mikemw

One day nurse ugly will need the services of the lowly EMS and may change their mind. Hopefully their unprofessional attitude will not effect the EMS response. I sympathize as I was an EMT-B for 20 years most ER nurses and docs appreciate the service and dedication that EMS personnel show on a daily basis. Unfortunately some er staff forget that the ER is a link in the chain of survial that starts on the street and often extends out to physical therapy staff or homehealth nurses Dont forget the majority of us appreciate your service and dedication - Stay Safe Mike Myers RN

I agree with debbyed I have worked both tele and ER. If indeed the patient was stable she could possibly wait for the MD to come in in 2 hours but I would have been concerned and definately keeping a close watch on her. BUT by your descripition the pt was not stable and at least needed a stat EKG and adenosine. I would also have done Q15 BPs until the MD arrived. An yes I would have put the code cart outside of her door or at least nearby. At the first sign of further deterioration of her condition I'd have been on the phone with the MD and if he still did not give an order then I would have contacted the house supervisor. Its better to error on the side of caution and have a live patient and pissed MD than a dead pt and be able to say I told you so. BE ASSERTIVE.

I work in an ER with 17 treament areas and a co-located fast track area with 8 treatment rooms for nonurgent patients. We see around 140 - 150 patients a day. Often we have "boarders" patients who have been admitted to the hospital but do not have available rooms. I just ended my shift and we had 4 patients in the er who had been admitted to telemetry beds but none were available. This is a daily problem to the extent that we have an oncall nurse from 11pm to 7am for the sole purpose of caring for "boarders". It is not that wee don't have the physical beds, we don't have the staff needed to utilize all available beds. Our telemetry and critical care areas ALWAYS have opening for nurses. We have 5 critical care units but one of them is closed every weekend because we do not have staff to keep them open. Even when we do not have boarders we often experience as much as 3 hour delays getting bed assignments for telemetry patients. This backs up our ER significantly. Our medical staf is as frustrated as the nursing staff but we still have not got the "pull" needed to change this situation. We often have patients in the hallway. So much for privacy and confidentiality; not to mention just plain unsafe. without doing this the CHFers and Chestpains would be sitting in the lobby. We have 5 major hospitaals in our city and tonight all five ERs were diverting patients because of this problem. I'm envious of you DEBBYED. If only we could get our administration to wake up and realize the lost revenue and dissatisfied patients. Mike M

Welcome to the world of managment. I think conflicts between coworkers is always a headache for a manager regardless of their experience. It takes good communications and listening skills. Often the verbalized problem is not the real issue. I do agree that often times the first action that should be attempted is for the people involved to attempt to talk out the problem. As PhantomRN pointed out this does not always work and may even cause further ill feelings. If the problem is behaivor that is unprofessional (gossiping about staff or patients) or unacceptable (continued tardiness substandard performance ) Then I believe it is an issue that needs a manger to addresss. If s manager does not address unacceable behavior it could be viewed as condoning it. If it is personal conflict then encourage the parties to work it out, but be available as moderator or facilitaor. If "personal conflicts" occrurr frequently with the same individual or are prevalent in the unit then there is also a problem lurking in the dark that needs management attention. One technique I used when I was a manger was letting my employees know my door was always open to discuss a problem but if they had identified a problem I expected facts, not hearsay and I asked what it was that they would like to see me do about it. If there are no facts, Rumor Control may have to be done. If there are no recommended solution, it is a complex issue or a nonissue (ie they just want to vent). Venting is OK by the way. I do it often but I tell my boss I'm venting and just didn't want to let my frustration out on my patients or coworkers. We often laugh about this afterwards. Mangement books help, but often you must to learn to deal with personnel issues by doing and see what works for you. One thing that may help take a load off for new graduate or someone with little experience, is to appoint an experienced person as mentor. Keep us posted on how it goes. Mike M

Clarice you sound like a manger I'd like to work for You appear to care. That is a trait that manager often loose becuase of what you are talking about. I have not been a manager as a nurse, but I was in the military for 20 years and have experience both as a first line supervisor and dept manager. As anyone with a military background can tell you, your "employees" are constantly being transfered. What I found to cope with this was to establish the mindset that this was going to happen. My best people were going to be leaving usually after a significant investment of my time and effort in helping them mature in their professionalism and skills. Take pride in the fact that you are helping that person develop as nurse while they are working for you and that the next employer will gain a better prepared nurse because of you. I understand your frustration, but dont get caaught in the trap of hardening yourself against your current employees for something that past employees have done. One thing that might give you a heads up is to ask what their goals are (both short term and long term). People who move voluntarily usually do it because it is helping them meet the goals they have set for themselves. For exmple my last manager knew I would be there for 1 year because I needed the expeirence from that floor to work in the emergency dept. She helped me develope the skills I needed but did not expect me to be there after I recieved the year's experience. I still keep in touch with her and have actually refrerred nurses to her because she was a good manger/mentor but I also know she put department funds and more of her time in to develping those who told her they would be there longer. I would have done the same and don't fault her for that. Hope this helps. Keep up the good work. Those of us at the bottom of the totum pole appreciate efforts of good mangers unfortunately we just dont take the time to let them know. Mike M

I can't tell you about differences between ICU and ER because I have never worked in an ICU. I have workled Surgical telemetry and ER both of which are considered Critical care, but differ significantly in types of patients seen. You asked about baackground for a nurse going to ER in our ER nurses coming to ER for the first time have experiences that range from new grad to 15 plus years in nursing with a variety of nursing backgrounds. I think a years experience in ursing is a good idea before going into a critical care area but not necessary. I saw this because in the ER you have to be able to care for patients in all categories of nursing. ER patients run the spectrum for newborn to over 100 years old. From minor problems like colds and sore throats, to dialysis patients and cancer patients experiences complications with their treatments or disease process. You also have to be able to care for all levels of trauma from I hit my finger with a hammer to life threating trauma codes and cardiac codes where you MUST know what to do How to do it and DO it NOW. This leads me to your next question what makes a good ER nurse. FLEXABILITY. If you like routine then the ER is not for you. If you work well under pressure, can shift from the adrenaline high of a trauma code to the soothing tone needed for a child who needs an IV but isn't about to let you stick them because they know it will hurt. Then when you are about to will this battle another crisis (2nd code) comes in and you must leave this task and return agian later. And now deal with the upset parent as well as an uncooperative child. While the person in the next room is demanding their pain medicaine now. You get the point. The interesting thing is I've seen new grads handle this type of stress better than some nurses with years of experience. A lot depends or your life experiences and personal nature. Don't let lack of experience keep you from trying. Knowledge and skills can be learned. We do have nurses from other units that come work PRN in our ER. We have some flight nurses who pick up a few extra hours as well as nurses from ICU, and one Nurse Administrator who works with us on a regular basis. In my opinion He is not only and excellent nurse but a skilled administrator (He also works ICUs often) I think this is what makes him such a good administrator. He stays in touch with what it is like in the units. By the way the med surg nurses also like him . If you are concerned about lack of experience with skills and knowledge ask around in your facility and see if there are in-house workshops that you can atttend. Also don't be afraid to ask those who are skilled at a certain task to help you improve. As for ICU I know that the patient we send to ICUs are very sick and definately need highly skilled nursing care as most are tetering on the boarder of life and death and nursing care recieved could make a difference in outcomes. Best of luck in wwhich ever area of nursing you decide to persue. MIKE M

Y2KRN: Dito to what they others have said. I just finished my first year as an ER nurse. Book knowledge should be combined with experience. Often I come home and read up on things I run across that I was not all that comfortable with. Expereince is the best teacher but don't forget to supplement that with a little book review too. The book that I found very helpful was "Emergency Nursing Core Curriculum" published by the Emergency Nurses Association (ENA). It is wrritten in outline format for the most part and is divided into sections such as cardiac, trauma, abdominal complaints, etc. Our ER uses this book as the main reference for new grads in the ER. Yep new grad in the ER. The ACLS ENPC and dsyrythmia books are all good references too. Its not easy ER nursing requires kowledge in all areas of nursing from peds to geriatics and Trauma and cardiac to nausea vomiting and diarreha. Don't forget the GI bleeds and overdoses. It takes time to learn and your coworkers should understand that, after all they all had to learn too.

I was an EMT for 20 years prior to becoming an RN. I am not aware of any special courses for RNs who wish to get an EMT certification. There are three levels of EMT but not all states utilize all three. The levels are Basic, Intermedicate and Paramedic. The EMT Basic class is normally 200 hours or less and is often offered as a 1 semester class through junior colleges. EMT basics as a rule do not do meds. National Registery allows EMT basics who have been properly trained to administer EPI pens and D50 if they are IV certified. Some states do not allow Basics to do IVs. The Paramedic is the most advanced and allow emergency drugs, intubation, and IV therapy in additon to many other skills. Your local EMS agencxy would be a good place to start to find out about local classes and levels used in your state. Also check into Advance life support (ACLS), Pre-hospital Trauma Life Suport (PTLS), Pediatric Advanced Life Support (PALS), Trauma Nurse Course (TNCC), Emergency Nurse Pediatrics Course (ENPC). The director of your local hospital ER may have info on these courses. The Basic EMT course includes many splinting bandaging skills as well as cspine immobilization that is seldom addressed in nursing course. I think it would benfit any RN to have at least and EMT basic certification. If you have specific questions I'll be glad to address them as best I can otherwise contact your local folks for info. All EMS agencies I worked with would have been happy to get an RN involved in our programs.