optimis

Certain techs at my hospital are allowed to start IVs and most are excellent at them. I am good at IVs and I do not consider myself a fool or lazy for delegating that task. We do have an IV therapy team, but they are for PICCs, midlines, central line dressing changes, and difficult sticks after 2 people have attempted. It takes at least 3 hours after a request is made for them to arrive. I would assume if you are needing promethazine and Dilaudid that you would not want to wait 3 hours. I am mildly surprised you have never had an IV in your AC before. I am more surprised you were given promethazine IV. My hospital has discontinued that practice because it is such a well known vesicant. We now only give it as a deep IM injection. When we did give it, it was diluted in a 100mL bag and given over 15 min. If you were given an IV push of promethazine with no fluids running, no wonder you had burning and IVs going bad!

I’m an ER nurse, so I’m a little biased towards the ER job. Lots of my coworkers have an hour commute. Does it suck? Yes. Are they used to it? Also yes. You have been at that other hospital for TWELVE years and they haven’t given you a FT offer AND they are obviously working on cutting down...I wouldn’t necessarily trust them to make sure I got enough hours every week. Loyalty doesn’t pay the bills.

I’m sorry that happened, but you did all the right things. I bet that you will obsessively check the route from now on. You can’t change what happened, but you can make sure it never happens again.

Go ahead and call the police. Please tell them you were in the ER, not responding (voluntarily or involuntarily) and now you want to file assault charges because someone tried to wake you up. See how that goes for you, buddy. You came to the ER. I will assess you and that means I NEED to talk to you if you are conscious. If you do not open your eyes or verbally respond, I will give you a good sternal rub. I also like to unlock the bed and give it a good shake. Very effective.

I’m at an inner city ED and I refuse to give taxi vouchers but I will give you a bus pass to get you out of the room (this is especially useful with our large homeless population). I figure that the $2 bus pass is cheaper than them holding up a room for another hour or so. Our state Medicaid program also has a transportation service, so we use that A LOT. They can wait in the lobby. We had one girl refuse to leave until we got her a ride to Colorado (from TN). Another RN went in and explained that it is the responsibility of the ER to save lives, not to be a free travel agency. He then gave her resources for the local homeless shelter that can provide traveler’s assistance and proceeded to carry her bags to the lobby where she can use the phone to call those resources. It was masterful.

This is a great problem to have! Congratulations! The shorter commute and lower ratios are definitely appealing and I have been in smaller hospitals that have a much more relaxed feel, which is nice. Personally, I like the bigger hospital because you will get exposed to more things (both in acuity and working with other departments). At the end of the day though, coworkers and managers can make or break the job. Good luck!

I agree with your rationale. I will always try to get a PIV in the ED before accessing a port. Risking a CLABSI for a better high is ridiculous. I dare management to write me up for that.

I agree to take a CNA course and work as a tech. Techs make the best nurses!!

Did your instructor tell you why you received a warning? As in, what was it that your instructor says you did wrong?

As nurses at my facility, we do not do any compounding. That is what pharmacy is for. I also NEVER mix meds in a syringe. I cannot tell you the amount of times I have told people what I am giving them and they suddenly remember a bad reaction or they decide to refuse something they asked for 15 minutes ago. I also like to make sure some meds are pushed slower than others.

My hospital has IR, but I don't think we do mechanical thrombectomies. At least none of my patients or patients I have heard about have had them. As an ER nurse, what exactly do you plan on doing to help me? Help with transport to CT is great, but unless you are down in the ER within 5 minutes of us calling a code stroke, we will already be on our way to CT before you get down there and our docs have already called the intensivists. Will you be with the patient the whole time until they go to IR or are you kind of in and out? Because having to keep another person updated when I am probably pretty swamped doesn't sound like something I want to do. What if they are a candidate for tPa? Or it is a hemorrhagic stroke? Would you just go back to the ICU? I like the idea of someone helping with transport and managing drips (I always love and extra set of hands and eyes), but part of what makes the ER great is the teamwork and trust we have with each other. Just throwing a random person in there could be awkward, especially if it's an ICU nurse that isn't necessarily nice when the ER brings up other patients.

You are asking a few different questions. It seems that you know that the hands down best way to get your foot in the door as an RN is to be a tech, but you also know the pay cut is not feasible. Understandable. I will tell you that nursing school will take over your life in a way you cannot imagine yet and having a full time teaching job (which I am assuming is in the 8am-3pm range) will be very difficult. Have a strong support system in place. Look for residency programs in your area. Those are billboards that say "We hire new grads". I loved my residency program. In terms of your salary as a nurse, keep in mind that a lot of places offer overtime. My hospital offers as much overtime as I want, whenever I want it. Yes, it is hard as a single mom, but that is an option that is out there.

The program is set up so that everyone takes the same classes together. It isn't like you can just take one class at a time. You are only ever taking 2-3 classes at a time and generally have either class or clinicals 3 days a week. There is no flexibility in the schedule. A lot of people had part time jobs, but it is diffficult. No one in my class had a full time job.

I think this absolutely depends on where you are. I'm in Nashville and just finished an Associates program. Most of my class had jobs lined up before we graduated. Some of us are doing residency programs, some are working on the unit where they have been techs, and some are working on units where we did clinicals. Our instructors are also really good about using their contacts to get students placed. Sometimes it's just about who you know.

The St Thomas Nurse Residency program does accept ASNs.