LV3677

Former CCI here. You do a match with the top few units that you like and the units request the CCIs that they want. It also depends on the needs of the unit; some may not be hiring by the time you are done, some may be down a lot of nurses and have a lot of needs. Interview is one day from what I remember. I don’t think things have changed.

Had one of these recently in the ED. Patient had a home medication regimen of the standard antiemetics that weren't resolving symptoms. The patient asked for Emend, which is an anti nausea medication used to premeditate for chemo patients. It worked beautifully for this patient, and was able to discharge home with a script for it.

UW for sure. My hometown is Spokane. WSU students are great, but if you want the experience of a level one trauma center/nationally recognized burn center/teaching hospital, you'll want to go to Seattle for UW's clinicals at Harborview. Not to mention it's incredibly difficult to get in UW's nursing program; way to go!

Whoops. Misread post. 3 months should be fine.

Level 1 trauma center. Two ED RN's for level one traumas- one primary, one circulating. EMT's run the Belmont and chart. ED resident does airway, trauma team does primary and secondary assessment. Other team members include pharmacy, RT, lab, pulmonary tech, XR and CT, and consulting services for the specific trauma, like neurosurg, ortho, etc. RN's are required to have TNCC and standard ED certifications, i.e., PALS, ACLS, etc. RN's must demonstrate the following set ups- RSI, chest tube, art line, CL, blood admin, ventilator management, tourniquet application...and other basic skills necessary for traumas. Only time we use ICU RN's is with ED initiated ECMO, in which the ED RN runs the code while the CVICU RN's and CT surgery manage the ECMO.

In my hospital, night shift does the bath for total care patients because of the amount of time it takes. Our night shifts are pretty busy, but there is less going on as far as consulting teams, physical therapy, etc. I would think about proposing to management that night shift do total care baths. Start keeping data about your workload, i.e., how many patients you were assigned to, how many are total care, # staff on the floor, etc. Then propose the data to your manager so you can show her the numbers, emphasizing better quality of care and patient safety.

Oh my lanta. I've worked with Paragon in an ED. It is a nightmare of a charting program- makes your job so much harder and you spend way more time trying to chart things. I am so sorry. I denied a job offer from a facility because they had it because it was so bad. You are going to feel uncomfortable for a little bit in the ED as you are adapting to your new environment. Communication is key- ask your preceptor to update you if she pulls meds or speaks with an MD. I usually update the EMT I work with as well as the plan of care changes so that they know what's going on- i.e., planning to discharge, planning to admit, needs XR/CT, etc.

VIP patients make me grumpy. One brought his/her own doctor and RN. What do you need me for? Sheesh.

Quit. Per your report, none of that sounds safe.

My practicum was an hour and a half away from where I was living at the time. I ended up moving to the city for the weeks I was doing my practicum. Most of my class commuted about 30-60 minutes for clinical. 40 minutes is not ideal, but it's not bad. Use the driving time as some time to decompress, reflect on your day, and think about how you can improve. Remember to go in with a positive attitude- treat every day as if it were a job interview. And before you stick up your nose at the thought of working at this hospital, remember that you will soon be new grad and that you're going to need a job, and/or a recommendation from your preceptor.

Windsurfer pointed out that it was your responsibility to complete the class and to remember that you are accountable for your actions. Bluntness is not rudeness- it's just straightforward. We don't know your school or scheduling, so I'm not sure how helpful we can be with suggestions. I suppose the only thing I can recommend is taking a summer course in chem, but it would be a similar style to your 4 week class. Again, you're responsible for your learning, so you'll have to be aggressive with ensuring that you comprehend the material with such a short time span.

The ED is inconsistently consistent- i.e., you get the same diagnoses over and over but the picture changes with each patient. Does that make sense? Some days you'll have down time, most days you're moving your whole shift. It depends on how big the ED is and what trauma level it is. Careful about saying less documentation- yes, you're doing focused assessments, but let's not forget about moving through numerous patients throughout the day. There's a decent amount of charting in the ED. To be blunt, I think you need more exposure to the areas that you're considering because from your post, you don't seem to know a lot about them. Try shadowing in different departments. It seems that you have these pictures in your head of what they are but haven't really experienced them.

Did you really just play this card? Pretty low in my book.

You mentioned that you live in California, which from what I hear, is a very difficult state for new grads to obtain a first job. Consider relocation if you can- Arizona, Utah, Idaho, Washington, etc. I would follow up with HR/recruiter, and if I hadn't heard anything for a few weeks, I'd consider other options.

Um, yes, I am very confused as to why you would infuse something through an arterial line, which is used for real time measurement of blood pressure, and is not indicated for medication administration. Are you sure you weren't speaking about central lines? That would make much more sense.