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CrazyGoonRN 12,771 Views

Joined Aug 14, '09. Posts: 443 (30% Liked) Likes: 356

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  • Dec 30 '17

    This is just not something we can help you with. Please discuss this with your wife's providers.

  • Jun 18 '17

    I remember the first time I heard about travel nursing. I thought the idea was awesome. Travel around the country and have adventures.

    I also remember the uneasy feeling I had about it. New hospital and jobs every three months? It sounded crazy.

    I wanted to encourage you to try something new in your career as well as some signs that travel nursing might be for you!

    Go have an adventure! It's pretty freaking awesome!


  • May 8 '17

    Quote from klone
    And I bet families of patients going into Med/Surg (or the ICU, or L&D, or OR) feel the same way. I've never met a patient who said "Yes, I TOTALLY want a brand new inexperienced nurse taking care of me!" But yet, new grads can't become experienced nurses without...experience.
    And that is my point - gain the basic experience in a LESS acute area than the ED.
    My family member has had new nurses on med-surg. While I have not been completely comfortable with the situation, I have been able to watch what happened as my family member has not been in a situation that requires critical or emergent nursing and medical care. In the ED there is no time for that; if my family member deteriorates or needs specific care and they need it now, this is not the time for the patient and family member to be hanging around hoping the new nurse will get their act together in time.

  • May 8 '17

    Quote from Rose_Queen
    I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.
    I agree with the OP.

    Regardless of whether people agree on the status of med-surg as a specialty, I think the point is that basic nursing training on a med-surg unit does provide good training in the fundamentals of nursing care that one will use in a number of other units/specialties, and provides a good knowledge base that is applicable to other nursing areas. In the ADN program where I received my clinical training approximately 20 years ago, I completed several clinical rotations on med-surg units: oncology (2 half semester rotations), student work experience, and preceptorship; ortho/neuro (one half semester rotation); general med-surg (one half semester rotation). We provided total care from the second week of classes. Along with patient assessments, and monitoring patients, once we were checked off on skills in skills lab, we could perform those skills in clinicals' with our instructor present for the first time (for certain skills, such as IV meds, we had to have our instructor present whenever we performed the skill throughout the program). We learned how to bathe, move, transfer patients, make occupied beds, and provide incontinence care. We had a chance to work on developing time management, charting, working with other team members, and team leadership. I found everything I learned on my med-surg rotations relevant on all of my other clinical rotations: rehab; L&D; ICU step-down; pediatrics; psych; geriatrics. My med-surg training formed the basis of my nursing training. I was exposed to a large variety of diagnoses and medical problems, and a variety of patient ages.

    Today, it seems as though many nursing students are barely trained to provide hands on nursing care any more. I have read numerous accounts of the lack of clinical training students have received, but I have never really read good explanations for the reasons why nursing training has changed so much. I remember when nurses who were hired into the ER/ICU were mostly experienced nurses. I don't really understand why facilities hire new nurses into specialties such as the ER, when the nurses can't even function at a basic level.

  • May 8 '17

    We have several new grads in our ER. I'm starting to think that most nurses should have at least a year on a more general ward before learning a specialty.

    I'm seeing some clueless mistakes, and lack of basic skill in pt care. That includes things like how to clean a pt and roll and change bedding. Basics about IV med administration, dose calculations, prioritizing, and realities of inpatient care. They have no idea how the rest of the hospital functions.

    On top of that, some of them seem to harbor elitist attitudes, as if they are already big hotshots. Yet, they themselves seem to lack the above mentioned skills.


  • May 2 '17

    So I did some digging and wanted to give a real life exam. I'm single and no dependents, under 30, and a non smoker. I looked into Anthem Blue Cross Blue Shield because they have a national network. The agency I'm speaking with also uses them so it was easier to compare value. My recruiter crunched some numbers based on two available contracts and gave me multiple scenarios for each.

    For vision, dental, and health I'm looking at $455/month out of pocket to have my own plan based on the choices I felt were best for me. There were 21 options for medical, 3 dental, and one vision. The agency will also give me $400/month to have my own insurance. This will be added to the housing stipend so it's tax free (provided it's not over the fed limit for housing in the area). Or an increased $2-3 hourly wage if taking provided housing. So we're looking at $55 out of pocket expense (maybe slightly more or less depending on taxes and overtime with the hourly rate option)

    If I take agency insurance vision/dental/medical, I will pay $110, $190, or $278 per month out of pocket (pretax) depending on the medical plan (only three options here and no choice in dental and vision). Insurance starts on Day 1 as long as paperwork is submitted 5 days before assignment starts. And you're covered for 30 days between assignments (they'll charge you out of your next couple checks). BUT NOTE: Another company I looked at, you're not covered until DAY 90!! So pay attention to this. Also, I'm not how much it would cost to put these plans on COBRA but let's just add $400 to your monthly rate. So $510, $590, or $678 completely out of pocket.

    The biggest differences were deductibles when you'd have to pay out of pocket for the big expenses but it really doesn't seem to matter once I crunch some numbers (I didn't do the lowest cost plan because it doesn't seem comparable to what I picked):

    Personal plan - 3500 deductible, $5700 annual max, 25% coinsurance (meaning how much of the remaining bill you have to pay after deductible, up until you hit the annual max). A outpatient services bill of $2000 will cost $2000. A $1500 ER bill will cost $1500. A hospital admission costing $8000 will cost $4626

    Agency plan Mid cost - $1000 deductible, $6350 annual max, 70% coinsurance (plus additional $500 copay for admission and $200 for ER visit). A outpatient services bill of $2000 will cost $1700. A $1500 ER bill will cost $1410. A hospital admission costing $8000 will cost $6050

    Agency plan highest cost - $700 deductible, $6350 annual max, and 80% coinsurance (plus additional $500 copay for admission and $200 for ER visit). A outpatient services bill of $2000 will cost $1740. A $1500 ER bill will cost $1380. A hospital admission costing $8000 will actually cause you to tap out at your annual max of $6350.

    I think in this case, my own plan makes more sense to me. Obviously, monthly cost could change if companies aren't offering anything in return for carry my own insurance or you change agencies and insurance often. But it's really just preference. I think I'd rather have my own insurance, not have to worry about a waiting periods if switching companies, etc. I also don't want to have to figure out a new network every couple months. Sometime the lowest cost isn't the most important thing.

    But if you're looking to save money monthly, there are other cheaper options. If it looks like if you're facing paying a high deductible, crap probably hit the fan and they all start to balance out in the end. (Sorry if a number or two from my math may be off. But I think the point is clear)

  • May 2 '17

    If you have a tax home (which enables tax free stipends if you work away from home), then you are required to file a resident income tax return in your home state. However, your work state always gets first crack at income taxes, and if your agency is paying you correctly, you will have paid income taxes in your work state. You are also required to file in every state worked (except a few states that do not have income tax).

    While I cannot speak to how Turbotax does with multiple states, the process of doing them yourself is pretty easy. First do your 1040 or have Turbotax do it (FreeTaxUSA online is similar to the Turbotax question process, and is well, free for IRS returns). Then go online, and do each state's non-resident income tax return. They pretty much just flow from your 1040, and the amount of money earned in that state. Do your home state tax return last. It will credit you for taxes paid to those other states.

    Returns are due today (or must be postmarked today if you have to file a paper return)! I did four tax returns a week ago in about two hours (after a couple months procrastinating), so it is doable.

  • May 1 '17

    Quote from sports2245
    I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.
    No. Peripheral edema is NOT a manifestation of both types of heart failure. It is a manifestation of right-sided heart failure.

    Heart failure is a gradual progressive condition. It starts and proceeds as follows:
    1. left-sided heart failure
      • ineffective left ventricular contractile function
        • increased workload and end-diastolic volume enlarge the left ventricle
      • pumping ability of the left ventricle fails, cardiac output falls
        • right ventricle becomes stressed because it's pumping against greater pulmonary vascular resistance and left ventricle pressure
      • blood backs up into left atrium and then into lungs
        • diminished function allows blood to pool in the ventricle and atrium and back up into the pulmonary veins and capillaries
        • rising capillary pressure pushes sodium and water into interstitial spaces
        • fluid in the extremities moves into the systemic circulation
      • Signs and symptoms
        • dyspnea
        • orthopnea
        • paroxysmal nocturnal dyspnea
        • reduced sympathetic stimulation while sleeping
        • pulmonary congestion
        • tachycardia
        • S3
        • S4
        • Cool, pale skin
        • restlessness
    2. right-sided heart failure
      • ineffective right ventricular contractile function
        • stressed right ventricle enlarges with the formation of stretched tissue
      • blood backs up into right atrium and peripheral circulation
        • blood pools in the right ventricle and right atrium
        • backed-up blood also distends the visceral veins
      • patient gains weight and develops peripheral edema
        • rising capillary pressure forces excess fluid from the capillaries into the interstitial space
      • Signs and symptoms
        • jugular vein distention
        • positive hepatojugular reflux
        • hepatomegaly
    3. systolic dysfunction
      • left ventricle can't pump enough blood out to systemic circulation
      • blood backs up into pulmonary circulation and pressure increases in pulmonary venous system
      • cardiac output falls; weakness and fatigue occur
    4. diastolic dysfunction
      • ability of left ventricle to relax and fill during diastole is reduced and stroke volume falls
      • high volumes needed in ventricles to maintain cardiac output
    The above information comes from Pathophysiology: A 2-in-1 Reference for Nurses, pages 182-185.

    Two terms connected with heart failure are preload and afterload. End-diastolic stretch is known as preload; afterload is the stress or tension that develops in the ventricular wall during systole. You need to develop a good understanding of heart failure, preload and afterload and how they all relate because all this information is at the basis of understanding the nursing diagnosis of Decreased Cardiac Output. Students are always asking what nursing diagnosis to use with certain medical diagnoses. Decreased Cardiac Output is used for any of the heart failures including congestive heart failure.

  • Apr 24 '17

    you may visit the georgia board of nursing's website at, click on "application downloads" and choose instructions for out of state applicant fingerprint background check. this will provide clear information regarding the necessary steps to obtain a background check without traveling to the state of georgia.

  • Mar 29 '17

    I did alot of research and sifted through alot of recruiters. I'm now signed up at a grand total of 8 agencies. But I can tell you of that 8 I regularly use only 3. Why? Because I require 3 things. Prompt communication (if I text or email during business hours on a weekday I expect a response in no more than a couple of course), the best pay package, and don't mess up my paycheck. I've found only a few recruiters who can do this for me consistently.

    So no, I don't think you have unrealistic expectations. And my superstar recruiter may seem lackluster to you. It's all very individual. I'd recommend you join some travel nursing facebook groups. They are lively and lots of support for newbies. Try The Gypsy Nurse oNE first.

  • Mar 21 '17

    Tip one: There is no perfect company. There is better and worse.

    Tip two: A lot of your experience depends on the recruiter. If you sign up with recruiter A and there is disconnect between you two, then you can be switched to recruiter B. Usually just takes an email or phone call to their manager. Keep it short as the reason for the switch. MOVE ON, if they will not meet your request.

    Tip three: Sign up with 4 agencies minimal. That means have active profiles ready to go. If you get canceled or terminated you have three other agencies that can possibly cook up something for you quick.

    Big question: What companies should I look into? Depends if you want to fatten the pockets of investors or mom and pops, lol Seriously...

    *Bigger companies are going to have more volume and desirable locations. You know them they invest highly in advertising...Cross Country, Aya and American Mobile. These companies are the main vendor for many hospitals. That means other agencies have to pay them a small percentage. A nurse can work directly with these large companies. Working directly does not mean the RN will get more money. Bigger companies have many different departments you have to deal with.
    *Rapid response companies like Faststaff and Healthsource Global are going to be limited locations and not as desirable. Taxable hourly is a high rate and the two listed will provide housing. Blue Force and Cru 48 will seldom provide housing.
    (Rapid Response means a nurse can start in 1-2 weeks. Critical emergent needs of the hospital.)
    *Smaller agencies might be limited to just 1-2 states but, they have less overhead cost. Less overhead means more money for the RN..

    **Ask some of the mid size or smaller agencies do they have direct contracts through the hospital. This usually means more money for you the RN.

    For those who have traveled please chime in why you work with XZY company.

  • Mar 15 '17

    One hour to never! It would be reasonable to give up after 3/4 days and broaden your search. Try to follow up and find out what the problem is (usually hospital HR in most cases) because it is possible there is something in your profile that makes you unqualified for the position submitted, or some negative they didn't like. Once in a while, you get useful intel from your failures.

  • Mar 14 '17

    You know, Karen, I was typing my response and one thought kept crossing my mind. Since my colleagues have done such a fabulous job already, I have chose not to defend my career choice against your inaccurate statements and just post the one thought.

    If you are so anti-traveler, why are you lurking in a travelers forum.

    As a side note, maybe you could use that time and put it to good use, like actually educating yourself on the facts that accompany traveling.

  • Mar 14 '17

    Also, we dont see the money that hospitals "shell out" for us. We dont make that much more. We dont get vacation pay, sick days or even 100% paid benefits. We go sometimes months without seeing our friends and family. So when you get "sick and tired of paying these high fees", just remember what we give up and live without just to help in your staffing crisis!

  • Mar 14 '17

    John Hopkins is notorious for cancelling travel contracts. I did not get cancelled when I worked there but about 4 travel nurses were cancelled the same time that I started. And I know that someone got on about not talking about the " nurses attitudes" but it is because of these staff nurses that some of these nurses were cancelled.
    Just a word of advice ANYWHERE you go, document, document, document. And I am not talking about regular chart documentation.
    Document on their procedures (if it is something different than you are used to) and who told you and the date.
    I work with Open Heart patients, in one hospital a nurse orienting me told me that they do not check potassium levels on day 2 even if the pt has a couple of PVCs on the monitor. I wrote it in my little book that I carry every where I go along with her name and the date that she told me. Guess what, when she realized that I was writing down her name she re-canted what she said. Once these staff nurses see that you are knowledgeable about your stuff, they will just respect you.

    Even recently, I received a patient who was in recent Afib and the resident decided to stop the amiodarone drip. Mind you, the pt was still in Afib. I mentioned this to her about 3 times in 30 mins. and she adamantly told me that she doesn't want the pt on the drip. Well, I charted on the patient's chart the number of times that the MD was made aware. I also told the charge nurse and made it known to the supervisor. People may think that I may have gone overboard but guess what, I am here for my patients and mind you my pt was finally put back on the drip and broke the Afib 2 hours after. And the attending came in the morning abd read my notes and thanked me for taking care of his patient.

    Just remember you have to be on top of your game as a travel nurse