I have worked med/surg and perinatal float. I always thought Mother baby was where nurses go to retire, but now having worked there... I know differently. I'm day shift, but it was steady and hopping. We typically have at least four moms with their babies. That's truly 8 patients! The charting there is insane... worse then anywhere else. It's definitely not a piece of cake job. The teaching is extensive and lots of different things to remember about both moms and babies there. PLUS, you're admitting and discharging like a fiend. Maybe it's just because I had med/surg down to a science and this is different for me.... but it's not a day at the park, for sure. It's still work.
I live and work in El Paso and there are a wealth of opportunities in all areas for you to work. Whether you are experienced or a new grad you will find something. Here's some info on the hospitals:
Las Palmas: Located on the west side near UTEP. An HCA hospital, one of the most profitable in the nation. Currently undergoing an ugly unionization process so if you go here expect to get rhetoric from both sides. Pay fairly well for experience.
Del Sol Medical Center: HCA Partner to Las Palmas in East El Paso. According to Forbes, the second most profitable hospital in the nation. Also undergoing unionization but not nearly as much rhetoric as Las Palmas. Doesn't pay as much for experience as Las Palmas but a new nurse at both can expect $22.50 an hour. Obviously when both hospitals finalize their union contract, which is projected later this year, pay will likely improve.
Sierra/Providence: Two tenet hospitals located near each other in West El Paso near UTEP with a fairly decent reputation. Ocassionally let staff go as they aren't as profiatbale as the two HCA partners, but nurses are usually safe. Pay for both new grads and experienced nurses is usually better but benefits, including PTO and 401(k) is much worse then the HCA facilities.
Sierra East: Brand new tenet hospital on El Paso's far east side. It's small and struggling to keep business since their location is in a part of the town that is VERY young. Their ER is like a peds clinic but they don't offer pediatric floor services. Pay is the same if not better then their sibling hospitals, and for a while they were offering everyone from new nurses to experienced nurses the best rates in town (not sure if they still are).
University Medical Center: typical county hospital in Central El Paso. Less emphasis on making profits. Pay for new grads is poor but raises are better than the HCA and tenet facilities so long run you will make more money here. On top of that if you make a career our of working here, after 25 years you can retire with a hefty pension. I reccomend this to new nurses. That said, conditions in ER are crazy.
Childer's Miracle Network Hospital: newly build next to UMC but different company with different pay and benefits. Still too new for me to know much about, but a friend that will be working there is getting compensated well, and everything is state of the art. Plus they are hiring like crazy.
Physicians Hospital: Small 60 bed hospital on the East Side that still does open hearts and primarily has patients that aren't very sick. They pay very well and is a decent place for nurses looking to make a buck. However, most nurses don't last very long there due to management issues.
There's also an Army hospital in El Paso but it can take forever to get a job there. IF you do get a job however, you will always work even if there are no patients. A friend working ICU there ususally never has patients and the nurses play a lot of cards.
In terms of location, the West side of El Paso is usually the more desirable part of town and is where more white people live. You will have more english speakers in the 3 west side hospitals. Houses and apartments here are more expensive, but the new houses being built on the far west side are affordable.
Central El paso is much older, with a large spanish speaking population. While there are lots of cool historic houses, I wouldn't suggest anyone new to the area living here.
East and particularly Far East El Paso is booming with anything from starter houses to million dollar homes. There are also more convenient retail locations as compared to the West Side, and in general more stuff to do.
Lastly, Northeast El Paso has a mix of homes 60+ years old and brand new homes due to the huge troop surge from fort bliss. Most neighborhoods are well established and safe, and houses can be dirt cheap. $70000 for 3 bedrooms and 1200SQft is very common. The old reputation for northeast El Paso was that it is where all the African American population lives and it is unsafe, but that no longer holds true, with some of the safest areas of town here.
I would just suggest living close to wherever you plan on working as all the hospitals have housing options that are nice nearby. (UMC might be the exception)
I have lived everywhere here and have worked or have friends that work at every hospital. If you have any specific questions, simply PM and I will be happy to address them for you. Best of luck!
Edit: Also, Spanish is a plus in El Paso, but not necessary. UMC has lots of nurses that dont speak a word, just like evry other hospital. Someone is always nearby that can help.
Seems to be a lot of misinformation in this thread, so I will try to clear up as much as I can.
Both spinal and epidural anesthesia work on the same principle, which is bathing nerves or nerve roots at or in the spinal canal with a local anesthetic medication to provide varying levels of analgesia or anesthesia for a number of different procedures. Neither depends on "vascular uptake" to be effective, though uptake into the vascular system is how the anesthetics are cleared, and why they wear off after a given amount of time.
A spinal anesthetic is a "one shot" anesthetic. A very small needle is inserted through the dura until there is a return of CSF. A small amout of local anesthetic, usually (but not always) with some narcotic, is injected, and the spinal needle is removed. Spinal anesthesia provides a very dense motor and sensory block. Depending on the volume, baricity, and type of agent injected, it can provide complete lack of feeling from about the nipple line down. (It can even go higher, but that is considered a bad thing, because respiratory muscles begin to be involved.) However, it is a one shot thing. Depending on the agents chosen for injection, duration can range from about 30 - 45 minutes, up to 90-120 minutes, and sometimes even longer. If it wears off before delivery, your only options are to deal with it, get another spinal injection, or use IV medications.
In epidural anesthesia, a special needle is used to identify the epidural space just outside of the dura. A very thin catheter is then threaded into this space, and again, local anesthetic, usually with narcotics, is administered. Again, we are attempting to block sensation at the nerve roots where they enter the spinal canal. Much higher volumes are used in epidural anesthesia. Additionally, the catheter is left in the back, so a continuous infusion of the local anesthetic medication can be administered to the catheter. Also, we can administer additional bolus doses of medication as labor progresses.
Generally, there is a greater degree of control with epidural over spinal anesthesia. I can vary the rate of infusion, and change medications to give greater or lesser levels of blockade, and by choice of medication administered, retain a greater degree of motor control, so mom can more effectively push. However, I can use epidural anesthetics to achieve a block as dense as spinal, so that surgery, to include c-section can be done on the patient with little or no discomfort. (It's not unusual to feel pressure, as when the surgeon pushes on the belly to help push the baby out, but it should NOT be painful.)
So, why do we sometimes choose spinal over epidural? Well, there are a lot of reasons. For example, I choose to give spinal anesthetics to patients having c-sections, because spinal is better for the baby than general, and mom gets to be awake when the baby is born. Additionally, time of onset is much faster with a spinal anesthetic. Generally, once I have an epidural in, I tell moms that it is going to take two to three contractions before they really start feeling any relief. With spinal anesthesia, the patient feels relief in about 10-30 seconds.
Generally, if the patient is going to have a procedure of known duration, and pain management post operatively is not going to be anesthesia's concern, we will use a spinal anesthetic. If we cannot predict the duration, or the duration is expected to be longer than can be achieved with spinal anesthesia, then epidural anesthesia is the way to go.
Having answered your question, allow me to step on my soapbox for a moment. As a CRNA, one of my pet peeves is a prejudice some nurses, physicians, and (most commonly) nurse midwives feel towards epidurals for labor and delivery. They believe (and convey to their patients) that they are somehow less of a woman if they need an epidural for labor. It is an antiquated idea, and one I believe harms women. Yes, I know, women had babies for thousands of years without epidurals. But then, we extracted teeth for thousands of years without anesthesia as well. Does it make a dental patient somehow less of a person for demanding local anesthesia before the dentist drills on their tooth?
I've actually been told by a nurse midwife that, with proper breathing and concentration (as she taught her patients) she could achieve the same level of pain control that I could achieve with an epidural. Nonsense. I don't care how much concentration or breathing you work on, you will never be able to make an incision without pain by this method. However, I can do so with an epidural.
I'm not suggesting that every woman must or should have an epidural. In fact, with I discuss them with my patients, one of the first things I say is that "I'm not here to sell you anything." I simply provide information, answer questions, and allow the mom to make her own decisions, and I respect her ability to do that. If she chooses not to have an epidural, great. That is HER choice. By the same token, it is unfair and unethical for others to allow their prejudice to color how they talk to patients. Present patients with options, and allow the patient to make a choice, unsullied by your preconceived notions.
This may seem like a silly question, but the reason I bring it up is because not only have i never had kids, I have no experience at all in mother/baby, only my clinical (im a nursing student finishing up my last year). In addition, im 21, short, skinny, and get that I look very young... some people go as far as to say i look like im 14 lol. I know appearance should have nothing to do with my ability to care for patients, and I dont think it will once I gain the experience i need to and become comfortable working as a nurse. I was just wondering if mothers would feel comfortable receiving care and newborn education from someone that looks so young and inexperience .... any youngsters in mother/baby that want to share their experience? maybe im just over analyzing this idk lol but I really want to work in maternity!
Don't worry about that. Im a L&D RN, and I have no kids. It makes no difference. You don't have to have gone through cancer to be a good oconology nurse
I must be spoiled where I work. This has never been an issue for me, and if my workplace decided to make it an issue, I'd be gone in a second. Nowhere did I say I'll work for free, and if they don't give me enough time to finish everything I need to do, then that's their problem. It amazes me how much money these hospitals make, yet they'll try to get rid of you over the extra $5 you deserve for completing your work. They're so short staffed, but they'll have all of these meetings to let everyone know the patient comes first. When are they ever going to realize you can't have it both ways?
"Please do not diaper my child, as the confined environment of the diaper may inhibit their emotional growth."
:icon_roll
I'm in total of agreeance (sic)!
I believe everyone has examples where patients ideas and concerns override the best evidenced-base practices. Most recent and very common, a patient with a High K+ level. "I refuse to drink that nasty Kayexalate." So, the physician and medical staff have to find another way, and more invasive way I might add.
Mechanic: "You need a new starter, and we can get a new one on your vehicle in about 2 hours."
Customer: "Oh, I am against starters." Can we find another way to start the vehicle...please." LOL
Oh brother. All I will say is after bathing MANY babies (thank goodness) and combing many clots of blood out of their hair, I think I'm on Team Bathe. And we don't just leave the babies hanging out to get cold. They're under a warmer the entire time. Giving birth may not always need a medical intervention but you're still in a hospital and there's certain precautions we need to follow.
I'm not OB/GYN was just surfing. Why in heaven's name would anyone refuse their baby a bath???? What's the rationale? The bigger question is why would the hospital comply?
Strike the last question. Customer service.
I've already done microbiology and physiology and made it through nursing school without chemistry. It's not about being afraid to fail it's about taking the straightest path and spending the least amount of money and time to reach the goal. I'm not a 20-something with 30-40 years of nursing left to take my time. Lucky if I get a nice 20 in before I'm too old.
I want to come work at your hospital then. I'm tired of trying to keep babies happy on pit!
So I just finished week one on the floor and I LOVE IT. I actually look forward to going to work for the first time in my life.
-Proud PP RN
I have worked med/surg and perinatal float. I always thought Mother baby was where nurses go to retire, but now having worked there... I know differently. I'm day shift, but it was steady and hopping. We typically have at least four moms with their babies. That's truly 8 patients! The charting there is insane... worse then anywhere else. It's definitely not a piece of cake job. The teaching is extensive and lots of different things to remember about both moms and babies there. PLUS, you're admitting and discharging like a fiend. Maybe it's just because I had med/surg down to a science and this is different for me.... but it's not a day at the park, for sure. It's still work.
I live and work in El Paso and there are a wealth of opportunities in all areas for you to work. Whether you are experienced or a new grad you will find something. Here's some info on the hospitals:
Las Palmas: Located on the west side near UTEP. An HCA hospital, one of the most profitable in the nation. Currently undergoing an ugly unionization process so if you go here expect to get rhetoric from both sides. Pay fairly well for experience.
Del Sol Medical Center: HCA Partner to Las Palmas in East El Paso. According to Forbes, the second most profitable hospital in the nation. Also undergoing unionization but not nearly as much rhetoric as Las Palmas. Doesn't pay as much for experience as Las Palmas but a new nurse at both can expect $22.50 an hour. Obviously when both hospitals finalize their union contract, which is projected later this year, pay will likely improve.
Sierra/Providence: Two tenet hospitals located near each other in West El Paso near UTEP with a fairly decent reputation. Ocassionally let staff go as they aren't as profiatbale as the two HCA partners, but nurses are usually safe. Pay for both new grads and experienced nurses is usually better but benefits, including PTO and 401(k) is much worse then the HCA facilities.
Sierra East: Brand new tenet hospital on El Paso's far east side. It's small and struggling to keep business since their location is in a part of the town that is VERY young. Their ER is like a peds clinic but they don't offer pediatric floor services. Pay is the same if not better then their sibling hospitals, and for a while they were offering everyone from new nurses to experienced nurses the best rates in town (not sure if they still are).
University Medical Center: typical county hospital in Central El Paso. Less emphasis on making profits. Pay for new grads is poor but raises are better than the HCA and tenet facilities so long run you will make more money here. On top of that if you make a career our of working here, after 25 years you can retire with a hefty pension. I reccomend this to new nurses. That said, conditions in ER are crazy.
Childer's Miracle Network Hospital: newly build next to UMC but different company with different pay and benefits. Still too new for me to know much about, but a friend that will be working there is getting compensated well, and everything is state of the art. Plus they are hiring like crazy.
Physicians Hospital: Small 60 bed hospital on the East Side that still does open hearts and primarily has patients that aren't very sick. They pay very well and is a decent place for nurses looking to make a buck. However, most nurses don't last very long there due to management issues.
There's also an Army hospital in El Paso but it can take forever to get a job there. IF you do get a job however, you will always work even if there are no patients. A friend working ICU there ususally never has patients and the nurses play a lot of cards.
In terms of location, the West side of El Paso is usually the more desirable part of town and is where more white people live. You will have more english speakers in the 3 west side hospitals. Houses and apartments here are more expensive, but the new houses being built on the far west side are affordable.
Central El paso is much older, with a large spanish speaking population. While there are lots of cool historic houses, I wouldn't suggest anyone new to the area living here.
East and particularly Far East El Paso is booming with anything from starter houses to million dollar homes. There are also more convenient retail locations as compared to the West Side, and in general more stuff to do.
Lastly, Northeast El Paso has a mix of homes 60+ years old and brand new homes due to the huge troop surge from fort bliss. Most neighborhoods are well established and safe, and houses can be dirt cheap. $70000 for 3 bedrooms and 1200SQft is very common. The old reputation for northeast El Paso was that it is where all the African American population lives and it is unsafe, but that no longer holds true, with some of the safest areas of town here.
I would just suggest living close to wherever you plan on working as all the hospitals have housing options that are nice nearby. (UMC might be the exception)
I have lived everywhere here and have worked or have friends that work at every hospital. If you have any specific questions, simply PM and I will be happy to address them for you. Best of luck!
Edit: Also, Spanish is a plus in El Paso, but not necessary. UMC has lots of nurses that dont speak a word, just like evry other hospital. Someone is always nearby that can help.
I've ALWAYS appreciated food gifts, of any sort. I think it's a really nice gesture even if it's not something I personally want to eat.
you wanted to gain experience in a variety of areas ? maybe ?
Seems to be a lot of misinformation in this thread, so I will try to clear up as much as I can.
Both spinal and epidural anesthesia work on the same principle, which is bathing nerves or nerve roots at or in the spinal canal with a local anesthetic medication to provide varying levels of analgesia or anesthesia for a number of different procedures. Neither depends on "vascular uptake" to be effective, though uptake into the vascular system is how the anesthetics are cleared, and why they wear off after a given amount of time.
A spinal anesthetic is a "one shot" anesthetic. A very small needle is inserted through the dura until there is a return of CSF. A small amout of local anesthetic, usually (but not always) with some narcotic, is injected, and the spinal needle is removed. Spinal anesthesia provides a very dense motor and sensory block. Depending on the volume, baricity, and type of agent injected, it can provide complete lack of feeling from about the nipple line down. (It can even go higher, but that is considered a bad thing, because respiratory muscles begin to be involved.) However, it is a one shot thing. Depending on the agents chosen for injection, duration can range from about 30 - 45 minutes, up to 90-120 minutes, and sometimes even longer. If it wears off before delivery, your only options are to deal with it, get another spinal injection, or use IV medications.
In epidural anesthesia, a special needle is used to identify the epidural space just outside of the dura. A very thin catheter is then threaded into this space, and again, local anesthetic, usually with narcotics, is administered. Again, we are attempting to block sensation at the nerve roots where they enter the spinal canal. Much higher volumes are used in epidural anesthesia. Additionally, the catheter is left in the back, so a continuous infusion of the local anesthetic medication can be administered to the catheter. Also, we can administer additional bolus doses of medication as labor progresses.
Generally, there is a greater degree of control with epidural over spinal anesthesia. I can vary the rate of infusion, and change medications to give greater or lesser levels of blockade, and by choice of medication administered, retain a greater degree of motor control, so mom can more effectively push. However, I can use epidural anesthetics to achieve a block as dense as spinal, so that surgery, to include c-section can be done on the patient with little or no discomfort. (It's not unusual to feel pressure, as when the surgeon pushes on the belly to help push the baby out, but it should NOT be painful.)
So, why do we sometimes choose spinal over epidural? Well, there are a lot of reasons. For example, I choose to give spinal anesthetics to patients having c-sections, because spinal is better for the baby than general, and mom gets to be awake when the baby is born. Additionally, time of onset is much faster with a spinal anesthetic. Generally, once I have an epidural in, I tell moms that it is going to take two to three contractions before they really start feeling any relief. With spinal anesthesia, the patient feels relief in about 10-30 seconds.
Generally, if the patient is going to have a procedure of known duration, and pain management post operatively is not going to be anesthesia's concern, we will use a spinal anesthetic. If we cannot predict the duration, or the duration is expected to be longer than can be achieved with spinal anesthesia, then epidural anesthesia is the way to go.
Having answered your question, allow me to step on my soapbox for a moment. As a CRNA, one of my pet peeves is a prejudice some nurses, physicians, and (most commonly) nurse midwives feel towards epidurals for labor and delivery. They believe (and convey to their patients) that they are somehow less of a woman if they need an epidural for labor. It is an antiquated idea, and one I believe harms women. Yes, I know, women had babies for thousands of years without epidurals. But then, we extracted teeth for thousands of years without anesthesia as well. Does it make a dental patient somehow less of a person for demanding local anesthesia before the dentist drills on their tooth?
I've actually been told by a nurse midwife that, with proper breathing and concentration (as she taught her patients) she could achieve the same level of pain control that I could achieve with an epidural. Nonsense. I don't care how much concentration or breathing you work on, you will never be able to make an incision without pain by this method. However, I can do so with an epidural.
I'm not suggesting that every woman must or should have an epidural. In fact, with I discuss them with my patients, one of the first things I say is that "I'm not here to sell you anything." I simply provide information, answer questions, and allow the mom to make her own decisions, and I respect her ability to do that. If she chooses not to have an epidural, great. That is HER choice. By the same token, it is unfair and unethical for others to allow their prejudice to color how they talk to patients. Present patients with options, and allow the patient to make a choice, unsullied by your preconceived notions.
Kevin McHugh, CRNA
I must be spoiled where I work. This has never been an issue for me, and if my workplace decided to make it an issue, I'd be gone in a second. Nowhere did I say I'll work for free, and if they don't give me enough time to finish everything I need to do, then that's their problem. It amazes me how much money these hospitals make, yet they'll try to get rid of you over the extra $5 you deserve for completing your work. They're so short staffed, but they'll have all of these meetings to let everyone know the patient comes first. When are they ever going to realize you can't have it both ways?
I believe everyone has examples where patients ideas and concerns override the best evidenced-base practices. Most recent and very common, a patient with a High K+ level. "I refuse to drink that nasty Kayexalate." So, the physician and medical staff have to find another way, and more invasive way I might add.
Mechanic: "You need a new starter, and we can get a new one on your vehicle in about 2 hours."
Customer: "Oh, I am against starters." Can we find another way to start the vehicle...please." LOL
Oh brother. All I will say is after bathing MANY babies (thank goodness) and combing many clots of blood out of their hair, I think I'm on Team Bathe. And we don't just leave the babies hanging out to get cold. They're under a warmer the entire time. Giving birth may not always need a medical intervention but you're still in a hospital and there's certain precautions we need to follow.
What will they think of next?
"Please do not diaper my child, as the confined environment of the diaper may inhibit their emotional growth."
:icon_roll
Strike the last question. Customer service.
I've already done microbiology and physiology and made it through nursing school without chemistry. It's not about being afraid to fail it's about taking the straightest path and spending the least amount of money and time to reach the goal. I'm not a 20-something with 30-40 years of nursing left to take my time. Lucky if I get a nice 20 in before I'm too old.