Cali Nurse

I will be applying for an Emergency full time position in Jun/Jul next year. I was thinkng of the yale group. Anybody work for them or have any suggesstions on if it if a good place to work? I know they have it split up in peds, adult Level one, and a smaller, community sized er. Just wondering how the job satisfaction is and how things are run. I am an ER nurse for 3 years now, med surg 2 years before that. Also coming out of the military with a lot of leadership experience. Thanks!

I just passed in June this year. I studied here and there for maybe 3 months. The best book I used was "CEN Review Manual", it's actually put out by the ENA. You can get it on the ENA website, it's $50 but worth it. The book gives you 5, 175 question tests with mixed questions from all topics that will be on the test. Also comes with a cd. Other books I used were Mosby's CEN Review, which has individual tests on each subject. I would also reccomend the Core Curriculum for Emergency Nursing. It's apparently the reference that is used to develop the questions. Personally, I would say it's a good idea to study at least a little of each topic and focus on what you feel you are weak in. I have 4 years of experience, 3 in ER and I thought the test was challenging. I took a review course 2 years ago and then put it off. I also took the online test practice test from the BON, which I failed, but I did pass the real test on the first try, so it can be done!

I work in a rural hospital and there's tons of downtime! I'm on here every night because I'm the only nurse on in my dept and have no other nurses to talk to. So it's nice to be able to see what other nurses think about things.

Did anyone else read the article addressing mod sedation in the Sept ENA newsletter? Very interesting and includes a list of agents that the ENA/ACEP support for use in procedural sedation. Includes (but not limited to): etomidate, propofol, ketamine, fentanyl, and midazolam. I've never worked in a facility that approved etomidate or propofol for CS, but the others we use regularly.

I wouldn't say there is a specific person who says "now is the time the pt can go to the floor". It's more like a process. The ER doc is ready for them to go as soon as the consulting physician says they are accepting the pt. In our hospital, the admitting doc calls the bed manager/admissions office and they assign the bed. So at that point you could technically call report, but there may be some stat orders added on that have to be done prior to admission which need to be included in report. So basically, the biggest factor is the bed manager because without that you don't know who to call report to. The primary nurse is the the one making sure all of this stuff gets done, so as soon as all the admit paperwork and orders are done the pt is ready to be transferred. The charge nurse is usually coming around and checking on how much longer the pt will be there, and sometimes will call report and help get everything done so the pt can get out of the ER, because they want that bed for another pt.

I'm a Navy nurse, have been in for 4 years. I did 1 1/2 years med/surg, the rest ER. I'm currently overseas, can't wait to get back to a busy hospital.

I'm sorry. It seemed like the EDinNC post was saying that if we can push parayltics for an RSI, and then monitor/sedate the pt once vented, that giving ketamine, a drug which is used commonly in CS should be in our scope of practice. That's why I made the comment. I didn't mean to offend.

I'm sorry if that came off as attitude, but you had just gone off on how ER nurses dump on you and I was trying to point out why it may seem that way. Like I said, I worked on a floor for 2 years and I remember getting multiple admissions per shift and how hard it was to juggle everything. I have a lot of respect for med/surg nurses. You guys have a really hard job and don't get a lot of credit for it. :)

If you would re-read the post you were commenting on, the person was talking about RSI and vented pts. I think any competent RN knows that paralytics are not used in CS.

OK, you obviously have some misconceptions about how the ER works. First of all, we do not sit on pts and ship them all up to the floor at once just to piss off the floor. We cannot send the pts up until we have admit orders, and sometimes the consulting physicans are the ones who decide to hold on to all the pts and dump off all the admit orders for 3 or 4 pts at once. So then we scramble to get the pts out, and yes some of them have been there for hours, and that is because we have been doing all the stat orders that you cannot do upstairs. We've been taking the pt's to CT, xray, giving meds, rushing around to get all that stuff done. I think you are envisioning the ER as a place where we have the TIME to sit around. No, we are trying to get the pts to the appropriate care areas so we can take care of the next EMERGENCY in the waiting room. The traige nurse does not "wait" until we are "ready" for the next pt. Most of the time I'm coming back from the floor or just finished cleaning the empty room and it's already filled. I really have to wonder at the lack of understanding that is out there. I started out on med/surg for 2 years and I don't remember thinking that the nurses in the ER were in any way responsible for the amount of admissions that we got on the floor. If you are not adequately staffed, that is not the ER's fault. Everyone has staffing issues, and the ER is not excluded from that. We need to work together here. I know that if a nurse on the floor asks for an extra amount of time and I am able to help them out, I do. But that is not always possible and should be appreciated when it is.

Well, I never thought I would end up in the ER. I was pretty reserved, started out on med-surg. When I transferred down to the ER 3 years ago I was amazed at how much more aggressive I could be and how much stress I could handle. It can really bring out a different side to you. I wouldn't say that I have the typical ER personality, but you need all different kinds down there. You do have to be able to take a lot of crap from people, which was hard at first. But as long as you aren't afraid to ask questions and work your butt off, you should be fine.

Christmas Day 2 years ago, I was working triage, my first Christmas in the ER. I started out the day thinking "people will only come in if it's a real emergency today". Ha! --5 day old baby with ingrown toenails --female with "bump" on breast --about 25 people who had small cuts from scissors from opening gifts, none of which were close to needing sutures --"bump" on back (turned out to be a zit) --person saw something hanging in back of his throat. Congratulations, you just discovered your uvula! I find this stuff too hilarious to be mad.

I have been in the Navy for 5 years now. I did not go to OIS, I did ROTC, so I can't give you any advice on that. But at my first duty station, Naval Hosp San Diego, I was on the fleet hospital Bremerton. I was on the platform for about 1 year and I only did classroom training with it. The fleet hospital was deployed while I was on the platform, but they only needed a certain number of people from the platform, and they did not activate me. Fleet hospitals are by no means on the front lines. But your experience with fleet hospital may be entirely different than mine, as some people did get deployed for 6 months at a time. Being an Ensign was very fun, but a lot of work. If you go to one of the big 3--San Diego, Portsmouth, or Bethesda--get ready to work hard. But it's really a time to learn how to be a nurse and how to be an officer. The navy is an exciting place to start out as a nurse. Good luck. Let me know if you have any more questions!