JustPeachyRN

Great job! Sounds like you really came through for your patient in a very difficult situation. Something else you may want to keep in your back pocket (especially if you are good at dropping a PICC) is using ultrasound for peripheral IV access. We are utilizing this in our ED for difficult sticks. We keep 2 inch 20g IV catheters specifically for this purpose. With a little practice, you can learn to insert these fairly quick.

Hello and congratulations! I started almost 2 years ago as a new grad RN in the ED. It is a steep learning curve. Don't be afraid to ask questions, even when you are off orientation. I agree with the above poster that said orientation is to make you safe, there will still be PLENTY to learn and experience off orientation. Soak it all in while you're on orientation. Watch what your peers do. If you don't know, ask. You will slowly learn to trust yourself more and more as time progresses, but don't become complacent. Almost 2 years into this, I still learn something new each day I go to work. Also, don't be too hard on yourself. There will be days that you feel defeated and worthless; don't let them get to you. Everything is a learning opportunity. Learn your policies and procedures for your area of employment, and know what is and is not within your scope of practice for your state. Just because you see a peer do something, doesn't mean it's right. That being said, you will learn a TON from your peers. The ED can be exhausting and brutal. Some days are rougher than others. However, (most of the time), I love what I do! It can be very gratifying and exciting. Good luck and best wishes! :)

I really like emcrit and ercast.

Went straight from school to ED and been at it for about a year and a half now. I agree with those who say it's like an addiction. I always joke with people that I have a twisted relationship with my job. All in one breath I can talk about how cool my job is and how much I love it, yet also how much I can hate it. I love the teamwork (especially on nights). Love my coworkers. Love the crazies, sick, and trauma patients. Dislike how it can be very emotionally draining. It's hard to picture myself doing anything else.

IV, zofran, morphine, fluids (1-2L if lots of vomiting), and typically 1G Invanz prior to OR.

Awful. Confusing, redundant, and glitchy are just a few words to describe it.

B.S. Psych/Math

Hey y'all, So I spoke with my manager the other day. We cannot bill pt's for items used. Based on way we currently bill, pt's get charged based on a level of acuity they are assigned by the Dr (i.e. level 3 may mean pt was on telemetry monitor, continuous SpO2 monitoring, cardiac workup...yada yada yada). Dr on billing sheet circles certain levels of acuity and procedures, say pt was level 2 and ortho procedure done, so pt gets billed for level 2 acuity and default ortho supplies charge. Hope that makes sense. Basically, if we charge pt's specifically for items used it's considered 'double dipping' and fraud for duplicate charging based on how our system is currently set up. This is why we are on a project to try to reduce our supply expenditure since we only charge based on a defaulted level of acuity assigned by the Drs. Something else we now do is try to use ACE wraps when appropriate instead of knee immobilizers, air cast splints, leatherette wrist splints, etc. Sometimes you have to use the real deal, but there are many times total immobilization is not required. Thanks again everyone for your great input! Any additional thoughts or ideas are greatly appreciated!

I don't think they have ever tried making them a chargeable item. I brought up the same idea with disposable BP cuffs by trying to make them charged to the patient, and the response I got was basically 'we don't have a good way to do that right now.' Not sure what that means, or even what all it would entail to charge patient's for specific items used. I know that reimbursements are at an all time low right now, which may have something to do with not wanting to charge pt's for commonly used items (low reimbursement perhaps means even if we charged we wouldn't necessarily recoup the cost). Any thoughts on this, Esme12? As far as where the real probes are going...that's anyone's guess I suppose. Some of the transport techs were historically bad about just unplugging the patient from the monitor and leaving the heart monitor leads, BP cuffs, and SpO2 probes all still attached to the pt. They have been reprimanded for this, but even when this was happening I never noticed pt's coming back with missing equipment. Although SpO2 probes are a big problem, I'm also interested in hearing from anyone involved with supply ordering in their ED and any ways other departments have cut down on their supply expenditure. Thanks again for everyone's input so far, a lot of valid points have been brought up!

New grad here, graduated in December and started out working in ED right away. I had the opportunity to complete a student preceptorship through my school in the same ED I accepted a position for, which I'm convinced helped me significantly during application process. I knew this ED was where I wanted to work, so I made sure I did everything I could to 'prove my worth' while there as a student and made a point to connect with the current staff in the department. If it's possible for you to connect somehow to other employees and management in that department, maybe by shadowing, an internship, or other means, I think that would be great. I think your EMT-B certification is a definite advantage (I came in fresh out of RN school with only a year of experience as a patient care tech floating mostly around med-surg and critical care departments in a different hospital, never to the ED). Best of luck! My managers have commented that they don't necessarily see hiring a new grad RN as a 'bad' or 'risky' move. What they explained to me is that they could hire a nurse with experience from other departments who just wont thrive in the ED, or can take in a new grad who appears to have an aptitude for the ED and help mold them into a great nurse. It just depends. It takes a special kind of person to be a great ED nurse, but I think there are many different versions of that 'special person' that will do well in the ED.

We have. We keep a few on hand for kiddos and miscellaneous situations when merited, but the cost of replacing after every patient would be astronomical. We're a smaller level 3 ED, but we see a TON of volume. The idea of a supply pyxis has been discussed before with poor reception. I am unsure of the rational behind this. I am also interested in switching to disposable BP cuffs that would follow the patient when admitted to inpatient, but same problem for now unless a supply pyxis is implemented and pt's can be charged for their supplies. I am considering re-introducing the idea of a supply pyxis with some additional supportive arguments. Thanks for your input!

Hey everyone! Newbie RN here. Started out straight from school in the ED 9 months ago and absolutely loving it. I've been reading posts for what feels like FOREVER on here, and just now finally joined! I've recently been assigned a project involving cutting down on our department's supply costs. Prior to my taking on this project, a recent change we made was purchasing anesthesia tubing and trying to use that as often as possible vs. primary tubing (several dollars cheaper for anesthesia). We have started seeing a significant reduction in our monthly supply spending from that alone, which is great, but we need some more ideas! One of our biggest problems is SpO2 probes going missing. We've tried zip-tying them to the cords in the monitor, and yet we still have to replace several a year at a cost of approx $250 per probe. Not sure what other solution there is to this, or if other EDs have encountered this problem as well. I'm looking for suggestions or ideas that are used in other EDs for commonly used supplies. Has anyone taken on a project like this in their department? Any input or resources would be greatly appreciated!