8jimi8ICURN 7,401 Views
Joined: Sep 19, '07;
Posts: 243 (24% Liked)
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Flight RN Rotor/Fixed HEMS/CCT; from
Flight RN, Trauma1 CVICU STICU MICU CCU
Please delete any knowledge you retain on renal dose of dopamine it's a myth but some old school folk keep believing in it. But it kills more patients than it helps recover
I saw this pay down of nursing rates coming 3 years ago and posted up in arms about it. I was flamed and about thrown off the boards here.
Nurses salaries have dropped dramatically in the past 3 years. With my years of experience(30yrs) in the hopsitals I should be making $40-45/hr in my state. I can't get a hospital position, only a per deim (for stepdowncardiac) which paid $36/hr. and got cancelled all the time.
This corporate climate does not ( repeat- does not) want to pay nurses!! Nurses wages cuts into their mega millions corporate(CEO, CFO and CNO) paydays. That is why we are working soooo short staffed, there is nooooooooooooo shortage of nurses, the powers that be in corportate heealth care know this, They are driving down the nurses wages. if we don't start growing a "big pair" we are going to be all working for minimum wage or less and with more advanced nursing education/degrees( MSN, DNP) Can't all see the MD's, DO' and lawyers of this country working for minimum wage- yeah right! While the pond scum in the Corporate chairs rake in mega millions with their business education degrees in a highly technical healthcare industry.
i received an offer from the regional level 1 trauma center in Columbia, SC, for permanent hire at 20.41/hr. That is WITH 3 years of experience and 2 in specialty. Now then i know the hospital down the road offers 5/hr more, but it isn't a trauma center.
It just depends on where you are. California offers considerably more. Maybe going agency will get you the rate you want.
I just accepted an offer for 40/hr here in Tucson, this very morning. Now then it is agency. But my f/t staff position at Uof A is considerably better than i was making when i left austin, and not much of a pay cut from what i was making as a traveler.
I've lived full time in my RV for 1 1/2 years. Have to say "I LOVE IT!" I'm working as a traveling hemodialysis RN. I have a 40 foot 2001 Safari Panther 455 (2 slides) diesel pusher motorhome. So I'm not really "rough-n-it". I tow my Honda Civic behind. This is truely a home on wheels...My laundry is running in my washer as I write. This is my third RV...all diesel pushers....but that is what my husband and I wanted because we "get up and go" often....a weekend here and a weekend there. Like to explore different areas. The higher price of gas doesn't really concern me because my agency pays my mileage from one place to another with no travel caps....this pays for my gas. And if gas gets too expensive I can also use biodiesel...which we have looked into and have found that Catepillar says it is OK to use in our engine and OK to use for our heater (we have a hydrohot system that provides us with instant UNLIMITED hotwater....and heats the coach beautifully...and I've camped very comfortably in zero degree weather). Tommorrow I'm finishing up my assignment on the West Coast....and I'm traveling all the way to the East Coast for my next assignment. The fun part is that I'm taking a month to get there. The added bonus of using an RV for your home is that the housing stipend puts more money (tax free) in your pocket. And our repairs and any other expenses....tax write off. Those are too biggies you're missing out on if you go the apartment route. Tomorrow it will take me about 1/2 hour to disconnect and get on the road....it usually takes us only 15 minutes to set up. Motorhomes have less set up requirements than a fifthwheel or a trailer but also require more maintence. Full time RVing is a different lifestyle that works well for some but not for others. I have stayed at some beautiful campgrounds. Right now...I'm in a beautiful campground in Washington....I'm completely emmerced in the forest....no one near me....so peaceful and quiet. I've really enjoyed staying here for the past three months....but now it's time for a new adventure. The best advice I can give someone thinking about buying a trailer or motorhome....is "do your homework" ie....get a good deal on the purchase because these all do depreciate. And make sure what you are looking at will suit your needs. What kind of climates will you be traveling too? Does it have enough insulation....or air conditioners? Is it big enough....or will I feel crowed, etc. Do you have pets? Climate is a big factor that I didn't think about until I had an RV. I have two big air conditioners on my rig....yet still wouldn't even consider taking a summer contract in a desert area. I've been in Phoenix in 110 degree weather and with both my a/c's on it was still about 80 degrees in the coach. I can see why the high end coaches have three a/c's and are well insulated. Anyway....hope this helps. Be happy to answer anymore questions about RV's. Have lots of experience and am an RV enthusiest.....just love being on the road....can't wait to get out there again next week. Guess I'm a gypsy at heart.
I think it depends on the program. Some want the ICU experience, but some take other experience into consideration such as ED at a level 1 trauma center. I know one specific program would consider PACU if you recovered open heart patients.
Yeah, it definitely depends on the program. All the programs I applied to didn't accept ER or PACU...but I've heard some do. I never ran across any that did when I was applying but I was limited to NYC and NJ, and there aren't a lot of programs around there.
Low SvO2 means the entire body is extracting more oxygen than normal from the blood. High means your body is taking less oxygen from the blood because the vessels are so clamped down they cannot get oxygen into the tissues.
Lactic acid is a byproduct of anaerobic metabolism, when the tissues have used up all the oxygen it can during aerobic metabolism. Everyone has what they call a normal SvO2 but for me it's 60-75%. That means 25-40% of the oxygen pumped out by your heart is being used by the body, 60-75% of the circulated oxygen makes it way back without being utilized. If your SvO2 is, for example, 55, you might not see anaerobic metabolism. Your body is just extracting more oxygen for normal function. At 30 or 40, you're likely going to see anaerobic metabolism and a concurrent rise in lactate or even lactic acidosis.
You can also see a rise in lactate without a drop in SvO2 for many other reasons (i.e. tissue death, respiratory distress, etc.), so you have to know the whole picture to utilize either the SvO2 or lactate properly to treat your patient.
In my limited experience, I have never had more than 3 step-down patients at a time. Step-down patients are often very time consuming and are just below critical. Five step-down patients would make me terribly nervous.
As nurses why do you guys think that medications only treat the symptoms of a disease instead of curing the disease? Is it because no one has come up any cures yet? () Or do you guys think it's a conspiracy?
I for one think it's a conspiracy and that's what I'm writing a paper on. Just wanted to know how you all felt. Thanks.
Side note: OMG just noticed I put "and" instead of "an" in my title. Disregard Please!
This phenomenon can be attributed to the obsequiously submissive nature of the profession. The reality of which in combination with the fact that the Nurse, is the lightning rod for everyone's frustrations, can be hard to take. Subsequently, a thick skin is required which is contrary to the purported philosophy of caring.
As a male in the profession, I am admittedly subjected to this just a tad bit less than the women. Behaviors on the part of patients, families, and to a lesser degree, co-workers, have been noted to be sometimes significantly different between genders. Perhaps my stature as a 50 yo, six foot tall middle aged married male, is enough to keep some, not all, mis-behaviors a bit in check.
I was a mechanic at a major airline prior to coming to health care. As such, I have had the opportunity to closely observe two distinctly different female dominated professions however, both sharing this obsequiously submissive characteristic. Imagine for a moment hundreds of "walkie-talkie" patients stuffed into a cylinder, all with call bells!
It's been my conclusion, that a subservient function in any capacity, is hard for the modern professional woman to stomach. The higher the degree of education, the harder this becomes. Of course, this varies on an individual basis.
In my case, having achieved job security, with a comfortable dual nurse income (my wife is also an RN) has made my personal life so distinctly different from my professional one, that I can take whatever nonsense may come my way with a smile on my face.
You should definitely fill out the Safe Harbor form, especially if caring for that patient will remove you from your other patients for an extended period of time. This way if anything were to happen to any of your other patients while you were attending to the combative patient you will not risk losing your license.
Make sure you are ready for the consequences. Facilities don't like for their nurses to invoke Safe Harbor as it involves a lot of paperwork and the peer review committee. In many cases they will attempt to revise the assignment. Even though you are protected from retaliation you need to make sure that you properly document any incidences that may occur from this time forward. Fill the form out as soon as you start your shift and request the signature of the person making the assignment.
I am a firm believer that you have to advocate for your rights. As TX nurses this option is available to us in order to protect our livelihood. If you chose not to fill out the Safe Harbor form and anything were to happen to one of your patients you may have to face further disciplinary action.
Everyone has one patient that really reminds them of why they want to be a nurse. Mine was a little old man I'll call 'Jim'. Jim was in the hospital because he fell at home, where he lived with his wife of 50+ years. He had suffered a GI bleed after eating...well, something he shouldn't have! Now, Jim was a sweet man, rarely asked for anything, but was confused. You see, he had dementia. As you probably already know, the ICU is the worst place for a dementia patient because there practically is no night and day. Just a never ending stream of nurses and doctors, tubes and medications 24/7.
So here is Jim, a stretched out skeleton with what passes for minimal body fat that I couldn't keep warm to save my life. I had to switch out his blankets from the warmer unit every 30 minutes or so, with one always wrapped around his head like a burka. He looked like a little old Jedi sitting up in his bed, which in itself made me laugh. But what really stood out about Jim was how he reacted to me. That morning, as I usually did with our patients who are awake (read: NOT sedated), I had introduced myself to Jim and told him to push his call bell if he needed anything. He smiled a toothless grin at me from under the blanket wrapped around his head, and said, "Thanks Jenny", then promptly resumed his nap. Now, my name isn't anything close to Jenny, but I let it go because I knew that trying to convince him that I wasn't 'Jenny' would only make his confusion worse.
Since the patient load was light that day, and I had a test coming up, I sat at a bedside table at the end of the ward where I could see all the patients in the beds, and pulled out my superlightweight textbook (that 30lb thing I've been lugging around for two years), highlighters and note cards. Within about 2 minutes, another patient's call bell went off, and I jumped up dutifully to attend to her. When Jim popped his little eyes open and did not see me sitting at the end of his bed (the last one on the ward), he promptly began yelling. His nurse rushed over to see what was the matter, and he just yelled "Where's Jenny?! I want Jenny, where is she?!"
Knowing he meant me, I rushed back to the other end of the ward to calm him down. As soon as he saw me, he quieted right down. I tucked his new warm blanket in around his chin, and retook my spot at the bedside table. All day long, Jim would peep his eyes open just enough to see if I was still there. As long as he could see me, he remained quiet and calm, but if he opened his eyes and I was gone, he began yelling again (which his unhappy nurse reminded me raised his blood pressure way beyond what she would like). So I spent the day within Jim's view, attending to only him and the patients in the two beds next to him.
When Jim opened his eyes, he would say "Jenny?", to which I always answered, "I'm right here luv". He would turn his head around to see me, and then smile his toothless smile, and lay back down. We did this routine about every 20-30 minutes for the majority of the day.
At about 1600, Jim's wife came for visiting hours. She saw me sitting with my textbook at Jim's bedside, while he slept peacefully, his head covered with his Jedi blanket. She asked me how he had been that day, and I laughed as I described how I had to remain within his view all day, and how he called me Jenny. Her eyes welled up a bit, and she said to me, "I guess you do resemble me a bit when I was your age. I'm Jenny". Her tears rolled down her wrinkled face and onto her freshly pressed blouse. I did the only thing I could think of at that moment: I hugged her.
She told me that she cared for Jim at home alone because their grown children had moved off and had children of their own. How Jim had been a war hero, a faithful husband, and a loving father. As I sat there and listened to her story, I realized that in his confusion, Jim thought that I was his wife, and that the reason he got upset when I got out of his view was because he missed her. She thanked me for taking such good care of him, and when she walked around his bed to lean over and kiss him hello, he smiled at her with so much love it broke my heart. Jim was more than a patient to me that day. He was a reminder of why I do what I do, the reason I decided to become a nurse in the first place. When I got home that night, I hugged my own husband, and told him about my day. He didn't have to say anything, I was just glad to have him listen, to be able to talk to me and know who I was.
I probably won't ever forget Jim, or his wife (the real Jenny). He left a mark on my heart that will serve as a permanent reminder...this is what I do.
We've all been there: you get an ambulance call that EMS is bringing in an elderly patient who had a ground level fall and now their leg is shortened and externally rotated. Oh and by the way, they have dementia. Ugh...could your night get any worse? Here are some tips for dealing with the patients who are demented:
1. Enlist family support if at all possible. Make sure the nursing home or facility has sent a current next of kin notification and try to get the NH to call the family as they already have a working relationship with them.
2. Provide the patient with their hearing aid and/or glasses or dentures. It is difficult enough to deal with someone who is confused and even more so to try and understand them when they can't hear or see you or answer back because they don't have their dentures in place.
3. Try to keep the interruptions and interactions to as few people as possible. Ensure consistency of caregivers in the ER if at all possible.
4. The ER is a loud and bright place. When you are done with your assessment, try turning off the overhead lights but ensure that a directional light remains on just not directed at the pts face.
5. Confused people have pain. Treat their pain and yes, with narcotics.
6. Keep them close to the nurses station if possible to ensure adequate eyes on them. Some pts will not be aware that they are seriously ill or injured and might try to climb over the bedrails. Keep them in sight.
and the pearson vue trick worked for me
This board for 1st year nurses saved me from quitting my job numerous times. I came here and still come here to rant, whine, complain, tell how great/horrible my shift was, and mostly for advice from others like me.
I was on here every morning when I got home from work just posting, finding others that posted that I could relate to and for support. I found comfort on this site b/c I could talk about work and problems and know that other nurses were going through the same crap/learning exp. if you want to call them that, that I was and still am going through.
I had a horrible first year as a new RN. If anyone had time one day you can read all my posts about how miserable I was and sometimes still am. But I know one thing I love being a nurse.
I endured all the abuse and nurse eating their young in the worst way, I was chewed up and spit out then rechewed and spit out a few times, like how a cow had 2 stomachs and regurgates their food only to be redigested...haha I don't know if that's true but it's the best one I could come up with.
I had never worked night's EVER in my life and when I went from day shift orientation which was 8 weeks to night shift orientation which was 4 weeks then to permanent night shift last year I hated my life. I hated it up until ... well I still hate it from time to time. It was had to break through with my night shift crew. It was AWFUL...I had no support, I would ask questions and have no one answer me, I was new so I was talked down to from my fellow nurses and MD's, unit clerks and staff. I was CONSTANTLY running in circles, I had no friends or just one person i could talk to. I was laughed at when calling for RRT's or CODES b/c everyone thought I was overreacting. I was also the only white American nurse coming onto the night shift crew in the last 10 years. I was working with a mostly Filipino/Indian staff. I didn't understand their language or why no one wanted to talk to me. I am a very out going person that usually gets along with everyone. I see people for who they are, PEOPLE, hence the reason I became a Nurse.
I was given the MOTHER of all pt. assignments every night. Never had 5 min. to think and had a ton of questions b/c I was a NEW NURSE. When I asked the questions, it was always the same reaction, like I should know the answer, DUH?? Well if I knew the answer I wouldn't be asking in the first place...UGGGGG....and at night I never knew who to call, what MD, resident..I wasn't pushy yet with the MD's to eval. the pt's so I would just say ok when they would not come and then ask what do I do now...what a headache.
I never stood up for my self when it came to assignments or admissions. Like I have had the first admission for the last 2 nights in a row and this is my 3rd night, and I am the only one who had been here for 3 nights in a row, and why am I getting the first admission agian on my 3rd night when this is the first night working for the rest of the RN's I am working with? Why don't they have 1st admission?
I was abused by the day shift RN's in the AM when I would give report. It would take me forever to give report in the AM. I would be grilled with 1000 questions and would not leave until well past 10am...yea 15 hour shifts were common for me...and when I got report at night at the start of my shift the day shift RN's would half A$$ report to me b/c they knew they could get away with it,leaving me with unfinished orders or phone calls that should have been made during their shift and I mean EARLY in their shift, and they would leave me floundering in the AM even though I checked the chart multiple times, for answers and explanations that I felt like an idiot b/c I didn't know.
I was left with blood transfusions that could have been done during the day, on top of pt's coming from the cath lab back to back with arterial femoral sheaths that, ME, the RN had to pull. Which I didn't even know what a femoral arterial sheath was until I started working on my unit AS A NEW GRAD.
I was told my first night off orientation I had to pull a sheath..ok at that point I knew what it was but had not pulled one on orientation. WELL TOO BAD...I PULLED A SHEATH....with supervision of course and having a major anxiety attack...well from that point on I had ALL the pt.'s with sheaths. I was pulling all the time.
NOW there is this night shift understanding that b/c we are 1/2 the staff of days we pull sheaths no matter what. It was about March this year I was about 6 months into my frist year of nursing and I was telling the day shift RN I pulled the sheath on her pt. The nursing educator overheard me say this and said, "Ang YOU DID WHAT????" I said "I pulled the sheath"....like I had done about 30 times before but didn't say that...the educator said to me, " ANGIE you are not supposed to be pulling sheaths until 6 months off orientation." HAHA little did I KNOW THAT, they had me pulling them my first night off orientation4 months ago..I didn't tell her that...She gave me some lecture and a bunch of paper work and then said, "WELL It's you're license if something happens". Then she banned me from pulling sheaths....HAHAHAHAHA This is the main procedure on my floor for night shift RN's post PTCA/RHC/LHC. Well that bann lasted all of 1 week b/c my night shift manager told the educator and the unit director how good I was at sheath pulling...and my night shift manager said to me, "Ang at night we do things differently as you can tell." With in 3 weeks of that conversation I had my sheath pulling certification, the fastest any new grad has ever had...
Well as of last night I pulled my 100th sheath. The most ever for a new nurse in a year and a half on my floor. I even teach the RN's how to pull and have MD's ask if I can help them..
Anyway...recently I had some day shift RN's whine about how I made them put an IV in a pt before they left at night, had she the nerve to say to me, "Ang you need to learn how to put IV's in a pt blah blah blah." This was a month ago. I flipped out on the RN who said this and said, "Every pt. you give me at night has a blown or expired IV that I have to restart, I replace about 5 IV's a night, so don't tell me how I have to LEARN to start an IV, b/c I restart all of yours."
IV's were a thing that I could not get to save my life. I sucked at starting IV's. I MEAN HORRIBLE!!! I tried and tried but I sucked. I finally got it one night, and from that night on I can put a line in anyone. I ,*excited* ,have become one of the RN's that if another RN can't start a line they come to for IV placement, so when that Day shift RN said that to me I was ready to flip.
I have been charge nurse a few times, which is not worth the extra $1 an hour but looks good on a resume. I have become a resource nurse for new night shift RN's. I have also become the night shift cardiac resource RN. I have my senior night shift RN's, who ignored me when I first started, asking me questions. I have learned to stick up for my self when it comes to pt. assignments and admissions. I am no longer passive to MD's bullying, b/c I know the MD's and they know me. I have gotten into numerous arguments with MD's and not felt bad about it. If I have a problem I make SURE someone listens to me, and if I call a resident I make SURE their butt is on my floor to eval the pt. and if not I call until they come eval. the pt, and I don't care if they don't cover the attending taking care of the pt. they are a TELE resident for a reason. I call the MD's at 3am if the residents are being restarted. I call the House MD all the time b/c I am not friends with all of them. Even if they don't cover the MD they still come anyway.
I no longer put up with the BS from my fellow nurses that I did for so long. It was like something clicked a few months ago. I just got fed up and like my one unit clerk who abused the heck out of me, literally I hated her I mean hated her, but now she is one of my dear friends said, "Angie, when did you become a real RN, and grew a pair of you know what? Honey you have arrived. Don't let anyone give you crap, your true nurse emerged and you are damn good at it and don't let anyone tell you otherwise. It took a while for you to come into your own but your patients love you, you give the night shift a different attitude, you laugh, you don't tolerate crap from anyone and you are one of the best nurses I have ever seen."
I also learned the cultures from the Indian and Filipino nurses and what they did in their hospitals in their countries.
My nursing assistants gave me an appreciation award plaque that is engraved with my name that hangs on my wall in my guest room under my College Diplomas..Both my B.S. and my A.S.N. and my dual state licenses in PA and NJ to remind me why I became a nurse.I have been named in the Press Ganey for patient satisfaction, and have been sent cards and the best feeling is when you see a pt. and they recognize you from a previous hosp. stay and remember your name and give you a hug it's the best feeling. My Night Shift Nurse manager has told me numerous times, "Ang if there is a Junior Registered Nurse of the Year Award, I would give it to you." She has also told my director of nursing for my floor about this. She has told me, "Ang you are a good nurse, and you grew and over came the transition of being a new nurse on a critical care floor as your first job, and also the cultural bounds that you faced being the first white American nurse on nights in 10 years working with nurses from different cultures, you did not discriminate or judge, you are one of us, a Nurse. I know it was hard for you moving away from home to an area you are unfamiliar with, no friends and as a new nurse. But you are one of us now"...she told me this last night.
As much as I hated my first year and it sucked ALOT..i have made friends for life..IT TOOK TIME, and I never thought I would say I REALLY DO LOVE MY FLOOR. I will always give my all as a Nurse and people respect that. YEA it sucks at first, I KNOW..and it still sucks most nights but I built a home...
AS NEW NURSES YOU HAVE TO GIVE IT TIME..YOU WILL HAVE THAT EPIPHANY..YOU WILL BREAK THROUGH....I can honestly say some of the people I hated the most..are the best thing that ever happened to me..it has made who I am today ...
hope this inspires some of you!!!:heartbeat
Sorry so long I just wanted to say IT DOES GET BETTER
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