mysticalwaters1

Hi! I was just wondering in nyc how much do per diems generally make? I'm considering perdiem in er somewhere. I work in pa in an er currently for the past 5 years. Thank you!

Wow I didn't realize that! I wonder if that happens a lot. That's not fair. you can argue as you stated the primary md works over the others but if you are seen by NP and PA the insurance should cover it. I can't stand insurance and drug coverage garbage. It used to be cheaper to get generic forms of drugs. I remember not even liking that and NOW my pharmacy coverage has a list of in and out meds and equivilents of unapproved meds. Not a generic form another drug. I mean works similar but it is a different drug. I can't stand that. I was on birth control pills for cramping. Put on estrostep and yes newer and more expensive but man did this stuff work but an equivilent was trivora. Now estrostep $50/mth, trivora $5/mth and supposedly very similar. Of course for price I moved to trivora now my cramping came back not as much, heavier bleeding, skin breaking out. What the heck not fair. And my only other medicine is restatsis for dry eye after trying multitude of abx, gtts, ointment, patanol, warm compresses, punctal plug and this was the last resort. There's no equivelent for this med. It's not approved. I only have to pay 50% which is better than 100% but it's $132/mth so I pay a little over $50. I didn't have laser eye surgery, it's a chronic condition not going away. Maybe it's due to some people it works and some it doesn't. It's suppose to increase tear production but maybe i thought I read not definite. But what a pain :angryfire

Thanks for all the helpful tips! I'm feeling more comfortable with the peds pts as I work with them more. It's refreshing than the constent 90 year olds I was used to working with! Even ivs are not as intimidating as it once was for me. It was baby night the last few times I worked! I'm finding getting just the right positions go a long way. And I think I was giving too much liquid meds at once to peds pts. I have no kids and not infant relatives so this is all new I appreciate all the input thanks!!!

My ER has weekly meetings with managment and chair of the ER physicians present right at 7am. So nights come to them right after their shift. Our ER is setup so when the relief is there if it's 0715 we can go to the meeting soon and it last for 1.5-2 hours so day shift will come in and out at the begining too. People mentioned about inservices and they try to schedule ones at this time too.

I hated flu shots too b/c every time I got one my shoulder felt warm and extremely sore as if a hammer hit it. Well maybe not that bad but very painful. I still would get them and still plan too, but this year I just got one several days ago and it was slightly sore in the muscle then completely gone. It was the first time I never had lots of soreness after. Is it due to it being updated for different strains, or technique in administering it???

Well if they are getting medical care in prison don't they go by hippa too? I'm not talking about family as the OP pointed out just your one comment here.

i love the hospitalist program. mostly due to the fact we had one available day and night to call for any pt concerns. however more and more primary mds i feel in some ways abuse them to not have to come to the hospital at all for pts. i don't know if this is good or bad. if they do this they'll need more hospitalists then would maybe be the solution. a good thing then maybe the primary mds can concentrate on their practice more and not have to be oncall. however is there lack of continuity in care with the primary doctor not available in the hospital. anyway, i just know the hospitalists in my hospital are awesome. they also come to codes and anyone who doesn't have a main doctor they are their. they are usually quite thourough as well i find. actually extremely throrough. also i've made comments to my family in friends honestly i would never consider getting involved with a doctor or surgeon with a practice due to being on call and constantly working. except for hospitalists and er doctors!!! just b/c they concentrate on their designated shifts and that's it!

Hey everyone! I've moved to my ER department and was wondering if anyone had pointers on how to interact and do nursing procedures on infants and peds pts. Here are several of my concerns and if anyone else has pointers please add on, mainly a lot of it is how to position children to do what you have to do: 1. How to give medicine to infants and toddlers? I usually have a needless syringe and try to stick it in and try to put it to the back of the mouth on one side by a cheek. I thought it would force children to swallow it but many times doing this the child still spits most of it out so what do you guys do? 2. How do you get throat swabs of kids that are not cooperating? If they are screaming I usually can do it but occasionally some I start to go in and they shut their mouth. One doctor held a finger by the jaw on either side of the face. 3. How do you position infants and peds pts for ivs and im. 4. How do you use arm boards for ivs. One peds nurse told me she got annoyed when an elbow guard was on a childs wrist b/c it's suppose to be the elbow to immobilize the arm. So I thought of that but then I had a 2 year old with the iv in a wrist. Even if I used the guard on the elbow she could still use the wrist. I put it on the wrist but should I have used a guard for each area to immobilize it? Or is that more for infants? Any other pointers especially concerns peds nurses have that ER nurses should do would be helpful and appreciated! I already know to use smaller volume IV solution bags and microdrip tubing I use I believe it's called a butreol container with IV tubing, and don't sacrifice an iv line to get blood.

I understand feeling the way you do but I really feel a lot of it is to vent and honestly it is quite funny. You really do have to joke about it. Now some posts can be too much and downright nasty. I think many of us understand we are health care professionals and not every pt knows all the stuff we do. I hear fellow nurses all the time make comments here and there it is funny but would never outright in front of a pt ridicule them. Some I think do get cynical probably they see the same thing over and over again. But I really feel it's just a coping mechanism and any other person does the same thing in there jobs for people not aware of their specialty.

Well I worked on a crazy respitory med surg unit for 3 years. Not as many years as you did but enought that I felt totally stagnated. Was not interesting. Limitted staff. Extremely needy pts and families with not enough help to address concerns. Sicker pts but still same conditions. Issues with coworkers that built up year after year. Finally a bunch of us all left to other areas. I moved to the ER and while I've been there 6months and does get crazy it's a different busy and I am much happier there. I do find it fullfilling. I learn new stuff and see interesting cases all the time. It's challenging and allways changing. I feel like I really help my pts. I feel more apprecitive there. My iv skills, and foley insertion improved DRAUMATICALLY. As well as seeing a multitude of different pts. It's wonderful. I tend to stay in my comfort zone so if my previous position was not driving me nuts I may have stayed and turned very nasty and depressed. Anyway back to someone working for many years and moving, another nurse on the same floor I worked on worked there for 20 long years and finally moved to short procedural unit. Does lots of colonoscopies, egds, and same day surgery stuff. She seems to really enjoy it. Also another RN left too after like 15 years there to just a float nurse. She would never have thought to float and she did and loves it. Mostly b/c she's not involved on politics on the floor and if she has a bad night she is usually some place different anyway! So anyway it seems in nursing you do have to move around. It's a hard job. Good luck to you hope you enjoye becomming a mid wife!

I'm in NE pa and one of the busiest ERs in the state. We have no such free clinics at least in my several towns surrounding the hospital. There's a community center for children and it's limitted. My grandmother in CT has a "Doc in a box" and sounds great! Has an MD and it's for non real emergent stuff but to get you in quick and out than using an ER or overbooked primary md office. My area sadly really if you don't have insurance YOU ARE SCREWED. And not all jobs offer insurance or have decent insurance. Something really needs to be done with this. I really feel it's a right to have medical coverage. I really think universal health care may have to be a reality b/c I see no other way. Despite issues and cost with it we are already in a black hole now. And for those who have the money they can get it. Even with my insurance if something happened to me I barely make enough to save a little. And yea I have a nice tv, dvd, car but I'm not totally blowing money. It's just healthcare CAN be so expensive it just takes one incidence even with insurance to get you in debt. I can't help the people against fixing this or providing some solution for everyone involved are against it but wait till something happens to you and you get screwed. It's just a mess.

Actually, I found it rather truthful and pointing out there needs to be more staffing, more space, and more resources for people without insurance. And I didn't find it slamming healthcare workers either. I was about to pounce about ER forced to be the backup for failure in healthcare such as lack of insurance, primary mds, and pt's not comming in with true emergencies but it actually mentioned all that! Ok I cringed when it said ambulance will get you in faster but they were refering to an authentic emergency and stating don't drive it it really is a problem. And DEFINITELY a pt can be forgotten despite all best intentions. I think it really is useful for pts to ask the ?s and it even points out don't be rude just firmly ask your questions. Infact I was really impressed how it mentioned if it is a simple cough go to the primary md first but does mention a problem with the ED is people with no insurance. It really is an eye opener and other nonhealthcare workers get to see it. AND THE MED LIST suggestion while common sense to me it was great they mentioned it. I think it was a good article.

I had a $3,000 sign on bonus and a $5,000 tuition reimbursement which was AWESOME for me. Staffing I think is allways an issue but overal my hospital I feel is alright although definitely issues. However, one of my coworkers called himself "nurse whore" b/c his plan was to go to places to get all the sign on bonuses. So one nearby area had a $15,000 sign on bonus for a 2 year commitment. Needless to say in less than 3 months he was back. It was AWFUL. No staffing and horrible work atmosphere, no secretary 10 pts with admissions no one to answer the phones limitted techs. So yes you have to becareful and while definitely bonuses are great for you you have to think is it well worth it if the working condition is awful I live near NYC so I often thought well mabye travel there for higher pay but the idea of that long commute just not for me at all even with more money. So there are definitely bonuses but it does seem the very large ones has an extremely high turnover rate. Oh yeah my tuition rembursement went straight to my college and the $3,000 bonus was split at $1,000 intervals throught my first year.

My one coworker couldn't stand working on our med surg floor after 7 years and switched to education as well and is enjoying it very much. I've used DR. Scholls arch support things in my shoes that help. I used to use Rockers shoes by Cherokee b/c it had nice arch support but when I switched to 12 hour shifts the sole was to thin. I switched to sketcher shoes mainly for the big cushiony sole and added arch support which helps. I try to sit when I can even if it's for 30sec while I make an addition to my charts.

I can't imagine physically hurting that bad but I did work on a med surg floor for 3 years and it got to the point I HATED comming to work. I was depressed, literally sick to my stomach comming in, exhuasted. What's worse is I started "wigging out" at the nursing station. I'd go "I can't do this." And yea if you could imagine that looked very professional. I actually thought going back to walmart to cashier or even going on to veternarian school. I tried to work /c management to fix lack of tech issues, no help from coworkers and I held out for 3 years /c not much change at all, or yes change, worse. I ultimately realized I liked dealing with pts but not on this particular floor. Very very heavy pts with not enought help. Sounds like you are experiencing similar issues. I would hate being at a desk for an entire shift so I on a whim jumped to the Emergency Department. It has it's own problems but that heavy burden working on the floors is not as intense and the ED has a nice mix of all different kinds of pts critical, to totally nonurgent. You just do what you can. Anyway my suggestion is it sounds like if things don't change on your unit for the better, and maybe explain this to your manager, and if no measures made to improve I'd find another area of nursing. You may not like ED but try anything you may have an intrest. Sometimes you just need to change and if you really don't like the new area go to another or go back if you want. But your symptoms sound like burn out. I've only been a nurse for 3 years and am 25 years old and consider my first 3 years of med surg burnout and I think that's pretty sad about our profession. But if you really enjoy the type of work you can really search to find something.

OOOH how could I forget that....happened where I was too jeeze!

Boys: Leto (pronounced Layto), Daniel, Tristan, Max Girls: Caitlyn/Kate, Kiera, Kayla, Gabrielle, Danielle, Ayla

I never had to really deal with ampules except for occasional vit K. Now in the ED I am continually giving the 3 vials of IV lopressor 5min apart and I can't stand ampules!!!! I've only nicked myself once and ALLWAYS had a difficult time breaking them open. I was taught use alcohol pad to do it but it was so sliperaly. Finally I just use 2x2 or even a 4x4 acutally and instead of grabbing and pushing it away from my face I place the ampule where it should break on the center of my thumb and they break much easier for me and evenly than ever before. Don't know if that helps. Others said deffective ones so maybe soon I will slice my thumb, ow! And I play flute so I can't STAND when I injure my hands even really dried hands!

I guess it all depends. I found a lot of busy times in med surg I couldn't get to my meal break. In the ED it can be so many people comming in I have no time for meals or bathroom break, however I work nights so I found if I brought food and when it would slow down I had time to eat and talk with coworkers, and others would read magazines but I had to do it at the desk. But some nights it never slows down and I'm lucky to scarf a power bar down if that (in fact I didn't drink water hardly and had several leg cramps some nights). I think that's what the floor nurses feel is this unpredictability with degrees of business but at the same time it is the sole reason why pts need to move out to keep the ED flow going. I do notice lots of my ED coworkers it's allways the floor just doesn't want the pt, and this may be true to an extent but all of us are busy and differnt areas of work. I did find in the ED we had way more teamwork and maybe it has to be so the nature of ED than I had on the floors. I was on a very heavy respitory med surg floor, then we hired some coworkers who were very lazy (I loved them as people but HATED working with them) low staff all the time b/c even the float nurses hated our floor. Just heavy constant care, needy pts. My theory was incopacitated unable to breath people therefore anxiety levels much higher and more support needed for them and it was so difficult. Also I felt stagnated there no advancement. Kept seeing the same stuff and same bull between different mds and the management of care with the pts. I mean no decisions being made. pt's staying literaly for 6 weeks. Could not stand it. Depressed, I cried, I HATED comming to work. I wanted try ICU but no job openinings. SPU became very appealing just to meet and greet treat the pt then let them leave became VERY appealing to me b/c I couldn't stand the constant care type pts which made me wonder do I really want ICU? Finally I saw and ED position. I allways thought ED, NEVER just b/c you have no clue what's comming in and that made me very nervous. ON med surg even though stuff can be unpredictable you still had a framwork of your shift, med pass assessments ect. I was so desperate to get off this particular floor I didn't even want to try med surg. I wanted something totally different. Then I got to thinking there's ICU situations in ED, so many different pts so you don't stagnate, you do tons IVs so that skill would improve as well as other nursing procedures like NGT, OGT, they'll train you in code situations, you'll be doing code type situations more than on reg floor and deal with LOTS of intubations so you'll know the procedure with meds and at least the airway can get secured, if heart stop go what you know do the best you can. So I thought why not? And boy am I SO ECSTATIC I did it. So I ultimately came to the decision I don't ok I'll be honest I detest med surg nursing. Now does it mean Ed less busy? I think it's just a totally different setup. And I like ED setup better than Med surg. IN med surg it is constant care and many times horrible to say it is very hard to treat pt's and families continually. In the ED you for that moment do what you can and send people on there way. You don't have this heaviness to repeatedly deal with the same care over and over again mixed with bad managment and poor cooperation with coworkers. I might have just had a very bad experience but I know many nurses do not like med surg. EVen 2 of my ED coworkers med surg nurses one for 10 years and other 20+ were awesome med surg nurses and they couldn't take it anymore. They love the ED and say they'll never go back. WHAT HAPPENED! I did notice on med surg the pts seemed sicker and sicker. Once again I don't think any one side is more or less busier I think it's the delivery of care is very different. I love the ED right now. Not that it doesn't have issues, I can't stand some of my coworkers cocky attitudes but at least there if you are not lazy and help as you can and jump in to do your part it's ok.

I have been working in our ED now about 5 months. I really like it although still nervous with very critical pts. But I worked med surg for 3 years prior and there was allways this clash between the floors and ED. You really do not know what it's like until you've worked in each area. I understood ED very busy and you allways take in pts no matter what but had no clue how it felt untill I started down there. And wow did it open my eyes. Unless I was right in the middle of something on med surg I'd take report from Ed. Our ED now states the floors should treat ED report and taking the pt as OR pt's are treated. OR they take or send immediately just the nature so if there is a bed we need to take pt's upstairs was the point and I had to admitt the attitude to take OR stuff was more urgent than Ed pts. It's no excuse but a lot of it is both sides are extremely busy, understaffed. But ultimately I think one huge factor is time management. I've gotten way better but many do not have it. I found the more experienced nurses I mean 20+ had it and I was floundering. But after a while with our turnover increasing draumatically a lot of my coworkers even myself it became a challenge to get everything done and having to deal with an admission comming in could be overkill and I know of many who would put it off. Now our new critcal beds the pt's from ED are not allowed to come up b/c not lack of beds...no staff. So it strains the ED staff b/c we do not take admissions it's ED and it is incredibly frustrating and it's not the nurses fault. A lot staff including Ed managers keeps saying can't they (floors) take an extra pt and I feel so torn b/c you want the pt's up there to make room for others but it's dangerous if not enough staff upstairs to even care for the pts. So then it's this war between one another with no respect b/c well you don't take the pt so you're screwing my liscense. It's just a mess and I really feel management feeds off this crap. Now that I'm in the ED, I can't BELIEVE how many times I call for report and 9/10 x I get let me have your extension I'll call or so and so call you back. I totally get it's busy. Just how come certain busy med surg floors I can give report quickly but some of our telemetry floors I can't and it's same people all the time. I think it's b/c in our telemetry it's not uncommon for several admissions, get admission begining of shift and discharging at the end. Now our critical areas have had at times no manager and in 10 years our ICU had 10 different managers so I think staff have become complacent WITH getting busier. But my experience comming from med surg floor...I would freak with just bp of 160/80. An ED nurse call report and I'd hound does MD know? I cringe now thinking about all the stuff that would frustrate me. So my priorities were different. And a peds nures I know had several issues she felt the ED would downplay critical cases just to get pts upstairs. Now look at me freaking over bp 160/80 could it be maybe not as critical as she thought but still lots work and followup? I don't know. She says Ed only worries about immediate needs and no one else. Now that is Ed nature but I don't think totally like that. I think it depends on the nurse. With Ed you may not experience something for an entire year then take care of someone and looking for someone with experience to ask ?s (but I do like how this makes ED so much different). The peds nurse complaints was that ED nurses with especiall infants drew blood from IV line and would clot off the line. I was originally taught to not stick an infant multiple times or make sure it's good first time. But I asked around and found out no you do not sacrifice a line on infant for blood draw b/c you can allways get a heel stick so only draw blood from line if it's very good. It freaks me b/c I didnt' know that! I'm really annoyed my ED educator was gone 2nd week into my orientation and had none for my entire orientation. Got a new educator my last few weeks of orientation. I'm not stupid, I ask ?s but I still wish more direction. I've seen a lot during orientation, active MIs, mult trauma with transfers, DKA ect. But maybe management needs to find out all the complaints each side has and devise more edu on it. Just talking with the peds nurse helped me a lot just for I don't work with kids every day. I also found out Rocephin Im very painful especially in kids and lidocaine with it can help. I had no idea! But especially ICU holds in the ED while interesting can be so time consuming. I took care one ICu pt, DKA and AWESOME experience but I had no time with other pts! It's not fair. Another thing...with ED our #s of pts in are consitent so a required #staff remains, whether we have it all the times that's another issue but on our reg floors if certain pt census they'd take a nurse off. So then admissions would fly through and you still have the workload originally b/c even though census is low you still have the same pt load compacted now with a high # of admissions. Then supervisor would find another nurse after nurses already drowning and the entire thing totally ineffetive. Not to mention one holiday a nurse was allowed go home. Then admissions and pt's in ED a lot and had not enough staff upstairs b/c that nurse was let go then there was no replacement or way to get that nurse back. Then they were ED hold. It's disgusting!!!!! Sorry I'm really going off here but honestly each side has there own issues but I have to admitt in the ED you really have no clue what's comming in so those pts do need to leave they can't hang out in the ED b/c we need our staff for all the pts comming in. Floor nurses I don't think it fully hits b/c they are in their own area and only worried about that which maybe is absolutely correct but it does create this discord between both sides and management should do more to fix it.

Thanks!!!

I found out my father said he can't donate blood due to his diabetes. I know guidlines are strict but I didn't realize how strict. I know it's suppose to be based on science but maybe it all has to be reviewed. Isn't the big thing now that many people do not know they even have hiv?

I was AMAZED when I got my nursing job how I was totally unprepared how to deal with management and coworker issues!!! It was worse than high school behavior! Luckily my dad helped me out!

That was awesome! I mean not your situation but how you were hired there under the circumstances!