helloworld

Where I work the typical nurse to patient ratio varies with acuity. We have several areas - resus is ideally 1:1 but often 1:2 when really busy, but they don't tend to linger in resus long if the systems are working as they should and patients move on to definitive care (OR, ICU, etc); monitoring (cardiac and more unwell patients) is 3:1 with a coordinator assisting and coordinating patient flow in and out of the area, and acutes (your renal colics, abdo pains, etc. area) is 1:6. You generally have a float nurse wandering around assisting if resus is not too busy. The ambulatory area can be 1:12 and often worse, but these patients are basically GP type patients so not too heavy, but it can get frantic. These ratios can vary with staffing, and turnover can be high in both ambulatory and acutes. Because of six hour targets to move patients out of Emergency Departments within 6 hours in New Zealand hospitals, most EDs now have designated short stay areas where you keep patients who need to be in the department for more than 6 hours but won't be admitted under a specialty team. These tend be 1:4 or 1:6 as well. Bear in mind that I'm speaking for my setting and for some of the EDs I'm familiar with in the Auckland area, this may not apply to Waikato. In the ED I'm quite independent as a nurse. Once I assess a patient I'm able to initiate a lot of the investigations, cannulate, order blood tests and initiate standing orders for pain relief. We have a duty consultant on every shift (what you'd call an attending) who i can approach for things that aren't on the standing orders that I think a patient needs and he or she will sign them off for me. Of course the duty consultants have to trust the nurse who's approaching them to ask for stuff, so you have to have proved your competency and shown you know your stuff and if they're unsure they'll come and eyeball the patient and get a bit more of a story, but they're usually happy for us to order preliminary stuff. Again this will vary from ED to ED. In my ED nurses are treated with respect and as an integral part of the team, and they're acknowledged as knowledgeable colleagues. Yes there's the odd weirdo who thinks we're still the handmaidens of the doctors but those weirdos are everywhere. I can't speak for the wards, but that's my experience with working here. Hope you find that helpful, and bear in mind that it might be helpful to pay a visit to the actual place where you want to work and have a chat with them, and maybe even pay a visit and do a temporary contract and see how you like it, maybe get one of those working holiday visas, it's a great way to check a place out without committing fully :) Good luck!!

I have worked in the US and now work in NZ (but not in Waikato), and while I love NZ (there's a reason it's called Godzone :) ) it's not 100% paradise, like every other place on earth it has its pros and cons. If you ask me specific questions I'll be happy to answer them. I work in an ED, inner city, super busy, Trauma 1 teaching hospital. NZ unlike the US is not very litigious so we don't practice under the gun fear of being sued nursing, which is kinda nice. Tell me what specific questions you have and I'll give it my best shot.

I work in the ER/ED because I love the challenge and the unpredictability of it. I started in the ED as a new grad in March and it was a baptism by fire, but my confidence has grown in leaps and bounds and I am in a place professionally and personally where I thought it would take me years to get to. It helps that I'm a fast learner and that I thrive on challenges and love to think on my feet. I also spend lots of time after work reading and keeping myself informed and updated on conditions, procedures, meds and all that. But I would not trade it for anything else. Eventually I would like to spend some time working in Trauma.

One would think we are speaking different languages here. Nobody is DEMANDING anything. This post is not about DEMANDING! It's about responding to a request from ICE for SUGGESTIONS on codes to be added to the OPT extension, period! Nobody said anything else. Nobody DEMANDED that rules be changed. We are simply discussing options and ideas. Who in the hell said that America MUST hire us? Nobody. You are all reacting to an issue that has not been raised in this thread. My reaction in the post before was to the naysaying that is completely unnecessary to the context of this thread.

Once again all the negative talk prevails, even though I already states I know the realities, the odds, and the numbers. It's enough to drive me crazy. Like I have said, no one is talking about taking jobs away from anyone. We're talking about OPT extension and responding to an open invitation from ICE to suggest new codes to be included for OPT extension. The threat of someone googling this site and finding my comments here and then emailing some congressperson makes no sense to me, and is really irrelevant. What will they do, completely abolish OPT for nurses in response to this thread?? It's almost like a conspiracy is in place to muzzle us from discussing our options by threatening how people will come and read this forum and react to the fact that we're talking about realities and brainstorming for ideas. It sounds to me like "shut up or you'll be in trouble". Come on people, no one is denying the reality or the depression. As for referring to our home countries as "where you nurses are unemployed" is really strange, and the comparisons made make no sense. I am not unemployed in my country. I made a choice to come to the US and I am employed here. Once my OPT is over I will go back to school and continue building my training and skills. I think extending OPT for nurses makes sense. It's my opinion and I am entitled to it, just as you are entitled to yours. Nobody mentioned any loopholes, legal or illegal. We're talking about an offer from ICE to suggest OPT extensions. Does that sound like a loophole to you? It almost feels like there's a programmed response to anyone who posts anything about working in the US, or about OPT, or F1, or GC, and that response is "No way, forget it, don't talk about it, not going to happen, no hope, etc". I for one I'm getting really tired of it all, We already said we know the realities and the numbers, stop shooting us down. For once allow us to have a discussion without all your naysaying. Thanks!

Once again, all factors considered, there is really nothing to lose. As floridanurse2008 has mentioned, this is about extending OPT for nurses trained here, not about hiring more foreign trained nurses. There is no call for negative emails to ICE, they do not invite people to send emails stating what should NOT be added to the STEM list, in which case, based on your arguments, all professions would suffer, instead they are inviting suggestions about what COULD be added. Let's not get things mixed up. No one is asking for foreigners to be hired before citizens, this is about OPT.

Doesn't hurt to try now does it? I think we all know the REALITY of retrogression that keeps on being pounded at us, and we're well aware of it and doing the best we can to deal with it. What will it hurt to try something proactive for a change? We don't need naysayers, we need ideas, and here is one. I applaud floridanurse2008 for taking the initiative to suggest this. So what if it doesn't work? And what if at the end of the extension nothing has changed? So what? It can't get any worse than it is now! So yeah, I will be sending an email too. I am a realist, I know what the reality is, I know the numbers, I know the odds, but I am also an optimist, and even if nothing works out I'll know I tried. Like I said, it won't hurt, I have nothing to lose as the situation stands. My OPT expires in February and I'm ready for what follows, but I am also willing to go through whichever open doors are there and be proactive, instead of hanging my head and letting the naysayers pound me down. I'm with you floridanurse2008, my email is on the way to sevis!

You need to focus on the NCLEX because none of that other stuff will help you without your RN. Focus on getting that squared away. Believe it or not things have a way of working out. The thing that's important is to have your RN. So take one thing at a time. Good luck to you

If you're still in nursing school you could start looking for new grad positions in an ICU/CCU. Before I get contradicted, let me say that there are ICU's and CCUs that take new grads. Mine does. They hired me right out of school but I opted for an ER position. Once you get the position you can use your one year OPT to get the required one year experience. In your application to CRNA school you can clarify that by the time you are ready to start the CRNA program you will have completed the one year experience.

The fee on the website is the current and correct one - $448. I got my certificate a few weeks ago and this is the amount I paid.

In my hospital we have residents and interns and NPs that come down to write admission orders. They see the pt, do the H&P, and write orders then page the admitting doc to verify the orders, so all we have to do once they're done is look through the orders, do anything that is labelled STAT or NOW, and then send the patients up. We have a policy that we only take verbal orders (like if a med needs to be changed because a pt's condition is changing or something like that) only if it's an emergency. Works really well.

You can stay in school with an expired visa as long as your I-20 is current. The visa only becomes an issue if you want to leave and return, but as long as your I94 references your I-20 you're legal to stay as long as your I-20 is current.

Yes you can, but why would you do that? Remember that as an International student you have to be a full time student. Which means that you would have to quit your OPT job. Once you're in school you're not allowed to work, so it doesn't make sense to waste your first OPT. What's the rush? There are no visas, so take your time. Get the work experience because a lot of RN-BSN programs will give you course credit for the work experience. And it will look good on your resume that you have one year experience. Also will be time to make money and save up for going back to school. Then when OPT is over, go back to school and do RN-BSN. You should start applying to programs but my advise is the same as everyone here, finish your OPT and then go back to school.

Regardless of the ratios or numbers, the fact that we do have an appreciable number of critical care cases EVERY single shift that I have worked means that critical care knowledge and experience is desirable. Bear in mind that I am a new grad here, and I am feeling I need to take some critical care classes ASAP so I am better prepared. I didn't come to the ED with any critical care experience except what I learned in school, but even from my position as a brand new nurse I can see why the job description read "critical care experience desired/preferred". They still hire new grads, and nurses with no critical care experience, but they train us and make sure there are critical care experienced nurses on each shift.

Not everyone in our ED does, but as a new nurse all my preceptors (Ihave about 3) have taught me to chart the vent settings each time I chart vitals (which is hourly) or any time they are changed or there is a significant change in the pt's condition. Also, every time I call report to the ICU or CCU on a pt on a vent or a BiPap, they always ask me the settings. i feel that my notes should tell the pt's story, and the vent settings are part of that story.