PMFB-RN

Two high school friends, both want to be nurses. Kelly (names have been changed) works hard in school to get accepted to a good college. Doing so ment she missed out on some fun. She got a 4.0 and accepted to Marquette University BSN program. Her friend Jeremy did OK in high school, graduated with a 3.2 GPA and got accepted to the local Wisconsin technical college's ADN program that costs $7k. He was able to pay for it by living at home and working part time. Two years later he graduates, passes NCLEX, and gets hired into a demanding 9 month nurse residency for new grads going directly into ICU. Four years after starting nursing school he has earned a BSN online that the hospital paid for, got his CCRN certification, has two solid years of experience, and earned $160k in those two years. He is now planning on applying to CRNA programs. At the same time Kelly graduates from Marquette with her BSN, passes NCLEX, and gets hired into the same nurse residency program where her old friend Jeremy is assigned as her secondary preceptor. Four years after starting nursing school Kelly is an RN with a BSN, zero experience, has earned no money, and has a $600/month student loan payment. Kelly realizes the difference in the paths the two of them took and is PISSED! Mostly at herself for choosing the path she did, but also at the adults who counseled and guided her in high school. I know both of them well and was Jeremy 's primary preceptor when he was a new grad. Kelly tells this story to anyone who will listen.

What they mostly care about is a solid track record to showing up to work when you are supposed to. Emphasize your reliability in your past work experience

WGU will get you a BSN faster than any other school.

As a full time senior staff RN who only works occasional OT (less than one shift/month) I made $161k in 2022. My base pay in in the $130K range, the rest of the pay being made up of NOC & weekend differential, holiday pay and that occasional OT. I work in the Twin Cities area of Minnesota. Which happens to be the highest paying area for nurses in the US relative to cost of living. That's why I relocated to work here. I have a good friend who is a UPS driver and as far as I'm concerned they deserve to be paid very well. They work hard for their money, often in appalling conditions.

Sounds like you and I went down very similar roads.

A few weeks into the first wave of COVID (my definition of a covid wave is when my hospital opens a covid ICU) I realized something. I was the last person most of these people would ever speak to. We were on a treadmill of keeping covid patients on the ward and treating them until they couldn't oxygenate anymore. Them we would intubate them, take them to the ICU where most of them would die. It was pretty much the roll of RRT (I'm full time rapid response RN) to determine when someone needed to be intubated and I attended/assisted with every intubation that happened on my shift. Sometimes 6 or 7 a shift. This went on for months. Sure some of there people would have nurses talking to them in the ICU, and thier families would speak to them via Face time, but once intubated very few ever spoke to another person again in thier life. So I started telling them that: " hey, I'm not trying to scare you, but I've seen how this goes. This may be your last chance to ever say anything again. Is there anything you want to tell me, or message you want me to pass on?" A lot of what I was told is about what you would expect, messages of love to thier families. But there was also a lot of other things. People confessed things to me, and expressed life regrets. Many of the things I was told were shocking to me, and even more were heartbreaking. I'm carrying around all this stuff. One day maybe I'll be ready to share the things I was told. But that day isn't here yet.

Several times in my career my fellow nurses have warned me about certain hospitals being awful places to work and I've appreciated that warning. Vanderbilt has a solid history of being a terrible place to work as a nurse. I'd suggest you and the others applying there just be grateful that you've been warned. Your decision to be dishonest and fabricate things about me isn't helpful at all.

I'm not an NP and can't answer your question about what they are looking for to promote to nurse 4 for NPs. But I can tell you for sure nurse 4 is not a permeant pay grade. You can only be a nurse 4 while in a nurse 4 position. If you leave a nurse 4 position you revert back to being a nurse 3. My former nurse manager, actually managed several departments recently left her position and stepped down to a single unit manager for personal reasons, but she lost her nurse 4 and is now a nurse 3, which is a permanent pay grade. Yes you can promote any time in your career, it's not a one shot deal.

I'm not frustrated and nothing I said would indicate I am. Your dishonesty is noted.

I'm appalled that any nurse would consider working for Vanderbilt after what they have done to nurses.

Your feelings are 100% normal and appropriate. Ide be worried if you didn't feel like that. In my unit we don't really start to considering a nurse a "can handle anything" critical care RN until about their 3rd year. Longer for some.

They all do.

In my unit we had two fully vaccinated people die of COVID. One had advanced leukemia and a trashed immune system. The other was a healthy young (31) man who came in to our ED with SOB and was dead less than four days later. Had our docs stumped and nothing we did seemed to matter. I'm not sure how many unvaccinated people died of COVID in our unit, over 50 though.

Nothing I said suggested or implied hatred towards the unvaxxed or anyone else and it's dishonest of you to falsely accuse me of hating. You have been consistently dishonest in this discussions, completely fabricating lies several times. I guess it's typical behavior for your kind.

There were two studies presented at a Wisconsin AACN conference I attended back in (I think) 2012 that supported smaller is better. Unfortunately I took the information I needed and have no memory of what the studies were called. I do remember that one of them was done an Baylor in Texas. As for catheter length influencing failure rates in PIVs, that's just my hypothesis based on my experience and observation. I have not seen that supported in studies either.

Even though smaller is better when administering vasoactive drips in a PIV, I naturally assumed that the small bore IV would not be a critical patients only access. Two 18ga in place until a central line can be placed and then Ill add a small bore for the drip. I looked at the PubMed article your linked to and didn't see where catheter length was taken into account. Typically smaller bore catheters are shorter. Our standard length for 22ga is one inch, vs 1.25 inch for 20 and 18ga PIVs. It's my observation that shorter catheters fail more often than longer ones. We have access to 22ga catheters that are 1.25 and 1.5 inches long and these are what I use when intending to run drips through them. Back in the old days everyone needed larger IVs "just in case". Like if they. become septic & hypotensive and need fluid recitation But now that we have EZ IO available and can always get access with it and larger IVs are not needed in every case.

Did you consider calling the cops and trying to get staff charged with battery? Something I would have definitely considered.

Nearly every advanced directive I've ever encountered was totally useless. Containing useless terms like "persistent vegetative state", or "brain dead". As if your body can't rot away in the ICU in the absence of brain death. My advanced directive is running to 10 double sided pages now and my attorney is a friend and former ICU nurse. It gets very detailed and complicated but the gist is, once I go into multi system organ failure, all they can give me of morphine and stool softeners. Most importantly, I have a large amount of life insurance. I want it to be worth my family's while to pull the plug on me. What ya'll need is a couple of highly publicized cases of staff being criminally charged for battery. We had a couple of them here in Wisconsin in the late 90's and everyone still mentions them.

Traditional nursing students don't do clinical on our covid wards. But some, like those assigned to a primary preceptor in accelerated BSN programs, take whatever patient their preceptor takes. They get fit tested by the hospital and N95 mask are (now) available.

Babylon Bee is fake news.

Nodays with small portable bedside ultrasound machines I can pretty much put and IV wherever I prefer it.

revolting

When running vasopressors in PIVs smaller is better. "Hemodilution is the solution" You want a relatively small catheter in a relatively large vein. Blood flow around the catheter helps deliver the medication where it's needed, and reduces vessel irritation. I use 22 gauged or smaller when running vaso active drips in PIVs.

Been there, doing that right now. This is why we have slow codes. Oh I know the ethics people always get their underpants in a bunch when I mention a slow code, but curiously they are never around when we could really use an ethics team, as described in the OP. But never a shortage of ethics Monday morning quarter backs to review and criticize. Like the OP and many of you, I could tell true story after true story similar to those the OP has described. As a full time rapid response team RN (our RRT is just one RN) and code blue leader, and documenter of all code blues that occur while I'm on shift I'm in a position to influence how we code people. In November I flat out refused to code a patient. I knew him well and he had been adamant he didn't want to be coded. He was a retired emergency physician and knew what he was talking about. Like described in the OP, his family changed his code status once he became hypoxic and confused. When he went into arrest I arrived to his staff RN doing CPR. I announced I could not in good conscious take part in the code. Well I'm the code leader so the ward nurses stopped their efforts. I fully expected to be fired, but nobody ever mentioned it to me or wanted to talk about it. I get the feeling that my nursing management REALLY doesn't want to talk about it. Luckily it was at night and no family members were present.

Obviously I'm dismayed at how evile these people are and showing how we are targets of evil, deranged people now.