TRUtraumaRN

We've had a pretty high turnover rate in our ED. But, I think management is largely to blame because in the past 5 years we've had 8 different managers... Makes it tough on the entire department because there's no sense of any direction or improvement and the only thing the managers do is kiss corporates rear to keep them happy till they're replaced or decide they don't want to be there anymore then we get another temp. It's funny because a permanent managers job has been posted since May and administration still hasn't found anyone meeting their "standards" and won't hire anyone local for the job. Funny that L&D has a high turnover rate because the nurses at my hospital in that department have all been there for years and years and aren't going anywhere.

Well I don't carry it in my pocket, but I carry around a jug of Golytely to help everyone rid themselves of the overwhelming amounts of crap that they're full of... :)

Everyone needs to watch the videos on YouTube if you've not seen them. Try searching for "how we would like to talk to patients" because they are most amusing and so true! There are a bunch of other animated videos along with that one :)

Honestly, I think all new grads need to start off on a med-surg unit unless your hospital offers a very intense residency program in the ER. Reason being, I've seen so many new grads come into the ER and they're excited about trauma and codes and all the adrenaline rush. As a new grad, you probably won't be thrown into that stuff till you have some more experience. I know our ER hired 4 new grads this spring (3 of them worked as externs) and only one of them is really working out so far... You need to get a good background in general nursing and have time go develop skills and assessment techniques before jumping into the chaos of the ER. I've seen lots of people come and go because its not what they expected. Yes you do get traumas and critical pts but they're mixed in with all the "regulars" that everyone knows and dreads, the people with a runny nose and cough, the pts from the nursing home they're trying to get rid of for the weekend, sprained ankles and tons of other complaints that could easily be seen at a doctors office or urgent care. Maybe try for ICU or a step down unit that way you can mature as a nurse and master the skills needed for the ER. Good luck!

Worked 7pm-7a and loved it and then the manager decided to place me on the 2p-2a shift cause we were so short. HATED IT! Like others have said, you're busy the moment you walk in the door and things have barely even begun to slow down (if at all...) when you leave. And in my ED, day shift was notorious for giving you random rooms throughout the ED so that the day shift nurses had their section of rooms altogether. For example, I'd have rooms 1, 12 and 15 (room 1 being on the hallway across from 12 and 15). They'd also wait to give you 3-4 pts all at once (most of the time pts were in rooms before you even got there and weren't worked up and nothing was done). I'm glad the 2-2 was just for once schedule cause I have to say I love my night shift crew. I also think that working night shift is a lot more manageable as far as lifestyle once you get the hang of things. Good luck!

I went to a 4 year college for 2 years before starting nursing at a community college (2 year degree). I had actually failed a couple courses prior to sending transcripts to the nursing program and still got in. GPA was still over a 3.0. They weren't related to nursing or science so there's always hope. Good luck!

I love trauma and I've found that the trauma ICU or surgical trauma ICU is much more exciting than an MICU. Every nurse is different as far as likes and dislikes. I'm strictly a trauma person. I hate medical pts so naturally I wasn't too thrilled working in the MICU (don't get me wrong there are tons of EXTREMELY critical pts and it's a huge challenge). I worked in a 16 bed STICU and loved it. Only thing is a lot of the fun stuff is already taken care of in the ED or OR, but you do get to still see a lot of procedures and cool stuff. Just depends on what you like. If you want to take care of them for a longer time then ICU is the way to go.

Make sure you get an excellent preceptor. Even after nurses are off orientation and have a couple years experience, you can still tell which nurse they precepted with. You'll end up being a lot like them, so get the best one you possibly can that's going to teach you the most. Buy a couple critical care books (AACN has a few) or even go ahead and get a CCRN exam book as those can be excellent teaching tools and once you have 2 years of experience you'll be eligible to sit for the exam. Good luck!

I was reading about this the other day cause it seems to be a hot topic in current treatment of TBI's. The Guidelines for Management of Severe Traumatic Brain Injury do not recommend prophylactic hyperventilation (PaCO2 less than 25 mm Hg). Keep the PaCO2 between 30 and 35 mm Hg for the first 24 hours. If hyperventilation is being used, recommendations suggest measuring cerebral oxygenation (SjO2, PbrO2...). A quick simple way to measure effectiveness of ventilations without an ABG is ETCO2 monitoring. Current therapy recommends keeping ETCO2 35-40 mm Hg. Levels below 35 should be avoided; however, in some instances (evidence of herniation or acute neuro deterioration) it is fine to hyperventilate with a goal of maintaining an ETCO2 30-35 mm Hg and discontinue when signs of herniation are alleviated. Hope this helps a little.