Hekate

Evidence-based practice would be my answer to you! Your practice is your responsibility and your patient's safety and well being should be your priority. Therefore, a N-years old manual is NOT a reference. No one has time in our profession! Yet we still have to keep up with the latest literature and best practice.It is up to you to read and keep up with the latest trends and best practices. HOB at 30 degrees is the standard of care in most places. Holding the feeds when the patient doesn't tolerate it is both a safe practice and common sense- Knowing where your feeding tube is (pre or post-pyloric sphincter) is of importance as well (they are not managed the same way)-Your supervisor is not the primary nurse, therefore, he or she does not have a say beyond advice. If another nurse does something that you think is wrong, that is also your responsibility to call her up on it (and check your references). There is so much more to cover, but if I have to sum it up, I'll say it again: Evidence-based practice H~

I would tend to agree with ParkerBeanCurd (what's that by the way?) At the same time, I do understand the points made in the other posts....So my question to you is: Are you going to spend time volunteering? If yes, then I don't see what the issue is. You are still providing a helpful service for free, and if it benefits you too, there is nothing wrong with that. It will indeed give you a good feel for the place and if you get hired as a RN, you will already know the inner work of the place, which would definitely be a plus! Try to work the desk if you can, this way you get a chance to familiarize yourself with the paper work/computer system, protocols, etc.... I think it should be a win-win situation ! But my advice: Try to keep a low profile from now on, and let people warm up to you before you share your goal with them. I hope it all works out in the end! Good luck H~

As an ACNP, your scope of practice is Acute or Chronic complex conditions. What it means is that you are primarily trained to take care of patients with complex health issues, and most practice in the ED and ICUs. The outpatient, clinic type of work is possible for the ACNP, however, it would have to be in a specialty clinic, i.e: cardiology, surgery/trauma follow-up etc... The ACNP's education only lightly touches to primary care topics and concerns. If you are set on only doing outpatient work, then ANP or FNP would probably be more adequate. The other question you should ask yourself is, what is the type of patient you would like to take care of- what I mean by that, is that if you are very interested in kids, pregnant women etc...then you should consider FNP who cover the whole life spectrum and could take care of kids, as well as adults, and follow pregnancies etc.... Not to fret though, because once you are an NP, you can always come back to do an addition specialty- for example, if you were a ANP and realized that you truly enjoy more complex health issues, you can do a cert to have your ACNP on top of your ANP (and they are often available online, but do have clinical requirements). I hope my post made sense and might help you a little..... Good luck, H~

Well, I wouldn't recomand Shoal Creek! One of my friends use to work there and it was VERY unsafe! The rest of Seton seem oriented toward quality of care and put a big emphasis on shared governance and education- If you are still considering applying to one of the Seton hospitals, don't hesitate to shoot me an email if you have questions! (and a few ICUs are willing to train med-surg nurses if you are still thinking about it). Cheers! H~

Ever thought about starting a "SMART management course/center" with your former boss? we need more managers like you! "1. Never ask anyone to do anything you have not done yourself first. (This includes working off-shifts, holidays and weekends. Every manager should work at least 1 non-day shift per pay period, if not more. 2. Never mess with people's schedule. See rule #1. Work for them if needed, to accomodate their reasonable requests for time off. 3. Never mess with people's pay. If an error occurs and it is your fault, fix it yesterday. If an error occurs and it is the employee's fault, fix it tomorrow. Never expect an honest employee to wait until the next pay period to receive their money. These rules served me well as a manger. I hae n idea if my former boss reads this board, but if she does, I hope Cathy R. of SC recognizes herself :)"

Hi There! I use to want to do the CRNA training as well....that is, until I shadowed one of the CRNA I use to work with. As he said it so well, the job of the CRNA is 95% boredom and 5% pure panic! I think it all boils down to your character and what you are looking for. If spending hours behind the drapes of an OR doesn't bore you to death, then it might be the right path for you.This is a simplistic approach on my part, because CRNAs are very knowledgeable professionals and their role is crucial. But the daily reality of the job is something you might want to look at up close. In my case, one day with a CRNA was enough to convince me that I wouldn't be happy in that role because I can't stand being bored, nor having to deal with prima dona surgeons. I truly admire CRNAs as I have worked closely with many, and they regularly saved the situation (and the patient)in the post-op Open heart settings. But I think that the assessment of the CRNA I shadowed was dead on: You do get the critical situations 5% of the time where your skills and knowledge will or not save the day. But for the 95% of the time left, their role is very repetitive and a lot of "rushing then waiting" for hours on end. I went for the Acute Care NP master because it offered a similar level of knowledge base practice while having a lot of hands-on and complex procedures. In my eyes, the added bonus is to continue to have busy and rich work days interacting with patients and colleagues. On the salary level however, an ACNP doesn't make nearly as much money as the CRNAs. It is a question of personal priorities....In my eyes, no amount of money could make up for boredom (but I am an adrenaline junky, so no reference by any means!) I hope this helps a little... Good luck! H~

very well. you are entitled to your opinion, but since you call my posts "disrespectful rants" and accuse me of playing the victim card, i'll ask you if you have actually read my posts in their context? i am merely reacting to posts that i find very disrespectful and ignorant. i don't appreciate being constantly bashed because i am a foreigner and many of you "believe" that foreigners "take" your jobs. so i am sharing the nice reality of a foreign nurse coming to the us. stating the xenophobic practices i have experienced in this country hardly counts as a "victim act". i find quite interesting how little compassion and understanding one can have. does that mean that if you were to witness someone being discriminated against you would not do or even feel anything? i guess it is a sacro-saint crime to criticize even the most evil practices in the country!? do you agree with everything happening around you? beside being treated like a piece of crap by immigration people and a few citizens, i consider to have it easy as far as life style is concerned. but in case my message didn't get across, what makes me sick is to see how much injustice, poverty and violence exists in this country despite it being portrayed as the land of all opportunities. coming from another country, i did and still do find shocking to see the disparities in a country that projects an image of such opulence. contrary to what you think, my disgust is caused by the lack of tolerance and generosity i see around me. i am floored to see how many people struggle with the bare minimum to get by day in and day out. where i come from is no paradise, but i can say that everyone is given an equal chance to education, health care and social support. i wish i could say the same thing about this country, but unfortunately, it isn't so.... do you disagree with that too? i would have expected to find a more socially oriented crowd amongst nurses! i guess i was wrong on this count as well.... one last thing: when you say something like "i can hardly take you seriously as a person", at least do us both the favor of giving some king of rational for your "opinion". otherwise, i could not take your criticism seriously either.

i believe you have truncated the part of my message explaining my reaction. it is quite typical to manipulate words by taking them out of their context! know that my husband is a us citizen. know that my knowledge of history is not limited to the history of the usa, but covers most of the world (that is 12 years of history classes....all year long, year after year.) i weigh my words before writing them and if you believe that the poverty in this country is caused by your generosity to foreigners, you are only showing the depth of your ignorance. in my practice as in my life, i make no difference in the way i treat people regardless of their origins. tomorrow i am spending my day volunteering for less fortunate than me, and these people happen to be americans. as far as pretending to know what other immigrants/foreigners really think, i will tell you this: most of them will never tell a non-immigrant what they really think because they know how their frank opinion would be received: like you received my opinion. with intolerance... ask yourself why the usa is "hated" by most of the rest of the world. certainly not because you are peace makers! you only intervene in conflicts where there is something to gain, and if you know your history that well, then you must know that the us has put people in power to then demote (and execute them) when they gained too much autonomy. please do prove me wrong and give me one single example of us intervention where genocides are taking place, but no oil or geopolitics positions are motivating the intervention. "to read that you are very discontent with out country concerns me with you being in the medical field." do please explain this remark. as is, it does not make any sens to me. once again, let me reiterate the fact that you have taken the end of my post out of context. i don't believe it to be a very honest process. if you lack the humility and the curiosity to wonder if there could be some truth in my opinion (which is based on experience, not on a preconceived notion) then you are just exemplifying the narrow mindedness i come across so often. to disregard all the other things i have written about my experience as a foreigner in this country worries me as far as your abilities to have compassion for a fellow human being.

at least we don't get called "sister" like in the uk! that would definitely be a difficult title for a male to wear! unless there is a male equivalent? brother ? just kiddin!

yes! many other professionals trained in other countries are indeed hired in the us. furthemore, many of these professionals are recruited by american hospitals, universities and companies in their own countries to come work for them on american soil! you know why? because they can't find the same level of trained professionals , researchers, doctors etc... in the us! i think that you are very much "biased" and i truly wonder under what rock you live. unless you are 100% indian, you too are from immigrant decent. fyi: i will likely always be hired over an american new grad because i have more experience! (and worldly experience at that!) if you think that coming to work in the us as a rn is an easy process, think again. it took me over a year of exams, tests, screenings and exorbitant fees (out of my pocket) in order to be allowed to work in the us. which didn't mean that i had a work visa. in order to have a work visa, i had to be offered a job , and for my future employer to prove that i was qualified and would receive such salary and such benefits. only then could i apply for my tn visa. each time i left the country, my work visa was ripped off from my passport and i had to re-apply upon returning on us ground (it doesn't matter whether it was for a week-end in canada or a month in timbuktu !) every single time, i would be searched, my luggage would be searched, and i would have to wait hours on end at the airport, often missing my corresponding flight, in order to be re-issued my tn visa. every single time, i was questioned and treated like a criminal. i haven't returned to my country for 2 years because of skewed immigration laws (and mistakes). which means that i haven't seen my family for all this time either. even if i travel within the us, i end up being the one chosen for a full search. a 100% of the time! i was even accused of bringing in forbidden food after i forgot to remove a clementine from my hand bag given to me on a us airline flight. this was a national flight and the clementine had a nice big sticker saying "florida" on it! none the less, i was treated like a terrorist! trust me, nothing is worth all the humiliation and aggravation i have (like many other foreigners) gone through in this country. nothing, beside maybe the love i have for my husband. and get this: although i am paying the same amount of taxes as any american, i am not eligible for any grant, loans etc....if i were to be unemployed, i wouldn't be eligible for unemployment. considering that 30% of my pay check goes to uncle sam, i think that you should actually be happy that foreign professionals work in your country! it means free money for you! it is so disappointing to come across people like you with so little heart and many preconceived notions...

i'll take the bait. would you please explain why it "is so wrong" for foreign nurses to have a work visa, a green card, or to become american citizens? i was so tempted to report your comment as inappropriate, but my curiosity wins over my disgust. so do please explain your position/ opinion or rational.

there are 2 possible answers to your question (i'll assume it is a question...) : 1) the foreign nurses hired over the american new grad had more experience, and is therefore less costly for the hospital to train. 2) the foreign nurse was sponsored by that particular hospital to obtain her work visa/green card and therefore owes that hospital between 2 and 5 years . as a result, the hospital gains an employee that they know will not quit at least until the end of their contract. lastly, it may be a combination of the above 2 answers....when an employer sponsors a foreign professional, they have to prove without a doubt that the foreigner they are about to hire and sponsor is better qualified than an american professional applying for the same job; or that no american professional has applied for the said job for x months.

i have heard this theory of yours many times before, and quite honestly, it makes me sick! an officer at the border gave me attitude when i went to renew my tn visa and basically said something like what you wrote above. my then fiance begged me to keep my mouth shut, but i just couldn't. so i will tell you the same thing i told this officer: i came to the us because my then fiance is a us citizen and it was the only way for us to be together. i didn't come for the salary, because i made more in my country. i didn't come for the social/health insurance "benefits" because i had better coverage and much lower costs in my country. i didn't come because the life style in the us is better since i think that social conscience and life style just suck in the us! i came from a country that is rated in the first 3 best health care systems, and where quality of life is as good as it can get. we work hard, but we value our personal time/family time just as much. we start off with 7 weeks of paid vacation per year. our education is paid by our taxes (which isn't higher than the us taxes, before you ask). univeristy cost me 200$ out of pocket per year. should i continue? despite being the land of all hopes, i find that the us is very much backward in so many areas that i feel sick to my stomach on a daily basis to witness the injustice, racism, narrow mindedness and greed going on here in the us of a! there are many immigrants who come to the us because the image this country projects outside is one of ease, affluence and freedom. but, to this day, i have yet to meet an immigrant who thinks that the image projected is anything like what they have experienced since coming here ! wake up my dear, your country is certainly not a god send, and many many americans live below the poverty level. the violence is unheard of in any other industrialized countries! this is not a land of opportunities as far as i am concerned. there is much segregation going on. much censure as well. education is the least of all priorities and that is because it is much easier for governments to manipulate a nation of ignorant people. there is much hatred and i am ashamed to ever be associated with the pettiness and narrow mindedness of so many people in this country! the only real "americans" were the indians living on these territories before the colons came and killed most of them, then parked the survivors in reservations. nothing to be proud of!!! people like you seem to forget where you came from. do your homework, learn your history, and stop spitting mean comments to create more hatred.

if finding a micu position is difficult because they only want experienced icu rns, you may be able to befriend the icu nurses/manager if you ask to shadow there (for free). it would allow you to get some experience (very little though) but more importantly, it may allow you to put a foot in the door. once you get to know the team and their manager, you can try asking for a position (or even to take prn icu shifts) directly to the icu manager~ this way you know that you have that manager's support before putting your request in to be transferred. the downfall of that theory is mostly time.... it would likely require for you to invest unpaid time in order to gain the network that will support you in your future request. maybe worth a try all the same? good luck to you and keep us posted! h~

hi, time has come to start my first 2 clinical rotations. issue: i am relocating to austin (tx) and don't (yet) know anyone there. i am in the acute care np track, and both clinicals need to be done within a hospital system. that being said, one rotation focuses on the assessment skills (head to toe, and specialized by system i.e : ear, nose and throat ~ cardiovascular etc...) and the second (simultaneous) focuses on prevention and maintaining health. i would have gladly contacted a pcp/family doc, but my program director thinks doc's approach isn't holistic enough and i would "catch" bad habits i would appreciate any link, direction, contact info (or whatever you can think of) to get me started in my search of a mentor for these upcoming clinical rotations. all suggestions welcome! many thanks, h~