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strawberryluv, BSN, RN 10,075 Views

Joined: Oct 8, '09; Posts: 720 (32% Liked) ; Likes: 416
from US
Specialty: LTC

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  • Sep 13 '17

    Here is the most up-to-date HRSA resource on HPSAs (shortage areas) for mental health and primary care:
    HRSA Data Warehouse – Shortage Areas

  • Sep 13 '17

    As a Bay Area resident, I'm surprised to see Alameda County on the list. There is a huge RN surplus in the entire Bay Area but if you account for specific specialty experience, there are specific specialties that likely have openings. NP market is different, however, I can see a need for primary care in parts of Alameda County.

  • Sep 9 '17


    1. Payne is also a Paramedic and was placed on leave by his EMS employer (as well as PD).

    2. Lt Douchbag (watch commander who told Payne to arrest then showed up at the hospital to berate a handcuffed Nurse Alex) is also on paid administrative leave.

  • Jul 19 '17

    FORMER patient. I see no policies stating this is an issue. I also had a nursing instructor who married one of her patients! It upsets me that there is a blanket policy on all of this. No authority can dictate my life. As for my professionalism, I am a highly respected nurse in my field and work with great compassion and competency. The fact that all of you are so disgusted makes me question your stigma. If it was a patient arrived to the ER with a broken arm and the same situation transpired, I doubt you would all have the same take on this. Right now, I'm saddened to think I work with people such as all of you.

  • Jul 19 '17

    Shonda Rhimes? Is that you?

  • Jul 19 '17

    The question isn't location dependent "what is the busiest" nor more subjective "what is the hardest." It was "what is the most technical?"

    I could say sub-specialties in informatics and research nursing are the most technical with the need to be able to program computer code, run the back-end interfaces for patient monitoring equipment, perform advanced statistical analysis, and deal with IRB rules.

    But I assume OP means the most technical bedside role. That would fall to a CVICU/ECMO RN who needs to be proficient in evaluation of more simultaneous continuous wave/numeric readouts, more frequent labs, and more invasive interventions than any specialty, pick a combo of: BIS monitor, hypothermia machine, IABP/Impella/ECMO, dual chamber external pacer, ventilator, CRRT, multiple vasoactives, paralytics, sedation, plus whatever other drips, plus all the other minor technological interventions/tubes/lines/drains.

    But one could argue that a critical care flight RN role is the most technical because much of the above is involved, but with the added technical factor of flight operations which includes confined spaces and altitude and the need for emergency response capability as most services do scene responses so add prehospital scene management and field stabilization/intubation.

    One could also argue wilderness medicine nursing is the most technical because of the massive amount of technical rescue and wilderness travel/equipment skills necessary, plus the physical fitness/survival capability, plus the need to make diagnosis and decisions without advanced diagnostic/monitoring tools/tests.

  • Jul 18 '17

    I would take this question as meaning which fields have the most use of technology and require learning of those particular skills? If that's the case some areas that come to mind include critical care (working with various lines, CRRT, vents, etc), dialysis (although my only experience was a shadow day), and perhaps some OR stuff like being an RNFA? I base that solely due to the additional skills required for those unique specialties. There is probably other specialties that I have no experience with that likely have a high technical aspect to it as well.

  • Mar 16 '17

    I'm not in nursing school yet, but you really need to address your anxiety with a professional.

    There will be exams in all of the options that you listed. Unless you address the issue of your anxiety, you are going to continue to fail.

    I absolutely think you should still pursue your career. You love it and do well clinically. You just need to work with someone to determine the source of your anxiety, how to work through it. I would only consider making a plan of attack AFTER you have done this.

    Also, talk to old professors/advisors at your school. I know you failed out, but maybe they can help you be successful in whatever you choose next. Have you ever taken one of those tests that tells you what kind of learner you are? Did you ever seek help when you first started failing?

    Need to figure out root of the problem before you press on.

  • Nov 13 '16

    1. Donald Trump says that we all have the right to affordable, quality healthcare, and he has a plan, a great plan. For one, I'm super curious about this 'great plan' and I can't wait to see what it is. Mind you, I totally don't think it exists, and I don't think he realizes all the intricacies involved, but I'm looking forward to finding out.

    2. Things will go like they are. Actual poor people, the disabled, and the elderly end up with halfway decent socialized medicine subsidized largely by the middle class. YAY Medicare/Medicaid. We've had this limited socialized healthcare my whole life. By we, I mean this country, because I don't get ****.

    3. Rich people will continue to get whatever healthcare they want, because they can afford it with or without insurance.

    4. The middle class gets poorer by paying for government subsidies that don't actually benefit them, and continues to struggle to afford their medical expenditures all around. The majority of us end up with high deductible health plans that MAY benefit us once we reach our max out of pocket (until you realize that your max out of pocket does not cover prescription drug costs, costs of 'elective procedures', and a bunch of other even more ridiculous things. There is no real max out of pocket. They will let you spend as much as you are willing and/or able to.

    And vent time? Obama said my PCP and GYN yearly check ups and pap smears have to be covered by any plan that I choose. I went to my PCP for the first time in several years. I wasn't sick, but I figured, what the hell, it's free, right? No, his office managed to bill me for a physical as well as a well visit (for the same 20 minute appointment?) so yeah, one of those two got covered, the other didn't, and I still paid over 100 dollars for my yearly visit. My doctor's cash rate is $94. It would have been cheaper for me to lie and tell my PCP that I don't have insurance when I visited his office, and paid the cash rate. Let's all let that one reverberate a little bit.

    Because years ago we made it illegal to turn away a woman in active labor in the Emergency Room, that has somehow spun completely out of control to the point where we are not allowed to turn away any street urchin that stumbles into the ER weekly for their weekly fall/non-cardiac chest pain/dilaudid fix/attention/turkey sandwich, and we are penalized if it's not the BEST DAMN TURKEY SANDWICH they have EVER ENJOYED, WITH A SMILE, and WITHIN 15 minutes of arrival. Our country spends too much on healthcare because we don't know where to draw the line, and we can't support our Nurses and Doctors, the front-line experts if you will, so they practice CYA medicine with a smile. I admitted a patient last night with an 'NSTEMI' (read: anxiety. No bump in enzymes after 12h and 2 sets in ED, no EKG changes). She received a 2 view CXR ($400+) and head CT ($1,200) in Emergency room. She received a 2 day ICU stay (4k/day). She received a cardiac catheterization ($9,200) that was not clinically indicated. She has bullied her way into a MRI for a subacute, incidental finding on her CT scan (neurosurgery said she didn't need an MRI). Anyway, another $1,200. So that's a minimum of $16,000 that this one woman racked up in 2 days. Don't worry, she won't be paying it. The best part? She comes every 2 weeks. So even when she's just turned away from the ER after repeating labs, cxr, and head ct EVERY TWO WEEKS, that's $1,600 for the ER visit plus $1,600 in testing. $3,200 a visit. Multiply that by her average 25 visits over the last year: $80k in unnecessary visits to the ER and SOME of the testing that they do on her every damn time. So even if she only managed to get admitted once this year (and I know it was at least 3 times but now I'm just getting mad) our total tax burden for this one individual is around $100k YEARLY. And there is NOTHING MEDICALLY WRONG WITH HER EXCEPT SHE NEEDS A VALIUM (but doesn't have access to a PCP to give her some). All I want is to see my PCP for 20 minutes once a year, but I pay more to do that than this fine individual. If you'll excuse me now, I need a valium. Or the whole bottle.

  • Oct 28 '16

    LTC has been a good place for me to land, so far. I worked on a busy Med-Surg floor for 4 months after I passed my NCLEX, and I absolutely hated it, to the point where I quit without giving notice. I had 8 total care patients, usually no CNA and supervisors that were unapproachable at best.

    Now I work on a busy rehab floor with anywhere from 11-15 residents. Residents w/total hips, paralysis, chemotherapy, radiation, terminal cancer, on hospice, etc. are the norm. So are PICC lines, nephrostomy tubes, Foley catheters, traches, etc. I love it, not because it's any easier but because I get to know the residents and their families. I have a general idea of what to expect when I come in. Things like new admits, falls and residents needing to be sent can (and usually does) happen during my shift, but it makes my med pass and day-to-day tasks easier when I know the resident and their family. They know what to expect, as well. The work environment is completely different, too: I always have 1 CNA, though usually 2, and even my more "hands off" supervisors will not hesitate to jump in and help out when I'm swamped. Most of them are the types that I can call with any question, no matter how "dumb" it may be, and they'll either have an answer or they'll be able to point me in the right direction of an answer.

    A good floor/unit for a new grad is one that understands that you're a new grad. It kind of sounds like the last place you worked wasn't a great fit for you. Don't be afraid to try out LTC. I've learned more about the human body and nursing in LTC than I did at the hospital, though I still use those 4 months of experience to care for my residents who are there for short term rehab. Keep the things you've learned. Best of luck with your future job!

  • Oct 28 '16

    Home health is the new Med Surg, but working alone.

  • Oct 17 '16

    We genuinely worry and care about our patients that it often consumes us. When a patient codes or expires, we are crushed. I once had a patient who got stuck at least 15 times by various staff members, including physicians, to get IV access. The patient took those sticks like a champ, but I still went home and boo-hooed because I hated to see him go through that. We hurt when our patients hurt.
    To me, this is the root cause of your issues.

    Personally, I do not worry about my patients. I assess them and intervene as I'm able. After that, I accept that things will run their course and I do not fret about it.

    When a patient dies, I generally remains dispassionately detached from the occurrence. I have had a couple of experiences with children that have made me sad and for which I've shed some tears but even then, I keep it at an arm's length... and I am never 'crushed' because I don't let myself care too much about it... because... this is my *job* and my job is to provide nursing care, not to become emotionally connected to what's happening. Sometimes I do begin to care more than I should and I actively nip it in the bud.

    And I certainly do not hurt when my patients hurt, even when we must poke them time and again, or when urology struggles to place a catheter, or difficult intubations, or chest tube insertions, or all the other invasive and painful things that we do to patients in order to treat them.

    I always recognize my role and that is of the professional nurse who is being paid to provide a service, one which I take very seriously and strive to perform at the highest level. My heart is my own and is reserved for my personal life.

    I would encourage you to seek counseling in an effort to learn to separate yourself from your work.

    Nursing is not a calling nor a mission; nursing is a job... and one which will chew you up if you get too close to it.

    Professional detachment...

  • Sep 14 '16

    This is not intended to have you question your choices or for me to one-up anyone. I'd like to share the twists and turns on my nursing path.

    At age 22, I graduated with a liberal arts degree. No jobs. At age 25, I entered a highly-respected ASN program at an urban university.

    Failed first-semester A&P (liberal arts backgrounds don't always translate to strong science study skills). Repeated full A&P course the following summer and rematriculated.

    Earned a D+ in Med-Surg III, and my Peds instructor didn't like me. Sat out a year, got a full-time job as a nursing assistant on a Med-Surg unit in an urban hospital. (Pre the days of CNAs).

    Graduated at age 28, a year later than my cohort. Started working Med-Surg; recruited to ICU within 5 months.

    My hospital had full tuition benefits. At age 33, I switched to 12-hour weekend nights, and entered an RN-MSN program at my previous university. Graduated as a CNS at age 36.

    Spent 2 years working off my obligation to my employer who had no CNS position for me to fill.

    At age 38, started full-time PhD study at a highly-ranked research-intensive university; awarded PhD in Nursing at age 44. Began faculty research and teaching role; continued research with elderly ICU survivors.

    Returned to school to pursue a post-master's NP at age 45. Became an NP, in addition to research and teaching role, at age 47. Love my gero patients!

    Married and raised a family during these years.

    The beauty of Nursing is that you often can bend it and shape it to fit your life circumstances. Was it easy - not always. Has it been interesting - yes and yes. Did my family support my continuing quest for increased knowledge to always provide better and better care for patients - yes. Grumbly at times - yes.

    You want to take life by the horns and do your best to make things happen. If you are passive, life will pass you by.

    Nursing, with all its bumps and bruises, is the BEST profession for those who are inquisitive and feel a call to caring.

    Take it from an old-timer. My family has my back. My patients keep me centered, and my students keep me young.

  • Sep 7 '16

    I am just over here trying to figure out where LTC pays more than ICU...

  • Sep 4 '16

    Hi Nurse Beth,

    I am currently in a hospital leadership position but I'm thinking of leaving this position to pursue a clinical career. After being in nursing administration, I'm not sure that this is the best career path for me. I'm sure many people in nursing administration go through these same challenges. I have about 25-30 more years before I retire, so I thought that now might be a good time to switch over. Any thoughts or insight?

    Dear Not Sure of Career Path,

    Thanks for your great question

    I would say....switch.

    The first and primary reason is that you are unsure. When you are doing what you should be doing, you do not generally feel unsure at the core. You may get tired, experience ups and downs, or have disappointments, but overall you are fulfilled and are at peace.

    Being effective and successful in a role (such as leadership) does not necessarily mean it's your destiny. It means you are multi talented. Many leadership skills are transferable to different roles. Your skills, honed during your leadership time, will help you succeed on a new trajectory.

    The second reason is that you do not want to live with regrets. It’s scary to venture into a new career path because there are no guarantees and none of us know the future. But it’s worse to never try than to try and not succeed. Trying and going for it is succeeding.

    You are smart to be aware of and consider the timing in your career. Essentially by switching tracks, you are starting over and you may have a bit of time/ground/finances to make up- but it's all good in that you bring all your experience to the table in whatever career path you choose.

    One of the awesome things about nursing is the incredible amount of options available. Really, the only thing that limits us is ourselves.

    So spread your wings and fly….and be an inspiration to all of us.

    Best wishes,

    Nurse Beth