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MedicalPartisan's Latest Activity

  1. MedicalPartisan

    Tips for a new grad ER nurse

    Awesome to hear! I'm doing great as well. I've been off my 6-month orientation for a little while now and things are going great so far. The more I learn the more I realize I know nothing but I'm just soaking up everything possible. I love learning. Keep up the good work!
  2. MedicalPartisan

    Tips for a new grad ER nurse

  3. MedicalPartisan

    What is the drug of choice in your area?

    Alcohol, spice, and crack are the standouts, I would say.
  4. MedicalPartisan

    Tips for a new grad ER nurse

    How has it been going in the ED for you guys?
  5. MedicalPartisan

    How impossible is CEN for a new grad?

    I graduated in December, took boards in January, and got hired in the ED in Febrary. I've worked 10 shifts thus far and am wondering how impossible CEN would be for me. Is this one of those things where it doesn't really matter "how smart you are" and is more about experience? I don't know what to expect but if it's doable for the average person I'd like to go ahead and become certified.
  6. MedicalPartisan

    Nurse to patient ratio

    We don't allow patients to be in the same room, regardless of relation, with minors being the exception. Does your facility?
  7. MedicalPartisan

    Tips for a new grad ER nurse

    Agree 100%. My patients teach me so much. They live with (whatever) day in and day out so they are much more knowledgeable than me in many cases. They generally love being able to tell you all about it, too.
  8. MedicalPartisan

    Will an ER tech help me land a job in the ED?

    Absolutely. Work hard and show them what you're capable of (work ethic wise). This is also advantageous as you will get to see the logistics of the ED and what the nurses do and will help you determine if that is the branch of nursing you truly want to pursue.
  9. MedicalPartisan

    O2 for Unresponsive Pt

    Do not EVER think you are wrong for asking a question. You would have been wrong had you not asked and simply assumed, even if your assumption was correct. Why? Because it was a gamble.
  10. MedicalPartisan

    Tips for a new grad ER nurse

    This is just one giant cluster of thoughts, so sorry in advance. No matter how level-headed and non-anxious you typically are, you will likely think there is no way you will be able to grasp it all even with all the training in the world. This feeling will ease and eventually pass. But because you're human, it doesn't matter if I, your friends, your colleagues, and everyone else attempt to ingrain this into you, you will not be able to see it that way because you're not there yet. TRY to know that you will, in time, be able to do this. ASK infinite questions. I hear nurses with 20 years of experience asking questions on a daily basis. Seriously. There will be things that you know since you're fresh out of school that even the best nurses don't know. The field of nursing will always be this way. That's why diversity is so great - EVERYONE brings something to the table. Nobody will think you're stupid for asking a question. They will think you're stupid if you don't ask a question and screw something up. YOU CAN NOT TAKE BACK WHAT YOU PUT IN YOUR PATIENT so know what you're giving. Know the 5 (I think it's 6 now) rights. Ask full name, date of birth, and allergies... every. single. time. If you word it well enough the patients won't get too annoyed. As I walk in with my meds I'll say (for example), 'Okay... my favorite question... full name and DOB? And you're not allergic to Dilaudid or Zofran, correct?' obviously this will change with an altered LOC, some patient's will agree to anything - use judgement and common sense with your interactions. Similarly, don't enter a room and say 'Mrs. Brown? 3, 1, 1957'? Even in coherent patients, sometimes they are in so much pain or not paying attention and, again, could agree to anything. Make them tell you. Be confident. Again, ALWAYS ask questions if you are unsure, BUT, the patients have nothing to do but to watch your every move so if you're nervous and questioning yourself they will become nervous as well and might even request someone else. They don't need to know it's your first time starting an IV, they don't need to know you've never inserted an NGT before, etc. If possible, and there is no safety risk, ask your questions outside the room and not at bedside. You need and want the patient to trust and have confidence in you as well. Don't ever say 'I know' to an educator or colleague. Even if the colleague or the nurse orienting your is telling you something you've known since intro to nursing, LISTEN. Be a sponge and absorb as much information as possible. If you are asked to do something, even a basic task, that you are not comfortable doing, SAY SO! You will not be judged for it. You can legitimately say (outside of the room), 'I'm not comfortable or completely confident as I've not done that before/in a while so I'd like to observe you to ensure I'm doing XYZ safely and correctly. Can you show me? Or Can we do it together?' If you've already been told how to do something or what to do in a scenario, DO NOT BE AFRAID to say, 'we went over this last week, I just want to be sure, for XYZ we are supposed to do this, right...?'. Sometimes it sucks when you forget something you've been told, I hate asking again, but never proceed if you don't know. Treat your colleges like GOLD. I'm not necessarily talking about just fellow nurses, I'm talking about techs, LPNs, and even the housekeeper. Appreciate them. Always say thank you. Appreciation goes so far and people will be more willing to help you. Even if the housekeeper is changing the trash at the other side of the nurses station that I couldn't care less if it was full or not because I'm not over there - I still ALWAYS say thank you! Your techs will be there for you when you need them most, so again, treat them like gold. You're busy, the techs are busy, everyone is busy. So do not delegate simply because you can. You are not above a bed bath. You are not above getting family coffee. That said, do not be afraid to delegate these things when need be. There may be a time when you have to ask a tech to clean an incontinent patient - that person MIGHT feel like you're the 'RN above them making them do the dirty work' but the goal is utilizing everyone to their max within their scope. The tech can't do a neuro assessment, they can't push meds, etc. So if you have tasks that MUST be completed by YOU, sometimes you have to delegate the 'dirty work' and you can't be afraid to do so. But what you can do is express your appreciation before and after their task, and at the end of the shift. Never be afraid to report things you find unethical or dangerous but don't be a tattle tale. Just use your judgement. For example, we had a patient the other day who was intoxicated and faking seizures and one of the nurses decided to push some 'nackle' (NaCl) (saline) to help with his seizures. This nurse didn't call it that, but they said 'this will help, just try and relax'. Miraculously, the patient felt much better and the seizures subsided. Nowadays, I'm pretty sure this is illegal. You can't tell someone you're giving them something and it's either A, a placebo, or B something else (ie. 'blood pressure med' that will secretly calm the patient EVEN if the sedative was ordered. The point is, this is against policy and not okay. You just have to use your judgement if you feel like you should report something. Was the patient harmed in ANY way? No. Was the act unethical? Eh... Maybe... Was it against policy? Yes. Would I personally report them? No. If you did, you would not be in the wrong whatsoever. But things sometimes can come back to bite you so just be careful. Again, though, NEVER be afraid to advocate for and protect your patient in other types of situations. This post is a disaster. I just worked 13 hours and am delirious so I apologize as there is no structure here, haha. I'm actually a new grad myself. Graduated in December, NCLEX in January, and I was hired in February. That said I've worked in the ED here as an emergency registrar for 8 years so I was comfortable in the environment and knew the logistics. Even so, my first two shifts were completely overwhelming. And not that I thought for a second 'all my years here' meant I knew how to be a nurse, but I definitely didn't think I'd be as overwhelmed as I was. Day three, things seemed a lot better. Day four, I felt even 2x better than day three. That's not to say that I 'know what I'm doing', I will be learning my entire career, but the feeling of 'okay maybe, one day, months and months from now, I will be able to do this on my own' is already surfacing. Because on day one, I didn't see it ever being possible. I'm now on my 7th shift as a practicing nurse and the fear of never being able to 'do this' is already gone. I know I will be able to get it all down with time now. TL;DR: Ask questions. All day. If you're not 100%, ASK. Also, once it goes in, you can't take it out. If you have to check the order 4 times before your comfortable giving it, do it. Be confident. Confidence and experience are not synonymous so being confident doesn't mean you're acting like you know it all. Advocate for your patient - if something doesn't feel right, it probably isn't. Treat every one you work with, down to the housekeeper like gold. Show your techs appreciation because they might be 'too busy' when you need them most. It's not your job to analyze John Doe's visit history and assume he's not really in pain. If there's an order, it's safe and appropriate, he get's the pain meds. But he's a drug seeker! Well... you're still giving the meds when it comes down to it, so spare yourself the negativity and self-caused stress and cynical perception and just do your job. Next though: Patient adds chest pain to their triage complaint because they know how to 'work the system' and get back the quickest? Ridiculous. But guess what? That frequent flyer drug seeker that you're now ignoring just so happens, out of all 25 visits this year, to actually be having a STEMI this time, but he's here ALL the time so you'll never know... until it's too late. You're going to ***** and complain - it's inevitable. But do it at the right time and place, and do NOT let it compromise your care. Also, hospitals are statistically-ish the number ONE workplace for gossip. Avoid it. You never know what relative of admin or management you're working with... and it's simply just not necessary. It's STUPID easy to get sucked in. No matter how sh***y your day is, it's absolutely not fair to take it out or let your patient suffer as a consequence on what may well be one of the worst days of their lives. Fake it. Then go home and drink or pray or meditate or whatever you have to do to let it out and return to work sane and refreshed. You most likely WILL be overwhelmed. You're not incapable of learning. You will get it. With time. Nobody can say anything to prevent this feeling of being overwhelmed from happening but I'm telling you, YOU WILL EVENTUALLY get it. Sometimes you will feel stupid, it's okay. But feel stupid, learn from your mistake, and move on. I think once I go to sleep and wake back up I'll revise this and add more but make it so much less of a cluster. I honestly don't remember half of what I said up there, and frankly, I'm too tired to proof read right now. CONGRATS ON PASSING AND LANDING THIS JOB! Night!
  11. MedicalPartisan

    Nurse to patient ratio

    In my level 2 trauma center the standard ratio is 4:1, trauma 1:1 (2 trauma rooms assigned to a nurse per shift but it's a team effort so they'd never be left to care for more than one unstable patient at once), procedural sedation 1:1, low acuity / ESI 4 or 5 get's a 6:1 but they also get a dedicated LPN and tech along with the mid-level PA/NP (charting on these patients is cake because we are permitted an 'agree with mid-level assessment' assessment on these patients rather than charting our own), and the behavioral section of the ED gets a 6:1. Our ED does not have assigned sections for techs or LPNs so they're kind of just pulled anywhere needed. IMO it'd be nice to have them assigned to pods like other health systems in the area but I guess it would be quite perturbing to have one tech sitting around on one side because they're not needed at the moment while another pod tech is running crazy. Woah... Major digress, sorry about that. I do not think our ratios are 'unsafe'. A 3:1 would be phenomenal (I think this may be the case in some parts of the country that have unions), but everyone always wants more staff and less workload. Yes, it absolutely sucks at times. No, there doesn't seem to be enough time to do XYZ but it's manageable. I think if you're overtired and burntout it'd be easy to make an error, but this is the case for any ratio. More than safety (because I don't think that's an issue here), what I really dislike about the workload and ratio is the fact that my time nursing is spent at the computer ticking each and every checkbox that TJC, DCF, and Medicare wants because if not, we get reimbursement penalties. It's ironic because as time goes on we spend less time with the patient and there is a crucial amount of emphasis placed on satisfaction nowadays but you hardly have the time to REALLY talk to your patient, REALLY educate them, et cetera. There's not many nurses I've talked to that don't feel this way. We work hard and seemingly run around every blasted minute of that 12 hour shift, but the vast majority of the time, I'm at the computer charting. It sucks. TL;DR: Unsafe per se? No. But it's hard work and there is absolutely potential for error, but this can happen at any ratio. Would I absolutely love 3:1? Sure. But I understand the 'way things are' (relative to reimbursement, FTEs, good benefits versus an easier workload with more staff and not-so-good benefits, et cetera, et cetera). 5:1 would be unsafe. 3:1 would be the sweet spot for the front-liners. 4:1 is the sweet spot from an admin perspective without creating an unacceptable margin for error.
  12. MedicalPartisan

    Precepting in CCU; Advice?

    Thank you so much! I will take all of that advice. The first day was phenomenal. My preceptor is amazing. Unfortunately, she is leaving to do travel nursing so I'll only get a few shifts with them but I will make the most out of it. You always hear people say it, but you can't comprehend it until you're there; I got to experience more yesterday than in any clinical day in the entire program! While I wouldn't feel comfortable starting in CCU (nor is it common for a new grad), I am absolutely loving it so far. My preceptor is willing to go at a pace that I feel comfortable at which is awesome. Luckily, I am very ambitious and seek out all opportunities so this isn't hurting me in the slightest, although I could see it being a disadvantage for some. I am so happy, haha.
  13. MedicalPartisan

    Precepting in CCU; Advice?

    I know this sub-forum isn't necessarily for students, but I figure the experienced nurses would know best. If you could give me a condensed list of the most important things I should look over to be best prepared, what would it encompass? Thanks!
  14. Sorry if this has been previously discussed, I did search the forum (and Google) but could not find a definitive answer. It was my understanding - or assumption, rather - that the in-person option included 'everything'. I was sure I wanted to sit for the in-person review, but upon research, it does not appear that this option includes access to the videos online. Can anyone confirm this? The statement '3 months of online access to streaming video lessons and realistic practice' that appears in the self-paced checklist does not appear under the in-person one. It seems like I've answered my own question but I want to be sure. I'd rather sacrifice the in-person review and have 3 months access to the videos that I can refer back to and re-watch if that's what it takes. I just thought this would be included in the most-expensive package.
  15. MedicalPartisan

    Are you the Doctor? (funny)

    Actually, you're wrong. The NCLEX licensure gives you the credentials of a registered nurse - hence the title graduate nurse. This is why credentials RN still must proceed BSN and MSN even though they are a higher level of education. You can have a Master of Science in nursing and not be registered. Hopefully you're just having a bad day because your attitude is awful.
  16. MedicalPartisan

    NCLEX Pharmacology is Seemingly Impossible

    I'm not talking about classifications here. I'm talking about the questions NCLEX is actually asking. There's no way to group these these implementation rules and I've no clue how to study them. Take X in the evening only, take Y with this or that to increase absorption, take Z on an empty stomach. It's inane at best. It seems most tricky with psych meds. In Saunders 6E NCLEX review, there are about 67 psych pharmacology questions and each one bares a new requirement. Obviously my 'impossible' attitude isn't going to help me, but how do you study this? Most threads here refer to meds and their classifications.