kitcat3968

Actually just stumbled across it one day while researching some nursing agency stuff. Like the board view. However, some of the topics get a little hot and some of the threads are pretty vicious. C -

I know Favorite Nurses has traveling LPNs. Check them out. I applied on-line a few years ago and am still working with them. Good Luck. Cathy

Please explain.

I presently worked part-time as staff, and for 2 agencies. They both contact me on Monday (so, Sunday night I figure my schedule for the week) and I give a couple days to one and a couple days to the other. I seems to work well for me. It still allows for scheduling flexability, varied assignments, etc. However, you MUST be able to keep a very current and accurate calendar. If needed, reserve Mon. and Tues. for one agency and Thurs. and Fri. for the other. This may help prevent any confusion. Cathy, RN, BSN - Cleveland

I presently work for Favorite Nurses, I think they are great. They really seem to have a grip on what's going on and I mean it's all the time. I always have plenty of options and if I'm cancel at one site they usually seem ready with another assignment. I also do some work for MSN - not going well, just feels like their fumbling around. Have worked for KForce, apparently I wasn't the only one that left. From what I understand, they lost many of their primary contracts in the Cleveland area because of miscommunication and misscheduling. Intellistaff, not worth the effort. Cathy, RN, BSN - Cleveland

Sorry, I disagree with the concept of unconscious sedation and etomidate. Yanking on a dislocated shoulder ALWAYS invokes a grimace with etomidate, therefore, there is some consciousness going on. The dosing, while being exact, also is going to effect different people differently. Just because there is no reversal agent does not make the drug any less effective - only better practioners, that are able to recognize the beginnings of possible problems. I personally like the drug because of the amnesic effects combined with the sedation. Not even OR can predict a person's response and control the situation when a person has an unexpected response to a med. What does having a feel for the AMBU and ventilating v. blowing up the belly have to do with the sedation? I'm not saying tubing someone, I'm just saying that the half-life is short, which can be reassuring knowing that the should is reduced and the pt. might have had an unexpected reaction to the medication. Cathy, RN, BSN - Cleveland

Sorry, as a part-time staff ER nurse with 7 years with the facility, in Cleveland, I make 26.98/hr. What the deal is with the other 2 cents - no one can answer. As an agency with this experience, and of course ACLS, PALS, BLS, I make 39/hr weekday 1st shift. If I haven't had enough of the abuse for one week and I pick up a weekend night shift through agency, I make 45/hr. The deal gets really sweet with weekend, night shift on a holiday - then it's 63/hr. For example, I since this past Christmas and New Year's fell on the weekends - I worked night shift 12/23 11p-7a and got the higher rate of 63/hr. Hope this helps. Cathy, RN, BSN, Cleveland

I've worked for Favorite Nurses for about 2-3 years now. I agree, their great. I just love my recruiters. For some reason, Favorite Nurses seems to have it on the ball over my other agency - MSN. They always seem to know whats going on no matter what time of day or night. That's important to me. If I decided at 4 a that I want to work later that day, I want to call and let someone know. If I call MSN, something just doesn't sound right - almost like their winging it and just agreeing with me. I don't know, maybe I'm crazy at 4 a. It may take a little while before you find and agency that right for you. Cathy, RN, BSN, Cleveland

I have found that agency is the perfect adjunct to school because of the flexability. I'm not sure I would be able to trade that part very easily. Cathy - Cleveland

I have found that signing up with more than one agency works well, provided you are a good calendar keeper - and I mean GOOD. Two is just about the max for me, each day has it's own abbreviation for which agency I'm working for that day and which facility, floor, and time. I like to rotate shifts every now and then. By signing up with more than one, you have that needed money assurance. Should you get cancelled by one, you call the other and let them know your available. Recruiters from both agencies call me every Monday and ask for my availability. Since I have already decided which days I want to work that week, I split them up and give a couple days to one and a couple days to the other. It seems to work for me and my paychecks tend to be pretty steady and without much fluctuation. Hope this works for you. Cathy - Cleveland

As a preceptor of the "new kids," here is what I have found to be the difference between a nurse who makes it and one who doesn't. Learn to see the BIG PICTURE. This is learning the subtle, the pt. is going to crash signs: agitated, restless, decreased mentation, etc. Don't just look at the monitor, look at the patient. Second, learn extensive time management and organizational skills. If your facility requires primary nursing without much assistance, you have to know which is more important, hanging Levaquin on a 40 year old pneumonia who will be d/c'd or eyeballing the new squad rolling in. Third, document when you do it or your documentation will never be accurate and, heaven forbid, never stand up in court. Knew a nurse who used to jot her documentation down on papertowels throughout the shift and then had to figure out who belonged to which at the end. Needless to say, she's no longer in ER. Fourth, learn not to panic. You know the basics or you never would have gotten your RN license. Once you have gone through and run a code, on the ER side, not the EMPT side, your comfort level will grow and eventually you'll be able to hit the zone and automatic pilot. Fifth, don't let the politics and the tension suck you in. This is the ultimate killer of ER staff, young and old. Hopes this helps. Cathy, RN, BSN, Cleveland 10+ year ER

Theory? In ER? Not where I'm am. If it is not published clinical research no one wants to hear it. Nursing models to some extent but that's about it. Our ER docs even conduct their own clinical research, outside of medications, to decide best practice for their group. Cathy, Cleveland

In Cleveland, beginning ER RNs, no matter the education, get about 20 per hour. Most experienced/senior staff/charge get about 27-30 per hour. Needless to say, it takes a while to reach the higher levels. Cathy, RN, BSN, Cleveland

We use Etomidate for conscious sedation. The bad part is it causes respiratory depression if not calculated to the ml and even worse, there is no reversal agent. The good news is it's half life in only about 7 minutes and I can bag anyone for that long if sats drop. Cathy, RN, BSN, Cleveland

I come from a 24 bed, 40,000 per year, suburban, soon-to-be ghetto, level 3 ER. As far as patient assingments go, we used to have primary nursing, 1 nurse to 4 beds. It worked very well. However, the senior staff found it quite amusing to let the new kids sink or swim and not help out when they were caught up. Because of this, we switched to "team nursing," 13 patients to two RNs and one ancillary staff (aide or EMTP). The problem with team nursing comes from having more than one critical patient at a time because then both RNs are busy and the ancillary staff sure as hell can't handle it. OUr charge is pretty much responsible for bed assignments from triage and squads. When I charge, I try very hard to bounce back and forth from team to team, provided there are beds available in that area. I have also worked at a 75 bed, 100,000 per year, inner city, level 1 ER and it pretty much functioned on the concept of primary nursing with the ancillary staff floating between a number of nurses. The ratio was generall 4:1. I much prefer primary nursing and specific assigments because it allows for accountabilty, responsiblity, a better knowledge of your patients, increased ability to detect subtle deteriorating changes, and the more interaction. But, management doesn't want to hear it because team nursing allows for more patients with less RN staff - which, I guess makes sense because of the lack of staff any facility is able to keep for long. Just my opinion. Cathy, RN, BSN, Cleveland