1fastRN

I just enrolled in RAMP...I was accused of diverting a non-narcotic drug at my previous job. I was fired, despite testing negative on a drug screen. After consulting with my lawyer, I decided to enter RAMP instead of fighting the board. I'm After I was fired, I immediately found a job at another hospital through an agency. Will I be allowed to continue working while I go through the RAMP program? Any help is appreciated. Thank you.

WHY do some ppl want the hand? i know some ppl with no veins sometimes say they only have luck in the hand...i get that...but some people WANT the hand. why! that ish HURTS! And i understand not wanting the AC because you bend your arm and its not comfy. but in a pinch its often the best spot. I personally like a nice juicy forearm vein Oh im a hard stick, *gets 18g blindfolded from across the room* WHY does everyone think theyre a hard stick??

maybe you need to look into employment at another facility.... personally i try to "kill em w kindness." I am always super nice to the meanest of patients...sometimes it works and my positive and empathic attitude (although im "faking" it) works, sometimes it doesnt. all i can do is try. dont let miserable people drag you down!

any chance of getting a part time or per diem gig in another ED or critical care setting? maybe at a smaller hospital?

Ever get the pain seeker with the trashy looking friend/gf/bf who is overly concerned with the medications being administered to the patient? What medication is that? Dilaudid. How m any mg? 1. Oh that wont do anything for her, she needs atleast 2mg. Let me guess....she also needs it pushed fast with benadryl? And these arent track marks, they are from all the bloodwork she gets drawn for her untractable pain, right? You must be in pharm school! So the other day I had a patient who was elderly with pneumonia. BP was holding steady in the 90s-99s.. He was given antibiotics and I hung a 1L bag to give him a 500ml bolus. It was infusing wide open and the pt was aaox3 with good color, strong pulses, and cap refill Oh...makes sense. All I could do was tell him his dad was in good hands. I do this every day and I am keeping a good eye on everyone I care for! Emergency medicine obviously isnt your specialty....judging by the fact you are now SQUEEZING the bolus as I leave the bedside. Recycling the blood pressure cuff q2 minutes isnt necessary either while your father is trying to rest at 4am.... Thar was a long shift!

We definitely are critical care, but I always view CC more as ICU. Emergency nursing is a beast of it's own,; we take every patient as they walk in. Of course, the ICU patients start in the ED, and as others have mentioned we often hold ICU patients in the ED....sometimes for days. ER nurses do it all!

Congrats! Noc-nursing is where it's at! I love my night crew!!! Night shift usually has great teamwork; we have less resources so we work together and help each other out. Hopefully it's the same where you are. As others have mentioned, there's no structure...or atleast structure in a sense as what you are used to. Very overwhelming at first but keep an open mind and just go with the flow. Prioritize, ask questions, and be flexible. Adaptability is the key to success. Don't get too caught up in writing things down, patients come and go too much. Just write down your initial report (I tend to write only the key things, Important things like why they are there, relevant stuff like patient is diabetic, then I'll write a quick checklist. I'll ask the previous nurse, "What does the patient need?" Ok they need to go to CT scan at 1945, we need a 2nd troponin at 2300, they need a bolus and unasyn. I write them as a checklist to refer back to.) Find out how you can get the patient out as quickly as possible, whether that means discharged, admitted, or to a holding area (if you have them) until they get a bed. After my initial cliff notes I get in report, I don't write much else down. Try to stay ahead of the game and ask the doctor what the plan is. Round on your patients to keep them happy, especially when the doctor is swamped. Just showing face every now and again (reevaluating pain, updating them on the plan of care, and seeing if they need anything), this can do wonders in terms of damage control. Patients get angry (rightfully so) when they're sitting and waiting and don't know what they're waiting for. So if the doc is taking forever just keep popping in so they don't feel like they've been forgotten. Throw in an IV and grab bloodwork while they wait, ask the doctor if you can "get them started" before hand, "Hey doctor, new patient Ms. R in room 4B has been c/o N&V x3 days. No allergies, no medical hx, can we give her zofran and some fluids?" Many doctors are cool with this. Half the time us ER nurses have the patient worked up before the MD even sees the patient if it's a busy night. Good luck!

Cool, I was thinking it was the epi, but I couldn't remember if she was given it which is why I was wondering why she had that reaction. So I guess we did give her epi! And yeah I think the blankets were just to calm her down so she could relax. Thanks guys! Silly question but I wasn't sure if she had actually gotten epi so I didn't know if it could be from another med.

A while back a young woman came into the ED with angioedema/oral swelling. She was treated with the usual cocktail IV: benadryl/pepcid/solumedrol. I believe she was given epi as well, but I can't remember. Anywho, after the meds were administered she started shivering pretty bad and got goosebumps all over her body. Another nurse grabbed her some warm blankets and said something to her saying not to worry, this was a normal side effect of the medications and she mentioned something about histamine release. Does anyone know the pathophysiology behind this? Does this have something to do with the response of the sympathetic nervous system or what? I thought the shivering could just be a result of anaphylactic shock but she made it seem like it was the med administration that caused it. Maybe I misheard her. Thanks for any clarification

I often get caught up so I just end up "forgetting" to pee. I'm getting better with it though! The main problem is that the bathroom is so far away it's really inconvenient. If they had one in each of the pods in our ER, I would have no problem! If they patients are super critical and everyone is drowning just as much, I sometimes really can't run off to go to the bathroom. Those super unstable patients make it impossible. Not just the hands on stuff, but charting all that hands on stuff. I'm definitely making more of an effort to "schedule" pee breaks in!

^^Ditto to the above poster. The best piece of advice someone gave me when I started: "The ER is like a game of chess. You want to figure out how you are going to get your patient in and out as fast as possible." You want to know the plan so you can "get rid of them ASAP". Otherwise, you'll be drowning before you know it. Talk to your doctors. If transport is backed up, push your patient to CT or wherever they need to go. The faster you work them up and know what the plan is, the faster they will be dispo'd. Discharge your people quick, and once their admitted get them the heck outta there! Whether that means to the floor (if they get a bed assignment) or to a holding area in the ER (if you have one). Because the patients won't stop rollin' in! If you see a patient just sitting there, ask the doctor what the deal is. They forget too! "Hey doc, Mr. Q's 2nd troponin just came back negative, are we discharging him?" Stay informed and on top of your patients. I've seen plenty of M/S nurses adapt wonderfully to the ED! I am a firm believer when it comes to a nurse in the ED, you either "get it" or you don't. I went straight to the ED so I can't speak from personally experience. Others have said floor nurses can struggle because you have to get them to lose the "bad habits" they have from working on the floor. Not actual bad habits, but it's just completely different. It might feel different because we area a lot more independent as nurses in the ER, there are a lot of protocols we can utilize. We often put in our own orders for labs to fast track the patient. We almost tell the doctors what we are doing instead of asking, especially if you have a good relationship with the MD. (i.e. Doc, patient X is complaining of abd pain and nausea again, is it okay if I give him 4mg of zofran and 1mg of dilaudid? We have him the dilaudid 3 hours ago which did the trick; his sat is 100% and BP is 132/69.) We know when a blood gas and respiratory treatment should be done, we order our own EKGs. We pull anticipated meds for the asthmatic patient before the doctor has seen them. Note: We don't practice outside of our scope, but a lot of what we do is anticipate what would be done in this situation and follow accordingly. ER nurses work closely with our doctors and the MDs have a trusting relationship with their good nurses. On a very busy night, it's not unusual for the nurse to have the patient fully worked up before the doc even gets to the room. It's a win-win for everyone. And of course the pace and unpredictable nature.... the ER is a whole 'nother animal. Keep an open mind, roll with the punches and you'll be fine. Good luck!

I dread these patients! Unless they're sick with legitimate AMS compared to their baseline, I honestly don't know what they want us to do about the irritated sundowning patient. Sometimes it seems they just don't want to deal with the patient so they send them to the ETD. One NH sent me in a "combative" dementia patient. They had given him Ativan just before the ambulance arrived. By the time he got to us he was sleepy and completely cooperative. What the heck? Why wouldn't you medicate and then reevaluate!? Or the caregivers/children who literally drop off their poor mother with Alzheimers so they can get a little vacation. Ugh don't get me started on that... I actually fear that one day I will have to be a caregiver for my mother. Then your stuck at the crossroads because it can be a full-time job yet I would never want to send her to a NH after all the trainwreck or seemingly neglected patients I have received in the ER.

Definitely! I'm not saying the complaint is unwarranted. Without a doubt we often roll our eyes at a patient's complaint and they end up way sicker. You just never know, but hey, that's the fun of the ER. Hence my young lady with a mild headache. Seemed like your typical migraine workup and she had 5/10 HA and no other real complaints. Okay, labs, reglan, and CT....then discharge home. NOPE! 36 years old and HUGE brain mass with shift!

I can't think of a better word than "juggle" to describe our jobs.

Well atleast I can rest easier knowing someone is in the same boat.... LOL Ugh how frustrating is it to come back to an assignment full of new orders to catch up on, and patients that are upset because they didn't get their meds yet? Meanwhile I was in CT with the stroked out lady. Keep on fighting the good fight!

Yes! ARGH!

Wondering if anyone else runs into this situation... When transporting a critical patient to CT/Xray or the unit (step-down/ICU), it is required that the nurse travels with the patient and monitors them on the portable monitor. We are SUPPOSED to have an extra nurse that is pulled from floating or whatever he/she is doing to transport the patient. So if I have an assignment another nurse would come and take my patient for their imaging studies while I take care of my other patients. Working nights with less than ideal staffing, this rarely happens. On days they usually have enough floaters to do the transport along with the transporter to push the stretcher. The role of the nurse is to monitor the patient and transfer them in a safe manner (i.e. maintaining c-collar precautions while putting them on the table for CT. Lately we don't even have enough transporters so I end up going by myself. Kind of unsettling because if I'm taking a patient to the ICU I am literally by myself at 3am in the desolate hallway if something goes wrong. Lately I've been taking my own patients. I'll literally have 8 patients or so, and I have to take my intubated ICU patient so he can get whatever needs to be done completed. So I have to walk away from my other 7 patients for however long and then come back with the patient. So I end up informing the other RNs in my area that I'm going and ask them to keep an eye out on my patients, pretty much just telling them "patients 1,2,3,4, and 5 are fine, just please keep at eye on this patients BP, he's on a cardizem drip." We work as a team a lot on nights so we all do this for each other no problem. One night I had to bring my guy up to ICU, me and the other RN in the area had 8 patients each. So this leaves the RN with 16 patients to keep an eye on. Safe, HA! I've been on the other end of this as well. It's either we personally transport the patient or they don't go. So then I come back from transporting/monitoring and have to play catch up with my other patients. It's terribly frustrating because A) It's not safe B) I'm behind with my other patients. Do you have the same issues at your facility? I'm going to send YET ANOTHER email to management addressing this issue. It puts us RNs in a bad spot because god forbid something happened I'd have no one to back me up; my patients were left unattended which is unacceptable. I'd be thrown under the bus in a heartbeat. But I have no other option! And night after night with no break or and "unoffical" break as we break each other so we can unload our bladders and get a quick snack in. The expectations they place on us with so few nurses and so many patients is unrealistic and a major safety issue. Any of this non-sense go on at your facility?

....an occupied patient's bed!? WITH a patient???

what is the relevance? makes no sense and dont see how this applies!

Who has time to sleep at work!? I'm too busy to even think about taking a nap! I do really wish there was a quiet area designated for nurses to nap during breaks though. I think by giving RNs 45 minutes to lay down and recharge would be great in terms of productivity and safety. I know I feel recharged after a 20 minute nap... 45 minutes would be a sweet spot to actually be able to fall asleep, shake off the grogginess and return to the floor. I don't see this happening. With all the research showing the benefit of a quick nap I really wish hospitals would take this into consideration. After 10 hours I start to feel sluggish and I'm not functioning 100%. Maybe one day in a perfect world we'll be able to nap, have something to eat, and be able to empty our poor bladders!

When I first started, a nurse told me every new ER nurse spends the first year drowning. Completely true. Stick with it! Nobody is perfect off that bat, but from what I've seen you either "get it" or you don't. Maybe ER nursing isn't for you, but the great part about nursing is there are SO many directions to go. So I say give it some time and then reevaluate if you're still having trouble. There's a lot of pressure in the ETD so your feelings are normal. I always found it kind of funny when the feedback I would get was that I needed to "be faster" after just a few weeks on the unit. Well duh, I was new! It's more important to learn things correctly at your own pace at first....speed will come. Keep your head up!

Or make them feel stupid in front of other nurses! I had a preceptor for a day when my regular preceptor called out. I don't even think she was interested in precepting and I got the feeling she was annoyed when the charge nurse asked her to precept me for the day. I wish she had just refused because it was the next 12 hours were incredibly awkward and embarrassing. She basically ignored me and went on as if it was a regular day. I would keep asking her questions and trying to get involved and she would sort of blow me off and let me do things here and there. I think she thought I was incompetent. I wanted to cry. I had never been treated like that, not even as a nursing student! To make matters worse, I was charting something and I overheard her and a couple other nurses (2 of which were med-surg floats and not even ER nurses) talking about how new grads shouldn't start in the ER. They went on and on and I was sitting right next to them. If I could have teleported myself I would have. Thank god for a tough skin, looking back on it, it seems 10x ruder now. What would make you think you can treat another human being like that!? Her passive aggressiveness was uncalled for but now that I think about it I don't think she even works on the unit anymore. Good riddance.

Haha that is great! I too, am guilty of not using my "inside voice." I also hate the dreaded "NURSEEEE!" call. I had a patient last week keep yelling "SISTER!" LOL I don't know if he thought I was a nun but he was older and with it so that was a good one. We also have a flamboyant male nurse on the unit, and a drunk patient kept calling him "Sista man". Oh the things patients say!

Breathe! You'll be fine. I was in your shoes. I did not apply until I had my license, and I was told it's hard to be considered for a job when you don't even have an active nursing license yet... My classmates that had jobs lined up were either techs or nursing assistants and had some sort of "in". I was told not to waste my time applying, just have my resume ready. I don't know if it's true, but it makes sense to me....an employer gets a stack of applications on their desk. Sometimes 100s. They're going to consider the most qualified candidates and I feel like if you're still a student, you'll probably be thrown to the bottom of the pile. Here's my advice: Build a solid resume and apply to any and everything you qualify for. It's competitive right now and it's discouraging. Especially since each application can take 15-30 minutes depending. It seems like a full time job. Follow-up with phone calls; be persistent with the jobs you really want. You can be a LITTLE picky, but please consider applying for less than ideal jobs. It's your first job and probably won't be your dream job, but it's a foot in the door. I think I applied to over 50 job openings and received ONE phone call back. ONE. But I got the job, and you'll get one too. Just be patient!

This is great! See this one all the time. Bloodwork isn't even back and they family is already asking, "What time will they be sending him home?" Or once they're admitted they want to know every single detail of the care plan.... like I would know that. Here's another one, patient JUST came in, "DID YOU CALL HIS DOCTOR!?"