Dave11

Some of my co-workers call me doctor. Can't figure out if thats a good thing or a bad thing....

The only time EMS notifies us PTA is if they are bringing in a code or someone who will need "the big room". The charge nurse is the one who signs them in and assigns them to a nurse. If the patient isn't that sick, we send them to triage. It can get overwhelming at times when 4 or 5 ambulances show up at once but it seems to work out pretty well overall.

I have absolutely no problem delegating or cajoling one of my nurses into taking another patient, believe me. I usually have to pick up the patients as the staff leaves because everyone else is loaded with 4-6 patients each already. The docs only take the triaged patients in. I would quit if they were taking patients that weren't triaged into the treatment area. We have standing orders and the triage nurse typically starts drawing labs,doing EKGs and having patients drinking contrast (which I have issues with)while waiting to be brought in. I have filed unsafe staffing forms but as far as I know, all they do is line bird cages with them. I have asked about the union stepping in but haven't gotten any solid answers on that as yet. No suprise there.

I work in Massachusetts and the docs are employed by the hospital. My staff at night takes a lot of abuse and does a fantastic job each night. I'm lucky to be working with them. Our compensation is an insult right now. The hospital is just starting to have similar positions on the floors and with the last contract it was agreed to hold off on raising the rate till they see how well it works out. We do use protocols. We have no LPN's at all. The supervisors do what they can but they generally have their hands full dealing with the floors.They have the thankless task of shuffling staff to meet demands, take sick calls and try to guess what the days census is going to be to call off extra staff when we have it. Then there have been a couple of supervisors that treat us like red headed step children in the ER. Today was a better day. I guess my meltdown temporarily blew away the black clouds.

I work in a small community hospital and recently took a charge position about 5 months ago. It has been stressful since the beginning but it seems to have gotten a lot worse lately. I work noon-midnight. I typically lose staff during the course of the shift whose patients I have to pick up so not only I am I doing charge duties, but I frequently am responsible for the psych patients and, on the bad days, have to cover triage also. One night a few weeks ago I was doing charge, covering 3 psych patients, 2medical patients and covering triage. Our medical director has been pushing the docs to get everyone in to be seen within a half hour. Most the docs will let me bring the patients in as rooms open but there are a couple that will bring them in on their own without consulting me to get a nurse assigned to them. I often hear "I just need to see them, they won't need anything" just before they order full sets of labs, ekg, cxr and ct scans. I also have to put together all the transfer and admission paperwork, answer the phones (that depends on which ward clerk i get, the good one or the useless one), sign in and assign the ambulance patients, get the floors to take the admissions when they are "too busy", make sure patients get off to ct and ultrasound, assist any of my nurses if/when they get deep in the weeds and deal with IT on those occasions when the system is having a case of the hiccups. Add to this that the house officers flat out insist on seeing patients in the ER instead of on the floor even though we have protocols in place for med/surg and tele patients. I wouldn't mind so much if we weren't busy, but it jambs up my beds waiting for orders on 4-6 patients in a 17 bed ER when we are busy. I'm not even going to go into the missing EKG, charts, orders etc that the admitting docs just leave lying around where ever and the wide variety of personalities/neurosis' of the nursing staff. I'm sure I'm forgetting a few things too. I just got home awhile ago and am just winding down enough to consider going to bed. Now, this is the first time I've done charge in the ER. Am I just being a whiny SOB or does his sound like a rediculous situation? I plan on speaking with one of the bosses tomorrow about this, but I'll take any suggestions/tips/ideas anyone wants to offer.

PM sent

just under $40/hr with 12 years experience. suburban Boston

:roll

Having just recently finishing precepting a new grad to the ER, I know it can be done. lol The facility must be willing to take the time to get you up to speed. I was with my new grad for the better part of a year and I am happy/proud/relieved to say they are doing great. Talk with some of the nurses in your ER and see if they think there is a good, or any, new grad program in place. They will be more than happy to let you know if they think it is lousy. If there is one thing nurses are not short of, its opinions.

take all the orientation you can get. the more the better. if at all possible, stick with one preceptor. bouncing you around from one person to another will only confuse you as everyone does things a bit different. if anything comes in that you either haven't seen before or only a couple of times, go stick your nose in that room and at the very least watch what is going on. most importantly, DON"T BE AFRAID TO ASK QUESTIONS. (bold for emphasis).

We used to be able to go on divert, but one of the larger local hospitals abused it to such an extent that none of us are allowed to anymore. One night we had 12 psych patients and couldn't possibly fit any more in the department (we have 6 psych beds). We called the local ambulance company and asked if they would send any more psychs to another hospital for a few hours so we could get the current batch sorted out. They brought in 3 more, then reported us to DPH for attempting to refuse patients.

She would have to be a VP at a major hospital or some such to be pulling in that kind of money. Depends on the base pay. I could crack 100k without too much effort. My wife, on the other hand, would have to practically live at work to reach that (she's an LPN).

When I was in nursing school, there wasn't a job to be found. By our second year, we were getting anxious about being able to get work upon graduation. The shortage hit about a year after we got out and doesn't look like its about to abate anytime soon. All the nursing programs are running at a 2-3 year wait to get in. The problem is not enough instructors to get all the people through the system. There are a lot of agency and travel nurses filling in the holes till staff can be hired/trained. Guess the shortage depends on where you live.

I work in a small community hospital. Our ER has 17 medical, 6 psych and 7 fast track beds. We currently triage first, then register the patients though that is supposed to change sometime in the near future. Probably when they can hire more registration personnel. The wait from triage can vary drastically. In the morning, there may be no wait but by dinner time its 4 hours or vice versa. The wait for inpatient beds has gotten better. Used to be 2-3 hours but recently its been closer to 1 hour. Except the ICU. there are never any beds available there because of staffing issues. We do labs/xrays/CT/EKG from the waiting room on busy days also. The only other new thing implemented is increasing the number of physicians during typical peak hours.

In my 12 years as a nurse I have found that HR departments are a black hole. Nothing escapes. Every job I've gotten was the result of me calling back at least once.

I always advise people to get the ADN first. You can always take part time classes to get the BSN while taking advantage of tuition reimbursement. Granted, it will take a long time as most places have lousy reimbursement but at least you are getting a good paycheck and experience while you do it. The other reason is the difference between ADN and BSN pay is miniscule. You will also be doing the same work as a BSN nurse. In my area, the majority of credits obtained in community colleges are transferrable to the state colleges, most of whom offer accelerated BSN programs for ADNs.

We do that in the ER all the time. I've never seen/had any problems with this mixture in the 6 years I've been in the ER.

My OB rotation was a monumental waste of time. I was the only male in that rotation and the instructor never found a patient for me. Spent the entire time reading charts. Thankfully, it was only half a semester.

going to have to remember that.

At my hospital, during the day an Ortho tech will come down and do the job. Other times it will be either the attending, the PA in fast track or a resident. Whoever is free first.

Before I became a nurse, I had a series of dead-end and low paying jobs, a couple of which I was laid off from. I got tired of living paycheck to paycheck in crappy little apartments. I decided to go to nursing school because my sister and best friend at the time were both nurses. I figured I was at least as smart as them and if they could do it, so could I. The other reason was I figured the hours would be flexible so I could go on in school once I figured out what I wanted to do. I made this decision 15 years ago. It took me a few years before I realized I was doing what I should be doing. I'm still a nurse and damn proud to be one too.

I've butted heads with the senior "day queens" a few times. The majority of the times was to keep from getting abused (i.e bad assignments consistantly, expected to cover meal breaks and not getting covered myself, etc). and no, I don't think its a gender thing because my female co-workers who are on the same shift as me get treated the same.

ER for the past 6 years. Next stop would probably be an IV team somewhere. I know what you mean.

definately sounds like a darwin award finalist. i dont know about where you work, but around here, if the cops bring someone in after seeing them ingest the remains of a bag of cocaine and their BP is 210/110 with a HR of 150, they arent going anywhere. period and end of argument. the person would be under the influence of a controlled substance and be deemed incompetent to make decisions like leaving AMA. i dont know the laws there, but around here, someone would get hung out to dry on that case.

i absolutly despised the ER for the better part of the first year. most of it was d/t the place i was working. i knew from the outset that the job was a bad fit for me, but i stuck it out for 3 years and jumped ship. that was 6 months ago and the new job is going great. i actually dont mind going to work again. still not certain what made me stay 3 years at the last place. cant decide if i just refused to give in or if i'm just a complete idiot. a few of my former co-workers had told me it takes up to 5 years to be completely comfortable in the ER. after 3.5 years, i feel more and more comfortable with each passing month. give it some more time. ask your preceptor, co-workers or manager how they feel you are doing.