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Mandy2016 BSN

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  1. Mandy2016

    Sexual Assault Exams

    I believe you absolutely did the right thing. It would have been horrible if you were in the middle of an exam, panicked, and then ended up contaminating evidence or causing harm to yourself or your patient. Everyone has a weak spot, it's nothing to be ashamed of. With your past trauma, I believe that was a perfectly acceptable reason to ask for an assignment change. I also can't imagine this type of patient being an every other day patient, so you hopefully won't even need to ask many more times. Stop punishing yourself! You deserve a little compassion from your team!
  2. Mandy2016

    Checking consciousness by touching the patient?

    Something I ask myself is if I or someone I loved presented this way, what would I want someone to do? Chances are, both you and a judge would reach the same answer. Any person who wouldn't want to be touched is either full of empty threats or is so sue-happy, you'd better believe they've lost all of their credibility and things will go in your favor anyway. But... if you're still worried about touching a patient, here are some alternatives: -Crank the head of the gurney up 90 degrees -Pull the blanket/towel away -One or two drops of saline from a flush onto the head -Drop something loud on the ground/ make some noise. One physician I work with has a rubber chicken. Yes, the cheap prop store kind. It's his first level-of-consciousness check after saying hello and, oh boy, does it work.
  3. Mandy2016

    Help! New grad ER nurse, leaving before year mark?

    THIS SOUNDS SO MUCH LIKE MY HOSPITAL IT'S SCARY. Our high turnover rate (due to being underpaid) has led to chronic understaffing, which makes them hire new grads like crazy. I was brand new when I started and after orientation it was the worst flu season California had seen in YEARS. Just like WiseAtHart, none of us had a lunch break for months, we always had a full patient load, and our overflow chairs were more dangerous than useful. Something that always stuck with me was when other RNs I worked with (including my preceptor) told me, "if you can make it here, you can make it anywhere," and that was the truth. As time went on, I became a stronger nurse. Critical thinking and time management take time to build, don't be too hard on yourself. If you have the option of picking your schedule, I would try to see what days the more experienced nurses work and try to get those days. At least you'll be able to pick their brains and they'll be there to help when something critical goes down. As far as violence goes, I would notify the charge RN and security immediately. If nothing else, they can stand by and watch your back if these people escalate. The security guards I work with regularly try to deescalate these types of patients. If they continue to be violent, it's either discharge, AMA, or restraints. Document everything, I mean every single word they say, all the ***** and the gestures. That way, you cover your *** and every other medical professional reading the chart will be warned about what kind of person they're dealing with. DO NOT tolerate patients who try to hurt you. I know many nurses will say it's just part of the job and you'll learn to deal with it- but that's total bs. Do no harm, but take no ***! No one can blame you for leaving if you do, but I encourage you to keep going. Coming from someone who started as a new grad in this environment and a preceptor to many other new nurses, I promise we all feel this way in the beginning. Remember, the end goal of the ER is to prevent death or permanent disability. If you keep your patients alive and prevent them from degrading, you have done your job and shouldn't feel like you are less than worthy for your unit. Will all of your patients be happy, pain free, and not hungry? Hardly ever, but that does not mean you are a bad nurse. The fact that you care, hesitate, and realize the dangers shows you have the core potential to be a great ER nurse. Don't give up
  4. Mandy2016

    CVICU to ER

    Go for your sister facility! It can be hard to get days in a lot of ERs, but the more experience you have in the ER the better your chances will be of being day shift in the future. While I have not worked nights, I have many friends and coworkers who have told me the toll it took on them and the huge lifestyle changes it required. But if you're a night owl, have blackout curtains, and great insulation at your place, nights may be for you! Don't be discouraged by moving from level I to level II. I actually work in a level III, but let me tell you, that does NOT stop anyone from sending us level I worthy patients on a regular basis. Countless GSWs, brain bleeds, and full arrests have come through our doors. We usually stabilize and transfer out patients who require equipment or procedures we can't provide (when possible) but that means we still get hours of one on one with serious injuries. It's a great learning experience. Best of luck!
  5. Mandy2016

    On call - what is it like for other ERs

    Is on call required for all nurses in your ER? If not, I would try to renegotiate your contract ASAP. Chances are, if you're not happy with this arrangement, neither are many other nurses and they'll be willing to negotiate to keep you. I understand the pressure of constantly being asked to pick up extra shifts by management. My ER has no on call nurses. The nurses in my unit basically refused until they started offering bonuses. Since the bonuses started, we've been having fewer and fewer short staffed days. If your hospital won't budge, I'd start looking elsewhere. Good ER nurses are always in demand. Best of luck!
  6. Mandy2016

    Why working as an ED nurse so competitive?

    When I was a new nurse out of school, I was surprised I landed an ER job. There was, of course, a catch. This ER was always packed and understaffed, many orientees didn't make it through training and none of the ICU nurses they cross trained were willing to come back lol. Once I got used to the hectic environment/ conditions, I really started to love it. Look for hospitals with high turnover rates, or any with large ERs, your chances will go up. If you're still not having luck, apply to any unit in the hospital that will take you. It's much easier for a hospital to cross train and then hire you full time in the ED than to accept and train a new hire. Even if it takes a lot longer, at least you'll be closing that gap in your resume. Best of luck!
  7. I actually hadn't heard of CIWA before, it seems like a great tool! We often get drunk patients who fall below an 8 and end up taking a bed for a whole night while much sicker patients are stuck in the waiting room or an overflow chair. This patient was about a 5 but because his blood alcohol level was so high, they considered him to be a valid enough patient to warrant a bed : / Thank you so much for teaching me about CIWA!
  8. Unfortunately, the budget at our facility greatly limits our resources. We always have between 2-5 security guards present, but it's basically up to them and any available EMTs to act as sitters for SI/HI patients unless they're in restraints. The hospital doesn't want to pay for many sitters and, unfortunately, the other floors get priority because they (basically devalue) our security guards and EMTs by considering them to be "extra personnel," instead of the essential personnel that they are. Starting now, I'm going to really push to get us sitters. I'm sure my coworkers will support me and I'm hoping for the best! Thank you for taking your time to reply!
  9. Mandy2016

    Anxious, Confused, and needing help/advice

    Hope this isn’t too late! YOU ARE NOT IN THE WRONG Although it would be difficult, I would attempt to find out if this preceptor has had other students in the past, contact them, and hear about their experiences. Chances are you’re not the first to experience this behavior from her. I have been dubbed master preceptor, and I live up to that expectation. I have worked in an emergency room for two years and have taught many new graduates and student nurses. Here’s the thing- you really don’t know a lot of stuff because there is so much they don’t teach you in school. But guess what? As a preceptor, we expect that!! Quite frankly, any instructor warner’s who expects you to know as little as 50% of what they do is an idiot with unrealistic expectations. Critical thinking skills and time management are the hardest things to learn, they take time, and you can only improve. A good preceptor knows this and tries to encourage the development of these traits instead of trying to break you down. I’m also a little outraged to here of two supposedly “professional” nurses behaving in this manner (1: your preceptor and 2: your professor). A nurse that belittles, abuses, and bullies you, or any other student has no business training anyone. For your professor, (I assume she knows what you’ve told us) to believe that it is in any way okay for you to keep training with this woman, should be ashamed of herself. Most importantly, if you talk with your professor/ instructor/ dean, speak in a calm, firm tone with clear, concise examples of the unacceptable behaviors she has demonstrated. Seriously, your professor should have viciously chewed her ear off the very SECOND you were assaulted over something so petty. If you were about to slam a patient with Succinylcholine, then, ya, that’s acceptable because life over limb. But not for something as trivial as a Foley like, worst case? You put in a new one. Big whoop. Less time in, more frequent changes, decreased risk of infection. I’m guessing she probably wasn’t thinking about that now was she? Don’t be afraid to reach out! There are a lot of wonderful preceptors out there, you’ll find one.
  10. Mandy2016

    Freaking out over a patient fall!!

    You can do everything right and still be wrong. This is something I have had to remind myself of on more than one occasion and I urge you to remember it and not be discouraged! You knew what was right, made an honest attempt to try to follow policy, and, as a result of your diligence, the patient did not get seriously injured. I remember nursing school, they teach nursing with "ivory tower" ideals that are just unrealistic for many patient care settings. My hospital doesn't even have a lift team due to budget cuts! As a result, our bariatric patients often have wounds we can't find/treat in the ER because we simply don't have the strength or tools to even turn a 500lb pt to see their backs. This makes us feel awful and causes increased risks to our patients. But remember, it is not our responsibility as nurses to pay for equipment the hospital will not provide, or put ourselves at risk of injury because of this. What's most important is that you learned from this experience and it will make you more vigilant. Experiences like this will only make you a better nurse, and the fact that you care so much says a lot about what a good nurse you're going to be! Don't lose hope!
  11. Hello everyone, First of all, big thank you to everyone who has taken time out of their day to read/reply to this. I'm an ER nurse who works in a VERY busy ER and often encounter patients who interfere with other patients' care in one way or another, but a few days ago I had an incredibly stressful experience. One of my patients, who was AAOx4 the entire morning, suddenly became unresponsive after an incredibly large GI bleed bowel movement and a large amount of bright red emesis. This patient was obviously critical to everyone around, which was, surprisingly, not the stressful part. The problem was the new ETOH patient on the other side of the curtain. This person had 0 compassion for his critical neighbor and continuously screamed for food, attention, and more narcotics. When I (and about half a dozen other staff members) tried to explain he would have to wait until there was time to give him more attention, he began to scream "I'm a fall risk and I'm just going to get out of bed and fall and hurt myself, then you'll all be sorry," along with other alarming statements. This patient made multiple attempts to get out of bed while screaming "here I go, I'm gunna fall now!" as I was either elbow deep in GI blood, preparing/administering drips, and trying to communicate with the providers to figure out what's next. This forced me to leave my patient countless times. Even though my other coworkers tried to help as much as possible, we had several patients that were just as critical, and we were stretched thin. There were no extra EMTs or security guards to act as a sitter (we never get sitters in the ER, it's not even an option for us) to keep him in bed, or at least stop him from falling. I wish I could have moved him to a different room (but there were none), let him leave AMA, or put him in an overflow chair, but I knew he was drunk, and he would definitely have ended up hurting himself. That day I was more scared then I ever have been of losing my license or, worse, causing an innocent patient to die because of this ETOH. My question is what could I have done? Put him in restrains for threatening to indirectly hurt himself? Could I have called the police afterword to press charges for interfering with another patient's treatment? If this ever happened again, what rights do I have (besides refusing the patient) to stop one patient from placing another at risk? I would really appreciate any advice/ legal knowledge. Thank you all again so much for your time.