cadency

Hey all! Just wanting to introduce myself and talk about endoscopy. I'm going to be starting a new position in the field in the next two or three weeks. I'm pretty excited - I shadowed for a little while and the area is interesting, lots to learn, and totally different. I presently work night shift in a level 1 ER. I've been in the ER nearing three years and I find the nights and politics of the area wear my body out. I get sick all the time and we are chronically short staffed. I've had a few naysayers who, when they find out, keep telling me that I'm going to hate it. When I ask why, they simply say I will be bored compared to the ER. Has anyone had this experience? I see mostly people on this forum wanting to go into it - for the hours and type of work load... not people complaining about how boring or how intensely stressful it is. Really, I'm going to start school for my masters soon. I think I could use easier and less stress! Has anyone had experiences with Endo being very cliquey? Along with the, "you'll hate it," I've also been told that... I guess the fine point is: If you started somewhere from endo, where did you start? What was the transition like for you? Would you do it again? Just from meeting people on the unit, once you get in endo... you stay there. Most of everyone had been there for a long time.

Thanks for all the input! Gonna try to keep my head up. I try to be so cautious with the adult population but it sounds like it'll be even more important for the kiddos! Will definitely ask lots of questions and y'all make me look forward to the change. It sounds challenging but I believe it'll be a worthwhile change in my skill set. Thanks again!

I was thinking about that the other day; more appys, more seizures, asthma/bronchiolitis, etc. So good point! I realize the focus will be totally different. I think it'll be challenging to the skill set. I realize that they also go down hill more quickly and more unpredictably - whereas adults tend to shut down (physically) more progressively. Thanks for the good luck and input! :)

I worked at another facility that forced you to use a disclaimer stating that anything on your facebook was not associated with the facility. The other option was to not even list you were working there. One of the girls I knew there got in trouble several times because SOMEONE ELSE was reporting her to HR . It was a large facility; HR didn't scan everyone. Someone was reporting her. Did the same happen to you? I just leave my place of employment off of my facebook...

I feel like I've seen more nursing cannibalism in the ER than I did when I was on the floors. I've also experienced a lot of "favoritism." Certain people given preference by those in power or certain people only being willing to help their "friends." I don't believe all units are like that and that fitting takes time. Keep your head up and do the best that you can. Don't be scared to put your head out of the room and yell, "I NEED SOME HELP IN HERE." when it happens. Sometimes, that's the only way to get the hep when everyone is busy with their patients... Good luck!

Some of the time management things will come with time; does your ER have set protocols? That helped me so much when I started that I began to anticipate what I would need for my abdominal pains and even my headaches. I could get most things done before the doctor even came to see my patient. (minus meds, of course) Someone else said it best; focusing on what absolutely needs to be done versus what would be great to be done. How does my patient look when the triage nurse walks them by me and into my room? Getting the skill of being able to assess who doesn't look right when they walk in will help as well. My walky-talky sore throat patient can wait while I prioritize care for my chest pain patient. Learning to "triage" your tasks is important and it is okay to go slow while you get there. I had 12 weeks of floor orientation and had to be able to take a 4 patient load by then. It's doable and if you need to ask your preceptor to hands off, that is okay. It's scary and ER nurses have a hard time to keep hands off during precepting. They are used to getting things done and doing it their way - not watching you do it. My preceptor finally started to float around and make sure everyone was okay while coming back to check on me every little bit. Taking that leap is sometimes the only way to get there. The ER tends to be a jack of all trades. I recently assisted with my first cardioversion of a wide complex tachycardia. We used fentanyl and versed. My hands shook giving the meds... but it went ok. You just always ask questions and don't be afraid to say, "I don't know how to do this." You can always grab a more experienced nurse and ask for the "see one, do one, teach one."

Grats! It'll be a ride! I started in the ER straight out of school and it can be a challenge... but definitely doable!

So I started in an all adult ER. I'm at a combination ER with minimal pediatric contact. I just got offered a position as a pediatric ER nurse with some cross over to the adult side if I want to. I accepted and am a combination of scared and excited. I was a preschool teacher in the past so I have some experience with kiddos and parents. I am unsure of what other issues I will run into and was hoping for feedback on the contrast between the two. What issues have you run into in the adult environment? What issues in the pediatric? I know all ERs aren't the same. My experiences, though, with management and some staff hasn't been good. I've found a lot of nurse cannibalism in both of the ones I have worked. Is this common in the pediatric focus? I'm frustrated with where I've been at. There's a lot of working short staffed, increasing assignments, pushing, and passive-aggressive management. Speech between coworkers can be very rude; things I can't even imagine saying to another person. Some of these things are being said in front of patients. I'm hoping that some of this changes in the peds arena; would love any input on that or if I'm gonna be stuck with some of these attitudes regardless of where I go? I understand and recognize that there will always be negative and gruff people wherever I go. Conflict, drama, inevitable... but I've worked other places that it is containable, limited, or short lived. This hasn't been true for either of the ER's I've worked in. I'm also looking for suggestions on the best ways to deal with pediatric populations; IV start tricks, assessment tricks, etc. Any thoughts, input, or advice would be appreciated! Thanks!

I can totally relate to this post right now. I've been in the ER environment for a year and a half. This being my second ER since I've been in a new state. I don't know if it's the state out here, but the ER environments have been very difficult compared to my other experiences in hospitals back in Arizona. I find, more than anything, a lot of burnout and roughness in the ER. Yes, the populations we see are the worst. Yes, occasionally some of the patients appreciate the care and not spit on it. Sure, the work is hard... but the staff is so burned out and miserable. Even in jest, the staff members are cussing each other, cussing in front of patients, being rude, saying things I cannot even imagine saying within ear shot of the patients' rooms. I find this wearing me out... Not all of the techs I know have been like that. I was a tech for 3 years and EMT trained... so I understand the stress they are under better as a nurse. I've run into some that are very... arrogant about their skills and find certain tech requirements beneath them and so won't do them. You learn who to ask, who not to ask, and what to just do on your own cause it's quicker. My ER has "goal" times for discharge of an hour and 20 minutes. Now they're cutting back on staff, 4 people have left and they've only replaced one of them... and putting on more charting/pt demands. Things that should be done quickly and take precedent are being ignored, delayed, or getting done inappropriately. Like you, I feel like I've had to make choices on what I can do well and take time to do and what needs to get shorted on. It can feel like an unsafe environment for my license. Maybe a new ER is in order? A new PRN job for a new challenge? Or a good vacation... Keep your head up; you aren't alone!

I'm a new grad in a level 1 trauma ED. Been there since March, but am in a nurse residency that gave us the benefit of working through 7 critical care units to find one that "matches" to us. Being a new grad nurse is a challenge and, a sI can relate, I will say that everything you're feeling is expected. If you didn't feel stupid, you aren't learning. I've talked to some of the nurses in my ED that have been there for years and because of the nature of the ER, they say there are STILL times that they feel stupid... and it's simply because in the ER, there is no real consistency. Unlike on a floor, you cannot predict or "assign" the appropriate patients to a new graduate. You can't take some of the same precautions on a floor for a new grad in the ER. The ER just doesn't work like that. You treat 'em and send them off. It sounds like that you did the best that you could do and that you had people around you to support you... and that, at this point, is the best thing for you. You'll continue to succeed as long as you rely on those around you to help you grow into this RN role. It'll be worth it once you know you've hit that moment... that "click," things are comfortable. Good job, I say! Keep working hard and know you're not the only ER grad feeling those things. PM if you ever need to...

Just to confirm... ED is royal blue dress code. When you go through, a lot of the units will have t-shirts they can wear. ED is the only unit that doesn't allow that... but when you're rotating through, prior to match day, it's okay to wear non-royal blue and a vandy t-shirt. Parking isn't a few dollars if you end up on day-shift unless you got for a shuttle lot some distance away. Parking on days can go beyong 72$ a month. It's easier on night shift and most critical care units guarantee that you will be on nights. This was not the case in the ED. There was possibility for day shift in the ED and some others were open for shifts like 3-3, 11-11 and 1-1. If you get nights, some of the garages are as cheap as 10.72$ a month.

We have a sickle cell protocol at my facility. O2, q30min dilaudid x 4, q1h dilaudid x 2 (iirc) and then see where the pain is at. If their pain is still unmanagable at that point, it decides whether we admit them or not. With those orders are always PRN benadryl and phenegran. I always simply assumed that it was for itching and had a SC patient recently tell me that the dilaudid made him itchy and nauseous. Though, it can definitely appear as though some prefer the snowed effect. Didn't know about the rest - such as the possible adjunct effects! Good to know! Good topic! Thanks for the discussion! :)

My only comment to this would be to consider what you want to do in the future and how long you intend to be at this job. An ED, you can take pretty much anywhere. Burn, however, is much more specialized and very very different. I rotated through a Burn ICU and it is not for everyone. I would ask for some shadow time on the unit if you have not already before you decide. Burn cannot go everywhere. You may be able to take the ICU experience into another ICU... and maybe, depending on the facility, be able to take it after several years experience back into an ED...

I graduated in May of 09 and relocated in January 2010 from Tucson to find a job because the market there was so tough.

I live in Antioch... it's about 25 minutes away from Vandy. Antioch's odd in the way that some areas are friendlier than others. Brentwood is posh and more expensive. The closer you get to Vandy, the more you'll pay. The Lexington apts are nice... and they're about 10-15 minutes away from Vandy... I can't really name off apt complexes so much as I can cities. There's a list of apartments on the Vandy benefits website that offer discounts to Vanderbilt Employees. The Lexington is one of them.