Glad2behere

What is really icky to me is to see all the divorcees trying to score a doc on our unit. I work at a teaching facility so it is similar to the original poster's. Faces change often. Docs, male or female, have made a huge investment in time, money, and emotion to their livlihood and it's actually entertaining to watch these dreamy eyes throw themselves in the path of guaranteed neglect simultaneously convincing themselves they will be first...sometimes wanting is better than having.

Our policy is not a strict NPO policy. All meds given PO remain PO with a sip of H2O preop. I work CCU, and rarely have I given Metoprolol IV. I gave it twice last week PO as the anesthesiologist was doing his preop assessment as we were moving the bed to OR. The second time I asked why he preferred to give it PO like that on the way to surgery. His response was to not change a thing the patient had already been doing, and preferred the the current patient baseline status.

Gosh, I never knew there was so much difference here. We use PICC lines all the time for draws, in fact, our protocol states that if a patient has to be stuck more than four times for the anticipated hospital stay, has inaccessible peripheral locations, or poor perfusion in the extremities, or disoriented and threaten a peripheral site, or on a ventilator, the PICC line goes in. We do use a 10 cc syringe, draw 7 cc, discard, draw the sample up to 20cc, and then flush with NS 7cc. No collapsed lines, and better infection control. All meds given must be given with at least a 1 to 3 ratio of NS, over 3 minutes.

Hi Wgbem, If you are in the HCA, you are ahead of me, so how far along are you in the program and what are your aspirations when you finish? I have found no posters here that have the MBA/HCA credentials who are willing to share career pathway do's and don'ts. Speaking from experience myself, the business world and the nursing world are two different animals desiring occasionally compatible outcomes, but not often. Trying to assimmilate the two is difficult. Seems to me you are on the track to be a Nurse Manager or Nursing Administration, that is not too far removed is it, from core nursing? My question in initiating this post was to see if the MBA/HCA degree has any value in the real setting, as opposed to all the hoopla that is generated by college professors to sell the program to students. In other words, does an MBA/HCA degree actually do much for career advancement, and are there opportunities that can be taken advantage of that these programs are tailoring themselves to those opportunities in the marketplace? Last thing I need is another plaque on the wall as an ego booster but possessing no substance.

llg, Thank you for the response. And the compliment. I suppose I will have to enter graduate school and sign up with you all. I will be glad to and feel alive again combing over financials and employing methods to maximize efficiency, but it's gonna cost 'em:D I'll split the increased bottom line and let them keep a larger percentage when the forecast is met. That is how you sell it upstairs, on a trial basis. Then take a percentage that is above the projections. That is how I did car dealerships, and hospitals are not that much different really, from a business perspective. Actually car dealerships are probably much more susceptible to business cycles than hospitals are, in a way making them easier in some aspects.

llg and ACNORN, Therein lies the itch. Admittedly, pharmacists make more for the reasons you all stated. On the nursing side of the equation, nursing and nursing leadership are considered the same thing. My observation is that they are not. Not any ole nurse can be a good NM and some NM's are worthless as nurses. There is a lot of role confusion here. Pharmacists are low census, as is nursing management. How many nurses for every NM, every DON or NA? I am not sure, but I would wager there are fewer nursing management positions than there are pharmacists for the same hospital census. Sure, it would be great if all nurses had a bump in salary, but that is not the objective sought. If every nursing management position had a $20k raise in the hospital, it would have virtually no impact on financial statements that could not be recovered very easily somewhere else in expenditures. There is simply too much money involved to not scrimp somewhere else. Too many early discharges, too many agency nurses, too much overtime, too many syringes walking home in people's pockets. The more I work in the hospital setting the more I am astounded by the incredible amount of waste that goes on as a laisse-faire fact of business. The paperwork alone is so self defeating and time consuming, and I understand most of it comes from liability issues, but still steamlining even that would lessen the printing bill. Maybe I am too much of an idealist, or having substantial business experience makes me cynical of much of what goes on in the healthcare environment, but I see daily things I could change and never touch the income stream...deal with that later. I think the mentality of questioning every expenditure, and asking a simple question would do wonders. That question is this "Am I trading a dollar for a dollar, or is that dollar going to bring back an equitable return?". If it doesn't, don't spend it!

ACNORN, Thank you for input, I have decided to initiate action and commence preparation for the GRE, I have to score about 1100 on the two parts that are accepted by the graduate school, surely I can get that done. I am not dissuaded one iota, but I did want to know some of the substance of what I am getting into from an internal perspective. All of you posting here have been very generous with your knowledge, and it is sincerely appreciated. I think you are correct about other avenues to pursue nursing leadership. This is a growth process and a learning curve, and to date, there has really been no need to accelerate or direct it. The roll call of individuals responding to this thread can be taken as evidence that that need is maturing and will be addressed. I feel I am in good company, will seek more education, and hope that I will be able to make contributions of significant caliber, adding to what has been done and what you are doing now.

Hey I applaud all of you posting here. I have learned a lot, this has been an interesting discussion. There must be some type of mechanism that can be activated to encourage nurses to enter leadership positions. Dr. Kate mentioned that potential candidates do not seek additional education until they are selected. That may be true, and I agree it often is. Maybe the primary reason is that nursing leadership is not that attractive financially, and consequently as llg and ACNORN have legitimate issues concerning those financial issues. Take a look here at what is happening and why. I have stated my desire to attend more formal education to succeed in nursing leadership, but the ambivalence I hear causes me to pause. $130-150K should not be a high mountain to climb. I have paid more than that in income taxes in one year! My son graduated from Texas A&M 1.5 years ago and yanks down over $90K, and he is still a grunt in his occupation. I will rattle everyone's cage here. It is no secret, you do not ask, and you do not receive. Now, stop following nursing school doctrine and engage in business doctrine, and get in there an get paid for what you are worth, and be able to show it on paper, spreadsheets and all. Show what you bring, not what you will settle for. That way when I get there some of it will already be done. :chuckle

Wow ACNORN, I agree, that is sad and stupid to not let you work extra. Geez, who is it going to hurt? That is just plumb dumb. A golden opportunity for them to create cohesion and leadership and it costs nothing more than they would pay to an agency, if that much. They are stupid and in denial, and should be congratulating you for your efforts. I am sure they didn't offer to increase your salary to decrease your anxiety either, as an incentive to stay in management. So the tide rises....

Oh ACNORN, Sorry to hear about the resignation of one of your better troops. That is one of the windows I am looking through that doesn't seem to change: total unawareness by upper levels of management that employee turnover is very costly, and I am sure you recognize this and must combat it daily. You are right about the shortage of staff nurses and management level nurses practicing, but is there really a shortage of nurses or a low supply of nurses willing to work within the current criteria? I suspect the latter. The common thought prevailing in this discussion is money. You and llg have both expressed some satisfaction with your duties, though not all the politics associated with it. The inability to make decisions you should be able to make because you are being restrained to do so. I know you wanted to keep that NM on board for several reasons, not least of all having to retrain and reorient someone and pay them more than you would have had to pay the one who resigned, and the interim distraction it caused by the influence it had on you by not being able to do something more productive than just maintaining status quo. I won't even mention the probability of nurses that will walk because they dislike the new personality or had loyalties to the previous NM. To me that is very bad management above you for not counting the dollars BEFORE instead of afterwards. The irony is you probably pleaded the case until you were blue, now there has been some dissatisfaction created in you....that didn't have to be there. AND if you leave, the one following you will be paid more! So futile the thinking of many management teams, that it is actually much more cost effective to keep your people on board and happy. It really does pay, but I don't think we will see the day.

llg, Remember in earlier posts I had stated that I was good in managerial accounting, well, numbers don't lie. That is the issue I am having trouble with most, and apparently there are many others. You're right, I'll have to bounce it off some more folks and get additional opinions and try to persuade myself that the numbers just cannot be so! Terrible isn't? If you have some ideas on what you are going to do with the remainder of your career, I'd like to hear them, as I feel you are much more knowledgeable in this arena than I, and by the way thanks for the input.

Well hello llg! Good to see you joined in. Everthing I am hearing that is coming back to me is not real encouraging. I know you are a also involved in the ironies of this particular situation and when people I have come to respect view it simarlarly, that verifies that I am asking the right questions. I am not sure how I would tolerate the politics, as the leadership postions I have had were telling everyone else what to do. I may appreciate the autonomy of a NP more than a NM or DON, but feel somewhat sure I could adapt. Actually, it's a lot of fun motivating people and I may enjoy it more in some ways. But it still boils down to dinero. I have been laboring over this for a while, all the time knowing I could hit the streets and up my income substantially...but that takes lots of hours. I resigned myself to not do that again. What I need is a nice little highly educated position that pays $130-150k per year and I promise I will leave everyone alone...for a month...maybe:chuckle

ACNORN, Thanks for the response. I have been in leadership positions before, but in a totally unrelated industry. I have recently reentered nursing, went through the RN refresher thing, and am now working in a CCU. A couple of years there will fine tune my skills, I am sure. I am male, 48 yo, and that is a big advantage. The hospital I am now employed by asked in the interview what I wanted to be in 5 years, and I unhesitantly stated "One of your nurse managers". Later I learned that was one of the decision criteria for my employment. I have had a BSN since 1977. I do not want to pursue another degree HCA or otherwise unless there is some financial gratification. I can also work as many nurses do, 60 hours a week if need be and yank down about 90k+. So my question is more a less a value question, would nurse mangement be feasible to pursue considering that the title of this thread is "Is your salary keeping up with your staff's?" Is it worth it, or would you rather leave the beeper on your desk and forget about it? I had to carry a beeper and pager and a mobile phone for years, so I know what that is all about. Thank you for bringing the publications to light and attending conventions and the like. I recognize their importance and attendant mingling with birds of a feather. Again, thanks for the so cordially sharing the information.

ocankhe and jt, Yielded. Probably true. We have a long, long way to go. I neglected the "cattie" factor entirely.

jt, The operative word here is peer. And you also make another assumption that is not necessarily true. That an evaluation is bad and nothing good comes from it. Nurses know who the good nurses are and who are not, are you unwilling to trust your coworkers? A hotel questionaire like you stated is a dubious effort, almost a joke, and I am laughing with you on that one. If a policy is initiated from administration to rate performance, yes, I would be in your camp. An evaluation mechanism by nurses of nurses may not be so bad, and can be utilized as an educational tool as well. It does not mean anyone has to be fired, dismissed, or dealt with in such harsh terms. Again, going back to my original premise of WHO is doing the evaluation on whom as a plausible idea worthy of some studious thought.

I think it depends on who is doing the evaluation and who sets the criteria for performance. There is a lot of documented success for companies who use peer evaluations to establish and maintain employee retention and performance. There is a lot to be learned there that healthcare has surrendered to sanctioning bodies and administration to police, grade, and promote job performance and professional acuity.

Hello ACORN, How does one groom themselves for a leadership position? I think it is exactly what I want to do because it seems to offer easier advancement that I can achieve with the least amount of effort. I am seriously think about enrolling in a Health Care Admin graduate school but have serious reservations about outcome and salary, so what does NM make, or a chief nurse, or DON? My mother was a DON for several years and states that that can be the job from hell, is your experience the same? Another thing, just where would one ascertain the salaries of nurrsing management from a formal publication. Do you have knowledge of any publication like this that you could share? Lastly, what is the tier structure of nurse mangement? And the approximate salary ranges of those positions?

Thanks for the response llg, Your thinking is close to what I have come up with also. I have already decided that I am not interested in sales, however I am very good at market strategy, and getting 110% for whomever works with me. I am also very good in managerial accounting, and can understand what a financial statement is really trying to say and why. If I interpret you correctly, I need to secure a nurse manager position somewhere immediately after graduate school and build from there. Or would the shorter path be to seek midmanagement in a LTC where the entry is easier? I am really more oriented to numbers and people and a very good motivator. I guess my question is should I back away from seeking a NM position as I am starting to think that may be a dead end street for what my ambitions are?

I am trying what career path to take now that I have reentered nursing, and if there is anyone who can relate experiences that may help me decide. I have my BSN circa 1977, now work CCU after a 20 year absence. I was previously self-employed and had about 16 employees, so I have a lot of managerial experience. I need to decide if it is best just to sit tight and be a 48yo male staff nurse and feel totally unfulfilled or if pursuing a graduate degree in Health Care Administration or a dual MSN/HCAD, MSN/MBA has any real benefit in salary over the next 15 years. I would like to do anesthesia, but we all do, so I must be realistic in what I can accomplish at this stage in my life. At 48, I think I may have too many miles to be accepted to anesthesia, but the HCAD and MBA I can do part time in as little as 2 years. Also, I would probably have to work some going to school and all CRNA's I have talked to say this is a no no. So if you were in my shoes what would you do?

I haven't seen any hospital that turns you loose after a 6-8 week internship. They let some slack develop in the lines by assigning you lower acuity patients, but you are not going to be expected to perform to the level of a seasoned vet. As you progress, so will the acuity of your patient load. Remember, it is YOUR responsibility to make sure you are patient safe and to communicate that with whomever is in command on the unit. ASK for help if you are not sure, this way you at least DO NO HARM. You'll do good.

Hey Y'all, This normal stuff. Just part of the game. I noticed on several interviews questions that I thought were totally irrelevant, and by the second interview I realized most of it was designed to shift my aspirations so that I could be persuaded to take a position or shift or pay scale less favorable to me. Interviewer: "So why do you want a position in SICU?" Me: "My orientation and experience in ICU settings have been pleasant productive ones". Interviewer: "Is this to say that you must have an ICU position?" Me, somewhat confused: "Absolutely!" Interviewer: "Well, we have a position open on 11 Tower, but it is a step-down unit, would that interest you?" Me: "Are you saying the position in SICU is not available?" Interviewer: "We have had a lot of applicants for that position." Me: "I realize that there are many applicants, and I cannot possibly be the only one, may I ask as to why you called me to be interviewed for the SICU if there is an overflow of applicants?" Interviewer: "We want you to be happy here with us so you must have SICU? We try our best to match nurses to their skills and our needs, perhaps you could work 11 Tower for a year and move to SICU then, provided of course, there is a position open and you have minimal mistakes." Me: To myself I think "OOOKKay, I have been called to sit for an ICU interview, have good experience in one of the best ICU's within a hundred miles, never have worked in a step-down unit, and feel deceived. If the position is filled, just say so lady" So I say to her when I stand to leave and shake her hand "I am so sorry, I really was only interested in the ICU position as an immediate hire, thank you for the opportunity to interview". Go eat lunch, have another interview that afternoon with another hospital for an even more skilled position. Interview the HR person, the NM, day supervisor, and the HR runs the background check while I am interviewing with the other two. I leave the supervisor and am handed directly back to the HR person and the question is immediate and not really a question "We are so glad you can join us! I have your physical set for Tuesday at 9am, is that within your time framework?" Don't let em buffalo ya.

Teeituptom, While I am not prounion nor antiunion, more of a live and let live I suppose, I think you're being very hard on jt for making a very simple news announcement with some well restrained editorialism. While I am not prounion, I am very willing to graciously admit and accept nursing unions contributions that has affected issues concerning nurses in Texas, realizing Texas is an antiunion state. I also realize I don't know a darn thing about conditions NY nurses must work in. If they feel they must strike and that many of them feel that way there must be some substance to it that we well treated Texans are clueless about. What works for them may not necessarily work for us and viceversa, but all things change. Jt simply showed us a snapshot of that change, a change that you and I may benefit from one day.

There obviously has to be some caring. No one has suggested that you can be a nurse without it. What has been said is that nursing has no patent on the empathetic qualities found in mankind, but because we nurses have generally been exploited in that regard, we call attention to it. But to base our whole discipline on caring is horse puckey. Love and caring are energy period. The focal point is that nursing has been so caught up in how much caring they do that they have forgotten that it is energy expended, until burnout, and then the high mortality rates of nursing careers. Maybe caring ain't so cool, particularly if it allows it to deplete the numbers of nurses exploited from all directions, and is probably the single most important factor that has an effect on attrition, because we are still having to fight for adequate staffing. Why do we have to fight for it? Because we have got on a megaphone and told the whole world how much we freaking care, and letting limits of emotional tolerance being set elsewhere. So, it's our own fault really. The question has evolved not from whether we care or not to very simply "How Much Do We Care?" That can be translated to affect pay, ratios, responsibilities, and emotional wear and tear. All caring has done as a basis for nursing is create one giant sinkhole and we are all trying to climb the sides.

Another way to look at this.... Would you trade one softdrink a day to better your profession? Work about an hour per month specifically to fund your professional advocacy? Make one meeting every occasionally? You pay Uncle Sam for 5 months straight.

Anybody know what the operating budget of the ANA might be ? Well, let's try this instead. 2,200,000 nurses factored by $200 annually per nurse. That is like $440,000,000. Or FOUR HUNDRED FORTY MILLION HUNSKIES to better our profession. How much does the AMA raise? Would this kinda money allow for some excruciating, well targeted change? Especially if you had a real voice in your own profession? Can't always get what you want, but if you try sometimes, you just might find, you get what you need. The power of money is awesome when focused in one direction.