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txrn13 2,688 Views

Joined: Dec 1, '10; Posts: 68 (4% Liked) ; Likes: 9
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  • Mar 9 '13

    Oh no! Are they giving you a decent severance package? You will be eligible for unemployment also... be sure to file right away. Your HR folks can guide you through the process.

    Been There, Done That - it's no fun at all.

    I would recommend

    See if your current employer will add you to the PRN roster. It's better than nothing, and they already know you're a good nurse.

    Sign up with all the local PRN registries. Be very flexible in accepting assignments.

    Cut all unnecessary expenses immediately. Be pro-active about notifying creditors about your situation before you get in trouble... many of them will work with you to prevent damage to your credit rating. Explore options to reduce rent/mortgage - including adding room-mates.

    Hopefully, you'll find something quickly and in a couple of months, this will all be just a bad memory

  • Mar 6 '13

    I don't think it is about looks. We too have hired alot of young, female, smaller build nurses. The turn over rate in hospital is huge, what nurse in their right mind would actually WANT to go back to bedside nursing?? A nurse in their 40-50's has probably figured it out and has been at the bedside and wants to be done at the bedside. So they leave it up to the young ones who need to figure that out, and need to gain experience before going anywhere else.

    Oh trust me, i've heard our experiened staff joke around with things and let me tell you, it actually hurts. They all crack jokes about how it should now be a requirement that "You are under 30 years old, slim with brown hair and a bubbly personality." I fall under that category of "Slim, young, brown hair" not an idiot. but the question i have for them is, do you ever think to look beyond that?? How about the fact i graduated with a 3.7GPA and made the deans list 4 years running. how about the fact i worked nights as a CNA while attending nursing school? How about the fact i have worked my butt off getting certifications in things you probably never heard of. How about the fact that my computer skills are far more superior than the 50 year old they just interviewed that can hardly even type? Look BEYOND the surface of these people.
    Yes, i think hospitals are hiring young, new grads because the are cheaper. It's a smart business move. if i were running a business and had to pick between a 55 year old with a great personality, 25+ years of experience and wanting $30.00 an hour and a 24 year old with 2 years experinece with a great personality and wanting $24.00 an hour...i would choose the 24 year old. The hosptial wants great satisfaction scores. A Patient really isn't going to care how much experience their nurse has (to a certain degree). Their satisfaction scores come from a smily face, a good personality, friendly nurses, good customer service etc. I've never heard a patient give a hospital a low satisfaction score because "My nurse only had 2 years of experience." So the way hospitals are shifting now days...experience really doesn't matter. I can do the same exact tasks as any nurse on my floor.

    Im 24 years old, and i am already training to be charge nurse...i have an orientee with me that has a daughter 1 year old than me. Sure, she has admitted to feeling a little uncomfortable with me being her superior. She has stated once she got to know me that has changed. She has taken me seriously.

    yea i do feel a little offended beause people judge all these newbies coming in. Look beyond that, get to know them. No i do NOT have my smart phone out all the time. I am professional when i am at work. yes ill pull it out on my break...because that is my BREAK, that is my time for me to be me and do want i want to do for 30 minutes. So yea...all in all, i have to say hospitals are making a smart BUSINESS move by hiring young, new and eager nurses to work the floors. They are cheaper and can do the same exact thing as any other nurse on the floor. I'm probably repeating myself a lot but think about it...

  • Mar 4 '13

    The first year of nursing is, in countless cases, also one of the most challenging years of a nurse's career because many different events are taking place.

    First of all, a significant number of newer nurses are acquiring the procedural skills that they did not fully cover in their nursing school clinical rotations, especially if one is immediately transitioning into a highly specialized area as a first healthcare job. Secondly, aspects of the 'real world' of nursing may clash with the idealized 'textbook version' of nursing. Third, it simply takes time for a newer nurse with less than one year of experience to find one's groove in the workplace and develop a comfort zone.

    Finally, untold numbers of new nurses have been pumped with the often paralyzing fear of the consequences that might result from mistakes. The fear of causing profound harm to a patient comes to mind. Also, the fear of action being taken against one's nursing license is frequently mentioned as a source of worry. "I'm afraid of losing my license" is an immensely common phrase.

    Moreover, some nurses live with the fear of someone personally filing a lawsuit against them. For instance, several years ago a new grad administered a deep intramuscular injection of promethazine (Phenergan) to the left arm when the patient had requested for the medication to be injected into the right arm. Later on during the shift the nurse was asking, "Can I get sued for giving it in the wrong arm?"

    In instances like the aforementioned scenario, knowledge is power. A little knowledge about legal issues in nursing can go a long way to alleviate many worries. As a general rule of thumb, unless the patient is irreparably injured or dead as a result of something the nurse has done (or failed to do), it is highly unlikely that the event is lawsuit material. Patients and families sometimes say the words "I'm going to sue you" to nurses as an intimidation tactic, and they do have the right to pursue legal action.

    However, they would first need to find a medical malpractice attorney who would be willing to take the case. And, as long as the proper injection technique was used and no harm resulted, most lawyers in existence would not waste the time on a case that involved giving an injection to the supposedly 'wrong' arm.

    I advise all nurses to take a course in nursing and the law to become reassured regarding the types of events that patients and families can and cannot sue for. A patient or family member must have a cause of action in order to sue you. And if you have not been found guilty of a tort (civil wrong), then any action to sue you would most likely be dismissed if it was filed. Generally, personal injury suits are extremely risky and very expensive for medical malpractice attorneys, so they typically do not take the case unless there is a clear cause of action (read: irreparable harm or death) and a large amount of monetary recovery is likely.

    In this litigious day and age, nurses can be individually named in lawsuits. However, physicians pay tens of thousands of dollars in premiums for medical malpractice policies, while nurses usually pay in the range of $100 yearly. The physician pays more because (s)he is more likely to be sued than the nurse.

    What is the point of all of this? Take a deep breath, practice safely, consider the ethical implications of everything you do, stay within your scope, ask for help when needed, don't allow anyone to intimidate you, and keep on learning about the wonderful art and science of nursing. Sometimes the words "I am going to sue" might be an everyday part of a person's vocabulary, even if he knows little about the process of suing.

  • Mar 4 '13

    Like others have said neither is better than the other. ED and ICU are two totally different beasts. I've tried to work in CVICU and ED and neither was a good fit for me. I'm not a person that handles unpredictability and that kind of stress well. In your case, you seem like you have the personality for both. ICU is challenging, you will be required to look at the whole picture rather then chief complaint. You will be managing very sick patients on mulitiple drips, vents, catheters, and drains. ICU is very intense. You can have 1-3 patients and sometimes your patients do become unpredictable and you have to fix it.
    ED is fast paced and all about "moving the meat". The patient either goes home, to the morgue or to the floors. You will have all different ages and people come through the door. How are you will babies/kids/ and the elderly? How do you feel about the homeless, drug seekers and alcholics? How about women in labor or pediatric clients. In the ED you are in all in one and will see it all. Many times ED nurses see all the things people who work the floors don't see because many patients are discharge from the ED. The ED requires thinking on your feet, good IV skills, able to keep calm in the storm. You will be challenged but just in a different way than ICU. Your main goal for the ICU patient is to stabalize them and get them to the ICU ASAP so that the ICU nurses and intensavists can develop a more indepth plan of care.
    You will laugh alot in the ED, and it is never a dull moment. The ICU is more intense and more quiet but hopefully you will have supportive co-workers through it all.
    Perhaps trauma ICU after you get ICU experience will be an option. Best of both worlds?Maybe.
    Ask for a share day in both to help you make a more informed decision.
    Good luck to you. Let us know what you choose!!!

  • Mar 4 '13

    OK - First enculturation lesson. We never refer to the "western area of Texas" - it is "West Texas". (we don't use '-ern' to indicate any area of the state) - LOL. Second lesson: 1 person = you, 2-3 people = y'all, > 3 people = all y'all. Now you're good to go.

    Houston metro area is always in need of experienced critical care nurses. Do you have a BSN? If not, I would strongly recommend that you get your CCRN. I am not familiar with relocation policies for travel nurses, but I don't believe that they will transport your home furnishings & housing arrangements are usually for short term only. Contracts may also have stipulations against accepting permanent positions with the travel client for a period of time. It's probably better to do your own job search.

    The Woodlands is great, but you will be faced with a horrendous commute if you are working anywhere outside the Woodlands. If the school district is important, you will probably want to take a look at this - . And if you want to get demographics on areas of the city, this is a great site Houston TX Real Estate Information - NeighborhoodScout

    I love Houston, but we have a lot of 'unique' issues when you are looking to invest in a home. Be sure to work with a very experienced realtor to make sure you aren't surprised. Evacuation zones, flood district classification, MUD taxes dictatorial HOAs - all potential minefields.

    Houston is only an hour from the beach. You need to review mandatory (hurricane) evacuation zones before deciding to live closer. Insurance costs can be daunting for higher risk zones. Hurricane Evacuation

  • Mar 3 '13

    Healthgrades names 2013's top hospitals

    Recognizes top cities for patient care

    DENVER | February 20, 2013

    A new report released Feb. 19 recognizes the nation's best hospitals for 2013 in addition to top cities in the United States for hospital care based on in-hospital mortality rates. Dayton, Ohio; Phoenix; and Milwaukee came out on top, all seeing mortality rates less than 5 percent.

    Also among the top cities for hospital care, when taking into account the risk-adjusted in-hospital mortality rates, were Cincinnati, Deltona/Daytona Beach, Fla., Salt Lake City, Minneapolis, Indianapolis, Detroit and Rochester, Minn.

    The report, "America's Best Hospitals 2013: Navigating Variability in Hospital Quality," conducted by Healthgrades, showed some states came up empty handed with the best hospital awards, including Alaska, Alabama, Arkansas, Delaware, Hawaii, Nevada, Oklahoma, Oregon, Vermont and West Virginia. Moreover, many states that have been consistently recognized for having the top hospitals in the nation - such as Massachusetts, home of Massachusetts General Hospital and Brigham and Women's, and Washington, home of the University of Washington Medical Center - also did not make the cut.

    By contrast, Florida (13 hospitals recognized); Ohio; Michigan; and California (all with nine hospitals recognized) walked away with the most awards. "The America's Best Hospitals distinction provides a measure of confidence for consumers," said Evan Marks, executive vice president, Informatics and Strategy, Healthgrades, in a statement. "Each hospital's exceptional performance reflects a dedication and approach to quality which has been evidenced across the organization and has been demonstrated consistently in terms of superior clinical outcomes." According to report officials, if all hospitals analyzed in the report performed at the level of the top hospitals, up to 165,000 lives could have been saved.

    Below is Healthgrades 2013 list of top hospitals in the nation:

    Hospital City State
    Mayo Clinic Hospital Phoenix AZ
    Hoag Memorial Hospital Presbyterian Newport Beach CA
    Huntington Memorial Hospital Pasadena CA
    Saddleback Memorial Medical Center - Laguna Hills Laguna Hills CA
    Saddleback Memorial Medical Center San Clemente San Clemente CA
    Saint John's Health Center Santa Monica CA
    Saint Vincent Medical Center Los Angeles CA
    Scripps Mercy Hospital San Diego CA
    John Muir Medical Center - Walnut Creek Walnut Creek CA
    Peninsula Medical Center Burlingame CA
    Mills Health Center San Mateo CA
    Sequoia Hospital Redwood City CA
    Penrose St. Francis Health Services Colorado Springs CO
    Saint Francis Medical Center Colorado Springs CO
    North Colorado Medical Center Greeley CO
    Hartford Hospital Hartford CT
    Middlesex Hospital Middletown CT
    Lee Memorial Hospital Fort Myers FL
    HealthPark MC / Lee Memorial Fort Myers FL
    Florida Hospital Fish Memorial Orange City FL
    Boca Raton Regional Hospital Boca Raton FL
    Cleveland Clinic Florida Weston FL
    Delray Medical Center Delray Beach FL
    Jupiter Medical Center Jupiter FL
    Kendall Regional Medical Center Miami FL
    Sarasota Memorial Hospital Sarasota FL
    Munroe Regional Medical Center Ocala FL
    Martin Memorial Medical Center Stuart FL
    Martin Memorial Hospital South Stuart FL
    Sebastian River Medical Center Sebastian FL
    Piedmont Fayette Hospital Fayetteville GA
    Piedmont Hospital Atlanta GA
    Northeast Georgia Medical Center Gainesville GA
    Houston Medical Center Warner Robins GA
    Mercy Medical Center - Cedar Rapids Cedar Rapids IA
    Saint Luke's Hospital Cedar Rapids IA
    Advocate Good Samaritan Hospital Downers Grove IL
    Alexian Brothers Medical Center Elk Grove Village IL
    Ingalls Memorial Hospital Harvey IL
    Palos Community Hospital Palos Heights IL
    Provena Saint Joseph Medical Center Joliet IL
    Saint Alexius Medical Center Hoffman Estates IL
    Skokie Hospital Skokie IL
    Community Hospital Munster IN
    Indiana University Health Methodist Hospital Indianapolis IN
    Indiana University Health University Hospital Indianapolis IN
    St. Vincent Indianapolis Hospital Indianapolis IN
    St. Vincent Women's Hospital Indianapolis IN
    Via Christi Hospital Wichita KS
    St. Elizabeth Edgewood Edgewood KY
    Owensboro Medical Health System Owensboro KY
    Ochsner Medical Center New Orleans LA
    Ochsner Medical Center - Westbank Gretna LA
    MedStar Franklin Square Hospital Center Baltimore MD
    MedStar Good Samaritan Hospital Baltimore MD
    Greater Baltimore Medical Center Baltimore MD
    MedStar Harbor Hospital Baltimore MD
    Saint Joseph Medical Center Towson MD
    Beaumont Hospital - Troy Troy MI
    Providence Hospital Southfield MI
    Saint Mary Mercy Hospital Livonia MI
    Spectrum Health Butterworth Hospital Grand Rapids MI
    Spectrum Health Blodgett Hospital Grand Rapids MI
    Holland Hospital Holland MI
    Allegiance Health Jackson MI
    Bronson Methodist Hospital Kalamazoo MI
    Munson Medical Center Traverse City MI
    Saint Luke's Hospital Duluth MN
    North Memorial Robbinsdale MN
    Skaggs Regional Medical Center Branson MO
    Boone Hospital Center Columbia MO
    Missouri Baptist Medical Center Saint Louis MO
    St. Luke's Hospital Chesterfield MO
    Benefis Health System Great Falls MT
    Rex Hospital Raleigh NC
    BryanLGH Medical Center East Lincoln NE
    BryanLGH Medical Center West Lincoln NE
    Community Medical Center Toms River NJ
    Hackensack University Medical Center Hackensack NJ
    Albany Medical Center Hospital Albany NY
    Maimonides Medical Center Brooklyn NY
    New York - Presbyterian Hospital New York NY
    New York - Presbyterian Hospital / Allen Pavillion New York - Presbyterian Hospital / Columbia University Medical Center New York NY
    Akron General Medical Center Akron OH
    Aultman Hospital Canton OH
    Bethesda North Hospital Cincinnati OH
    Christ Hospital Cincinnati OH
    EMH Elyria Medical Center Elyria OH
    Hillcrest Hospital Mayfield Heights OH
    Marymount Hospital Garfield Heights OH
    South Pointe Hospital Warrensville Heights OH
    Grandview Medical Center Dayton OH
    Lehigh Valley Hospital Allentown PA
    Hamot Medical Center Erie PA
    Lancaster General Hospital Lancaster PA
    Alle Kiski Medical Center Natrona Heights PA
    The Western Pennsylvania Hospital - Forbes Regional Campus Monroeville PA
    Anmed Health Anderson SC
    Memorial Healthcare System Chattanooga TN
    Saint Thomas Hospital Nashville TN
    Memorial Hermann Healthcare System - Southwest Houston TX
    Memorial Hermann Northwest Hospital Houston TX
    Memorial Hermann Southeast Hospital Memorial Houston TX
    Hermann The Woodlands Hospital The Woodlands TX
    The Methodist Hospital Houston TX
    Diagnostic Center Hospital Houston TX
    Mother Frances Hospital - Tyler Tyler TX
    Intermountain Medical Center Murray UT
    Bon Secours Memorial Regional Medical Center Mechanicsville VA
    Henrico Doctors' Hospital Richmond VA
    Parham Doctors' Hospital Richmond VA
    Retreat Doctors' Hospital Richmond VA
    Augusta Health Fishersville VA
    Gundersen Lutheran Medical Center La Crosse WI
    Aurora Saint Luke's Medical Center Milwaukee WI
    Saint Luke's Medical Center Cudahy WI
    Aurora Sinai Medical Center Milwaukee WI
    West Allis Memorial Hospital West Allis WI


  • Feb 23 '13

    Hmm - so are you going to ignore the increasing amount of research that links > BSN% staff with better patient outcomes? (American Association of Colleges of Nursing | Creating a More Highly Qualified Nursing Workforce) I realize that this is an emotional issue for some, but critical thinking should not stop at the bedside.

  • Feb 23 '13

    I have a BSN and my program had no prereqs- I entered college directly out of high school. I also never once took a gym class in college and took several psych classes (adolescent and child which are completely relevant to me as a pediatric nurse). I also took several years of Spanish and use it regularly working in a major city with a large Hispanic population. Never took a baking class either nor have I ever heard of one offered at a university.

  • Feb 23 '13

    Wow... Bitter much?? I'm sorry - but I'm tired of people trying to dumb down the BSN. How can more education be a bad thing?? Do I think having a BSN makes me a better nurse than an ADN? NO! I was trained by an AMAZING ADN preceptor & work alongside many fantastic ADN nurses. But am I proud of earning my bachelor degree? HELL YES! It makes me angry that this is always such a hot topic for debate. Why judge someone for continuing their own education? And for the record - it was not just "an extra PE class" that earned me that degree! That's just an ignorant statement to make & it's offensive. I have yet to hear a BSN nurse make derogatory comments toward ADN nurses...because quite honestly, I don't believe that most BSN nurses consider it an issue, but damned if I don't constantly see a new thread on AN nearly every week bashing nurses who went for their BSN. It's all so petty and not conducive to the work environment at all! Sorry to come across harsh - it's just frustrating to be made to feel like I need to constantly defend my hard earned degree. I am proud of it, just as an ADN should be proud of theirs.

  • Feb 19 '13

    I am in the same position.

    I had an interview this Tuesday, but it has only been 3 days.

    They let me know that they will be notifying me next week, so it is a waiting game.

    It's nerve wrecking definitely. I have done the same as you, sent a Thank you letter with very high hopes.

    My suggestion is to just wait. They maybe still interviewing, and finalizing things so one day passed the date they told you they would reach you, is okay. Keep applying to other places, and keep hoping for the best.

    I'm praying that after this last interview , this hospital is the one for me..... If not, I know that possibly there is a better one out there for me. Just staying optimistic.


  • Feb 19 '13

    It is perfectly appropriate to call the other recruiter and say, "I interviewed with you in November, and was wondering if you had made a decision yet. I've received another offer, but I really would like to work for your institution. Could you tell me where you are in the selection process?"

    You'll be told: we're still interviewing, we chose someone else, might help speed them up and come to a decision.

    .What it won't do is, is anger them. Go for it.

  • Feb 19 '13

    you do not have a job offer until you have an orientation start date AND a signed letter from HR with your signature, thier diectors's signature stating job title, salary, and start date. Anything else is just empty words. My advice is to say nothing, continue to interview as if you don't have a job which at the moment you do not because where's your paycheck. After you get an offer letter from a company then you can decide ... and when one is a choice of solid offer vs. tentative offer at better company always take the solid one. It makes no sense to turn down cash for something that may not go through because then you would be left without a job. good luck

  • Feb 7 '13

    how to start an iv while sweaty and on a screaming patient

    how to start an iv upside down...

    how to convince someone to look at my patient who is crumping

    what crumping means (and also what it looks like)

    the phone extension for security

    and when to call security...

    how to spot the fakers...

    how to fake out the fakers...

    how to develop a thick enough skin to be part of the most hated/complained about dept in the whole building...

    what nursing judgment means (and that's all i am gonna say)

    (been in the ER for 8 months and still love it!)

  • Feb 7 '13

    It is absolutely a completely different environment with completely different priorities. I have precepted some nurses who have come to the ED from other specialties. Some suggestions:

    Focus your assessments on the chief complaint. If it's an ambulatory asthmatic having an exacerbation, it's not important what their feet or their backside look like ... just CXR, steroids, neb tx ... disposition.

    You can assess & get history & screening questions while starting a line & getting labs.

    Food & drinks are now optional and only for those patients who have a diagnosis, disposition, and are not NPO ... so take that out of your vocabulary.

    Never waste an opportunity to obtain bodily fluids, ha ha. Ambulatory patient asks where the rest room is? "Here, let me give you a cup just in case we need a urine specimen at some point."

    It takes a little time to adjust from the "this is my team of patients for the day" mindset to the revolving door of the ED.

    And ask your preceptor(s) for specifics on areas in which you can improve -- this demonstrates your willingness to accept constructive feedback and ensures that they have an opportunity to meaningfully contribute to your progress.

    Welcome to the dark side ... keep us updated on how you're doing!

  • Feb 7 '13

    I agree with the previous poster. I establish a baseline for my patient when my shift starts and yes focus assessment based on the chief complaint. Speak to the CC and the outcomes of your interventions. Always collect bodily fluids when possible. Be a forward thinker. If you have a chest pain pt you know they need a line, labs, EKG, 02 and put on the monitor. A nausea, vomiting pt your focus is gonna be GI. The pt will be NPO and need fluids. A female of childbearing age will need a urine pregnancy test (ALWAYS). If you can anticipate the needs it will make your life a little easier. When you know a pt is being admitted start on what needs to be done before the patient goes to the floor. MRSA swab, med rec or whatever your hospital protocol is. I have been a nurse for 1.5 years and I came from a med-surg/stepdown unit to the ER. Time management was a struggle for me as well initially but with time it will get better trust me. Best wishes!!