CoolhandHutch

Two completely different mindsets. The OR is very linear and controlled. The ED is very ADD. After having done both, I'm very much the latter.

In the ED, there seems to be a favor of rate control over rhythm control for AFib, hence the use of cardizem. Plus, you mentioned your patient having symptoms for a week- it's possible he has been in afib that long and you wouldn't want to convert him without making sure he is nice and anticoaglated....stable people will get a TEE as well.

The major issue is not the setting but acuity of the patient. Do primary care/family MDs only practice in the clinic? No, they see patients in the hospital. Do they see patients in the ICU? Typically no. Point is, the consensus model provides that your patients you care for match your formal training..NOT where these patients are physically.

I did my RN-BSN completion through an online program and currently I am doing my ACNP through a "traditional" program. A few thoughts about this whole thing: Being an online/distant educated student requires, IMHO, a higher level of organization and motivation when compared to onsite programs. It's also true that a certain amount of learning happens in the classroom, especially within discussions with classmates, yet many online programs are discovering this and trying to bring this to the 'net. I agree with the consensus that many private and for-profit programs are starting to erode at our credibility...now if we can stop all the infighting that trying to determine our "best education" credentials and stop changing the alphabet soup behind our names....that's a wholly different matter. Ask your doctor if he/she ever heard of telemedicine. If you cannot educate someone over Wi-Fi, how could you possibly treat them?

Much like the "Recommended Education for Entry into Nursing Practice" is the BSN, the same goes for the DNP. Now, how long have we being hearing about the BSN? Today, there are many hospitals that are driving this change (BSN as education requirement)- not schools. However, there are many schools that are changing their MSN programs into DNP programs- but there is no "law" that is driving this. Just a recommendation.

I'm good at making VERY realistic poop from a combination of wet toilet paper and a few drops of betadine. Drop it in a bed pan and leave it at the nurses station....not very professional but it's what I'm good at :)

The hardest part about assessing patients in the ED is trying to figure out what to do with those that have very vague complaints...and making sure they are not ominous. For example, a 20 year female that states "I just don't feel good. I threw up once today" can be very different than the 80 year old that states the same thing. Zofran ODT and OTD for one, ECG and labs for the other. I always quote the patient on their initial complaint and let that determine my assessment. You won't have time for head-to-toes but if some says they are SOB- listen to heart & lungs, check for edema, move on. You will find your groove in time.

I would be more worried about the older, female nurses that resent/dislike/are irritated by/scared of male nurses. They're out there. Now, you are also going to run into male nurses that hate everyone. Or female nurses that only like male nurses that are friends with female nurses. More often, you will discover docs that will not date nurses, or doctors, or anyone else in the health field. Or your experience may find you dating a doctor, could be a male or female depending on your tastes. Point is, quit worrying about it. My docs respect me (and will respect you) not because I am a male nurse but because I do a good job and they can trust me. I doubt that was the case in my first few years but it's probably the same measured caution they were using with me that I use now when dealing with med students and 1st year residents. Do docs think you are dumb? Maybe. I do know that I have saved several from making medication errors and caught things they missed. It happens, they're thankful, we move on. As far as the dating thing goes....#1. Don't sh*t where you get your food. Ever. #2. And masculinity doesn't come from your profession. FYI

I did the BSN completion program at JU and would not recommend it- they only "kinda" offer the gen eds- I had to go elsewhere to get stuff like humanities, international studies, and so on. It may have changed somewhat by now, I enrolled in 2004. However, I am paying less per credit hour for my MSN than I did for my BSN. Look around, find something local and hopefully cheaper. Whatever you do, make absolutely sure you understand what will transfer and what you will have to take.

If you think nursing is restrictive, wait until you start with your nutrition classes. There are some more progressive areas in nursing which might suit you but on the whole, it's Western medicine. I understand where you are, I feel somewhat the same- proper food and nutrition (NOT the FDA's silly recommendations) along with exercise will stave off most CHRONIC diseases. Understand, though, that there are some facets of "the pill popping" mentality that are superior, and in most cases, the only intervention that will return an individual to health. Acupuncture won't reduce a dislocated joint and most certainly won't unblock a coronary artery when it decides to get pinched off. As far as erasing medical errors, that's a matter of integrity. I can assure you, however, it is not encouraged, tolerated, or remotely acceptable.

What's the hurry? Is your patient crumping? Then IO or EJ. For routine stuff, I've done upper arms up to the shoulder. Seen a boob done once, didn't really see the point. Occasionally would do feet in non-diabetics but that's getting phased out in most hospitals. I haven't seen any literature that finds a greater incidence infiltration from "non-traditional" sites but that's mostly because I haven't looked. Most hospitals would/should have a policy about PIV sites. Don't bother asking the doc if you can do it somewhere unless you know what your policy says.

The one thing you need to remember that when you get a patient into the ICU the "groundwork" is usually done...line, labs, tubed, drips. Usually. If you are really fortunate, you might even have a patient in a gown. Pants might be on still even though there's a new foley in place. I digress. The fun part comes from separating the crap from the crump. Is that routine sore throat a peritonsillar abscess or epiglottis? What about that old lady who just feels "really weak" that has a unhemolyzed K+ of 9.7? You won't be bored.

I have heard of some hospital systems doing this, Press Ganey be damned! There is typically more to it- kids under 12 or 16 are exempt, as are people over the age of 60- I can't remember the particulars but you get the idea. No one is going to miss the MI or CVA, this is for people that show up for STDs, uncomplicated URIs, rashes, etc ad nauseum.

I have my pitchfork and torch, where we headed?

Give it time. And, IMHO, the incident report about not getting someone cleaned out is crap!

Big plans for the future? You realize you're in nursing, right? Last I heard, community organizing was the best route to go for "big plans"......

In my experience, in order from most to least accurate: mom's hands, foley, rectal, oral, tympanic, forehead scanner doohickie...those things suck.

.....even the frequent flyers crump. It's just a matter of time.

One person posted recently that the difference between ER and ICU nurses was; ER = ADD, ICU = OCD. There's more truth in that than you might believe. Never have truer words been spoken. I have also heard the ED called "fast food" and the ICU called "fine dining". Works for me. There is a bunch of crap that comes with working in the ED...but that will be true with any job. I explain to nurses new to the ED that I don't come to work for the 99% of the patients that really don't need me but for the 1% that do. And the best part is that you don't know when that 1% is going to walk in and try to crump on you.

As that tube is sliding past the vocal cords, my ED docs can count on me asking the same thing every time..."What are we keeping him/her down with?" Saves a bunch of frantic maneuvering when your intubated patient is profoundly tachy and it dawns on you that they are paralyzed but not sedated.

I always tell my nurses this: PROTECT THE HEART Hide the K Remove the K So, in that regards, calcium always first, the insulin/d50, then kayex. Remember, insulin/d50 only shifts the K but it's still in the body. Always figure out what the "exit plan" is...kayex or dialysis. And remember! The floor nurses LOVE it when you give the kayex right before leaving the ER ] Oh, and let's play the "highest K game"...9.7. Twice. Drawn off a port, no hemolysis. ECG looked like a rolling wave. Pt was a&o throughout, complained only of feeling really weak. Puckered! 2g ca, bicarb, insulin/d50 then off for emergent dialysis. Good times.

I took several classes from APUS and had no trouble transferring them to my school. Before you take any class, copy and paste the "course description" and send it to your advisor. They should have no problem telling you if it will work or not. APUS is accredited so it just boils down to taking the right class for your pre-reqs. IMHO, if your advisor can't tell you if the class will be accepted based on the course description, you need a better advisor

I work at an urban ED that sees somewhere north of 60,000 people at year, mostly complex medical with the occasional walk-GSW (almost once a week it seems). We're a nationally accredited heart center and various other things but we have no official trauma status. I've been tasked with gathering the preliminary information to get this party started. There's a level one adult literally right down the street and there are other factors that I think we'd be a comfortable level III (adult only). We are a teaching facility but currently do not have an ED residency program- that's in the works as well and not "my baby". So, who do I need to talk to first? I've worked level one before and have a pretty good idea of many of the "is and outs" of maintain status but have no idea how to get started. Thanks in advanced for any information. I do appreciate it.

Is nursing a good job? I work in the ER and I can't imagine myself doing anything else. I've joked with my wife that if I won the lottery I'd still have to do this because, well, it's pretty dang fun. Patients can be rude, docs can be rude, residents can be clueless, but these are personality issues. They're everywhere and in every profession; we don't have the market cornered on asshats. There is stress. Imagine running a peds code. I've cried at work before. It can be tough sometimes. But like I said, I can't imagine doing anything else.