sameasalways

Hi, I did infusions for almost 3 years at a rheumatology clinic and loved it. I am considering applying for home infusion nurse in Spokane WA and am not sure what I should ask for with pay. It says they pay travel time and 0.58 cents per gallon or the use of company car. Has anyone done this and what would be fair pay? Thanks!

Most of our pts are long time steroid users and have autoimmune issues. I always assess for possible valves etc. It's not always possible to detect a valve prior to IV insertion, and we try to avoid the AC if possible, which is usually the easiest spot for a lot of pt's. I had considered attaching NS flush to the end, however I was not sure if that would make the Nexiva lose its vacuum? Does it? I used to do that all the time with regular IV'S before working pre/post where we simply attached the free flowing IV fluids and the IV floated in quite easily if you hit a valve. I am not sure how floating an IV was messy? I never had any messes with IV starts or floating them except when I was new to it all. I generally never tried to go through valves if the vein wasn't visible long enough for the catheter to fit, because floating it was successful 99% of the time wheras attempting to go through valve in a vein that wasnt fully visible was unlikely to be successful. On the other hand, If the vein was long and visible, yes I would just go through the valve. Unfortunately, the vast majority of our infusion patients are not those types of candidates. Nexiva is at a disadvantage with that, although it is easier to do blood draws with them.

I know this isn't probably approved technique, but when using any other IV besides Nexiva, I would take a 4x4 or 2x2 and once the IV is in, I would place it under the port so that any blood that leaked out would drain on and get absorbed by that when pulling the needle out. It was quite nice. I wish they made a pad like this for IV starts that was similar to a pantiliner for women, but just a 4x4 instead. They could make it in awsome bright or dark colors, like Coban.

Frankly, neither do I!! I am stuck with them at my new job. I could finagle IV'S into almost any vein until these guys, and I have watched their videos and read forums on common IV mistakes made with them. They simply aren't as adaptable as regular IV's in my opinion (can't float them)..and for a good enough percentage of IV starts, you encounter a valve and in that situation, it's not always the best option to push the IV past the valve. Then you have to re-stick the pt.

Somehow I don't THINK I read everyone's posts/replies and just now saw them. It is obvious to me I was not clear about a few things. The pt did not have "order", verbal or written, to give the meds every 3 minutes and titration to effect. After everyone acting like I had 3 heads at that GI clinic, they finally posted a written order. I was happy with that. The AK board of nursing requires the physician ordering the mod sedation to be present at bedside..the docs on base do not do that. I wrote the BON specifically about it and they stated that the doc can not leave the room. In terms of the O2, the policy is to get 3 room air vital signs, taken 3 min apart, with an Aldrete of 9 prior to bringing pt to recovery. I understand this is to make sure the pt is safe in recovery since there might only be 1 RN there with multiple pts recovering. The pts .. some of them are an ASA 3 and 4. Why? Because the doc doesn't care. He specifically told me that the CRNA s at the facility he doesn't trust and that propofol itself is dangerous. he said he doesn't like to get anesthesia from the hospital involved because of those 2 reasons. It breaks their own facility policy but he is a Lt Col, and what he says goes. Asa 3 and 4 are not all the time obviously but they happen there. They do not have xmas trees hooked up in recovery. a they had a broken ambubag bag mask for who knows how long there. Essentially I quit working there due to safety concerns over my license as moderate sedation is a high risk procedure for nurses and the person in charge could care less about my nursing license. Also, the facility will not support or back an RN there who is hired as a contractor. I was educated on this at a very large legal briefing I went to there.

Hi..I just started at a Rheumatology office for infusions. I have never worked infusions before, and the infusion clinic uses the Nexiva IV. I used to work Pre/Post at a hospital and then a GI clinic, and we used regukar IV'S which we could float the IV'S catheter in very quickly and easily if we hit a valve/obstruction. Does anyone have experience with Nexiva? It's quite frustrating to hit a valve with this catheter. Can you still try to float the catheter in by priming the tubing with NS or will that prevent flashback in the chamber? Thanks!

Thanks it's helpful to see what others are doing. The dr writes a 1st time order such as 75 of Fentanyl and 3 of Versed. Then we give the dose and he is not present. He comes back when the pt is "asleep". (Nurse rubs her finger across forehead and pt doesn't react). After that, it's 25 of Fentanyl and 1 of versed as needed every 3 minutes. Do your patients have to have an aldrete before they leave? Our general anesthesia patients could be an 8 to be discharged from the hospital I worked at before. Here, they say the pt must be a 10 for discharge. I have not been in the recovery area yet working. Friday was my 1st day in procedures. One other thing...they make the sedating RN document all the biopsies and findings as the dr calls them out. Is that typical? I don't want to be a whiner but everything I have read about moderate sedation states the sedating RN can not have other responsibilities.

Hi...Today was my 2nd day at new job in GI. It was my 1st day in procedure, with a nurse and observing and assisting with the cases..mainly learning how they do things, and the paperwork aspect of it. I have lots of concerns. The patient acts like they are asleep.. They seem more like deep sedation than moderate sedation, is this normal....they once in a while wince if they get more awake. And then they are given more Fentanyl and Versed. Like I said, I am not familiar with doing these types of cases for moderate sedation. When we did moderate sedation at the hospital, the pt was much more alert and responsive. I have never done moderate sedation for upper/lower GI cases, so I am not sure if this is typical. Also I was told the pt can't leave the procedure room if they aren't an aldrete of 9 or above. The nurse said they had to have 3 vitals of the pt on RA (done every 3 min) before the pt can be brought out..so she stops (they all probably do) stop the O2 at the beginning of the procedure for Egd . (so the pt can be brought out almost immediately to the recovery area. The dr writes an order for the mod. sedation at the beginning of the case that says what to give, then he steps out of the room until the pt is asleep and the tech is sent to get him/her. Once it has been 3 minutes, whether the dr is in the room or not, they are pushing 25 Fentanyl with 1 Versed every 3 minutes until the pt is "asleep". They maintain this until the dr reaches the cecum. They like to stop then, so that the pt will be awake and able to roll out of the procedure room once the procedure is over...and that way they will usually have been on RA x 3 sets of vitals as well, once the procedure is over. The doctor then signs the order on the sheet where the nurse writes down what was given...and we are told to circle the "verbal order" part written under each section where we write what was given, when. I voiced my concerns about not having actual orders and was told it is their policy. Is this all reasonable? I would like to see the actual policy but I have yet to see ONE. Disturbingly, the GI doc said they do ASA 3, ASA 4 all the time with RN moderate sedation. Where I used to work, that was a big no-no. For the record, my new position is at a military outpatient GI clinic; my last job was at a small community hospital in the PACU and Pre-op area. We did moderate sedation on pain patients and bronchoscopes and some AV grafts or pacemaker implant. The patient obviously had local with some of these procedures, and they were far more awake.

Thanks I appreciate it. So far, I enjoy pre-op the most and PACU is okay. Of course always better than working the floor. Office work was okay, but I missed the hands on care I have now. Hoping for an outpatient surgery center of some sort, up there.

New grads make about 22/hr here..(just as a reference point).

thx, I make almost 34/hr here and I heard Cola was higher there... I will definitely be disapointed if I don't make more there. It looks like getting a Nursing license transferred is more complicated than it was here, as NC and VA are compact states. I read something about having to get a letter from a supervisor or something of that nature as part of getting the license to transfer. Seemed a little different, and I wondered how long it would take to get an active license for AK due to that.

Hi, I am AN RN with 3 yr med-surg experience on a very busy floor, 2 years office RN & telephone triage experience, and will have close to 2.5 yr experience in a small community hospital Pre/Post (PACU) when I arrive. I am basically just looking for any recommendations on places of employment where people are really liking their work environment, and that is a safe place to work for your nursing license and for patients. I am also wondering about what I should expect for pay. Any opinions, good/bad are welcome. I know most hospitals or places have that "one" area or floor to stay also way from. Thanks in advance! (oh btw, I don't really have a preference for a specific area or specialty of nursing..I am open to anything).

Our GI patients are phase 2 ut not always awake and talking etc. Some of them are super sleepy for up to 10 minutes then start snapping out of it but they are wide awake once they are awake and we an get them out the door close to their 30 minute time limit. I definitly wouldn't want 2 phase 2 pts like that or 3 we. you ha e them in seperate rooms. I guess I will just have to wait and see how things go down...

According to Aspan standards, or my interpretation of them, what you are saying about a max of 2 pts if one is a phase 1, seems accurate. The email sent out last week states that the expectation will be to take 2-3 pts at a time, but doesn't specify circumstances. Typically we only have 1 phase 1 pt, sometimes 2 phase 2 patients. Sometimes a phase 1 pt and a phase 2 pt that is stable. My concern is, are they saying we will be doing a phase 1 and 2 phase 2? Is that still ok? I am not sure, it doesn't feel right... The vast majority don't come out with an airway at all. But they are still phase one and drowsy or unresponsive to voice or light sternal rub at the worst. We do inpatient and outpatient and don't have transport. I guess management didn't specify the way these extra patients will be managed...I am concerned because of light corner cutting going on and perhaps getting worse, but maybe getting better (hopefully since we have new management starting soon). I think other facilities are busier than we are, but also more organized than we are? if that makes sense...I don't feel our nurse manager looks out for safety. Mainly, she just doesnt understand what PACU does. She has often come out in to the Pacu asking "how long has that patient been here", or "why is that pt still here?", when the patient is always there for either unstable vitals or problems with pain/nausea... (if they are in Pacu longer than the 1 hour they are supposed to be). She doesn't understand how to look in to the documentation to check, and will interrupt you while on the phone waiting to give the floor nurse report with these sorts of questions. Most pts are there for their alotted time, but if there is an issue with O2, BP, Pain, or Nausea or sedation level then we have to keep them until they are an aldrete 8. Even if their Aldrete is 8, we can't discharge them if they require NC O2, and we can't get phase 2 sign outs on a pt still on O2. (phase 1 patients to the floor obviously we can as long as aldrete 8). I am not sure if the place is just teetering on unsafe, or if I am just not a good fit for either PACU , or just this specific PACU. I would like to be in an environment more focused on safety and a positive learning environment. An example of that is when I received a pt that was on neosynephrine and needed 2 U PRBC. I had never given either product in Pacu because we very rarely get a pt that unstable. The problem was 2 fold, I didn't know the rate to hang the neosynephrine (pt brought out by CRNA, not anestesiologist), and his BP was stable running at the drip the CRNA had him at. 2ndly, I had never hung blood using their tubing without an IV (I had worked at a different facility and it was a busy MedSurg floor, so we had to use IV pumps for all blood products, not just run it open in to the pt), and our blood tubing utilized a Pall filter, which this facilities blood tubing doesn't use). Suffice it to say, when I got the patient, the charge nurse said to another nurse that she wasn't going to help "because they need to learn how to manage complex patients". Then, after all this was sorted out and I was started on the 2nd unit PRBC, the manager asked why I hadn't brought the pt to the floor yet.... I hadn't brought the pt to the floor yet because you can't transport a pt who is receiving blood. That was my understanding but at the time I wasn't confident in my answer because I didn't have the confidence to say that. I was pretty unfamiliar at the time with hanging blood in the PACU (this was about 6 months ago). I have had a lot of complex situations and patients before, on the MedSurg floor...but I was not familiar with the med Neosynephrine or hanging blood products in this facility. I felt very unhappy with the response of the charge nurse and the manager in that situation. I will say that the charge nurse spoke up to the manager when she had asked why the pt had not been transported to the floor yet ("because he was getting blood"). I had not been in a work environment with that level of negativity. Please bear in mind I am the kind of person who gets along with virtually anyone, but I am not very aggressive. I especially try not to say a lot at this specific facility, due to concerns of being the squeaky wheel. I have been a nurse for 7 years, so I am not brand new, but I certainly have lots I can learn too. Sorry about the rambling...I really like the majority of people I work with, and I know it's a great job, but I keep feeling like it is unsafe every day in the PACU if something goes wonky in an unusual way/unexpected way.

Oh I forgot to say that the regular pacu bays (4) are on one wall, and the 2 GI rooms are right next to them, but they are actually rooms with doors, so if you are in one room you don't know what's happenning in the other room. If you have a pt in a bay, and a pt in the GI room, you can kind of see their monitor or and hear it if you turn and walk over by the door to the GI room , but if you are in the GI room you won't see or hear the monitor on the pt in the Bay. The manager and charge nurse act like you are being ridiculous to bring up such a concern...hence why I am careful to voice concerns.

I tread very very lightly, I am actually afraid to say very much at work because management has been so poor. The manager of surgical services who oversees Pre and Post-op has worked in the OR pretty much her whole life and she has no idea what we do in recovery. I am seriously considering looking for a different job but they just hired a new manager and I am hoping things get better. The job itself has been awesome except for their lack of policy and concerns of safety. They just opened as a new hospital 2 years ago so I think a lot of stuff was just kind of thrown together and see what happens type situation.

Thank you! The requirement here is taking a moderate sedation CBL. We do moderate sedation on the weekly here, but like I said, it rotates through each nurse. We do moderate sedation for radiology procedures, bronchoscopes, Pain injections mainly. But also pacemaker implants and AV fistula placements. We have a policy from regional, and it says that each moderate sedation nurse must complete a yearly competency, but it doesn't state what the yearly competency is. Where I used to work, the nurses who did it had to be checked off and go to a class once a year where they were checked off and take a test. I am not happy with this facility in general because of their loose tendency to follow policy. I do not feel safe doing moderate sedation here, but they have put me on the committee and I am hoping to make it better without insulting anyone.

Anyone do moderate sedation? I have recently been nominated to be on the moderate sedation committee where I work. I wondered what your yearly check-off consisted of and what your training consisted of in order to do moderate sedation? I am very concerned about these issues as are the other nurses I work with. Most of us I feel had somewhat lousy training on it. I don't want to say that and make anyone look bad, but as a whole, I do not think our facility has been very organized about training or preparing nurses to do this. We are expected to understand the anesthesia cart...this is what we are using to monitor the pts O2, respirations, heart rate, and BP on the anesthesia cart. This is done in one of the OR's or the procedure room, and each anesthesia cart is a little bit different in each room. Also, we are not familiar with the OR and procedure rooms in terms of where every single item is...like a tongue depress or , or face mask, etc. We are now having to start doing moderate sedation down in Radiology too, so they do not always have everything we need, plus we do not have access to the Pyxis there. I began bringing my own items to the room to prevent scavenging in a time of need. Not every nurse does this. We only do moderate sedation about once a week, and each nurse must rotate through. This means you only do it about once every 4 weeks, sometimes longer in between. We had a situation come about where an ICU charge nurse was teaching a floor nurse how to do it, and it was discovered they did not have the reversals pulled or any O2 nasal cannula available. I want to make sure we are all safe, and any info others have is appreciated.

Hi, we are a small Pacu and so when we do phase 1 patients we do phase 2 for them as well. Sometimes (like for GI) we only do phase 2. How many patients do you typically have in a situation like this? I am a little concerned because management recently sent out an email stating we would be expected to have 2 and up to 3 patients at a time. We have 4 Pacu bays, seperated by curtains. There are 2 rooms right next to Pacu that we often use for pre-op and then phase 2 recovery of the same GI pt. My concern is having 2 or more patients and one or 2 are in seperate rooms so you don't know what is happenning to 1 or more patients being recovered. The GI pts come out every 15-20 min, so when you have 2, it's okay except that you frequently have one pt ready to leave in a wheelchair but you can't take them down because the next GI is coming down the hall for recovery. We don't have a set person to take the patient out to the car, and recently they sent a email stating that due to increased patient loads/cases, nurses were not to help other nurses (so that we can "get our work finished in time")...and that they appreciate how teamwork oriented we are and that in order to be and team we need to only ask the charge nurse for help if help is needed , rather than jumping in and helping other nurses. I have never worked Pacu anywhere but here...it's a small place and the vast majority of our patients are outpatients. We do get TURPS, and some bowel resections, total knees/hips etc. The inpatients are generally easiest because you can bring them to the floor in 30 min, whereas the outpatients we have to get them dressed, do DC instructions, etc. and they are there for an hour. I can handle 2 pts at a time, I just have some concerns about the pts being in different rooms and until now most of the nurses have really worked together, and we ALWAYS get everything done. ..Maybe I am being negative about the email and upcoming changes?

I was a med/surg nurse on a 60 bed unit for 3 years, then in a cardiology office for 2 years. Now I am in what I would call a "very small" hospital (they have about 40 beds, and about 10 of those are "ICU" beds, which is very rarely full, and often the ICU patients are not what I would call a typical ICU patient). I am very new to PACU, and I acknowledge that (I started working 2.5 months ago in PACU). This is my first job that you could classify as "critical care" so I know I lack experience in this. A few days ago one of the PACU nurses had a situation that makes me uncomfortable and I was wondering how this situation would be dealt with typically. We do a lot of outpatient surgeries in our PACU, and most really are outpatient, although the total knees/hips go to the floor. One of the cardioversion patients HR went down in to the 10's after cardioversion, and then stayed in the 30's. The other nurses said the patient was still awake, etc but she was definitely ill-looking and drowsy (I saw her). **After the cardioversions here, the cardiologist leaves immediately, so he was not there for the heart rate issues. He was notified via phone but stated "lets just keep an eye on her and admit her to ICU". I am probably being paranoid because I am not accustomed to these types of issues, but I keep thinking what if she had gotten worse and in the meantime an RRT had not been called? Would the nurse be at fault for knowing the policy states that an RRT should be called for a heart rate that low, and one wasn't called? I am thinking worse case scenario/if she would have deteriorated and we could have prevented it by calling an RRT (and probably over-thinking, or at least it feels like it). This patient was in the PACU with a low heart rate in 30's for about 20-30 minutes. I guess a rapid could have been called if her mental status declined further etc, or HR got worse.

I am getting hired to a cardiovascular clinic in the region and I have 3 years nursing experience (August will be 3 years). I understand clinics pay less than the hospital. I was wondering what an appropriate and fair salary range might be for that area? Also, since I don't have much cardio experience and this is a specialized clinic (the office knows I don't have a lot of cardiac experience) does anyone have any recommendations for books that I might use to brush up on basics so that when they are explaining some of the more complicated issues I will understand what the basics are and therefore grasp the more complicated issues? (Does that make sense)? I live in a low cost-of-living area where my rent is 700/month for a house in a good area with great schools for my kids. To live in the area where this clinic is and have a townhome with good schools the rent will be approximately 1500/month. So there is a huge cost of living increase but I have seen that the pay for nurses in the area does not compensate for that :-( Thanks so much!

Hi everyone, I am an RN on a very busy post-op surgical and medical floor. We receive all sorts of surgeries and also medical patients. They typically have multiple co-morbidities; However, even if they have a cardiac history, we are not treating them for cardiac issues. Sometimes they will be put on remote-telemetry due to their IV BP medication or history or sometimes they will C/O chest pain and be put on remote telemetry. My main concern right now is I have been doing that job for 3 years (almost) and am probably getting hired to a cardiovascular clinic. I did make it clear to them that this is the nature of my job and that I would require training and be asking lots of questions (and I feel bad because I know the questions will seems really "dumb")...even though people say there is no such thing LOL. I am wondering if anyone has any advice on things to research and read about to help prepare myself for this job. It is a large cardiovascular office with 12 cardiologists and multiple RN's and MA's. They have their own coumadin clinic which I will also be responsible for helping with. We will dose their Lovenox/coumadin off a web based program using their INR, PT levels that are checked. My other primary responsibility will be doing nurse referrals. The calls come in to the secretary who filters out depending on if the patient needs an appointment, or needs a nurse referral. Those referrals are sent to a computer and when I click them I am told I will have access to their medical history, medications, and tests. There will be another nurse right beside me for if I have questions or need to bounce ideas off of her. I am really excited as cardiology is my one big weakness. I do not get to utitilize cardiac care at work in any detailed manner and am barely familiar with the drugs and on the simplest of terms. I have had acute patients that probably belong on a step-down unit before, but still, cardiac care is something I don't deal with on an intrinsic basis. I am looking for help with what medications and procedures I should be familiar with and if anyone has any ideas for books or quick references I can use. I do not know the abbreviations a lot of you have been using either. Thanks so much!

This sounds like extreme discrimination to me. How long have you been employed? I work on a super busy Med-Surg floor as an RN and we have nurses all the time who are pregnant!!! CNA's too! Are you kidding? Yes I would think they need a Doctor's note or something in regard to how long you can work and how long you plan on working before taking leave. Also for their short-term disability (which you probably don't qualify for if you didn't sign up for it when you started) and also for your Family medical leave.

i have applied for this job. it is a 30 minute drive during good traffic. they said i would get 4-5 patients a day and that it is 8-5 mon-fri and that we are paid hourly. the area is kind of spread out in that town but she said i would get the southern part which is closer to where i live. i think i would love hospice nursing. i am just wondering what i should be looking for with a home health hospice position. i know this sounds weird too but i was thinking a lot of these people must be on some heavy narcotics..how do you give narcotics at home in a safe manner so that you can't be accused of stealing them or something???? i am sorry i have been working in a hospital for 3 years and narcotics are counted and witnessed when wasted, ect. so it does make me nervous about doing that in a home by myself. (i think i would love the job, fyi, i just am unsure of what constitutes a "good" home health set-up/employment/agency). thanks so much!

I have applied for this job. It is a 30 minute drive during good traffic. They said I would get 4-5 patients a day and that it is 8-5 mon-fri and that we are paid hourly. The area is kind of spread out in that town but she said I would get the southern part which is closer to where I live. I think I would love hospice nursing. I am just wondering what I should be looking for with a home health hospice position. I know this sounds weird too but I was thinking a lot of these people must be on some heavy narcotics..how do you give narcotics at home in a safe manner so that you can't be accused of stealing them or something???? I am sorry I have been working in a hospital for 3 years and narcotics are counted and witnessed when wasted, ect. So it does make me nervous about doing that in a home by myself. (I think I would love the job, FYI, I just am unsure of what constitutes a "good" home health set-up/employment/agency). Thanks so much!