PacoUSA, BSN, RN 40,120 Views
Joined Mar 25, '09.
Posts: 3,513 (33% Liked)
Thanks! I guess the nurse I was handing off to didn’t understand that the femstop order was there only to be used if needed. It clearly was not needed at that time since the patient’s site was CDI and no hematoma present. But she seemed to insist why wasn’t it done. That is why I was confused. In my mind, I was like “why do I need to use a femstop at this time just because the order is there and the site looks fine?”
Personally, I would wait until you have 2 full years as staff before traveling. You will be more comfortable with your skills overall (you will be surprised how much one more year makes a difference) and you will also be more competitive for assignments with that amount of experience. I also recommend starting out at one of the best hospitals in the country as a traveler, as that makes your profile shine more for future assignments (The first three hospitals I worked for as a traveler are currently in the top 10 of US News and World Reports and although that sounds sappy to have it did impress future nurse managers enough to interview/offer me contracts quite readily).
I have been traveling for about 3 years now. I speak fluent Spanish and English and am quite proud of this skill. I enjoy having Spanish-speaking patients because I feel they are more comfortable with me and I feel like I am able to understand their needs more than an English-only speaking nurse.
The problem lies when I do not have the Spanish-speaking patient assigned to me and the English-speaking nurses periodically pull me away to have me translate between them and their patients. Granted, I am busy enough with my own group and feel like getting pulled to translate for someone else's patient just "adds" to my work. I feel it is easier just to give me that patient and avoid the pull away.
Tonight I mentioned this to another traveler at handoff and he said that yes I would be able to argue for a few more dollars per hour for being bilingual, and I am wondering if this is true. If so, I feel like I cheated myself for the last 3 years for not requesting this be factored into my pay.
Note that I still insist on staff using certified translators when obtaining consents or providing medical consults. But if I am being pulled several times a shift to ask a patient if they need a bedpan or whether they are in pain, it gets to be a hardship on my own flow.
Currently working tele unit in California, we never have more than 4 patients at once as regulated by law. On med-surg units where I sometimes float, the ratio goes to 5 patients per nurse. The only difference is the telemetry box, which magically reduces your patient load by one. I recommend learning tele so that you can avoid 5:1 ratios, because I personally feel that there is a fine line in workload between 4 and 5 patients.
So I was working a tele unit today and I had a patient come up from the cath lab this evening. He had 4 stents placed in his left leg and iliac vessels. Cath site was left groin, which I observed was C/D/I in a gauze and tegaderm, no hematoma. Patient instructed to lie flat until 1730, which was about 2 hours from arrival to unit. At 1730 I allowed him to incline HOB to eat dinner. By handoff, groin site was still C/D/I, no hematoma, and patient VS were very stable taken per protocol.
At handoff, the nurse questioned me whether the femstop that was ordered was placed. I was confused, I said no (in my mind I was asking myself why as the site was not bleeding nor hematoma present). Mind you, I have never used a femstop before nor would I know how to use one, nor know what one actually looks like - but I know what one is for. I told her I was not sure why the femstop was still listed in the interventions (Meditech for anyone familiar with that EMR). Most all post-cath patients I have cared for have presented on the unit with hemodynamically stable groin sites and all I needed to do was monitor the site and assure stable VS. So I was confused why this nurse was asking me why the fem stop order was not executed by me. I thought this was all done in the cath lab (this unit has had some patients that require sheath pulls, but I have not done those either).
I am a nurse with 5 years tele experience and the nurse I handed off to probably seems like she has less than that (but more experience than me on the unit I am working on). I did approach the charge nurse afterwards about this and she seemed likewise confused as to what happened. She said she did not think he needed the femstop despite it being still ordered.
So I was wondering whether I was right in being confused. Granted I should learn more about femstops for future reference (and the charge said we would review policy next time we work together) but my instincts were telling me this was not needed at the time but the nurse was semi-insisting that it wasn't done, so I am like, am I missing something??
Quit. Quit now.
Your manager is an out-of-touch idiot.
Watch your HCAHPS scores plummet.
If I were a patient, I would forbid you from waking me up for this nonsense and I would refuse this while I had visitors.
I have since left that hospital, and I'm pretty sure I barely made a memorable impression for her to remember me and make a connection, so I believe my anonymity is still intact 😉
None of your business? Sounds to me like YOU are the inappropriate one. I guess me walking by your patient's room when you are in the med room and seeing he is about to fall should not be any of my business either? 😒 You are the type of nurse that makes it hard to work in a hospital 😒
So I left travel nursing several months ago to start a new staff job in a new specialty at a new hospital. Most of my experience up to that point had been at large university hospitals, several of which are nationally ranked. The hospital at which I accepted this new job is a smaller regional community hospital about 20 miles from a major metropolitan area.
Long story short, I had a horrible experience. Orientation was inadequate, disorganized nurse educator, I had a hard time making friends with the staff (as opposed to when I was a traveler where I had no trouble making bonds), and to boot my preceptor threw me under the bus at the end which caused my reviews to suck. It was the end of my probation so I ended up resigning. Not the place for me and I am not looking back. I am however looking for a place to burn my uniforms lol.
So I decided to return to travel nursing, starting a new assignment at a US News top 10 hospital within the major metropolitan area of my prior facility. I guess I now know where I belong -- the big hospitals.
So the other day I happen to glance at the computer screen of the unit secretary (who I have since learned is doing prereqs) as I walked behind her and noticed that she was reading a post on this site.
What was interesting about this is that at that very moment she was reading one of MY posts from 2012 ... what are the chances? I kept silent. And she will never know that the real PacoUSA was standing right behind her.
I left Florida to pursue nursing up north. Smart move on my part. Sunshine money means nothing in my world. Now I do travel nursing, and I wont even consider an assignment in Florida.
It has been about 6 months since my last post, so I thought I'd write a little update. I am not even sure if anyone is following my thread but the info I am sure is good for anyone who chooses to look for it later.
So as of right now, I have started the ED preceptorship at the same hospital at which I am currently completing my travel assignment (I hesitate to post the name of the hospital where I am at this time due to anonymity, but what I can say is that it is one of the top 10 hospitals in the USA based on US News and World Reports). My current hospital did not have an existing relationship with UCSD to allow their students to do preceptorships there, so I had to go through a little red tape to make this happen.
I started the process by contacting the nurse educator of the ED, who in turn referred me to someone else, specifically someone whose job is to arrange student externships and clinical experiences. She was spot on the person I needed to speak to. She explained to me what was needed to establish a relationship with the hospital and the school. She forwarded me the information and I in turn sent it to UCSD. They already knew what to do with the information, having already done this with other hospitals, so as far as my legwork this was done. My only problem was that I discovered that this process would take about 12 weeks (!!!) to complete, and was told that their affiliated school's nursing students would take priority in clinical placement before I would. I understood that. So what I ended up doing was extending my travel assignment another 3 months so I could accommodate simultaneous preceptorship and work. It was a success.
I was later informed by mid-summer that I was able to start in late August (after all the nursing students completed their summer externships) and was given the name of my preceptor. She and I got in contact and arranged a schedule around her. The beauty of the 60 hours is that I can complete them in five 12h shifts. I have already completed one shift with her, and tomorrow will be my next. As long as I complete them before I leave (but according to UCSD, complete before the current quarter ends in Dec), I am good. So far, the one shift has demonstrated to me that I am on the right track in choosing this specialty. I really enjoy the dynamic and the fervor of the ED and I am sure I will enjoy working in one in the future.
BTW, I must make mention that I am happy to report that I have ALREADY secured a full-time RN job in an ER back home! This will start 2 weeks after I leave my current assignment. I have been blessed to have gotten a job even before I totally earned the certificate. They were actually impressed that I was pursuing this certificate as it shows that I was committed to ED nursing and that it shows my eagerness for advancement and learning. So even though I have not fully earned the certificate yet, I believe it served the purpose I intended it for, and that makes the cost worth it to me in this competitive environment.
In my next post later on, I will talk about what I have to do paperwise to complete my preceptorship aside from attending the 60 hours.
You're a sucker. Learn to say no. You're going to kill yourself with that kind of schedule. Is it worth your health to work like that? No, it's not. Keep working like that and you only have yourself to blame for the consequences. The 'nice' money you're earning will all go to pay for your medical bills later on when your body gives out by the time you're 30. And what life do you have working so much without any free time to enjoy yourself?
Think about what you're doing to yourself.
My first job was on a med/tele unit with an inordinate number of patients with heavy psych co-morbidities. We were not an official med psych unit per se, but it turns out we were a dumping ground for these kind of patients because other med surg units refused to take them. Found out some of the doctors at the hospital nicknamed our unit "The Abyss" because of our reputation. It took a toll on the staff, working with these patients was tough and naturally the turnover was incredibly high.
Age is just a number. It should reflect physical and mental capability. Some 60 year olds still run circles around 20 somethings.
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