gemmi999

Give her a call and just inquire, gently, about the status of the job. My last interview I thought I for sure bombed, a week after the interview I hadn't heard anything. I called and they said they were about to call me (which, eh, probably not true) about checking references. Two weeks later still hadn't heard, I called again and they offered the job over that phone call. You never know. The manager could be busy/disorganized/out of town/have a family situation or something. As long as you're polite and straight forward, I think calling is appropriate!

I second what another post said about looking in Riverside. I graduated in 2015 from a school in SD. I didn't want to wait for the new grad cycle to start up (approx. 5 months from graduation date) so I applied to smaller hospitals in San Bernardino and Riverside. I got hired in Victorville 2 weeks after getting my license. It's Victorville, meth central, but it got me my year of experience. And it's DIRT cheap to live there compared to San Diego. Try Victorville, Hemet, Menifee, Palm Desert...they're all less desirable locations/hospitals but they probably have openings.

Pick up a per diem job in California if you're after the pay. Group your days together once a month and fly in and out, do as many shifts as you can. Work at a hospital in Florida the rest of the time. Per Diem pays way more, the hospital job in florida will hopefully cover insurance and allow you to put money away in a 401k. Maybe look into bankruptcy? See what percentage of your debt could be wiped away. You own your house you said...

Do you have a union representative? A copy of your evaluation? Any write ups or previous meetings regarding issues ranging from more then a year ago? It does sound like they are trying to fire you/set up cause to fire you because of either expense or personal vendetta. Get a lawyer, keep a paper trail. Print everything that is in your email or forward it to another email address that is *not* associated with your job. Basically, get your ducks in a row. Then, decide what you want to do. Do you want to wait to be fired and then go on unemployment? Do you want a legal fight? Can you afford to have a prolonged period of unemployment if you decide to take it to court/mediation? Does your boss have a boss? If so, you can set up a meeting with your evaluation from 6 weeks previous that had no complaints listed and ask what is going on. You can meet with HR regarding the incident. You have the power, you get to decide what to do with it.

I have a genuine question for my ER nurse peeps out there. Today I was the float/circulator in my ER. My day was spent triaging ambulance runs, stabilizing unstable patients, discharging patients, repeat. Our ER has a 4 to 1 ratio. ALL DAY LONG one of the day nurses kept forgetting their fourth patient. I ended up assessing/medicating/discharging that room/patient for them at least three times. I reminded him repeatedly that he had another patient but he just said: "I'm busy with my other three patient's right now" and not really making an effort to see/address the needs of his fourth patient. Another nurse literally saw me triaging one of his patients at 1820 and then did not show up again until after shift change. The patient came in with a complete heart block, r/out head bleed vs hyperkalemia. He didn't even check on them. I ended up doing everything, including stat CT head, etc. I don't mind floating/helping but at what point are you not just the float but doing the other RNs entire run for them? When do you say "enough" and have the nurse start picking up their own slack? I don't mean this in a mean way, but how can you learn to manage 4 patients (or one critical patient) if you let the circulator do everything?

I don't think nursing is a calling. I specifically chose nursing, and then specifically chose ER nursing because it is a steady job, with a good paycheck, that has the ability to get overtime on a regular basis compared to med/surg nursing. There is always a minimum staff ratio to the ED because you staff based on what could happen, not what is currently in the ED at that specific moment. I do think a lot of nurses would be better able to handle nursing and the drama/politics/etc that go with nursing if they viewed it as a job and not a calling. The reason that is important to me is because a job is something that you go to, and leave. A calling implies a lot more, and thus you are less likely to leave the drama/politics/bs behind. If the job is not working out, you are free to leave the job. But more importantly you are free to think about what it is about the job that you find unsatisfying. If it is a calling that is not working you, there is a bigger onus of self blame because it's "your calling" and "if it's not working out I must be doing something wrong". So, in conclusion: Nursing is a job. Not all jobs are perfect all the time, but bedside nursing has definite pros. And by thinking of it as a job versus a calling you can remain more detached/leave work drama at work/have a better work/life balance and remain a bedside nurse for (hopefully) longer.

It does come with time. I started in the ER at a small, community hospital. 10 weeks into my orientation I was told that I wasn't "getting it" with regards to the critical patients and they wanted me to spend a month in ICU getting more critical care experience. I cross trained and did my time. Then I was told that they wanted me to stay in ICU due to nurse shortage in ICU. I said no and went back to ER, really apprehensive because only 1 month earlier I'd been told I wasn't cutting it. It took time. I definitely have some stories about getting talking to by doc's regarding not giving them the right info/too much info, etc. I remember I interrupted a doc huddle/transfer patient care meeting to tell the doc that the dialysis patient's (who had missed two appointments for dialysis) BP was elevated at like, 230/145. He looked at me and basically said: "Hypertension is not a good enough reason to interrupt this meeting UNLESS the patient is having a stroke or stroke like symptoms. Is she?" and I was just ah--"um...I dunno?" and backed away. I hadn't done a full assessment of her, I hadn't thought it through or talked to the charge/other nurses about it. I was treating the number, not the patient. It comes with time, patience, and experience. Give yourself all three of those and you'll be golden!

A lot of good comments above, I don't have much to add. 1) You survived your (assumed) first RRT! There is a reason Rapid Response Teams exist--to prevent Code Blues. Your patient didn't code, you called a rapid because you recognized the change in patient condition and realized you needed more resources to help the patient. The RRT does just that--it brings you the resources you need in a fast manner. NEVER be scared to call a Rapid because the worst that will happen is the team will be like: "AH, whaa?" and then go back to their day. The best that will happen is you will get your patient the resources the patient needs in a timely fashion. 2) Other posts talked about recognition in change in pt. baseline/increased SOB/need for oxygen. I don't know your facility protocols but in my facility the MD needs to know if oxygen is started. Mostly because oxygen is technically a drug and they're supposed to "order" it. I think of it as a checks and balances act instead--if you felt that the patient condition needed oxygen, that means there is a change in patient condition. You need to communicate that change to the MD which is why you're calling, not necessarily for the actual oxygen order, but to facilitate the communication. For example, I had a patient receive IM morphine on my last shift by the float nurse while I was busy with a critical patient. I went to assess my patient after the critical patient was stabilized and she was desatting into the 60s. I placed her on a simple mask, ensured she was breathing and awake/alert, and told the MD. Not that I necessarily started oxygen, but that the patient is *very* sensitive to morphine along with her other drugs and we needed to be aware. MD told admitting MD, less morphine was ordered then standard dose and constant pulse ox was ordered for the floor. 3) Insulin is tricky. You have orders to check it q whatever hours, same with vital signs. For example q4 hrs. That is the minimum you need to do vital signs on a patient per orders. However, there is not a maximum number of times you need to do vital signs. You can do them as often as you feel the need. The same goes with BG. If you gave insulin and didn't see the patient eat lunch, you need to think: "what is the peak time of effect of that insulin? What time will that be?" and make a note to check the BG around that time, in addition to physically assessing the patient. 4) Remember that Rome wasn't built in a day. It takes time to learn what you need to know to be an educated nurse. What I still do to this day is ask questions and look stuff up. If I don't know something I will ask, and continue asking, over and over again, until I know enough to educate myself using trusty sources. Start with Sepsis, in this case. Ask your preceptor what your hospital's sepsis protocols are. Then read them and see if you can understand *why* they are in place. Why do we give broad spectrum antibiotics within X hours, why do we give IVF boluses, why do we culture everything, etc. Keep asking, keep reading, keep learning until you feel comfortable with that dx and then move on to the next. Don't beat yourself up, focus on what you did correctly and take time to acknowledge what steps you'd take next time, instead of what steps you took today. Think to yourself: -- "Okay, I started oxygen today but I didn't tell the admitting MD. Next time I have a patient I need to start oxygen on, I know I need to either make a note of it to talk to the MD on rounds/page the MD/tell the charge and see if it warrant's a page or if it can wait for rounds" -- "Okay, today I gave insulin but didn't see the patient eat. Next time I have a patient that seems confused I'm going to encourage the patient to eat and then give insulin (if time permits). If time doesn't permit, I'm going to ask a CNA to help the patient and then tell me how much of the meal they ate. If the CNA says they didn't eat a lot, I know I have to keep a closer eye on the patient and do more frequent accuchecks/FS"

My favorite is the kid's that come to the ER with stomach pain with their entire mouth covered in bright red dust. The parents then want to know why we aren't doing a blood test/ct scan for their obviously ill child who has "appendicitis" who is smiling, playing on the phone, with stable vital signs and NO pain at all on palpation of the abd. When you ask when they last ate, it was twenty minutes prior to arrival (a bag of "chips"), they didn't throw up, they aren't nauseous, they just have a stomach that hurts. When a GI cocktail calms the pain and they're sent home to follow up with their PCP, the parent pulls out another bag of the fiery death chips to "celebrate" their child not dying. With the all important school note that excuses them from school for two days because the parent states if they don't have the note the school "people" said they would be contacting child services because the child has missed X amount of days already. Ohh, and, since they're there, would we mind looking at her rash? She doesn't want to sign in, just wants a MD to look at it and see if it's a spider bite. And maybe give her an antibiotic...

Sometimes I really wonder. I know nursing is a female dominated profession, and in general females are paid less then men. Part of it is society and the glass ceiling but part of it is how we are conditioned to view work and our place within the work place. I can practically guarantee that if nursing was male dominated there would be a lot less discussion about what the job is paying to train you and other people losing out on a job if you took it. For what it's worth I took a job as a new grad and lasted 10 months. I quit and have been with my current job for about 3 years. I was honest when I quit (and broke a contract--never had to pay, either) that I didn't feel safe working there because they wanted me and other new grad's to be charge after less then 1 year. It was an ER, it was dangerous. I feel like as women we tend to undervalue our skill set and give too much thought to the workplace and their needs. I do think we've been conditioned to think of others as perhaps more important then ourselves and this is one way it is showing. Take the job, quit when you move, and when people ask why you quit? You moved out of state for personal reasons. End of story. No one will give you a side eye.

My workplace currently uses a breaker nurse. It is helpful but at the same time the Charge RN views the breaker as an extra set of hands and will routinely pull them from breaking to assist with critical patient's that come into the ER. I couldn't imagine having to do a breaker buddy in our ER, it's

That is what scares me. You literally just typed in that you haven't had an unstable patient. You haven't had to critically think about it/call the doctor/call the rapid team/intubate/upgrade the patient. That indicates that you're probably getting the more stable patient's on the floor, the ones that don't require quite as much work. Just an FYI--that isn't something to brag about. Having to call a RRT/MIT isn't a failing of the nurse, it's something that should be celebrated. That means the nurse recognized a change in patient condition, tried getting ahold of the doc, and if they couldn't got the patient the help they need.

I think a lot depends on your temperament. During nursing school clinical's I *hated* ICUs, all of them without question. I hated NICU/PICU/Cardiac ICU. I didn't like how sick the patient was, how emotional the family was, etc. I did 1 shift in the ER and I fell in love with it. Most of the patient's walked in and walked out, families were there sometimes but not nearly as emotional. Of course, three years into ER I realize how much time is spent taking care of the sick patient's before they get to ICU (if they get to ICU at all...) and their families are just as emotional. However, the ADD nature of the ER helps me with this. If my patient is sick/dying/dead and the family is there and I feel overwhelmed I can often times see my other patients who might be a three-year old with a cough that is smily and happy. It helps me balance out the emotion of the more critical patient's. There are weeks at a time when our ER is just a second ICU, filled with ICU holds (which does suck), but overtime I have gotten better at taking care of ICU patients and dealing with my own emotional response to really sick patients. I have the skill set but I still mostly hate it. Reminds me too much of when my mom was in the ICU. But when ED is at it's ED prime, there are so many other types of patients that I still love it. And I love my coworkers too!

Everyone has said it better then I can say it, but basically try not to screw over the next nurse (no matter what shift). Make sure all meds have been administered, nothing is going to run dry/overflow (IVF, chest tubes, etc), and VS have been charted/stable or are unstable and calls/interventions have been started. If it's a rapid response/code blue, stay. If it's "oh, Ms. So and So is requesting her Norco and I have to go get report for my others patient's, do you mind..." then you say: "Sorry, I have to go *give* report and head home".

My first piece of advice? Don't say that again. The cop did have a reason to pull you over--you were driving while impaired. Fact--most people pulled over for DUIs aren't driving erratic, they're driving *slower* then the flow of traffic because they're trying to be careful and not get caught DUI. Accepted that you made a mistake, get a lawyer, pass your boards. Don't make unrealistic statements or grandiose claims: "I'm never drinking again!" because they don't mean as much to the BRN/Court compared to honest statements. "I messed up, I realize that I could have done x,y,z to prevent this from happening. In the future this is what I will do to ensure that I don't risk the safety of others by driving while impaired". Take your lumps, do the time because you did the time, and hopefully you'll have a long and fruitful career after. It sucks but it happened, now learn from it.

I literally click a few boxes and hope I remember if I did it in the right or left deltoid, etc. I'm horrible at remembering left vs right being inverted for pt's.

I've seen quite a few cases in my ER. The way the doctor explains it best is that the patient is allergic to MJ. Not quite true but pt's understand allergy and to avoid repeated exposure. Haldol works *wonders* on this! More then the typical antiemesis medications at least.

It really depends. When we get a call that a code 3 is coming in to one of my beds (or really any bed, now that I think about it) I ensure the room is getting prepared by a tech. But then I round on my other patients, take care of the little things, so that I can focus on the critical patient for the next 1hr plus that they need. I update vitals/give PO meds/make sure no one is up for d/c. The way our system is I can't access meds until the patient is registered, so I can't pre-prime IV fluids, etc. I would have given the routine med, too, just so I don't have to worry about that patient for a bit.

I'm still stuck on the fact that RNs can't do EKG's at your ER. I can't count the number of EKGs I do, if a tech is splinting someone/transporting someone/not available/called out sick. When I'm in triage and need a stat EKG, I try to get a tech to do it WHILE I triage to save time but if one isn't available I do my own EKGs.

A bunch of people have commented above about what you can say in the interview, so I'm not going to comment on that. I just want to tell you not to let that dumb unit get you down. When I was a new grad in ER, our ER director changed 3 times in 12 weeks. The third time the director didn't like new grad's in the ER so at the end of my preceptorship I got called into her office, told I wasn't cutting it, and needed to cross train for 1 month in ICU to get more critical pt. experience. I gritted my teeth, did my cross training, and at the end of the month was told that ER didn't want me back, but ICU liked me and I could stay there full time. I politely said no, my contract was for ER nights, and that was what I was going to do. The director threw a fit (she was in charge of both ER and ICU) and kept trying to get me to stay in ICU. I didn't want that, and kept insisting she either let me go back to ER or I would file a complaint with HR because she was violating my contract. Long story short, my preceptorship "mysteriously" got cancelled and I got thrown onto nights in ER the very next day. When I asked around in ER to the charge RN, etc, they all said that she was just trying to fill out the ICU staffing because they were so short. After a whole month of anxiety and doubt that I wasn't good enough for ER, it felt nice to hear this. More importantly, it made me realize that management and other nurses do stuff for their own reasons without necessarily considering how it will effect you. So hold your head high and remember that the unit is the one with the problem, not you! You are a good nurse!

Do not decide that you hate your foley catheter and try to take it out yourself--By cutting the catheter about 1 inch from where it leaves your member. The nurse will not be able to deflate the balloon, the urine will still keep coming out but there is no container to collect it in, and you will be transferred to a larger hospital because the MD at the small, community hospital couldn't figure out how to drain the foley balloon either. Seriously, any suggestions?

ER is full of different personalities. There are definitely the loud/brash personalities but introverts can thrive there too! Biggest thing is team work. Offer to help others because it creates good karma and there will definitely be shifts where you need the help! One thing to note--you won't always have critical patient's. It's maybe an 80/20 ratio. 80% of people that come in don't get admitted. Of that 80%, maybe 10 - 15 % really even needed to come in. Most treat the ER as a PCP, coming in for routine things like med refills, UTIs, coughs, injures from two - four years ago that they want to check out, etc. You do get critical patient's and you do need to stay on your toes to catch them, but the majority of the time it is more common things. The single biggest thing I will say about surviving in the ER? ASK QUESTIONS/BE HONEST. If it is a disease process you don't know, a medication you've never given, a rhythm that just looks funky--ASK someone. Every ER doc I've ever worked with will take the time to educate (if it's not mid code or whatever). Just the other day I had a bad asthma patient and the doc wanted to give terbutaline. We don't give that routinely. I'd never given it. You step up and ask the doc/ask the charge. Everyone in the ER that day had never given it, we called pharmacy. We all learned because I stopped and asked.

The only time I've used ubags are when 1) I straight cath'd a kid but no urine output for whatever reason. I place the ubag until I try again in approx. 30 - 45 minutes, just in case they urinate in that time. It can be helpful for determining how dehydrated the kid is, etc. 2) Parent refuses straight cath 3) MD states he just wants a u-bag to see if kiddo is passing glucose or something in his/her urine Otherwise, straight cath with extra urine cup at bedside because half the time when you're cleaning the kid, the kid ends up peeing and if you're lucky you can literally catch some mid stream.

I'm polite with most of our ED patient's to a degree. I don't remember names well, so it's always "ma'am" or "sir" when I talk to them. If they're being PIA, I will tell them to stop it in a firm voice. I has told more then one patient that they aren't my only patient, they aren't my sickest patient, and that I'd get back to them when I had a moment but they needed to be patient. I have also set time frames with some--I'll check on you every 30 minutes. If you don't ask then, you have to wait 30 minutes. Some PITA we switch helping, or make the MD do it. One threated to sue all the nurses, so the doc got to give her meds because we wouldn't go into the room. She had her camera up and was recording everything.

Worst change of shift report I got was a patient in the ER, on a bipap, with only IV access an EJ that has the bipap straps rubbing against it every time the patient moved. The IV looked horribly unstable, the patient's VS were in the toliet, and the RN was at the bedside giving medicine (I don't remember what). I remember looking at the patient and thinking: "****, he needs a central because he's going to end up coding". Before I even got report I was talking to the ER doc about pt needing better access, etc. The RN comes over and gives me basically: "SOB, on bipap, cardiac irregularities, all medical hx in the chart" and starts talking about her other two patient's. Normally that's all fine because I can just look up details if I need them. So, mid report on my other patient's, the first patient starts getting hypoxic, taking bipap off due to hypoxia, and codes. We immediately call a code and spend the next 45 minutes coding him/stabilizing the pt. I then get to help the MD with the central line, do all the drips he needs, etc, and haven't even sat down at the computer to chart, have my notes sheet with times and figure I'll just do a *bunch* of charting once the patient was stable. Admitting MD calls and me and the ER doc go talk to him, admitting MD is asking his medical hx and both the MD and I go to the chart because the first, primary RN had triaged the patient and said it was all in the chart. NOTHING on the patient was charted. No notes about medical hx, no previous vitals, not even the meds the RN gave at change of shift. That then became the worst shift ever because I had to figure out what had already been done, figure out his entire hx, he's intubated and relatively unstable and just...ugh. Long night.