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ayysolapsu09

ayysolapsu09

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  1. ayysolapsu09

    New Trauma Nurse Help

    A lot of good stuff here. A piece of advice that I have heard before is to be the "scribe" during a code. Everyone is supposed to shout their stuff out as things are being done (Epi at 0400, followed by flush, etc). If you are in charge of writing down what is happening, you can more quickly understand the flow of a code. Your ACLS will become more based in reality vs. theory if you have a few codes under your belt where you wrote stuff down. Another piece of advice is to do all parts of a code at least once. It is only scary if you've never done it before. You will probably mess something up at least once, and that's OK because your team will have your back if they're a good team. I don't sweat missing an IV because there are 3 others who are better at IVs than me (and I'm pretty good). It is a journey, and a scary one, but dive in head first and you'll be just fine.
  2. ayysolapsu09

    Needing some advice

    I did the same thing. I ran EMS for 4 years while going to RN school. Being an EMT really helped hone my assessment skills and made it easier to pick out the "sick" patients quicker. It also eased the transition by getting me comfortably assessing patients; funny enough, the toughest thing non-experienced providers had to deal with was touching their patients, something you get intimately familiar with as an EMT and as a CNA. The most important thing that I learned while working as an EMT was determining if a person was sick or not, and if I had the resources to handle my patient then and there or if I needed to call for help. These two questions need to be evaluated inside of 5 seconds; the other 25 are used to figure out what resources you need exactly, be it a medic, a helicopter, firefighters, cops, or all the above. If you can do that, you are head and shoulders above your classmates for a good while.
  3. ayysolapsu09

    Best stethoscope for an ER Nurse?

    One of the posters compared a stethoscope with golf clubs, and how you shouldn't spend money on clubs until you're good. Speaking as a golfer, bear with me while I expand that analogy to include the reality. An expensive set of clubs is not nearly as important as getting your current set fitted to your swing. Your golf swing tendencies may not be completely corrected with lessons; therefore, having a set of golf clubs that responds predictably to your swing is vital to being a consistent player, and to improving. I spent about $350 on my used $150 set to shorten and adjust the lie angle on all my irons. What this did was make my mistakes and swing pattern more predictable, thereby making me a better player. Leaving the analogy...Listen to many hearts, lungs, and bowels with different scopes. See what you like. If it happens to be the most expensive one then so be it. Don't listen to us. If your ears need an electronically-enhanced scope, Treat Yo Self. Littman Classic III is a great scope, if it works for you. Mine is a Cardiology III. It was great in the back of an ambulance, relatively light, and I trust my ears and my brain with it. Before that, I used a cardiology III knock off that was $90 bucks, a Littman Lightweight, and some other blacked out "tactical" scope (funny enough, my current scope looks way cooler than the blacked out tactical scope). Couldn't hear squat. Cardiology IIIs may suck for you, and the derided Sprague Double tube may be the best one for your ears (incidentally, I have sometimes heard better with the red contact precaution scopes than my current one, so I guess I don't know anymore). Get your ears and your brain fitted for the best scope for you. Don't listen to us. Listen to your patients.
  4. ayysolapsu09

    New Grad hired in the ER, question.

    I have been a nurse for a grand total of 7 months, and have been working as an EMT for 4 years while going to RN school. Most of my instructors thought I would end up in the ED because of my pre-hospital experience. I personally thought differently, and opted to work on a med-surg floor. My intangible goal was to be as well-rounded as possible, with a more concrete goal being able to handle a full run of 5 patients for 12 hours. I'm still working on that, but I am certainly doing much better now than I was when I started. Due to some unforeseen circumstances, I am moving to North Carolina to work in a small ER in the Asheville area. Right now I am extremely excited about the move, but I definitely wish I was still working more Med-Surg. While working EMS, I realized that I would be dealing with the same patient population in the ER as I would be if I was in the field. I also realized that my understanding of longer term patient care would be limited by the shorter interactions presented in the ER. I am further conflicted by my possible master's routes (NP vs NA) which I need to examine on a much closer level. I knew that I would be moving at some point during RN school, so I decided that the best course of action for me was to help my resume and get some general med-surg experience, advance onto critical care experience once I had a handle on the basics, and advance onto whatever choices made the most sense for me when the time to make those choices arrived. I can safely say that I lacked no shortage of critical thinking in the med-surg department; many times orders were put in that I had to think about the orders and the safe and proper implementation of the orders in regards to the patient presentation. What's more is that there were some clinical decisions about contacting the physician that had to be made; I didn't have the luxury of an MD at my hip, as they usually are in the ED. When I asked my doctor a question, it had to be important, and I had to make sure I covered my end as completely as possible before contacting them (nothing sucks more than calling a doctor with half the information on hand, I feel like a jackass when I do that, esp. at nights when there is only one hospitalist for the entire hospital). I also have to rule out what I can rule out on my own before contacting an MD (ex. blood sugar for stroke mimics). I don't think I lack the critical thinking experience; it is certainly not as deep as an ICU experience, but it is challenging in its own right. I wanted to run as a PHRN in PA, so that meant that I could do whatever I wanted and still satisfy my pre-hospital itch (no more I think, that doesn't exist in NC unfortunately). Would I have gained as much out of a 6-month stint in a CC unit? Maybe. But I know I milked out as much as I could in my own department. In that regard, I think new nurses can work wherever they want, but what matters is that they want to work there; I don't want to work with a nurse who doesn't want to be there. I knew a few of those, and it's depressing and demoralizing. Enjoy what you do, or find something you like. Anyone who doesn't like it can pound sand.
  5. ayysolapsu09

    Freezing During Critical Situations

    Rory Miller writes in his book called Facing Violence: Preparing for the Unexpected about glitches. Rory Miller is a former corrections officer and jack of all trades who writes extensively about self defense principles that can be easily applied to any walk of life (such as medicine). Two things that he discusses are glitches and the OODA loop (Observe, Orient, Decide, Act). If people freeze, it is generally because of a combination of those two factors. Glitches occur for various reasons (Miller talked about one developing for him because he didn't have life insurance; once he got that, he was no longer thinking about his children and family during a violent encounter with inmates, and the developing glitch was diffused), and can occur in anyone at anytime. A good way to fix glitches is to examine why you freeze to begin with; is it because you over analyze when you should fix what you can at that time? Is it because your past encounters with failure are interfering in your present trust in your skills? That is for you to examine on your own and come to an understanding on why you freeze. You say that it is a fear of harming patients, but is that because you don't trust your skills and education? You could precept new RNs, that would very clearly show you where you are strong and where you need work. You could also imagine these disaster scenarios and think about what you would do. In my spare moments working the ambulance, I like to think about my stable patient suddenly crashing on me. What do I do first? What is next? What do I tell my partner who is driving? I picture myself performing the physical actions of cutting the shirt, placing the pads on, turning on the defibrillator, beginning compressions, and everything else that goes with that particular scenario. That way it feels like I've already done it before. Another aspect is the OODA loop, which stands for Observe, Orient, Decide and Act. Sometimes, your brain gets stuck on the observe and orient part, and you are unable to Decide and Act. This can happen for a few reasons. The fix for this, generally speaking, is to go back to basics. I've frozen multiple times in my short EMS/RN career. Several times I've encountered situations that are just so foreign that I don't know how to handle it. What I do is tell myself that I'm frozen, that I have to do something, and remind myself of ABCs, quite literally. Is there a patent airway? Are they breathing? Is there a pulse? If I can answer those questions, I know I have some discretionary time to think. If I can't, I have to fix what is broken. I think that any action that attempts to correct an ABC is not going to harm the patient, even if it may not be the best one. It is simplistic, especially considering you work in an ICU, but starting from the ground up gives traction and allows you to clearly assess the situation. If you have a minute, you should buy his book and read it. It is mainly about understanding the dynamics of self defense, but much of it can be applied to daily life. Just my $0.02.
  6. ayysolapsu09

    What is harder- nursing school or first year working?

    I am currently 6 months into my first nursing job, and I have to say that working is much more stressful than school. I worked EMS while going to nursing school, so school was relatively easy. It has been stated before, but as a student you really don't have the same perspective as a nurse in charge of executing the care plan of the patient. I joke that I lost 15 lbs. since starting my new job because I walk around 5 miles a day and constantly worry about losing my job, and even though that is slightly hyperbolic it holds a little bit of truth; I never had the same sort of responsibility I have now, and managing that is much more complicated than I anticipated. So, hands down, working is much more stressful than school.
  7. ayysolapsu09

    New Correctional Nursing Position

    Hi all, I just recently got a phone call with an offer of employment with the North Carolina Dept. of Public Safety as an RN. I'm fairly certain I will be offered a position in a moderate security to minimum security facility in the state (don't know exactly which facility as of yet, and I probably wouldn't post it if I did know). Quick background; I have only 5 months of med-surg nursing experience, but I've worked as an EMT for the past 5 years while going to RN school. Before that, I was a correctional officer for a county facility in PA for three years. So prison is not an unfamiliar environment per say, but correctional nursing certainly is new for me. I was wondering if anyone knew specifically anything about the NC state system in particular, and any information on being a new correctional nurse in general would also be appreciated. I was also informed that the eMAR software was called Hero. I haven't found too much online for its efficacy. I was curious if any of you have used the software in your careers and what your thoughts are on it (the only eMAR software I'm familiar with is Cerner). Again, I am receptive to any of your experiences from your careers, and any advice before starting on this new adventure. Thanks for your input.
  8. ayysolapsu09

    Starting in ICU

    Another aspect is the mobility you gain in nursing with a strong base. I just graduated and started in Med-Surg because I don't intend on staying where I am at in the long term (5-10 years or so). I think that being able to put 1-2 years of med-surg experience on my resume will help me greatly in any future nursing endeavors I choose to pursue. If you want to change hospitals in the future and only have ICU experience, you may find it hard to transition into a position that is not an ICU job, whatever that may be. A good med-surg background will help you work basically anywhere. There is also the argument that new grads today see themselves as the exception, rather than the norm, which builds that confidence without competence that puts patient care at risk. If we graduated with more of a realistic idea of our skills, maybe we would all start in a "lower acuity" floor and learn competence, which builds real confidence. Just my 2 cents.
  9. ayysolapsu09

    Job market question

    Hi all, I'm a nursing student about a semester and a quarter from graduating (still have to get through that stuff, so I know that I'm thinking a little bit into the future). I was wondering about everyone's opinions on what type of nursing I should get into after I get their license. I know it is a very personal question, and some nurses will have their own opinions about the subject. I want either a) your individual input and experience on the matter, and b) an analysis of the information I have gotten so far. I've talked to several nurses who have been working for a while now, and they have told me that I should do med-surg nursing for a little bit before I get into specialties such as ICU/ER/CVICU/etc. They have told me that med-surg will give me depth in the numerous disease processes I will encounter, versus the breadth seen in the ER or the complexity seen in the ICU/CVICU. I'm currently an EMT, and in EMS we focus completely on stabilization; long-term care and recovery of a patient is not in the back of our minds during a stroke or cardiac arrest. I think that is a strength in ER nursing, but a weakness everywhere else, and I would like to fix that. If that line of reasoning is lacking, please let me know. Another reason I have been told (and please correct me on this one if I'm wrong) is that being able to put med-surg experience on a job application makes your resume that much more diverse. I plan to move out from the area I am currently living in a few years, and I don't know exactly where I will go at this point. My thinking is that I can use these few years after graduation to make myself as well-rounded of a nurse as possible, which includes a little bit of time in med-surg. Let me know what you all think on the matter.
  10. ayysolapsu09

    Disrespectful patient

    It's all been pretty much said, but I wouldn't mind putting in my $0.02. I'm currently in RN school, working as an EMT, and worked previously in a county prison as a Booking officer. I don't have a lot of RN experience, but I have a lot of experience with people who are emotionally disturbed. In the past six years, I've had my fair share of inmates/patients who were emotionally disturbed in some way. I can honestly say, if I were to approach and speak to those people in the same manner you did, I probably would A) have been assaulted more, and B) have more suicides on my conscience than what I already have. I kind of roll my eyes during lectures when my instructors ask us to imagine how patients feel concerning their issues (how do you think they feel after they just lost their newborn? geesus), but it's not because I think how they feel isn't relevant. Rather, it is because it is second nature to me to figure out how someone feels when I speak to them. I need to suss out whether an individual is going to attack me, whether they like me, if they are going to talk to me or not, and how to approach individuals and situations and leave in one piece. Recently I had to juggle two different EDPs in one scene while managing a firefighter who decided to shoot off his mouth and become argumentative with one of the EDPs. Recognizing what you say and how you say it affects a scene is invaluable information. Back to the OP. You have no idea what your patient is going through. You don't know his life story. You don't know what his mother is going through. And your response is to criticize and diminish the patient? I can think of a hundred different ways to approach a patient, and that is not one of them. Eye contact? Yeah, it's rude to not do that. So? You complained about not getting respect? Who do you think you are? No one is entitled to respect, it is always earned. He was on his phone. Politely ask him to get off, or come back in 10. You probably have more important stuff to do anyways. His mom probably does support his behaviors; so what? You still do your job, and be a professional. He began punching himself in his head? It seems like you didn't do anything to stop/help that, so again, you probably didn't do your job correctly there. Hopefully you re-evaluate your clinical decisions and better yourself for the next time.
  11. ayysolapsu09

    Are You Cut Out to be an Emergency Department (ED) Nurse?

    I'm entering nursing school in about a month, and I am looking at the ED as a place where I eventually want to work. I used to work Booking at a county correctional facility, and there are a lot of the same elements involved. You have basic work that doesn't change from person to person (basic commitment process compared to patient assessments, routine process doesn't really change a whole lot), but there is an element of unpredictability (either from the inmate/detainee, or from inmates already committed) that just makes every day different. One minute you could be committing a fairly stable inmate, and the next dealing with a different, combative and suicidal inmate while also rapidly treating a suicide victim (really happened, craziest day in my memory), and a few hours later commit 19 federally-charged detainees in 4 hours (also happened, different day, best teamwork scenario I've been a part of besides cardiac arrests). I'm currently an EMT, and that fills the unpredictability void pretty well until I get my dream job. Everything the article mentioned is what I want in my career, and I certainly hope I'll be good enough to get there.
  12. ayysolapsu09

    Hola

    Just wanted to do a quick intro. I'm about to enter nursing school this fall at Lock Haven University in PA. I have a bachelors in Criminal Justice, and worked as a corrections officer in a large county facility for three years before quitting to pursue nursing prerequisite courses. I'm currently an EMT in the area, and I will hopefully pull through nursing school and begin my career (ASN, BSN, MSN maybe, Flight nurse maybe, PHRN definitely, who the hell knows what else). I've enjoyed reading all the posts here for a while now, and i figured now is as good a time as any to jump out of the shadows, so to speak. Anyways, good to be here. I'm open to any pieces of advice anyone can lend, and I'm available for any kind of advice I can give (not too much in the realm of nursing, but it's an open offer).
  13. ayysolapsu09

    Night shift blues

    If I did wine I'd do a chilled white. But beer bottles are sturdier, so there's less of a chance of them breaking and cutting you up. Beer cans are probably the best in terms of safety. But to each his own for sure, as long as alcohol is involved it's all good :)
  14. ayysolapsu09

    Night shift blues

    In one of my previous jobs I was a corrections officer. I worked mainly 3-11, but I'd also do a lot of 11-7 double shifts. That meant that I'd get home by around 7:30 or so and have to be at work at 3 again that day if I was on the schedule (you couldn't call off after taking an OT shift and still get the OT). The thing that worked for me was getting a hot shower and drinking a cold beer in the shower. It sounds a little weird, but a beer in the shower is one of the most therapeutic things you can do for yourself. It's like a mini vacation. Of course, you can't make it a regular thing, no way could I have a beer every time. But every so often, that would help more than anything else. Give it a try one day.
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