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.

To a drunk patient who fell and had a head lac: "This is your tetorifice shot." "I don't want a shot!" "Well it prevents lockjaw.. so you can keep drinkin'!" "Oh, okay."

I graduated in May 2008 and I've been working in my ED for about 5 months. I absolutely love my job and would do it for free! I had a 3 month orientation and when I came off orientation, time management was still an issue for me.. being on my own was when I became much more productive. A few time management tips I've picked up: Walk by the room on the way out to get a pt and snap up a gown, grab a sheet, ready the room. Get the patient, get urine from just about everyone, if ambulatory I'll jokingly tell them "the bathroom is just down the hall, think you can take a walk and give me a urine sample before you get in this lovely, revealing gown?" I joke a little with my patients, it makes the experience better for them, and they are more cooperative for me! I instruct them to bring the urine cup back to their room and change into the gown. I'll go put the chart in the doc rack.. come back and grab vitals on them (knowing I won't need to revitalize for another hour). Another big thing is just getting experience.. following protocols and anticipating orders.. if someone comes in for a toothache I'm not grabbing pee and blood but if someone comes in for abdominal pain I get pee, and I start their IV, send blood to the lab. A fever and I've got the labs and 2 sets of blood cultures in the lab, plus NS running before the doc sets foot in the room... we have a few freedoms in my ED and I take advantage of them. But this comes with experience and paying attention.. I'm still new but I go by protocols and know my 'for sure' NS bolus complaints, I know which babies are getting a rectal temp and Tylenol or Motrin as soon as they hit my room. Get it OUT of the way. Waiting for the doc to order labs, then the tech to enter them, THEN going in to draw blood and send it to the lab.. big time suck. Waiting 40 minutes for a doc to hit the room on a febrile toddler and then order Tylenol, then wait for it to work.. time suck. I used to feel *bad* for starting anything bigger than a 20g IV on anyone, now I do 18s on just about everyone as the fluids go in quicker, they feel better faster, and get out quicker.. which is what they (and I) want. My ED requires hourly VS on each patient. I keep an eye on my chart rack, when I'm getting a patient via ambulance I'll grab vitals on my current patients and update them as I wait on EMS. Never go anywhere empty handed.. I try to keep moving.. cleaning a room after a discharge is not beneath me, emptying a laundry bag is not beneath me, I'll grab a blanket if I anticipate a patient needing one, look over discharge instructions on your way to a room so you can anticipate and answer any questions. My biggest time management tip is really just being kind and respectful to the patients. There are always some patients who are uncooperative and painful but if I'm nice to my patients, keep them informed, and empathize with even their ridiculous complaints and they are just so much more cooperative and they leave a lot happier.

Ed I am planning on applying to UHC pretty soon, I am moving to Clarksburg from Pennsylvania in a few months. I am curious to know what the pay range is there.. if you're comfortable giving a ballpark please let me know. I just graduated in May and passed my boards last week (hallelujiah!) do you know if UHC hires really, really new nurses? I'm really glad to see this thread, good to know UHC sounds like a good place.

We have a total know it all in our class, she is constantly "adding on" to what the instructor teaches us.. her experience? No she's never worked with patients, her MOM is a nurse, this is what she keeps telling us. My mom is a nurse practitioner but does anyone there know that? No, because I lay low and keep my mouth shut lol. The instructor already gets a pained look on her face every time our know-it-all starts saying "just to add on to that..." heh. Today we were learning to take blood pressure our know it all skipped out early without trying it because she already knows how to do it, just watch for the needle to jump. Our instructor told us (after she left) that she will be watching and listening in to make sure we don't go by the needle jumping as it is not always accurate. We also have 3 CNAs in our class and they have been nothing but helpful and kind whether we're in lab or clinical.

Oh! Almost forgot.. My friends who got in last year went to their orientation and told me that the instructors asked the crowd "who here has kids? a job? a spouse? more classes than just the nursing classes to take?" and when people would raise their hands the instructors would *tsk tsk* and say "well you're never going to get through the program." At orientation!! I only have micro left as far as non core classes but sheesh, why does the school have that nifty little printout on the site advertising nursing as a 2 year program wherein you take A&P, psych, etc with the nursing, if they act like that? As it is when I finish (accepted for Fall 06 at North) it will have taken me 3.5 years total. I'm excited though,.. even if the instructors are mean they must be doing something right as the NCLEX pass rate here is decent.

I've heard the same about the CCAC instructors.. a male friend of mine told me the instructors are "eat their young" brutal and actually seem happy when people have to withdraw.. he's not a catty sort at all so I'm worried! Anyone have any input on the summer drug calc class? Is it necessary or could I just get the book and figure it out myself? (summer babysitting issues).

I'm going to CCAC North and I got my letter today, accepted for day option! WOo! What a relief! Do you have your CPR cert yet? If not where are you doing it?

Hi all! I had my first test (lecture) and lab test this week.. I was so mad at myself because on the practical test I was rushing through, happy to be answering one I *knew* (levels of organization: chemical, cellular, etc) and I didn't *read* the question and I answered it in Ascending order (how we were taught) and my friends later told me the ? was for Descending order. I hate trick questions! I'm thinking I probably got a B on that test, a low A on the lab test. The lab test was ALL multiple choice but for some metric conversions at the end. Two women in class today totally misunderstood or ignored the teacher when he said we'd go up to the microscopes in 2 groups, odds and evens based on your lab station #.. after everyone was DONE doing the microscope parts, they spoke up that they hadn't yet done the microscope part of the test.. he said too bad, the mics were put away.. so they just flunked that part I guess. The teacher handed out our bone list today, we have two weeks to learn 200 bones! I was so relieved to have the 2 A&P tests out of the way this week so I could spend the weekend studying for my first Psych test. Ha! I'll be learning 100 bones! I just came here hoping to find some good A&P websites and happened on this awesome post, it is so good being able to read all your experiences!!

We had to dissect a rat last week and my lab partners were too squeamish so I took over and just did it. I feel like I learned from the experience, but probably no more than I could have learned from a good computer program. I wouldn't have cut my finger on a computer program either! My instructor mentioned that years ago they used live frogs, I could never, ever kill something. I know theoretically it's not much better cutting one up that someone killed for me but I know what lab rats go through and I believe mine was better off dead. I didn't like doing it but my familys needs comes first, I need to have a career, and I'm not rocking the boat as one of "those" people before I can even get into the highly competitive nursing program. I even have a pet rat. There were 2 cats on display, one had been pregnant and the teacher had removed a tiny baby for us to observe. I asked him where the cats came from because you could see dead fleas all over the cat and obviously it wasn't a "planned pregnancy" so wherever they came from was deplorable. He said they are cats euthanized by shelters and are donated. I totally agree with above posters who blame the cats predicaments on irresponsible owners. And man, if any of yalls cats ever does get lost, notify the shelters FAST. I don't let mine (all spayed) outside but once in a while they slip out and all I could think of while looking at those poor cats was that I hope they didn't just get lost Edited to say: The reason I have in inkling to what lab rats go through is due to my intro to psych class right now we're learning about animal testing by psychologists, and it is so horrifying. Didn't want to sound like someone with extensive rat abuse knowledge.

I don't know of any cute ways to learn them, the easiest way for me is just looking at them as the building blocks of each other.. can't have an organ without tissue, can't have an organ SYSTEM without organs, etc. I like acronyms too but this one is probably pretty important for us to get the concept of how they 'make' each other, not just the order. I love the system acronym posted here I am SO using that one :-)