harley007

These are all great answers especially that at 18 you are legally able to make your own decision. Don't have the funds to obtain your needed education in the field of your choice? Run not walk to the best US Naval recruitment office you can find. Try several if need be until you really connect with a recruiter that truly understands what you really want to do for a career. If you can find a program you really love the navy will educate you and you in turn will provide our country with a certain number of years of service in your chosen field. I have three adult children that have done this and while like every profession, job or education you may not like everything that occurs, you will end up as a US Naval Veteran if you fulfill what you years of service and provided education with decency and honor. if enough years are served you can obtain your education plus a full retirement by the time you are in your early 40's. Then you can choose to begin a second career in the private sector with a full retirement already under your belt from the US Navy and experiences nobody can rival. Like being forced into becoming a nurse this is either something that interests you or it does not. If it does feel right to you must always, ALWAYS, get your package of orders signed & sealed before you head off for every assignment in particular your first one. No promises of future possibilities such as "Well your the next one for that assignment", or "You should be eligible for the program you love." ... written in hard copy with a duplicate for you to hold onto or you could easily find yourself in nursing school! Good Luck no matter what you choose!

Here's my own two strange deliveries: Had signed birth plan with my OB for my first delivery of identical twin girls! Everything goes great = leave me the hell alone or there's a life-threatening emergency = do what is needed. Walked into L&D @ 8cm & sadly got the new MD on-call. He literally stamped his feet & screamed at me demanding all sorts of interventions, which we were refused so he left. I was walking for entire L&D as the RN used a fetoscope. My reg. OB arrived for delivery & had the twins standing, no meds, interventions or epis. I nursed them both at same time q 2hr post delivery & left hospital 17 hours later. 16 months later had planned baby #3 - in labor at home & just decided time to go to hospital when cord prolapsed 4 inches. I dropped to the floor raised my butt in the air & held baby's head back. Husband called Del Rm, explained situation & asked them to meet us at ER door. Ran to our car barefoot in snow & resumed position in the back seat. Hospital was 4 minutes away & met at door by OB plus security. As I stood up cord fell to my knees. Security picked me & popped me on stretcher as OB put her hand in on baby's head. Flew stark raving nude from the waist down with OB running along with hand in place through the main ER to Del Rm. Residents just ran around like chickens with heads cut off & anesthesia was at cardiac code. As residents began to scrub OB MD appeared along with Anesthesia. OB MD slept at hospital due to snow. He then grabbed a bottle of betadine & sprayed my abdomen, grabbed a pair of gloves & scalpel then began cutting 30 seconds before I lost consciousness Everyone forgot my husband was still in the Del Rm for the entire delivery. Time from prolapse to delivery = 16 minutes. Baby meconiumed, but did not inhale. 18 years later he graduate from top level college cum laude so I guess there had been enough 02! OMG!!!!! :0

I am sincerely sorry to have given such a simple & incomplete explanation of the Medicare reimbursement that severely impacted numerous large hospitals in many states. As I've mentioned, the Medicare crisis hit my hospital when our when our Cath. Lab had a unusual decreased in case volume, thus when evaluating needed cutbacks the Lab appeared to be an accurate candidate. This followed the afore mentioned discontinued funding for traveling staff, a significant increased in all staff on call time, decreased hours in some cases and a changed difficult scheduling. As the National Health Care issues began to resolve our case load returned to normal volume and on most days it's well above our previous case levels. Now we work with a higher number of cases per day with a significantly decreased staff. Out staff is a very close group of, caring, highly experience and technically well trained staff with almost no turnover. The Department's Director is an incredible fiscal & staff manger who shares her concerns with our situation as do the Cardiologists. We all hope a bit more time of proven consistent volume will justify giving us relief from at least the extra call and tough scheduling. Any positive thoughts sent our way would be very much appreciated.

Please let me explain, I am not discussing cuts under the new National Health Care. This is Medicare's autocratic rating system that has penalized many large state hospitals as much as 35 million dollars/year. It your read the rating system it makes a certain amount of sense, but as we all know no matter how great the quality of care given, many patient's with multi-system issues are sadly going to unknowingly drag down the rated quality of care. In the main, this patient grouping does not respond to the evaluation polls concerning the quality of their provided care due to their heart breaking & overwhelming struggles just to get by. In states that do not have "for profit" hospitals, All hospital naturally must and willingly do treat every patients in need without question of cost or ability to pay. Add in that a large portion of any Medicare reimbursement is now is based greatly on the patient's evaluation of their care. Statistically this type of response is not well generated from this financially struggling population. The rating is also further lowered by the statistics the show many of these patients are admitted more than once for the same preventable DX because there is a major lack of awareness of the available assistance that is possible for regular no cost preventative health care. Thanks for listening!

Firstly as far as reimbursement etc., each state is different. Medicare cuts to hospitals in some areas have been huge. Now even some of our very complex angioplasty patients are being discharged as day patients and that causes a decrease in income. Many more of our STEMI patients do state that they had a positive study ... but.... Their confusion about what the cost would be to them with the new National Health Coverage caused them to not schedule elective angiograms. Plus how many times have we all heard "I only had "SOB" or "The CP went away when I rested so I didn't think it was serious"? Our staffing and hours were cut because of the consistent decreased volume and other income issues. Now the volume has been running above our usual of 25+/- cases per day and call remains super busy. Staffing is stretched to the ultimate max with the volume of work, extra call and working late to finish the elective cases. So far everyone is hanging in there and hoping this consistent increase in the volume of care will be proof of our need to reinstate staffing and resolve the call issues. Sadly if this is not handled our wonderful history of a well season very experienced staff with almost no turn over may change in a big way.

Is anyone else experiencing a decrease in the number of cases per day in your Cath Lab? I work in what has always been a super busy interventional lab. With the insurance changes in beginning of this year, our numbers are down 30% for scheduled angiograms with possible angioplasty. Patients are told they need an angiogram after a positive stress test. They decide to hold off as they are uncertain what their coverage really is and how much the preventative procedure will cost. On the other hand our STEMI numbers have increased quite a bit. It appears that the same patient population is arriving as emergent STEMI cases when they possibly could have had preventative angioplasty. It is so frustrating to realize many of these STEMI patients could be the sad result of uncertainty about the new national insurance program.Is anyone else experiencing a decrease in the number of cases per day?

I think it might depend on your lab and what your MD's prefer. We frequently do FFR/IVUS in our lab and all four labs have installed bedside equipment. The Pyxis has pre-mixed Adenosine infusion bags ready to go - what a time saver! Less than 10% of the patients are below or above the weight limit for the pre-mixed. If so, we're back to mixing that time consuming drip, along with a thrombolytic agent and everything prepping everything else that's needed for an FFR.

I was educated as a RN 38 years ago and I completed an AS/Diploma program. I didn't take the NCLEX as a nurse educated that long ago took a 5 part - 2 day long state board of examination to qualify as a Registered Nurse. My clinical rotations involved hundreds of clinical hours as the AS/Diploma was a 3 year program with only one week off each summer. Even on the days we attended our college classes the local university we were required to return to the hospital for afternoons of clinical instruction or additional hours of clinical experience. Our endless clinical hours always included an instructor breathing down your back every second. By our last portion of our third year we weekly administered medications for an entire "floor" of 44 patients and were constantly verbally questioned on each medication given. We were required to spend 3 months on site at a large psychiatric hospital and a month's rotation at a rehabilitation facility. Before I completed my RN program I had already graduated and worked as an LPN. Once again the LPN program was a non-stop clinical and classroom experience including working evenings and nights while attending regular classes - Yes, back then we were actually used as hospital staff. So let me see, that would make me an RN with 40 years experience as a nurse including working in the ER, ICU and the last 10 years in the Cath. Lab which has been the specialty closest to my "heart". Our interventional lab runs four rooms and averages about 25+ patients a day. With a very, very rare exception, our STEMI times meet the national standards 100% of the time. We are always involved in numerous studies, run a separate large EP Dept. and are always the first lab in a multi-state area to use the newest stent, balloon etc. THREE of my five children are on active military duty and all of them are advanced trained corpsman. I am quite aware of their intense training and the responsibility these three have at sea or on the battle field. But, my education's advantage is it's more broad based and all specialty inclusive. Although I love working with any passionate Cath. Lab team member from RCIS, RT, Paramedic, etc., etc. I still feel that only a RN should be administering medications. It's not only the knowledge of the medications but the total patient care including issues that involve other specialties. I know you as much as I are still amazed at the unusual conditions that our patients surprise us with that affect their care aside from their CVD. That is where I feel my broader based education has an advantage. I graduated high school at 16 & even with 40 years of being a nurse I still jog like a maniac. So I'll can certainly match you or your colleagues and run you down in or out of the lab. :) Alright my dear enough said. Please keep your wonderful passion for the Cath. Lab but remember to play nice & no generalizations!

I bit my MD's office RN when I was 3 y/o because needles freaked me out so badly! This was also back in the days of house calls & I would talk the poor busy GP MD's ear off just to delay my shot. Meanwhile, I was reading "Cherry Ames" books like they were the bible and knew even at that young age I wanted to be a nurse. When I was 12 I was so very sick with tonsilitis that I couldn't even lift my head up when the MD came for his visit. I just laid there with a temp of 104 and took my shot of Penicillin like a champ. Ever since then needles and I have been friends :)

I am a Cath. Lab RN and maybe I am confused in reading some replies but, my hospitals "door to opened artery" goal time is under 90 minutes. (I believe that is the national standard - naturally if there is transport involved that is another issue.) We beat that time 99.999% of the time and have had a number of 30 minute saves. Our EMS FAX any possible ST/MI EKG's into the ER MD and a team wide beeper system is alerted with one click of a computer button. EMS sending the EKG to the ER MD allows us to be there from home before the patient's arrival to the ER & it is a tremendous help. We many times hit the ER before the heparin drip is even hung ... forget the prep! If it is during the day heaven and earth are moved to open up a lab. We literally run the patient from the ER down to the lab. Our computer/xray system is thankfully stare of the art and quick to set up. Even the MD's are there from home as fast as we are. All the departments involved in the care of this type of patient have met and co-ordinated care so that everything possible is done to "shave" minutes off the time it takes to get the patient from the ER to the lab. Thus that blocked vessel can be opened ASAP and the heart muscle is spared as much as possible. I guess what I am saying is I can't imagine the ER having time to prep the groin because we arrive so quickly. By the way in a with an acute MI we prep both sides of the groin - just in case there is an problem. As many people have said, we all become a huge team working together and the patient is the number one concern for everyone. Love my job!

Best advice? Just hang in there until you are comfortable. You work tele so I am sure you are all set with recognizing what a dangerous EKG tracing is and I assume an S-T elevation. Review you basic heart anatomy so you know all of the coronary arteries. Most tasks are learned through repetition such as scrubbing and setting up the table and recording the case. Conscious sedation is usually administer by the circulating RN so that a good area to review. The cardiologists usually want what they want NOW so learn the equipment and where it is kept. An easy way to do that is to always assist with stocking the room you are working in and or help put away the equipment deliveries in your main supply room. Most of all, remember that everyone on the staff started off just like you and had to learn everything from scratch so they may be talented but they're not super heros .... although some may think they are:) In a diagnostic lab it takes a good six months to feel confident and in a interventional lab it takes about a year. If you have any other questions just e-mail me I would love to help. Best of luck!

In reply to the above post - As I said I just had this test. At my last position the screen was done during a physical and there was an area for you to write down your current meds. For this new job I was sent from HR directly to a lab. What I didn't mention before was that in the written disclosure they give you to read and sign before you take the test, it stated clearly that there was no need for any type of disclosure of your current medications. To double check this I asked the tech because before they always asked for a list. He stated that I could write a list for my own reference to use if they called me about an issue. But, as it stated in the written and signed disclosure there was no place or need for me to list current medications on the lab form itself or anywhere else. I even went back to HR and confirmed this. So, perhaps in my state things have changed. I was just describing my own recent experience and maybe I should have been more informative. So in general, if they allow you to list your meds then go for it with total honesty as the bottom line is a long as it is prescribed then you are going to be just fine.

Congratulations on the position! It sounds like you picked the perfect situation to allow you to get a really broad based set of experiences. You seem to be very motivated and I am sure you will due great in this new job. Maybe in a couple of years you'll make the jump into the CCL. But you know, our prep & recovery unit nurses really love their jobs so who knows you may decide that is the place for you? Either way the best of luck to you!

It is so nice to find a CCL thread as I totally love working in my lab. especially the opportunity to give 100% of my attention and care to just one patient. Sure I will admit I love to have my skills challenged when a patient starts to circle the drain. It still amazes me how we all pull together and even with just the on-call team of three staff we stabilize the patient and except for anesthesia, we have yet to call for extra help with a "code blue" We have a designated pre & post holding unit and a separate self contained EP lab. The patient is transfer from holding unit directly to the table by one of our specially trained CNA transporters. We do 20+ cases a day ... everything from diagnostic, angioplasty, IABP, temp. pacers, pressure wire, IVUS, etc., etc. Staff is expected to do the triple threat of circulating, scrubbing and recording. We are lucky to have an amazing state of the art system that records the case, prints, and collects all the ACC data. Call is from 6p to 6a but staff tries to say if we are drowning in cases at the end of the day. It sure helps to keep more than one lab running with 5 add on cases backed up. Last week was my worst call ever! I took on two extra call nights due to a sick call and was up all night and then worked the next day for those two days and then did the same for my own scheduled night ... naturally it was also my weekend on-call. I still love this position more than I can say and they will have to kick me out the front door dragging my walker behind to get me to leave. Glad to meet you all!

I just a a screen for a new position two weeks ago and the tech told me they were basically looking for illegal drugs. They did not want a list of any meds. and if anything turned up positive as long as it was prescribed there would be no problem. Good luck!