AZQuik

Those percentages are a little different where I am, but this post is a good indicator of a day in an inner city ED. Things change a bit when you factor in your duty for the day as well.

A lot of good advice here, but the bottom line is, the more codes you work (not practice), will make them more mundane, and settle your adrenaline a bit. Until then master the skill. Start iv's the same way every time. Pretty soon the muscle memory off tkit, clean, poke will become so ingrained it will be automatic. Often the tube goes in during a stop in CPR, time it so that's the poke. Also, don't be afraid of the i/o. Much easier in general, and during compressions much easier than hitting a vein.

Yeah post something calling other people cowards and see if you get a positive response. Trolling 100% I work with nurses in the Ed that are full time school nurses and they are not cowards. Come work with me a few shifts and call my coworkers cowards. Very dismissive for a group of people that have a set of vitals and a chief complaint, and figure out the correct differential AND stabilize the pt before anyone else knew they existed. That kind of thinking is exactly what healthcare does not need. In the future, back that statement up, or sit on it.

Honestly the

Depends on what I'm charting and why. I do intakes/assessments I usually chart in room unless there is a reason I don't want to be there. Flow and discharges I usually chart out of room. Meds are tricky because as er nurses we can get away with charting without scanning, but I try to cart meds floor fashion unless emergent or super busy emergent is next doorway

Visits/week does not factor into esi level. Period. 2's can be 1's or 3/4/5's depending. 5's can be 1's....depending. If you can justify your reason for picking X. Don't worry about it.

Ratios are ok but there needs to be some flexibility. Sometimes a migraine turns into a an acute stroke eligible for TPA(in a 6:1 zone, and other times a 2 turns into a 3, but someone freaked out and saw three 2's in a 5:1 zone and moved em all to a higher ratio. Turns out they are all reproducible chest pain tachycardic because they live in the desert and are dehydrated. BUT, since they are 50+ y/o men with a CC of chest pain, they are a 2 until the trop comes back. So now you move them and have a 3:1 nurse getting them a sandwich, and pointing them to the bathroom, until the three hour repeat trop/ecg is due. Think their FB was updated during that time?

You are allowed to tell them, there are X people waiting and, Y is the longest wait." When they complain I tell them, " based on my triage I think you should get a medical screening by a provider, but I cannot hold you here against your will, if you really want to leave, for whatever reason, I am forced, by law, to let you determine your own treatment" Unless of course they are not free to go, in which case I need to find a room

Pay depends on where in the country you are, but it's not great. I mean you can be ok, but you aren't getting rich. You won't starve though. It's a lot of drama and work. More than you would think. A starting new grad probably makes a few buck more than the average high paid construction worker. More if you work differentials. It's not bad, but like I said you aren't getting rich. Should be pretty easy to find nurses pay in your area

Honestly I don't think of an "er nurse" as a "critical care nurse". Not to say a nurse can't be good at both, and there is a lot of overlap in drugs/blood tests/skills/charting. But really they are different in mindset, and obviously pt load/demographics. In my opinion, if a critical pt comes in, the ER specializes in stabilizing. The ICU is where the healing begins. The real difference IMO is that The ED nurse needs to be able to have two septic pts tubed and on pressors while having one to three other whatevers. Facing that the mind set will always be," well, did they die"? The icu nurse is trying to get their pt to the floor, so they can decompress the ED. Two totally different mindsets and priorities. Who cares which one the CRNA school accepts? Want to get into X school? Meet X requirements. The two points are apples and oranges to the parent of the child you are coding, no matter if you are in the ICU,or the ED

Usually hard working, respectful people working together on an interdisciplinary team find respect for each other. Unfortunately not everyone is hard working or respectful. I work in a busy high acuity ED and still find time to say please, thanks, and great job. Those saying the ED is too busy for these words are flat out wrong. Seems many here took offense to the OP, I think if the shoe fits, wear it. If you don't act like described in the OP why the offense? I've watched RN's do non work related things while the tech handles the code brown. I think the things the OP vented about have merit.

Are you using a cross sectional view or longitudinal view?

Body fluids in my eye. Gross

Can't quote for some reason, but @ Lev

If you want to feel like you are doing your share, do more of the things you can do. Most of our baby incubators do not deal with people who are violent if we can help it, aren't lifting a ton, etc. but they can help check in an EMS, wipe a but, or get an ekg done. Divide and concur. Ask for help when needed, and offer help at every opportunity. If a nurse is busy and they get an EMS, go check it in. Line and lab, do an assessment, hook me up to a monitor, grab a bag of fluids, and do an ekg, or whatever it is that needs done. People will appreciate it so long as you hold the standard of care and aren't a liability when doing these things. Then ask for help if you need it. Come back in 6 weeks and kick some butt! Six weeks isn't even two schedules. Go get it!

The internship will not be unsuccessful due to your pregnancy. I have seen new grad nurses do it. Give it a go and see what happens. Use your maternity leave to be with your child and get your CEN so things stay just a bit fresher. Be ready for a few bumpy days when you go back. Congratulations!

Many less train wrecks in the ED. The difference is they often have crashed before they arrive. No lines, no tube, knife in their pocket, restrained by EMS, blood and commit everywhere. Or whatever "unsanitized situation" is happening. We usually get them stable and send them up. Then you have the other 3-4 rooms with frequent flyer abd pain work up, vag bleed, chest pain, and HA. I would say lower acuity in general, but when they crash the environment can be very different than an ICU. You might like it. Never know till you try

Sounds like TRALI. Often transfusion reactions require a cxr because this is a risk.

I work in a level 1 teaching hospital in the ER. This whole conversation is amusing to me. I hold a med and walk over and tell the doc. No waking someone up, no 12 hours later someone is asking about xyz. One of the awesome aspects about my Dept. Of course we get a lot of exposure to communicable diseases (pt in room 12 for 6 hours, guess what? He has TB, PT through triage, into a room, down to X-ray and ct, back and forth to the bathroom, he has cdiff, and bed bugs, etc) but never why didn't you give X med 12 hours ago.

See this a lot with our regular alcoholics. We do etoh level strictly on blood. I wish we would go to a breathalyzer to get this info. If after obtaining a breath level, a more exact level is needed we could stick em. Many times These guys come in and crump, but due to years of 4-5 times a week of iv starts access becomes an unnecessary challenge.

Sometimes picking up the pace simply means move faster. If you can't do it while starting an iv or hanging a med, do it while walking to get supplies etc.

Yup. Need another nurse or a few techs/medics. Managing several icu pt's is possible with enough help, remember in the Ed we stabilize. You can do this with enough help. You will not be able to provide icu type care which promotes healing. That is not possible with such a load. That said, it takes time. You would basically turn into central command delegating and taking info back so you can coordinate care.

I would have gotten that Hershey bar! Not because I'm so awesome, I just love chocolate (and rewarded challenges that much!)

Yes it's possible, but not very likely. Yes we are all sticking to the treatment. I don't judge too much. Not my job, but I don't refuse to accept that we should treat even if the pt says I don't do drugs. It's also possible she took a pill and was drugged. Even on different days. Opiate tox shows up long after use, and roofie probably aren't showing up on an er utox. Did they Narcan her? Unknown AMS which requires intubation should get a dose of Narcan and assessed for improvement.

Doesn't really sound like etoh. She should be tachycardic from diuretics and hypoxia. Unless she has crumped that far and gets tubed. I've seen a lot of that with spice but they usually come in hopped up and restrained. DKA with some comorbidities can present in some freaky ways, but this doesn't sound DKA. Still, a few labs can start you thinking that way. No fever? Opiate of with sepsis could look similar. I don't know as far as diagnosis without more info