Content That NRSKarenRN Likes

Content That NRSKarenRN Likes

NRSKarenRN, BSN, RN Moderator 101,177 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,224 (22% Liked) Likes: 13,104

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  • May 20

    Quote from srercg
    I don't think it looks "desperate and pushy" . IN a competitive market - you pretty much HAVE to go the extra mile, keep applying for the more coveted positions - managers are used to that.

    The only time an applicant is seen as a nag - that I can think of - is if they have reviewed the resume', and called the applicants manager - gotten some negative info about that nurse - and until the NM does the professional thing and replies to the applicant and explains about their decision not to hire - they are going to be "nagged" by the applicant.

    NM - if there is some reason why they do not want to hire an applicant - and the applicant is continually applying - should be making a call to the applicant to explain "We received your resume, however, in looking into your employment history there were some negative considerations, and so we have decided that you are not a good fit for our unit." or something to that effect letting the applicant know - they do not want to hire that individual so they stop applying.

    Contrary to popular belief - or what is supposed to happen - not all mgrs. will go back 6 months and look at really old resumes/applications because too many will have outdated info, outdated contacts, already have jobs and won't hire someone that would leave a new job in only 6 months - .....they will look at more recently received apps-they don't have a lot of time to waste - so yes, it is beneficial to keep on your target so your are in the right place at the right time.
    Oh wow. As a Nurse Manager and a Director I don't have the time to go through and call every single applicant and discuss why I didn't select them. The applications that I don't select are sent the form letter from the application management system.

    Let's talk about the application management system...I have used Taleo and HiringManager. In both of those systems once the position is filled, I can no longer see the applications or resumes. They are gone. When a new position is posted, I assume only new applicants are sent to me. I don't believe that HR goes back through the older applications that were not selected the first time and re-sends them to me via the system. (I could be wrong here) So...apply every time.

    I oversee Labor and Delivery, Postpartum and NICU. I typically want the path to NICU to be via Postpartum, Peds, PICU, and ICU. I will hire people who have postpartum experience because they have normal newborn experience. Peds and PICU are in the ballpark. ICU has critical care skills. It is very difficult to come to a NICU without having experience in one of those areas. I would attempt to transfer to one of those areas first.

    Most organizations have email with a global email address book. If you know that NM email...send her a quick email outlining your interest to eventually work in the NICU and ask what her preferred path to NICU would be. Attempt to meet with her or call her. Don't be pushy...but I like the initiative it shows when someone takes that extra bit of effort. Just my opinion and experience.

  • May 12

    Quote from Lemon Bars
    Money is the main answer to why I don't remain a scribe, though intellectual and career growth are also part of it. Where I work medical assistants and scribes make $12 to $14 an hour with zero advancement opportunities. That's just not enough money.
    I entered nursing for the pay, advancement opportunities, flexibility, career mobility, and educational progression. So far I've reaped all of these benefits from my nursing career and have no regrets.

  • May 11

    Here is my two cents and why I think that parents coming into nursing care need a course in how things run from experienced parents.

    If you want nurses to do something non-technical (and possibly not a service required to be offered by the agency) like fold laundry and you don't like the way they do it, you have three options. You can show them how you like, you can not give them the laundry to fold or you can deal with it because it means your child was stable enough that the nurse actually had 10 minutes of down time to fold laundry.

    If you don't like the sheet selection by a nurse and you know that sheet changing day is today, then go in to the linen closet and pick out the set of sheets you want used. It's not complicated.

  • May 11

    I remember when my mother in law was dying of cancer at the age of 58. Her breast cancer had spread to her spine, leaving her unable to walk. Her husband was on the waiting list for a double lung transplant. Even with his horrible health, he tried to work at his small business every day. Because the children lived out of town/out of state, my MIL needed a nurse at least 12 hours a day for the first 3 months after her diagnosis. The last two months required 24/7 care. They spent every dime they had on good nursing care, and my husband and his sister lost their inheritance to pay for that care. It was worth every penny.
    There was an issue of a certain nurse who didn't want to do light laundry and light house work. When calling agencies to find a perfect fit, my father in law made sure he explained how great his need was (waiting for lungs and very ill himself), and that his wife was in a wheelchair, had cancer etc. They assured him that their nurses do light chores and laundry after all patient care has been done. Well...this particular nurse didn't just NOT do those things, she was rude and ugly about it. She also left my wheelchair bound MIL alone for about 5 hours because she was asked to start the dishwasher. Needless to say, the agency fired her.
    It can not be stated enough...know the terms of service. People assume too much about nurses and the agencies that send them out. Ask questions and be clear. And most importantly, if the patient or the nurse find themselves at an impass, stay classy.

  • May 11

    Quote from systoly
    just to throw something out there

    doing pt.'s laundry is not on the 485
    helpful nurse does pt.'s laundry
    washer breaks down
    family wants agency to replace washer

    too far fetched?
    Not has happened & the agency was none too thrilled as it was a $1000 front loading washer that was relatively new!!!!!

    Fortunately my cases are limited to put dirty clothing/bedding in laundry basket or laundry room. Perhaps soak stains or apply stain remover as needed. I have one case where nurses have been specifically asked to NOT fold or put away laundry as one over zealous colleague decided to rearrange/reorganize the child's dresser and mom could not find anything when trying to get client ready for school in AM. Parents were NOT amused. (Apparently nurse was bored. Moms answer was "bring a book" leave my home alone. ).

    I did wipe down my clients wheel chair yesterday at parents request while the client was playing next to me. I was shocked at the amount of crumbs and junk stuck in a chair of a kiddo that eats next to nothing by mouth!!! This I put in the same category as wiping down a nebulizer or feeding pump, cleaning out syringes or suction, cleaning a MDI spacer etc.

  • May 11

    I've always done my patient's laundry at night on home care cases. Why? To be helpful to my families, to relieve even a tiny bit of the crushing burden that comes with having a ventilator dependent child, and to give me something to do at night and break up the monotony of night shift, and because it needs to be done.

    No, I'm not a maid. And yes, I am an RN with a master's and board certified in critical care and peds.

    I consider nothing that my patient needs 'beneath' me. When I became a nurse, I understood that it's not all about me- it's about them.

    And besides, it's not like they are asking me to beat the clothes with a rock down by the river, it is loading a washer, moving the clothes to the dryer. A maximum of ten minutes actual work per load. I don't think it should be that big a deal.

  • May 11

    Tell them you're highly interested in learning how to be the best ICU nurse you can be and your long term goal is to learn to be a charge nurse, implement new evidenced based changes on the unit with the managers approval, become a leader in the nursing community, become certified and proficient on CRRT, IABP, Rotoprone beds, CABG, hypothermia protocols, ventricular drains, etc and obtain your CCRN, ACLS, PALS, etc. Tell them you look forward to precepting new grads and new orientee's to the unit once you've obtained enough experience and proven your skill to do so. Tell them you want to be a standout at bedside procedures with the intensivist and pulmonologists (so they'll eventually write you impressive glowing letters of recommendation). Tell the managers you'll be interested in working full time and picking up as much overtime as they'll let you (because you're trying to put away at least $100,000 in a savings account).

    Then leave and go to CRNA school.

    The funny thing, coming from a guy who just got accepted into a CRNA DNP program, is that everything I just listed is what you're going to need to do and then some to be competitive for CRNA school. So just go ahead and make the managers day and tell them you'll do all these things, because they will love it. They don't have to know that the reason you're going to be a superstar ICU nurse is because you're aspiring to get into CRNA school. They already know most of their employees are either trying to get into CRNA school or toying around with the idea and trying to get up the nerve to try it. They also know a huge percentage of those who don't get into CRNA school or decide that it's more intense than they want to do will just go to CRNP school instead and leave anyway.

    The ICU is a revolving door of bright nurses willing to work hard and learn hard to broaden their horizons and nursing skills. It's often used as a stepping stone and rarely do people stay in it as a bedside nurse for their entire career. Almost all the nurses I know who stay long term in the unit into their older age become "charge nurse" or "sepsis nurse" or "rapid response nurse" roles that don't take patients and mostly just walk around overseeing everybody else.

    Plan that your journey to get into CRNA school will take 5 years anyway. It's safer to plan realistically and be surprised if you get it done within 3 to 4 years instead of 5<.

    Not to mention that a huge percentage of my fellow new grads who started in the ICU with me who all said we would go to CRNA school did in fact change their mind, or actually life changed their mind for them. Actually 4 years later I'm the only one starting CRNA school.

    I hope this helps and good luck on your journey, enjoy the process!

  • May 11

    I would "put a positive spin" on the situation as much as possible by finding a middle ground between "shooting yourself in the foot" by telling them you are looking for temporary employment only ... and lying by saying you want to work for them forever.

    The reality is that you have not yet been accepted in CRNA school -- and may never actually go to CRNA school. It's just something you think you want now. You might change your mind, some better idea might come along, you might apply and not get accepted, etc. So I would say things like:

    1. I'm not sure, but I know I am ready to move on from my current job and would like to give the ICU a try.
    2. I've considered CRNA school, but not ready to make a commitment. A lot might happen in the next couple of years and I am open to considering lots of possibilities. But regardless of what I eventually decide, I know that I am interested in learning to care for patients who are move complex and unstable at this point of my career.

    Don't deny that you are considering CRNA school ... but don't make it sound like that future is guaranteed for you. Give the impression that you are open to considering lots of options -- including CRNA school, but also including falling in love with ICU nursing and staying there a long time. In truth, a lot really can happen over the next year or two that might change your mind.

    Maybe I am just a good liar -- but that is what I would do.

  • May 11

    Quote from barcode120x
    It's not being careless, it's staffing's job to find nurses to staff the hospital. It's like when a school teacher calls in sick at work. it's the school's job for them to find a replacement for that shift. You can't blame them for looking for help. A shift has to be filled, regardless of what type and where it's at.
    A shift has to be filled? No, they just expect us to work shorter and in areas where we aren't fully competent.

    A facility that truly wanted to staff a call off would have an established pool of people to call on. Not this random call everyone who isn't here for this shift stuff.

  • May 5

    CRNAs work independently in every state. There is no need for anesthesiologists (MDAs) in any state to supervise CRNAs. Certain facilities require MDAs to supervise or medically direct CRNAs, but that is facility driven not state or federal law. Those facilities that utilize medical direction do this mainly for reimbursement purposes (that is my opinion which is justified by numerous research studies showing the safety of independent CRNAs).
    It gets more complicated in that some states require "supervision" of CRNAs or don't allow CRNAs to write post op orders. These states where CRNAs work without MDAs generally utilize a standard form in each facility, to my understanding, that allows the surgeon/dentist/podiatrist to order anesthesia and be the "supervising" physician. Supervision in these situations meet the legal and often the billing definitions, but has nothing to do with what most people understand as supervision. Supervision of a CRNA: A Concept Without a Reliable Definition

  • May 5

    I personally applaud CRNAs for what they do and the advanced training they receive. I hope that 220k helps them pay off the 150k in student loans they have. Not to mention malpractice insurance, continuing ed, etc. If we could all safely do their job, hospitals would surely have figured that out a long time ago and made it a sign off with a preceptor on our orientation sheets, saving them hundreds of thousands of dollars.

  • May 5

    Yeah. Let's pay people less who, with one slight error, could easily kill a patient.

  • May 5

    Quote from offlabel
    Well....just at what point are they competent for that or competent oversight by another CRNA? 2 months? A year? When? That's what difference it makes.
    Every CRNA should be competent to work independently from day 1 after graduation or they shouldn't be a CRNA IMHO. That is how I was trained and that is how I train all my students.

  • May 5

    Quote from TriciaJ
    Am I the only one who is extremely put off by this? The complaint is that CRNAs are overpaid, over-educated and don't require much in the way of skills. Before I disparaged someone else's value, I think I would make sure I could write at a fifth grade level.
    Exactly. With the same mindset as the OP, one could say that nurses (RNs/LPNs) are replaceable because med techs can give meds, take vitals, and follow physician orders. Because really, what else is there? Apparently education is of no value, and neither is spelling/grammar.

  • Apr 29

    I guess I am a bit unclear on this. Your mother GAVE you this medication to take? Right before a drug test? And why were you all worked up over a drug test to begin with? With all that being said, it makes me sad that you are continuing to blame yourself--you didn't "mess up" you were listening to your mother, who I am unclear on what the motivation of her actions were.

    There seems to be more to this situation than you have indicated. To be blunt, there seems to be a lot of sabotage happening, the specifics of which is none of my business, and at this point not exactly relevant.

    However, my suggestion is that going forward you seek some assistance in controlling your anxiety. That you speak to your academic advisor on how to proceed with your education and defer the clinical portion--which is what I am assuming the drug test was for. That you perhaps look into a summer schedule of a certification (ie:medical coding, informatics) then decide if you want to proceed in the fall with your nursing education when you are able to get all of your ducks in a row.

    You need options and choices. You need to be informed of where all of your classes stand at present--and degree options. Just until you are able to manage your anxiety.

    Unfortunately, if the thought of a pee test gets you into a state of panic, the pressure and pace of clinicals may not be the best thing for you right now.

    Speaking of peeing, don't get into a peeing contest with Mom. What's done is done, and regardless of the circumstances surrounding this, you need to change up your dynamic going forward. Whomever you see about your anxiety can assist with this as well.

    Best wishes.