PedsERRN

If you know you want to do peds, then go for it! Choose a med-surg floor at a chldren's hospital-that will give you the largest base of knowledge as a new grad

It all depends on what sub-specialty and the nurse-to-pt ratios at your hospital. In the ED, we don't always have time for that. When I worked step-down, we usually did.

We use mostly 24 gauge PIVs on pts up to 3-4 years old. On a fat 2y/o, You should be able to place a 22 or 20(AC), however threading them can be a problem. The shorter length usually works out better. In peds, we always use the smallest one that will get the job done!:)

Apparently the "pumps and pearls" group have finally noticed that our LOS is too long for admissions. My boss asked me to sit on a committee to improve our times. We are brainstorming ideas to decrease this time. Does anyone have anything that worked out well at their facility? Also, what is your EDs average time from admission to bed? Thanks for your help! Anna

We often allow families in the room for codes. We are a level one trauma center and have a social worker who stays in the back of the room with the parent and explains procedures. We will advise the SW if things are going to get bad, i.e. cracking a chest, and they will discuss with the family if they still want to stay. I've had parents thank me for letting them be there. I've always worked peds, so it's not that much of a transition-we always have families at the bedside for everything else!

Thanks guys, this really helps! :)

We are having a serious problem with lack of documentation on our unit. I believe that anyone should be able to pick up a chart and know exactly what is happening with a patient. Not so in our ER! Most of the nurses feel that they don't have time to properly document, but I'm also finding they don't know what to document. I'm trying to come up with a documentation tip sheet for the nurses because I worry about their liability if something should happen to one of their patients after they relinquished care to someone else. I looked on the ENA website but can't find anything about standards. Can anyone share with me time frames for documentation? For example, VS q4h, assess q2h, assess within x amount of time after an intervention? Thanks for the help! :)

To clarify-Our ED techs are all CNAs and EMT-I or EMT-P. They recently decided at our hospital that they can't hang IV fluids, but have continued to let them start IVs. They can go to the floor and start lines. Does anyone have an IV team that includes techs?

Has anyone heard about a new law that will prevent techs from starting IVs? Our techs are the experts at IV starts; I don't know what the hospital will do if we can't use them!

Palm pilot pre-loaded with medical info(Epocrates and such)

We have several pregnant nurses-I think there is something in the water! They all plan on working until the end, unless they have complications. On this note, does anyone have a policy regarding pregnant nurses in triage? We always thought there was one that you can't triage during the first trimester, but it turned out to be a myth. Now it is up to the individual nurse, but I think we should find out for sure. I work in a peds ED, so we get a lot of coxsackie and a large group of our sickle cell pts carry parvo. Just wondering!

We throw ours in the red trash. Our compliance person said that it is good because it gets burned.

We go up with Cerner in December, and hope to have the ER piece up by next Spring. My boss used it at another hospital and said it was great. She said it's very user friendly and (of course) drastically reduced errors in meds/treatments.Good luck!

I have been a pediatric nurse for 9 years, and currently work in DC. This is the first union hospital I've worked at, and find that the union stifles the nursing culture here. It is not mandatory to be a full member of the union but all RNs pay dues and most function within the rules of the union contract. They started a union because the older nurses seemed to be getting fired just before retirement age. A good reason, no doubt. However, at the time the union started, one of the inpatient units was starting to pilot a totally nurse-run unit; the union decided that this blurred the line of management versus staff and said "no." Raises cannot be based on performance according to the union contract, so everyone gets the same raise no matter what. This really affects the "extra" activities on the unit. Those who are internally motivated to make it a better place still are, but those who are externally motivated are no longer motivated by a bigger raise. I recently went over to the dark side and took a shift coordinator(supervisor) position. In most hospitals this is not considered a management position, but here it has to be (you can't be in the union and part of the leadership team of the unit.) I am so glad to no longer be a part of the union, but it is very frustrating trying to make positive changes in a union environment. Hope this helps-sorry it is so wordy!

Have you considered using your RN for something similar? Doctors without Borders or the like? You could get a similar experience and be marketable when you return.

Sorry if I offended! I didn't mean to bash on the police-they are doing what they have to do. They had a juvenille who had a bad outcome, and now they are mandated to bring them all in no matter what the complaint. I have all the respect in the world for our police, and feel bad for them when they have to sit with a pt with no real complaint for a long time before a doc can get to them. The kids have learned that they will come to us, and often make things up to delay going to lock-up. My husband is a cop, and we often ***** together about the policies that affect us both(ours and theirs.) So-I wasn't bashing the police, it just kills me what these kids will say is wrong with them to get out of lock-up for a couple of hours.

We have to medically clear any juvenille arrested in DC if they have any kind of complaint before they can go to lock-up. MPD recently implemented this policy, and we've seen some really ill patients. My two favorites: 1. My wrists hurt. Me-Can you show me where they hurt? Him-where the handcuffs are. Me-Officer, can you loosen those a notch? (Officer loosens cuffs) Him-That's much better. 2. Me-Why are you here? Him-Back pain. Me-Can you rate your pain on a 1-10 scale? Him-It doesn't hurt now. Me-When did it hurt? Him-When the cop had his knee in my back. Me-Let me get this straight. Your back hurt when the officer had you pinned to the ground with his knee, but stopped as soon as he removed the knee? Him-Yeah. I also like it when you ask the officer what is wrong with the patient and get the response "nothing." Then why did you bring him here? I know they are only following their policies, but it is so annoying, especially when the ED is full. It's not like we can bring the handcuffed patients out into a pediatric waiting room!

We are going for magnet status soon, and I heard that easy recognition of nursing staff is required. I think this means we would have to switch to color-coded scrubs. Anybody know if this is true?

There is a difference in not treating someone because of your beliefs and not treating someone because of their beliefs. For example-A devout Christian may refuse to assist with or perform abortions(this isn't new-Providence won't do hysterectomies!), but it is not okay to say you won't treat anyone who believes in abortion. See the difference? What comes next-seperate hospitals for gays and straights? Can I visit my gay friend in the hospital? Or he me? Should we decide who we treat by race or sex? :angryfire

Check out Georgetown University-I think they had a program a few years ago where they would hire you as a tech and pay for your school and then you had to agree to work there for a few years after you graduate.

I think that a lot of institutions don't foster precepting very well. Some nurses are great preceptors and love doing it, others outright hate it-which is okay, we don't all have to like the same things. The last place I worked had set preceptors. They took a class and knew who their resources were in the hospital. If you weren't a preceptor, you didn't precept, not students, techs, or other nurses. We had a clinical instructor employed by our hospital who orchestrated all the nursing students in the hospital. She assigned them to a specific nurse for that rotation. When the students came in the night before clinicals to pick their pts, they would post the pts they picked at the nurses station. Then the night charge nurse would assign those pts to the correct preceptor. This ensured that the students had a good experience and that the nurses with students wanted to be with them. The students weren't a burden to anyone, so noone was mean to them. This is the best way I've ever seen students handled. I think more places should do this; it promotes a win-win situation!

When we interview new grads for internships, we look at both grades and experience. Any out of school stuff would help, like working as a tech or unit clerk or volunteering in the medical field. We focus our interviews on behaviors more than knowledge. An example-Tell me about a time you had to deal with an irate pt/family. What did you do? What was the outcome? For a new grad, we care more about who you are than what you know. It is easy to teach someone new skills and knowledge, but very hard to change behaviors. Good Luck! :)

I like computer charting-it is much easier once you get used to it, also much faster and more thourough than our paper charts. Plus, you don't have to decipher your coworkers handwriting!

Best are the ones who don't medicate the child at home because they want us to see how high the fever was. No matter how many times you tell people that it won't change the treatment(assuming they have athermometer and we know the child actually had a fever!) They believe it will get the child seen faster-of course sometimes this works-when they have a seizure in triage! Hang in there and remember-we can educate them one person at a time! :)

Would you like to come work at my hospital?