gvrn13

Hello, I'm currently an emergency department nurse.... While I enjoy this very much, every time I interact with a post partum mother who is nursing, I get so happy by being able to offer them support, being their advocate, and by offering my personal breastfeeding advice when asked. I feel like I may have to pursue becoming a lactation consultant, that it is my calling. I am in N.Y, does anybody have any advice on how to go about this? Anybody made the transition and feel like it was what they were meant to do??

Thanks. I've only been in this er for about 3 months. This particular dr is very much into pointing out EVERYTHING that you did or didn't do.... If you take initiative and do something it's why didn't you wait for orders, if you don't do something it's why are you waiting? I feel the more I try not to screw up around him, the more I am.

Thanks. I've only been in this er for about 3 months. This particular dr is very much into pointing out EVERYTHING that you did or didn't do.... If you take initiative and do something it's why didn't you wait for orders, if you don't do something it's why are you waiting? I feel the more I try not to screw up around him, the more I am.

Great points by everyone!! I think I'm doing ok but there is usually one case where I'm going back and thinking what I should have done differently so I can be better. I wasn't necessarily trying to tailor my triage to a cranky dr, but just trying to do it the best and most accurate way. Epigastric pain would have been the best chief complaint, but honestly I'm not sure that it is listed, I'll have to check. Next time I'm having difficulty getting a. SPO2 I will definitely be putting a sensor on the forehead. Thanks again for helping a new nurse think it through.

Wow thanks all for your input!! Like I said I'm new to triage so still unsure. The reason I didn't put "chest pain" is because the day before while working with a full of himself dr, he got annoyed at me for putting chest pain for a pt who was pointing to epigastric. That one I put cp as chief complaint, but than wrote a note about pointing to epigastric region. Once the word chest pain is written, it starts the cascade of ekg within 10 minutes, so I had this dr in my ear when I saw this kid. The spo2 I was thinking it would be quicker for me to get him into the back than start messing around with different probes, esp for a 20 year old who had no history and was in no distress and had no complaints besides the burning in his stomach. The mother was annoyed because they were waiting in the cubicle. It was change of shift and the dr was literally going to be in there in 10 minutes. When I went back the next day and asked the nurse who took him the kid got a Gi cocktail, normal ekg.

Thank you nurses for your feedback!!! Just curious if either of you would have thought twice about the raynauds??

Hi, so I have a long question about a pt I triaged the other night and was hoping to get some insight from some experienced nurses. On a side note, I've been an ER nurse for almost 2 years, only been doing triage for the past few weeks. I have a doctor at work who is very hard on me, so when I was triaging this particular pt, I heard his voice in my ear. A 20 year old male came in c/o chest pain x2 days. Denied SOB, nausea, vomiting, pain going down left arm or up his chin/neck,said pain 5/10. when I asked him where his pain was he pointed straight to his epigastric region, right under his sternum. I asked him several different ways, the pain was not in his chest, not on the left side of his chest, right in the epigastric. He had dusky colored fingers, when I asked him about this he said his hands were always cold and looked like this in the winter. Because of this I was not able to get a SPO2, but I palpated a pule of about 70. He had no complaints of his hands, because as he put it this was normal. I put chief complaint as "abd pain" and put him at ESI of 3. I wrote in my initial note that pt was c/o of "chest pain" but that he pointed to his epigastric region, that it was ongoing for 2 days, and denied other symptoms. I told the charge nurse, it was change of shift, and then told the oncoming dr what was going on. The pt waited longer than I guess the mother thought he should have given that he said chest pain, she though he should've had a ECG immediately. When the other nurse told her that he was put down as abd pain she was angry that he was not in as chest pain. Now this would have been the case had I put chest pain down at the complaint, but I did not think it really was. So my question, is would you have put chest pain down because that's what the pt said, or when I did my assessment and thought it was abd, would you have put that down? Also would the raynauds have had any play, and that I didn't get an SPO2 initially? The doctor that was oncoming gave me a problem on a previous night because I put down chest pain because that was what the pt said, when it was really epigastric pain. I'm still learning and looking for input.

I have been a nurse for 2 years, I have not experienced this "nurses eat their young". If anything, it has been the exact opposite and I have had nothing but people who have been open and receptive to my questions and have offered their guidance. If anything, I really think it's the CNA's that have tried to eat me. For some reason, it has been an extreme power struggle no matter how nicely, or how many different ways you have to ask somebody to do THEIR job!!! This has led to me doing most things myself, but then that leads to resentment as well because they are like "oh I just did vitals", or "I'll do that", but when you ask them, it's "that's not my patient", or "I don't have that room". Can't win no matter what, you just have to go with it.

The great ED nurses that I've worked with have the ability to take care of 10 patients, and somehow treat each one of them like they are their only patient. When you've reached this mastery of multi-tasking, you have made it. I personally have not reached this level yet!! Also the sense of humor, because seriously you can't even make up half of the stuff that you will see or hear. And a poker face... never let them see you sweat!!

As shocking as it may seem, waiting 2 hours for an order is not long in my hospital. Once the pt is admitted, I can no longer ask the ED doctor for an order, I need to call the admitting doctor, which may or may not be the hospitalist. If it's the hospitalist, it will be a quick fix. If it's not, it is almost torturous waiting for an external doctor to call back, some of whom don't for several hours. I have no problem calling someone in the middle of the night for something that should have been initially included in the orders. It's ridiculous, and I feel bad, it's an injustice to my patients who are in pain. Then, by the time you get the order verified, and whether or not it's available in the pyxis, it's just crazy. Sorry you had to go through this. And as a future note, when you are a nurse, and you're going through the chart if you don't notice a PRN, it's better to call before you need it just to get it on the chart just in case.

I agree with the other comments that you shouldn't quit while on orientation. You didn't say how long you've been at the hospital (I didn't see if you did), but everything changes when you're off orientation. While with a preceptor, you are basically at their mercy, following them and doing things the way they would do it. Their way, is not necessarily going to be your way. When you're off orientation, and have your own rhythm, you will find a way to get everything done, and they may include a complete head to toe assessment on every patient. I work in the ED, been off orientation now for about 4 months, and it is so much easier to function without somebody watching me, and telling me what they would do (not that I didn't appreciate the guidance or safety net, but just sometimes the comments were too much for me to handle, trying to remember the way that particular person likes things done, and remember that I should be doing things somebody else's way and not the way that I think is more comfortable or right for me). Give it more time, I think it will make you a better nurse. And if I heard people talking about me, I would probably confront them. Not only is it rude, but it's not right. Everybody has been a new nurse at some point in time, and they should not be pairing you up with somebody who doesn't want to be a preceptor.

This is interesting to me. I'm a newish nurse in the ED, and anytime I've placed one it has always been with a seasoned nurse, and we have always used the swallow small sips of water trick. Not a full cup, but just when it hits that area where they feel like gagging it back up, a couple of sips will help it go down when other wise it wouldn't. I'm interested in what everyone has to say.

Hi, my first job out of school was an outpatient oncology center where I, along with the other nurses were responsible for mixing our own drugs. I actually wrote a similar question on here about the safety aspect and got a lot of good information. The nurses at this job, did not really even think twice about mixing. It was just what they did. There was a hood to mix, and gloves were always used, a gown not so much. I was always nervous doing this, but I did do it for about 6 months. Some nurses on here will tell you to not do this, that it's not right, but I have found that this is how it is done in the outpatient facilities in my area. If you are going to take this job, I would take the "chemo provider course" that is offered through ONS, your employer may pay for it. Taking this course is not certification, just more of a background of information on these extremely dangerous drugs and how they should be handled and side effects and such. I personally felt that I was thrown into that job, and was not really given too much info about giving chemo. Do some research, and see how you feel. Good luck!!

Thank you all for responding!!! Just needed some reassurance, that it really is ok! I'm new at this job, and still meeting people, and just really hate to look incompetent.. I really want to be one of those nurses that make it look easy... how do they do that???

So last night in the ED during a trauma alert with a pt who had gotten punched in the head and was post ictal I was trying to get a BP because the automatic was coming up 198/100.... well, I wasn't able to get it, after trying several times and getting more flustered because I could hear all the docs telling me to pump the cuff higher, did I get it yet, the trauma surgeon was like really?? and came over and took it himself... he got 140/70.. I completely cracked under the pressure, I might have broken a sweat. I got so flustered and I had told them when I was trying that it was around 140, and they were like no it's higher, why can't you get it?? I feel completely incompetent that I was unable to get it, in front of all these people. And all I can think is REALLY???? How hard is it to get a bp???? Every time I see this trauma surgeon, I know it's going to come down to the bp!!! Anyone have similar, embarrassing, make you feel really stupid stories???

When I worked in oncology I would always ask the pt their preference. Some of them don't want to be stuck in the peripheral, and some have really bad IV access, so why wouldn't you use the port? A port needs to be accessed and flushed every 8 weeks or so, so if it would coincide with the lab draw, you would just get 2 things done at once. And on the flip side, some didn't want their port used because it took too long or what have you, and that was fine as long as it wasn't "scheduled" to be flushed. And I'm thinking that as long as it is done as a sterile procedure, you should be ok infection wise. (My opinion as somewhat of a still newbie nurse)

Thank you for all the advice!! I really do enjoy learning how other mothers have done it, and how even though it's hard (what isn't?), it is doable and will be ok. And sistermoon, congratulations on your little miracle arriving!

And now I'm four months preggo And congratulations to you prnqday!! Motherhood... it's a roller coaster like no other, but you will love the person that you become from it!!

Thank you all for the kind words! What a comfort to hear from other nurses that I have time to prove myself, and that a baby, and maternity leave is not the end of a career. Right now I'm just going to focus on the ED and doing a fantastic job, and just take everything as it comes. I've worked too hard and for too long, to let anything side track me. When I start to pop, I will just have to let my manager know that I haven't just been on an ice cream binge.

Thank you all for responding. Honestly I've been so overwhelmed, and I teared up when I read all the kind words and telling me that it is doable. I have had such a hard time with the "mothers guilt".. Why is it as women, that everything has to be a compromise? If I'm a great nurse, then my family is lacking because I'm woking too much/too tired/working crazy hours/going to school/getting another degree. And if I'm being a fantastic mother, then I'm not paying enough attention to work/not working enough/not doing good enough in school/not researching things I don't know, that I should. I just keep waiting for things to fall into place, and I am confident that they will, but it just seems that more things keep getting piled on top of the things I already have. And I forgot to mention that part of my agreement with my hospital for my hire was that I will be in a BSN program in the fall. So just add school work into the mix.

I have been a nurse for a year, I was lucky enough to find a job straight out of school. After 9 months at my mediocre first job, I was lucky enough to land my dream job... overnights in the ED of a very busy level II hospital not too far from my house!!! I can't even believe how lucky I am that the director of the emergency room decided to give me a chance. I am on my second week of orientation and will starting out on the floor on Monday... I am so excited!!! I am the mother of 2 young girls and this schedule will work out fantastically with their school, and me being home more. So what's the problem you might say???? Well, I just found out I'm pregnant... (let me just preface this whole thing by saying that I AM happy I am going to have another baby.. all children are blessing, and I can't wait to meet my new little one).. I can't even believe that I am writing those words. I can't say that I didn't want to have another child, but the timing, is really just so off!! I can't even believe that after working at this new job for 9 months, 5 months on my own, I will have to go on maternity leave. To be honest I feel like an idiot... This job is the perfect opportunity for me, they hired me with only my associates degree, and they have magnet status!! I can't help but feel dread when thinking about telling my manager that I'm pregnant. And who knows if my job will be there after I am done with maternity leave. I am just in shock, and I don't know what to do... The only thing I can think of is that saying that goes "if you want to hear God laugh, tell him your plans". Are there any mothers who have had a similar experience?? Any advice on how to make the ED and motherhood x3 work???? I am just thinking about a newborn, and working overnights, and being up all night, and not being able to sleep during the day. And my manager, this woman is amazing, and so smart and really giving me a chance by giving me a job, I almost feel like I'm going to disappoint her!!! And I really just needed to vent to some anonymous people who will maybe offer some advice. I have been listening to my husband tell me for 3 days that everything is going to be ok, and I KNOW it is.. but I don't think you can really understand if you're not living the nurse life.

I have been a nurse for a year, I was lucky enough to find a job straight out of school. After 9 months at my mediocre first job, I was lucky enough to land my dream job... overnights in the ED of a very busy level II hospital not too far from my house!!! I can't even believe how lucky I am that the director of the emergency room decided to give me a chance. I am on my second week of orientation and will starting out on the floor on Monday... I am so excited!!! I am the mother of 2 young girls and this schedule will work out fantastically with their school, and me being home more. So what's the problem you might say???? Well, I just found out I'm pregnant... (let me just preface this whole thing by saying that I AM happy I am going to have another baby.. all children are blessing, and I can't wait to meet my new little one).. I can't even believe that I am writing those words. I can't say that I didn't want to have another child, but the timing, is really just so off!! I can't even believe that after working at this new job for 9 months, 5 months on my own, I will have to go on maternity leave. To be honest I feel like an idiot... This job is the perfect opportunity for me, they hired me with only my associates degree, and they have magnet status!! I can't help but feel dread when thinking about telling my manager that I'm pregnant. And who knows if my job will be there after I am done with maternity leave. I am just in shock, and I don't know what to do... The only thing I can think of is that saying that goes "if you want to hear God laugh, tell him your plans". Are there any mothers who have had a similar experience?? Any advice on how to make the ED and motherhood x3 work???? I am just thinking about a newborn, and working overnights, and being up all night, and not being able to sleep during the day. And my manager, this woman is amazing, and so smart and really giving me a chance by giving me a job, I almost feel like I'm going to disappoint her!!! And I really just needed to vent to some anonymous people who will maybe offer some advice. I have been listening to my husband tell me for 3 days that everything is going to be ok, and I KNOW it is.. but I don't think you can really understand if you're not living the nurse life.

The first interview I went on, they actually asked if they could take my picture for this reason exactly (I wound up getting this job)... While I understand why they did it, and I do think it is and was helpful, I don't think you should put a picture on your resume. It just doesn't seem professional to me for you to be the one to initiate it.

I would focus on knowing the normal range for a CBC and a CMP, specifically electrolytes.

I've never worked in a nursing home, but that sounds crazy. I would have a hard time working there too. Sounds like it's a disaster waiting to happen.