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FatsWaller

FatsWaller

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  1. FatsWaller

    Hate my new hospital culture 2 days in, is it me?

    Very few protocols, about 5 or 6, of which the majority is just lab work orders. And they do not include very much. The cardiac protocol does not even have an EKG as part of it. And it has been made very clear we are not to initiate the orders if it is suspected the patient will be picked up….not seen…picked up by an MD within 15-20 minutes. And the protocols are never to be initiated once an MD has their name on the patient. Ya this place is odd. No sepsis protocol, no fever protocol, no suspected fracture/obvious deformity protocol, no SOA for a breathing tx protocol, no excessive pain over 7/10 protocol, no hyperglycemic/hypoglycemic protocol, etc. Its sad my rinky dink trauma hospital in Kentucky had more sensible protocols and what not than a place with unlimited resources and clout. Whatever…the job hunt continues haha.
  2. FatsWaller

    Hate my new hospital culture 2 days in, is it me?

    I am glad to know someone else here who has worked there agrees. I know I am not the only one. In fact, it's sad, many of the staff I have talked to say they cannot stand working there and hate. Because so many hate working here the overall attitudes, morale and just environment for lack of a better word...sucks. Many I have spoken to, in fact most, are all new-newish hires within the past few months. I was able to talk to a nurse who had been there for about 6 years and she hates it too but she said turn-around is atrocious and it makes sense why such a "prestigious" well sought after medical center would even require travelers in the first place. They cannot hold onto staff because nobody wants to work there. I would say 3/5 people I've spoken to say they are doing a year "for the resume boost" and getting out. Kind of sad but that's how this place seems to be. My time is too valuable and life is too short for me to work somewhere where not only I am miserable but the vibe/morale is too. Plus, the acuity is so low, I haven't learned but 2 things since working (and its only because I normally don't work with peds. This has taught me to better question the environment and shadow my next position before taking it. I knew this wouldn't be the best fit but didn't think I would dislike it so bad. Haha autonomy!? What autonomy…at this place as an RN you have none. An MD order is required for every single solitary item. I mean seriously. I went from an institution where RNs were able to put in medication orders and just have the doc co-sign (depending on your rapport with the MD) to a place where we are not allowed to get even a verbal order and have to have a placed order to obtain a peripheral line, an EKG (even emergent), a meal. Don't get me wrong, I get that if I wanted autonomy, I should have gone to Med-School but in some circumstances, there has to be a middle. I feel this institution is so restricting that it leads to delay of care, annoys physicians more as they have to be found or called for every RN intervention, and even dangerous in some circumstances. It's odd for ED. I agree though, it's a question I will most definitely be asking from now on. I definitely would love to work at county, in fact I have been trying forever but the damned process is just so slow and convoluted. I know my personality would fit much better with county or perhaps even St. Francis. I just love and thrive with grit, low SES patients, high ED acuity and traumas. So, I need to find my niche here in California and I hope it exists!!
  3. Super quick background on myself, born and raised in California, went to undergrad in Oregon went to RN school in Kentucky. Got a job at a trauma heavy, busy, high acuity Trauma I center following graduation and was thrown right into sick patients, challenging situations and working the trauma bays. I loved it, learned more than I could have imagined, and more importantly loved the environment. The staff were like family, camaraderie was huge, the relationship between the nurses and physicians were top notch with everyone being approachable, involved in the care and decision-making processes. Everyone had each other's back from day one. In all it was a place that was enjoyable to come to work and honestly fun. Now don't get me wrong, I am not painting a picture of some unicorn fairyland environment where everyone was happy go lucky all the time, there were its issues as well, like the standard issues with management and occasional disagreements between RN and RN or MD, but for the most part it was good. I stayed at this hospital for almost two years and finally decided it was time to go home to California. I knew there would be some changes to get used to. Southern California has a lot of trauma centers and volume wouldn't be as high. I expected there to a lot more protocols and stricter rules, it's the most litigious state so I expected some heavily defensive medicine and nursing practices. I got a job at a Level I ER in a very affluent part of Los Angeles. I won't name the name but that provides enough to know which hospital I am talking about for those familiar enough. This wasn't my first choice of hospital, I prefer the gritty, trauma heavy hospitals which this is not, but the pay was extremely generous and the name carries a lot of weight on the resume. I am 2 weeks in and I cannot stand any aspect of it, and I just don't know if it is a California thing or a hospital specific thing. There are so many strict protocols I am afraid to perform even an IV start without the ok of another RN and confirmation there is an MD order to do so. There is zero camaraderie or any form of it within the department. Staff is downright afraid of managers and I have been told that I am not to address management in anyway within my first 2 months of employment as they do not wish to hear from me, only from my preceptor the first 13 shifts and then other staff such as charge RN. Apparently after two months I can approach them but they are not approachable, I am not to be personable with them or joke with them about anything, just more of a robotic interaction is to be expected. Staff does not say hello or want to talk in anyway, they do not seem to enjoy their jobs and honestly very few have any substance. They come in, do the work presented to them in front of their face and leave with minimal interactions. The relationships between RNs and MDs are almost nonexistent and disconnected. Many do not want to/nor need to hear from the RN and verbal/phone orders are not allowed, not sure yet if this is written protocol or just a rule (this is an ER, seriously?). I have been told by travelers (the only staff that is personable and will interact normally), that the place is horrible and miserable, and that RNs throw eachother under the bus at any chance they get. A select few of staff who I have been willing to interact have told me the same and told me that the place allows for almost no RN critical thinking or autonomy and that many lose their skills here. I can definitely see that already now 5 shifts in. Despite being an experienced trauma nurse, I have been told I am "not allowed to touch a trauma patient for at least a year". Honesty I can deal with that (there are almost no traumas anyway) and the rules but I have kept my head down so far but I have watched staff members get chewed out by others for differences in care (not even doing anything wrong just their own way) and for showing even the smallest slip of a personality. Everyone seems to just be a task machine, and there are no interactions with other staff or physicians. Many of the nurses seem to carry a chip on their shoulders and think they are better than other nurses. I have been disgusted with the interactions I've seen with the RNs and the volunteers, transporters, techs, paramedics, emts, and firemen. They treat them like trash and like they are above them and it's not ok. I think many feel they can act this way because they work at a "prestigious" institution, an attitude I do not like. Teams throughout the night are switched an average of 3 times, requiring a complete change in care team and most RNs don't even give a report. You just come back from break and you get assigned a different team. I know there are going to be those out there who say it's a job and this is how it should be and camaraderie isn't something that should exist anyway. That I should show up, keep my head down, be a sheep and work and collect my paycheck and go home but I disagree. If that was the work environment I wanted, I would be working in a cubicle in some office. I have to spend 12 hours a day/4 days a week with these people. They become a second family. Camaraderie is extremely important and I should be able to trust and enjoy those I am working alongside. This was true when I was a firefighter, an EMT and even my last ER job. Overall, I am very unhappy, and I wish I wasn't but I just don't know if this is how every hospital in California is or not. I spoke to some travelers and they all assured me it was not and that this was all very unique to this hospital, (many of which said is their worse assignment they have ever had), but I was just curious if it's me. Should I just stick it out, or find somewhere I click better? I applied for other jobs after my second shift, but I don't want to leave if this is just how every hospital is and I'll just be unhappy at another facility. I would rather take a pay cut and be happy then make what I am with this miserable milieu and group of people.
  4. FatsWaller

    "I Narcanned Your Honor Student"

    I mean I am not saying that everyone can't cope differently. How you cope with this profession is not mine or any one else's business. OP said that this message "Deeply Disturbed" him/her, and its my observation/opinion that if a simple sticker deeply disturbs them then they better find a slew of coping mechanisms because the unjust, unfair horrors of nursing will make this look like nothing. How they cope is how they cope, I m just saying you need to learn how. I wouldn't call it a stressor, especially in my ER with 20+ overdoses a shift if not much more. I am very much used to and even find amusing our frequent fliers. Is it annoying?, sure, do I care or let it frustrate me, not even a little bit. I would assume our ERs are different. We have multiple codes a night, we had 6 last night in a 5 hour span, its not so much jadedness as just another job to do, in fact codes are one of the easiest interventions you can do as a trauma RN, the steps are so ingrained and practiced with us that its now second nature, especially with the traumatic arrests we get. And its close knit, and a teaching hospital, so there are many people always standing around, talking, asking questions, debating, stepping in, etc.
  5. FatsWaller

    "I Narcanned Your Honor Student"

    This bumper sticker is on my clipboard at work If you don't get it or find it insulting/inappropriate, you are in for a world of hurt if you end up working as a nurse, especially in ER/ICU/Psych. When you Narcan the exact same people every SHIFT! I literally know some of these patients better than my family members. yes people OD purposely in front of the hospital, and many of them are college students or "look" like normal people, it shows this issue isn't just a "far away issue that is in the ghetto" its seeping into "perfect suburbia" and the "upper class highschools" too. The sticker is humorous, and a play on a common bumper sticker found on minivans next to stick figure families, and highlights that the issue is getting larger. From an ER nurse to a student, if this offends you….get over it. Wait until you work your first code and those working and standing around are laughing/talking about your weekend plans with other nurses/docs while you perform compressions. This profession is filled with horrors, disease, sadness, travesty, and a lot of crap that makes no sense (morally, scientifically, and medically). If you are going to let a sticker hurt any of your ‘feelers', you are not only going to be poor at your job, but you will probably bottle a lot up and have some psych issues of your own down the road. How are you supposed to lose a 14 year old patient to a MVC and 3 minutes later go back out to the floor and take care of your 4 other patients as they give you flack and yell at you for not answering their call light for water as they eat they're McDonalds before their unnecessary abd CT, or MeeMaw who is 99 and had a stroke, and is on the vent and lived a long great life but the family insists on ignoring her DNR wish and you have to convince them this is not ideal.) How will you separate your emotions and just move on…..this is how, medical professionals joke and talk and have dark humor and that's how you cope. The ones who get emotionally invested in every single case, who take it all personal, who cry and moan about this stupid crap, they don't make it long, at least in the ER, and I'm glad, because I wouldn't want to work with a person like that.
  6. I do find it interesting that California, as usual is one of the top states "suffering" from a nursing shortage, but is one of the states that also makes if extremely hard for a new graduate RN to find a job. I had to relocate to Kentucky just to land my first RN job out of school in an ER because after applying to over 100 hospitals, 90 replied "Unfortunately one year of acute care experience needed" and the others had such competitive residency programs the chances were slim to none (tens of thousands of applicants for 80 spots). Just a catch 22 if you ask me. I'm sure New York and Florida are similar. If the shortage is so drastic, hire nurses...there are plenty trying to get hired, believe me.
  7. FatsWaller

    NREMT Paramedic/AEMT Challenge

    This seems to be such a hot topic, but I disagree with a few of the posters. It is completely dependent on where you work and what department you work in, especially if you have a specialty certification (TCRN, CFRN, CCRN, CEN, CTRN). I work as a trauma nurse in a busy trauma I center that sees a large diversity of patient cases and injuries. Also, most of the EMS workers in the surrounding counties (we are the only trauma center in the region, ~80 mile radius) are BLS so not much of anything has been done when the patient arrives. I can't really think of something I haven't done that a paramedic does in the field (aside from a cricothyrotomy, which aren't done very often). I was also an EMT/Firefighter for a while so I know what medics do, I am aware of the difference of being in the field from a trauma bay. But every day I initiate and titrate paralytics, intubation drugs, vasoactive drips, blood products, crystalloid and colloid resuscitation, emergent splinting and traction/reduction, I place EJs daily, IOs about twice a week, every trauma/chest pain patient gets a 12 lead and I interpret it (especially if triaging, you can't believe how many EMT/medics come in with ‘fake' patient vitals and misinterpreted 12 leads saying, they're fine”, on more than one occasion..off to the cath lab…) I often assist with chest tube insertion, insert LMA, Kings, and on some occasions ET tubes when needed, set up and maintain ventilators. I interpret ongoing lifepak rhythms and cardiovert/shock/pace as needed, codes…you are correct in that is the simplest intervention, and we run them every day. ACLS/PALS? Every trauma nurse here is proficient, and we are also required to have TNCC within 6 months and TCRN + CEN in a year and a half. We are trained in central lines to assist residents, we are proficient in USPIV placement, internal defibrillation, assisting emergent EVD placement, cracking chests, etc . I am not sitting here saying that I would be ready tomorrow to go out and act as a paramedic, but If I took a bridge course, or landed a job as a flight RN and needed my cert, I am glad states like California allow me to challenge the education because I do not need a two-year long course. you must still attend the entire 480 hours of field internship, including 40 ALS patient contacts and have to take the NREMT paramedic exams, so I don't see what else you need to prove you are competent. Hell, an intubation course to freshen up maybe. All I know is I would be 100% confident in my abilities to provide above competent care as a paramedic, especially after 480 hours and passing the boards. Now if you are an RN in med-surg, surgical services, PCU, TCU, and hell many ICU's, then yes I can see where opinions like AnnieOakley and Waterpeace stem, I would not trust these nurses either, there would be too much to learn. Not that they aren't as smart or proficient, but they do not handle emergent situations daily or at all with limited information and time. It's a completely different type of nursing, hence why the age old ER vs ICU/Floor RN thing exists.
  8. FatsWaller

    ER vs Trauma Nurse

    My ER is also a trauma 1 hospital, we have a trauma room with 4 bays(stretchers) where our emergent issues roll into. We generally have a "room 9" (trauma room) nurse who is assigned to it at every shift and this nurse runs the trauma from a nursing perspective (gets manual BP, IV access, blood and emergent drugs, tools, etc) and this position just fluctuates and cycles like team assignments. The charge nurse or any available nurse comes in and writes. If more than one trauma/stroke comes in then nurses on the floor just come to the trauma room when the initial buzzer goes off and just fill in where need be. So basically I guess at my ER, we are all trauma nurses. They do provide all the nurses with TNCC within 6 months of hire if they need it, as well has NIHstoke certs, acls, pals and they push CEN.
  9. FatsWaller

    Propofol Dosing in ER

    The ER I work in if the patient isn't adequately sedated by just propofol and the threat of extubation exists then we just tack on fentanyl and versed drip. Same vise versa. I prefer Fentanyl and versed drips and I advocate for it if possible but if its not doing the job we tack on propofol as well, assuming the access exists of course.
  10. I work in a very busy ER that is also a trauma department, and although there is alot of drama, there is also an insane amount of camaraderie. I have noticed ER's and some of the intense or bigger ICU's tend to form bonds along the nurses in a similar sense to that of those in my EMS/FIRE history. I also notice a big difference in which shift. I work nights and many mornings 10-15 of us all go get bloody mary's and mimosas and share crazy stories. The ER docs and even some of the specialists like neurosurgery come too. I think its great opportunities to network and get to know ppl you work with everyday on another level. We all go out fairly often
  11. FatsWaller

    Are test banks allowed if the professor doesn't use them

    I mean I had an instructor who just used the questions in the book word for word and must have used some sort of study bank as there were certain quizlets online that contained information that was 99% her exams. In my opinion, if your an instructor who is stupid enough to not tailor your own class and write your own tests then I don't see how its a student's fault they are using all resources (not illegal ones) to their disposal. I feel strongly about that because that instructor was one of the worst educators I ever dealt with and her lectures and notes did not follow the tests she gave whatsoever, and all because she just copied and pasted some instructor bank without even looking to see if the questions pertained to class content. We pay far too much for our educations to have half-assed instructors like that. I dont see the issue with quizlet, study-blue, or other online resources as long as they are not made solely for the purpose of instructors and require you (the student) to somehow defraud the system or illegally obtain. Like some said, I don't see how it matters anyway unless you're telling your instructor all the resources you use to study. At the end of the day, you're going to need to know the material for boards/real life but study it how you want. just not illegally
  12. FatsWaller

    How fast did you land a job?

    Exactly. It depends where you are located. Unless you are accepted into a new grad residency program, on the West Coast landing a job prior to graduation or at all...sadly, is extremely rare if not non-existent unless you have some serious connections. I had two job offers (ED and CVICU, the only places I applied) 3 months prior to graduation in the Louisville area (where I went to school). Obviously contingent on graduating, and they gave alot of time to take the boards as Kentucky issues a provisional license that lasts for 6 months after graduation. I took my boards immediately after graduation though because I saw no reason to procrastinate. Most people in my program also had jobs (in their preferred area) prior to graduating due to the high level of respect for our program in the area and local shortage. Because I was from California, and wanted to go back home, I also applied to hospitals before and after graduation in the LA/San Bernardino area, I got alot of rejections stating they didnt hire new grads, 1 year was needed, and some laughs that I even thought I had a chance before completing NCLEX as I was told I wouldn't even if I had.
  13. FatsWaller

    Why can't we all just get along?

    I think it's the overall field. Nursing and other medical programs/fields are highly competitive to get into, and highly competitive once you're out (whether to get a job, or go onto more school). So I think for many, it's always been a competition, a pissing contest, a feeling you must stand out compared to the person next to you, and that's a hard cycle to break once you have been doing it for so many years. I'm not saying I like it, but I have found myself feeling like I'm not good enough or am being made look bad when a person does better than me in class, thus that resentment can easily fester to anger, to unhealthy competition, even when there is no real need for any. I just try and remember what my dad always told me "there will always be someone better than you at some point" it's just life and it is what it is. People get caught up in everyone around them instead of worrying about the most important thing, themselves.
  14. FatsWaller

    Men in the nursing field, is there a problem?

    25 years is a little dramatic, especially depending on what your age is. I mean I'm 24 so I definitely wouldn't want to perform peri/Foley care on a female who is my age or within 10 years of my age without another RN present, but it also would be dependent on the situation. If its a 50 year old I would have no issues. I'll be working ER trauma 1, so If someone comes in and is in need of a Foley immediately or some kind of peri care, Ill probably just do it, not waste time looking for a nurse to step away from her patient to awkwardly watch me. That being said, my issue is mainly with other nurses. As I said earlier, I haven't had any patients deny me, but I have been able to read their face and realize they weren't comfortable with it, so I offered a female. As a student, graduating in 12 days, I have had nurses who were uncomfortable with me providing care to a female, despite the patients being 100% ok with it, and that, for lack of a better word, pisses me off. 2 days ago in my peds clinical, my instructor asked me to go into a room and watch the nurse straight-cath a 3 year old girl as I have yet to see a straight cath perfomed. The pt was paralyzed and was very used to the procedure. I stepped in with my peers (females) and I was immediately (and rudely I might add) asked to get out” as the nurse didn't feel comfortable with me there. The patient obviously didn't care. There was no history of no male caregivers” or issues with males, so what the hell? This was the third time this happened to me in a year of clinicals. The two other times were in my OB clinical with two other nurses. I honesty was pretty livid, and as I left made sure to say I am glad I get the same opportunities for education as my female peers”, she just scoffed. I didn't go any further with it as I want to graduate and didn't want to make waves, but when another nurse plays this kind of bull, I think it's wrong, discriminatory, embarrassing and unprofessional, my instructor completely agreed.
  15. I would have to describe my Accelerated program the same way as you described yours. Your there for only 12 months so the teacher's don't have time to care about you, drama runs high and the whole year is essentially NCLEX prep course.
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