zmansc

Personally, I went straight into the ED. Many have argued that new grads should not go directly to specialty areas, and my hospital has even made this change recently. I think it's wrong, but I'm already in so I'm not going to argue that point with our admin. I will say some of the best ED nurses I've met never worked the floors, and the same for some of the best ICU nurses, and other specialty areas. When I was graduating there were a few large hospitals in bigger cities that had new grad programs (I don't recall the term they used, probably a residency), where the new grads who were selected had both a didactic program and worked a certain number of shifts in the specialty area of their choosing. If it hadn't been so far, or my local hospital hadn't offered me the job they did, I would have gone that route. Since my local community access hospital did offer me the ED position when I graduated, I took it, and I'm not dissatisfied with the results of that at all. IF ED is your goal, you can certainly learn all you need to there. I stepped up to a larger ED two years after I started (PRN only) because I wanted to learn some things that I thought we didn't do... Turns out, there wasn't alot to learn that I hadn't done here, just more volume divided by more nurses. I will say that I strongly suggest against making up your mind of what specialty you wish to spend then rest of your career in too early. You are very new to nursing, and there is alot you could do. If you have interest in one specialty (ED) then by all means put it at the top of your list, I did, and I'm glad I did. I now work as a float though. I still get to play in the ED when they need me there, other days I play in the ICU, or wherever they need me. You may find that you have multiple interests as you learn more about the various areas. As you gain experience in an area or two, you may find other areas that peak your interest. I only say this because you are the only one who can determine the best path for you. The great thing about nursing is if you don't like what your doing, there are many other areas for you to go and find a better fit, a better job. Good Luck!

Seems more in that vein. I haven't looked at both to reconcile the differences, but the much more organized list is to my way of thinking much easier to grasp, especially for new to the ED nurses. I like your idea of posts on each med, or category of meds to delve into more detail, good idea!

At our facility the traffic picks up around 10a, so the 10-10 and 11-11 shifts were very hard to fill, as you came in and had to hit the ground running. The 7a-7p shift nurses usually had time to stock the rooms, check the crash carts, and ease into the day a bit more. Also, it was very difficult to see the crew you had been working with leave and a new crew come on while you still had 3 or 4 hours on your shift. On the good side, as some have mentioned is sleeping in a bit later, and if you like to be busy, you will not be disappointed! I also felt like I could be a part of both the day shift crews and night shift crews I worked with. I didn't mind it so much (I was 10a-10p), but traditionally they are harder shifts to fill.

I'd say a fair portion of this list either isn't used at all, or is so rarely used that only a very cursory knowledge is necessary and listing all of the medications as if they are all of equal value is somewhat misleading. I do think this list and the many other lists of meds to be aware of are all good starting points for new nurses to the ED setting however. From an educational standpoint, I think it would be easier for new ED nurses to gain a working knowledge of this list if they were presented in an easier to grasp format, for example by drug categories. Just my $.02 (adjusted for inflation of course). I am curious to poll the ED nurses here on use of romazicon at their facility. I have never seen it used at my facility. Every provider I talk to feels the potential side effects out weigh the potential benefit. Is it used at your facility? How frequently? What is the criteria where the docs decide it is worth the potential side effects? How often does it induce seizures?

Angel is from the same folks that made BlackBoard, they have alot in common. Yes, FNU did switch from Angel to Canvas, as Angel & Blackboard have many issues and Canvas is one of the better learning management tools available these days. The switch has gone much better than I expected, with very few glitches that I know of.

WGU has an online NP program, or would you be taking a different track for WGU? I ask because I didn't see one when I looked. Many online and B&M programs require some level of assistance from the student in identifying the preceptor. This can be a major issue for some. In addition they often have (hopefully have) requirements that your preceptor has to meet. My program is very picky, other programs are more or less picky. Make sure you are up to this task if you pick a program that puts this requirement on you, it is not trivial and as others have said, many have had issues with this requirement. Personally I would look for programs that are picky about your preceptors, and spend alot of time early building a network within the provider community as your network will help you to identify preceptors that will give you a high quality clinical practicum. I would also look for programs that spend time personally visiting and remotely monitoring your clinical practicum. I would also assess how well the program's didactic environment is setup. There are programs (of all types) that do a very poor job of limiting cheating, etc. You want to avoid these programs.

To me the issues at hand are: 1) Can you as a new grad assimilate directly to the ED, or do you need to work in Med/Surg first? 2) The commute, adding 1hr each way to a 12 hr shift, makes it a 14hr day, very tough especially with taking care of the kiddos. How will that work in your family life? 3) The neighborhood of the facility, will you be safe? As others have mentioned above, the quality of the training program for new grads in the ED your considering will be a huge factor in determining the answer to question 1. I went directly to an ED RN position, but I had a very good supportive team and good program for training me up. My ED Director understood that they needed to put me on a team with seasoned RNs when I moved from an orientee to taking my own load. I had a mother hen who watched over me very closely, sometimes too closely for my liking, but I quickly learned she was doing what she thought was best for me and my patients and she quickly learned she could trust my judgement. Not all new grads are cut out for the ED first, even with a good program, so a good solid self assessment of yourself is vital to determining this as well. I'm assuming you have done this and that you feel you would be able to be successful in this situation. As for question 2, only you know the answer to this question. Also, any potential Med/Surg job would presumably have a commute of some time, so the real difference isn't 2 hr, but something less than that. Is relocating an option to reduce the commute? I'm not suggesting moving to the south side, but maybe a place that has a 30min commute? If you own the home, I doubt I would consider that, but if you rent it might be something to consider... As for question 3, I don't know enough about the safety of the area the hospital is located in, and what you would be exposing yourself to. I have to presume the hospital is safe within the facility, but that would be something you would have to assess yourself. If you know individuals working in the facility they may be able to tell you what issues they have regarding safety and the location. Good Luck with whatever you decide.

An FNP can work anywhere that is within their state's scope of practice law (with caveat below). So, by that, the question to you would be, what does your state's scope of practice law say in regards to this? The caveat to this is: does your local hospital, or the hospitals within your region, hire FNPs? If so to do what role? Within the scope that your state allows, facilities can choose whomever they wish to hire. Either by having formal limitations, or informal ones. They often consider insurance reimbursement limitations in your state in making these decisions. My own state's SOP law is very vague on this, basically saying that if you are trained to perform the work, you can do it. Thus there are ERs in my state that are fully staffed by NPs. I'm only partially familiar with them, so I can't say how they determine if the provider is trained to treat all of the patient population that is/will come into the ED. I also know of several EDs in other states that are staffed by NPs exclusively. All of these hospitals that I know of are rural hospitals, and at the very least the vast majority of the NPs are trained as FNPs (I don't have the credentials of all the providers here). My own local community hospital has two providers, one MD 24x7 and one NP/PA 12x7. The mix of NP to PA has varied over the years. All of the NPs are FNPs as the facility wants them to be able to see all patients. One ACNP was considered mainly because she had many years of experience in our ED. Officially, our ED policy states that the NP/PA take levels 3-5 pt only unless the physician is overloaded and directs them to take 1&2s. Unofficially almost all the providers split the patients on a provider available basis. Level 1&2 probably get a physician 75-80% of the time. Also, our provider group has protocols for the providers to become checked off on skills (for physician provider as well as NP/PA, many of the physician providers are not board certified although they are working on improving that ratio), so that is how the group and facility meet the "trained" aspect of the SOP. My own facility has toyed with the idea of, and hired both NPs & PAs for the hospitalist group, but they have never stuck. I think the main issue has been the distribution of work, basically the physicians have only given the grunt work to the NP/PA. In the cases I know of the NP has been an FNP, again for the reason of all age groups. I think this will improve over time, and at some point there will be FNPs hired into the group that will stick. I know of several FNP Hospitalists in many states, so I have to believe we will figure out how to make it work at some point. The medical director of our ICU has expressed interest in hiring FNPs to staff the ICU. At this point it is a proposal, so I don't know where that will end up. Again there will be issues of putting the proper training and checkoff procedures in place to meet the SOP. Personally, if I was to try to make a career in any of these settings, I would consider going back and getting my ACNP.

As with any program, your specific situation may be different than mine, so I certainly think you should consider your options, however, for me I feel the FNU program was the best choice available by far. The program goes to great lengths to make sure that the students are well prepared, and works hard to monitor the clinical practicum. They have an excellent pass rate, in part because of the rigor of the program, in part because they have a prep course during the lsat term, and in part because they make you take school, learning, and the career you are entering seriously. I'm sure I'm biased towards it, but I do believe I made an excellent choice. Good luck to you on your choice.

My school will not allow a student to use one of these services, but it does pay a small honorarium to the preceptor(s) when the student completes their clinical practicum. Personally, I'd love to see a clearinghouse run and managed by an independent third party that connects students with preceptors from all the programs and standards for the monitoring of said students (at least minimums) so that preceptors would know what is expected from student to student of them, and all schools would have to do a minimum of monitoring of the practicum. I think the current ad hoc system is not consistent enough.

There are DNP programs for nursing education. That would qualify you as having a DNP and you wouldn't have to work or be an APRN. If you are saying that you want/need both a DNP and to be an APRN, in that case I do not know what the options would be for a new grad, I would suggest talking to the other faculty members and asking them if they were able to do 4 or 8 hr part time when they first graduated, and if they thought their current employer would be open to such an arrangement when you graduated. Personally, I would think places like an urgent care or walk-in clinic might be interested in someone to cover shifts or do a weekend shift kind of thing, but I don't know that for your area.

I believe the OP is from FL. Frontier has a online program that would require you to do two campus visits. There are several students in my cohort that are from FL and they split about 50/50 between driving to campus and flying. Personally, I would not want to miss out on what is taught during the campus visits, but I understand your desire to keep your costs down as much as possible. Good Luck with whatever program you find.

I'm in the FNP program, not the CNM (CNEP) program at FNU, so I would double check with the admissions folks at FNU to verify. However, my program has a requirement that I not precept at the same facility I'm employed at, so I think you would be able to do so only IF you quit working there before you started your clinical practicum.

Re Nebraska: I believe the requirement of 2000 hr is with either a physician or an NP. Re NY: NY passed a bill last year that the NY NPs believe gives them full practice authority, however there were a few modifications from what the AANP wanted the bill to have, so the state has not been "turned green". If you read the bill, it is either FPA or very darn close. In the case of NY there is also a required number of hours and I believe that is with a physician. In either case Nebraska getting FPA is great. There are many states that are working on it this term, hopefully we will see a few more take this step forward.

1) While male NPs may be few and far between, I seriously doubt that is going to help your admissions, of course my school started in midwifery, so my opinion on that may be biased! lol 2) What is your GPA now? There are plenty of ADN-BSN programs that can be completed in 1yr, getting a 4.0 in those classes should increase your overall GPA, show the programs you have the academic chops, and open your options up significantly as well as give you a good year of RN experience which will help you to apply the material while your in your program. That year while your in your BSN program will also give you time to network with providers. This will help you in multiple ways: 1 - When it comes time to apply you will have several providers who will be willing to write you amazing references, at many programs these will offset your still lower than average GPA. 2 - When it comes time to find preceptors, these will be the folks that will be willing to precept you, or will help you make other contacts with their friends who will precept you. 3 - When you eventually graduate, here you go again, reference letters and potential job offers will be coming from these folks. Never underestimate the power of a strong network!

Who is they? Your coworkers? Mentor? Your supervisor? I would talk to them. Ask if you are progressing according to plan, or what you need to do differently to improve. I have mentored a RN who moved from our BHU to the ED, she was initially not very team oriented and we often found her sitting at the nursing station when she could be helping others. After a open and frank discussion, she learned to be more team oriented and willing to try to help and after a few weeks of this new attitude the perception of her in the unit changed dramatically. I'm not saying this to disparage BHU nursing in any way, it just happens that at OUR BHU team nursing is not how they do it, so this was something that was fairly foreign to this particular RN. Once she was given appropriate guidance she adjusted. I'm also not suggesting that you don't participate in your team, but there might be something that you don't know that you don't do that a simple conversation would help you identify and make an adjustment and the sooner you do that the better off you and your colleagues will be. At the same time, she expressed that we tended to train by the sink or swim method more than she was comfortable, which was a valid issue. We do tend to train with the "do what you know how to do, and if you don't know how to do something, get someone to help you" method alot, especially with "experienced" nurses even if their experiences have very little overlap with what they will be doing in the ED. Because this was an issue, she and I sat down every couple of shifts and discussed things that she felt uncomfortable about, I gave her some homework and I took some homework, and we would spend as much time as possible during the next shift or immediately before on occasion to discuss what she had learned or to teach her specifics about that subject. This was mostly for things like assessments, drips, etc. Basic skills like IVs, Foleys, NGs, etc were typically things that were picked up during the shifts (watch one, do one, teach one). I think this relates well to your idea to take notes and research when you get home, which I applaud as a great idea. My suggestion is that you express to your mentor and supervisor that you are trying to do this, and that you would be willing to have them give you ideas of things to research on your own time to help you get up to speed.

Prepare yourself for what, the interview or to be an ER RN? Don't worry about doing additional things to be ready to be an ED RN, you are not going to learn to be an ED RN until your facility trains you to be an ED RN. Floor nursing will not train you, nor will OR nursing, anymore than being an ED RN would train you to be a Floor/ICU/OR/Whatever RN. Each has some overlap, but none is fully like the other. What you can do is prepare for your interview. First step in that regard is to research what facilities have programs for bringing new grad RNs into their ED. Typically you want to find one that is going to have the best training program during your initial period and seems to understand that they are going to be putting an investment into you and thus you are willing to invest in them by making a commitment to work there for several years. At the same time, make sure you have top notch references. Keep working at your facility, discuss with your bosses your desires and plans and see if they would be willing to be good references for you. If they value you and want you in their facility, they will try to make that happen. Also I would suggest you determine which is more important to you, starting out in an ED vs some other position in the hospital or staying in your current location? You will find that the broader your search the more likely you are to meet other criteria, but it is very often a tradeoff. I have yet to find the perfect job, with the highest salary, best training/support, etc within walking distance of my house. As for preparing to be an ED RN, do your best in school, pass the NCLEX, find the job, and let them train you. Work hard and be receptive to learning from your new peers, help out whenever possible and latch on to those co-workers who you click with and are willing to teach you. When your at work make notes of subjects you want to research later, and then study them in your off time. Make yourself available for classes whenever possible, they will open your mind to other ideas. Learn from your mistakes, and don't let yourself get too high or too low, no one is perfect. Good Luck with whatever you find and decide.

My school has these creatures, I believe they call themselves "Librarians".... I'd never heard of them before, but they actually are trained on how to do this very thing, and get this, they are only a phone call or text message away! They also have recorded sessions you can watch where they explain how to do various queries so nighthawks can learn without calling them in the middle of the night! Amazing, eh? I've never needed to try, but I bet a quick search on youtube would pull up a few good videos as well. It's amazing what is available online these days!

I'm assuming your school has you find preceptors. I am also assuming that there is a high demand for preceptors in your area. In which case, I think it would be difficult (but certainly not impossible) to limit yourself to the few possible preceptors who might be available on off hours with either a 100% FTE or 75% FTE position and get all of your clinical time in as described. Jules A did give a suggestion of the most likely option if you choose to go this route, and that is if your school will allow you to get all your clinical hours in facilities that are open 24hr. ED, Urgent Care, etc. Even retail during weekends for some. It won't be ideal, but it could be done if all the pieces fall into place. I would suggest start with checking with your schools requirements for preceptors & sites, to see what limitations that gives you, then networking with your friends in the provider community to see if you can find sites that might be available to you. The more connections you have the more likely you are going to be to succeed in this plan. Good Luck!

Was the order written for one bag, or for many bags? I follow the orders as written, and the MAR we use shows if the order is for one or multiple doses (so does the paper order in cases where it is written). If the order does not indicate, I would clarify with the provider... Never assume.

nicktexas and IIg gave you some excellent advice. I would only add that there are many programs that are more interested in finding the 100 easy students who are trying to get into their program than they are to helping you, the unusual student who may need them to work at getting you the things you need to complete the program. --- SHAMELESS PROGRAM PLUG HERE --- I have found that my program (Frontier Nursing University) is very oriented towards working with individuals, and has worked with others who have had difficulties in the past. They are an online program, and I believe they are accredited in all 50 states (last I checked, it sounds like your state is more picky, so you should double check that). They have a WHNP which you mentioned you might be interested in. The program is not easy, but most of the parts that are audio based also have reading components with most if not all of the material that is presented in audio form, so I would think that would make the didactic about as workable as possible for someone with a hearing disability. The clinicals would be with providers you identified, so hopefully you would be able to find providers that already knew of your limitations and were willing to work around them. Personally, I would assume that will be your biggest difficulty regardless of the program you choose. --- END OF SHAMELESS PLUG --- Good luck with whatever you choose.

I don't believe that ER nurses eat new nurses alive, at least that is not my experience. I do believe there are nurses who have better dispositions to teaching new grads than others. I hate the "eat their young" thing because I just don't see it any more than I see it in any other profession. We deal with life and death, and as such when you make a mistake in a critical situation, or don't move fast enough or whatever expect a short, direct, command so that the rest of the team can progress. Don't take it personal, it's the situation. If however someone is being a jerk to you when you are dealing with patients that are not that critical, then that is a true jerk who needs an attitude adjustment regardless of whom they are talking to. As for where to start, I would suggest if your goal is a Level 1 Trauma Center ED job, then apply to every Level 1 Trauma Center as many of them have programs for bringing in new grads. Start your application process early, cultivate the best references you can, and work towards that goal. I have heard the "new grads need to work on the floors" argument many times, I personally don't believe it. I didn't, and I did fine. Many of my coworkers did, and most of them said later on that it didn't help them significantly, mostly it wasted a year where they could be learning how to be an excellent ED nurse. Good Luck on your journey.

Interesting, I have never seen a foster care physical in the ED here, I'm assuming it is different state requirements or something. Thanks for the explanation.

Seriously? I'm not questioning that it would take a while to get into your PCP, that can take quite a while here too. But the ED?! I would have expected retail, walk-in clinic, or even UC. I know most of my ED colleagues would be very frustrated to have to do a complete physical (I assume they are complete) and fill out significant amounts of government forms as if this is an emergent condition. Do the ED providers also do DOT physicals in your area?

Last I checked there were still more MSN/FNP programs than DNP/FNP programs, so I would suggest broaden your search and you will probably find some. Some programs may also advertise themselves as DNP but offer both, for example my program (Frontier Nursing University) is a DNP program, but students are allowed to "opt-out" after completion of a certain portion of the program and get their MSN/FNP, sit for boards, practice, make money, pay loan debt down, and do all the other things that comes with no longer being in school if they wish.