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  1. Pixie.RN

    Emergency Nursing

    The Emergency Nurse Emergency Nurses specialize in caring for patients in potentially emergent or critical condition, be it from illness or injury. Because this specialty is unique in that patients do not necessarily arrive with a diagnosis, emergency nurses must be able to rapidly recognize impending threats. Patients will range in age from neonates to centenarians, and will arrive in all conditions. Care of these patients is typically intended to be short-term in duration; however, with hospital crowding, lack of beds for admission, and lack of access, some patients become very familiar to staff. And no, it's nothing like on TV! Work Environment Emergency Nurses most commonly work in the hospital-based ED setting, though they are also employed at freestanding EDs, urgent care centers, and in prehospital environments in some areas. Typically an Emergency Nurse can expect to have Unlicensed Assistive Personnel (UAP) in the department, such as unit secretaries, registration associates, and Patient Care Technicians (PCTs). Other interdisciplinary team members may include radiology techs, lab techs, respiratory therapists, and/or other specialists who participate in caring for patients. The entire team, including providers, works closely to care for patients and arrive at a diagnosis and favorable disposition. Skills / Qualities of Emergency Nurses Emergency Nurses should possess excellent assessment skills to ensure that their patients are not experiencing an immediate or potential life threat. Often emergency nurses are the first to see patients, before the providers; as such, rapid recognition and identification of health issues is essential. Communication is also key to elucidating a patient's reason for visiting the ED, which may provide clues to a current or potential health issue. The environment is fast-paced and constantly changing. Duties of the Emergency Nurse The Emergency Nurse may fill many roles (not all-inclusive): Triage Nurse Charge Nurse (directing patient flow) Direct patient care Nurse Trauma Nurse The Emergency Nurse constantly communicates with patients, often acting as the patient's advocate. He or she must be attuned to any changes in patient condition that require a change in treatment or intervention, and must keep the rest of the team apprised of any such changes. Emergency Nurses often make arrangements for admission or transfer of patients, which can be a complex and time-consuming task requiring close communication with the accepting facility staff, the patient, any family, and the transport team. Education Requirements Graduate from accredited nursing program (RN, LPN/LVN) Successfully pass NCLEX-RN or NCLEX-PN Current, unencumbered RN or LPN/LVN license in U.S. state of practice An Emergency Department (ED) may employ a variety of types of nurses, including LPNs, ADN-prepared RNs, BSN-prepared RNs, MSN-prepared RNs (often in department management or education), and even Nurse Practitioners (NP) and/or Clinical Nurse Specialists (CNS) in a mid-level provider role. Not all types of nurses will be present in all EDs as hiring preferences vary by location. Additional certifications that an Emergency Nurse may be required to obtain or might want to pursue include: Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nursing Core Course (TNCC), Emergency Nursing Pediatric Course (ENPC), and Advanced Burn Life Support (ABLS). Additional courses may be required by or available at other locations; this list is not all-inclusive. Emergency Nursing as a Specialty As the "Emergency Room" (ER) has morphed into the full-fledged "Emergency Department" (ED), so has the emergency nursing specialty grown in prominence. There have been emergency nurses for decades; the Emergency Nurses Association (ENA) was founded in 1970 and was only officially recognized by the American Nurses Association (ANA) as a specialty in 2011. Board Certification BCEN Two primary emergency-related board certifications for RNs are the Certified Emergency Nurse (CEN) and the Certified Pediatric Emergency Nurse (CPEN) credentials from the Board of Certification for Emergency Nursing (BCEN). To qualify for the CEN, one must be an RN with an unrestricted license in the US or its territories, and there is no minimum practice requirement, though two years is recommended. To qualify for the CPEN, a candidate must hold a current unrestricted RN license in the United States or Canada. The certification board recommends 2 years’ experience in the specialty area however, it is not required. A trauma-specific board certification is the BCEN's Trauma Certified Registered Nurse (TCRN) credential. To sit for the exam, one must hold a current, unrestricted RN license in the United States or its Territories. A nursing certificate that is equivalent to a US RN is also acceptable. The certification board recommends you have 2 years’ experience in your specialty area, but it is not required. There are other certifications available through the BCEN. Additional Certifications Additional certifications that an Emergency Nurse may be required to obtain or might want to pursue include (not all-inclusive): Basic Life Support (BLS) Advanced Cardiovascular Life Support (ACLS) Pediatric Advanced Life Support (PALS) Trauma Nursing Core Course (TNCC) Emergency Nursing Pediatric Course (ENPC) Advanced Burn Life Support (ABLS). Additional courses may be required by or available at other locations; this list is not all-inclusive. Job Outlook Though the downturn in hiring has certainly affected nursing across the board, this is a specialty that has been relatively stable for experienced nurses. New graduate nurses may have more difficulty with direct entry into emergency nursing practice, but emergency nursing opportunities remain available and desirable. Salary (2020) According to salary.com, the average annual salary for the Staff Nurse RN in the Emergency Room in the U.S. is $76,332 with a range typically falling between $68,162 and $84,782. Salary will vary by education and location. Emergency nurses typically work in shifts, which results in shift differential and other benefits. Choosing a Specialty but not sure which one is best for you? Download Nursing Specialties Guide!
  2. "Go check the waiting room!" I looked up sharply from the ER nursing schedules I was doing. It was 10:30 p.m. I would be done by 11 p.m. Did I hear that or was it my imagination? There was no one in the office but me! I got up and stretched. Slipping on my white coat and stethoscope I walked out to the waiting room. It was packed. I stood by the security desk casually making conversation with Tony, the guard while my eyes swept across the big room. Hopeful eyes looked at me. My eyes stopped at the older African American gentleman sitting quietly between four young white men. He was answering their questions in monosyllables. I saw them exchange worried glances at each other. I walked towards them observing the grey pallor on the man's skin. "Something is wrong" ... "Hi, I am Annie the ED manager. Who is the patient here?" One of the young guy's piped up, "It's Mr. Gary!", and nodded toward the older gentleman. "Hi, Mr. Gary! How are you?" "I've had better days!", he mumbled. "And, you are--?" I asked looking at the four young men. "We are Gary's friends. We work together as caddies at the Green Meadows Golf Course!" "OK! So what's going on? Why did you come to the ER?" "Cause, something is wrong! This is just not him!" "What do you mean?" "Gary is very fun loving and is always joking around! He has changed in the last one month!" "Yeah! Ever since the fall!", one of the other guys chimed in. "What fall?" I asked casually as I watched Gary rubbing his temples. "He fell backward last month. I think he slipped. He was checked out in the ER and was sent home. He's been different since then! He's very lethargic!" "His balance is off and he vomited today!" "Mr. Gary! Do you have a headache?" "Yes! The worst headache in my life!" "Have you been taking something for it?" "Been popping Aspirins and motrins! Nothings working!" History, Assessment and Action "Let's get you in. I am going to triage you inside!" I grabbed a wheelchair and told his friends to wait outside. As Tony, the security guard, swiped me into the ED, I motioned Claire the secretary and asked her to send in for a stat registration to stretcher A1. "Any medical problems?" "I have a funny heart rhythm! Can't remember the name!" "Atrial Fibrillation?" "Yes!" "Are you on coumadin or warfarin, which is a blood thinner?" "Yes, 7.5 mg every night!" I groaned inwardly. He could be a bleed! I had Joan, the ED tech, hook him up to a monitor, get vitals and a stat EKG as I triaged him. Got Vilma, the nurse, to throw in 2 large bore lines in him and send labs including Type and screen. I went over to Rick, one of the Attendings in the ED. "Rick! We may have a bleed. Guy in A1, name's Gary, 72 years old, no allergies, had a fall 1 month ago and has the worst headache of his life. He has been taking Asprin, motrin and coumadin! A Perfect cocktail! His friends noticed a change in his behavior and brought him to the ED!" "Great! Let's get a stat CT Head!" He quickly examined Gary while I called over to CAT scan and informed them. Within 10 minutes we were looking at the films with the neurologist who we paged - a large subdural bleed. It was a short matter of time before his airway got compromised! Gary was getting disoriented. He was electively intubated and arrangements made for his transfer to our main hospital Neuro ICU. Vilma gave report and Claire called for an ACLS transport. It was 11:30 p.m. "He's like a dad to us" I went outside to speak to Gary's friends! "How is he doing?" They were all anxious as they had not seen him for an hour. "Well! He is stable and I want to thank you for being good friends!" "What's going on?" "Your friend Gary was behaving differently because he was having a bleed in his head! It was getting worse as it was causing a headache and Gary was taking medications for the headache like motrin and aspirin that are blood thinners and made him bleed more, a vicious cycle. He is also on a blood thinner coumadin which worsened the problem!" "Is he bleeding in the head?" "Yes, the bleed is putting pressure on his brain and so we had to intubate him as it would affect his breathing at any point." "He's on a ventilator?" "Yes, he is. The good news is that his vitals are good but he needs to be transferred over to our main hospital for further treatment. Does he have family?" "He has a sister in North Carolina but we are his family here!" "OK! That's good! I will have Vilma, his nurse, keep you informed. If you can find out his sister's information, let Vilma know!" "OK ! We will! Thanks, Nurse Annie!" "Thank you! Gary has great friends in you! You saved his life bringing him in today!" "He's like a dad to us! We just want him to be OK!" Reflection I smiled and walked away back to my office thanking God for the humanity those young men, all New Yorkers, showed to their coworker despite their age and racial differences! As I headed out of the ambulance bay, Gary was being loaded up for the transfer by the ACLS team. The young men anxiously watched and planned to follow him to the main hospital. As I drove home, I reflected on the story of the good Samaritan and thought of the right choices those men made to help Gary! I wondered which of their Guardian Angel's spoke to me in my office! I had plenty to choose from! Thank God for good people in the world! References/Resources WebMD: Subdural Hematoma
  3. Pixie.RN

    Trauma Nursing

    What is Trauma Nursing? Trauma nurses specialize in caring for patients injured through trauma, be it accidental or intentional. Trauma nurses must be well versed in stabilizing patients and rapidly recognizing impending life threats. Patients will range in age from neonates to centenarians. Care of these patients can range from short-term in the emergency department (ED) or dedicated trauma unit to long-term in ICUs and rehabilitation units. When these patients enter the system, they don't necessarily arrive with an obvious diagnosis and can benefit from the clinical acumen of experienced trauma nurses. This specialty also requires close coordination and communication with members of the treatment team, ancillary services, and family members. Education Requirements Educational requirements include LPNs, ADN-prepared RNs, BSN-prepared RNs, MSN-prepared RNs, and even Nurse Practitioners (NP) and/or Clinical Nurse Specialists (CNS) in a mid-level provider role. Not all types of nurses will be present in all trauma units as hiring preferences vary by location. Additional certifications that trauma nurses may be required to obtain or might pursue include Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nursing Core Course (TNCC), Emergency Nursing Pediatric Course (ENPC), and Advanced Burn Life Support (ABLS). Additional courses may be required by or available at other locations; this list is not all-inclusive. BCEN Certification Two emergency-related board certifications that Trauma RNs may have or seek to obtain are the Certified Emergency Nurse (CEN) and the Certified Pediatric Emergency Nurse (CPEN) credentials from the Board of Certification for Emergency Nursing (BCEN). To qualify for the CEN, one must be an RN with an unrestricted license in the US or its territories, and there is no minimum practice requirement, though two years is recommended. To qualify for the CPEN, a candidate must hold a current unrestricted RN license in the United States or Canada. The certification board recommends 2 years’ experience in the specialty area however, it is not required. A trauma-specific board certification is the BCEN's Trauma Certified Registered Nurse (TCRN) credential. To sit for the exam, one must hold a current, unrestricted RN license in the United States or its Territories. A nursing certificate that is equivalent to a US RN is also acceptable. The certification board recommends you have 2 years’ experience in your specialty area, but it is not required. There are other certifications available through the BCEN. AACN Certification / Eligibility In the critical care/Trauma ICU arena, trauma nurses may have or wish to pursue the CCRN certification for critical care through the American Association of Critical-Care Nurses (AACN). To qualify to take the CCRN exam, RNs and APRNs must have a current, unencumbered license in the United States. Exam candidates must also meet one of two clinical practice requirement options: 1) practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application; or 2) practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill patients, with 144 of those hours accrued in the most recent year preceding application. The exam is available for three populations of care: adults, pediatrics, and neonates. Practice hours are those spent caring for a single patient population (adult, pediatric or neonatal) matching the exam for which you are applying. Applicants must include the contact information of a professional reference who can verify clinical practice. There are several other certification levels available (not all-inclusive): CMC (Adult) PCCN (Adult) ACNPC-AG (Adult-Gero.) ACCNS-N (Neonatal) ENA Training Course The Trauma Nursing Core Course (TNCC) training course is available from the Emergency Nurses Association (ENA) for RNs. Verification as a TNCC provider is earned upon successful completion. Participants must be a Registered Nurse with an unencumbered RN license. LPNs are eligible to attend except for the written and psychomotor evaluations. They do not receive verification and are awarded contact hours. Work Environment Trauma nurses often work in the hospital-based ED setting, though some facilities have dedicated trauma units that receive only trauma cases meeting certain criteria. Typically a trauma nurse can expect to have Unlicensed Assistive Personnel (UAP) in the department such as unit secretaries, registration associates, and Patient Care Technicians (PCTs). The broader interdisciplinary team also includes radiology techs, lab techs, respiratory therapists, and other specialists who participate in caring for trauma patients. The entire team, including providers, works closely to stabilize and care for patients. Some facilities also have Trauma ICUs (TICUs). These units are typically staffed with similar assistive personnel and also include a broad interdisciplinary team with the goal of moving the patient toward recovery and eventually a step-down unit or rehabilitation facility. Skills / Qualities Trauma nurses should possess excellent assessment skills to identify and reverse potential life threats. Often trauma nurses are the first to see trauma patients; as such, rapid recognition and identification of issues is essential. The environment is fast-paced and constantly changing, and a trauma nurse must be able to thrive in the chaos of trauma resuscitation. As trauma resuscitation methods are constantly changing and improving through research, trauma nurses should constantly seek new evidence-based information via professional journals and online networking. Job Outlook Though the downturn in hiring has certainly affected nursing across the board, this is a specialty that has been relatively stable for experienced nurses. New graduate nurses may have more difficulty with direct entry into trauma nursing practice, but because emergency nursing opportunities remain available and desirable, that specialty could serve as a gateway to a trauma nursing role. Salary (2020) Salary will vary by education and location. Trauma nurses typically work in shifts, which results in shift differential and other benefits. According to ZipRecruiter, the average yearly pay for an RN Trauma Nurse in the U.S. is $91,025 with ranges between $65,500 to $106,000. According to salary.com, the average annual salary for the Trauma Nurse Practitioner in the U.S. is $94,492 with a range typically falling between $83,718 and $105,878.