Should You Be An E.R. Nurse?

An E. R. is a challenging and high pressure work environment that involves high stress and heavy patient turnover. But nurses coming up through the ranks should seriously appraise whether or not an Emergency Room is the proper career choice for them.
The hiring convention to screen candidates for professional nursing E. R. jobs is to hire from within. Or to hire nurses with commensurate nursing experience from Emergency Room or Urgent Care assignments elsewhere.
The hospital may depend on direct referrals for staffing its Emergency Room. There are some fast-track programs available. The hiring managers from a given hospital or Urgent Care clinic may want to review a student nurse’s transcript if they apply before graduation. If the compensation is particularly desirable, a second interview may be required after references and NCLEX test scores are reviewed.

All E. R. nurses do not operate in a real time work place at the same level. An E. R. can be a daily test of patience, nerves, and professionalism.. The skill sets for an E. R. nurse applicant should be above average in quality and the personality type of the nurse candidate adaptible. But those who can’t function in the fast-paced and demanding hospital or clinic E. R. should face facts about the suitability of their destination job title.
Of all the stressful career choices in the world, an Emergency Room nurse ranks directly behind police officer and firefighter. The Turn-and-burn mentality of many high volume E. R. facilities can wear out the freshness of a newly qualified nurse and age them prematurely.
Some nurses stay in this line of work out of feelings of dedication and trying to make a difference in the world. All too often, such nurses experience stress snd occupational burnout.
Also, the associated risks of depression, addiction, and alcohol and drug abuse for nurses working in the Emergency Room is far higher than the more sedate clinic or the long term care facility nursing pace. The work in an Emergency Room by nature does not absorb nursing errors and the consequences of nursing carelessness can be disastrous.
E. R. employers are not as forgiving of mistakes as normal-pace-type nursing employers might be. Patients in an E. R. setting present a challenge to any nurse lacking in “people skills”. Nurses must often deliver very difficult news to individuals or groups of people already crippled by lack of a family or support system.
Emergency Room nurses put in almost double the performance intensity of clinic desk nurses or long term care med pass nurses. The hours can be brutal and the schedules can make home and family commitments impossible. Physicians will demand near-perfect nursing performance from E. R. nurses at all times. No matter how fatigued or overworked the nurse is, he or she will be required to have a seamlessly professional attitude, critical thinking skills, and alert demeanor.
An E.R. nurse is the Gold standard” if nursing. More than any other kind of nurse, except the Home Health nurse, an Emergency Room nurse is the ambassador for the entire occupational body of nurses worldwide. Patients new to the world of medical care will see more interaction with E. R. nurses than with any other provider personnel.
Student nurses aiming for Emergency Room tenure need to honestly evaluate their skills. Performance in practicals skill development and internships will yield qualified feedback. The unpredictability of the E.R. work environment demands heightened nursing skills, quick thinking, and stamina.
If the feedback a newly qualified nurse gets from their nursing school professors, supervisors and peers falls short of the mark, nurse candidates should rethink applying for work in an Urgent Care setting. Student nurses browsing their career choices should review their strengths and weaknesses when selecting their occupational nursing career environment. Career counselors can answer further questions along these lines.

Slackers: The Ethical Divide of Nursing

The ethical divide between professional nurses with morals and accountability, and the others, becomes clear just as soon as a newly qualified student nurse becomes a professional. As in many occupations, nursing has its share of sour apples. And, as in many professions, some employees work to find a way around the system. Some nurses commit timekeeping violations. Others goof off and text on the job. Some chat too much with other workers, ignoring monitoring and auditing tasks. Slackers send a message that nursing is not serious business.
Sooner or later many nurses developed a career path. Many nurses begin with small slips, like writing inaccurate representations of events to favor their colleagues. And some others gang up on certain patients, to teach them a lesson. it’s human nature in some people to become predators against others and take advantage, but better nurses withstand the temptation to abuse those vulnerable and in their care.
Many times advisors and instructors will stress the importance of contacts within the industry and joining new network of friends. But this can backfire. Nurses cherish the bonds of friendship between each other, and sometimes too much. Would a friend ask you to risk your license putting false paperwork into a patient’s chart? Would you report a friend who removed records from the chart and shredded them? Would you realize if a future supervisor didn’t hire you because they remembered the deeds of a nurse clique or “posse’ you used to be with in the past? Being able to choose the company you keep may be the last true luxury nurses have. You may pay a price in the future for fun times today.
Nurses starting their first job take their license as proof they have studied hard, mastered all materials, and learned the necessary techniques and skills to provide positive and meaningful care to benefit all patients. Yet after a while, newly licensed nurses will start to notice something. Not all nurses share their same commitment. Some are lazy, some never finish the job right, and some just find ways to do things that are sloppy and incomplete. Every nurse must find the way they choose to deal with this.
Some nurses view a nursing job as a part time paycheck an avenue to another career. They want to be an actor, or an artists, or even have another job. Maybe they found their way to nursing through family connections and it didn’t seem all that hard to do. But they really don’t like the work, and they don’t mind if it shows. These nurses use their phone a lot when they are supposed to be working, and spend a lot of work time goofing around, looking at take-out menus or chatting with vendors and providers who come by to visit. But the medical world does not smile on this kind of slacking.
This kind of nonchalance leads to many nursing errors, such as too much or missing medication, skipped insulin doses, erratic chart-keeping, and missed shifts due to inability to copy the schedule. These type of employees perhaps showed more promise once upon a time. And many facilities can‘t afford to let such nurses go because a shortage of qualified and experienced nurses keeps them reliant on current staff. They arrive at work and hang out, looking for ways to skip the work and get coffee, hide in closets and rooms to talk to others, and just hang around.
Usually for nurses like these, the big attraction to coming to work is to socialize with the people working there. This can be a problem, because the bonds between nursing co-workers should not be more important than the professional commitment as a provider. Often, many nurses can prey upon the weaknesses of others. They can use peer pressure to cause one nurse to treat a certain patient or even a co-worker nurse badly or with disrespect. This is slacker peer pressure.
Yet so many nurses convince themselves that coming to work late doesn’t matter, that calling in sick for entertainment and social reasons doesn’t help co-workers, and that unclocked breaks just don’t really count as infringements. These types of nurses can contribute to an entire downturn in morale, because nurses working hard observe their peers slipping by with doing much less. Why should work hard, a nurse might say to themselves, when if ‘so and so” was here, they would just watch the clock until the small hand clicked at the top?
Sadly, many types of people use nursing to abuse the system. The steal medications, overcharge insurance companies, send false bills, and sign invoices for amounts of supplies much larger than what was actually used. Nurses may not realize that when they are asked to sign a bunch of audits, or when other staff convince them to sign many orders the did not witness or to even file papers in the chart that are not legitimate, they are risking their license. And showing new nurses whom to trust on the job is not something you can teach in a textbook.
Insurance fraud usually starts in small to medium sized businesses where slacking off and discovery of errors puts some people at a disadvantage. A nurse who has noticed a serious error made by one of their co-workers can choose to report it, or instead leverage this information for better shifts, a raise, or even a promotion. Nurses should be vigilant to review their state nursing board website and keep updated on the regulations governing their license. Maybe some employees notice that an employee takes off work an hour early every day their manager is not in the office. A new nurse trainee observes that not every staff member has t clock in and out per timekeeping regulations. Maybe they notice that the physical therapy staff bill for more sessions with their patient clients that actually occurred. Any omission of reporting such things can build a situation where nobody has ethics and finally some incident brings the whole situation to light. And at that point, nobody is a winner.
Many slacker nurses or people who are just too burned out to care adopt a philosophy of “say nothing, do nothing” at work. They think this keeps them free from blame when situations arise on the job for nurses to commit dishonest acts or abuse patients. When the nursing employees have this many compromising issues on the job, the patient care comes second. Soon, going to work in really a tripwire into unethical behavior that could lose them their job, let alone their license. And many nurses later confess to horrible infringements of patient rights simply because they got strong-armed on the job from the director of nursing or the administrator.
It is so much easier, in nursing, just to keep a clean slate and make sure that the nurses you choose to associate with are the one most admired and emulated by all. The nurses with authority are the ones who should provide a leadership example for everyone. As a new nurse, any nurse who questions why a felow employee is performing a certain action or declaring certain statements or giving orders, should be vocal to their superiors about just what is going on. Just the knowledge that one person had noticed this might be enough to form a correction plan and sever “bad apples” from a healthy tree.

The Changing Vision of Nursing

†Today nurses face challenges in the nursing world their predecessors never did. The slightest mistake can end up on YouTube. A crotchety patient might become a vexatious litigant. And worst of all, you could make a career ending mistake.

Newly licensed LVN nurses and RN nurses can safeguard their careers by following the best practices of their facility and the standard operating procedure of conventional nurses.For nurses to stay ethical and keep their noses clean, vigilance and propriety are necessary.

Good manners toward patients is the best practice. But for peers and other staff as well. Managers can appreciate the benefit of a new hire who is a good example. The spectrum of nursing careers can always include a nurse who is polished,perfect, and professional.

The stereotype of s nurse can be from a TV show or from examples people see over time. A paunchy, chain-smoking nurse tapping away at their phone is dividing their attention span before they clock in. The oversexed stereotype nurses who spends most of heir time socializing will often end up the subject of complaints.And nurses given supervisory roles when their performance is substandard will always suggest unfounded favorirism.

Additionally, nurses can look for good ways to stay motivated and meet personal goals. The stability that a career in nursing can offer provides financial security, as well as a few “chicken soup for the soul” experiences.These are often priceless insights into the human condition.

The payoffs of a career in nursing can be concrete and financial in nature or they can be as abstruse as angels dancing on the head of a pin.But each nursing professional needs to decide for themselves where monetary goals stop and vocational goals begin.

Many nurses find their vocation in helping people. Others ate looking for a way to migrate to another career, such as teaching or business. But the toll that care giving occupations take is becoming more difficult to ignore. Statistics on addiction, drug abuse, Petty crime and white-collar crime in the field of nursing is a well kept secret. Nurses often admit to feeding an addiction while on the job. Nurses fight smoking habits made deadly by their sheer casualness masking a dependence. Nurses can have delayed reactions to many of the experiences by they see and encounter PTSD later.

And some nurses worry about if there will be a nursing field in the future. Technical issues are turning the field of medicine into an adjunct of the insurance industry. How much nursing benefit can decades of dialysis provide? How can pacemakers and stints and implants improve the quality of life?

Decisions are being made every day to extend and lengthen life using equipment and materials foreign to the body’s natural makeup. The safety and longevity of many of these methods requires backups of conventional nurses to oversee and treat complex medical conditions.

This type of scientific leap forward will always need development and monitoring by medical professionals. And as long as people age and have health crises, a nurse ( or several hundred thousand) will be needed. Therefore the future of any nursing career is wide open.


Where Have All the Good Nurses Gone?

Those familiar with the nursing landscape and the patient options universe have been noticing a talent vacuum for some time. Has the general quality of nursing fallen off? Where have all the good nurses gone? Hospital policy and budget cuts, public mental health policy and supervisory practices combine to eradicate the best and most talented nurses out the door.

Risk averse nursing workplaces are becoming harder and harder to find, thanks to Social Security’s failure to keep mentally ill populations locked appropriately in pace. Mentally ill patients now take up regular population beds, a violation of nursing care in ethics if not in deed. Because these are not actually critical care patients, i. e. no amount of direct nursing care can restore mental logic or activities. Many new nurses (and old ones) do not have concentrations and/or documentation and licensing for strictly psychiatric patients, even if patient organization loads and assignments offer them these patients!

Consider: if a nurse applied for a position of equivalent nursing station in a psychiatric ward they would not be accepted because they did not have the credentials or experience. These patients would formerly have been residents of hospital wards more suited to round the clock care specific to this kind of patient need. And ward backups could otherwise have absorbed the extra patient care load.

But burnout of regular nursing staff and nursing shortages are behind this new gap in patient care. Why, as one old pro asks, should they wear themselves out simply because the State wants to save a few bucks on medical costs? They don’t get paid more for severely heavier care demand patients. But according to the present model of overstuffed wards, they are expected to do the work!

This “Lost Generation” of nurses will pass on thankless extra work, thank you very much. Generally speaking, more experienced nurses in older conventional labor models could be counted on to fulfill more complex nursing tasks to more demanding and more complex critical care patients, such as dementia, Alzheimer’s, or even Huntington’s Disease cases. But many experienced nurses looking to retirement do not feel the same push to fulfill additional case work per patient for no additional compensation.

More experienced nurses are simply not to be depended upon anymore to “pick up the slack” because newer grads want the easier cases and managerial staff can’t be troubled to properly supervise them. The charge nurses assign them to heavier load patients. Nurses are likely to pass on extra shifts or extra duty and extended hours, because they will simply get dealt the harder tasking. Nurses are likely to call in sick and take the personal time owing than spend the day chasing a thankless care load.

Many new nurses are “new grads”, shining with brand new diplomas but heartily lacking on practical nursing experience. New grads, as they are being termed are simply not experienced enough to care for mentally ill patients. These patients can be a significant drain on ward care time, because they need nurturing and coaxing to eat, take medications, and need more intensive body nursing than an ambulatory patient. And ambulatory and non-mental patient populations are deleteriously affected. Patients who “behave see the “problem children” get all the attention.

How taxing is the average mentally ill patient on a regular care ward tasking? Take for example the fictional case of “Robert Fickle,” an aging dementia victim undergoing unilateral amputation of the right leg. His care requires negative ionization chamber care and round the clock nursing care of a (1:1) one to one ratio assigned directly to him. But there is no rest for those on the same ward as Robert Fickle.

Fickle has transformed a quiet and orderly ward into a chaotic and noisome irritant. Bawling incessantly, he wears down every nurse and supervisor. Encouraged by the attention he receives, Robert continues to yell and scream if he does not get the attention of every person who passes into his field of vision, and yells abuse at other patients or staff if they do not instantly hurry to his side. The social worker licensed to carry out medical activities for Robert Fickle is only employed onsite from nine a.m. to five p.m.

Robert has abandoned all attempts at coping and spends all night yelling at nurses and passersby in the ward. Robert refuse to wear his hearing aid and can be heard all the way down the hall on a nightly basis, haranguing nurses for hours about fictional missed appointments he must get to (at five o’clock in the morning). There is no way to shut the noise out and other patients suffer to no avail.

Robert’s constant verbalizations wear out the nurses, who must complete the charts and medicine dosages of other patients while this noise is going on. It is very distracting and nurses feel put upon to keep their performance error free in this environment. The new admissions to the ward are accompanied by family and visitors, who are struck with amazement at this spectacle while their loved ones are taken into “restful” hospital care.

Sickle’s “condition” rule the ward. He refuses to stay in bed and insists on sitting in the doorway of his room, heckling patients and hospital staff, employees and visitors alike as they walk by, with imperious screams and abusive catcalls. Hospital policy limits what nurses can do or say to limit this nuisance. Numerous complaints from other patients go on “deaf ears”.

So, where are all the good nurses? Looking for alternate employment, or counting their days until retirement. And considering that any of us might be the next “Robert Sickle”, that is food for thought indeed.

Nurse Training Tips

Nurses need to be trained how to treat patients and fulfill all their needs Nurses cannot pick and chose which chores they need to do on which patient nor do they get to arrange their timeframe that suit them best. Often a case load of staff nurse means that the patient will be juggling various jobs or needy patients they like. There is much more to nursing than giving shots or checking histories, and nurse must be ready at all times to perform all needed nursing tasks to as many patients as are required. The reality is that in medical institutions situations exist with multiple charge patient realities.
Nurses are involved in physical administration of medicines, nursing bedridden patients, charting and file administrations. his involves witnesses pharmaceutical tracking, supply ordering, LVN communication,  as well as  medicines, review of patient symptoms, and room administration. Conflicts may come up, paperwork confusions, and records administration problems that nurse must deal with and treat patents all the while. May nurses grow accustomed in training to addressing single charge situations. But in reality, medical institutions
Nursing involves all facets of the patient experience and as well as performing history and readings resolutions. The paperwork responsibilities, reporting of charting, and intaking new patients at the same time can overflow within timed shifts more often than not.
Nurses who are not well trained to perform these duties will find themselves putting in extra unpaid hours keeping up. it is not unusual to see charge nurses working unpaid overtime completing records, updating charts, and finishing up with patients. Many institutions running on thin budgets will discharge nurses after a census, and nurses must complete their shift charting and other communication and patient treatment responsibilities on their own honor.
They may be reassigned to other wards or areas as needed. There will be slow days and there will fast days, but nurses are responsible for treating all patients at the highest level of care no matter what their time limitations are. The time sensitivity of all duties a nurse performs means they must be completed whether time permits or not. Therefore a nurse must involve themselves with each patient outside the minimums of ward responsibility to make sure adequate care is administrated.
For example, in a clinical care situation in training, a nurse might have to alter the setting on a EKG machine or test out various pharmaceutical applications on a patient to achieve the best result for lowered blood pressure.  But the time and physical availability for results and communications in real time versus training environment may not match the situation in reality. Phones do not ring on the ward training, another nurse needing help, or a new admission coming onto the scene may distract a nurse.
In training, a nurse does have to deal with the  professional responsibilities and commitments. Outside training the career comes to the fore. Outside training a nurse will be assessed at all times for professional advancement and adequacy.Nurse who take too long over rote task like takin vitals get a reputations for being “spacy”, not very good at time management, and get complaints from patients about lack of communications and poor medical skills.
The nurse must support requests from the team and the charge nurse no matter how many requirements their charges have currently running. The nursing team will often offer additional training for things like vein location for putting in a line, or even best placement of equipment for taking vitals. But past a certain point poor training becomes evident and staff will officially take note a nurse is incompetent or unhelpful handling multiple charges.
Nursing students have a training experience that is of simple academic cases of ongoing treatment cases. But in reality, medical care plans are much more complex. Handling people is involved. Patients may be resistant to treatment or not observant of dietary restrictions or rest orders as given by the physician. Nurses without good people skills, nurse swith no experience dealing with patients, and nurses without a complete understanding of the pathology involved will offer career damage unless they absorb the training required.
Nurses on the job often give qualified objections because they have not had a chance to speak with the doctor before issuing pain or treatment medications to a patient they have never seen before. Patients are likewise alarmed they are not seen or given a consultation before a dosage regiment is instituted.
Nurses in this instance carry more responsibility to review both the patient set of criteria and the possible side effects of a drug versus the entire set of pharmaceuticals being introduced to the patent’s bloodstream. Often a nurse can spot a contraindication before anyone else, and the thrust is upon them to do so. Nurses must also counsel the patient and asses them psychologically at all times.
When shifts change, nurses must convey the most timely changes in patient assessment to the next charge nurse. These must be done in accurate medical terminology in a transparent style.If nurses on the next shift have poor training and fuzzy communication skills, the primary nurse’s best contribution is the maximum value to the patient ad the medical caregiver. The nurse’s clarity of thought, mission to deliver the best nursing possible, and the motivation to promote healing can transform the most basic training into a sterling bonus advantage for the patient.
Nurses must assess patients in an ongoing manner. Is the patient a physical threat to themselves or others? Is the effect of any change or restriction in medication or privileges affecting them negatively? Are they speaking to themselves or others in a manner that shows a change in self esteem or motivation to heal? These observations are important and training in them will take place over the course of a nursing career.
Some patients may create incidences of panic disorder and need to be housed a negative ion chamber. They may try to not take their medication, create obstacles to treatment, or become even more ill. Student nurse skills must adapt and grow to meet the situation. Academic training will not train a nurse to speak to a patient in crisis.
It is hard to train a nurse for the variety of challenges and issues that come up for their patients in this kind of scenario. Occasionally physicians will be flexible and changes to the individual care plan will be made. It is vital to the medical outcome that these circumstances be communicated to the next nurses and on-call physicians. Being able to perform simple tasks like recording dosages and medical administration while balancing management of multiple patients can get tricky.But adequately trained nurses will meet and surpass their challenges to succeed and shine.
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