nycRN3

Lol. I had a parent bring in her 4 year old (not the first child) for cold like symptoms. During our assessment the mother explains that she was diagnosed yesterday with a cold and has been giving her the prescribed medication (Tylenol & Motrin for temperature control) and wants to know why she is still sneezing. She was advocating for antibiotics. Not on my watch. I'm not going to have a hand in making antibiotic resistant strains lol. Loading people up with antibiotics for absolutely no reason. I thoroughly educated her about a virus and it's life cycle. Then it dawned on me that noone probably spent the time to explain this to her because she did not speak English. Some cases are funny like coming to the ED for a tooth extraction and the pt being upset that we discharge them to the dental clinic. Sorry.

Okay after allnurses did something weird with my response I am back to state my pointers. Here are some tips that helped me transition from a mother/baby nurse to an ED nurse: Know where your supplies are. Nothing is more annoying and time consuming then not knowing where to find something when you need it. It's even more frustrating when you're in the middle of a code and someone points at you and says, "Hey can you pass me a XYZ." Learn how to do assessments . . . FOCUS ASSESSMENTS. I know a lot of floor nurses may get upset that I can not give them a full head-to-toe assessment but that is not what the ED is for. Know your ABC's.In the ED everyone thinks that they are a priority, and if you try to get the pillow for every patient who wants one meanwhile in room 3 your patient is still wheezing waiting for their duo nebs. Not a good look. Sure your patient is having an asthma exacerbation, but HCAHPS should improve because you got three patient's a pillow in record time! (Obviously I am being sarcastic, lol) Anticipate pt's needs and MD/PA/NP orders. Almost all ED patients are hungry and mid triage they will ask you the most important question, "When can I get a sandwich?" I pretty much answer the question before they can ask, "Hey since you're coming in with abdominal pain I recommend you not eat anything until your labs and imaging results come back." Women under 55 get a urine cup from me immediately for urine pregnancy test. Before any medication orders or imaging is placed that requires a negative pregnancy test. Especially since people like to act like their kidneys no longer work when you ask for a urine sample. I always hear "I just went two hours ago." If the doctor plans on intubating a patient I'll say, "Hey do you need a glide-o-scope? Want a bougie nearby? Lets get an OG tube also. Do you want this patient to be sedated with Propofol?" Consolidate care. I know that I said finding supplies is time consuming but so is not bundling care. I get as much done for a patient at once. focus assessment, gown, monitor (if required), labs/IV, medication, documentation. Therefore I only need to go back to check back on my paient (based on acuity), update them, or if they call for me. TEAM WORK! Pretty self explanatory. You're going to spend so much time with your coworkers. They are your work family. Even the ones you don't really vibe well with. I even help nurses who don't help people. Don't be the nurse who doesn't help people because there WILL come a time when you need help. Especially because the help you give is not really for the nurse it's for the patient. It's making sure their needs are addressed, making sure the lab test are sent out in a timely matter. Policies.You may think you know a policy, but do you REALLY know a policy? It's happened to me a few times where policies have changed on me a few times. Your coworkers may not be aware. Luckily for us we a clinical nurse specialist for the ED who goes around and updates us. I like to save some of the major ones to my favorites. CODES. For codes I like to increase my responsibilities. At first I would just watch. Then I moved into being the one to insert the IV line, then I'd get the meds, then I'd be the scribe. I am still improving myself and always watching the nurses who inspire me and learning what I could have done better. September 6, 2017 made it one year since I have been in the ED and I have learned so much I am truly proud of myself. I am also humbled by how much more I have to learn. But it is a process, and don't be ashamed to say with confidence, "Hey, I am unfamiliar with this. Can you help me this time, so that I can know what to do?" (But yeah, also be careful of which nurse you're asking for help because some nurses follow their own policies.) Best of luck!

I've done something slightly like this and it does help a lot. I'm going to visualize the whole patient and interventions next time though. Such a great tip!

I am so annoyed I had such a thoughtful response and everything was deleted.

ED Nurse

I know this was directed towards L&D nurses but I thought you may be interested in a Postpartum nurse's answer. The standard order is two 1000mL bags of Pitocin in either D5LR or LR if they are diabetic @125mL/hr. If the mother had a C/S the two bags of Pitocin are followed up with a bag of LR to replace electrolytes. In my case the patients are not aware of what is in the bag or why they are receiving it. It does bother me not because I have to explain it, but how can a healthcare provider give something to someone without briefly explaining its purpose.

Congrats I recently started working on a postpartum unit and I enjoy it very much. They won't expect you to know much but it is always great to come in knowing a little something and building from that. Here are a few things you should brush up on: Postpartum assessment -Especially how to assess the fundus and what your findings indicate. Newborn assessment Common breast feeding faqs Common PP meds: Pitocin Magnesium Sulfate Methergine Colace Lovenox I think that is a great foundation to build on.

Bonding with your patient is completely normal. Especially when they are so cute and squishy. I still think about one of my pt from pediatric home care (I've been off that case for sometime now). I think you'll be able to build a sense of detachment without being jaded. I think what helps is first accepting that even if you are the best nurse for that pt on that day his/her life is not up to you. You don't even have to believe it is up to God (I am not trying to force any beliefs on anyone) just acknowledge and accept that you are not in total control of that person's life and that ultimately what will be will be.

I am new to PP/Mother-Baby. I have been in "classroom" for sometime and have spent a total of 4 days orienting on the floor. I will be orienting on the unit for 8 weeks. The most common advice I have seen on this forum is to, "ask questions." I always use to roll my eyes at that tip of advice but it is so true. I find that when I assume I know what to do or what something means I am usually wrong and it is better to ask. Offer your help when appropriate. In the beginning of your orientation they most likely won't expect or ask for you to do anything complicated. Doing this does two things: It shows your enthusiasm to be a part of the team and it provides you with the opportunity to learn how to navigate through the unit and locate things. Do some learning on your own. I have a desire to be the best OB nurse I can possibly be and to do so I can't rely on the hospital to teach me everything there is to know (not to say that the hospital is not capable of doing so or that it is even possible for me to learn everything). By learning outside of the clinical setting your able to make links in your mind and you'll find that things will become less complicated. If you have a nurse educator take full advantage of them. They now the ins and outs of their department/unit. They'll be able to provide you with resources and schedule for available classes that will help you become a great nurse. Get to know other staff members. I think it is a HUGE mistake to think that only the doctors and nurses are significant. Every member of the team plays an important role in patient satisfaction in my opinion. Hope that was helpful.

@brillohead Haha I was typing @brillopad sorry

@brillopad How we were going to get there was an issue for me. But it has been clarified and the agency told me that the licensing will be handled. Thank you. I kid you not you nurses explained the situation so clearly to me which allowed me to change my mind.

@brillopad The 2 hours back home is a factor for me because if we reach back to NYC later than I am used to leaving it will impact my ride back home because I take public transportation. The public transportation I take comes few and far between after a certain time.

Thanks everyone especially @justbeachynurse and @ladyfree28 I was a bit afraid and I have to say that you all were so great at explaining the situation to me. It looks like the insurance provides the transportation (which is great because I was a bit worried about how we were getting there) and I like the mom and patient so I thought I would just suck it up and go. I think it will be a great experience. I looked at it like this: not many nurses get to travel out of state for free. Although it is for a visit the mom said we could probably walk around a bit before the van picks us up to go home.

@justbeachynurse I work a 12 hour shift. I guess a bit of me doesn't want to travel for 4 hours going and coming and then it takes me 2 hours to get home

@justbeachynurse Yes, crossing state lines the mother told me they just had to do paperwork but no one has ever spoke to me about it. I don't know a bit of it is nerves I've never really tRaveled with a family. I've been to many doctors visits but that was within nyc.