Latest Comments by PacoUSA

PacoUSA, BSN, RN 42,016 Views

Joined: Mar 25, '09; Posts: 3,522 (33% Liked) ; Likes: 3,428

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  • 0

    Quote from NedRN
    I have to believe there are ICU's out there who would love someone with your experience in a shortened internship. There is an association of teaching hospitals. Find them online, and start cold calling. In fact, I'd suggest skipping HR and calling managers instead, possibly directors in a facility with multiple ICUs.

    Alternatively, you could continue to travel, work a few weeks to get a good reputation, and beg for ICU days with easier patients. Confidence that is not cocky goes a long way, especially after they know you. That might lead to a staff offer or even an extension at the same facility at least partially ICU. That's a longer road of course. You might also select assignments if they want step down or PCU float - good deal for both of you. More experience for you, and cheaper bill rate for them. Probably have to interview to find if this is possible so you could be wasting your agency and the manager's time. But a good recruiter could submit you with this sort of pre-condition.
    I like your advice, thanks! I just secured a travel position (PCU day shift) starting next month in a city I would not mind settling in for a while, perhaps this is the open door I have been waiting for??

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    Seems like California is the only state where nurses are in abundance. New grads have to leave the state to get their 1st year of experience and it is the most popular state for travelers. There are noticeable shortages elsewhere it seems. Pay is also a factor I am sure!

  • 0

    Quote from NedRN
    Consider applying at the PCU that offered you a staff position two years ago.
    I've tried that, but ironically every time I have looked to see if there are openings there aren't any. And it seems internal candidates at this hospital get priority.

    Quote from NedRN
    Dislike continual chaos and changing pt assignments? ICU. Thoughtful planning care for one or two patients? ICU.
    These two phrases you mentioned ring more true to me than the ones you mentioned about ED. This is why I am leaning more to ICU. In fact, I did try to go perm a year ago in an ED back home, but that failed miserably due to that place being a bad hospital with a bad environment and an even worse preceptor who made me look like a liar to management. So, after 3 months there I left without looking back and back to travel nursing. It did not make me hate the ED, only the hospital which is surprisingly a Magnet hospital too :/ ...

    I would love to go straight into an ICU with my current experience, but all the ICU jobs I see want ICU experience (so dammit HOW do I get the experience you want if no one wants to hire without experience???). My best bet I think is to get into a system with my current experience and internally transfer after a year or two.

  • 0

    I am in the same boat as you. I have done tele for almost 6 years and I am not learning anything new, or should I say it's rare that I learn anything new. My wanderlust in traveling is pretty much at a stall and I could easily stay where I am for a few years, so I am looking to switch my specialty as well. Med surg tele is no longer enough to keep me traveling!

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    Sounds to me like I need to leave travel to get the proper experience.

    I have almost 6 years of telemetry experience (3+ as a traveler) but on some assignments I have floated to PCU. In fact, I had an entire 16-week contract on a neuro PCU and left with great recommendations (in hindsight, I should have stayed there as I was offered to stay permanently, but that is besides the point) - unfortunately that was now 2 years ago. I am currently applying for PCU assignments because I often take care of patients that are quite high in acuity and are easily true stepdown patients (multiple cardiac drips, variable and frequent VS, etc. tho never vents) but because of bed management and a smaller PCU these patients are placed on larger telemetry units. This experience does not seem to be enough to get a PCU assignment in some hospitals (except for the one time I got on a neuro PCU). My references unfortunately can only attest to the fact that I have been an excellent nurse and that their units are telemetry (ie, they don't seem to acknowledge that they are some stepdown-level patients there or that I have successfully worked with these patients).

    I eventually want to return to staff to become an ICU or ER nurse because I am "bored" with traditional stable telemetry patients as I am eager to learn more critical skills. I truly enjoy (for lack of a better word) working with more unstable patients because I feel more productive and interested in what I do. I realize the competition is higher now than it used to be for travel assignments even in the 3 years I have done it. So in theory these PCU assignments should go to nurses that have worked in an official PCU for lengths of time. However, I hate working with more critical patients masked on a lower acuity unit and having my skills washed out based on the unit I am on and not being able to prove this on an interview with a manager (ie, they will say if it was not a PCU you did not work in PCU). My skills checklist for PCU are also consistent with this (except of course with regards to vents).

    I am already beginning the process of looking at permanent jobs that will provide me the skills I wish to have, but I doubt I will return to travel nursing after that. I may have to take a tele job and transition internally if that is the easiest way to go.

    Anyway, thanks for reading.

  • 1
    servantldr likes this.

    Quote from SeaH20RN
    congrats! thanks for the update. what experience did you have previously? Good luck in the ER keep us posted.
    Thanks! I was a pcu/tele nurse for 4 years at the time I finished the course (about 3 years when I started). You probably read my last update above so that is what has transpired since. Good luck to you too!

  • 0

    I can't believe it has been a year since my last post. A lot has transpired since then so I will briefly update:

    I completed my 60-hr preceptorship at a major trauma hospital and it went very well. All that was required was documentation of my having participated in certain procedures (preceptor signoffs on a form) and I had to submit journal entries on each of my shifts (which were about 5 shifts of 12 hours each). In addition, I had to submit a 50 question multiple choice final exam which did not seem too hard but was based on info I would have learned in the ER. A month later, I received a very nice embossed completion certificate which is now in my portfolio. Done!!

    I started working in a different ER back home sometime after that (job I had obtained before finishing up the certificate) -- and I resigned at my 90-day evaluation (!!!). This happened NOT because I did not like the ER, I actually liked it. But it turns out I was at a horrible hospital with a horrible orientation and a much more horrible preceptor who threw me under the bus based on misinformation. I decided I could not stay in that environment, I am too valuable a nurse to be trashed like that. Unfortunately, this was not evident in the interview and had I even known this at the beginning I would have gone elsewhere. So I returned to travel nursing and ended up taking an assignment ironically in ED holding. I enjoyed my time there and moved on to another assignment.

    So in sum, I remain interested in ED nursing though I am now trying to be very careful where I choose to continue that specialty. I have since become quite interested in ICU so I am also considering that route. So I am at a crossroads in my career.

    However, I don't regret taking the course because the experience is invaluable and shows a lot of personal initiative. It remains on my resume and I am proud of that! I do recommend this course to anyone interested in entering the ER as an experienced nurse.

    The End!

  • 0

    I have worked PCU and tele for almost 6 years now, and in my experience there seems to be more "prestige" attached to the CCRN than PCCN. I don't believe it as a fact, but that is the impression I get from hiring nurses. It is akin to two MBAs (one from Harvard and one from State U) going for the same job. The Harvard MBA is more than likely going to get the interview solely on the name. That is unfortunate, but that is how society is. I come from another industry in which where you went to school matters quite greatly, and unfortunately I did not know that until after I graduated. So right now the CCRN seems to be the equivalent in nursing.

    Although I have the experience to take and pass the PCCN, I will not take it because I feel that will pigeonhole me into that specialty and it will be harder for me to get into ICU, where I would definitely pursue CCRN. This may not be totally true, but is just based on what I have seen in the industry personally. I have aspirations of climbing the leadership ladder, but I don't want to do it before getting CCRN.

  • 1
    MurseJJ likes this.

    In my experience, PCU is easier than med-surg due to the lower patient ratio. More time to critically think about your patient's needs

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    Thanks! I guess the nurse I was handing off to didn’t understand that the femstop order was there only to be used if needed. It clearly was not needed at that time since the patient’s site was CDI and no hematoma present. But she seemed to insist why wasn’t it done. That is why I was confused. In my mind, I was like “why do I need to use a femstop at this time just because the order is there and the site looks fine?”

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    Personally, I would wait until you have 2 full years as staff before traveling. You will be more comfortable with your skills overall (you will be surprised how much one more year makes a difference) and you will also be more competitive for assignments with that amount of experience. I also recommend starting out at one of the best hospitals in the country as a traveler, as that makes your profile shine more for future assignments (The first three hospitals I worked for as a traveler are currently in the top 10 of US News and World Reports and although that sounds sappy to have it did impress future nurse managers enough to interview/offer me contracts quite readily).

  • 0

    I have been traveling for about 3 years now. I speak fluent Spanish and English and am quite proud of this skill. I enjoy having Spanish-speaking patients because I feel they are more comfortable with me and I feel like I am able to understand their needs more than an English-only speaking nurse.

    The problem lies when I do not have the Spanish-speaking patient assigned to me and the English-speaking nurses periodically pull me away to have me translate between them and their patients. Granted, I am busy enough with my own group and feel like getting pulled to translate for someone else's patient just "adds" to my work. I feel it is easier just to give me that patient and avoid the pull away.

    Tonight I mentioned this to another traveler at handoff and he said that yes I would be able to argue for a few more dollars per hour for being bilingual, and I am wondering if this is true. If so, I feel like I cheated myself for the last 3 years for not requesting this be factored into my pay.

    Note that I still insist on staff using certified translators when obtaining consents or providing medical consults. But if I am being pulled several times a shift to ask a patient if they need a bedpan or whether they are in pain, it gets to be a hardship on my own flow.

  • 0

    Currently working tele unit in California, we never have more than 4 patients at once as regulated by law. On med-surg units where I sometimes float, the ratio goes to 5 patients per nurse. The only difference is the telemetry box, which magically reduces your patient load by one. I recommend learning tele so that you can avoid 5:1 ratios, because I personally feel that there is a fine line in workload between 4 and 5 patients.

  • 0

    So I was working a tele unit today and I had a patient come up from the cath lab this evening. He had 4 stents placed in his left leg and iliac vessels. Cath site was left groin, which I observed was C/D/I in a gauze and tegaderm, no hematoma. Patient instructed to lie flat until 1730, which was about 2 hours from arrival to unit. At 1730 I allowed him to incline HOB to eat dinner. By handoff, groin site was still C/D/I, no hematoma, and patient VS were very stable taken per protocol.

    At handoff, the nurse questioned me whether the femstop that was ordered was placed. I was confused, I said no (in my mind I was asking myself why as the site was not bleeding nor hematoma present). Mind you, I have never used a femstop before nor would I know how to use one, nor know what one actually looks like - but I know what one is for. I told her I was not sure why the femstop was still listed in the interventions (Meditech for anyone familiar with that EMR). Most all post-cath patients I have cared for have presented on the unit with hemodynamically stable groin sites and all I needed to do was monitor the site and assure stable VS. So I was confused why this nurse was asking me why the fem stop order was not executed by me. I thought this was all done in the cath lab (this unit has had some patients that require sheath pulls, but I have not done those either).

    I am a nurse with 5 years tele experience and the nurse I handed off to probably seems like she has less than that (but more experience than me on the unit I am working on). I did approach the charge nurse afterwards about this and she seemed likewise confused as to what happened. She said she did not think he needed the femstop despite it being still ordered.

    So I was wondering whether I was right in being confused. Granted I should learn more about femstops for future reference (and the charge said we would review policy next time we work together) but my instincts were telling me this was not needed at the time but the nurse was semi-insisting that it wasn't done, so I am like, am I missing something??

    Advice? Thanks!

  • 4
    TriciaJ, JennyMac, Here.I.Stand, and 1 other like this.

    Quit. Quit now.

    Your manager is an out-of-touch idiot.

    Watch your HCAHPS scores plummet.

    If I were a patient, I would forbid you from waking me up for this nonsense and I would refuse this while I had visitors.