caddywompus

I remember coming from MS to ED and being both amazed and terrified by all I could do and was expected to do without an order. It took a while to get standing orders/protocols and to feel even a little confident. Definitely like being a new grad again!

In a perfect world... Where to start? As others have said, ED is very different from other areas of nursing, and each ED has its own culture and flow. For many nurses, coming to the ED can be a little shocking or eye-opening. All of the "fluff and puff" goes to the wayside. There just isn't time. Even if there is time now, in ten minutes that can all change. I'm not saying we are uncaring. You just have to prioritize your care. Then re-prioritize. Then start over again. A few things- the disdain for psych patients. It's not disdain, really. You'll find if you work ED, psych isn't always psych. Sometimes it's "I don't want to go to jail, so I'm going to say I'm suicidal." Or "I got evicted and need a place to crash. Better go to the ER." With that said, many are truly psych patients and there's no doubt the system could be better. Psych patients, like all patients are as varied as they come. Some are manipulative. Some are just plain dangerous. And some are just sad. You said, "I would like to think about the future for the patient and not just their present needs." You have to remember, the ED is focused on present needs. ED is meant to stabilize. Stabilize and Move. A disregard for all things not life-threatening- that is why it's called EMERGENCY DEPARTMENT. Sorry, not at all trying to sound harsh. Assessments are quick and focused. They have to be to ensure there is a room and staff available for the patient brought in not breathing or post-trauma. I don't mean that it is only important if it's life threatening, just that again, it's priorities first. Example, a chief complaint of "Elbow pain x 3 months" is lower priority than "Elbow pain and limited ROM post-fall at 0300." It's not that the 3 month elbow pain doesn't matter. It's just obviously not acute. If often makes us wonder "why now" is it an ED visit? The second CC gives us something to work with, something to rule out. We don't do that- Not sure about this one. No doubt it can and has been used to avoid work. Human nature being what it is. I can't think of any examples. I think we do what we can in the limited time we have with our patients. ED is awesome if you can let go of the little things, prioritize, and adapt. You'll find you have to be quite direct to get things done. I don't mean rude. Just direct. Direct with co-workers, patients, and patient's families. Some will test you. Confidence shows. Speed with empathy. We have to move the patients or the gears come to a grinding halt. Remember this, the ED (and maybe L&D?) is the only department that can't say no to another patient. The doors are always open, regardless of staffing, icy weather, and full-moons. I wouldn't want it any other way!

I graduated with my BSN from SNHU. It's a great program, intense but workable. I wasn't crazy about the group work but it was really only a small portion of the assignments. The professors are very helpful, but know your APA formatting as there is a lot of writing involved. The program is now CCNE accredited and retroactive for past graduates. I am very happy I chose this school.

This post is completely biased due to failure. I passed with Excelsior on the first attempt with no repeats and had a wonderful, though stressful (of course) clinical experience. You are in NO WAY required to use The College Network and Excelsior is clear about that. I bought all of my materials from Amazon for cheap. I have no regrets about going through Excelsior. They also publish their pass/fail rates and this information is easy to find. It's been a few years since I've looked at it, but at that time the clinical pass rate was somewhere around 64%. With all that said, I am sorry EC didn't work out for you and wish you the best.

I agree with the others that BSN and then MPH sounds like the best way to go, however, I disagree with GrnTea's comment about "seductive" online programs. Sure there are reputable programs and diploma mill programs. Most graduate nursing programs are either online entirely or have an online component/hybrid format, even the top universities offer this. Online school is hard. Those who think it's "seductive" are the ones who haven't done it.

It's probably not allowed for lab techs, but as an RN in the ER, I do it all the time and it's common practice. I've often wondered why they don't pull from the IV lines when they have one available. It would certainly be easier on the patient. I'm sure it has something to do with infection control, though I don't see the risk of infection being higher for a lab tech than for a nurse.

I think your administrator is going in the right direction. I have worked with nurses who have excellent hark skills but were just awful to be around. Awful for other nurses and awful interacting with patients. Then I have been around nurses who needed a little work on their hard skills, which let's be honest, can be learned in a short amount of time with practice, who were absolutely delightful to work with. Of course what the admin wants is the happy medium which is hard to find. People skills are important when working with people, especially people who are for the most part less-educated, or educated in other fields. And if everyone has a good attitude, learning those hard skills will come faster because no one will be afraid to ask for help.

OP, I too call them boards sometimes and NCLEX other times. I hope you find the answers you are looking for. Of course we can all google a lot of answers. But then why would we ever talk to each other? Sending

I work with someone who failed three times and passed on the fourth attempt. She's a great nurse, even as a fairly new grad. I passed on the second attempt and took all 265 questions the first time, 75 the second time. I can't imagine doing that 6 times, but if it is what you really want, why not go for it? You've already invested so much.

Some of you take a simple comment about a pet peeve and just go too far. We all have pet peeves. I voiced one of mine. Is it not time to let it go? Yes, I have a degree in English. It happened along the nursing road when I wasn't sure what I wanted to do. Sometimes I'm still not sure. The comment about ellipses being overused and making a writer appear to lack confidence comes from something I learned in a writing class. I have also read it in a few writing instructional books. It's not relevant here and I was not trying to offend anyone. As for the name Caddywompus, it's a slang term for bent/askew/slightly off. It's been spelled different ways- catywompus, cattywompus, cadywompus, and more. Thanks for asking. Cool word, isn't it? Here is how I first heard it. "Can you help me reposition xyz? She's all caddywompus in the bed." I said, "She's all what?" Then she explained. Since then it has been my favorite word.

smo153, I applied to staff nurse positions. I thought residency was for new grads. I'll check into that. Thanks

I would not recommend writing such an email, ever. It would definitely seem overly aggressive. You applied. You interviewed. If they want to hire you, they will. Just don't take it personally. You never know who you are competing with for a job. Sometimes these things are a blessing in disguise. One job I wanted so bad. I got an interview. It went great. I was even told, "We'll be seeing you back here soon." I did not get the job. Months later I found out that if given the job, I would have been working with someone I knew years ago and DETESTED. One door closes and another opens. It's the worst time to be a new grad. I feel for you. Don't be offended. Realistic feedback is positive feedback.

I had a phone interview three weeks ago. It seemed to go well. The recruiter said she would recommend me and that I would probably receive a call the next day. Nobody ever called. I'm trying not to get too down. I just went right back to applying on their website. I've heard the turnover is slow there. I guess if no one wants to leave then that's a good sign.

Ok, I consider myself to have a good sense of humor, definitely twisted (hence the name), but starting in an ER is stressful enough, or at least it was for me without being pranked. I guess it just depends on the orientee. I'm sure I could have handled someone jumping out of a box, but if I wasted 20 minutes outside with a wheelchair I would not like that.

I work with sharks too. It is hard, especially when you are new. I can't say anything about this that hasn't already been said, but I must say this- for the love of God people stop doing this ... all the time. Sorry, I'm a grammar nerd. Those three little dots are overused and improperly used ALL THE TIME. A period ends a sentence. An ellipsis indicates an omission. Sorry, rant over. https://www.thefreedictionary.com/ellipsis Hang in there. The first year of nursing is the hardest. You're still learning. Keep your head up ?