HRM672

The difference in perspectives is funny. I work in a peds ED, so I hate having ADULT PATIENTS. Can't wait to get rid of them. Strokes, heart attacks, drug seeking, drunk...please go to the adult hospital if you are over 21.

XTRN...interesting. In peds we give Sildenafil (Viagra) to pulmonary hypertension kids. Not with Nitro, but sometimes with other cardiac drugs. And often with Aspirin. Maybe it's not an issue with our little ones because it's not working in that way anyway? I'm talking little kids...babies. Haven't seen teens taking it.

Ah, thanks Roy, I bet that's it! I keep meaning to read that. Must be time. Excellent example of going bad. I have to add that for kids, I like the (admittedly, less professional) term "crapping out". It's such a good description of what kids do. They compensate, and compensate, and compensate...and look good, look good, look good...then they crap out. Fast and furious.

Thanks for all the tips. I spent 5 years on tele and now I'm new to the ER. I've had 4 shifts off orientation and go back to work tomorrow. Here's what I've learned: The paramedics and EDTs have a lot of knowledge and skill to share. It's rotten when they are out sick. -It's amazing to me how many of the things I already know apply here in the ER, and are helpful to me. It's even more amazing how many things I don't know, and how much I have to learn. -I work my 3 shifts in a row, and after I'm off sometime during my off days I spend 20 minutes looking up all the things I wish I had known during the week. It's helped me tremendously. -It's going to take alot of time for me to develop the kind of friendships I had in my old area, but I'll get there. Most of all, the ER is fun. I'm glad I made the change. P.S.: We used the term "crumping" all the time on my step down floor. In the same hospital, no one in the ER had heard it. I was surprised to see it on here. I'm interested to know where it originated?

We use non-sequential numbers, and people hate it. It seems to stress them out to have to carry around their number. They complain about it, and half the time they don't pay attention and I end up calling the name anyway.

Hi Amy!! Thanks for the post, I am reaping your responses too. I have done peds tele for 5 years and yesterday was my 2nd night on orientation after transferring to ER (still peds, a level 1 peds trauma ctr). I love it! So different, but of course that's exactly what I wanted. I learned more in the last 2 days than I have in quite a while, I was getting stagnant and I am so glad I made the move.

Not to worry, Afox, I've been a nurse on a tele floor for 5 years and I am switching to ER in a week. I am excited but nervous too! If you weren't nervous, I'd be worried! It's always tough to start something new, but worth it!

Yes please make this a sticky! My ER interview if Friday and this is a great thread.

In my opinion, nursing school does not prepare you to be a nurse--it prepares you to LEARN to be a nurse after you graduate. A new nurse graduate should have the skills s/he needs to learn to be a nurse, and hopefully will start a job where the rest of the staff and their preceptor will be prepared to help complete that education.

When I first read your post and it said 2 RN's I assumed there was an LPN also! This sounds completely unsafe to me. When kids go bad they do it fast. I work on a 27 bed unit, so we don't have the same staffing issues, but we do have a rule (which rarely comes into play, but has before on Christmas, etc) that there are a minimum of 3 nurses. Period. Even if we are down to 3 kids. It seems like at the VERY LEAST there should always be 3 people, even if the 3rd is a PCA who can help with call lights, phones, etc. I don't understand how they would expect 2 nurses to be starting an IV, an no one else available to monitor call lights, etc in case of an emergency. There are alot of activities which require 2 nurses and would leave no one available. Double checking high alert medications, helping with kids who are fighters, starting IV's, starting/dose changes on PCA's or drips, managing kids who are deteriorating, doing sterile procedures or dressing changes....the list is endless.

Our peds hospital won't take anyone in PACU who hasn't had PICU or CICU experience, and no one in float pool who hasn't had peds experience. Have you tried one of the floors?

My personal opinion is that there are so many different areas to work in nursing that no one should stay at one that's not a good fit. It does take a while to get adjusted. I think about a year after graduating to feel comfortable. But you shouldn't be completely miserable. That's just my two cents :)

You guys will do great. Don't worry :)

I had trouble with the fast infant HR at first. With practice you'll get better. Our practice (inpatient cardiac unit) is to count apical pulse for 1 full minute and verify pulses in all extremities with initial assessment. I check central and peripheral pulses with the initial assessment. In a code or emergency I use the brachial or femoral, whichever I can get to easier.

I think the bloodwork to determine if you are a CF carrier is optional. I was offered it (and did have the test) at my infertility doctor, but I am now in my 5th pregnancy (2 miscarriages) and it has never been mentioned to me at the normal OB.

I agree! If you are going to have a good orientation, then go for the peds!

You are right. People don't want to move because they are afraid of change. You always have the option to seek another position, there are alot of possibilities in nursing. There are GREAT jobs, I have one, and I found it right out of nursing school.

I'm 35, and this was a second career for me. I work full time and I am pregnant with our 5th/my 3rd child. My other little ones are one and two! Among other reasons I love this job, I can work full time, and only need childcare 2 days a week! I work one weekend day and two weekdays. I have all the benefits of a stay at home mom, and all the income of a working Mom. The floor I work on is full of positive people who enjoy their job. I can only think of one person who complains about nursing and she's been complaining about everything since the day I met her. There really are good environments out there! I didn't find them when I was in nursing school. I thought I had made a mistake. Shadow when you interview. Find areas with low turnover...there's a reason! Get to your interview early and walk around and listen to the employees interacting with each other. See how long it takes someone to ask if you need help. See how often they offer to help each other. Find a good floor, and you'll enjoy nursing. On a good floor, people help each other and everyone gets a lunch break. With good management, they work hard to keep everyone happy with the schedule and people help each other out if they need time off. The naysayers always spout of more than those who are happy. Just ignore them...or use them as a warning sign to look elsewhere for employment!

I love my job, and so do most of the people I work with. Find a positive floor when you graduate. If you are having trouble, try peds!

An otherwise healthy baby who just had a coughing fit? When they act hungry but at least 30 mins is what I would do.

Transilluminator is a must, for me, at least. Keep it in your pyxis so no one steals it. My rule is if I don't see it, I don't stick. Start looking and see what you can find. If you don't see anything, don't stick blindly, but if you see it you may surprise yourself, especially if you are a good stick on adults. My other rule is, I only stick twice. If I can't get it in 2 sticks, I find someone else. As far as it turning your stomach to stick a baby, you have to think of why they need the IV, and frame it in your mind as what you are doing FOR them, not TO them. Those are my thoughts :)

As long as there are no suspected perfusion issues (I work on a cardiac floor). It seems like the red color would make it hard to evaluate skin tone?

Calculation tip...unless it's a teenager in a children's hospital, very rarely will you give more than one pre-filled syringe or use more than one vial of medication for pediatric dosing. Usually you will use only part of a syringe or vial. If you do find that you need more than one, it's a red flag to stop and triple check what you are doing. Most pediatric dosing is weight based. You can check the dosing based on the patient's weight as well as a double-check to the order. Pharmacy will also do this. If it's not a drug you are very familiar with the dosing parameters for, it's always a good idea to triple check what the doc and pharmacist have done. And most important...if the parent tells you that it's not the drug or amount their child normally takes...they are probably right! Always stop and verify.

It's funny for me to read this thread because I drop NG tubes every day...but usually only on babies or toddlers. It sounds so much harder on an adult! Thanks for all of the interesting tips I can use with my next teen or older child.

I agree, your manager should already know what's going on. Surely she is on the floor enough to see how things are running, and at a minimum she reviews the assignment sheets?