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joyful_wanderer

joyful_wanderer

ER, PACU, ICU
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joyful_wanderer has 6 years experience and specializes in ER, PACU, ICU.

joyful_wanderer's Latest Activity

  1. joyful_wanderer

    Psych pts protocol

    RNGummy I love the way your unit is set up! Ours seriously was an old supply closet that we emptied out and placed chairs in it. There are no doors and its down the back hallway of the ER. Its a horrible set up. Pts try to run all the time and they feed off of each other like piranhas.
  2. joyful_wanderer

    Psych pts protocol

    Phones cause so many issues!!!
  3. joyful_wanderer

    Psych pts protocol

    So I realize this is a nation wide problem and I wasn't sure which specialty to ask this question under but my ER sees a LOT of psych pts. Mostly are honestly drunkacidal but the police bring them in on holds and then we have to keep them until they are sober enough to be cleared by our behavior health team. The other group of people we get are meth patients that our brought in for odd behavior and SI statements as well and we have to hold them in our ER. So here is the issue for my department. We have no set protocols or standards as to what to do with these pts. We place them all in chairs in a room and let security watch them. However, there is constant debate as to if we should get them changed, or let them keep their phones, or if we just need to take their backpack/bags away from them while they are there. It is all provider dependent. I cant even tell you how many times in the last month we have caught patients shooting up with meth/heroin in the psych room or BR. Any way, I spoke to my manager and am creating standard protocols that will apply to every patient being brought in for psych/SI/HI behavior. I was wondering what are some practices that others have at their facility or protocols that you follow when getting in a new psych related pt? I have always come from ERs where everything is removed and given a hospital gown and no access to a phone until seen by BH. Any advice is appreciated.
  4. joyful_wanderer

    Pay range for PMHNP in Alaska

    Hello, Im currently in a MSN program and want to pursue PMHNP over anything else. However, when I try to look up online what the pay range is in AK it says $40,000- $60,000 annually and I was wondering if anyone can confirm. Currently I make almost twice that as an ER nurse. I really want to pursue advance practice but not if I am going to make less. Anyway, if anyone can weigh in on expected pay for AK that would be great.
  5. joyful_wanderer

    Low GRE scores, dyslexic

    I've been doing the Kaplan review but have not had very promising scores :-| I guess I will find out if I get in or not with a low score.
  6. joyful_wanderer

    Low GRE scores, dyslexic

    Thanks! I have a test date scheduled. Just dreading it.
  7. joyful_wanderer

    AACN CCRN self assessment exam

    To answer my own question. I took the CCRN and passed! I know the test is not graded on a percentage but I got 82% so pretty close to the practice test. The questions were pretty similar in format and difficulty.
  8. joyful_wanderer

    Low GRE scores, dyslexic

    I was wondering as far as applying for CRNA programs if people got in with low GRE scores. I haven't taken it yet but test like this have always been my weakness! I know the schools look at the overall application but when it comes to core academics like language and math I am horrible. I always have been and have always struggled with it in school. I am dyslexic and have other learning "disabilities" which don't hold me back except when I am being tested on it specifically. On the positive side I graduated my ADN program with honors and my BSN program with honors. I have my CCRN, CEN, and CPEN.... My biggest fear is not being able to fulfill my dream because of my academic weakness.... and really only is an academic weakness. Also, are there any SRNA that have learning disabilities/dyslexic? I was just wondering if you found it to hold you back or have you been able to use it to your advantage and work around it?
  9. joyful_wanderer

    CRNA program in Puerto Rico

    Hey all! I was just wondering if anyone was currently in the CRNA program or considering the program through the University of Puerto Rico? The program seems to be semi well formed and is accredited by the COA, CCNE, and MSCHE. I know it may not be the most advanced hospital in the world but my goal in becoming a CRNA is to be able to do more medical missions. I have spent most of my time as a nurse in rural, rural Alaska and doing a few medical missions. For my goal it seems like it would be a great program. Plus I could get better at my spanglish. Just wondering if anyone had anything positive or negative to say about it. Thanks!
  10. joyful_wanderer

    Cross Training to ICU

    I started out in an ER in a very rural hospital. There was no ICU and if we had ICU status pts we kept them in the ER till we could medevac them out which at minimum would be 3 hours up to several days (rural Alaska). Knowing your resources (books, site links, people) ahead of time will make it easier to look things up in a crunch. Next is time and experience. The only way you will become more comfortable is to do it. It can and will get scary but you will make it to the end of the shift and everything you went through will give you experience for the next time. Congrats on the job!
  11. joyful_wanderer

    Spice?

    We have been seeing a crazy amount of spice pt. You never know how they are going to respond. They present like PCP mixed with Benadryl OD and any other combination of things. We have been holding them in the ER because there is no other place to put them. The ICU keeps getting filled up with intubated spice pts. They usually only need to be intubated for a few hours depending on how much they are seizing or if they stop breathing. There are three hospitals in my area and we are all seeing it. Mostly among the homeless population and college kids. There have been several deaths related to spice use as well. I worked last night and we had three spice patients back to back. One we wanted to intubate but vents were limited and the ICU was full so we just maintained them with oral/nasal airways. Anchorage police: 12-year-old hospitalized after showing symptoms of spice overdose | KTVA Anchorage CBS 11
  12. I keep coming back to your post. I really wish I could answer your question. Yes, pain is what the patient says. Their perception is their reality. Not sure of the exact situation you mentioned plus I wasn't there to see it. I have no idea what the patients injuries were but I do know that at the different ERs I have worked at we don't always give narcotic pain medications to patients just because they say their pain is a 10/10. Part of me wants to respond and say "if the staff knew this patient that well he probably is a drug seeker". I know I have personally made the same assumptions about other patients that I have taken care of frequently. At the same time I have seen patients induce vomiting to get different meds or more pain meds. It is sad but maybe some of us ER nurses do get jaded. As far as it being the patients right to be pain free..... there are some "pains" that no matter what we give or do will not make a patient pain free. In regards to not letting a patient get their fix. Is it in our best nursing practice to further enable a patient with their addiction? If they truly are a drug seeker. There has been times that doctors have written narcotics for patients (ones we considered drug seekers) just to appease them simply because they are acting out or giving their nurse a hard time. In that case is it appropriate? Unfortunately you are going to see and hear things you may not agree with or that may cause you to question your own beliefs and I guess all I can really say is be the best nurse that you can be. Treat patients they way you would want to be treated as a patient. Be the nurse that you would want to have. Maybe make a list of all the reasons that you became a nurse or all the things you value about nursing so that you can reflect on it in the future if you ever find that you have become slightly jaded or running low on compassion. Perhaps its something that we should all do. BTW congratulations on the new job and career!
  13. Like this one? Transfer Mattress
  14. joyful_wanderer

    ED techs to start IVs?

    Our techs do IVs, labs, splints, and sutures. They are really good at it too! Having worked at another hospital where our techs were not able to do as much it can really make a difference! I've been told that it is because the practice under the MD's license at least in our state.
  15. joyful_wanderer

    ER to OR

    I'm glad I am not the only one with that fear! Thanks for sharing!
  16. joyful_wanderer

    Getting IV Experience

    Is your facility associated with any hospital? I work in the ER and we have had nurses from other units and facilities come spend time with us to gain more experience.