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GCom24 ASN, RN

Medical-Surgical, Emergency
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GCom24 has 2 years experience as a ASN, RN and specializes in Medical-Surgical, Emergency.

GCom24's Latest Activity

  1. GCom24

    Podcasts

    I absolutely love EMCrit, it's what introduced me to the world of FOAMed. Definitely check them out and SMACC. If you're still hungry: Total EM, and The Skeptic's Guide to Emergency Medicine. Also, check out the blog RebelEM. Another great one that I recently found is "Dr. Smith's ECG Blog," excellent blog for ECG interpretation.
  2. GCom24

    Feel stupid

    You'd love my hospital then ;P They've come up with this system where we print out a "SBAR" sheet that is automatically filled in with hx, vs, meds given, IV site, etc. etc., we fax it to the receiving floor. Then we call them and say "I've faxed the SBAR, the patient will be leaving in 15 minutes, if you have any questions you can call me back. Buh bye." I'm still not sure it's the best, safest, or most efficient way of moving patients. But it's our policy for now, so I'll play along. But to get back to you dealing with your situation. Definitely agree with jguiney. You may have over looked a BS of 270, but that's not a life threatening emergency. They're not in DKA. That's a discharge-able blood sugar if nothing else was going on. Further in the situation, obviously, the ED doc saw it, the hospitalist saw it, no one ordered any insulin. It's not a biggy. I don't mean to imply we should rely on the physicians to do all the critical thinking, but in this case, the 270 glucose was definitely not a concern. A lot of diabetics are walking around the mall at 300+ lmao You'll get better at report, but your report and their report are just vastly different. Like CX_EDRN said.. sorry, while I was stabilizing their respiratory distress, I didn't manage to find out if they use, have a sore on their bum, have community support, and got their flu shot this year. Seriously, get off my ish. They couldn't breathe, now they can, they're coming to you, you can do your job when they get up there, I've a code coming to my other room.
  3. GCom24

    Advice for ED Team Leader

    Thanks for the advice! I actually had my interview today, and feel like I killed it. There's two other candidates, but I should know something in about 2 weeks. So I'm pretty excited. I think as an ISTP, I will be able to bring a unique leadership style to the team. I know what you mean about the ISTP/not-wanting-to-be-micro-managed deal. I like to think since I'm not a big personal fan of being micro-managed, I won't find myself micro-managing my team members. However, I've never held a leadership role of this magnitude, so I'll be interested to see how I grow in this position if chosen.
  4. GCom24

    So what's going to happen to health care now?

    My view on what will happen, he will open insurance companies to be sold across state-lines which will broaden the market, slash through geographic monopolies and allow the beauty of competition to flourish. This will drive companies to provide highly competitive rates to consumers. He is not going to touch pre-existing condition legislature, keeping kids until 26. It's going to have some tremendous effects in my opinion. I think we're going to see drops in premiums and deductables. Competition will allow the true supply/demand variables to drive market prices down. Companies will be forced to provide truly affordable/solid plans in order to compete and stay alive, because if Company A won't then Company B will and everyone will shop there. If you couldn't afford it before, you certainly still couldn't afford it after ACA, didn't solve anything. Not to mention states who didn't expand medicaid benefits. This will actually free-market dynamics to force insurance companies to provide reasonable, affordable, and good policies.
  5. GCom24

    Am I ill-suited to the ED?

    So, in this specific situation. I will guarantee that the doctor. "Hey, you have xyz, I'd like to keep you at least over night to make sure your xyz lab stays stable, your BP is stable, etc. But everything looks fairly normal right now, but you had chest pain, and it's just in the best interest to hang out with us." You get the idea. Patient doesn't want to stay, obviously, financial reason, other commitments in life, etc. whatever the reason, just who really wants to stay, amirite? Doc says "All right, well if you want to go, you can go." /leavesroom You go in, "All right so the doctor has recommended to stay, to make sure your troponin doesn't rise, you don't have another episode, just to make sure everything is chill. If you leave, you're accepting responsibility that if you go outside and go into cardiac arrest and hit a light pole, we are not liable." Patient says the doctor said I was fine, no nevermind, I want to stay! Oh my! Moral of the story, that patient has the right to accept, decline, refuse treatment, and the right to change her mind. It's her dang-blasted life, sheesh. You by every stretch were in the right. Don't sweat it. You advocated for your patient's decision. Period. Game. Touchdown. Super bowl. Home run. Checkmate. So on that one, that nurse can squash all the noise. This. Hm, first let me premise this with, if you have any questions, are confused, unsure, worried, whatever, feel free to PM me, or post it here, whichever. So let me share my back ground story that I think might help. My last year of school, I worked as an ED Tech. I struggled with a lot of conflicting attitudes and ways of doing things, etc. that contradicted everything I learned in school. I wanted to wait until I had an order before I did anything because "YOU DONT DO ANYTHING WITHOUT AN ORDER MR STUDENT, YOU WILL BE SUED, IT WILL KILL YOU, AND YOU'LL GET EBOLA >:OOO" (nursing instructor rage) Okay well, I slowly (only working on weekends, got a better feel of how this machine that is ED works. If someone's O2 is 86%, you do not go looking for the doctor, ask him for an order, then wait til it's in, and then go back to your patient that is now 78% and cyanotic, and now apply some supplemental oxygen. You will learn what's what, when to do it, and how. That's purely time and experience. Chest pain? Oh okay I'm going to get the tech to grab the EKG machine, I'm put some cardiac leads on em, I'ma throw some O2 on em, I'm gonna drop a line in em, and go ahead and get a rainbow of labs, draw an extra so the tech can go run a istat and get us a Chem8 and trops. Then I'm going to go ahead and get the aspirin and nitro, and throw those in. Then, since we've managed to knock all of this out before the doc has even gotten to the room, he or she already has a EKG, a line, appropriate treatments started per protocol, and he/she is already ahead in the game. Makes things more efficient for everyone, and sure he'll drop orders in later, and I'll chart em off. Success! When I graduated, I worked for a year in Med-Surg, but the itch for the ER forever burned inside me. Med-Surg taught me a lot of great traditional nursing skills, some specialized things from that floor. (I.E. I'm the only ED nurse in our dept that knows how to set up a peritoneal dialysis cycle, I'm the go-to for CBI, and some other nephrology/dialysis skills. So I loved the floor, but I yearned for that thrill, that flavor that the ED offered, I finally got a call that they wanted to get me down there. I went, I love it, haven't regretted it for a second. I've been a nurse 2 years now, and not that I found what I love, I literally love to go to work, I look forward to it. It will definitely take time to get that point. How do you differentiate between "This needs to be done, we don't have time to do it that way." versus "I'm lazy, and we just do this instead or the right evidence based way you have been taught. Well, again time, but something more tangible and helpful: I know it's basic, but literally, think ABCs.. Airway Breathing Circulation. You just have to address, life-threatening/most serious things first. Then it is up to you to manage your time and resources, and you are free to address other issues as needed and best fits you as an individual. There is no law or rule that says you cannot take care of little/non acute issues in the ED if it is possible and time allows. You just have to balance and not let another more pressing issue suffer while you, idk, call 12 different family members for someone trying to find them a ride home.
  6. GCom24

    Nurses Who Smoke Marijuana

    Just have to bump this again. If you're done with it, carry on. It is bewildering that marijuana is talked about as if it's a mind-altering substance in the same caliber as LSD or psilocybin. I do not think anyone so far has argued that marijuana, where legal by state and federal law for recreational or medical use, then be ratified by the BON to allow nurses to blaze up right before a long shift in the exact same way that alcohol which is legal at state and federal levels for just recreational use would anyone ever think, oh that means I can do a couple tequila shots before we run this code. the effects that THC and ETOH have on an individual are so drastically different. It's like hm, should I give clonazepam for this acute anxiety attack or should I slam em with 10 of haldol and follow it up with some ketamine? Do you want your pt moderately relaxed or dissociated and sedated? I totally get the state I really think all I can say is, when that day comes and the only thing between those who wish to do so and doing it is the BON, it is time for serious petitioning, research, and action. i want to see it legal for recreational and medicinal in all 50. And as public health advocates, it's something we can get behind. Drug and violence that occur around marijuana is irrelevant to the substance in and of itself. See prohibition.
  7. GCom24

    Am I ill-suited to the ED?

    1. A general and open disdain for psych patients. So, psych patients can be very testing. A general ED course involves, presentation, needs medical clearance, needs 1-2 liters of fluid to lower a CPK, then patient holds a bed for 10 or more hours (I have heard cases of 24-48 hours) before placement can be found in a psychiatric facility. This is frustrating because you have a patient who literally does not need any medical attention at this point, but is holding a bed, reducing throughput, all the while, they need to be fed, blanketed, toileted, etc. etc., also reducing your tech availability because they are on 1:1 observation. You add to all of this, the patient may be acutely psychotic, delusional, manic, suffering hallucinations, combative, wandering in the halls, calling out loudly (disturbing other patients), etc. This is just a frustrating situation that, right or wrong, leads to a stigma associated with psych patients in the ED. Of course, they deserve proper, compassionate, evidence-based care, but you will inevitably hear venting from staff. 2. A nurse told me to discharge a patient AMA even though the patient told me she had changed her mind and would like to stay. I refused to discharge her, by the way. That did not go well, but I survived. (this I attribute to the bad nurse). In addition to this, there was a general rush to clear the beds, especially during busy times. To this, that RN in question does not have the scope to disposition patients. Consult the physician. It'd be useless to D/C her though, she can walk right back to triage and check right back in if she so pleases. So, why not let her stay. 3. I was told that we do not address problems that weren't "what the patient came in for." I also attribute this to the bad nurse, because the charts suggest that we do in fact do that, or we are supposed to. This is a complicated, entirely subjective discussion in and of itself. As someone else stated, if someone comes in for toothache, but oh, it turns out you're in SVT, we might need to take care of that. Then of course, we do not just give ibuprofen/antibiotics and discharge. In the same vein though, if you come in for "toothache," but your back is hurting (as it has 15+ years) and you just lost your script for pain meds, oh and I think my toenail is ingrown, do you guys cut those? And can I get sandwich and ginger ale too? This (to me) is the case of "Mm, no, you came here for a toothache. This is not your primary care provider, we cannot manage chronic pain here, our provider is not a podiatrist, and food is for admitted patients." This just taps on over-reliance on the ED, lack of access to primary care, access to insurance, etc. But we just can't treat all of the things all of the time, it's not what we're here for. Sometimes you just have to tell us what hurts the most and we'll go with that. 4. A disregard for all things not immediately life threatening. For example, a physician removed an unconscious patient's leg dressings, then just threw the bandages back on without tape saying, "Ok, that's done." When I addressed this problem with the nurse and asked if I could redress the wounds she said "No, we don't do that. The ICU will take care of it." But the ICU did not have a bed for the patient for the rest of the 12 hour shift. There's a couple comments, I would make on this. First and foremost, hospital geography does not have to define care. Now, I can't imagine having the time or supplies to do any full on debridement, wet-to-dry, hypo-silver-aquagel-P90X wound dressing in the ED, but come on, there is nothing wrong with letting a student nurse (or doing it yourself) throw some kerlix and gauze on a leg. In this case, that nurse needs to get over him or herself. That legs going to take 30 seconds or a minute to do some basic first-aid on. What next, we don't put patients on the bed pan, ICU can take care of that. Good luck explaining why you transported a patient to the ICU in pile of stool. It's a matter of time and resource management. No, we don't always have time to get cups of water, find extra pillows, but I have seen on more than one occassion the "THIS IS THE ER, AIN'T NOBODY GOT TIME FOR THAT" mentality used to cop out of providing some basic care when it would have been perfectly possible to do. ***On a side note, I am noticing most of my issues have to do with one nurse whom I feel gave poor care. *** 5. In general, I heard a lot of "we don't do that." in response to my questions about interventions See number 4, I think lol. In summary, I think all of your internal frustration and confusion is most definitely temporary and "fixable," not to say that you are broken. Emergency nursing is most definitely 100% different from any other area. It takes a certain mindset, a certain focus, a really different model of care than the traditional "nursing model" that you might find in other areas. I think school puts you in a very med-surg, very Nightingale-esque mindset of nursing. You want to fix the whole person, body, mind and soul. Emergency medicine/nursing flips the entire healthcare dynamic upside down. When you go to a PCP with cough, congestion. They're going to say, "Okay this is most likely acute sinusitis, doesn't really need antibiotics, but I'm going to get a crap review on Yelp if I don't prescribe anything so, here's a script for penicillin, get well soon." So emergency medicine flips this, and says, "Okay SOB, cough, congestion. I need to rule out pneumonia, acute bronchitis, CHF exacerbation, etc." So run some basic labs, get a CXR, order a DuoNeb in the meantime. When that all comes back negative, okay you're not dying, here's a script for abx, discharge. Anyway, all of that is to say, emergency nursing requires you to take everything you learned in school and adapt it, refine it, flip it upside down to look for acute signs and symptoms, changes, recognize and response to them. It will a good year there to do this, and then you'll continue doing that, learning and changing it, growing for the rest of your career. I do not think an ill experience with one not-so-super preceptor defines you as a poor candidate for ER. If it's in your blood, go for it.
  8. What is your certification? FNP? AGACNP? Dual-certified? Post-masters certs? Any thoughts on ENP programs vs FNP with ENP cert?
  9. GCom24

    ER Nurse Advice Needed

    Not sure where you are geographically, or in your program, but, in my state, we hire ED Techs that either A) Are a CNA, B) Are a EMT, or C) Have completed one year of nursing school. Option C is how I got to spend weekends during my second year of nursing school working as a tech in the ED. Great experience! So I would give it a shot. Another option if the ED where you are utilizes them, is to look into being a scribe. I've never done it, nor do we use them at my ED, but it seems like that could be -very- educational.
  10. GCom24

    George Washington University FNP Fall 2016

    Hey everyone, I know this thread has been quiet for awhile, but I'm looking at GWU's RN-BSN/MSN bridge program. I'm just curious about the admission requirements. So.. my ADN GPA is 2.78... Not very good at all, I know. There are 10 credits that I need to meet that part of the admission (Micro, Eng 112, and a Ethics course). According to these GPA calculators online, even if I make all A's in those classes, my GPA would only be 2.87.. Also, according to this calculator, it would take 30 credits of A's to just get to 3.0.. Has anyone had any luck getting into this program with a subpar GPA? I can't stand the idea of paying for 10 classes I don't "need" to try and raise my GPA. I have 2 years experience as an RN. *feeling defeated* :T
  11. GCom24

    Do you ever wish you were a doctor?

    I'll throw in my two cents here, I'm definitely struggling with this idea right now. I'm looking at DO, PA and NP routes of advancement. At this point in my life, I definitely wish I had somehow had the foresight to go straight to med school out of high school. But I had no idea I was even going to be a nurse, much less want to be a healthcare provider at the age of 18. I work in an ER, and only wish to be a MD/DO for the ability to manage patients, push the edges of intervention, and just do more. So I'm looking at these different routes of achieving that goal. NP seems the most attainable, I only hope that at the end of that, I don't feel disappointed/frustrated by a lack of autonomy and scope. Don't get me wrong, I absolutely love being a RN in the emergency setting. I literally look forward to going to work. I am absolutely grateful that through what seems to be chance and fate, that I found myself where I am, and if I do this forever, I will be happy. I only feel driven by this desire to do more, to learn more, and attain more skills. That's what makes me wish I had done it differently.
  12. GCom24

    Nursing Medical Symbol: What is it about?

    I didn't know about that verse, I like that! Thanks! I always thought that a right or left upper arm tattoo would be classic.
  13. GCom24

    Nursing Medical Symbol: What is it about?

    Love that verse, didn't know about that! I always thought a classic right or left upper arm tattoo would be awesome.
  14. GCom24

    Nursing Medical Symbol: What is it about?

    What up allnurses, simple question here. The caduceus symbol (two snakes, one staff, wings) is commonly used to represent healthcare/medicine, much nursing-related paraphernalia, etc. While historically speaking, this is incorrect, The caduceus is technically a symbol of commerce (jokes about the current state of healthcare aside ). The "proper" symbol would be the rod of Asclepius, the deity of medicine and healing. This is seen in the star of life, used by EMS personnel. So my question is, as ER nurses, if you were getting a shirt, hat, tattoo, etc. would you want the caduceus, the rod of Asclepius, or the Star of Life on it? Which one and why? I appreciate any input.
  15. We have recently changed our report and transport processes. ER Techs can transport all pts except ICU. If the pt is going medical, then our report is filling out a SBAR form, faxing it to the floor, confirming that it was received, do you have any questions, okay the pt will be up in about 15 minutes. Done. We must give verbal report for ICU and step down pts. It works pretty well other than certain med-surg nurses insisting on a verbal report.
  16. Been a nurse now for a little over a year.. Worked in Med-Surg since I graduated, I always wanted to do ER, that was my dream. I wouldn't trade it for anything. Nursing school taught me a great deal about myself. And this career has only continued to do so. Wouldn't trade the experiences, the friends, any of it. Every job has it's days. But this one sure does bring me satisfaction. Like others, I would have gone straight to nursing instead of as a second degree. P.S. I start in the ER in one month. (Keep chasing your dreams)