet, but did a quick search and didn't see it: http://www.acepnow.com/article/myths-emergency-medicine/ text: See link for complete article

very intelligent and SPOT ON advice, I appreciate it. to be clear, I do have at least a couple of patients shake my hand on discharge and tell me I was excellent on each shift (which does make it worth it). I do provide personable interactions and very detailed assessments. I do attempt to comfort the patient even if it's an extra rolled up sheet under their legs or sacrum or a cup of water. I've had 4 positive comment cards written about me in the last 5 months, actually. It's just the really difficult patients that irk me, I suppose. But I hear (as this post proves) it's basically the same everywhere. I think it makes sense not to internalize it and to just leave work at work when I go home. It's just tough looking over my shoulder and feeling I need to carry pepper spray with me when I leave the building! BUT despite this, I do think I belong, particularly in trauma where most of my interest lies. I think I just need to focus on getting certified (will be in early June) and requesting more placement in that area of the ED. I just know I also have to pay my dues in the beginning and sort of prove myself to colleagues in the meantime. good point, I definitely DEFINITELY feel a little "tougher" a little more "resourceful" and like I have grown thicker skin so far in my first 5 months in the ED oh my gosh, thank you so much!! :) I love you? 100% - I often vent to my neighbor who was an ED nurse for 3 years and has been an ICU nurse for 2 years and she says the exact same thing! THE FAMILIES!!! ugh.

I think you are missing my point entirely - never did I say ALL my pts are drug or ETOH addicts, but you are very VERY wrong about people not specifically choosing to come to the ED "just because they are drug seekers or drunk" - it happens all the time and I think several people would agree with me on this one. At the end of the night/morning, several people don't want to leave - they want the free bed and sandwich they get at the ER, they don't want to go back to the street or the shelter, many of them are so abusive to the staff, they are escorted out by hospital police. Now please don't twist my words and deduce that I'm not passionate or dedicated in my job. Despite what it may seem to you, I do not discriminate, and I am kind to my patients. I get the feeling like you think I deserve the abuse. I don't think ANY nurse "deserves" the threats and verbal abuse they sometimes encounter in the ED. You're right, of course I'm lucky to have this job as a new grad, and I knew exactly what I was getting into, but my specific question was "How do I not care enough to let the stuff get to me but still care enough to provide good care to everyone?" It was not "how do I ignore/block out these patients and survive my shifts?"

So I'm adjusting to working in the ED and really do enjoy what I do for the most part in terms of the actual job and the care I provide. I enjoy the fast paced and collaborative nature of ED work, and I feel like I've learned so much and now want my CEN and Trauma certification. What's the problem, you ask? I'm normally a very relaxed person, but the last 3 months I've been overloaded with stress - experiencing nightmares, losing my hair and having my chronic psoriasis flare up all over my face and hands! It's gotten to the point where I actually dread going into work if I'm working the acute area and not trauma or critical (where the complaints are actually valid) What I find extremely difficult about my ED in particular is the patients. 9 times out of 10 they are nasty no matter what you say or do. My ED is in an inner city hospital with a very low income patient population. We're a Trauma Level II hospital and see a lot of gunshot/stab wounds, sexual assault, drug overdoses, etc. ETOH and drug abuse runs rampant, a good 1/3 of our patients are prisoners who verbally abuse you or harass you while you're just trying to do your job. I get threatened or cursed out on almost every single shift. Of course there are the regular complaints about wait time - people lying to my face saying they've been there 8 hours when I know from their chart they were triaged less than an hour ago. But then there are the drunks peeing all over themselves, screaming for a sandwich, calling me a ****** when I explain we don't have any food and then demanding I go across to Peds to get them some juice. Then the abd pain people who are no joke, sleeping or eating right there in no distress at all, complaining and complaining that they're in so much pain and, oh, they also need a Dr's note for work. Then the drug seekers who claim they have a history of sickle cell and are experiencing a crisis, then they get irate after you explain you can't give them more than the 6u of morphine and 4u dilaudid you just gave them... and then you get the CBC back and their WBCs are 100% normal and the pt is still saying they're in pain as they're nodding off in bed. the guy who comes in claiming he missed his methadone dose today, doesn't have his clinic card to confirm his program dosage, and after waiting an hour claims to now have chest pain as he's sleeping in bed (really knows how to work the system)... the people with asthma who come in reeking of cigarettes, they take a couple of treatments and walk out before even being seen by a Dr., the confused elderly woman who has no idea why she's in your ED other than her daughter just "dropped me off" right outside... I have seen patients physically assault each other, elderly patients just abandoned there by their kids, patients lying about sexual assault to get people in trouble, drug seekers, the same ETOH patients every. single. night. I know I'm a good RN, I don't have a lazy bone in my body, I know I do my job well, and I shouldn't have to require the patient's approval, but for some reason it just makes me wonder why I do what I do - why I voluntarily go into a place to work my @ss off and to only get grief from patients in return. ?!? It's a large city hospital too, and I so don't want to end up like some of the other nurses - absolutely jaded. How do I not care enough to let the stuff get to me but still care enough to provide good care to everyone?

well the obvious are the psych patients... I had one the other day who swore there was a squirrel stuck in her lady parts. but one time I was working trauma and this lady comes in saying she fell on black ice - I asked her what hurt, what was her trauma, and she said it burned when she peed! of course me and my colleagues later said "she fell on black SOMETHING" - I mean, of course I ruled out any kidney or perineal injury - she just knew how to work the system and bypass EZ Care (fast track). that's all I got as I'm very very new, but I'm sure I'll have more to come.

I'll echo what everyone else said - I am technically a new grad (June 2013) and the only reason I got a job in my ED is because I externed here over the summer and made some nice connections. I realize I am very very VERY lucky. That said, the types of certifications that will likely help you are ACLS and PALS if you haven't gotten it already, and you can also get certified in trauma, IV therapy, wound care etc. etc. - check to see what's available to you in your area. All that stuff looks good on a resume, but I don't think, even if you passed the CEN (and everyone I've spoken to say it's impossible to pass with less than a year experience), that it will look good on your resume without the experience to match it. The only way to beef up your resume is to add relevant certifications and get SOME sort of real world clinical experience, even if it's volunteering or working as a visiting nurse for now.

I might be relocating to Huntington Beach, CA from NYC in a little less than a year from now. I know it's a little premature, but I'm just wondering how the job market is there and if anyone had any advice on getting a job? Technically I am a new RN, but I will have had a solid year experience in the Emergency Department by that time. The thing is though, I do not yet have my BSN. I'm hoping to be at least halfway through an RN to BSN program by then. Ideally, I'm looking for something in the ED or ICU, but eventually would like to work for an Endocrinology practice as a diabetes educator so that would be a nice option as well. If I cannot find an RN job at a facility or practice, how hard would it be to work as a visiting nurse, long term care facility nurse or even a per diem nurse? Any information is greatly appreciated, many thanks!!

Maybe of the seconds/minutes you're supposed to push? I know nurses who push meds way too fast (like in 5 secs) but I don't even count, I just do it as slow as possible giving a few seconds between each advancement of the plunger. But even if it's ordered IVP, I never ever give certain meds that way for the sake of the patient - like Reglan, Morphine or Dilauded (if they are naive), or SoluMedrol! I inject the med in 50mL of NS and run it wide open.

You'll never be bored in the ED but you could get jaded from the type of patients you see over and over and of course the workload is pretty insane. But orientation will walk you through everything step by step as long as you're a relatively fast learner you should be okay. I love the ED! Good luck!! :)

I have an ASN, was pinned in June, did an externship in July/August, got licensed in September and was offered a job from the hospital I externed at in October in the ER. Yes, hospitals do hire ASNs but you really need to either get in from the inside (ie already work there as a tech or something) OR have volunteered or externed there. My classmate where this was not the case are ALL still unemployed, and I know some BSNs who waited 8mos before finally getting a job. Getting an RN job at a hospital is very competitive but it's possible - I suggest you volunteer or extern in order to increase your chances of getting in. It will absolutely not be a Mt Sinai, North Shore, Continuum or any private hospital as most are magnet status (doesn't matter what you already have a BSN in) and tend not to hire new grads even if you've got a BSN from Columbia - check out the HHC city hospitals. You might also want to increase your chances by getting some experience under your belt such as working at a blood bank, clinic, urgent care facility or even as a visiting nurse or at a long tern care facility.