tfrankern

i believe this is yet another example of the highly educated/degreed nurse who has been away from the bedside too long trying to tell bedside nurses how to do their jobs...and hospital administrators love this stuff. Without really examining the testing tools they jump on the bandwagon so they can promote how innovative they are in implementing new tools to keep nurses up to date and educated etc. etc.,, blah, blah blah.....in reality, having educators for departments and using experienced staff to train and evaluate nurses is really the best option. I can tell by having a conversation with a new traveler whether or not she/he is worth a flip...and i don't need to administer any test. Just by the content of conversation of a group of nurses you can tell who know what the heck they are doing and who doesn't. And most times everybody in a unit KNOWS the folks that need to be refreshed, updated, re-educated or whatever. And in a group with strong minded people like the ICU settings peers usually have no problem telling each other or going to management about an unsafe employee. I don't care what the traveler really scored on her assessment test. All I want to know is that when I'm in a sticky situation they will know what to do to help me out. Whether or not they have team building/player skills is one thing when you are sitting around chatting or need help changing a bed full of poop, but when it's crunch time, I don't know many true ICU nurses that will not jump in and help whether they like the team member or not. And if they can jump in and help out in critical situation that tells me the have critical thinking skills....some people are not test takers, especially the kind of tests that are trying to trip you up so the author can prove how great the program is by "weeding" out all these bad nurses. Its a shame actually that nurses feel the need to do that to others in their profession. After all we all started wearing little white uniforms and shoes and scared to death of our first clinical rotation. Just because some choose to become Masters and others prefer to stick with the heart of true nursing at the bedside doesn't mean the Masters prep nurse is a better nurse when it comes down to what nursing truly is. There are many nurses I've known over the years who were LVN's that I would prefer take care of my loved ones than if the MSN educator or manager came to the bedside and said I'm going to be working on the floor today and I'll be your nurse..!!!! AAhhhhhh!!!! The point is that we have got to stop this nonsense of competition between the "classes" in our profession or we will continue to make less money, have less benefits and have less say in our daily work routine than other Professions. Let's just all play nicely in the sandbox and try to help other nurses rather than show off their flaws so we can look smarter...

I have got to reply to this one!!!! I hope the moron giving you the push did not just push it with out diluting it first. Phenergan should ALWAYS be diluted with like 10cc of normal saline and never pushed (regardless of site of PIV). I've had it IV as well and it burns like fire in your veins, even diluted. I think the key is education. Somewhere along the way you learn these things but it may not be in nursing school. I use toradol often in my IVIG pt's in an infusion suite. They would not do with out it and don't complain much of burning but then again I dilute and push slowly. I don't know what the literature says on this in particular but I know I've never had a pt complain about pain from toradol. I am also a frequent patient so I don't want to see us not use IV phenergan either but we've got to learn about our drugs before we go about randomly giving them. Hope you are doing better...tf 29 May I end up in ER w/24 hours of extreme chills (long sleeve T-shirt, PJs, 2 blankets, quilt and down sleeping bag), intermittent, transient bone and joint pain, nausea and vomiting. I was given an IV set near the base of the thumb for fluids and then an IV "push" of phenergan and toradol at the site of the IV set rather than up the line where it would have been somewhat diluted. As a 30 year Crohn's disease patient I have had PLENTY of IV and IM phenergan and demerol w/o any discomfort or problems. But this one BURNED and HURT! The nurse continued the "push" and explained that it was the phenergan. I didn't really believe this given my previous experiences and assumed it was really the toradol as that was my first experience with it. The pain and burning only lasted a few minutes after the "push". I had no swelling of the hand or arm, no pain, no redness for several days. Long enough that I never even thought of the IV push when I began with a bruised type feeling on the inside of the arm just above the wrist and the outside of the arm 1/2 below the elbow. Several days after that I did notice a hard stretch of vein about 3/4" long 1/2 way below the elbow on the outside of the arm. Later a "bump" at the wrist, still later another 3/4" hard stretch of vein just above and a little to the outside of the bump. And then a 1/2" hard spot in the vein below the base of the thumb at the wrist. It finally occured to me that this was probably the result of the IV push but since there was no redness, no swelling, no tenderness unless I kept poking the areas I didn't bother seeing a doctor about it. (Heaven knows I see him enough as it is, bless his heart!). 21 July the "bump" at the wrist turned red and was tender. Hot compresses did nothing for it that evening nor the next morning. My family doctor isn't in the office on Fridays and I figured the ER IV push was the cause so I went to ER. I was told it was "just" superficial thrombophlebits that could take as much as 6 months to resolve and was about to be released (which was ok with me as long as the doctors weren't concerned). But the "lead" ER doctor came in, first time I had seen her, and she said she would feel more comfortable ordering a venous ultrasound before I was released as she had had 2 STs go "sour" on her in the previous 3 months. I didn't have a problem with that so of course I agreed. What the heck, she was the doctor. Ha! Turns out I had a deep vein thrombosis in the axillary vein in that upper arm! You could have floored me!! I ended up being admitted and given IV heparin drip and oral coumadin. Upon release 3 days later I had to agree to daily blood draws which was a cheap price to pay to be released from the hospital since I didn't feel sick and didnt hurt. I've since been reading up on STs and DVT and realize my part in letting things go so far. However, I've found quite a bit of controversey on IV phenergan (and also demerol). The Infusion Nurses Society Standard # 43 specifically states phenergan should NOT be given IV due to its PH and potential for harm. Frankly, given my experience thru the years and the blessing that IV and IM phenergan (and demerol) has been I would hate to see its use be discontinued. However, this was the first and only time phenergan was ever administered IV that close to the IV set instead of up the line where it gets diluted w/the IV fluids. I'd be interested in your thoughts and experiences on this event and the use and method of administering IV phenergan. Mind you, my mother worked at this hospital all the while I was growing up, other than Mayo Clinic it is the only hospital I have ever gone to (altho we have another in town) and I've been volunteering here for several years in Endoscopy or Messenger Service. I'm not looking to cause any trouble and I know my ER nurse from previous encounters in the cafeteria and elsewhere at the hospital and he is a fine and conscientious nurse. He was marvelous when my brother in law was brought in with an AAA.

:rotfl: you guys crack me up...i love the prostitute in a brothel thing...hahahaha....are there any administrators out there that read this stuff???? i'd love to be a fly on the wall and see the faces and comments at the board meeting that somebody gets guts enough to read these at....of course it'll never happen....i thought about leaving the "profession" many times and the only way i've been able to keep my sanity is to do agency and i traveled a bit....i've been trying to focus on what satisfaction i get from the personal aspects of the job....i may seem gooey at this point but i've been angry for about 10 years (which is how long i've been doing this craziness) and it hasn't helped me and the job and the administrators haven't changed, in spite of all the "gritching"?? i and many others have done (okay that word is a country thing..i can't help it, my country comes out sometimes) my point here is that i don't do this for THEM i do it for me. And i certainly don't do it for the money. That was my other mistake. When i was a NA and making $6/hr i thought the RN's making $12/hr were just greedy and they should manage their money better, after all they were making twice what I did and blah blah blah....needless to say i learned quickly the more you make the more you spend. I am also working on living within my means these days and saving money rather than just blowing it on crap. the job is never going to change, and it's never gonna pay better so i gotta find a way to make it work for me.....tf

I have worked in just about every area of nursing including ICU,CCU,SICU,ER NICU TELE, PICU, home health and finally hospice. I've done lots of agency and had experience with traveling as well. IT'S NOT ABOUT THE MONEY!!! If nurses actually got paid for what we do and not for what we are supposed to do for the goodness of other people the healthcare industry would not be able to afford us. Think about what you do in every day at your job and compare that to a regular 8-5, M-F job. Most people in other fields do much less for the same if not much more than nurses. Now that isn't to say that nursing isn't flexible and you can go do agency and make fast cash when you are in a bind. But, when you get a little older, those long, hard agency shifts get more difficult. So, you end up finding a place where you can be of service, be fulfilled in your career and get paid for it. I make a living but there is nothing left over and no savings to be had. As for benefits, most of the places I've worked in nursing, the healthcare field in general has sucky benefits. Oh, i've got insurance ok, but the copays are ridiculous, especially when I'm caring for people who get everything for free or that have wonderful benefits from their employer etc. Generally, I'm happy with what I do and probably wouldn't do anything else but I do get on my soapbox about the disrespect that we are shown and the lack of adequate compensation. Do it for the love of it, not for the cash, you will burn out quickly if you do.

:rotfl: :rotfl: I've been a nurse in Texas for 10 years. During that time I've traveled to other states as well. After 10 years I make 21.50 per hour...does that sound like a lot to you??? An of course the CRNA's make about 100,000/yr but they have a masters degree and are educated in advanced nursing skills. I'm sure that the CRNA's make more in other states as well. Nobody can say that it's because I work in an area that doesn't pay much either, because I have done everything from Adult Icu, Pedi Icu, ER, Home Health, Hospice, Post-op, Nicu, etc. and they all pay CRAP money for what we do. But, I am a nurse and this is what I do. If you want to be wealthy, don't be a nurse. We don't do this for the money. Of course if it is so bad we have to ask ourselves why don't we get another job...like at Wal-Mart, for instance???? Because, they REALLY pay CRAP and so does every other employer out there unless you are into computers or law or a real estate mogul etc. So, get used to it, you will be mesmerized by the big $$$ ads, but remember if it sounds too good to be true, IT IS!!! Also, the border towns are very high risk for lawsuit and losing your license. Also, the border towns are not very pretty to look at...but lots of places in Texas are....sorry the nurse who was here 3 years didn't get to see those places.... Nurses in Texas are not given the respect they should have either. We still bow down to doctors and kiss *** to administration. My experience in other states was good although I did have to pay State income tax which I don't here, and the people were mostly rude in other states, which they aren't here, and everything from milk to housing is very very expensive, which it isn't here.....so, I guess it all works out in the wash (that's a Texas saying). I hear that in Alaska RN's are making over $100/hr.....probably another fable...Good Luck....