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All this is really good info. A couple words of caution concerning anticoagulation...If a pt. falls while in the hospital, or is admitted due to a fall CHECK their meds to see if they are on any type of anticoagulant. Sounds simple, I know, but I see this being missed a lot. Do NOT give a dose of coumain to a pt who has been on the med for a while without an INR in front of your eyes. Take the extra 2 mins to look it up. If the pt has been on coumain for several days (or months) and no recent INR is available, get one before you give the med. I saw a nurse really dig her toes in with a dose of coumain one time and she saved her butt and the pt's big time. The pt had been on coumain at home for months for a-fib. She had been in the hosp about 5 days and no PT/INR had been drawn. The nurse saw this and approached the doc. He said the pt has been on the med for so long, no lab is needed. WRONG. So, she waited unitl 5pm when the on call doc took over, and called to get her labs drawn. The pt's INR was 28 and her PTT was 80 something. It was a miracle the woman wasn't bleeding out. The nurse took the extra time to follow up and it really paid off. Also, tell your pts going home on anticoagulation to be especially cautious against any trauma to their body. They need to be cautious of bumping their knee on the end table or even getting a paper cut. Sometimes pts don't connect that anticoagulation=easy brusining=potential to bleed a lot and need to be told outright.

I have my BSN and I am looking for an MSN program. I would like to be a CNO, so I want to go the Master's in Nursing Administration route. I have found many different types of degrees. I have seen many dual degree options including: MSN/MBA, Master's in Nursing Administration/Master's in Management, and a Masters in Nursing and Healthcare Administration. I am leaning toward the MSN/MHA option. Any opinions on this? Which degree will provide the most opportunities for me?

I haven't been able to check in for a while, and I appreciate all your replies! The replies are about what I expected. Some of you completely missed the point of my post, some of you got it and are complacent, and some of you see the more global aspects of what I said. The issue boils down to the fact that nurses are generally regarded as easily replaceable assets, and docs are treated as irreplacable, precious resources. I agree that it doesn't really matter what people wear, as long as their care is up to par. But the broader picture is that docs are allowed to do whatever they want, including dress, treatment of nurses and pts, etc. and the whole dress issue is just a small part of it. Yes, I understand that docs are not employees of any hospital, they make the hospital money, and the hospital is reluctant to tango with then. Docs should be required to give respectful care to their pts. If RT's are required to give respectful care, so should docs. I do feel that being presentable is part of respecting the patient. I know hospitals view nurses as liabiltities and an expense. The fact that nurses are viewed in this light, in my opinion, has lead to a lot of the problems in our profession and the general lack of respect we endure from docs, our pts, their families, and the community at large. We all know that good nurses who deliver excellent care will make the pts want to come back which will, in turn, make the hospital money. Why do pts come to hospitals? Because they need nursing care, not because they need a doc standing over them 24/7. If a pt. loves their doc but hates their nurse, how likely will they be to come back to that hospital? I know I will probably get berated for this and be seen as taking things too seriously, but maybe that's how the state of affairs of nursing got to this place to begin with. And the situation I originally posted about was not an emergency. The doc was there for rounds, as he was covering for the group over the weekend. My apologies for not making that clear.

I filed a complaint about two respiratory therapists and a doctor who came to visit my ICU patient and were dressed unprofessionally. One therapist was wearing scrubs with the pants too low and the shirt too high, leaving his red boxers visible. The other RT had on street clothes and a lab coat (which he only put on after I asked him who he was.) The on call surgeon came in wearing flip flops, khaki shorts, and a white t-shirt. He didn't have a lab coat, name tag, or stethoscope or any other item identifying him a a medical professional. I know him from another hospital, or I would have been asking him the same "who are you" question when he waltzed into my pt's room and started pulling back blankets. I told all this to our charge nurse, who naturally was upset at the RT's and left a message for our unit manager. When I got to the doctor part, she said that they play by a different set of rules and they can do whatever they want. It's a rhetorical question, but why is it that MD's are not held to the same accountability the rest of us are? He still has a responsibility to my patient to look presentable, whether he's a surgeon or not. How hard would it have been for him to throw on a lab coat (at the very least) on his way in the door? There are so many instances where doctors can get away with stuff that we "grunts" never could. If I talked to doctors the way they have talked to me, I'd be fired. If I was as abrupt and rough with patients as I've seen some doctors be, I'd be written up. When are we going to hold our doctors accountable for their actions?

Thanks for the posts. We are a small facility and don't have a unit clerk all the time. We never have a CNA. It's really hard when I'm trying to be a one person show and it really is a big deal when they tell us now we have to copy MARs too. We do have PCA flowsheets, but that is part of what's considered "nurse to nurse communication" along with the nurse's notes. As far as our DON stepping in....yeah...I won't hold my breath.

I would go for the RN hands down. You will be able to find a job easier, you'll be more thoroughly educated, you'll make much more money (at my hospital it's nearly double), and you will have endless career choices and many opportunities to advance that you won't have as an LPN. If you do a LPN-RN program it will end up taking you longer to finish and it will be more costly in the end.

I think the assistant or whatever she is should be cautioned against using the term "nurse" so loosely. Of course it's offensive to us because we know how hard it was to get through school and how hard it is to be a nurse. My problems with this are: 1. She shouldn't be calling herself a nurse. 2. Does she really understand how important sterility and cleanliness is? 3. She has no right to be giving medication (if she did so) 4. Using unlicensed personnel to do nurse jobs is only opening the door for RNs to be undervalued even more and eventually someone will get the bright idea that untrained persons could give meds to hospitalized pts and have an expanded role in the care of such patients. I would not go back to that doctor.

I think it's sad for you to be leaving nursing so soon. I would encourage you to give it ample time because nursing can be a rewarding career. BUT, if you know deep down that nursing is not for you, then I would leave as well. Nursing is a constant pressure cooker and if you don't do it as a labor of love you won't be happy.

If nothing else, know that you are not alone. I cried my first week off orientation and was convinced that nursing was not for me my first 3 months. It WILL click and it WILL become more tolerable/easier for you. Things that are so hard and confusing right now will become routine.....you'll see. You'll look back in a year and be amazed at how far you've come. If it were easy to be a nurse, there wouldn't be the nursing shortage. HANG IN THERE!

Thanks!

We have come up with a new problem at our hospital. If a med is not signed off on the MAR, it is not considered given, therefore the hospital cannot charge for the med to avoid medicare fraud issues. It used to be good enough to document IV fluids, IV drips, and PCA use in our nurse's notes or on the PCA flowsheet (as appropriate.) Now, when a pt is transferred to the floor, another facility, or home we have to copy every MAR page and put it in a bin for pharmacy to come up and count the # of meds signed off and to make sure the count matches the # of meds charged out from the pharmacy. (Yes, we still paper chart and pharmacy brings our meds to us instead of us getting everything out of the pyxis.) In some places we are double and triple documenting. We still have to put our IVs and drips on our notes but also on the MAR. Nurses notes are considered "nurse to nurse communication" and not a "legal document for medicaiton charges." It is very annoying to have another step added to our transfer process and I get tired of the "oh, the nurses will do it" attitude. Also, I wonder if they can tell us that our nurses notes are not legal documentation for one thing, will it be legal documentation that we really did call that MD or of vital signs? I think we're setting ourselves up for problems if we're able to pick and choose which parts of the nursing notes are valid legal documentation. Also, anytime we double document it is just begging for trouble. How are medicines charged for at your facilities? Any suggestions for how to handle this? Thanks!

I didn't know if it meant ACLS or what. I keep seeing one person write RNC every time she signs something and I was wondering what it meant.

What does the "C" in RN, C mean? What kind of certification is it?

I have never worked in a hospital that uses agency nurses. My mgr's goal is to "keep the agency out." I did clinicals in a hospital that used several agency nurses. It was the agency nurses vs. the staff. The staff was very rude to the agency nurses and gave them the CRAP assignments and way too many pts. BUT, I think the reason they were so awful to the agency nurses is that the hospital was awful to work for. There were a lot of internal mgmt problems and the hospital nearly went under. None of the nurses were happy. They received insulting pay and had terrible benefits. I think they took out a lot of their frustrations on the agency. I guess a lot of it depends on the climate of the particular hospital you go to work for. At our hospital we have asked for agency nurses because we need the help so bad, so I don't think we would be mean. Our particular floor is like family and very accepting to new employees. Hope this helps.

Hi guys, I am hoping some of you can give me some advice. I am thinking of going to work for an agency and I want some feedback to help me decide if it's the right thing to do. The main reason I want to be a traveler is to see different parts of the country. I am 22 years old and my husband and I have no kids, and we think this is the best time of our lives to go out and "live a little." I have been a RN for 1 1/2 years and will have my BSN this Dec. Can you tell me some of the things you like and dislike about being agency nurses? How much control do you have over when and where you want to work? How do contracts work? I know it's not something we like to talk about much, but what kind of salary can I expect? Are benefits available?Your insights will be greatly appreciated.