gere7404

We take new grads that did their practicum in the ER or critical care We take nurses with previous experience on a case basis, with a preference for nurses with critical care experience

My ER used to be 3:1 ratio but now my employer is citing this law and making us go 4:1 kinda sucks to get worse ratios out of this deal when all the other floors are staying the same or getting better ratios ngl

Float pool gets training on all of the med surg floors but seems to spend a lot of their time boarding patients in the ER.... they get a $6 differential to be flexible and I think the new grads who start float pool do a lot better than the floor nurses who pick up less flexible habits and don't like change — float pool nurses can get shuffled around a lot depending on staffing needs

If you’re on a telemetry unit you might have to run cardizem or amiodarone both are pretty simple in terms of titration — cardizem goes up until you get the heart rate you’re aiming for (~90) and then you take it back down, amiodarone starts off at 1 and then you half it after six hours. you just have to make sure to keep an eye out on your telemetry to make sure the rates aren’t going too slow or getting wacky. Also have to take frequent BPs, especially with cardizem.

EMTs are tech 1s, medics are tech 2s…. Tech 2s can start IVs and draw blood they both do wound care and apply splints and help move pts and objects around the unit.

I don’t think you need to bug out anywhere to avoid monkey pox

We have a tracking device that has a button we're supposed to press if we're under duress 9/10 it goes off when someone leans over something and it gets pressed accidentally I've never heard of anyone getting in trouble because they were caught not rounding or being somewhere they weren't supposed to be because of it

Depends on the availability of the testing center, I think three weeks was the quickest I was able to sign up for it

For free content, Mark Boswell has great videos on Youtube, but they’re from the previous blueprint so I’m not sure what info he’s missing. You can watch his stuff and compare it to the bcen blueprint for 2022 and then study the stuff he left out. He’s also a member here, but I’m not sure how active he is these days. if you’re willing to pay for it, Solheim Enterprises has an online lecture course that has been updated for the 2022 test blueprint. the ENA sells a practice test book that has five exams in it with codes for a couple more online exams (one is timed and includes 175 questions like the real thing), it’s a pretty good way to gauge how prepared you are. They’re a bit more in depth than the actual exam questions, and if you can get >70% on them consistently you’ll have no problem on the actual CEN.

I’m not sure what the changes to the NCLEX are can anyone elaborate?

I’ve been in the ER three years and have a CEN and TCRN — I still ask questions when I don’t know something and learn something new every time I go to work relax, it’s normal.

“Nobody told me I was getting a patient!” ”can you call back to give me report? I’m about to do a med pass.” ”I can’t take report right now, I’m in an isolation room.”

I mean, is specialty certification really the most important? Plenty of great cvicu nurses without CVRN credentials…. on a side note, I got my tcrn cert added to my badge today and they put my credentials in right order instead of RN, BSN like they had been doing

it goes highest level of education first, so like Rose Queen said, the MS would go before the BSN. Then you put the highest level of nursing licensure (RN, LPN, etc), then any certifications you hold (CCRN, CEN, RN-BC, whatever) so yours would be Lauren, MS, BSN, RN However at my work for some reason they put the RN before the BSN on our badge, so my badge says RN, BSN, CEN.... weird not sure why they do that

Mid-shift usually gets assigned support roles at the ERs I've worked at; you're either helping in triage or fast track like you're experiencing, get stuck opening hallway bed zones where you can fit them during surge times, or go around breaking people for lunch. Very rarely do I see our mid-shifters get a normal zone because then people will have to shift around and pick up their zone when they go home in the middle of night shift.

the VA sucks, especially for paying new grads. you can put that $15/hr into a 401K and make more than whatever the current FERS benefits are. telemetry is easy to learn, check out skillstat.com; you'll also probably have to get ACLS to work tele so that will help you understand and identify rhythms.

I had to do like two days in a L&D unit in nursing school, it felt like 1/2 and 1/2 families were either cool with me being there and helping or asked me to stand in the corner so I couldn't see their loved one's lady parts. Honestly, it didn't bother me at all because I had no desire to work in L&D. I think our entire maternal/child, pediatrics, and NICU are 100% staffed with females at my hospital.

Yep, rates dropped to where it wasn't profitable to continue traveling with how expensive my duplicated expenses have become. Went back to my home hospital where we are now facing severe staffing shortages as we lost many staff nurses for travel gigs (we'll see how many come back), and almost none of the current travelers are extending due to the massive drop in rates with the increased cost of living in the area.

At my hospital you get an extra $1.25/hr for having certifications relevant to your unit, so there might be financial incentive to become certified. You also might know a lot about your specialty, but I guarantee if you do a bit of studying or take a prep course for your cert you'll learn new concepts or understand a lot more about stuff you thought you knew well. I can say honestly that reviewing for the material to take my CEN made me a better ER nurse with a greater understanding of a lot of the conditions that I see and better prepared for providing interventions to them. Plus, I liked the research and studying -- I'm doing it over again with the TCRN and enjoying learning new things I didn't consider about trauma.

Congrats on the new job. You should know what normal values of vitals and labs are, and you should be able to interpret basic telemetry (like, recognize what rhythms will kill your patient). A lot of what you need to know will depend on your department’s specialty, and your preceptor should fill you in.

I like my job but I think after 30 years I’d be done, too.

I left to go traveling last Summer when rates were insane. They dropped to the point where it was barely more profitable to travel d/t duplicate expenses. The hospital system I traveled to had a huge portion of their staff made up of various travelers. Towards the end of my last contract they stopped approving extensions and started to cancel or reduce the rates of their higher-paid travelers, and their staffing started to get bad. I left and went back to my old hospital. We've got very few travelers, a lot of the same staff before I left. In general, it's a pretty easy hospital, union protected, and great ratios. A lot of travelers stay just because it's a pretty chill ER to work in. We're a level II and we see a decent volume of traffic but we generally only have 3:1 ratios.

Hey, never thought that smallpox vaccine the army made me get would be useful for anything! great write up, thanks for taking the time to make it.

This is huge, especially coming from a kind of nursing where you work alone a lot. ER nurses need to just jump in when they see something has to be done. We aren’t possessive about our patients like they get on the floor, all of us could use a hand pretty much all the time, so when someone offers it, take it! Goes both ways, if you see a coworker who has a bunch of critical patients, ask them what you can do to help. You see an ambulance coming in and the nurse for that room is busy in another one? Jump in and start the triage and getting the patient worked up.

Well, hopefully they have better ratios in the ER you're going to than the step-down unit -- my hospital has a 3:1 ratio for both units, so it's a lot less stressful to manage! Going back to the PCU isn't really going to help you much in the ER, they're very different and you'll want to try to relearn things the ER way. As a PCU nurse coming to the ER you're going to be an "advanced beginner;" you're going to be competent in some of the hands on skills and you'll have knowledge of medications and stuff, but it will be some rewiring to prioritize and think like an ER nurse.... Don't be afraid to say you don't know how to do something or ask for demonstrations, we do a lot more hands-on skills based tasks than most of the inpatient units, so if you have never done it or it's been a while just be up front and say so, so you can learn safely. Things are not structured with times generally in the ER, you're going to have STAT orders thrown at you for all your patients frequently and recognizing which is important and which can wait is a big challenge when you first transition to the ER. Patients come in, get moved to imaging, get admitted and transferred upstairs constantly, so being able to reprioritize on the fly is crucial. We see people for their chief complaint, so we don't go digging into their charts or histories nearly as much as you would on the PCU. Hell, to be honest, most of the time I don't even remember my patients names because we flip our rooms so quickly. Sheehy's manual of emergency care is a great resource to read up on how different conditions may manifest, and what kind of tests/diagnostics you are going to be doing to help the doctor rule out things and come up with a diagnosis. I'd also recommend watching the CEN stuff for the major systems (cardiac, respiratory, neuro, abdominal) from Mark Boswell on Youtube. It's free, and it covers the workups and interventions for the more common things you'll see.