Bobjohnny

I know an ED Attending that just started there. From what he said, they just went from a non-leveled to a Level 2 Trauma center with crap-all around besides them. I remember seeing a sign-on bonus for them not too awful long ago, $10,000 sign on bonus, that gets paid after 2 years. If I recall correctly, Maniilaq Health Center in Kotzebue has open positions, sign on bonuses & room/board assistance.

Ultrasound Guided Peripheral IV? No idea what an HCAHP is. Y'all really use lido for every IV insertion? That seems excessive, at least to me, but to each their own. My thought process for this has always been, "Why get stuck twice when you can get stuck once?" But, its not within our standard protocols & we'd have to obtain an order every time we do it. Anecdotally, it seems as if the few times I've interacted with people that use lido consistently have lower success rates. But, this is also just when pre-op can't get an IV and calls the ED (the lido is in their protocols).

Your story actually made me lol Ruby Vee

That is completely how I ended up in nursing. It was a 2 year degree that made decent money. Fortunately it's something I'm not terrible at, and only hate my job a couple days a week. Although I am a bit of a nurse nerd now, and occasionally read Uptodate in my spare time.

TCRN is s specialty certification much like CEN, CPEN, etc. These specialty certifications are supposed to indicate that you've achieved an advanced level of competence in the specialty area. I can only speak specifically for the CEN as that is the only one I have, but the tests are fairly difficult. I think it shows a dedication to your profession. You also get to add more letters behind your name. TNCC is a class that provides education. That certification show that you have passed a class and should have a certain minimal level of competence related to the content of that course.

I've never worked at a leveled trauma facility (my state only does 1, 2 & 3). But, I can say with confidence that you will see plenty of crap shows at any facility. What kind of volume does the level 4 see? From many of the nurses I've spoken to that have worked at level 1(and most level 2's), as a RN you get to do considerably more with your patients if you aren't at a big receiving facility. There aren't a million med students, residents, fellows & nursing students constantly in all of your rooms. We still get STEMIS, acute CVAs, GSWs, etc. etc. We just don't have to do the long term management or prep them for OR. Stabilize as best you can and ship. You can always ask to do a shadow shift for the shift you would be working as well. Give you an idea of what its like, and also the opportunity to speak with some of your potential future coworkers.

The way that it helped level load this a facility I previously worked at was that during the 'Golden Hour' ED was required to transport all patients. From 0600-0800 & 1800-2000 all admits were required to be transported by the ED RN. The rest of the time the inpatient nurse was required to come get the patient. Our bed management was also able to see the ED tracker and was able to determine if we were dead, if so ED was asked to transport the patient. My current facility uses a different method. We recently got dedicated ED transporters. They take patients to radiology as well as transport them to the inpatient units. Transport cannot take monitored patients. However, they are only available 1100-2300. The rest of the time our EMTs transport patients(this can include monitored patients). The only ones RNs are required to transport are patients going to ICU & some medication specific things (ex: nitro, cardizem, cardene, dopamine, dobutamine not going to ICU).

The two things I've seen that work well when people show up unwanted at your door are: imply that you're a polygamist & answer with a firearm in sight. In neither case have the unwanted visitors returned.

If you haven't taken those classes or ACLS, PALS, etc. for some reason take them close to when you test. I took my PALS renewal on a Friday and took my CEN on the following Monday. I knew my pediatric algorithms backward and forward. I'm uncertain as to how useful the ENA study guide is, as I did't use it. I would also check out the following thread: https://allnurses.com/emergency-nursing/cen-2016-1023524.html

This seems to be the biggest factor that our facility has identified in regards to patients deteriorating without being noted. We had a relatively high proportion of new grads (about a year ago we had somebody that had been a nurse for 5 months doing charge on a med-surg floor). There has been significant improvement as our facility wide level of experience has increased. We've recently instituted a family initiated rapid response to help reduce the number of code that occur outside of ED & ICU. It has not been implemented long enough to garner any data.

Seems like an awful lot to waste if you're giving it IM. Or is it coming from pharmacy at 25mg in 50ml? I'd hate to stick a patient that many times.

I do believe the amount of money that the indicated CEOs are making is ridiculous. The CEO of my hospital is an absolute idiot, he is a super nice guy but still an imbecile. But a fair wage is what you choose to work for. If the minimum wage was $15 when I was going to college to be an RN and start out at $22.90, I wouldn't have actually been an RN. I believe in a living wage, but I don't believe that the federal government is the one to legislate it. Biloxi knows what work there, just as Anchorage and Buckeye know what work in there respective markets. It just seems like a heavy handed, across the board change, is shooting ourselves in the proverbial foot. How many of those NAs will continue to be NAs when they can leave the ECF and work as a burger flipper for the same amount of money, if the job isn't automated, as well as considerably less stress? For those saying that increased minimum wage does not lead to inflation/increased prices: Chipotle In San Francisco Will Be Much More Expensive | The Daily Caller San Francisco Bookstore Closing Due to Minimum Wage Increase

As others have indicated, Sheehy's is good.

Also make sure that you talk up being a resource to fellow staff and how you perform service recovery in this position. Make sure to have examples in mind of the normal off the shelf questions if you get an interview. Ex: Tell me about a difficult situation and how you dealt with it. What is your greatest weakness? What is your greatest strength? What is the most important thing you can do if you don't get this job? Honestly, my interview got me my current job. There was another nurse (that was also in house), who's resume was slightly better than mine. But, I interviewed well (or so I'm told) and got the job over the other candidate when she didn't interview well. You can always buy some time to come up with an answer by rephrasing the question. "Tell you about a difficult situation and how I dealt with it, correct?"

I've seen on numerous occasions where we give patient satisfaction IVF, Duonebs, etc. Heard a provider call it that one time, and the term has stuck and pervaded our ED for such treatments.

My wife had an allergic reaction to them. After an hour of her first shift wearing them, I had to take her different shoes. Her feet were swollen several sizes beyond normal, with hives, and only on her feet. In the trash they went.

As other posters as indicated it's a combination of factors: #1) They can. #2) It's tradition As for the post I quoted. I feel your pain, I basically bought the cheapest white shoes possible that weren't a total piece of crap when I was in school. Now, I wear my steel toe leather work boots just like I did before I was a nurse and at a job that involved 8-10 hours of continuous walking and standing. They are heavy suckers, but I've also never had my toes run over by a cot.

Neither of those is an option at my facility on shift. Although we can do extended length (40mm) peripheral angios to access a Basilic or Cephalic. But, if a provider insists a patient needs access(and you agree) & they refuse to put in central, what do you do? Know what I mean? Do what you can with what you've got.

This is the same thing I always suggest. We did this with one of our new grads in our ED. She just started IVs for a full 12 hour shift & she go it in about 45 sticks or so.

I don't see anything addressing the triage nurse with 25 patients in the lobby. Plus, limiting a fast track nurse to 4 patients is a waste of resources. Note: I did not look in additional locations for information about the California staffing ratio law. If somebody has info on how they address triage with 20-40 patients in the lobby, please let me know.

There was a facility that I used to work contingent at, that when the code button was pushed it would send a notification to the iPhones assigned to House Supervisor, ED Charge, ICU charge & Hospitalist. It also would send a notification to the pagers for the assigned team members from the various different departments, it was fantastic. That place had the best cooperation between inpatient and ED staff. ED went to inpatient codes & ICU came to ED codes/traumas/etc.

Med/Surg 5:1 ICU 2:1, 1:1 or 1:2 depending on acuity etc Icu Stepdown 1:3 ED we generally staff 1:3/1:4 occasionally it'll end up at 1:5 if it's terrible. Although the triage nurse can sometimes be 1:30+, If acuity dictates we'll sometimes go 1:1 or 2:1.

We currently do not have any ED protocols. The only facility wide protocols that we have are to d/c a foley post-op, and send a stool for c-diff if the patient has loose BM. We switched medical directors about 18months ago and the new one has yet to sign them. We have repeatedly harassed him about signing new ones, but he continues to fiddle fart around. Thankfully most of our Docs will allow us to do our triage, ask them for an order based on it and then we order it when they give us the verbal go ahead. Also a bunch of our midlevels will toss in orders when they're not busy in fast track, which is about 85% of the time since our fast track only has enough physical space for four patients.

I've noticed that crowd control during codes (& traumas) are an issue at both facilities Where I've worked in the ED. However, at one facility charges & staff were empowered to kick unnecessary people out. I'm thinking that I'm going to bring this up at either (or both) our next Charge nurse meeting or staff meeting.

My employer always pays for about 5 or 6 people to go. They CNO is mandating that 4 of 6 people in managerial/Director level positions from our 3 hospitals must go this year. I'm really hoping I don't have to go, I have absolutely no desire to visit The People's Republic. Although, getting paid to go would be a nice break from regular work. I'm also really not going to want to go with the wife being 30+ weeks pregnant.