Hopecascade

Nocturnal hypoxemia in subjects at high risk for OSA is associated with an increased potency of opioid analgesia. We follow ASPAN recommendations for OSA patients as best that we can. We do not have the protocol you mentioned. Is that from your Anesthsia dept.?

Uniform throughout the hospital. 50 cents more per hour with certification in your area. Union hospital 30+ years experience $43hr. East Coast pay, is usually higher than down South or Midwest in the USA. 10or 15% shift differentials for off shifts, evenings and nights. On call pay is 1 1/2 times hourly rate guaranteed four hours of pay even if you are only there one hour.

Hi Sometimes you have to move them out quickly. If they are a MAC case and meet the discharge criteria you can have them out in 30min. That is a transition for a critical care nurse! Your background will bode well for you and your patients. Airway is the first priority in the PACU. Brush up on Phase I and Phase II recovery and criterion for discharge. Review anesthetic agents, emergence delirium, hypothermia, neuromuscular blockade agents, etc. Good luck. I also recommend Drain's book A Critical Care Approach to Perianesthesia Nursing. It is through and comprehensive. Get to know your anesthesia providers and ask questions. Review ASA classes so you are aware the type of patient you are receiving just by the class. ☺️

I like the quick thinking and rapid responses you need. I like the turnover of patients. I dislike " holds " waiting for rooms. Some places call them boarders. I don't like when families expect to stay and pull up a chair for a good long chat. Families should just stay for 5 minutes or so, the patient is delirious for goodness sakes! I don't like having to mix pre-ops with post-ops late in the day/ evening when the SDS nurses have gone home. I like the highly technical critical skill level you need. I like comforting the patients. Good luck!

I think employers should offer more tuition reimbursement to RN's. RN-BSN programs are expensive. It is a bit of a racket Magnet hospitals now require BSN's. So we work hard and spend lots of money to the universities to get our BSN. I just started back to college. I have been avoiding it.

It sounds like your anesthesia providers are not providing opioids during their cases. Talk to your manager and the CRNA's.It might be your patient population, are they chronic pain patients? Trying to play catch up in the PACU is rough. I don't see IM Demerol used anymore. We use IV Demerol only for a one time dose for shivering/rigors. Some surgeons don't like blocks and use local sparingly. All of your patients should not be coming out of anesthesia writhing in pain. It sounds like you worked with a better group of anesthesia providers who managed pain much better in your old job. Good luck.

Thanks for your reply. I do maintain my own home and come home on weekends. This was my first time as a traveler. I am learning as I go along. I appreciate your input. I am still undecided about signing a new contract at the same facility. From your reply I should move along.

I have reassigned at the same hospital for a year,with a small 30 day break. I wish I asked for a bonus after each 13 week assignment. Also has anyone worked at one hospital with your agency wanting to tax your housing stipend? I have an upcoming contract and that is what they want to do. They said 30 day break does not count, it is considered consecutive. They want me to have a 13 week break or will tax my pay and housing stipend. I am undecided. I might look into another travel company.

I wish I could say, " you should have told the anesthesia provider and myself that you take percocets tens around the clock x2 years, if we had known we would have upped your dose of pain meds right away in PACU. No wonder you are writhing in pain! It truly hurts to Not share. If your allergies are to all pain medicines except Dilaudid how convenient for you? Seriously if your ABD hurts that bad why did you get a bag of cheetos from the snack machine on the way in to the ED?

This is in reply to the nasal airway in the mouth: I do use this and have seen it done. They are softer and it works with less irritation of the gag reflex. I have had one CRNA that does it and it works :). "Is my surgery all done? Did it go OK? What time is it? Can I have a drink? Can I eat? " This is asked in a Q 5 min LOOP I wish I could play back my same answers on a loop.

He Is supposed to be computer literate. But I only saw him use the pound key!

I am sorry this happened to you. I don't know what group 1 & 2 are. Do you want to leave or fight to stay? Think what recourse you could have to deal with her. Document what happened, take it to HR. File your own grievance and calmly proceed. Your story and others are what is chilling about nursing. It will take stamina to take a stand with this manager. She is not an entity unto herself, upper management has the ultimate power. Employees do have rights. Nurses have rights too. The patient is NOT always right. Your record should speak for your integrity, too. Sometimes dealing with a difficult toxic manager is not worth the struggle. There are professional managers with sound judgement and integrity out there. I wish you all the best.

Never Fear Dr. WonderDog is here!

I saw his stupid pet tricks last night. I laughed more than the patient did!

Two dermatone levels from initial assessment. They are all ready in a bed and are transferred to the floor. If they are SDS they must be able to stand to get into a wheelchair. They must void in SDS. I hope this helps