MeryMellen

I am a new grad and just came off orientation in December. I had several preceptors, some were wonderful, some were just ok. The best preceptors talked me through each patient. So when they came through the door with certain symptoms they would go through what the worse case scenario would be and what labs and tests should be done to help rule out those dx. I started out just following my preceptor for the first week or so then I started with my own patient to do start to finish. Within about 2 or 3 weeks I felt comfortable with one patient then they moved me to two. Once I was comfortable I moved to 3, etc. I noticed that at the beginning of orientation my preceptor did a lot of the talking but at the end I was doing all the talking. I would stress to her that she does not know everything and is not expected to know everything, the more she asks questions and uses the time she has for orientation the more she'll gain. If she has a questions about something even if she thinks it's stupid, she should ask and not feel uncomfortable cause she may not have you as a safety net in the future. Now's the time to know nothing... not 6 months from now when she's on her own. The thing I wish I had heard at the beginning of Orientation is that the expectation is not that everything ordered is going to be done within 5 minutes. The MD's know that... but for some reason I used to get easily flustered by a long "to do" list. PRIORITIZE! Who's the most important patient to see? What "task" is the most important to complete for that patient? Learning to pull myself away from sick patients to two minutes to pop my head into other patient's rooms was a challange, but is important.

Maybe it has something to do with not rewarming patients too quickly. If you raise the temperature too quickly in a person with a hypothalmus that is properly funtioning they can have a drop in temperature.

Fibromyalgia and Chronic Fatigue Syndrome are dx when everything else has been ruled out, right?

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Congrats! :) I'm a recent grad and a new ER nurse. A few people I work with have taken the CEN exam, I was wondering what's a good period of time to work as an ER nurse before taking the exam? I certainly don't want to take it in the next year or anything, but I was just looking for suggestions for when I should start thinking about taking it! Thanks!

I did learn to advance the catheter once I had access to the vein, but it's a technique I picked up watching other nurses, I found I had more success with this method so I've stuck to it. I think it's less painful because it's quick. With getting access with the needle then advancing the catheter I think patients become a little sqeamish because they can actually feel the catheter sliding into place, if you do it quickly with the needle and catheter it's fast. That's my theory anyways.

I know that it seems like you would blow the vein. But if you're inserting an IV with a 1 inch catheter or 1-1/4 inch you should be pretty confident that you have a straight vein of that length because either method of inserting the IV something is going to go wrong. If you wait for flash back and then advance just the catheter and it's not going in the direction of the vein you could kink the catheter and then it's of no use. And obviously if you advance with the needle you could blow a vein. It's really all about being able to feel a good straight vein. I have better luck advancing the catheter with the needle it's less painful for the pt. believe it or not and when I do advance just the catheter half the time it's kinked. Hope this helps.

12mg of Dilaudid! I think a lot of people don't even bat an eyelash at giving 1mg of Dilaudid, but may think twice if given an order for 10mg of Morphine. 12mg of Dilaudid is the equivilant of 96-120mg of Morphine! That's insane!

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I don't know if it is just me but often I feel that Hyperglycemia is undertreated in the ER. So many patients come in with BS of 300, 400, 500 and will never receive an order for insulin unless I ask for it? Is this just the Physicians I work with or is it a common problem?

I had a Resident order Nitro x3 SL for CHF the other day, it's something I'd never seen and some of the other more experienced RN's have never seen either. How effective is Nitro in treating CHF? Is this an old tx that a new resident happened to dig up or is it a newer tx? Or is it commonly used and just something that myself and other co-RN's did not happen to know of? Just curious:) Thanks in advance

I work in an ER that does not have filtered needles. I find this to be a big issue, one of the medications that we give a ton of is Phenergan. Many of the RNs where I work are not educated about the damage that Phenergan can cause to the vein (perhaps because they do not see the damage they've done because the pts are long gone by the time a phlebitis develops) But I've seen many many patients that are "frequent flyers" for N/V come back with hardened veins probably because they got Phenergan their last time around. I wonder if a large part of the phlebitis' that I see return are mechanical phlebitis' from the shards of glass?

Does anyone know of any contraindication for a patient with a Femoral Central line being OOB?