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brewski09's Latest Activity

  1. brewski09

    I'm Stuck - Need to Make a Quick Decision

    I have my ADN and RN to BSN both from online based programs and no one ever even asked or cared. The biggest thing they cared about is the BSN. My program had hefty community and leadership projects as well as a number of hours I had to meet volunteering in a RN role for community health nursing but they were pretty generous in what they'd accept and it was self scheduled. Asa thought, will they let you spread out the clinical time? I would bet most if not all their students are working so this 2 days of clinical would be a hardship.
  2. brewski09

    Training for ER; Didn't do so hot

    Isnt that what the ED is saying by hiring someone with no hospital experience? "we will take the time to train you because we realize you don't have the experience necessary to hit the ground running." And I also believe your preceptor is a teacher and mentor. I still ask my preceptor questions and I've been off orientation almost a year already.
  3. brewski09

    Being Pulled into the Office for calling CAT

    This patient would have been an ERT (or whatever you want to call it) at my hospital and would have very quickly progressed down the ACLS pathway to pacing for symptomatic bradycardia. This comes from both progressive care/Stepdown and ED and it should apply to any floor in any hospital as its ACLS. As for the reprimand, your manager can make or break your job. Unfortunately, I think I'd be looking for another job myself after this event. Also, we have event reporting that we can bring the situation to light for upper management so you may be able to report this upward for review. Enough complaints about this one doctor and they'll get the message.
  4. brewski09

    Barcode scanning in ED?

    A previous ED I was in made the transition and now it bugs me that my current one doesn't scan (yet). I'll likely end up a superuser since so many are resistant. Scanning meds cuts down on potential errors. Also, there should still be an emergency override function to not scan for "codes" and all manner of ED shenanigans that we see. I would be very surprised if the hospital didn't use a mobile device or have a computer in every room since the documentation is so critical. You're ED should have the same computer standards as any other critical care area where they are expecting bedside charting and Med administration with barcode scanning (see what the ICU does and that should be the standard of care/equipment you should be afforded in the ED too).
  5. brewski09

    Ultrasound Guided IV insertions

    I echo the question of what part are you having difficulty with because there are bound to be plenty of certified people on here that might be able to help with more info. I've yet to use any lido or other pain mitigating mess for U/S PIV insertion (it isn't in our standard practice for adult patients) and many of our patients thank us for getting an IV so they don't have to get poked again.
  6. brewski09

    IO + Lab work

    It takes a fair amount of time to start an U/S guided PIV and it isn't 100% successful. Also remember that the PICC nurse couldn't do a PICC line in the ER (which I've never seen them in any ER I've worked in) so the likelihood of starting an ultrasound line is slim to none. That PICC RN should also be trained in U/S PIV placement.
  7. brewski09

    New Grad in MICU, Now with Offer for PICU..

    When I was a new grad I thought I was going to be an ER nurse right out of the gate but due to better than expected retention they were overstaffed so I had to look outside my department. I ended up between SICU/NCCU and PCU/Stepdown. Both unit managers told me they wanted a minimum commitment of 2 years because of the cost to train a new grad is so great. It ended up being an amazing experience that I only left because we moved back home. Stick with your job, it will ground you for the rest of your career.
  8. brewski09

    PCCN certification - Should I expect a pay differential?

    i would only expect a pay increase of the hospital says they give one. Otherwise it's still a good investment in yourself but probably not likely to get you a differential. It does make for a good bargaining chip if you are in a non-Union hospital come review and raise time.
  9. brewski09

    6 months in the ED -- should I "get it" by now?

    Whoa, lots going on here. I'm not sure this preceptor has the right training for the job. It takes an entirely different skill set to precept/train than we learn as nurses and it takes a lot of practice to get good at it. Ive been in the ED for 6 months now and feel competent no matter what they throw at me but I had ED tech experience, prehospital experience, and 2 years of very high acuity critical care experience as an RN. This is after being tested with sick patients on pretty much every shift since I've been off orientation and I would still defer to my preceptor as the better nurse every time because she has a lot more experience and ER knowledge than I do (basically she is a better ER nurse than I am right now). Our new grads get 6 months minimum of orientation with a ratio of 4:1 max, 2:1 max ICU, and then get full support from management and the hospital for another 6 months. They told our managers that 6 months might not be enough when they were where you are now but they have turned out just fine. They know what they are doing even if they didn't trust that they did. Our preceptors are not negative like yours sounds because they were selected as good candidates and trained to precept. I guess im saying stick with it and trust in yourself and in what you know. I wouldn't give up on the ED yet, maybe just that preceptor/that ED if it doesn't improve. Also, Shehy's makes a great emergency nursing manual to help see bigger pictures and know how to treat the patients walking/rolling through your doors.
  10. brewski09

    Age and nursing school

    Seriously, 22 is not old. I was 28 when I started nursing school and left a career as a retail manager to do it. The oldest person in my class was 52 and the youngest was 26.
  11. brewski09

    My preceptor is everything they taught us NOT to be...

    There are serious issues here as well as some thug a that aren't an issue. First of all, scanning mess and then not giving them until later can be viewed as a reportable medication error as well as falsifying documentation to the hospital and the BON. I think that is a very big issue and absolutely do not practice this way nor do I find it okay. The vitals not being charged by the techs u till that far after can also be coo soldered falsifying documentation and is also unsafe when giving cardiac meds. I also agree with the insulin issue, meds within an hour of the finger stick is pretty standard practice. the dressing change I've seen go both ways. I prefer the sterile gloves because they are so much better protecting me for dressing changes that are involved like that. However, look up your hospital policy on the dressing change. Look it up for everything for that matter and print it out so you can tell your manager the policies you were following. If leave that unit if I were you because the managers and your preceptor don't seem very open. FYI, if you are a union hospital have your union rep there even though you aren't off probation yet, they may still be able to help.
  12. At my old hospital my managers I interviewed with wanted a 2 year commitment to recoup the costs of training. This was for ICU & PCU. I took the PCU job and was a very productive employee, but still felt like 2 years was an appropriate amount of time before leaving both from an experience point of view and from a longevity on one unit point of view. Also, my hospital just changed recently from 6 months minimum in position to 18 months minimum in position before they would even consider an internal transfer for unit stability.
  13. brewski09

    Pre-employment evaluations/tests

    I am moving soon and looking at jobs in my new area. I've come across performance evaluations and medication exams (most notably at the UC Health System in California). I'm curious what kind of things are actually tested when you apply to this kind of staff nursing job. I haven't heard of these tests in my area or most others.
  14. brewski09

    Stethoscope.. Help choosing one.

    Littman classic II around $80. It wirks well and I would get another one. Don't worry about a nicer one unless you get hired onto a cardiac unit. Then it's worth $150 or more. With that said, I still have my $10 stethoscope from my nursing school kit and it's my backup in case I forget mine at home. I like to be able to hear without struggling though, soI've stuck with the classic II since the beginning of nursing school.
  15. brewski09

    Cause of uneven pulse/ox wave form

    Was the patient having bigeminal PVC or PAC (really any premature beats)? I've seen something similar to what you described in adult patients where the second beat does not produce as big of a pulseox waveform because of the decreased preload caused by premature second contraction of the heart. I would make sure the MD was aware of this, but they may not do anything if the patient is otherwise stable.
  16. brewski09

    Macbook Air vs Macbook Pro

    I would go with the air. Great performance for the non-gamer, excellent battery life over 3 years out, the solid state components are more durable (think malfunctioning hard drive), and you can get a great cd/DVD USB driven player/burner for $50. Mine is Asia and works great with our Mac air and our asus branded windows 7 laptop. Also, don't forget to get a backup hard drive in case the laptop gets stolen and schedule it to run regularly.