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Ceteris Paribus

Ceteris Paribus

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Wife is a nurse and I hope to be one.

Ceteris Paribus's Latest Activity

  1. Ceteris Paribus

    Giving Digoxin with an Amiodarone drip and HR of 48

    Well here were my thoughts: I came from a hospital (about two months ago) where giving dig in this circumstances would have been unthinkable (against hospital policy). The hospital (small town) where I now work simply doesn't have a policy on this. I honestly felt that giving the dig. could have pushed the patient "over the edge". That's why I posted here because I wasn't really satisfied with my response (or the input from my co-workers) and want to respond better the next time. I've only been a nurse for about 18 months and this is the first time where I've been ordered to do something that I felt clearly put the client in jeopardy.
  2. I had a client a few nights back who had been transferred to our PCU after going into tachycardia in the 150's. (not sure what type of tach, but I'm pretty sure it was a narrow complex). The person was elderly, anemic and had lung Ca with mets to the kidneys, history of PE and many other things. Any way by the time I came on evening shift the client was in sinus brady at around 50 with a pressure of around 92/50, AOL 2-3, GCS 14-15 and with Amiodarone going at 0.5 mg per minute per protocol. Anyway, I'm supposed to give 0.25 mg of dig (the second of four doses) the first brought her out of the tach on the other unit. I called the cardiologist because I didn't want to give the dig with the Amio drip and borderline HR/BP. He responded "the dig won't affect the heart rate and you need to give it". He did have me run down the medications to make sure she wasn't also on a Beta or Ca++ blocker. I consulted with my charge nurse and was told that if this Doctor says to give the drug then that is what I need to do. So 0200 rolls around and it's time for another dose of dig and the HR is now 47-48 with the pressure 91/45. I'm told that this doctor hates to be called late and besides the protocol only specifies calling doc for HR under 40 (the Amiodarone protocol that is). I consult with several other nurses and end up not giving the dose and charting that the patient refused (she actually did, but with my explanation of the circumstances). If I ever encounter this situation again what are some better options for me. Also were my concerns about the low HR/BP without basis (with regard to giving the dig).
  3. Ceteris Paribus

    Could "pitch in clubs" be one way to fight Hawais' high cost of living?

    Going back to the AA example from school what impressed/amazed me was that there seemed to ALWAYS be a meeting somewhere! The way I envisioned this working you would join the organization and then you could attend ANY of the get togethers so long as you brought a dish. Also, like AA any money given beyond bringing the dish (to help pay expenses) would be strictly voluntary.
  4. Ceteris Paribus

    Would this budget work on Oahu?

    Thanks for the input. I had pretty much resigned myself to Oahu for several reasons. First, I felt it was the only island which offered a reasonable chance at a job. Second, although like the rest of Hawaii although it is expensive they at LEAST do have places like Wallmart/Sam's club (they may also have food pantries in Honolulu if things get real tight). As for family we basically have none other than our son ditto for friends and working nights/weekends we VERY seldom see those few friends that we have. If we can find travel assignements we will definitely try that route for sure!
  5. Ceteris Paribus

    Would this budget work on Oahu?

    My significant other does her most expensive shopping at Wallmart and usually the clothes that we purchase come from the DAV thrift store (about half the price of Good Will). I do believe that the visit idea is a must, but again I'm looking at a five year event horizon.
  6. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    If I earn an income which facilitates doing so I will repay the loans. However, I'm going to remain in school however long it takes to earn a BSN and then NP degree of some sort. I do not feel that obeying current rules to minimize my payments is defrauding the system (indeed by definition fraud implies intentional deceit and a violation of the law neither of which apply to staying in school part time). Thankfully, we live in a free nation where we don't need the endorsement of others to live where we choose. You may not welcome me in Hawaii, but I welcome, you to Indiana or wherever you may choose to live. Furthermore, I am eternally grateful that we live in a nation where those with diverse opnions can peacefully coexist.
  7. Ceteris Paribus

    New rn desperate for advice!!!! =(

    Well take this advice for what it is worth from someone who takes pride in being viewed as an over the top "psycho": Here's what I would do: 1. Monitor www.indeed.com daily. Use the advanced search feature to list only jobs posted in the last several weeks. They list virtually EVERY job from all websites. Try to be the FIRST to apply. Also I would apply even to the ones that I was SLIGHTLY underqualified for (those say asking for a year of experience). 2. I would actually start VISITING the nurse managers on a regular basis at the hospitals/units where I was interested in working. Ask them to consider you in the future even if they do not have anything currently available. Tell them (if you are) that you are willing to work any shift and EVERY holiday. If you can become more than a NAME then you will have something of an edge. I've heard of people who wanted to work in certain difficult areas (to get jobs) like labor and delivery who utilized this approach. Also it might be useful to get business cards to leave in lieu of or in addition to a resume. During nursing school I was successful in getting an L&D interview for a classmate just by walking in and asking the manager during clinical downtime. Often people will respond positively by polite "in your face" audacity. Unfortunately, some of the time the response will be negative so you have to be ready to roll with rejection and take it in stride. 3. Take the waitress job or whatever, but as hard as it will be MAKE yourself use every available free hour looking for nursing work. If you could find a second or third shift job all the better since it would leave more time during the days (when managers are in) to look for employment. If you cannot find an RN job right now consider taking an aide/Tech job. At least this will give you SOME relevent experience and more importantly people (other nurses and managers) will get to KNOW you!
  8. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    Thanks for the input. Keep in mind that my goal is a FIVE year one. Not even I am so foolish as to think that I have a good chance of finding employment without having five plus years of experience a more advanced degree, a better job market and every certification available for what I hope is ICU nursing by that point (CCRN ect). As to stopping the pontification not a chance! It's who I am dude! My SO will tell you that I will often launch into a five minute "Braveheart" speech on the mortal coil of mankind before even taking out the trash! This is not a new obsession for me. Literally, half my nursing class literally expected me to abandon my family and move to Hawaii as a Bushman on the day I graduated!
  9. Ceteris Paribus

    Which areas in Florida are the best of the worst for finding jobs?

    My significant other has had her license for about a month while I've only had mine for a few weeks. I'm getting calls back on most of the applications that file, but my followup working nights has been less than ideal. We had hoped to MOVE on a travel assignment (at least for her) to avoid coming down for interviews. Thus, far the only travel opportunities have been in Gainsville and Penescola and she's still not willing to consider these over Orlando/Tampa. Based upon my "weekly job tracking" on www.indeed.com (searching only jobs posted within 7 days, by city keep in mind that this pulls virtually every job from all job sites posted online), Orlando/Tampa is creating virtually twice as many jobs as here in Indianapolis.
  10. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    As a free market liberatrarian I believe that money/perks are great motivators! When I used to wait tables no doubt money was my primary goal however I gave 110% to each and every one of my customers (I used to sometimes annoy my co-workers, parents, and friends by saying things with a fanatical zeal like the customer is my God and I will have no Gods before them), this is not to say that I always did a good job because frankly I just wasn't that GOOD of a server. In the same way although I entered nursing in large part for the money, flexibility and benefits I still give 110% each and every shift. I seldom take breaks (only to use the restroom), allmost never take lunches (only when they occassionally have ribtips and then only for 10 minutes to run to the cafteria), and usually stay late to chart "off clock". I serve each of my clients like they were the President himself and it doesn't matter if it's a prostitute with late stage HIV (a typical type of client at my inner city facility) or my own mother (and speaking of nepotism if I were in position to hire someone it wouldn't matter where they were from or if they were my best friend or worst enemy if anything I would hire my enemy first just to prove my fanatical dedication to my ideals of equality). This is not to say that I always do a good job, because I'm frankly not that good of nurse yet, but darnit I'm trying very hard to be the best one I can be. Yes, I'm motivated by the HOPE for a worthwhile future/career with good pay and flexibility, but I wouldn't try even one percent harder were I motivated by the promise of eternal life and salvation and the revocation of my sins (as were the Crusaders who approached their goals with fanatical zeal). As I look back upon my youth saying "the customer is my God" was foolish, but serving each and everyone of my clients to the absolute best of my ability matters to me greatly.
  11. Ceteris Paribus

    Nursing Resource Centers COULD these exist some day?

    The power of Allnurses to organize and inspire such a vast compendium of nursing thought, practice, news, and opinion along with the awesome existing example of the YMCA is actually what inspired this vision. What if there were place(s) where this thought could actually be translated into physical reality?
  12. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    I would argue that I would simply prefer to stay in school and take classes and continue to improve my educational base if I can do so at price that is less expensive than paying the loans directly. I would argue that it's no more a matter of taking advantage of a loophole than those who trade their cars in for $4000.00 subsidies paid for by other tax payers or banks that take billions based upon governmental programs that authorize them to do so. At least half my debt (the Perkins loans) could actually be forgiven OUTRIGHT, if I only applied based upon the type of facility that I work in as a nurse (but I haven't applied for this and have no intention of doing so). Also, if I took a job at the VA (as several of my classmates did) ALL of my loans would have been repaid outright by the government (plus I would make more, have more vacation time, and better insurance/retirement pay). If it's not "stealing" to accept a job which pays the loans off with government money, then how is it such to defer my loans indefinitely while I'm in school?
  13. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    She is a pretty "matter of fact" person and doesn't care to participate in online activities especially discussion boards. She loves to socialize, but vastly prefers face to face interaction. Our son is homeschooled so changing schools isn't an issue. No doubt she has higher standards for life than me. I could literally be happy living in a tent (as long as it's near the beach and I can afford at least one decent meal once a week or so, indeed during nursing school when I dropped from 270 to 180 over the course of a year I often water/multivitamin fasted two sometimes three days per week (and ate low carb the rest of the time when it was necessary to meet my self imposed weight loss goals). She is on board with Florida perhaps to an even greater degree than myself (it may not be paradise, but at least they have Disney, the beach, and no snow) and providing that we can find jobs which approximate what we currently earn (about $28.00, and $30.00 with night shift diff included) will be movnig within the next three to six months. She would consider herself (self described) a Jimmy Buffet, Hedonist, but with conservative, Glenn Beck like liberatarian social/political views. She considers me something of a left wing nut job, but never the less sometimes finds me at least remotely attractive if only in passing. Before being nurses we were once essentially "debt free" and gambled it all on a business which did well for several years. We basically decided to go back to school, take on massive debt and earn about 1/2 the money to enter a field that we felt would offer better long term prospects and offer the potential for life time growth (not to mention things like health insurance and work weeks which were not seven days per week and 16 hours long!). Plus, as I said originally we literally sat down and said what job(s) could do where we could dependably find work even in places like Hawaii (at one time nursing pretty much fit the bill!).
  14. I pay about $60.00 per month to the YMCA and really love the place. I can go there and swim, lift weights, take various free (and not free) classes ranging from karate and yoga to aerobics and fencing lessons. One can participate in various/numerous self help/interest groups ranging from weight loss to hiking. High quality childcare is available up to two hours per day for free so that even when my significant other is working I can still go. If I want I can even get a massage, personalized fitness training, tennis or swimming lessons. I can mingle, talk, chat and just hang out with other often like minded (as well as radically diverse) individuals. I would like to see something similar for HEALTH PROFESSIONALS (thinks nurses, RT's, tech's, doctors, X-ray/lab techs et al). This would be a place where you could brush up on your ACLS with supervised "mega codes", improve your IV skills, grab a cup of java, catch a workout, network, or just vent about the difficulties of nursing and ways things might be improved. It would be open 24/7 (although obviously not all services would be available all the time). I pay $60.00 per month to the Y, and I would pay even MORE to be able to go somewhere like this! My vision is a network of such places in literally every major (and eventually minor) citiy in the country funded by both members AND local organizations with an interest in promoting health care excellence. Could such a place as this become reality and if so what would it take?
  15. Understanding of course that like most of the rest of the country that jobs are hard to come by in Florida WHERE in the state has the most opportunities? We hope to move to Florida by mid to late Oct. My significant other has about 5 years as a cardiac ICU nurse and I have only a year as a PCU nurse. She prefers Orlando (I prefer Tampa), but I am willing to commute anywhere within about a 90 minute radius. We live in Indiana currently and expect to take a SLIGHT pay cut (I currently earn 21.75/hr plus shift diff for working nights) she earns about 25.00 plus differentials for nights. Would Miami offer superior prospects? Fort Myers? Jacksonville?
  16. Ceteris Paribus

    So what do I need to do to SUCCESSFULLY move to Oahu?

    Thanks for the input. I would make one point of divergence however. Just because the average stay is two years that doesn't necessarily mean that the trip wasn't worthwhile! I believe that Thor Hyerdahl "only" stayed on Fatu Hiva with his wife for a year (it nearly cost both of them their lives), but it was one of the defining experiences of his life! Those who walked on the moon were able to experience it for a matter of HOURS and yet for many it was THE defining experience of their existence. IF we moved to Oahu (or one of the other islands) for a year or two and ended up coming back to the mainland would we really be any worse off than in our current situation? Would we regret the decision to move out there in the first place? My significant other and I agree on at least one thing we don't plan to EVER retire! Whether or not I live in Antarctica or Hawaii, my plan is to stay in school until I DIE (penniless so that I won't even leave an estate for the government to confiscate). Indeed, one of my "dreams" is to start a "cheaper, online, but accredidated" college where those like myself (in boatloads of student loan debt) could take 6 hours to defer their loans (basically forever), but instead of charging $150.00 per credit hour, get the rate down to closer to $50.00! I know MANY people who started, but did not finish med school or law school who owe as MUCH or even MORE than me, but instead of making 55K per year earn less than 30. Here's the thing one way or another I'm going to get to the islands the only questions is whether or not it will be living in a nice apartment/condo or in a tent somewhere up in the Ko'olau mountains. An even more basic question is which scenario would ultimately make me happier!