srvjamz

I have a bit of a different perspective. I notice that ED nurses come into the department two different ways. New hires are either coming in from other EDs or else as a beginner typically straight out of nursing school. Obviously one is cheaper than the other. ED needs a mix of both kinds. However, I would often volunteer to float to the dept when needs were high. I have always been a hard worker and I don’t complain to others about much. I would offer to cover shifts for them when a regular ED nurse needed off. I was very visible on nursing councils. Eventually, after making friends on that unit as well as with the manager during all those council meetings, I asked for more official training So I could do a better job. Because I ended up there so much anyway, I knew when an opening was available. I asked to be hired and has been great ever since. I did this at 50 years old. You can bet your last resume that there is no way I could have sent an application in to become an ED nurse at age and had a chance. I am still there as well as another part time ED job at another facility. It’s pretty easy for me to find a job now. If you really want to work in the emergency department (although I am sure this would work for any goal)... you may have to get creative. When other nurses know you, your work ethic and team work skills...it helps. Don’t give up. You don’t sound like a quitter to me?

be careful not to underestimate this course. some nurses where I work did not study relying on years of experience and did not pass the first time. focus on megacode scenario located in back of book and STUDY before the class with the materials they should send at least 2 weeks ahead of time !

There are a lot of factors that can influence individual geographic areas. It's VERY competitive in my large metroplex. I have seen this exact shift described in the above comment over the last 20 years. There are no more LVNS at my facility. The last one left 3 years ago. If they hire an ADN (which they will not do if there's an equivalent BSN candidate)then a contact to get BSN within 3 years is signed. They will not hire an ADN manager because it influences reporting to magnet surveys. Magnet surveys require reporting % of BSNs for all nursing staff. Is it completely true everywhere ? Another facility (state run psych) I worked at simultaneously will hire LVNS . The pay for RNs there is really poor just as it is in nursing homes where they also still hire LVNS. I had the job PRN for experience factor I wanted. When there was a TRUE nursing shortage 20 years ago as an ADN I could walk in anywhere and get a job...now moving around is possible still but not as easy. All job listings post either: BSN only or ADN/BSN preferred.

congratulations ! now go show them what you are made of !!

do your best to try to land a job at a small hospital. I have worked in all different sizes and the really small hospitals can give great opportunities. All the better if you are willing to drive because that means less applicants to compete with.. I am 52 although I have had acute care experience my whole career it most mostly med surgical/psych... at the small hospital where I work now there are greater requests for floating to other units. I eventually was able to transition just this last year to the ED after floating enough times where they could get to know me as a person who loves to learn and works as hard as any 30 year old. It's an opportunity I feel lucky to have at my age. I also believe that my willingness to commit to time serving on committees and projects paid off as well when I asked management for a chance. try joining a professional nursing organization and serving in different volunteer capacities with them which you can also add to your resume not to mention the networking opportunities ! Another place to give nurses who may be in hiring postions a chance to see you. try writing for different nursing outlets (allnurses even lists opportunities to submit stuff) and add that to your resume. don't quit !! don't give up !!

I think the very best ER nurses are ones who came from an EMS background. I do not have that experience and am considering going to a bridge program that gives RNs a paramedic license just for the experience. I suppose it has to do with starting IVs in moving vehicles and poor surroundings or maybe its the much better 12 lead EKG training they seem to have compared to the very sporifice education that RNs seem to get in school. Go for it..

Thank you so much EDRN for being willing to write about this topic. we use Alaris pumps at our facility and I have many times struggled with the door situation. I always thought it was just me. If more were willing to do what you are doing.. all might have been averted for you as there may be a pattern here. Certainly equipment failure should be looked at.. Because of your generosity, I am going to be more careful in the future .. that being said.. 1. have you heard yet about the outcome? I agree with many others here that BON rules should not reach for pulling your license as a first response and it makes me sad to think you must worry. Nine years of solid practice demonstates a great nurse who is human.. 2. Since my tenure in the ED I have had two other learning opportunities to validate Sun0408 post that to STAY and WATCH to make sure things are working correctly is a good idea. One involved rapid blood transfusion where I forgot to clamp the saline bag when unclamping blood bag.. blood backed up but was still deliverable). Another was transporting patient to floor where O2 was hooked up but (according to floor staff) not turned on (have my doubts about that one but unable to prove). Although you did not actually leave this patients side as I had in my examples.. Thank you again

I am interested in your statements that in NYC (#1)it can be hard with an associates degree to obtain a job (#2) you are afraid to talk to the ED Nursing Director because the Director is always saying how "short staffed" the department is. This would indicate to me that the hospital you work at probably chews thru nurses like candy.. and I can see why that might be the case. I work at a rural hospital ED and we have 3 patients apiece. Most importantly, we have some great team work. Everyone steps in to help when they have free time to get rooms "turned over".. from the charge nurse to the triage nurse. I have been a nurse over 20 years and I know this is not the case in every hospital which is why I drive 45 min one way to work where I do. You are in a tough spot because it would be great to change hospitals but you dont have enough experience to do that yet and stay in ED. Its not you (you're smart enough to see how dangerous this situation is).. its not the job (ER nursing is very rewarding).. its where you work. I would go with the suggestion to start pushing back but again that may be hard given your general learning curve. See if you can find a friend in the department... see if you can buy them breakfast and be honest and ask for their help... and try following their advice. When you leave work try keeping a journal of what your shift was like.. the problems and ways to improve on your own what you can. It is a good opportunity if you can make it work long enough to gain experience. Obviously if you can work in THAT hospital you can work anywhere.

There is ALOT of wisdom here and a HOT topic with 12 pages (and counting) of comments. Some of it might hurt your feelings and I can see why...but it is a GREAT opportunity to restart for a great career. After 20+ years in numerous settings, I can say that getting along with others is extremely important (unless you are Dr. House). Co-worker navigation cannot be underestimated and you can learn how with some of the great suggestions on the replies. Much of my career has been floating to multiple units so staying on the good side is essential. Do I know a co-worker is lazy? sure I do! if I have some free moments I will offer to check their patients glucose or grab a vital sign. Trust me they will sing your praises. Are they difficult to get along with? absolutely! I keep my cheerful smile and ignore them unless they need to talk to me first. If YOU have a tough time working with them you better believe you are not alone..so others will really admire how you handle yourself. My work speaks for itself and I dont waste time trying to change other nurses. That is going to backfire on me as well but this is also the MANGAERS job IMO. Precepting is short...managers do NOT want to deal with spats between nurses and trust me you will be labeled. Now, I KNOW you are smart enough to realize patient safety (TRUE safety) demands getting involved but I find those incidents pretty rare. Try not to be discouraged and most importantly think about how you will handle stuff like this in the future... with your passion for excellence you have alot to give :)

I float alot to different departments and quite agree with LibraSun. There are battles between ICU and Med/Surg.. battles between Med/Surg and ER... battles between OR and General Surgical...battles between units and house supervisors and so on... ANY time you are bringing a patient to another unit you are bringing more "work" to that nurse. It takes alot of emotional maturity to try to look at all the things the delivering (no pun) unit has done RIGHT and focus on teamwork to quietly amend the missed items that may have been missed. Cross training not only helps with gaining perspective.. it also puts a personal relationship barrier to the easy complaining about someone you only know as a person who brings you more "work".

psych meds decrease ER beds

When I read your original post I see someone who is a high achiever and expects alot out of herself. It seems as if you achieve every goal you set for yourself. you state " I love my patients but I have days where I dont think I am doing it right. I beat myself up after a busy shift..think of all the things I could have done differently..play it over in my head..so I dont sleep.." Later you admit that you can be so hard on yourself " it hurts". This does not look like job "burn out" to me but a coping mechanism you are using that's really not going to work out well in the nursing field. You most likely are hard on yourself whether its school, work, or now parenting. Perfection in nursing is a myth. Perfection in parenting is also a myth. Life AND nursing can be really hard but you can find happiness in both. I urge you to find someone you can talk to who can help you let go of expecting so much of yourself. I bet you are a really great nurse and we need to keep nurses who have a strong sense of personal responsibility. Every job in nursing will take every ounce of effort you have to give but you also have to protect your own life-work balance. Good luck to you ! (PS as far as wanting psych with no close facilities I have a good friend who got her NP and does home visits for psych patients to help out with their medication monitoring. She makes awesome money because these patients have trouble making the drive to regular dr visits and you did say you like home health too)

I agree. I brought this up to our system hospital educators and they are now developing a free course for the employees. I predict we will see more " Cyclical CEU" requirements in the future. I notice Florida is well ahead of Texas in this area. So far in Texas it is the RNs responsibility to stay up to date AND TRACK. The state of Florida is using an electronic tracking system called CE Broker to track each nurse's CEUs.

I agree that I also do not have a problem taking orders from them.. I think my real issue is how as nurses we take orders from an increasing number of disciplines and it did not used to be that way. Vancomycin in particular is on my mind as something that has changed. I had a critical vanc lab value and for all intents and purposes my call to the physician seemed irrelevant. I am calling pharmacy with critical lab values and not the doctor?

BON bulletin April 2014 states "each of the above requirements will become effective with renewal cycle that starts jan 1, 2014. " So if you just submitted CEU proof..you were in the midst of a cycle and it should not count.