vampireslayer

I was reading that I should avoid soy sauce and red wine vinegar because they may cause a positive alcohol test result. And vanilla extract too. Are there any other foods that might cause a positive result? What about apple cider vinegar? Now I'm feeling paranoid about everything! I use red wine vinegar a lot! And I frequently use soy sauce in my marinades when I grill chicken.

I'm wondering what the benefit is to self reporting to tpapn, versus waiting to see what your employer plans to do with you, and letting them third party refer you to tpapn if that's what they decide.

I already mentioned this earlier, but wanted to reiterate, PLEASE think about the basics, the ABCs and the nursing process. If the question is about what you would consider for a patient just arriving, remember you'd always assess before acting. Also, on the ABCs, I found several, probably 4 or 5, where I think I probably got them right because I chose "A" (airway) over the "real world answer". The only example I can think of was about a patient who comes in hypotensive and tachycardic. In real life, you'd start a line and give fluids ASAP, but on the test, there's a "put the patient on oxygen", can't remember if they were also SOB, but in any case, I still think most of us would jump to the "C" and start an IV and give fluids, but I answered using the "A" answer, which was oxygen, and you don't get results about exactly which answers you got right/wrong, I remember thinking there were several questions just like that, and I passed with several more right answers than I'd needed for a passing score. VS

chicagobsn, i feel your pain! i went home MANY times in tears! in fact, i recall actually crying in the bathroom on break a few times as well. my preceptor was ex-military, an EXCELLENT nurse and he taught me well, but at the time, it was hell. i kept thinking "i'm too old to feel this stupid". although a different preceptor might help, please try to hold off on that for a few more shifts. i can tell you from experience, i had a friend who was precepted by a really good, but REALLY....harsh, i guess is the word i'm looking for, nurse. my friend ended up requesting a new preceptor, and even if it's not right and it's not fair, the word got around that my friend was a "know it all", was "whiny" etc. she would question her preceptor, and it came across NOT as "ok, help me understand why we're doing this" it was more "i disagree with what you're telling me we should do". make sure you're questions are very obvious attempts to learn, not to disagree. also, sometimes now when i precept, i can get the same way...we have SO MANY things we need to do, and it's easier when things get critical with patients to have the orientee go do the things i know they can do, while i make sure our crashing patient doesn't "go to the light". it is more helpful for the orientee to be right there in the thick of things, of course, and you should have been allowed to stay in that code, but in the end, we still have to make sure all our patients get the care they need. i'm not defending her actions, but i've been there as a preceptor myself and it's hard when you have a dozen things you know that need to be done, not to take the "easy way out" with your orientee, just to get caught up...with the intention that once you get caught up you can slow down and explain things. i don't know if this happens at your ED, but sometimes with us, when we have an orientee with us, we end up getting more patients, or more of the higher acuity ones, because the triage nurse or person who assigns the EMS stretchers knows there's 2 of you...you're SUPPOSED to be treated as one nurse, while you're working together, but when things get tight and there are patients who NEED A BED NOW, the preceptor/orientee team gets more than their fair share. that's not the way it's supposed to be, but it happens. i remember my preceptor taking another pt, then another, then another, until we were carrying twice as many patients as anyone else, and he'd have me running all over doing things on all of them...he pushed me HARD, but after orientation, i learned how to push myself when i needed to, because of the way he'd taught me. it was really awful at the time, but now i am grateful for what i went through with him. he was mean sometimes, and hard on me a lot, and i may have learned just as well with someone more gentle and supportive, but i do think in the end i learned a lot from him. good luck!! this too shall pass. VS Editing to add: didn't realize there were 3 pages to this post, and i missed your post about getting a new preceptor when i typed mine. i'm glad things are better for you!

Woo Hoo XIGRIS!!!!! CONGRATS!!! Did you find yourself dazed afterwards and unable to really recall the questions you'd had, like I did? In the end, which study materials did you find most helpful? VS

I remember going through this! EXACTLY THIS. Thinking "this is not brain surgery, why can't I get these?" I hate to admit, but just getting practice is the big key, but for some pointers, first off, make sure you're holding down the skin below the stick point so the vein doesn't roll away from you, and make sure that stick is fast, it can roll away so quick, you need to be quicker! Also, check out the vein you're going for while it's still wet from the alcohol or chloroprep. What I do when I can't find one is rub several common sites, (the AC, the hand, the thumb side of the wrist, you'll usually find a big one there) with alcohol first, just to see what it looks like wet (with a tournaquet in place). Then use the cholorprep or whatever is your protocol prep, and let that dry. Veins show up much better when they're wet so that's a good way to find them. And finally, I think what my biggest mistake before I finally got good at them, was I didn't know where the vein was going. I was "aiming" at the bulge I could see or feel, but you really need to see or feel the course of the vein, figure out which direction it's heading or you'll go right through it at a right angle to the vein! I know that sounds stupid, but I really think that I just assumed I knew, from the small section of bulging vein I could see, that I knew which direction it was heading. Feel it, look close, if you aren't sure, start lower so that the last 1/2 of your catheter ends up in the section of vein that you can see, in case it bifurcates right at the point you're entering. Not sure if that's clear, but I remember MANY times getting in and getting flash, and I couldn't advance the catheter...my preceptor would take over, redirect the catheter a good 45 degrees one way or another and it'd slide right in! And one last thing, don't give up if you get flash then get stuck...either it won't advance or it won't give blood...maybe you did go right through, you can salvage that without a 2nd stick. Pull the catheter out SLOWLY until it starts to bleed for you...draw the labs you need, if you need them, then flush it in with a saline flush and it often will just slide right in. Either you'd hit a valve, so it wouldn't advance, OR you'd gone through the other side, but pulling out you'd ended up in the vein and the 2nd puncture (if you went straight through) will seal itself quickly. Good luck! I really honestly remember feeling so helpless, when I couldn't get my IVs. Can't get anything going, no meds, no labs, until you get an IV, and it took me so long to master this! But you will do it! VS

I passed!! I just got home, and there is a big disclaimer at the beginning of the exam that says I can't reproduce in any way any of the questions from the exam. So I'll just give you what I learned about the studying materials. There were several people taking the exam at the same time, some CEN and others were resp. therapists, and some others. First off, I like the MED ED CEN Exam Review CDs by Jeff Solheim the best, as far as study materials, and liked the CEN Secrets the least. The CEN Secrets seemed to me like just an outline. Like someone who'd attended a lecture, learned stuff, took brief notes, and copied those notes into an outline. Now, of course, if I'd actually attended the original lecture, those notes are what I would have ended up with, but for me, I need to hear or read the original material first, not just a brief terms or outline of s/s. Now to the big shocker, I don't think you can really study for this thing. It's tough! I know I passed, so I must have studied ok, but still, I am shocked at how many questions I had to outright guess on, and how many I was convinced every single answer was the right one! And all the details I studied about specific disease processes, wouldn't you know those diseases were on the test, but not the stuff that I studied! Some altogether unrelated question! I know that one thing I did, was just without question chose "put 100% oxygen on" no matter what!! I don't know which questions I got right and which were wrong, but I do know that was an option frequently and I always chose it! You also have to keep an eye on what they are asking...like one question was asking about how you'd go about planning the patient's care, and all the answers were "implementation" answers except one assessment one. So even though all those implementations were things you'd really do, that's not what they're asking, they're asking about how to prepare the plan of care, which would involve assessment first. There were honestly things I was digging back into my brain that came from nursing school, that hadn't been covered in ANY of my review materials, neither of the 2 CEN Review classes, nothing. And some were so obvious they were laughable! It just covered the spectrum from incredibly easy to incredibly difficult! And finally, I think if I could give advice, I'd say get one good study material, a text book, a set of CDs, whatever, that covers systems, but honestly I do think sitting down and doing sample questions would probably have helped me more. Use Mosby or the one that ENA offers for practice questions. That may have highlighted things, not details on diseases, but thought processes to go through, that I could have used. I didn't do that cuz I HATE sitting down doing practice tests, even though every study reference I have ever seen advises you to do that!! I figured if I know the topic, I can answer the questions, but maybe??? I don't know, maybe it would have helped. But then again, I passed so maybe just studying the topics was enough. And by the way, I started studying in earnest a couple months ago by taking the practice test from the ENA website. I didn't look up the answers in a text book and try to choose the best one, and I didn't let it grade me as I went, I just sat down and took it like it was a regular test and got my score at the end. I got 84%, and my score on the real thing today was 84.7% so I think maybe that practice test is a good indicator of how you'll really do. Whew! I'm glad that's over with. Good luck everyone. VS

Ok everyone, it's time. I take the test this Friday. It took several weeks after I sent in my card saying I wanted to sign up, before getting the authorization letter in the mail that gave me the permission to sign up for the exam. I took the week off work, and have been going through a set of CDs while driving to/from work in my car during the last 4 months or so. It's hard to do that when I hear something that I know I'll need to write down, but can't take notes while driving! So this week my plan is to review, again, all the CDs (its the MED ED CEN Exam Review set of CDs), while taking notes only on the things that I didn't know or think I'll need to memorize, like the locations of STEMI and which areas (lateral, septal, inferior, etc) are infarcting if certain leads show ST elevation. Also things like the Parkland burn formula. I KNOW this info, but have taken notes just to review it before the exam. Now I'm done with the CDs, have 4 pages of notes to review, and will review those today. Then I'll move on to the rest of my study materials that I've accumulated over the year that I've been planning on taking this test: Mosby's CEN Review, Sheehy's textbook, the ENA CEN Review book, and the CEN secrets. On all of those, I am going to concentrate on Neuro, Respiratory, Cardiac and Ortho, because those have the highest % of questions on the exam. I feel like I've got enough review and work experience in the other areas, and I only have today and tomorrow to review, so that fills my plate for these next 2 days. I'm studying throughout the day, taking frequent breaks, and trying to wrap up by evening, 6 or 7pm, each day. No point in overloading my brain and not retaining it all. So I will take the test Friday June 6, and will come back and let the rest of you know how I did. Does anyone know the legalities of actually giving out any questions or topics that I remember from the test? Seems like somewhere on the NCLEX there was some statement that said you weren't allowed to discuss the questions afterward. Is that the case here? If i can't remember exact questions, I will at least try to remember topics that showed up on my exam, to help the rest of you. VS

well, i started out trying to study a little every day, and i did that for a while. i have lots of study materials available, keep hearing about more and i guess i think if i throw enough money at this, i'll pass! so i keep buying more! anyway, i did go ahead and buy that "CEN Secrets" thing too, haven't looked at it too close yet but got one good thing so far out of it for ME: don't overy study. if you are at a level that you can pass, then you've studied enough and just take the stupid test. i know there are people who'd taken it several times cuz they didn't pass, but for me, i tend to take tests well, always have, got great grades (straight A's) in nursing school (not bragging, it's just that i retain things, and don't get test anxiety). so what i did was take the sample exam on the BCEN website. it cost $30 to have it graded, and once you grade it you can't go back and review it over and over, but it did have the reasons why each answer was right, after it was graded, whether you'd gotten it right or wrong. by the way, i scored an 84% so I figure that's good enough to pass the CEN. Now of course the sample was only 50 questions, NOT 175, but overall, i think i already have the basic knowledge and don't need months of study. so i went ahead and sent in my card to request "permission" to sign up. if understand the process right, i'll get an email or card in the mail saying "you now have 90 days in which to take the test. sign up for your test date on this xyz website". so i haven't gotten that yet, but as soon as i do, i'll give myself something like 6 weeks, and then take the test. so my game plan is to use all my study materials, sheehy's, mosby's, dr. laura's, and the "CEN secrets" clinical parts (that one has lots of test taking strategies too) and concentrate on cardio, resp and neuro. then i'll study the other stuff as my study time (6 weeks) runs out. and just hope for the best. its not a great, well thought out study plan, but i have the materials here, i have the basic knowledge and the experience, so i think at least this first time that's what i'm going to do. no sitting down with a calendar and figuring out # of hours to spend on each topic, # of review questions to take each day etc. NOT that those aren't great ways to study, just that i am hoping i can do this more casually. we'll see! i'll let y'all know. VS

Our ER is trying to revise our triage template (computer charting) to remove any questions that are not needed at triage. Not saying we won't ask them EVENTUALLY, once the patient gets back into a room, but to avoid the backup that we've had, where people may sit out in the lobby for an hour before anyone ever speaks to them, we're trying to find ways to triage faster. We've had nurses say certain questions MUST BE ASKED during the triage process, as per JCAHO (I think...and maybe EMTALA??). We're screening for suicide & abuse, of course, TB, fall risk, alcohol use, drug use, smoking. All that along with an assessment. So what REALLY HAS to be done at triage, and what can wait until the patient gets a bed? I really think the problem is that the new nurses (who shouldn't be in triage in the first place, but that's another story, staffing is stretched to the limit right now) can't do a quick focused assessment. Their triage takes way too long, and we get backed up. NOT because of the previously mentioned questions, but because they're assessing every little thing rather than doing a focused assessment. Obviously quicker assessments will come in time for all of them. But for now, what exactly are REQUIRED triage screening questions, and what can wait until the person gets a room? Can anyone give me a sample of exactly what is asked in your ER? Our assessment screen even has things like "behavior" and "appearance". That's appropriate if the person is suicidal or homicidal and the behavoir is "agitated" or "combative" or whatever, but 99% of the time, nurses will write "apearance is uncomfortable" (yeah, duh, they have abdominal pain of course they're uncomfortable) and "behavior is cooperative" (that doesn't help me, where as agitated or combative might). Same with respiratory...most nurses think it's crucial to chart ALL the Resp. fields "breathing is even & unlabored, airway is patent, breath sounds are clear bilaterally" while others are happy with "no deficits noted". We have LOTS of that, where some nurses are fine iwth "no deficits" and move on, while others insist upon charting "abdomen is soft & non-tender in 4 quadrants, bowels sounds present in 4 quadrants, denies n/v/d" even when the chief complaint has nothing to do with GI! And cardiac is another one that most people feel is crucial to at least chart "denies chest pain, denies SOB", they won't just chart "no deficits", and they won't skip the field altogether. Dermatologic "skin is intact, warm, normal color and dry" rather than "no deficits" or skipping that field altogether. We are "supposed" to be charting by exception but they feel they need to "CYA" by charting all of it...hence triage is taking a few minutes longer for each patient, which isn't a big deal until you get 15 people behind that haven't been triaged. So what are our legal (or EMTALA or JCAHO) requirements on charting and screening in triage? And what are our liability risks for "no deficits" or not charting something at all? I've never been involved in a court case where my charting came up so I honestly don't know how to help the triage committee pare down the process within legal and liability constraints, and we have nurses who simply refuse to triage any way other than the way they've always done it, which is a complete and full assessment (with NEVER a "no deficits noted" comment)! Maybe they're being smart and I'm naive, and if so, I need to know that! Any help would be appreciated as we try to streamline our process. VS

Sounds like we have a lot of review sites & materials to choose from. My problem is I get overwhelmed when I have too many choices! Even in a restaurant, I can't stand it when I get a menu that's pages and pages and pages! Just give me a few things to choose from, please! Anyway, I am PRN and we get NO incentive to get our CEN, other than "personal satisfaction". Ok fine. My hospital offers full time employees reimbursement for the test fee, but not for me. But even so, I am so happy with the flexibility of PRN, working only when I want, picking up 1/2 shifts or 3/4 shifts whenever I want to, that I wouldn't trade it for a full-time position anyway. CENs at my hospital are fairly rare I think. Maybe 10% of our ER nurses? I'm just guessing, it might be even lower, but not common, I know that. VS

I've gotten several emails, some from the hospital I work at, some random emails from schools that somehow got my email address, about "RN to BSN" for ADNs. I have my 2-year ADN, I'm an RN in the ED at a great Level 1 trauma center. I like my job, it's a 2nd career and have already gone down the path of teaching (I liked it OK, but don't plan to go back) and management (yuck!) from a previous corporate career. But for some odd reason, I feel, maybe because of all these "RN to BSN" offers, that I SHOULD get my BSN. I can't get into management without a BSN, but I don't want to! I can't go back to a nursing school and teach without my BSN (and MSN), but I don't want to! I like bedside nursing, I've only been doing it for 2 years now so maybe that'll change as I get older, but for now, I love my job. I am a "straight A's" kind of person, so when I was in nursing school, it dominated my life. I studied all the time. I have 3 kids and would continue working if I went back to school so I am sure I would expect myself to get straight A's again, and I'd obsess about school for the entire time I was going. Sounds like a lot of work and no fun. I don't understand this feeling I have, it's kind of a feeling that ADNs are just "inferior" although I don't believe that I am...it's sort of the LVN vs RN concept in my mind, ya know? ADN vs BSN. LVNs (LPNs) are being "phased out". Same thing here: I have been told that in the future, some hospitals won't hire ADNs at all...but with such a huge shortage I don't see that happening any time soon. I know Magnet status is based on having a certain % of BSNs, I think that might be where some of my feelings of "inferiority" come from, I work at a Magnet hospital. So what do all you BSNs and ADNs think? Is it worth it? Should I bother? Why do I even consider it? My sort of "informal" life plan is to wait until I become interested in a new job, and then get turned down for it because I don't have my BSN...then that'll spur me on to get it. If that never happens, then I guess I never needed it. VS

I started studying about 6 months ago, then it kind of went by the wayside when something came up...can't even remember what it was that interrupted my studying! I was all excited about it, attended a CEN review course offered at my hospital, bought several review materials, then....nothing! So I'm going to start again, and try to take it over the summer. Mosby's CEN Exam Review was recommended to me by another nurse. I could only find a used one, maybe they don't publish it anymore, and all the ones I found online were missing the CD that gives sample questions, but it does have questions in the book. What I liked about this book is that the sample questions are organized by topic, whereas another book I bought, the CEN Review Manual published by the national ENA is just a whole bunch of review questions. They're good questions, gives you the rationale for the right answers etc, but it's organized like a sample test, just random topics thrown together. I like to study system by system, ya know? And THEN I bought the ENA's Emergency Nursing Core Curriculum. I thought it would be like a textbook (I'm a geek, I LIKE reading textbooks!), but it's not. It's in outline form, not in paragraph form. Really hard for me to get into, to read. I was given Sheehy's Emergency Nursing Principles and Practices when I started my ER nursing orientation 2 1/2 years ago, and it's a basic textbook, and pretty good. I think I'll spend some time reading that. Ok, FINALLY, I got the CDs of Laura von Frolio. I listened to them in my car, and will go back and listen again soon, but I did worry it was outdated. First off, no there are NOT 250 questions anymore. If you read on the ENA website, there are only 175 (I think). Anyway, that worried me, if that info is outdated, how much of the rest of it is, and I just don't know it? Like, she uses "Dilantin" for all sorts of things, but we NEVER use Dilantin anymore. For seizures we use Cerebyx, of course actively seizing we use Ativan, but the lecture mentioned Dilantin in all sorts of other ways, nothing to do with seizures, and I just don't ever see it used in my ER. I actually contacted them, and asked if the material is reviewed for up-to-date changes, and gave them the example of the # of questions on the test, which was clearly outdated, and they of course assured me it was all still valid. Also, the CDs were simply someone recording one of her review classes, and while it is very entertaining and she is a wonderful and interesting speaker and obviously incredibly knowledgable, I was surprised at how poor the audio quality was. Sometimes the sound went out completely for a minute or two, then came back on. Usually it sounded like whatever material I missed was repeated, but you'd think if they're making money off this they could edit out the audio errors like that! Anyway, so I have bought lots of books but don't really have a study plan. There's another CEN review course I'm going to take in a few weeks, hopefully that'll help me get motivated. One thing I did realize, a "word of advice" was that when I attended my first CEN review course, a lot of the stuff was review, a lot was just "oh yeah, I'd forgotten but now I know", and then there were things that were totally "uhhhh, I NEVER knew that". I thought (stupidly) I'd remember what things I needed to go back and review, but of course I didn't, after walking out of the auditorium I forgot everything I'd told myself I needed to re-learn and review, so next time, make sure you keep notes on things you feel the need to go back later and review. I was making notes in my notebook but then couldn't find them all later, so this time I'll have a separate sheet of paper of topics to review on my own later. Good luck to us all! VS

OMG, I think we work with the same woman! I have one that is just exactly as you describe. I'm not much of a "confronter", and I don't think it works most of the time anyway. The whole "clear the air" idea generally results in more animosity, from what I've ever seen. I agree with everyone who said that if you do speak to her about it, don't do it alone, I guarantee it won't go well! She's already proven she won't be receptive to reasoned conversation about your working relationship. In my case, the only time I ever sort of confronted her (after many instances just like the ones you mentioned) the nurse rolled her eyes at me when I did something, can't even recall what it was, and I lost it, just outright said "WHAT IS YOUR PROBLEM???" Any normal person would have replied "nothing, nothing at all", but of course, witch from hell couldn't just deny, she said soemthign about "well I just don't see why everyone has to try to make everything so complicated"...had to do with me & a tech, and possibly a 2nd nurse, if I remember right, doing a bunch of things with a patient at triage, all at once...you know how it appears chaotic when there's a lot of activity going on, when in fact it's just a lot of necessary tasks being done all at once. Anyway, I ignored her. And now, when I see her I just look directly into her eyes, with absolutely no expression whatsoever, I just want her to know that I see her, I know she's there, I don't greet her, I don't do anything, I just look, then walk away. Sorry, that makes me as big a witch as her I guess...but the "kill 'em with kindness" didn't work on her, not at all, made her more condescending, the small confrontation (the "what is your problem") had no effect, so now I just make every attempt to ignore her existence. She does the same to me. She has a core of friends, she's been there a long time, I just don't get it, she instantly took a dislike to me. But I've also heard other people say the same thing so it's not just me.. We do currently have a program going on right now that's specifically about "horizontal violence" in this very way, people being condescending, trying to sabotage others, the whole "nurses eating their young" thing, and our educator is leading this initiative. It's more trying to reward the opposite behavior, rewarding people who have shown that they're helpful to their coworkers, rather than punitive to the people who are mean...but our educator is also a friend of mine so I did give this person's name to her, just on the off-chance that she might hear that name again from some others, and it might go somewhere. I don't plan to escalate it myself, but if that name is brought up about that subject enough, maybe someone will look more closely at her. Who knows. So anyway, no advice, I know I don't handle it maturely, but I dont' want a confrontation with her, I dont' want to escalate anything, and I don't work with her often, so....I feel your pain! VS

I have SOOOO been there! I was a new grad in the ER, and stressed myself sick for months! One thing you never mentioned but I thought might be an issue is the fact that you were a tech. You have skills that the nurses don't, so I wonder if you're doing things that other nurses would request a tech to do for them, just because you know how to do it? Simple things like wound care, splinting, arm slings, crutch training, foleys, NG tubes, our techs do those things. I know some hospitals require the nurse to do some of those things (esp NG's and foleys) but ours doesn't. Doesn't mean the nurses can't do them or don't know how, but those are some of the things we can delegate to a tech, to help keep up our pace. Techs can also draw blood (can't start IVs though, but can draw blood and blood cultures) and at some hospitals techs can do d-sticks (ours can't). Anyway, my point is maybe you could lighten your task load a little if you sit back and think of things that can be delegated to techs, but that you're still doing on your own? It will get better, really. And the chest pain had priority over the DC, at least until you get them on a monitor and get IV access in them (had a CPR just yesterday, SOB, just came in, not on the monitor yet, no IV access yet, was talking when she arrived, then crashhhhhh). You can't do more than one thing at a time, just set your priorities. Sounds like you really do know what you're doing, it just takes time to get the speed up. VS