jeremyRN

Thanks for your reply. I am referring to how AL and SL are deducted when you take leave on a 72/80 schedule. I have been reading that if you work a 72 hour schedule with the VA, that they deduct 1.111 hours of AL for every 1 hour taken. So if you take 36 hours, you are actually charged for approx. 40 hours. But while you are charged more for taking leave, you still accrue at the same as an 80 hour nurse (8 x AL and 4 x SL every 2 weeks). It is a very convoluted policy that we are trying to weed through and find out the pros and cons of switching to a 72 hour schedule. We are trying to determine how it will affect our leave, pay, retirement, etc... I know it is popular at some VA locations, but is not currently being used on any units at my hospital.

I work for the VA ER in Las Vegas, and our unit is considering the 72/80 schedule. Does anyone have any experience with this? If so, do you like it? What are some of the pros and cons? Also, how does the AL and SL work when you take leave? Do you still accumulate leave and retirement at the same rate? Thanks. Any information will be helpful.

I work in a large, busy, urban ER where patient's often experience extensive waits before physician evaluation. We are currently working on establishing a protocol that would allow us to administer pain medication in triage before the patient sees the physician. Depending on the patient's stated pain level and symptoms, it would allow us to administer NSAIDs as well as Percocet and Morphine IM. Does your ER have a triage protocol or standing order for pain management? If so what are the parameters? Has this been successful, or have there been any adverse events related to this practice at your facility? Are the nurses obligated to medicate all patients with pain, or do they retain some discretion on when to enact the protocol? Some of the concerns that our committee has had regarding this practice have been, safety - what if the patient has and adverse reaction, gets dizzy, falls etc.... What if the patient feels better then leaves the triage area after they are medicated, only to find out they have an appy or an ectopic? Will drug seeking be a problem? Looking forward to any thoughts and discussion related to this topic.

I sometimes wish there were a Dilaudid shortage. We could post a sign in triage and reduce our daily census by at least 25%.

Just a couple of days ago, I was asking a a patient about his allergies. He replied, "I am allergic to the wind." I kept a straight face and asked what kind of reaction he has. His response, "it gives me the chills".

I live and work in Nevada and under our state BON, RNs may administer medication for the purpose of induction of short-term therapeutic, diagnostic or procedural sedation. There is no limit on the type or route of the medication. There are several pages of documentation required for each procedure including q 2-5 minute VS during procedure and extensive post-procedural monitoring. RT is at the bedside, crash cart at bedside, MD at bedside, usually at least one RN at bedside. Sometimes there are 2 RNs (if you are lucky); one for documenting and the other for administering the medication and monitoring. I would have to say propofol is the drug of choice in our department. Etomidate and Versed are also pretty common. Fentanyl is usually given as well for pain control. I do not see ketamine as often, usually only in peds cases. Ketamine is such a creepy drug to give, and I have seen pts freak out after waking up. I love propofol, especially when it seems to act as a truth serum in some patients. They say the funniest things when they are coming out of it.

In the state of Nevada, the Board of Nursing requires that badges worn by nurses must show the first name and last initial only. The hospital cannot override that requirement.

I was never taught the arm raise either. I was taught that the IV should be an 18 or 20 gage in the AC if possible (large vessel closer to the heart). I usually have a 3 or 12 lead running too, just bacause it is cool to look at when you have a successful conversion.

A few days ago I saw "Hungry" as the complaint.

I completely agree. UMC has great benefits - full pension, longevity bonuses (big check annually after 8 years based on percentage of pay). There are docs, residents, RT, Lab techs, Radiology 24/7. When a code is called on the floor (even on graveyard) so many people show up that you have to kick people out of the room. ER docs will even come up to the floor for intubation, code etc... if necessary.

Salary is not the only thing you should be considering when applying as a new grad. What about sign on bonuses, medical benifits, retirement, longevity pay, and even more important - staffing ratios, training, probationary periods? Some hospitals in town may seem inviting because they are offering $27-29/hr for new graduates, but what are the working conditions like. Make sure you ask a lot of questions during your interview and do your research. What is their nursing turnover rate? How long is your probation period? What kind of training will you receive? Union or non-union? Do they have safe staffing ratios in effect? Is patient acuity taken into account (as it should) when making staffing assignments? You do not want to be stuck taking care of 8-10 patients on your own after only being on the job for 4-6 weeks and putting your new license at risk. Good Luck.

ooooh! What a great idea. It almost makes me want to go back to school. Ha Ha!!

When I went to UNLV, we had to take a math exam each semester and pass with a 90%. I think that we had at least two attempts at the test though. From what I here, this is pretty much the norm for most nursing programs. Don't stress about it though, nobody was dropped from the program because of the math exams. Everyone eventually passed them when I was in school. Good luck.

I probably do at least one or two a day. Sometimes the docs or residents will place an OG tube after they intubate, but it is usually the nurses. We are a teaching hospital too with a lot of nursing students, new grads, residents and interns, and there is a lot of competition to get skills checked off; however, if it is a nursing skill, then the nurses usually get first stab at it.

We use a computer charting system in our ER called EMSTAT, and it allows more than one person to chart on the same patient at the same time. In fact if you are watching the screen, it will update as new information is entered. I love the system and can't imagine going back to handwritten charting. (Unless the system goes down, of course!)