EmergencyNurse2012

Hey everyone. I'm an ER nurse and have been since graduating nursing school in 2011. Question: I've heard that OR nursing is a huge learning curve and I'd like to learn as much as I can before I start in the OR of a Level 1 Trauma center in mid March. What resources (books, videos, etc) have been your go-to's? I would value any input you have for me as I know that it will be a challenging environment and nothing like what I'm used to experiencing (they told me I most likely won't be comfortable for at least a year-if then). I will go through their peri-op 101 course and have up to a total of six months orientation. What should I focus on? OR nurses at this facility do not specialize in a certain service, every OR circulating nurse is expected to be able to be able to circulate in on every surgery they perform (other than transplant and CV-they have special teams for those). What do you wish you had known prior to starting in the OR?

Just my two cents here. Six years ago, I graduated with my ADN at age 40. When I was in nursing school, our instructors drove home the Institute of Medicine's study, The future of Nursing. To make a long story short, the Institute recommends that ALL nurses have a minimum of a BSN before 2020 in order to practice Nursing. Many states, hospitals, and management are embracing this study and requiring all nurses working in hospitals/critical care areas to have a minimum of a BSN. The area in which I work (southeast) has many hospitals, Schools of Nursing, and other healthcare opportunities for nurses. All the area hospitals phased out LPN's in their ER's 4 years ago and job announcements for for nurses in hospitals in my area include a blip about having a BSN or currently enrolled in a BSN program as an educational requirement. Why say all this if you've already stated that this is not a requirement in your area? It may quickly become a requirement and you may find yourself being required to earn a BSN (why not do it now instead of later). Also, and more importantly, while you may not see your living situation changing, circumstances may change and you may find that you must relocate permanently or temporarily to an area that requires a BSN. Case in point; in February of this year, my mother got suddenly, violently ill where she lived in Pennsylvania and was diagnosed with stage 4 cancer. The commuting to PA from the southeast was expensive, time consuming and not practical. I was looking into travel nursing which would have covered all my needs. It would have kept me financially solvent, provided a place to stay, allowed me to see my mother and help her navigate her journey. She unfortunately succumbed to the cancer while I was in the process of getting set up to travel. (all the hospitals in her area require a minimum of a BSN in order to practice). I still have siblings in PA and as we are all getting older, I want the ability to either travel nurse (if need be) or move to where they are if they need long term help. I would NOT sign a contract for a 5-7 year commitment in order to receive educational reimbursement (unless your employer reimburses 100% of all your costs) and even then, I would be very hesitant as I like the freedom to try new things, move different places and experience new cultures. If you are 100% sure that you would not find yourself looking for employment anywhere else in-between now and the next 15-17 years when you retire, then, don't pursue the BSN. If there is any chance your hospital may close or be acquired in a merger or take over, then there is a chance you will need a BSN. Just my two cents. By the way, I had an aunt who earned her LPN at 60. She worked in a SNF until she was 74. Rock on , Grengemly!

While working on an Intermediate Cardiac Unit, I had a patient that was prepped and went into the Cardiac Cath lab for a "routine cath" but came out without any stents and a diagnosis that led to open heart surgery two days later. His wife was very tearful and panicked. She stated she was afraid of losing her husband. I spent time and comforted her and the family that was present. The patient confided in me later that night, after everyone went home, that he was terrified that he was going to die on the table without reconciling with one of his sons. We talked for a while and why he and his son were estranged. He said I gave him the courage to call his son. He and his son reconciled the following day prior to his open heart surgery. The Cardiac PACU and ICU were very close to my unit and he had requested I come see him after he was out of surgery. When I went into his room, he looked dead, had five IV pumps with four channel each, was swollen everywhere. I almost didn't go into the room as I didn't think he would even know I was there and I didn't want to interrupt the work his nurse was doing. The nurse welcomed me in, I went into the room, held his hand and whispered his name and that I was so grateful to hear the surgery sent well. He squeezed my hand, opened his eyes, said my name and told me that he knew I was there before I went it because, "I know your smell, can feel your care from across the room". I actually laughed at the smell comment and said "Oh, that's the 12 hour shift on me, SORRY"! He told me that he will never forget me and what I did to get him and his son reconciled. The other big compliment that I received was from a retired surgeon. The ER doctor, having worked with this surgeon, warned me before we entered the room that the patient was going to be a challenge (he referred to him as formerly being "god" in the hospital and that he would be a curmudgeon) I actually love challenging patients and we hit it off immediately. I purposely took a nurse extern into the room to teach her how to deal with difficult patients and keep her cool. I had her start his IV while he and I bantered. He ended up telling me and my charge nurse (who knew him and his reputation and wanted to ensure he was happy with the care I was providing) that I was "among the best, a keeper, very knowledgable". He told us I needed to go along up to the floor with him and be his nurse on the floor, which I where I put my foot down and told him that ER nurses notoriously do not do well on the floor and he would have to behave himself upstairs. I went to leave the room after thanking him for allowing me to take part in his care and he held his hand out to shake hands, he ended up giving me a hug and thanked me again. Working in an ER, compliments are few and far between because we are often caring for people and families on the worst days of their lives...

NYCNurse17, Your post hit a serious nerve with me. I graduated from a regionally accredited (Western Board of Governors and approved by the California Board of Nursing) ADN program. Shortly after graduation, I moved from California to Georgia and applied to all the hospitals in the area including the VA. I was extended a job offer by the VA, went through the pre-employment physical, UDS and everything required. I received an awkward phone call requesting to know how my degree was accredited. To make a very long story short, I provided all the required documentation regarding accreditation only to be told that "your degree is not accredited". The VA, at the time I applied, required NLN or CCNE accreditation in order for your degree to be recognized by the VA system. My point to the VA was that my degree is indeed accredited-just not by either NLN or CCNE. I was shaken to my core by the VA not recognizing my degree and RETRACTING their offer for employment. Why?? My whole adult life has been spent within the military health care system-as a consumer. My spouse is now a veteran. At the time I was told my degree was not good enough to work for the VA, we had spent 22 years in service to the country. Not only is my spouse a veteran, but most of my family are as well. My point? I KNOW the military health care system, I know the unique needs of veterans, and active duty members and to be told that I (and my degree) were not good enough to care for our national treasures, was devastating. I sought to gain understanding of how this could be the stance of the local VA system. I requested and was granted a meeting with the Chief Nurse Officer of the local VA. She looked me in the eyes and told me, "I can't take a chance on you and your (subpar) education". It was the final straw in the coffin of any VA career I had hoped to have. I left her office broken, dismayed and more angry than I think I had ever been, up to that point. In retrospect, I understand that she was just relaying their policy. I however, sincerely disagree with this policy. I moved on and was hired on as an Emergency Department nurse at a Magnet facility. I am still an Emergency Department nurse-going on six years. The Lord had other plans and it turned out to be a blessing that i was not hired on at the VA…Their mistreatment of veterans and delay in treatment became national news within months of finding me unfit to care for people just like my spouse and family members-simply because my degree was not accredited by their required agencies. I am grateful that the practices that caused the VA to become national news, are being addressed-they have a long way to go, but it is being addressed. When I searched for RN to BSN programs, the first requirement I imposed on any program was accreditation by CCNE. I am happy to say that I completed my BSN in March of this year and the sky is the limit of where I can go from here. My advice is to apply places other than the VA. If your heart or goal is to eventually work at a VA, plug away at your accredited BSN-but do not wait to get experience. Get working experience while you work on your BSN. If I can get hired at a Magnet Designated facility with an ADN, you can too. By the way, I was 40 when I graduated with my ADN so I was also fighting against ageism in the hiring process. You CAN get hired. Network and gain your certifications. Before I graduated with my ADN, our class proactively all were certified in ACLS, PALS and BLS. Anyway, I wish you the best in starting your career.

My question is how the flip does a resident walk into an intubation with propofol in his/her hands???? Who pulled it from pyxis? Why was it already spiked? This is a MAJOR no, no in our facility (level 2 trauma center). Nurses with over 20 years experience each, recently got fired for propofol "going missing" in-between the ER and ICU. It is a serious offense and every, every drop of that stuff has to be accounted for. I've NEVER had a provider (PA, NP, MD or DO) have access to propofol without a nurse pulling it from pyxis or pharmacy preparing and giving it to a nurse to administer. Our facility had a problem with narc and propofol diversion-as a result, there are cameras at every pyxis, in triage, in pediatrics, in the hallways. Anyway, my point is, I'd have a very big problem with a resident handing me a bottle of spiked propofol-regardless of it being a RSI situation. I'd call for a facility-wide review of this whole situation and particularly how the propofol was obtained and the chain of custody. Our facility policy states we must scan the IV pump along with the patient and the medication prior to administration, the pump must be zero'd and handoffs must be done between the reporting nurse and the receiving nurse within the EMAR at handoffs/shift changes.

Keeper Mom, I feel your pain…Had one myself the other day. Up in my face, literally calling me to the room every 2 minutes to put mom on the bedpan, fluff her pillow, dress her wounds, on and on. I had a new CVA in my trauma room and a critically ill patient in my other room. I finally went to my charge nurse and offered to pay her to discharge "mom" home for me. She looked at me and rolled her eyes and said, "why does this feel like a set up"? I told her if I went back in that room, I'd probably lose my job as I was going to tell the guy that his expectations were ridiculous and that I wouldn't be coming back in any time soon. This was after I had repeatedly responded to the room and in between requested he not wait in the hallway or at the nurses station for me……Our team is usually very good with running interference with families like this-but the team was overwhelmed with multiple critically ill patients all at the same time, so, I was on my own. Oh, mom and the critically ill patient were tag teaming code browns so much so team members getting supplies from the supply closet asked, "who in the world? Where is that coming from? What??" I just said, "that's my circus". Everyone in our department knows what that means. Anyway, I'm usually very good at diffusing difficult family dynamics and usually hold my own, but that particular family member was extra trying and I had a LOT going on in my other rooms (code stroke and full septic work up with cultures, lactic, fluid resuscitation, and antibiotics. I think we all have days/nights when we need backup from our team members. When I have un-welcomed, extra inquisitive questions from patients/patient family members about my private life, I redirect back to the care of the patient and treatment plan of care. If that doesn't work, I usually, laughingly, say something like, "How about we focus on getting you better and back to your life"? That usually conveys that I'm not willing to give out personal details. If they persist, I can make an excuse to leave the room to gather supplies or equipment. As far as the engagement ring comment, I probably would have said something really snarky like, "I saw it, I liked it, I bought it for myself". That would have started a whole new conversation though...

I must agree with other posts stating that having a DUI when young is different than having your third as a 38 year old. It shows a pattern of worrisome behavior. It is highly unlikely that a reputable nursing school would grant acceptance into their program and even more unlikely for a Board of Nursing to overlook the most recent DUI.

You need to take into account the location as well as the work situation. If you are accustomed to northern winters and you like winter, then that would not be a problem. If you are accustomed to the south east and have never lived away from family, then that may cause a significant challenge in addition to the learning curve you will experience as a new grad. The job offer as you have described it sounds like a dream opportunity for a new grad. Set hours and day shift are highly desired by many people. I am a night person and do my best work from 1500-2200. My first two and a half years after graduating nursing school were on night shift with a bad 12-hour shift schedule (I was always at work or sleeping) when my kids had sports meets or JROTC functions. I missed a huge majority of their formative years in high school and I regret that… If I had been offered the job you described, I would have jumped on it-but that is what would have suited my family lifestyle. Sit down and determine what is best for you and your family situation before accepting any position, but also factor in that new grads do not generally get offered highly desirable positions and schedules…again, it all hinges on what will work for you personally. If I were given this job offer today, I would most likely accept it. It would give me more time with my family and more time to do what I want to do, in particular, not work every other weekend.

Hey everyone. I need some advice regarding travel nursing from nurses that have or are traveled. I've been an ER nurse for 5 years and would like to travel. Is there anything you wish you had known prior to traveling? What are some things that are important for you to have in your contract prior to accepting it? What are your opinions on companies, specifically, what companies are the best regarding monetary compensation, placement, advocacy, and flexibility? Thanks!

I have no where near the amount of years in as you, but I feel burnt out too. I have my ADN and will graduate with my BSN next summer-but I'm soooo over school and working and all the demands on my time-just want to be able to breathe and not have to do anything for anyone else for a bit. I love the idea of taking six months off and just doing something enjoyable like baking, write a novel, travel and just BEING. I wish you and the Hostess truck well!

YES! YES! YES! NursecatRN! I'm paying $2000 per course to learn little to nothing new over what I learned from the Associates degree program from which I graduated. To say it's frustrating is an immense understatement. I want to learn things that better my practice, deepen my knowledge of physiology, pharmacology, anatomy, and evidenced based practice along with leadership/management/legal topics. The motto of the Emergency Nurse Association is Safe Practice, Safe Care-I have yet to learn anything in the RN to BSN classes that helps meet that standard. It is very disconcerting to say the least. I also take issue with the profession of nursing taking directives from the medical field….It is as if we are de-evolving. The IOM study "The Future of Nursing" states nurses should practice to the full extent of their scope of practice-yet I feel we are in so many ways but mere puppets for the medical community. (Forgive me-I am very frustrated with being told I MUST get my BSN, pay $2000/course to have PhD's 'teaching' the classes and yet not learn anything of practical use as a critical care nurse). Another frustration is the individuals that are 'teaching' these classes may post one or 2 sentence replies to classroom discussion forums and not teach a single thing throughout the entire semester. Spending all my free time outside of work writing papers that aren't graded on content-but on APA formatting is excruciating. Before starting this program, I LOVED to research and write papers. I now have a great disdain for the whole process. Perhaps I'm just burnt out in general. Before writing a post stating I must just be in a very bad RN to BSN program, I've spoken with many co-workers attending various programs, and they have verbalized experiencing requirements and environments very similar to mine. I think we, as a profession need to examine why, what, and to what end we are being mandated to learn and pay out of pocket to learn the material that is required. If the end goal is truly better outcomes, why are we not learning advanced pharmacology, physiology, patient care, and anatomy along with the management/leadership courses? For those reading this that are interested, heres a list of the courses my program requires: Organizations and Systems Management/outcomes Policy Law Ethics/Regulations Nursing Research & Informatics (Did learn some new information) Nursing Leadership & Management (very similar information to that in organizations and sys. management) Health Promotion/vulnerable/diverse populations Assessment comm/collab (NO different than ADN program) Orientation to BSN

Everyone is different, but it took me every bit of two years to feel comfortable…Stay open for suggestions, seek feedback on your performance from people who will tell you the truth and never stop learning… Welcome to the ER!

Dear undecided, Breathe. If your coworkers are supportive and telling you that you are doing a good job, you most likely are doing a phenomenal job. You are in a very challenging speciality. It will take some time to feel comfortable and confident. Embrace all the good that is happening with your current situation. 1. You made it through the orientation process. 2. You have supportive coworkers. 3. You are learning valuable life and job skills. 4. Your coworkers are not only hearing your concerns, they are also verbalizing support. Many, many times we are our own worst critic. Try to focus on all the good things that happen in each shift, learn from those that don't go well, and grow. I started in a very busy urban emergency department right out of nursing school. I didn't even feel comfortable with IV's or foleys. I too went sleepless between shifts, laid awake worrying about what I forgot to document or what tasks went undone at change of shift. I had myself tied in knots......but it did eventually get better. When I realized no one was asking me to be perfect, they just wanted my practice to be safe. My coworkers were not verbally supportive, but they were physically supportive. By that I mean that they came along side me and helped pick up my slack (helped by triaging an ambulance while I stabilized a cat. 2 in another room). I try my best to be supportive of all my coworkers and verbalize appreciation for the jobs everyone else is completing from housekeeping to dietary to unit clerks to nurses and doctors. The other week I had a patient decompensate within five minutes of the hospitalist being in the room. The patient went ashen in color, diaphorectic and had a bp of 70/38. Thankfully, the hospitalist was still on the floor and when I stepped out in the hall to grab the ekg machine, I mentioned the change of status to the DR. Who came to the bedside immediately. It was a team effort and he was stabilized and went to cath lab a lot sooner than later due to the hospitalist quick response to my change of status report. THAT is why I am a nurse. I love knowing that the actions we took, saved this mans life. Again, you made it through orientation, your coworkers are supportive and you are learning and growing professionally. From what you've said, you sound like you have the makings of a great ICU nurse. By the way-it took me a full 2 years to feel comfortable with what ever patient came to my rooms. This past week I started a new ER job in a smaller facility with an antiquated charting system...I'm feeling anxious about learning everything regarding the charting system, it is very difficult to use-in addition to learning all new coworkers and equipment. Anyway-we are in the same boat-I'm determined to see the best in this situation. I have a great preceptor, it's much closer to my house so I get to sleep in, and people seem helpful and approachable. Best wishes in whatever path you choose to take-know that you aren't alone.

Regarding the post that delineated the differences between an RN and BSN as the Bachelors prepared nurse has a degree and RN takes the licensing exam in order to practice. This is not entirely accurate. While I am an RN without a Bachelors Degree, I DO have a degree in nursing, albeit an Associates Degree of Nursing (ADN). I'm 5 classes away from my Bachelors and so far, everything covered by the five classes I've taken towards my Bachelors was covered in my Associates Degree program-with the exception of in-depth study of research. I'm looking forward to learning information that will make the $1800 I'm paying per class out-of-pocket, worth the time and effort......

So, I'm having a surreal moment right now and just thought I'd kick it out here into cyberland. I applied for and was hired on as an ER nurse in a competing facility in town. The thing is, I feel like the whole thing isn't real and not happening, even though I do know it is....See, I had applied for this same job about a year ago, was interviewed and not hired at that time. So this time, I didn't feel like the interview went any better than last time, imagine my surprise when I get a call the same day and told, we want you, when can you start? It was with great trepidation that I submitted that resignation letter this morning. I'm half afraid of my nurse manager's reaction, and will surely get it in the morning. Anyway...just had to put it out there and let it go fly into cyber neverland.......