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.

I'm not sure where you work, but the doctors at the hospital I work at (teaching hospital) are not beautiful and "well oiled" -most of the residents and fellows who work the floor and do consults look similar to the nurses- hair pulled back and minimal makeup. I don't see why I should go all out to get pretty for work when I'm not in the business of beauty- I'm in the business of keeping people alive.

Personally, I would list internships and relevant experience to the job. You can bring up your experience with waitressing and catering jobs as evidence that you're good at prioritizing, etc etc. I started submitting applications 5 months before graduation, but they were applications specifically for residency programs. Many residencies have early application dates.

Study a little every day to solidify information. Get a study group of 2-3 like minded individuals who study well together. Treat every clinical experience as a job interview- nursing is a small world, and the hospital you're doing your clinicals at may be your future employer. Get plenty of sleep. Find a good stress relief- working out, reading, walking, whatever. Nursing school is stressful. As for studying, I liked to plan my time in hours of studying that I thought it would take me to feel comfortable with the material. I did the same things with my assignments- that way I could block out my time. 2 hours to complete this paper, one hour to complete this module, 30 minutes to do this quiz, etc. Don't buy your books right away. Find out which ones are absolutely needed for the semester. They are ridiculously expensive. For online books, my friends and I would split the cost and access the same book. Way cheaper. Take advantage of opportunities to amp up your resume. Extra classes, continuing education, volunteering, student nurse association, traveling to other countries for nursing, etc. You have 2 years to build that resume. I'd recommend a hospital job as well after getting your CNA- really gives you an extra edge in my opinion.

Congrats on the position! I would recommend a medication quick reference book that you can keep in your pocket- with medications like pressors, ketamine, cardiac gtts, etc. I keep a penlight, trauma sheers, and hemostats in my pocket, so if you don't have those I would recommend them. Oh, and hang out with the pharmacists and pick their brains- they are amazing. Get to know your techs/EMT's- they can teach you so much. Have them show you things that they know. For instance, in the level 1 that I work in, they mostly operate the Belmont (rapid infuser) but in case an EMT wasn't available, I want to know all the ins and outs of the Belmont so that I can operate it. Other than that, when you have free time, help out your fellow coworkers, or ask them to show you things that are interesting. Murmurs, lung sounds, wounds, etc. Freshen up on your assessments, like being be able to rip a good neuro exam. Other than that, be able to take criticism/feedback well, and always ask what you can improve upon. Good luck, and congrats again!

Adult ED nurse here. If you are interested in ED, jump into it. It's sink or swim really. You could volunteer if you want, but why? What's the end game for being a volunteer when you have a license? Go for it. We have several excellent nurses at my hospital who have backgrounds in psych nursing. Very helpful for crisis patients.

I started applying to residency programs 3 months prior to graduation. I applied for nursing jobs on hospital websites about 1 month prior to graduation. I put that I did not have a current license but put my anticipated NCLEX date. I ended up getting a residency, and most of my classmates were hired prior to graduation

Adult ED nurse here. I love Danskos. Tennis shoes are good as well, but I would recommend having a spare pair in your locker in case something saturates them, along with a spare set of scrubs, socks, and underwear. I also keep a bottle of shampoo in my bag in case I need to shower. I have at least 3 sets of scrubs. I would recommend getting at least 3 sets to start. I prefer wearing Koi tops and Cherokee bottoms because they have a ton of pockets. I like having pockets- I carry trauma shears, hemostats, tape, pen light, pens, emergency medication book, and stethoscope in my scrub pockets. I can't stand having my stethoscope around my neck. Some nurses I work with prefer having the stethoscope holder that clips to their scrubs. I would recommend getting a pocket sized pediatric emergency medication reference book. I would also recommend that you start looking at the top 50 medications used in the pediatric ED, familiarizing yourself with common side effects, dosage/kg, and therapeutic effects. You should also be familiar with vital signs, common diagnoses, and focused assessments. I would also recommend getting some peppermint oil for those particularly smelly situations.

I wouldn't pay more than $25 for a pulse ox monitor. I think I paid about that for mine; lasted a year. Look at the reviews to determine which one is best for her.

My nursing program utilized ebooks and program codes, which were incredibly expensive. However, you can easily reduce the cost of ebooks by finding out how many computers/ipads get access to the ebook then finding people to split the cost with, provided that they use only their mode for accessing the ebook. We were able to purchase program codes separately, which significantly reduced the cost of purchasing the ebook with the program code. I made the mistake of purchasing books prior to classes starting. It's a waste of money. Go in, assess what the professors will use, and then find the cheapest way to get your hands on them- older editions, renting, etc. Also...1k for a book? Insane. I would be absolutely livid. No. There's gotta be a way around that.

Like the PP stated, if there are issues about hyperkalemia, i.e., burns, then roc is the choice. "Succinylcholine (SCh) is a depolarizing neuromuscular-blocking agent, which produce sustained opening of the nicotinic cholinergic receptor channel. Under normal conditions, post-junctional membrane depolarization results in leakage of potassium that produces an increase of 0.5 – 1.0 mEq/L in serum K+ concentration. When SCh depolarizes muscle that has been traumatized (crush injury) or denervated (upper motor neuron lesion) enough K+ may leak from cells to produce systemic hyperkalemia and cardiac arrest. This susceptibility to hyperkalemia is thought to be caused by proliferation of junctional and extrajunctional cholinergic receptors." Source: https://www.openanesthesia.org/neuromuscular_disease_succinylcholine_hyperkalemia/