TheCoppertop

Venting!! Is this a slow time to get interviews? Feeling discouraged! i've been fully vetted by two larger, good reputation agencies and submitted to a couple jobs Dec 22. Sure its going to be slow over the holidays but thought for sure I'd hear something by now. So far I was stood up for one hospital call so I've had not even one interview. Recruiters have even gone quiet. Beginning to wonder! Flew to California in Oct to get my license (temp took 3 weeks, have perm now), I have a stellar history, 8 yrs ER experience, trauma, all my certs.. I haven't traveled before and am very eager to get going, to have some adventure this year. Starting to get a little impatient and discouraged! Now should just go start the whole process all over again with other agencies or is this just a very bad time? I am still at my job of 5 yrs and need to put in 2 wks notice before I go and then a week travel time so I'm wondering if that is hurting me, not being ready to start in a week. I've considered quitting my job and heading out, taking agency if I have to but I'm not quite *that* irresponsible/adventurous! Anyone else struggling to get a shot out there?

Definitely no!!! I started as a med surg nurse on a tele floor in 2008.. all I wanted was to do ER but there were no spots open. So I did the MS gig for three months, talked to the ER nurses when they brought up patients, made friends, met the director, and they let me come down and float an ER shift to try it out. Later when a spot opened up, I was a shoo-in. You don't have to stay in med surg, but it gets your foot in the door. I'm a supervisor in an ED now and oversee new grad orientation, even 12 weeks isn't enough for some new grads to be functional, let alone completely out of the nest. Like everyone else I have to chime in this sounds terribly dangerous to your career.. not simply dangerous to your license but also to your foundation and satisfaction as a nurse.. ours is a profession where we start out feeling in over our heads to begin with, even with support and proper training! Take a perm spot somewhere and get your feet under you, time flies and before you know it you will be ready.

I think I've been doing it too long, the pt ridiculousness barely even peeves me anymore. I just expect them to not know the name of a single med they're on, except of course "Dilaudid 6mg three times a day, Soma 3 times a day, and Ativan 1mg four times a day, then... Some little white one, and a purple pill and a couple more...." They only ever know the names of their *awesome* meds, not the ones keeping them alive. Now I'm more annoyed by staff.. Like midlevels ordering blood cultures on everyone for any complaint, docs and MLPs CT scanning everyone who walks in the door without any talk about risks of radiation, and my biggest is when people deny a febrile pt a warm blanket! The poor sucker is shivering and suffering, the body temp is set by the hypothalmus, not a damn blanket.

My biggest pet peeve lately is management! I work in a craaazy busy ED and end-year overtime has been forbidden. So we start off every day with minimum staff, and if there are any call-offs, we're screwed. They'll try and call in nurses for 4 hour shifts (so as not to exceed 40 hours) but everyone knows its insanely busy if they're calling, and non-ot, why bother.Last week I worked a 12.5 hour shift with no lunch. There were 4 call-offs and no call-on takers. We also, thanks to mgmt now have to keep all drinks and food in the breakroom and sadly, I was so busy with criticals all day I couldn't make it to the breakroom. Usually a neighboring nurse will cover me but my neighbors had huge, high acuity loads and I had intubated, trying-to-dies and I had to stay at bedside. I got the opportunity to have a blissful 30sec to pee off my morning coffee but that was the only time I left all day. Starving, frazzled, and dehydrated at 6pm (11 hours in!) I see a perky manager coming through to HELP! "Our" big goal this year was to get new pts back to the beds within 8 minutes so the manager came in to help housekeeping by cleaning beds, then running out to triage to bring pts back... For nurses to care for, nurses who were super TIED UP, and had worked 11 hours without food or drink. I was furious, I mean, if you want to HELP, watch these pts for me, or hang this heparin on my PE so I don't accidentally hang it on my 8cm AAA because my brain has run out of carbs. Thanks!

From EMS: "22yo male acute onset chest pain during apprehension by law enforcement."

Thanks iluvivt! I always listen to the patient too, and just this week I started 2 18s on grateful pts who told me the back of their forearm is the only place they can get a vein, and both thanked me "for listening" as they both said nurses usually don't listen and they get stuck multiple times! I always look, even when pts say they ALWAYS get a PICC or ALWAYS need ultrasound and I can usually get something! This pt was well versed in being a patient and right off the bat was saying "I have the right to refuse you sticking me and I refuse". Lovely.

Thanks to all who replied! I know I did the right thing for the patient and I do feel better about it now. I'm at a L1 Trauma center and I'm surprised RNs cant do EJs, I've done quite a few at my previous jobs! I'm in that new job "prove myself" period and it sucks how something like this can knock you miles back down the ladder! The doc strode off before I could say anything and that irked me too. Its weird here, the docs have little offices with closed doors and we're supposed to relay issues to supervisors (charge nurses) and they in turn go speak to the docs. Like "Psst, hey supe! can you go enter the sanctum and tell the doc that my patient just went pulseless? k thanks!"Its bizarre to me, had this happened at any other place I've worked I knew the docs well enough to say heyyyy hotshot, this is what happened! Not here! I'm here for the Trauma experience but after a few years I will go back to a mid-size hospital where I can communicate. Its tough being a nameless face amongst 80+ nurses. I pride myself on being a careful and trusted nurse. I'm already doing well, kicked off orientation 4 weeks early because I got it, and assigned to critical rooms straight off. I don't say much but when my previous docs heard me say something was wrong, they trusted me and hopped to it.

I've been an ED nurse for 5 years and just moved to a new state, a new job. I'm as confident as I can be after 5 years, I definitely don't know it all but I can hold my own. Yesterday, my 2nd week off orientation I had a critical care room with 2 bad pts plus I was responsible for a medical bed until the 1pm nurse arrived. It was 12:30 and in the med bed I got a meth smoker, not taking her meds, already had a few CVAs, she was a mess. Blubbering about how I wasn't allowed to stick her as she always gets IVs in her neck from the doc, they know her there. So when the doc came in I told him this and he ordered an ultrasound guided IV. He gave her hell about her pressure and not taking her MANY bp meds, he seemed really freaked about her shape and kept having me cycle her BP. Her BP was 250/150 range, repeatedly. She was a mess. So the ultrasound nurse, an ER nurse, came and set to work, I gave this pt the ordered ntg, sl clonidine po (made her chew 0.3) and had to get ATBs on board on my septic pt so I ran to do that while that nurse got the IV and blood. I was in my critical room when the doc (I don't know) called me out of the room and asked me if I had Meth lady. I said yes and he said all gruffy "put her in trendelenberg and set up an EJ". Nice, the ultrasound nurse struck out on her fried veins and didn't tell me, just left. So I put her in trendelenburg and set up the EJ. Her pressure spiked even HIGHER, her face was all red, she was moaning, and after about 10 min the *doubt* set in. "Omg, we put *hypotensive* pts in this position! Crap, did he say reverse trendelenburg because of her pressure? Her damn heads gonna blow off! He's gonna walk in here and flip! And if she strokes out it'll be my fault!" A good 10 min went by and I got nervous, put her in reverse. So he walked in and YELLED at me, "THATS NOT TRENDELENBURG! Put the patient in trendelenburg, thats her head LOWER and I'll be back!" He huffed out and I felt this -->. big. Fortunately then my med bed relief nurse walked in and I was able to apologetically hand the whole mess to her. It really shook me for the day though, I was afraid of having the patient in that position, in her condition for a good period of time when she obviously worsened in trendelenburg. I didn't know the doc isn't very experienced and wanted her neck veins extra full (he tried and couldn't get it, made u/s come back). What a mess. Even when you're confident in what you're doing you can still have these "I'm so stupid" shaken moments, right? I wish I could just accept that I did the right thing due to her worsening but the doubt I had is what bugs me. i hate it when docs flip out like that and huff off before you can say "she got worse while waiting!" Anyone else?

I did that a lot as a new nurse. I found myself looking on the cards a lot so then I started a game, I'd answer it myself, then check the card to be sure, and soon I didn't need pedi vs, celcius/fahrenheit conversions, etc anymore. Its a good way to learn. I'd still be lost w/o phone numbers though!

Volunteer to help with whatever you can, but not at the neglect of your own pts. Ask questions! You should stop by beforehand and see if there are protocols for workups and study those if you can. You'll soon see trends like every abd pain gets a UA and IV/full labs, culture sore throats, do EKGs on chest pains immediately as in before you take a blood pressure or put them on the monitor (hopefully your ER will have good team work and staff enough for multiple sets of hands to be on the pt). If you will be getting peds pts weigh every single one!Biggest tip I can give you after working in 3 ERs is that TIME is most important! Get urine from the pt on the way to their room from triage, once they get in bed, forget it. 2 hours later you're bringing out catheter threats. Get the urine and blood in the lab ASAP, get admitted pts upstairs ASAP, no ER should ever sit on pts. You'll learn how to be politely firm with pts. Don't feed or water any pts unless you get the ok.Dazzle your instructor by asking pt name/birthdate *constantly* and allergies anytime you so much as flush an IV. Dont feel like a newb by doing this, it is vital to safe pt care and a lot of nurses get lax about it. Make it your habit from the get go.Also make it a habit to put pts in gowns before they know what hit them. Noooooothing more annoying than getting snipped at by a doc because your preceptee started an IV on a pt still in their street clothes. Your preceptor should be right with you but this is the real world and as you advance it is very realistic that your preceptor will say "hey while I'm doing this, go settle our new pt in room X and start a line, draw labs. "Not to generalize the group but don't get disheartened if you have a bad day or feel like you screw up at some point. I've found ER staff is generally quick to bark but also quick to forgive and move on.As for what could get you booted? I've had several students myself and of course been around countless others in the ED. I've seen several get all dazzled by the ER docs and want to sit at their feet loudly asking advice about going to med school, while the preceptor rolls their eyes and gets insulted/annoyed lol, ER docs can be pretty cool but don't be that student. Won't get you booted but definitely will get you an ice cold preceptor.Have fun and pay close attention, this is a great opportunity for you to see if you really want to live life in the pit!

Best advice I ever got as a new nurse dealt with a horrifically sick child. Kid came in, was soon intubated, naked on the bed and all I could think of was my son, about the same age. I was brand new, standing in a corner completely frozen and shocked when a kind, very experienced male nurse encouraged me to start a 2nd IV. He took my shoulders and said "focus on the TASK, don't look at the big picture here, don't look at his little body. Your focus is on his arm where you're starting another line to helpmmake him better." it really helped and years later I always think of that when I have a sick kid, make sure someone is watching/monitoring the patient as a whole, and focus on my tasks! Or be the watcher so another nurse can focus on everything but the fact that this is a child. As far as dying goes, you get used to it. Not in a callous way, but as a certainty in life. We all die, it is a process and sometimes it happens tragically and/or too soon, but it is always an honor to be the nurse who fights like hell to prevent it, and/or enables a pt/pts family to let go with dignity and comfort.

Lol 2 come to mind.One a guy around 30 who checked in as chest pain, then told the doc he was really there because he just found out that a place he worked at 10 years ago, was found to contain asbestos and he wanted to get checked.Best triage sign-in ever though was "Eating carpet". A 3 yr old boy with PICA and a hilariously apropos name (damn you HIPAA) ate some carpet fibers. We female nurses guffawed like hell at that CC and figure he'll someday be very popular with the ladies.

I had one that unfortunately, I blew my top over. Yall don't need to shame me, I got lucky on this one but it is definitely my low point as a nurse. He came in, acting disoriented, stating in triage that he "took too many pills" we rushed him in thinking he was a methadone OD, then he corrected himself, see, throughout the past week he TOOK TOO MANY of his one month prescription, and now he was all out, and needed a refill! On and on and on it went. He was going to kill himself if we didn't give him narcs, but if we would medicate him, then he promised he wouldn't kill himself. We were slammed busy and had some terribly critical stuff going on. He was a longtime addict with no veins.. And he was just miserable, nasty, whiny, abusive... So numerous nurses tried to line and lab him, I go to draw at least labs with a butterfly, of course blew the teensy pinkie knuckle vein which was the ONLY vein I could remotely find. Blew it, pulled out the butterfly and held pressure. He whines "OWW you're hurting me! What IS THAT?"I replied "Its a f*^%#ing cotton ball!"HE ACTUALLY LAUGHED, and said "I like you!"I was just about to quit that job (it was bad) due to my s.o. Transferring out of state, had a much needed 4 month break and returned to ER nursing fresh and pleasant!

Its a tough one. There's no way around it. I struggle with keeping it impersonal because really, it can feel very personal sometimes. I worked at a small community hospital, very rural, and therefore the seekers didn't have shopping options. We'd get a certain few almost EVERY day, one especially already prescribed scads of vicodin, xanax, and soma. Her son was in the paper for selling drugs. Every day it was a new story of picking up her grandkid and feeling something pop in her back, or chest pain, or fell down steps, or migraine, I am not exaggerating when I say it was EVERY DAY. Sometimes she'd get a generous doc, sometimes not. In triage I even asked her "did you try taking your vicodin?" but she'd say she threw it up and needed dilaudid IM. What can you do? You just can't take it personally. Yes the true seekers lie to your face and you'll feel like you look like a fool believing them, offering a sympathetic smile and great customer service. It gets super frustrating when, like we often did, you have 3 nurses including yourself as triage/charge, 12 full beds, 8 waiting, a STEMI, a nasty bleed you're trying like hell to get flown and its about to start snowing, and oh by the way, SHE just checked in and you have to go triage her for picking up the grandkid wrong again. I try and just do my job, advocate for the pts when I can, and go home every day thanking God I'm not in her shoes. Its tempting to want to feel like you're giving in or letting them win a point by getting them high but you just have to do your job.

Kudos to you for bringing food! I always find it hilarious when a pt announces her child is a nurse, its said with soo much pride and yes the sane ones usually do look mortified (its the ones who buck up their chests like "you've been WARNED" that are usually the ones that annoy, and usually they work in a docs office or haven't practiced in eons). I'd never have handed you the EKG all snotty, I'd have seen your reaction, winked at you and figured 'awesome, if she poops the bed I'll have extra hands!' lol My SO and I recently relocated and I'm on the job search. He came home from work a couple weeks ago with a big chunk of metal in his eye. It was 7pm on a Friday night so off to the ER we went. It was great to go in and scope out the nearby ER, spy on what charting system they use, yay! good vibe and coffee allowed at the nurses station (priorities!), and with a sane patient who knew better than to "out" me. I HATE being outed as an ER nurse when I'm with family! I think it is universal though, my ex husband is a very successful chef and I'll never forget the color draining from his face when we went to a fannnncy restaurant with his mother and she announced to the waiter that he's a world class CHEF so the food better be good! No matter how many times patients or their families grate my nerves with the IMANURSE *warning* I'll never forget the time I played that card when my mom was 1000 miles away in an ED having an addisonian crisis brought on by an ileus. She called me, she's a family NP and knows her disease so she knew what was probably going on. She had been there 2 hours without a blood draw or a steroid injection and she was in terrible pain, dry heaving, and getting confused, asked me "I'm feeling really foggy but... shouldn't they be checking my potassium? I can't believe I haven't gotten steroids yet!" I nearly lost it in frustration over being so far away and I just said GET ME A NURSE ON THE PHONE! Yep, I was THAT daughter.