brewski09

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

I think working as a CNA is almost necessary in the current competitive market for nursing. Not only do you get to see the application if what you are studying, you pretty much need the relevant work experience to get a job these days. I was a retail manager when I was starting RN school and left to be a CNA in the emergency department (I have EMT/Fire background too). I learned at least as much on the job as in classes and one of my coworkers have me the reference that got me my job.

the hospitals in my area call them dynamaps, which is a brand name kinda like Kleenex.

we have a pill splitter/crusher available for each patient. if they don't need it, it doesn't get issued. We also have a silent night pill crusher where you put the pill in a thick plastic envelope and crush it in there if you wish to use it. the envelopes satisfy the individuality requirement because the medicine does not touch the actual crusher. everyone with cost concerns, just imagine you crush a pill for one patient and then use the same pill crusher for the next patient and they have an allergy to the last medicine you crushed. is it still overkill ???

There is something wrong with you. Was doing CrossFit during nursing school but stopped at the moment to focus on cardio (ran a10 mile race recently and have some more planned this fall. I'll start again as the weather turns. In Columbus, OH.

Okay, so your hospital will have a list of approved abbreviations. start there. beyond that, you have listed a lot of unapproved abbreviations and some that aren't even accurate anymore, but people still use. AC or a/c is the antecubital area. L f/a H/L is left forearm heplock. PAC could be several things, but I am pretty sure it is a Percutaneous access catheter, which would indicate a semi-permanent line like a central line (triple lumen CVC) or a PICC line, but I could also see someone using it for an implanted port too. Now for the heplock issue. Its not a hep-lock unless it is dwelled with heparin. PIV's or peripheral IV's used to be dwelled with heparin, but aren't anymore d/t safety issues. This bugs me because we do dwell implanted ports with Heparin when we deaccess them at my hospital, so I would report that the line is hep-locked or heparin dwelled. It also requires an order at my hospital (no standing orders for this are allowed). If you didn't flush it with heparin, then don't call it a hep-lock. Just my two cents on this one...

Is hand hygiene and a 'no touch technique' of the ports sufficient or is a sterile glove mandatory prior to every use of the port I don't think I have seen a policy requiring gloves to handle IV access, but if you were required to wear gloves, I can't see sterile gloves being required. Even wearing gloves, you wouldn't want to touch the hub of the access port. Is cleaning of the ports with an alcohol/chlorhexidine based antiseptic solution mandatory before every use of the port? Alcohol yes, chlorohexidine, check your hospital policy because the hospital may include that for central lines. our critical care units require you to "scrub the hub" for 30 seconds. the literature (i've been told) says you need at least 15 seconds of hub cleaning in order to kill the bacteria. Some areas of our hospital and some other hospitals in the area use an alcohol or cholorohexidine impregnated attachment that cleans the port/hub for the RN. All you do is put it on and the next time you want to use the port, you remove it and use it right away. How can the cap (which has been removed from the port for an IV infusion) of the CV line port kept sterile till the IV infusion gets completed? Is it safe to use it again or a new cap is required after each infusion? If you are talking about the same cap I am thinking about, why are you removing it at all? You shouldn't need to remove the cap for an infusion (hence why they are also referred to in technical terms as an intermittent infusion device). Sure, you need to change it after certain things (like blood draws and blood administration), but you shouldn't need to remove it for a standard IV infusion. Once removed, get a new one. Is it the usual practice everywhere to have the individual lines (lumens) of the CV line (for example the three lines of a triple lumen catheter) 'dressed' with a sterile gauze pack? Not doing so makes the lumens gets separated in different directions and sometimes they get contaminated by reaching unsterile areas like the hairy chest. Its okay for the lumens to be on the patient's body, that's why you "scrub the hub" in the first place, to kill the bacteria that may be on the lumen. The chest hair will likely contain the same normal flora as the rest of the body. Also, once you walk away from the patient, that sterile technique you used is no longer considered sterile. I have seen things like this (putting an alcohol pad package over an IV cap), but this is not an approved cleaning technique at our hospital. Hope this helped a little.

I saw something saying a Las Angeles woman may have named her twins orangejelo and lemonjelo after Freakonomics came out... (someone find me the facepalm please)

Native American by chance? I grew up with a friend that had a normal first name, but also went by a similar Native American name.

pens (one color is fine unless you paper document), stethoscope (I have a Littman Classic II and have seen many ED nurses use this one as well) (maybe not depending on your ED - they may be laying around everywhere), trauma shears, hemostats (always hard to find when you need them). The lock is a good idea. a notepad is also useful. i used to grab a sheet of paper when i got to work and just organize myself that way so it wasn't so big in my pocket, but many ED nurses i know do carry a notepad. The scrubs are unnecessary (to me) because our hospital provides loaners if you get something on you. also, if its small, just clean it with some hydrogen peroxide or saniwipes. throw some flushes and alcohol wipes in your pocket when you get on shift. you can carry the sharpie, but it isn't used that much and skin marking pens are always available. look stuff up while you are there. you need to know it sooner than later in most cases and can get a quick idea of what you are looking for from intranet searches or other resources supplied by your hospital. just look at what the MD uses to search for their information and get familiar with the same system if you can, it will help a lot. good luck

being a male RN, I can't get offended by the term "murse." Its just not important enough. That, and I worked in an ED where it was about 50% male nurses, and we all joked around about everything with "mursing" being one of the common ones. Our patients enjoyed our commeraderie on the unit, which was partially brought about by our joking around with each other so much.