sonnyluv

Please read you articles before you post. It is a very simple equation: Too many nurses=lower salaries=CEO's make more money. Has congress helped nurses in the past? Congress is run by lobbyists who work for large hospitals. Where do you think this bill came from?

Hey All! I'm an I.C.U/ E.R. nurse about to get into the precepting game. While it's not quite the same as teaching newbies (I'll be teaching mostly experienced nurses) I would absolutely LOVE TO HEAR ABOUT SOME OF THE TRICKIEST, STICKIEST AND MOST UNBELIEVABLE SITUATIONS YOU HAVE FOUND YOURSELF IN WITH A NEWBIE!! Thanks so much- Looking for lessons to learn from and get a chuckle or two while I can- Sonny

Do the mature thing and back off, do not engage, be polite and let them fly straight into the ground.

I apologize you feel like there is hazing going on. My post is responsible for that sentiment. Believe it or not, I sympathize with you more than I have issues with the BSN. I think it's wonderful that nursing is moving forward, becoming undeniably more professional. Nurses are gifted, talented, dynamic pro's and we deserve a whole lot more credit than we get. The BSN frustrates me because it is not changing the profession for the better. It seems to be raising the bar for expectations with no reward. And while your focus is on employment and becoming a nurse you will soon ask yourself, "Okay, I'm a nurse, I know what I'm doing, I'm educated, why no growth? Why are nurses pay and status capped so early but responsibilities grow exponentially." Nursing is a field of lateral movements, not upward. This is my second career, I have a B.A. in media. I worked in a corporate environment. I cannot believe the expectations placed on nurses and the offensive demand that we do what we are told because if we don't we are greedy evil people who hate our patients. That's a generalization but a subtle pervasive attitude I pick up on from many unsatisfied nurses. It's ridiculous. With your BSN your scope of practice is not much different than mine. Your pay is not much more than an ADN (though it absolutely should be). I guess my frustration lies with the fact that I see the BSN graduates and I expect to hear excitement about this wonderful career, I expect to hear talk about moving nursing forward, more talk of nursing research, more talk of pay improvements (nursing salaries on a whole have been relatively stagnant for the last 8 years yet we are expected to do more and know more), more talk of professional recognition amongst our peers for the amazing jobs we do on a daily basis. But there is an utter disconnect regarding the fact that nursing is a rough, sometimes brutal sport. After you find a job and get settled in I assure you will ask yourself, what did this degree do for me? If it got you your foot in the door, great-but what about that horrible nursing shortage? You will be forced to confront an absurd amount of hostility coming from senior nurses who feel insecure or cheated. The behavior of experienced nurses towards new nurses is not only illegal but is tolerated and encouraged. It breeds resentment and profound insecurity. I see no collective thought or direction from our field. I don't advocate that anybody talk politics or salary at work but my friends who are new BSN's seem to expect senior nurses to take care of all matters political. The fact is, senior nurses are EXTREMELY THREATENED by new nurses of any degree. We work cheaper, we take more crap from management and admin cuz we don't know better. And worst of all, they are expected to train their own replacements. Hospitals do let go of senior nurses rather easily. I feel such resentment among older nurses and I sympathize to a point. Newer nurses have more career possibilities, the treatment of nurses is much much better than it was 20 years ago. I've only had a problem with one or two docs but I constantly find senior nurses saying horrible things about me and my coworkers. Senior nurses that have mentored me have had to do so quietly for fear of retribution from their peers. Nursing simply has not caught up to modern standards of professionalism. Nursing hasn't been about making the doc happy or even being afraid of him/her. It is a collaborative sport that is incredibly satisfying when someone gets better, heals. But if the healers are neglected, poorly treated, burned out, uninterested in expanding their own field, well then , everybody suffers. I'm grateful there are more BSN's-if you guys don't lead us who will?

I agree, to get in right out of school the BSN is undeniably an asset. It just seems sad to me that it takes a recession/depression to make any sense out of the BSN. And the salary premiums are like, a buck an hour. That's not a premium, that's literally pocket change to keep BSN R.N.'s from realizing they're getting jipped.Obviously, IMO. In regards to the Kaiser CTICU- HAVE YOU SEEN THE MINIMUM REQUIREMENTS FOR THAT POSITION??!! OMG! THEY WANT A LETTER OF REFERENCE FROM A CARDIOTHORACIC SURGEON, BSN, IABP, CRRT, 3 YEARS MINIMUM, CCRN. But here's what's messed up about that- they aren't going to pay you ONE RED CENT MORE FOR THAT KNOWLEDGE, EXPERIENCE, AND LEVEL OF CERTIFICATION. Sure you'll get the 10K bonus, which will be 5K after taxes but that's it? All those years of learning, stress, studying and your base will be two or three bucks above a new grad on med-surge. Forget it. Honestly, at that level you are expected to know as much as M.D.'s. That is no exaggeration, about half your day is spent arguing with M.D.'s about why their orders are 1) written wrong 2) just plain wrong. I love critical care, I love my time in the I.C.U, and I realize this is a bit off topic but-and it feels great to say this: risk vs. reward- it just aint worth it. I've started a new job at a providence ER, non-trauma. Just helping patients out, learning more and more, and guess what? I realistically am expected to know 50% less than what was required of me on a daily basis in the I.C.U. I never got paid for that knowledge, all I got was more stress, more dead bodies, more sad families and more flak from management. Anytime I would put my foot down, use evidence based research to back up my points some busy body nurse would float by and say"well I have 20 years of experience and maybe your little book says that but I'VE NEVER DONE IT LIKE THAT SO IT'S WRONG." End of discussion. I took a break and now I realize, it just wasn't worth it. Perhaps if my base came out to a 100k a year, maybe it would have been, but frankly, I made as much as med surge nurses who weren't even required to be able to understand a single ecg rhythm, or any ACLS, yet I was required to be able to expertly read a 12 lead ecg! Knowledge is power and I enjoyed what I learned so much, it really was invigorating. In the end, having that knowledge, having NO power and a monster mortgage sucks. Being an elite I.C.U. nurse seems to be more about ego than anything else. Forget about it! Sorry ya'll, my 2 pennies. I have so much less stress in my life and MAKE THE SAME PAY! It just wasn't worth it. Most of you out there are thinking: CRNA. Go for it if the prestige and money are your passion. Nothing wrong with that. But just remember, there are costs. Cheers S

I'm not sure I agree with you, at all. Hospitals don't care one way or another if you have a BSN. They certainly don't pay much more for it. What they want is experience. I appreciate your insight but 1) I've been working in one of the best I.C.U.'s in this wonderful city since August, with an ADN and a decent resume 2) Having been in the medical field for almost 6 years now, a nurse for 15 months, I can say that four year nursing students TRADITIONALLY have less clinical experience than anyone else on the floor. A BSN does not mean you have 4 years of experience. It means you took your undergrad at the same place you got your nursing degree, paid a lot more in loans and if you want, can move into management sooner than me. (enjoy.) I haven't seen an LVN on a hospital floor in three years. Comparing a "two year RN" to a "four year RN" to a "LPN" is nonsensical. While it looks good on a resume you will find that during the interview with the hiring manager it will not get you very far. Oh yeah, the VA is hiring basic RN's, without any experience. I'm still getting calls from kaiser and Providence. frankly pumpkinnutter, the whole BSN thing is kind of a load. Nurses with BSN's have a hard time coming up with reasons as to why they actually need the BSN and they seem incapable of commanding or even asking for more money with it. In fact, BSN grads are the only new nurses who don't talk about money. Why is that? Bad word, money? I think not! Just too professional I guess. The reality is a lot of BSN's have never had a job before. Maybe they worked part time, or volunteered somewhere but the vast majority get their credentials rammed in their face, they are the most easily overworked, and seem utterly incapable of taking themselves seriously. They do gossip a lot though. Cheers S

Haven't signed yet, thanks for the advice!

Hey all! I'm about to take my first travel assignment. I will be going to Los Angeles to an I.C.U. They are offering $1500/month for living expenses and $25/hour for pay. $400 for travel costs. Insurance for me and my wife+ son will be $150 every two weeks. They say they don't pay any shift differential. Their logic is bizzare, something like "if you like working nights then why should we pay you more..." really nonsensical. That's their offer. I have a year of experience going in. So-wise travelers, am I getting a good deal or no?

perfect! Range is 10-20mmhg.

You're not burned out! You are a human being working your heiney off and due to cultural norms, media representation, lack of knowledge on the general publics part you don't get the credit you deserve. This has got to be in the top three reasons nurses leave the field. Especially L&D nurses. The nurse who helped my wife and I deliver our baby was awesome. The doctor showed up an hour after being paged and vacuumed out my little son. She took a quick look at the kid and then literally left without saying a word. We thanked our nurse so profusely, hugged her, she was in tears, so grateful. Look, we are surrounded by other professionals who have more education, more degrees, and often a lack of modesty. Doctors see nothing wrong with A) Reminding everyone of the work they do and B) Taking credit for it. (And C: demanding they get paid for it) It's somehow ingrained in nurses to not feel worthy of the credit we deserve or even to stand up and say "I deserve some crdit here!" How can you politely remind a family that you are skilled, knowledgeable, and caring for them in their time of need, more than the Doc? Impossible and probably selfish. Keep in mind there are good nurses and bad nurses, too. Some R.N.'s don't have a very large base of learning to work with nor are they interested in continuing to expand knowledge and grow. I also think there are more medical assistants calling themselves nurses then ever before. But I agree with another poster, they WILL remember you, and they will be grateful. But I know how you feel, they just don't understand how much of the machine you are actually operating.

Hey all! Starting in a new I.C.U tomorrow and have the written portion of the clinical competency. Am I nervous! So I am studying hemodynamic monitoring and I can't seem to find any literature, online or off, about mean pulmonary artery pressure: How to measure, significance of values, and alterations of. Would I simply just put a line through the middle of the PAP- or do I average the A-wave like in PAWP. Thanks for any advice given- getting close to the wire here (alright pun intended!) and this one is a doozy. Even pacep.org doesn't have and they seem to be pretty thorough on the whole topic. Thanks, Sonny

I think you should appropriately state what you did and why it was strong work. Often, we nurses don't give ourselves credit for the great work we do. And pointing out the code you had that went well (sounds like) reminds everyone what we are here for and what nurses can do. Take some credit!

Hey all- Good friend of mine is an anesthesiologist who runs a busy pain management clinic. He is also a certified Family Medicine Doc. He wants to start up urgent care/ basic family care clinics with NP's as business partners. His idea: NP invests 50% start up cost, owns half of business. We split billings 50/50. My understanding is he wants to start multpiple clinics and said he would also want someone to oversee facility management. Could lead to a managerial role for me. This is in California.　 But I am hesitant to finish pursuing my NP license. The more practicing NP's I meet the more discouraged and worried I get about the rewards. Coming from a corporate/professional background I see NP's as a largely unsavy business group. Poorly promoted as practioners and certainly poorly received. Worst of all, the NP's I have shadowed in a multitude of specialties, including masters degree trained CNS (I know different job) have absolutely been clinically proficient and clearly an asset to the groups they worked for. They truly are talented at what they do. Unfortunately, many of these professionals bristle at the talk of compensation or negotiation. I felt as if the pervasive attitude was "We are lucky for what we get and it beats working on the floor." I also noticed obvious condescension from MD peers. Some of the NP's I shadowed (11 total, I research hard) still seem to have the R.N. instinctual fear of M.D. authority and like less professional R.N.'s talked with cattiness about fellow staff. No talk of negotiation, some talk of bonus, NO PROFIT SHARING! WHAAAT? Several simply said (generalizing) "I didn't like being on the floor" implying to me that they didn't see themselves as a new professional entity but merely doing something different then working as a staff R.N. I see salary starts for NP's barely more than non-advanced practice nurses. I find many NP's justify the inequities of their treatment with again , "It beats being on the floor." What!? In my opinion, as a male RN, NP's are absolute proof of sexism and glass ceilings. Why is it that PA`s start in upper 70's to low 90's, while NP are lucky to start at 40/hr and often get pigeon-holed into salary postions in the low 70's where they work like dogs. I have a friend who just graduated from UCLA with a NP/CNS (dual certification) specialty in cardiology. She met with a group of cardiologists for a position, they ask her what is she looking for most of all. She says "respect". The president of the group says point blank, "No. You will not get it here." She is offered 72K, 50 hour work week minimum. She will be on call 3 weeks out of the month FIELDING NIGHTT PAGES FOR THE MD MEMBERS OF THE TEAM TO DECIDE IF THEY SHOULD BE DISTURBED FROM THEIR PRINCELY SLEEP. The same cardiology group not only utilizes PA's but it also has TO TRAIN THEIR PA'S in cardiology but starts them in the mid 80's. PA'S have one week on call. She tells them to take a hike. No other better offers presented. Now she is back working with me in critical care, 50K+ in debt, exhausted and furious. My MD friend is not impressed with PA`s professionally and has had good experiences with NP's (Of course!). The bottom line is there are simply not enough MD'S going into or existing in primary medicine yet the AMA still attacks advanced nursing every chance it gets. I don't want to get into this fight for a living but at first glance my friend is offering me a genuinely great opportunity. Sad to say, while I may be business savvy, if my peers are not, and are working for a few thousand more than non-advanced practice nurses while passing rigourous didatic, clinical training and then passing challenging licensing tests all for little promotion and recognition it's going to be a long slog that will put a strain on my family in many ways- trying to move ahead while everyone stays back. Just doesn't seem worth it. So: Am I wanted as a business savvy negotiator among NP peers? Or will it be much of the same as it is in critical care: Institutionalized mal-treatment. Professional insecurities, petty infighting, the patient lost in the shuffle. I`m inclined to go CRNA for business reasons but my passion lies with working with families and giving excellent primary care. I just keep asking myself- why is there such a difference between CRNA and NP? Perhaps there was a time when NP'S were not adequately trained for the positions they attemped to take on? Why is no one effectively promoting the advanced nurse as cost saving effecient and competent professionals that they are? Thanks all, long post-my apologies. It's just that I take this commitment seriously and if I plan to move ahead, I`m moving ahead. I do not mean to offend anyone I am just being frank. No doubt, people who have different opinions than me will inform me and I encourage the discussion. Looking for some light at the end of the tunnel here! Sonny

I'm in a SoCal ICU, full time staffer. Census is down very low. Called off once to twice a week. Very worried!

Thank you for saying that and I believe what you say holds true. Your post reminds me about what I hope to find in Portland: compassion and a friendly atmosphere with rationality. Frankly, I am pessimistic about the economy and I DO NOT expect this recession/depression to let up anytime soon. And for some reason, at least in LA, we have started getting more foreign/visa nurses- now they are coming from Morocco and Ethiopa, Nepal. Its baffling... I just want to say this: If you can possibly move to a bigger market, like Los Angeles (maybe Seattle?) then by all means get your experience, fatten up the resume and come back. I understand if you have obligations, family, but to get your career started this is what you must do. It is a shame, escpecially after all the "shortage" hype but Portland will always be there, it is for me. Do what you`ve got to do...

you are going to psyche baby. Start lifting weights and building personal boundaries. It's challenging, rewarding and in most places pays better. And for your first lesson in psyche: when people "groan" at you- ask them why. Good luck

An update- I have secured a full time position in a critical care unit in Portland. I am overjoyed and can't wait to start. Bought a house, too. I feel lucky, there were a lot of applicants for the job. I was told by the panel that I "had the best interview". My SoCal experience helped-plus years of being an EMT- I was told by one interviewer, "You present yourself and your abilites well"- which I took to mean I answered honestly and CORRECTLY to their many questions. First question: "How comfortable are you with a fresh open heart?" Answer: "I have never had a fresh open heart. I have a year of critical care experience, I belive that assignment is out of my scope. But I have experienced this...(listing cardiac experiences)". They didn't expect me to be familiar with hearts-I'm too new. A B.S. test if you will. I saw some of the other candidates. They were wearing jeans, shirts not tucked in. They looked like they were just there to chat-too relaxed. I wore a suit. I'm probably not the best candidate but at least they knew I was serious. I also told them during the interview, "I want this job. If my experience and education is lacking then I will study and practice until I am up to par. I will not complain and you will get no attitude. I believe in the team." Cheesy, but it's true. There was also a clinical situation question thrown at me during the interview- kind of like the NCLEX, I thought about the process and priorities, just hit it: ABC's. That's what matters right? I guess it sucks to have someone come from out of state scoop a prime job but I kind of feel like- if the experience you need to fatten your resume is not in Portland at this time then go to where it is for a year or two and move back. I tried to go to nursing school in Portland but I was basically told it was only for Oregon residents. Oregon wouldn't even take me. So I stayed in LA, focused on the highest level trauma centers I could find, tried to pick the highest level of care. I saw more in one year at a level two trauma center South LA then you would see in five years at level one in Portland. I'm not saying I'm better-most of the time I was getting unbelievable admits. I was so stressed, mind maxed out, freaked out, but after a year I finally have got it under control and the experiences are mine to share. Now I have to let go of high's and lows. They even asked me during the interview, "Can you let go of truama?" I had been thinking about this myself for weeks but when they asked me during the interview I was stumped. Waiting for the admit, ohhh man, right before the patient comes-cracking jokes, ask the RT how their family is, joke around with the rez, tell them to wake up. Pretending everything is cool, random staff showing up-some downplaying hte admit "It's just a flesh wound" others hyping it up, "His brain was coming out of his mouth!" and then Whoosh! You're in it, everybody is politely and not so politely stepping on toes, older nurses do it their way, newer nurses do it diffrently- get your pressor's on, try and get someone to page the trauma surgeon, "where the F-- is she?" SO the patient appears to be oxygenating and now you've got a few minutes to think, you've bought some time. Now you actually have to sit down, WITH A MONSTER ADRENALINE RUSH ON, and go through medication reconcilliation, find out what happened in the ER, figure out if anything other than obvious trauma brought them to you. No flesh wounds or brains at all. The septic patients. Lot of work and following up on history. You find out that they have an advance directive. Get the House supervisor. And then the patients BP quietly drops to 60/40 and it's on again. Can't tube them but they want life saving medications. Life ala carte. I paid my dues for an entry level job in a critcal care unit in Portland where I will continue to learn to be a better R.N.

Seems like everybody is doing EXACTLY what we hate having done to ourselves when a mistake happens. The blame game. This woman, a N.P., encountered a patient who had an addiction to various medication. The patient specifically requested diprivan, which the N.P. could not provide. From what I've heard, the description "hot on one side of his body and cold on the other" sounds an awful lot like acute withdrawal. Perhaps the patient had just ran out of his supply OR had been receiving high dosages for such a long time that he was in a perpetual state of withdrawal which is what happens to patients who are given innappropriately large doses of opiate/benzo medication. Legally, she was obligated to perform an assessment and rule out life threatening acute distress, i.e. hypertensive crisis from the withdrawal or suicidal ideation. If no life threatening situation existed SHE WAS LEGALLY OBLIGATED TO DO NOTHING OTHER THEN A PEP TALK AT THAT TIME. That's it guys. It appears at this point that the patient was being over medicated by multiple MD's or what a lot of us have come to know as "doctor shopping" i.e. getting pain meds for perpetual abdominal/ back pain from different , unknowing physicians. As an N.P. (I'm not clear in what capacity she was performing this position), even if she suspected prescription drug abuse she was not obligated to investigate, even if multiple pill bottles were lying around as a reason for the multiple prescriptions is feasible. Would we hope as fellow R.N.'s that she would take the initiative to call the M.D's and evaluate the situation then call their respective licensing boards. Of course in hind sight all of this is obvious but lets stop blaming. And we all know that our profession, on many levels of the chain caters to "V.I.P.'s". It's not illegal to be an addict, it's not illegal to be Michael Jackson. It's illegal to irresponsibly prescribe pain medication but then again, it's not illegal to have a team of doctor's or recieve an I.V. in one's home. Final point: She covered her bottom on tv, but we don't know what she knew at the time. Sounds like a one time incident, do we know how long she was his provider? And HIPPAA rights after death are debatable as her lawyer no doubt advised her of this before she went on national tv. And to the general public: she shed a tear, she felt his pain. She appeared sincere. From a PR standpoint, that's one for the nurses, doctor's lose another round as they are all in hiding. Though we know that she -most likely-was lacking in professionalism. Did she know about the fake patient names- we don't know. We know NOW he had a celebrity sized addiction.

C'mon, don't take your frustrations out on "transplants". Nursing is one big job market, from hectic LA to peacefull oregon to boring kansas. Every trend, every salary effects everyone else. Native has nothing to do with it. A nurse is a nurse is a great nurse. And obviously, I would have to become an Oregonian to work in Portland as a full time staffer wouldn't I?

AWESOME! Couldn't ask for better advice-to everyone who has replied and especially to this post. Great material to study and help me formulate my practice questions.

Awesome advice. Thanks so much!

Hey everybody! It's happening. My dream. I've got an interview on Tuesday for mixed I.C.U. in a city that has very few positions available. I'm shaking in my clogs- I've been told the interview will be in front of a panel of 5 interviewers! I have one year of experience as an I.C.U. nurse in a mixed ICU trauma center in a big city, moving to a smaller city. I meet the minimum requirements for the position I have applied for. I want this job so badly, to continue my critical care training, to have a foundation for the future, and to work and learn with fellow professional nurses. What am I in for with this interview? In addition to personal questions about my work qualities I suppose there will be technical questions and that's what scares me. I know, I know, if I want to be a critical care nurse then I better darn well know what I am doing, and I feel like I do. Going from new grad to high acuity critical care was an incredible challenge. BUT THERE IS SO MUCH I DON'T KNOW. I don't want to pretend that I know it all, cuz that's simply not true. But they want an ICU nurse with one year of experience, which I have. The bottom line is, I work with really experienced nurses, who are pretty rough on me and I probably deserve it- I make some pretty bonehead mistakes. But I love nursing, I really enjoy working with my patients and the hospital that I have an interview at will help me grow so much. I just feel incompetent compared to them. How do I kick butt on the interview, oh wise critical care nurses out there?!! What are the toughest interview questions they could ask? Thanks guys, I'm gonna get this job! Sonny

If you performed the procedures you say you did (which you didn't, you ASSISTED) then you were in fact impersonating A DOCTOR. Yeah, not impressed too much with this kind of weird thread.

Paramedics, by law, can not give the same meds nurses can, they are however about as equal as LVN's. Yeah, hospital management is going to try to get back into the scam business by hiring the lesser trained. People will die, lawsuits will be made, we will prevail. Please stop blaming Obama for a genralized situation that pretty much seems to be coming from your head. Cheers.

you are being patronizing and rude. This is a legitimate question that every nurse should think about. Garbage men are called sanitation engineers, the janitors at my hospital are called environmental services, etc. It baffles me that nursing, a field that is so full of political struggle, rampant worker abuse and patient neglect resulting from that abuse should be so flippant about the fact that the very title 'NURSE' has NEGATIVE CONNOTATIONS. Clearly, many of the poster on allnurses.com are positive about the feminine side of nursing but frankly, I find this website to often be sexist towards men and encouraging an unprofessional attitude towards nursing itself. I believe the original poster has asked a legitimate question, if you do not care to answer, fine. Stop trying to turn this on him and why not, for the first itme in a while-take a look around. (The truth is you have nothing to compare it to because most nurses have not worked in a professional environment. You just don't know how bad you have it...) I was thinking something like Physical Clinician. Sounds good, eh? 15 bucks more an hour and more autonomy to better treat my patients with that title, no doubt.