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  1. unfortunately, in an inner city ER, I see this frequently. We admit these folks for several days until placement in a facility or home health can be set up. You are right on the spot, a busy ER, is constantly challenged trying to meet this populations needs. Thank you for this article and those to follow.
  2. Zookeeper3

    How much free time do you generally have as an RN?

    I worked sun, mon and tuesday.... 12 hr. shifts... then sun, mon tuesday.... that was the bomb. Don't ask what I'm doing now... but I need some time with husband each night... argh... but good.
  3. Zookeeper3

    I finally moved on and THANK YOU

    About six months ago, maybe more, I posted one of my rare threads about my personal burn out.. heck we all do here. At the time, I was still recovering from my daughters MVA, the brain injury and my exhaustion working in an ICU and dealing with her recovery (I had work at work and work at home with her recovery). I had burnt out and simply didn't care anymore, I was really lost. After 15 years of doing ICU, and dealing with a sick teen, I didn't know how to get away. I wasn't ready to go and take something new on with all that, and yet had to go. Anyone that was so point blank honest with me and told me to go for my patient safety, my home needs, my sanity... it was tough to hear, and I appreciated all your blunt and kind words. They were tough to read, and I read them over and over. So I just wanted to say, that sometimes it's easy to knee jerk and be snarky here... sometimes someone really is looking for advice and simply needs to hear the tough words and needs them put softly because they are hurting. I've finally healed and I'm leaving bedside ICU care for and EPS job. For all you wise folks that knew I was done then, I heard ya... and I'm finally ready, so thank you for your time, your "words" have stayed with me. I'm ready to grow and move on... took a touch longer than I would have liked.. but with 15 years of a safety net, I had to wait for some healing and the right time. You all do make a difference in what you say here and I wanted to give a sincere thanks to all your help, time and well wishes. We're going to be just fine. Sincere thanks.
  4. Zookeeper3

    I Quit Bedside Nursing

    I have to add, that as of Tuesday I'm leaving bedside myself, after 15 years ICU... I'm going to an EPS lab.. basically cardiac ablasions and pacemakers... very little to no bedside nursing. I wanted to share this with you to point out how versatile nursing really is. Yes, it's easier for me and I have more options because of my exp., BUT you can apply for labor delivery, hospice, home health, ER, short stay, a doctors office... nephrology... get my point. You are a degreed professional that has some very important basic skills and you've not job hopped through the worst!!!!! Better is out there, that's why I love this profession, we can always re-invent ourselves! Your job market might be tighter than mine... but persistance with resumes and phone calls will make a huge difference.... keep at it, I know you're exhausted, but if your next choice is only half as bad and you add to your resume and can do what ever for the next year and move on... that's how us nurses move up the ladder. So you're at the bottom now... time to move up and fight for it to get out. You'll know if something is better in your heart when it comes up. It's out there but you'll have to work very hard to get to it. You can do it!
  5. Zookeeper3

    Taking a pay cut to enter into Nursing

    I am going to be blunt and many newbies still in love with the idea of "making a difference to humanity" will disagree, and I mean NO disrespect to them, they are our future and I love them. I am not disgruntled but will be honest and point blank here. After 15 years, with all the shift differentials working nights I make $35/hr. Sounds incredible doesn't it! -I'm exposed without warning to TB, HIV and Hepatitis as well as MRSA and bring that home to my family -I"m an ICU nurse, so I'm responsible for wiping the behind every 30 minutes of a GI bleed, the noncompliant renal failure getting kayexallate, the liver failure getting lactulose, the patient that refuses to use the call bell and just poops in the bed, the sedated patient on tube feeds that can't help it. -The confused patient that is spitting and bites and kicks and hurts me, and no they are all not confused. -The 86 year old patient end stage cancer DNR, that the family demands we code, against patient wishes.. again and again and again with no hope of a peaceful death. -The drug seeker that manipulates, yells, demeans me with demands and calls management on me whom reply with "make them happy so our satisfaction scores are high no matter what" -the 20yr. old that is in every, YES every week with DKA (they don't take their insulin and their body eats itself for food)... demanding high dose pain meds, a meal and the TV clicker and the VCR. -The very routine 300lb-600 lb patients that have broken my back and my knees that refuse to lift a drink cup to their mouth and demand me to cater to them... but obviously could feed themselves. -The shooting victims whom are "pillars of our society" that have every local "homey" on the street coming in all acting up carrying on deterring from really sick patients. - The patients whom are kept alive on live support, suffering with no quality of life for TWO more weeks until the family gets that next social security check... and the first and 15th of the month is very common to withdraw life support after noon when the checks have cleared. -Overdoses that result in multisystem body failures when they were simply a cry for help, many resulting in brain injuries which cause a vegatative status, while some wake up and scream that they failed -Family drama, dysfunctional families in their worst stressful moments that bring all that crap into where I work and they make their issues more important than my patients. -Management, all through a shift of this that rides my chaffed behind wanted 20 pages of charting filled out to get medical reimbursement while my patient is crashing, and my other one is one of the above. Finally... the documenting... I have to cover my behind while writing a phone book because eveyone wants a quick buck and they'll sue me...and they do because there is always fault to find because we're simply human, trying our best in these and many more circumstances. If you think this is worth $35/hr... knock your silly behind out. I have yet to teach you about press gainey and patient satisfaction scores... all while we have 24 hr. open visitation... have at it. I need combat pay. That is the REAL world of being a nurse, what you do in between that makes a difference... barely keeps you whole.
  6. Zookeeper3

    Advice Please Help

    NO! Unless I'm very mistaken... chamberland has little to no transfer credits. You will need this to get into a CRNA school. PLUS, please read this very carefully, little to no programs that are fully accredited will allow you to transfer mid nursing degree. You're expecting... part time is the best option. I did nursing school full time with three young ones at home all under 4 with a premie... It was hell. One extra year.. to have peace of mind at home and school is worth it's weight in gold... you have the rest of your life to be a CRNA... only a limited amount of time at home with part time school as it is with all the work. From your associates... you can work part time and work at an on line BSN program, which will be cake because you'll have transfer credits... only have to do nursing. After a year or less... get into an ICU for a year or two while caring for your family and getting that needed BSN with all A's.... you need top grades to get into the CRNA program... Nothing less. The CRNA program, unless you're lucky to have one in your drivable distance.... that you GET accpeted to... will prevent you from working due to the course load.... so you need your finances and home life WELL in order to succeed... with twins.. you may need to hit that 4 year mark where they are in pre-school so you can afford to NOT work... have them gone only part time and have an 80 hr. plus a week course load. I mean no disrespect... but you need to do better research into your schools of choice, what is really involved and the finances of managing a family with out working with student loans and then CRNA school You have more research than a board can provide to make the right decisions. I"m only providing food for thought here. Chamberland doesn't transfer... and you need a financial plan to make this happen... wanting it tomorrow, is what we all want, that doesn't make it a viable option.
  7. Zookeeper3

    How do you manage staffing in the ER?

    If you're looking for a ratio.. we take 4 patients... only one trauma or code room per nurse with three other rooms. They very well may end up all ICU patients, or they'll all be minor and you have the proverbial revolving door.
  8. Zookeeper3

    I Quit Bedside Nursing

    OP, I promise you... it is NOT like that everywhere. I work with wonderful co-workers whom help each other and generally like each other. Never burn a bridge, get other employment first. Very important! Sometimes the grass is grenner than green in the neighbors lawn:cool:
  9. Zookeeper3

    Arizona may require hospitals to check citizenship

    from piedpiper" anyway, do you know how much it actually costs to pay for immigrants to get health care? noah timothy did the math and found out that we are talking about $30 per taxpayer (noah, 2009). thirty bucks. i spent that much on dinner and drinks last saturday. i spend more to fill up my car. my boyfriend spent that much on flowers yesterday on valentines day. it's really not a big deal to us, but for some kid that needs a lifesaving surgery, it would mean the difference between life and death. so here is how to really get hit with a huge healthcare bill (more then 30 bucks) for illegal immigrants: deny thier health care, and then when they get dragged into the er shell out the thousands of dollars that critical care costs. or let them die on the streets. either way, we as a county are either broke in our pockets or broke in our souls. noah, t. (2009, november 20). the nativism tax. retrieved from http://www.slate.com/id/2236288/" pied p, please do your research.... noah did not do the math and come up with these numbers, they came from the center for immigration studies, based upon the us census for 2008, not including any illegal who did not fill out a census form, was in prison, in hiding or in a nursing home. so do not claim the costs will be as cheap to me as dinner out... based on flawed data to use a flawed thought. my family in neck deep in dept from my daughters injury, while the illegals i treat have thier debt written off. i know this because they brag of it. when the grass is no longer greener, there will be little reason to break our laws and help increase our debt. pied p, please go back, read the references and actual data with the size of study groups you post for reference to ensure it's really valid. thanks in advance.
  10. Zookeeper3

    Leaving the ICU after 15 years

    Over the past year many of you have been wonderfully supportive as I've dealt with my daughters car accident and her lingering traumatic brain issues with my issues in working critical care. My best memories are the blunt ones.. where I was burnt out and many people reminded me that I needed to still care to practice. Many suggested I move on for the safety of my patients due to my burn out level. I'm done, you all were right, and I've taken a position in an electrophysiology lab, which had no bedside nursing care or family that has burnt me out over this last year. I feel it's a safe change, one that affords me learning and protects my peeps from my burn out. I just wanted to thank everyone, and there were so many of you, that gave me permission to move on, move out, STAY in nursing but find another way in which my skills were an asset. I don't know that this is my answer to my issues, but I wanted to say thank you all so much, your words really made a difference and I finally am whole and steady enough to make that change. Leaving bedside ICU nursing after 15 years.... never would have imagined...and off I go:D Thank you all!
  11. Zookeeper3

    Disrespectful, Lazy CNAs who bully

    Everyone is going to burn my butt for saying so, but you asked so I'm saying. nurses, especially new ones have no delegation skills and want to make friends and find a happy place in their new home. No one is taught in school to say.. "put down the phone and answer the call light"... you practice sterile technique until you puke, but no one teaches you to say.. " you need to round on my patients and hit the call bell when you need help turning". or "while you're making turning rounds, it makes sense to have a cart with ice to refill the water containers". Yell all you want at me fellow nurses, but I believe we grow this problem from lack of delegating skills and we grow lazy assistants. Sure it's easier and "quicker" to do it yourself.. Shame on us all for doing that.. delegate that what ever it is... yet be available to help with your patient. I've always had fun at work, always been nice, "please see what bed 12 needs again, thank you". No excuses as to why I'm busy... what I have to do. Attitude... rolling eyes, sitting longer than I'd like them to respond... "You must not have heard me, bed 12 needs you now"... and I'll stand there and wait if I had to ask a second time. If you're sharing an aide, know that they are pulled in many directions and be respectful of that.... "bed 12 is soaked in urine... what are you working on now?" Then you can see if there are multiple nurses competing for an aides time and you can prioritize... this happens frequently. The bully... is easily fixed with their peers in tow... you take the bully on quickly... that's the one that sets the stage for bad behavior of the others... take the bully down, let them save face, don't pull rank. Try once to pull them aside, usually never works... but have a quick chat with them with the charge nurse and let them know next time they sit and delay patient care it goes on record... they will test you... write them up to management. The bully then USUALLY gets worse.. pull them aside and give them the option in private to work together or continue the paper trail... Worse behaviour... more paper trail... pull them aside, " I really regret that you are forcing me to do this... helps is some of the new aids can hear...but your care is not up to my standards... if you need help in your assignment and can't get your work done you need to let me know" Now they are looked at as incapable with their peers and they generally don't like that. From there I keep calling them out, ever so nicely saying if "you're having difficulties maybe ..... the new CNA needs to help support you. Then I talk to the newer CNA's whom one... know I'll write them up and go to management, two, they generally don't want to follow this person much longer and three I've taken away the bullies groupies and made them stand out in a very poor way. Sure it's alot of work and we as professional nurses are responsible for that delegation, and making sure it happens. Usually us nurses allowed this mess to occur and we're responsible to fix it. You can't fix your fellow nurses, but those CNA's will work for you... and care for your patients... the other fearful nurses... let them take up that slack and dare to complain... I promise you you'll help them fix that. Zero tolerance in a polite and respectful way.
  12. Zookeeper3

    Care plans are stupid.

    Care plans are a JOINT COMMISSION requirement. Period. They are stupid, they are a waste of time, they evolved from a thought process of linking MD diagnosis to a nurse driven diagnosis.. and so on...to keep our profession an independent profession... BUT until the joint doesn't require them ... we must do them. Nursing created this monster to be a professional segregation from the MD's... so no one is giving that extra paperwork up anytime soon. No matter how irrelevant and archaic it is. Deal. Sorry and yes it sucks. Thank god real world care plans are nothing like school ones. It could be worse, remember that.
  13. Zookeeper3

    code blue question

    Really need to add... what ever you policy is... for god's sake... please... please make sure the patient is NOT, NOT a DNR FIRST before you begin.... or check very quickly after you've asked for a code to be called. Don't even get me started on that one... if people snicker after running so be it.. but LOOK! Coding and reviving a DNR only to get transferred to the ICU on a vent is hell for the patient, the family and you.
  14. Zookeeper3

    code blue question

    It's very good that you are asking these questions, being new you've not experienced what "GOING BAD" really is First NEVER, NEVER EVER leave your patient... scream, call out, hit the emergency button call a code with the patients own phone, but don't leave them..... well ok, you can stick your head out the door and scream for help. Then the ABC's starting with you....assess yourself, deep breath and check airway, breathing and circulation. Guppy breathing... 5 times a minute or agonal does not count, nor does the non responsive can't maintain their airway and they are a limp doll, it's an emergency..... So is a thready pulse when you can't get a BP... just compress... the patient WILL OBJECT if you shouldn't be doing it, and they'll object quickly. After you've called a code, you don't leave, you direct your team to check a blood sugar AND shut off the PCA pump and give narcan if they have a med pump...the usual culprits if patient not septic and surgical. Order someone to page the MD stat, get you the chart and pull up the am labs.... while the code begins... YOU don't code, you're needed then once the team arrives to talk with the doc, call the family and answer a ton of questions... let the code team then do their work... don't leave! I"m missing a ton of advice, but time is brain tissue... don't try taking a bp for 10 minutes... if you can't palpate femoral pulses and no bp registers, get on that chest stat...not breathing well... ambu them.... if on a pca, reverse it... and check a blood sugar asap. You don't have to do it all, shout out those needs until the code team arrives and NEVER leave your patient. Thats the best advice I can give as and ICU nurse who runs to floor codes and frequently finds an almost dead patient alone, with no interventions having been done when I get there.
  15. While HR people are VERY busy, and you'll likely only meet the receptionist.... it can give you a feeler as to how they treat people. I returned back to my place of work as a re-hire and was NOT impressed with the hiring process, to the point that I complained. Looking back, it was an excellent view of how things had changed and I was simply a warm body to fill a position. NOT suggesting this is true in every circumstance... just food for thought. As the first response stated, almost all are on the internet and your detail to completion of a resume is the key to get a call. Smaller hospitals, absolutely, get face time, be dressed, friendly and treat the receptionist very well. Receptionists are the gatekeepers... if you're at all snarky or impatient with them, they can cut you right off to the very people you need.