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Kitkat7985

Kitkat7985

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  1. Kitkat7985

    Currently on orientation at a level 1 trauma ER,help!

    I totally understand what you're going through!!! I was a float pool nurse and requested to cross train to ER. It was such a reality check at how different the two worlds are!!! Especially to then go to icu from ER LOL! I felt like a complete moron when I first started training in the ER even though I had four years nursing experience under my belt. I remember how intimidating it was initially, and it was very strange adjusting to such a different pace and expectations. You should be proud of yourself for jumping in and pushing yourself beyond your comfort zone! Remind yourself that you are not a new grad- you have a lot of experience and have seen all kinds of different diagnoses and how to react/treat them. You're getting these same patients upstairs ! You have the knowledge, you just have to switch up the way in which you give care. I pretty much had to mentally drop everything I would normally do on the floor, and switch to a whole other mind set to fit the ED. Forget the floor routine and learn this routine with a new set of eyes :) The floor is a more controlled environment with somewhat expected schedules throughout the day, and very detailed assessments and charting. You (mostly) know your patients in detail, diagnoses, course of hospitalization, treatment, etc. ED is the flip side lol. That's what is so exciting though! You are like a detective. You don't know what kind of patient is going to walk through those doors, so you have to use your critical thinking/assessment skills as soon as you lay eyes on them. Your priorities are triage, stabilize, then send them up or send them home. If they need to go up, move them out fast since they will start having new orders/tests rolling through. Plus, there are patients waiting for their bed that need to be helped. This is why the ER and floor nurses can sometimes get frustrated with one another lol. The units are two different beasts. ER doesn't have time to get all of the information the floor may want because its not a priority- they have limited time the patient can sit in the ER... Plus Probably dealing with dual codes and Alphas and combative patients coming in all at once :) ! They just don't have time. I remember when I was a new grad I had an ER nurse laugh their butt off when I asked when their last bowel movement was lol!!! You truly understand both worlds :). If a patient is icu status, get them as stable as possible (so if they code it won't be during transport) then move them out ASAP. Make sure they have iv access before they travel and go to the icu. Have extra staff with you with these patients, esp RT. Always have a monitor on your patient during transport. With your level 1 trauma ER, I'm sure they have an especially organized system in place when initially getting a patient settled, and when a patient starts to deteriorate/code. Whenever we got a patient in, the whole team came in at once and had the patient set up within minutes. It's pretty cool to witness and be a part of. One person would get them in a gown and get them on the monitor/taking vitals, while one person would put an IV in and draw blood to send out, another one getting history/meds to start getting an idea of what's going on, etc .. It was like a well oiled machine and is really impressive. Make sure your rooms are set up, esp with bag, suction, Christmas tree.. start frequent vitals (helps monitor your other patients when you can't check on them as much as you would like). Know where your line cart is, crash cart, where to find emergent items/meds. Be proactive according to your ER (ie chest pain? Get an ekg instead of waiting for the doc order). You will have more independence in that respect compared to the floor where you have to wait or page out to get an order to put in. Remind yourself that you have seen these complaints/diagnoses before with all of your experience and already know different things to expect. But I think whats the most important thing is tapping into your nurse gut/intuition. You've seen those patients on the floor- where you take one look at them and know they're going to crash any minute. You will use this a lot in the ER, which is very important since you don't know the reason why this patient is here. They become priority. Never make assumptions. Even a simple abdominal pain or a walky talky with stable vitals could turn into a total **** show within the next five minutes! Don't rely solely on vitals, since those are often abnormal when the patient is already deteriorating. Make sure you have good access at all times. Go for an 18/20G in a big vein in case you need to bolus/give them blood/contrast. Tell your mates and doc ASAP when you get a bad feeling. Your team is everything since it can get so hectic- everyone takes care of each other's patients. Get to know the people you work with and help as much as you can. If you feel like you're drowning, tell them ASAP and they will step in and help. Accept that your shift will always be unpredictable and that you have to be flexible with whatever goes down :) you won't be able to give super detailed care like you would on the floor because you just don't have the time. So don't be hard on yourself about that, you have to focus on stabilizing and getting people out to where they need to go. Focus on the patients complaint and anything that could relate to that, not a whole head to toe assessment. Keep working on your critical thinking skills... this can always be improved no matter how long you're in nursing! Be proactive with this as well. You can practice doing this with coworkers or friends. Example: someone comes in throwing up blood. What do you expect to do while they are with you? (The answer to every patient is always get them on the monitor, vitals, send out blood and urine, etc....if you don't know what to do in a situation always start with that!). Get at least two large bore IVs in. Prepare for possible blood transfusion. Get lab called in ASAP to start type and screen. Send out labs. Ekg. Spike and prep to bolus at least 1 NS bag since they're probably hypovolemic. Maybe get a pressure bag in the room just in case, and blood transfusion tubing ready. Print the consent out for the doc ASAP. NPO. Freq vitals. If they're diaphoretic and pale you know they're in shock and deteriorating. Meanwhile try to get a history and meds. Drinker? NSAIDs? Etc. You will get better at multitasking this all at the same time. Always think one step ahead. "Prepare for the worst and hope for the best". I always keep an eye on the I'll looking older patients and more stubborn/stoic patients that won't tell you they feel well until they suddenly deteriorate. * I recommend taking TNCC if they don't make this mandatory. Re-Prioritize your patients constantly. Keep paper and pen on you at all times, you will always be needing to write down random stuff lol. Make a cheat sheet to keep on you with phone numbers, door codes, etc. Find a mentor(s) that can help support/guide you, and give you feedback. You can be honest with your peers and just say how you are so excited, but nervous about starting since it's so different, and to please give any feedback to help you be a better ED nurse :) teams are crucial, and they will want to help; They won't let you drown. you are never alone so always ask for help as soon as you have a question or feel something isn't right. Lastly, don't forget about you! Bathroom breaks, keep bottled water at your desk, try at least steal a few minutes for a snack on and off. Sorry for the essay but I SOO know how you feel... and my ideas are all over the place since my last one didn't go through lol anyways, You will be great, just go with the flow and support your team. Let us know how it goes !
  2. Kitkat7985

    What's your best 'Nurse Hack'?

    Congratulations!! You should be so proud of yourself! Remember, you got this far for a reason so own that and don't forget it! Your first year will be the hardest, but every new nurse pretty much hears that while still in nursing school. And I wouldn't be surprised if you have been referred to as a "baby" nurse, which is why you mention that term. Just don't let that term make you feel less than you are :). As a first year new grad, you will be working on time management the most, so a good hack to that would be finding different things that work best for you ie. Brain sheets, time management schedule you can plot out to stay on Track, etc. You will begin to find your own path that's best for you :). Always come prepared. Know that each day can be different which will make you adjust your shift- happens all of the time, be flexible! If you don't know something, look it up. Know why someone is getting the meds and treatment that they are. Double, triple check things if they don't seem right! Everyone makes mistakes that you may catch. Try to stay up to date on charting, at least getting in your assessment before 12. Make sure your room is prepared for anything that may happen- prepare for the worst, hope for the best that includes getting cords out of the way and like what another poster said, clearing a direct pathway to the patient. The most important thing of all is to get help if your patient seems like they are taking a turn for the worse. Vitals are often the last thing that will tell you someone is tanking, assessing your patient and listening to your gut is critical. Never doubt yourself. Use your coworkers, charge, and docs with any concerns you have. Remember you're not alone in these situations, you are surrounded by back up :) and btw that 60cc syringe for turtle catheter placement is genius lol!
  3. Kitkat7985

    Told to fake vital signs

    This is a situation where you get out of that place immediately and you take them down. The facility is required to have equipment that allows you to do your job, so having to go out and buy basic supplies to take a blood pressure is ridiculous. Sounds like this is the status quo for your work? " Make it happen". The CNAs who bought their own supplies are trying to protect their license. Never ever EVER fake vital signs. When something goes down in that facility, which it will, the state will investigate and will see that there weren't any supplies to begin with. Your license will be gone. The nurse who knowingly tells you to get fake vitals and then gives drugs based on that needs to have her license pulled. This whole thing is very disturbing and ILLEGAL. Report them immediately. You could inadvertently be a part of losing a patient when the correct care and monitoring isn't being done right.
  4. Kitkat7985

    I hate nursing

    I'm sorry you are suffering so much and for so long. It sounds like total burnout and PTSD to boot. And perhaps family persuasion to make you go into the field, especially since you've hated it since the beginning. It's time to look for another job in nursing (if that's truly what you choose in your heart) and find something that's not bedside/totally different than what you have done. Your body is trying to tell you that this is not what you should be doing. Fight or flight is kicking in and you are ignoring it and overriding what your body is telling you. Overwhelming anxiety and depression with unhealthy coping behaviors shows this. It's so incredibly easy to get "stuck". But You are in a place where you have to change something for your own sanity. Before getting your RN maybe consider if it's even worth it for you. If your heart is not TRULY in this field than it seems like your adding more suffering to your plate. Nursing either isn't for you, or else you need a completely different environment to work in. Time for some soul searching about what is best for you!
  5. Ugh my heartfelt long response didn't make it through abbreviated version I guess... the longer I'm in the ICU, the more OCD/control freak I have become. I HAVE to know EVERYTHING about my patient; assessment wise and physio wise. It's easy to hurt/kill a patient if you don't.. and any little deviation can mean something critical to me when someone is that sick. The doctor will also look to you to know everything. Besides the doc rounding once or twice, the nurse is in total control of their patients. It makes it more interesting if you are in a pod with one or two other nurses and don't have a cna, secretary, or tele tech :) and when one patient starts crashing it effects the whole pod. (as a side note, I honestly can't remember the last time I sat and just watched my patients! Just recently I clocked 7 miles in my pod without even going on a road trip!) Perhaps the nurse you spoke with was trying to see a trend in the K? When getting a rapid transfer we need to know as much as possible to figure out what's coming to us (i.e. Like When you're trying to get report from ER/PACU/etc). As soon as we hang up the phone we're running to prep the room, and that includes setting things up for your patient based on the report we get. They are crashing and we have to figure out why, and you can bet the doc will be looking to you for all info once they get there! Besides this, we have to ensure our other patient is stabilized before the cluster begins within minutes. I almost never have time to look at the chart when they're coming in that fast, so I want to know everything from the nurse. This will be key in giving me answers about what's about to happen, since most patients crash or code upon arrival. Plus, I trust that nurse and what they say/think because they will know them the best. Maybe she was burned that day and took it out on you, which she shouldn't have. I've gotten flack from every department though lol. knowing all departments, I understand the flow better and why people act/say what they do in certain situations. I always keep in the back of mind that we're all here for the patient, and are dealing with our own personal issues on top of dealing with internal unit issues and requirements. People have bad days and you may never even know the extent of the crapiness they're dealing with on their end. But on the flip side, if someone is being condescending and unnecessarily nitpicky, refer them to the chart. If they cross that line of unprofessionalism, it's ok to say "I'm just doing my job, you understand". Sometimes people get caught up in what's happening and forget how they come off. You can also talk with your manager about it. Because ultimately, no one deserves to be made to feel inferior. We're all nurses, and we are all saving lives. One department is not better than another. We are like a machine, where every part is vital to saving a patient. ICU nurses are not all like what you have encountered! And all that matters is that you did the best you could do, and you hand the patient over from there :)
  6. I come from 5 years as a float pool nurse that worked the floor and later cross trained to ER. I now work in ICU but am still a "baby" . The one pervasive theme I noticed was that each department vies against the others. It's probably an innate us vs them kind of think. Each department has their own specialty knowledge, with their own ways of doing things that works best for that department. obviously this can set the stage for irritation and miscommunication, especially when something is quickly happening. That being said, there are always the stereotypical Us vs Them groups we all know : ER vs ICU, ICU vs Floor, Floor vs ER.... Totally different areas of nursing with different priorities. Working all three areas has helped me see this in ways I didn't understand before. When I worked floor, I would get so frustrated with ER and the report I would get. It was really not a whole lot I could work with. Or having to talk to a different nurse who knew nothing about the patient because the primary nurse was unavailable. There would only be so much I could find in the ER report too, so it would be frustrating not knowing what was coming. Lines were messed up, things needing to be done, etc... and when you're running with 6 patients on days and drowning, it was the last thing you needed.. Yet when I also worked in ER, my mind was blown by the total chaos all the time. Lots of patients per nurse. You have absolutely no clue what's walking in the door to you. Continuous codes, traumas, combative patients, etc...everyone running! The primary goal was to get them stable and up to the floor, where they would get more thorough attention and care. Eye opening for sure!! Would then work the next shift on the floor, and would have to change my nurse think to adapt to that unit now. So many needs for so many patients, making it hard to know as much as I would have liked about their whole admission. And since it's impossible to monitor your 4+ patients so closely on the floor in addition to q4 vitals only, a patient can deteriorate quickly without staff knowing for some time. At this point I would want my patient out of there and to the unit, knowing our floor couldn't do anything more at this point and it's now beyond my scope. Plus I would have multiple other patients that needed me.... giving report to ICU was always intense for me. Especially since in those situations it's a rapid transfer and I wouldn't know numbers off the top of my head or extreme details that I didn't need on the floor. I don't think it's right for an ICU nurse to give you heat during report; it's not right no matter what department the transfer is hapson
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