OldIsNew

Dear DrER0802--Congratulations on your nursing degree!! Thank you for your commitment!! I've been nursing now for 37years, and still love it. I have worn many hats during my tenure. Nursing is one of the few professions which allows this! Your decision is not as easy as asking someone else! The first thing that struck me is that you have been in a unit that has had multiple managers in 8 years. That is a sign of a not-steady unit! I say some angel is looking out for you and has given you an opportunity for better. When I started as a nurse, all I wanted was to be a trauma nurse. Things did not work out, and I ended up in MICU, in a University hospital. It was the best thing that could have happened to me! The knowledge that I gained served me well all these years. The biggest question to ask yourself is: what do you like? ER is never the same. The age of patients is from birth to 110 (if you go to a Community ER, you may have to deliver a baby!) Teaching institutions generally see sicker patients, and, as you mentioned, more devastating trauma. Med students, Interns and Residents often perform duties that RNS perform in Community settings. My advice is find a unit with a strong onboarding program! Even though you have great experience, the transition from assistant to RN is important. You want to be somewhere that supports that transition. Best wishes!

Hi there! Thank you for enjoying nursing and the ER well enough to keep studying! I am a Critical Care CNS in the ER. Unfortunately, I do not have a very good response for you. I am practicing as a staff RN, not as a CNS. There is currently not a certification exam for Adult Acute Care or ER CNS. IMHO, the CNS role has always been difficult to define. We tried for many years to keep strong and explain the importance of advanced learning in nursing that stayed close to the bedside. In 2015, the consensus model for APRNs was finalized, and we got the very short end of the stick. I no longer can even come close to explain what a CNS is to the majority of administrators, especially when most applications are electronic! Almost unanimously, I am asked to practice as an NP. I ended up in Quality and Patient Safety for many years, which I loved. I was teaching on the side, which I also loved. I loved the work I was doing, but it left me in an office, and away from the bedside. I became a CNS because I wanted to be an "Advanced Nurse". Fortunately, I found a strong hospital system which has a nursing ladder that rewards expertise at the bedside. This allows me to participate in research as well. My income would not be much higher if I became an NP (at this stage). It was not easy to find, and I hope it lasts! Be very careful when you go to grad school. It has become big business. The professors can have up to 50 students each! I was one of 9! There are other opportunities at the graduate level, not just NP or CNS. You can specialize in education, or clinical leadership (CNL), which is very close to what I used to do. There's also case management (a very cost effective way to reduce chronic disease ED abuse.) I've been a CNS now for 30 years, which is a long time. I will never regret my decision. It just hasn't been easy! At the end of the day: where do you see yourself in 30 years? How flexible are you? Are you planning to stay in your current facility? Does your facility use CNS? If not, contact one in a facility and practice where you think you would like to practice. I think ER would be a great place to practice as a CNS!! We still have many quality indicators to meet, and the staff education is also in demand. As above, a CNS could also assist in the development of alternative pathways for chronic disease visits. Sadly, I do not see that it would be supported much by administrators or ED docs. That would be something you would need to explore as well. PS--If you do decide to go the NP route, please be sure that you go to a school for ED NP! There are many NPs in ED who are practicing beyond the scope of their education and license. It does not fare well for them during malpractice lawsuits. I wish you the very best of luck in your decision!!

I am an old nurse returning back to ED after 25 years away ( ICU, PACU, Admin). I am so frustrated with myself at discharge. In the past year, I have had THREE HIPAA violations! It seems that I get wrapped up in what I'm doing and don't check EVERY sheet at discharge. How do I make sure this doesn't happen? I typically discharge between 12 and 15 patients/shift after full work ups. I would love to spend more time, but we are also "dinged" on long times. Any suggestions??? I am afraid I will lose my job if this happens again.