Small ER no RT after 9pm

[Nurse-please, BSN]

Hey Guys...me again! Man, I love this group.

So I picked up a casual ER position about 1 hour from my house in the middle of NOWHERE.

It's a small facility...7 bed ER. I think 15 bed inpatient.. normal ER census is 14 a day. Two RNs staffed in the ER during the day, with 1 RN at night with med surge charge RN to call as your back up. Physician in house. No RT after 9pm. There lies my problem...Every facility I've worked in I've always had RT to rely on. I'm mostly hesitant for intubations and managing a vent. They will be training me in on this...but I'm still nervous to not have an RT to rely on! While I have been around plenty of intubations and vents.. I have not had to solely manage one or be second assist during intubation. My hope is that they have solid providers.. fingers crossed or I am out. But you know how that can go at these small-time hospitals. I have just about 2 years ER experience in busy ERs. I suppose a solid ICU nurse would maybe feel comfortable in this situation.

I plan to travel nurse in the near future and one of the reasons I thought this would be good experience is if I land an assignment in some rinky dink ER, I'll have had that exposure as staff and see the ins and outs of working in small facility. I want to kind of push myself into feeling comfortable managing these patients solely on my own.

Is this crazy thinking? Would you guys take a position like this?

Thanks again!

[Wuzzie]

10 minutes ago, Nurse-please said:

I plan to travel nurse in the near future and one of the reasons I thought this would be good experience is if I land an assignment in some rinky dink ER, I'll have had that exposure as staff and see the ins and outs of working in small facility. I want to kind of push myself into feeling comfortable managing these patients solely on my own.

Is this crazy thinking? Would you guys take a position like this?

I'd work in one of these hospitals in a heartbeat. You will gain tremendous experience. With proper education you'll be fine with intubations and short-term routine vent management (I assume these patients are sent out). You might even get to do some things that nurses in larger hospitals don't routinely do.

[speedynurse, ADN, BSN, RN, EMT-P]

On 7/8/2020 at 11:24 AM, Nurse-please said:

Hey Guys...me again! Man, I love this group.

So I picked up a casual ER position about 1 hour from my house in the middle of NOWHERE.

It's a small facility...7 bed ER. I think 15 bed inpatient.. normal ER census is 14 a day. Two RNs staffed in the ER during the day, with 1 RN at night with med surge charge RN to call as your back up. Physician in house. No RT after 9pm. There lies my problem...Every facility I've worked in I've always had RT to rely on. I'm mostly hesitant for intubations and managing a vent. They will be training me in on this...but I'm still nervous to not have an RT to rely on! While I have been around plenty of intubations and vents.. I have not had to solely manage one or be second assist during intubation. My hope is that they have solid providers.. fingers crossed or I am out. But you know how that can go at these small-time hospitals. I have just about 2 years ER experience in busy ERs. I suppose a solid ICU nurse would maybe feel comfortable in this situation.

I plan to travel nurse in the near future and one of the reasons I thought this would be good experience is if I land an assignment in some rinky dink ER, I'll have had that exposure as staff and see the ins and outs of working in small facility. I want to kind of push myself into feeling comfortable managing these patients solely on my own.

Is this crazy thinking? Would you guys take a position like this?

Thanks again!

I transferred from a bigger hospital with a larger ER and more resources to a freestanding ED several months ago. It was nerve-wracking to have no L&D nurses as resources, no NICU, no RT. But I was trained in vent management, BiPAP management, and ABGs and actually enjoy the new skills. It’s completely doable and even intriguing to learn new things.

[canoehead, BSN, RN]

I worked at a hospital in Maine with exactly those conditions. Sometimes I'd have a secretary to help, but if she called out, it was me and the janitor. He'd direct visitors, answer the phone and keep the papers on the right charts while the doc and I went from room to room. It was a great experience. We got some critical patients to stabilize and ship, and you had to know where everything was and how to use it. Also some rigging of alternatives at times. The RT was on call, so if someone was vented they would come and set up the vent in the ICU, but if they were transferred we bagged until EHS transfer arrived.

My advice, be sure you know where everything is and how to use it BEFORE the pooh hits the fan. Think about possible situations, and who you would call. We were told we could call EHS if we needed more help, but in reality they snuck out after about thirty minutes if there wasn't something cool to do...keep your helpers busy and tell them to talk to you BEFORE they leave.

Think about getting meds that aren't stocked, like Mannitol or dantrolene, for example. Or who to call if you get a rape case, you'll be at least two hours 1-1 with that patient, who will cover the ER? Be clear on policies, do you offer cab vouchers? The patients will test you and you need to know the hospital will back you up. Find out the number for a supervising person on call in case something really serious happens, and make sure you have access to it personally every shift.

[Lunah, MSN, RN]

My first ED was a freestanding ED, without RTs ever. Or pharmacy. Or L&D. It was just us! We had a CT and x-ray with the appropriate people for those, but could only get ultrasound after hours if we suspected torsion. In any case, I learned a lot about vents. I wasn't skerred of the intubations because I was a paramedic for 5 years before I became a nurse, but I made sure I knew how to work the vents, to include various modes (SIMV, BiPAP, etc.), giving in-line albuterol treatments, what the alarms meant, how to troubleshoot, etc. I also got really good at getting ABGs! I loved it there. Good luck!!