ImaERtraumaRN

In our level II... ...experienced RNs get 6 weeks, new grads get 20 weeks or longer if they need it. The new grad orientation is based on ENA recommendations. New grads also have 5 hr weekly classes during the 20 week orientation specific to the ED. All RNs also get ACLS, TNCC, and ENPC.

Ouch. I think there are some assumptions being made in this thread that many times are just not true - at least in our ER. In our ER we do not have any control over when our patients get beds. Nobody sits around and waits to d/c patients to the floor right before leaving. In fact it is a real pain for us because we are trying to give/take report on patients while others are arriving at the same time. Our EMT's in the unit who help transport are also in report. It is false to assume that we are trying to "clean house" at shift change. When a bed becomes available for our patient we try to send them up for the very reasons that Taz has mentioned above, not to mention the fact that many times we have 5-6 critically ill patients, 2-3 which are rolling in by EMS and placed into beds that have not been assessed OR stabilized yet. At least when they come to the floor they have SOME sort of diagnosis and direction for care. Some are stepdown or ICU patients that have been waiting on beds for hours. Other more stable patients are put into the hallway to make room for the more critical patient when report cannot be given. We cannot refuse to take patients because we dont have enough beds or nurses. I cannot simply deny report on those patients, nor can I say a bed is not available because I am in report on another patient or passing meds. I try to give report to the floor before I leave NOT because I am trying to run out of the door at shift change, but because it is more important that my patient be ensured continuity of care. That means the person who stabilized and provided care to the patient all day should be reporting off and not someone who just took report 30 minutes ago who knows virtually nothing about the subtle changes that may be significant to the patients needs. With that being said I understand that transporting and giving/getting report at shift change is a problem. I try hard not to have to give report to the floor at shift change, and when I arrive with the patient on the floor I help move the patient, tuck them into bed, put them on telemetry, and many times get their first set of vitals before leaving them - having NEVER seen the primary nurse or CNA during that time. Many times the bed has not even been pulled back or the correct equipment in the room in anticipation of the patient when I called report a significant amount of time earlier. I dont feel the need to be greeted when I show up, but preparation in anticipation of my arrival would be wonderful. I know this is an age-old issue and has been discussed to death. There are challenges on both sides of the issue and not a lot of good answers to the problem. I try very hard to consider both sides of the issue and adapt as much as I can to ensure the best care to the patient. I just think it is important to consider what it is like to walk in each other's mocassins occasionally.

A friend of mine just went to critical care transport for the same reasons. One on one, or TWO on one pt. care, no primadonna docs. They *do* transport our crackheads and other mental health patients, but there arent as many as make it into our ED just for some "special pampering". He is loving the change and I am considering following his footsteps after a couple more years.

Once you have experienced first hand EVERY situation you can possibly encounter, THEN you feel completely comfortable. :lol2: Truly we all have questions and situations that arise that we just have never had to deal with. I have learned that "improv" is a good thing. A good nurse told me once that while in orientation to worry about my clincal practice because the paperwork and protocols for everything else were secondary and could be perfected later. She was right. Hopefully you are on a floor where you can ask questions even after you are out of orientation. Eventually you will be the one answering the questions for the next newby. Go easy on yourself!

While I know that the OP said that she is ashamed about this behavior, I just can't get over the fact that she just "tucked him back in" and left the room. I am quite certain that this would equate to negligence in any courtroom when considering what a "safe and prudent nurse would do". In fact, I think it goes beyond a med error or other unsafe act because she was aware the pt. was seizing and did nothing. It could very well be seen as criminal if this pt had died from injury or aspiration. If it was my family member and they had lasting effects from this negligent behavior I would have pursued it with the BON and beyond. That being said, what's done is done and now it's time to learn from the behavior, get to the root of what caused it to happen and move forward. Many new grad RNs "freeze" when faced with an emergent situation because even though they have learned about this very subject in school, they have never had to apply the skill in "real life". So, was the situation that she "froze", didnt know what to do, then was too embarrassed that she didnt know what to do that she didnt tell anyone else about the incident? I think it's plausable. Not an excuse, but plausable. I think that additional preceptorship is a good choice, but I also think that seeking out other learning opportunities is in order. Seek out every code, seizure and uncommon event on your unit and ask to watch, do or evaluate. While you are still orienting, tell your coworkers to come get you when someone is going bad - and ask what signs/symptoms they noticed. If you have a rapid response team ask to round with them for a shift, or spend a shift in the ED watching trauma or resusitations. Spend a day with respiratory therapy and working with vented patients. My belief is that if you emmerse yourself in the situations you most fear, that soon they will become much more manageable.

I say listen to your instructors, your mentors and your heart. If you are someone who adapts to an environment quickly, has good organizational skills and learns quickly then a specialty area might be the way to go. You will understand that every patient is a learning opportunity, and there may even be research/reading you will need to do on your own time (without prompting) in order to make your practice stronger. Many times I find myself going home and looking up something I ran into that day that I didnt know about. I was a new grad in the ED and the choice was the right one for me. I also had a very good orientation with 20 weeks of classes and preceptorship. On the other hand, if you had clinical instructors tell you that you need to work on organization, or you need more work in a specific med/surge area, then you may want to go for the foundations first. Our hospital will allow you to transfer w/in the first 6 months if your position is not a good fit. If you find yourself stressed out, burned out or overwhelmed transferring does not equal to failure. I would have been miserable in med/surge. It isnt for me and I know that. That doesn't mean that it isnt a great place for others. I had to follow my heart and commit to doing everything I could to ensure my own success. Good Luck!

I have NEVER heard of a preceptor telling a nurse to leave during a shift and ESPECIALLY without explanation. We can only learn from our mistakes if we are told what we did and are given the opportunity to correct ourselves the next time. :angryfire :angryfire :angryfire Regardless of whether or not you did something to make her upset, you are a professional (new grad or not) with a license and should be treated as such. You have spent a lot of time and energy getting into the program, graduating and passing boards and nursing is your career. You owe it to yourself to ensure that you get the best orientation and training wherever you work and you really have to demand that if you are getting less than you deserve. I would request a different preceptor and speak to your manager about the reasons why. If you are concerned about backlash have your manager simply relay that there was a personality conflict, otherwise I think the preceptor should be called out on her unprofessional behavior. Remember, you are going to be solely responsible for your actions after your orientation and that is the only opportunity you will have to REALLY learn the ropes before you are on your own. Good Luck!

Congrats on getting into Nursing school. It is quite the roller coaster ride but you sound dedicated and that is really what it takes. Safety is incorporated into your schooling and it becomes part of your practice as a student nurse, and should be part of your practice as a nurse as well. Needlesticks are not as common esp. with all the needleless devices out there becoming the norm. I work in the ED and have only seen a couple - one was on a needle a trauma pt. had in his pocket and the nurse was helping him undress. It was a learning experience for all of us, and luckily all her tests came back fine. So, if this is really what you want to do then relax and just go for it! Dont let others steer you off of your path. You will be so surprised at how fast the time goes.

Priorities are different in the ER, it takes more than a couple of days to learn the pace and to "get in the groove". Watch your preceptor and how he/she does things and in what order, but dont expect that you will have things down to a science after such a short time. Soon you will notice that you do things on auto pilot that used to take a great deal of thought, and be able to do things more quickly and efficiently. Be good to yourself and good luck!

This is an age-old problem. At our hospital we tried using faxed written reports but it seemed that something was lost in not giving a verbal report. Also, sometimes the paperwork was lost and that was a problem too. We recently went back to verbal reports and now deal with the "I'm not ready" issue. It would be nice if there was a rotating "admissions RN" that could be on call to take report in shifts, maybe a two hour block. This way the pt. could be accepted, admitted with a history done and then handed off to the recieving RN with all the info gathered by the admissions RN. Of course, that would be in a perfect world where there was plenty of staffing. My biggest issue is when there are beds closed up on the units but we are not allowed to close beds in the ER due to staffing. We are holding with pts in the hallways and EMS rolling in, but due to staffing issues we have beds closed upstairs. Oh well, what are you going to do???

nope...dont think this is crazy at all...I have a few I get attached to, but I really like not taking every one of them home with me. I think if I had to care for them day in and day out I would be emotionally drained.

Of course I like knowing I'm helping people on one of (for the most part) the sickest and probably worst days of their lives. For all that I complain about the "whiners" and the "whiner's familes" I really like providing care to those who genuinely need it. And, truth be told, there is NOTHING like standing in the trauma bay with your gown and gloves on when you have a serious trauma 5 mins. out and guessing what it will be and anticipating the plan of care...except when they roll them in. PURE adrenaline...

Appendicitis can be misdiagnosed as UTI - it depends on how the symptoms present. We do not do abdominal ultrasounds on every pt - especially if the urinalysis comes back positive and there is no other evidence of appendicitis -which I dont have much to go on as far as that is concerned. There may have been additional labwork however the article that was posted above states "No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases". A kidney infection or even PID can cause elevated WBCs, high fever and severe abd. pain. Of course, I dont have the labs or assessment info to evaluate what the MD was thinking. In our ED we always assess for rebound tenderness - although this is absent in many depending on the location of the appendix in the abdominal cavity. And any time symptoms increase in severity the pt should return to the ED. I think part of the problem lies in that many EDs do unnecessary testing that costs the pt. a great deal of money when the diagnosis could have been made based on more inexpensive diagnostic criteria.

One step further - Decorticate means you are still protecting your core, which is a GOOD thing, therefore decorticate is the BETTER of the two.

Me too! Hope she is feeling better today!