Zookeeper3

I''m finding this as well in my Florida hospital. My unit has... get ready... a 68% of staff with 2 years exp. or less in our ICU. I'm exhausted from precepting, exhausted from my name being called thirty times an hour in every direction, and I left and went to rapid response The changes in health care... no foley's or central lines in my vented and sedated patient?? Really? Open visitation, families sleeping in recliners when I can't get to either the vent or IV pumps (all allowed), pharmacy that makes me count their pyxis meds, central supply that acts dumb and takes forever... lab that looses labs, then takes two hours to process stats, ..... .... and then I'm going to round hourly, use scripting, fetch coffee and blankets... fill out six extra forms to prove I did my work, while never being allotted the real time to do so.... THEN I can't make the frequent flier DKA'er happy who is NPO, they score me low on patient satisfaction survey... and I NEED remediation?? These are a few reasons why... patients are going to have increased morbidity and mortaility rates, but administration wants to make dang sure they are happy in the process.... Those who know better are leaving.

Dartmouth is hiring....

Thank you so much. I'm an ICU and ER nurse. I had no idea about AA, great information, thank you! Normally social work sets these things up, but we are doing more and more without resources lately. I really appreciate your time!

Hey all, I am working in an inner city ER with frequent flyers. THere is this middle aged man always found passed out on the road. We admit him, he goes through detox and starts to drink right after discharge. I've really started to bond with him. He says that AA doesn't work for him because he is a quiet loner and three meetings a day plus sponser calls turns him away from the program. I had suggested the program for general addicts, is it allanon? Can't recall, social work had set it up. Well he's back again. Now I know I can't help everyone, expecially until they are ready. But ARE there alternatives to sobriety instead of a super structured environment such as AA? Thanks

Depends upon the type of nursing. In the ICU, we do a full body system SBAR, with labs, the almighty wish list from the doc, family issues and general patient needs... like social work. A small ICU I've just worked at prints a kardex for the patients and both nurses review at the same time (computerized charting), it's redundant, but that's what they do. In the ER where I work, computerized charting completely, we pull up each patient and go through a SBAR format, while looking at what orders need to be completed. My issue with the kardex, is that the chart is generally not referenced and you only get a he said/ she said, and I miss orders that are pending until midnight chart checks and it is dangerous. If the kardex is used with a review of the paper chart and signed off in a shift change than I think this works just fine. I have little to no floor or nursing home experience so take my points with a grain of salt if the ICU/step down/ER doesn't apply to your situation, you may have other methods that work best and I respect that.

One more suggestion.. when a preceptee and I are having a difficult relationship, I make a contract to meet with them after report and allow them to give feedback as to how the shift went and what I was expected to do different. If it was reasonable, and usually always is, I would listen until they were done and pointed out three things that needed to be worked on the next shift and asked them to pick one. We agreed on it. The next shift I would reaffirm our teaching plan and adjust my praise, correction based upon the feedback. Not every preceptor has the people skills to do this, but you should DEMAND it upon your next hire. Make a contract with your next preceptor and give feedback. All too often, preceptors are chosen for their excellent clinical, NOT people skills. We need you newbies to give us feeback in an appropriate setting to teach us too! We are always evolving and learning. Give your next preceptor the chance to adjust to your needs, BUT you NEED to STATE them, as well as how you like to learn for us to know!

THe hard truth is that you will come across people like this your ENTIRE career and you just can't keep quitting!!!! I have told my kids and all those I have precepted for 17 years, that you DON'T have to like the person educating them, as long as they are competent and you can learn from them. THis is precious advice. I learned skills from hard nosed nasty nurses, I learned how to interact with the caring ones. I learned how to stand toe to toe with a screaming doctor from those nasty nurses. I learned how to drop everything and hold a hand and just listen from the caring ones. Each peer you encounter in your career has the potential to teach you something each and every shift. You can't run from the hard ones, but you can figure out what you need from them and what they need from you. ex. the hard a$$ nurse gets assigned the difficult needy on the call buzzer patient. I offer to take that one from them, and tell them I need the patient experience. The trade off is that my lab draw skills stink and I want her to help me improve my skills with the morning lab draws. This is about knowing how to work and work with people. It is a skill to be learned that will serve you well as you slowly become proficient in dealing with a wide breth of patients. It starts with our peers, please don't let ANYONE drive you out of a job, unless you are going to be fired, there is always wiggle room to work out a compromise. May I finally suggest, in the future, you immediately pull this nurse away in private and discuss how you prefer these situations be handled. It sure as heck is uncomfortable, but I've been pulled in for doing a few of the things you mentioned and quickly adjusted my precepting verbage and actions... ... we all learn from each other, you need to put in the difficult actions by stating what you need, like and dislike. I wish you well.

If you do a search here, you will find some strong opinions and some excellent advice that mirrors your thoughts, though not everyone is that social network savy. Once it's posted, it's there forever! I never ever post any specifics, but I do have pics of me drinking a beer or a frozen foo foo here and there. I might say," sure as all get out, it was a full moon and the crazies were out in full force". Now it didn't say I was at work, where I work, what type of work I do anywhere on my site. I could be working flipping burgers for all the public knows. I know enough to call my nurse friends and have a private complaint session... a public forum is NOT the place. In fact I am VERY careful here as well, as some need to heed that and give less details too!

You did great! Now management may speak to you and that is their role to investigate conflicts/complaints. Just remember though, there is a time to act instead of react. It's hard when someone is so RUDE! It took tons of practice, but I get quieter, and smile deeper (my devious smile) with these folks. - "I would have happily been here sooner if only you had hit your call bell to alert me of your needs..." -"your tone of voice is offensive, I will be happy to come back in a few minutes if you need to calm your tone of voice " -"did you mean ""please get me a smaller cup""?" -MY PERSONAL FAVORITE "I'm sorry, but your verbal abuse of calling me lazy will not be tolerated, I am stepping out to get the charge nurse to speak to you. If you want a new nurse I understand, we have many new nurses on staff tonight whom lack the years of experience that I posess, that you may find more suiting to your needs" I drive management simply crazy because my hands are folded infront of me, my smile strong, my voice oh so sweet. When you can master that, the sweet sweet words that you use to stand your ground protect you and leave your patient looking like the butt that they are. And that blanket thing, or "feed me" or any demand meant to be demeaning for me to serve them instead of facilitate independence is met with "oh, no sir, I am here to help you get strong, recover and return home as quickly as possible. So you do what you can yourself first and I'll do what you can't. Thank you for understanding I am here to provide EXCELLENT care to you" Choke on that press gainey!

no good deed goes unpunished :uhoh21:

My facility has it in the policy that lockers are hospital property and are subject to search without notice. Two staff members must be present, one must be security, one the manager or assistant manager of the unit. Everything found, is written down in a detailed report by security. Now in fairness, this is in MY policy, not yours and a professional manager will ask any gawkers to excuse themselves to provide privacy to their search, but we all know which lockers belong to our peers! My old management would wisely search several locker to prevent the team from knowing the true "suspect". This does stink, and I'm ticked off simply by a nurse educator going through my work mailbox looking for papers. I know in my head it's company property, but still feel violated. So I understand how you feel. THis does protect you from errant co-workers who stash things like insulin, drugs like haldol and benadryl to be dispensed to patients without orders...( don't ask), let alone a narcotic diverter. I'm glad that nurse weeded herself out. You still should consider a sit down with the manager and an HR rep. to discuss how the search went down and was poorly handled.

Its a medical floor that may or may not take surgical patients. The primary doctors are in a residency program. They have a MD license, but need their training as intern, resident and specialty. They have supervising docs whom I assure you, you will be speaking to as these docs are in a learning phase. I have taught these guys a ton only to have to re-teach them three years later not to dare get an attitude with me. Its great because there is always a doctor in house. Its a struggle because they are slow to make decisions, check with the resident for everything and you have to spoon feed them sometimes.

Hmn, this is a wild card. I too had a DWAI, driving while under the influence, not intoxicated... three beers in three hours and was underage. This didn't prevent any employment, although I still have to disclose I have a conviction dating back to 1990 on my license and most times I apply. Because these charges are pending and not final, I would simply call HR and alert them to this on Monday, as well as get a lawyer to get it reduced. If conviced, even if you feel you were wrongly accused, any felony or misdomener must be reported if asked in the future. just know it automatically doesn't bar you in most states, although OHIO BON refused me because of my DWAI, even though it was 12 years ago.

Back in 1995 in a huge nursing shortage, yeah right... in Buffalo, I had to take a geriatric psyc position at $10/hr. I was dang pleased to get it, sick I know. That launched my career. I litterally applied to every single facility in an hours drive. Nursing homes wouldn't even take me. (no disrespect for my nursing home peers). Point is I had to take anything, anything no matter what the hours and it was 3-11 with three school aged kids, was hell on my marriage. After a year, and months of looking and begging recruiters (I think I wore down one who gave up and hired me into a long term vent dependent floor). From there I wanted ICU. I had to move my family 600 miles out of state to do this. I never would have though we were able to just up and leave, it was inconceivable, but we did. Now 17 years later, I've done everything from managed two ICU's, done EP/cath lab, precepted almost all of it and now my kids are grown and I'm a travel nurse. Things are not that different now, only if you are in a tight market like I was, know that I put in applications to every single facility every 30 days, called each HR person weekly and got on a first name basis with them. It WAS my full time job to get a job. Heck, I even brought in donuts to severat HR people that I had gotten close with from so many calls, just to thank them. I worked my hind end off, for the crappiest job and celebrated it. It really, really took that much work. Reconsider your efforts and compare them to mine and see if anything I did to succeed can assist you in your search. Constant pleasant follow up calls is what I firmly believe made the difference. I wasn't pushy, but friendly, asked for advice and stayed in contact with EVERY recruiter. I either wore them down, or they respected my drive to be hired, I'll never know.

One more point, thanks for putting up with me on my rant. I'm abit hot on this topic, as I've just changed my own BP meds, to more affordable ones with more side effects that drive me nuts, to save money so I can afford to pay for my daughters co-pays. My cupboard are stocked with ramen noodles. I'm an RN, my husband is an engineer and we do this to pay off the debt and not loose our house. At some point soon, my daughters health will be affected, as will ours, with our financial challenges and our quality of life will suffer. People don't realize, it happens to the educated, hard working and insured. It I happen to live with, every single day.

There are many caveots that this article, altough well meaning, meant to look at another side of the insured vrs. uninsured. I work in an inner city ER in VA, where the poorest of public housing is a mile away. I wish the authors spent a weekend in my ER. 1. The uninsured come in self pay. Show up for UTI's, pregnancy tests, STD exposure, bug bites (seriously), a cough, asthma (because an inhaler is $75/month), nausea for two hours... ya get the picture. They have no transportation and call 911 to get care. They come in with BP's of 180/95, blood glucose levels in the 300's. Nothing to admit for, and we are not a primary care clinic to treat, nor do they follow up and see the clinic and manage those co-morbidities. They just want a quick fix. So the tax payers and those with insurance pay for this. In ten years, these folks will have shot kidneys, need dialysis, have limbs amputated from neuropathy, not be able to work, and cost more money. The total costs and long term longetivity is not yet in the calculations, although much of it has been ignored in this study. 2. The UNDER insured person, has a yearly deductable of $700-1K in outright payments before insurance covers. They only come in in emergencies. Their insurance only covers 60-70% of treatment once in the system for care. At this point, they either go bankrupt, have already crappy payment and don't pay, and the tax payers and those that HAVE insurance pay for it. 3. Young people, 20-40, think they don't need it, or choose to not pay the premiums and a car accident (only auto insurance pays), or a catastrophic diagnosis like cancer comes and they either are bankrupt, or don't pay. Then the tax payers or those with insurance cover those costs. 4. People like me, have excellent health insurance, have an auto accident with their kid, and insurance doesn't cover it and leaves it for auto, lawyers, legal fees, and two hard working very insured parents have the choice to declare bankruptsy on daughters $250k bill, not pay it, or do payment plans (all while we have excellent insurance that won't pay and the lawyers take all the settlement from auto, fighting the health insurance to pay). Then my kid has a PRE-EXISTING condition, that won't be covered by my health insurance for a year. Costs us around 500$/month for seizure meds and neurologist and ortho. So we can look at this study for what it is trying to prove by number fudging... as any study can do, or we can be educated and simply think.... those that go without any basic care have the same morbidity and mortalitiy rates? SERIOUSLY??? Sure, seems really reasonable to me. And even if this fallicy could be true.... who paid for it? WE DID.

Forgot to add... many states require you to obtain an instate drivers license after 30 days residency. If you get pulled over by the cops, you need a copy of your travel contract with you in the car to prove that you haven't broken any local laws. I keep mine in the glove compartment, just in case. You will have a "local address", when the cop asks and having that contract saves you time and tickets in the event you are pulled.

You need an accountant that is IRS CERTIFIED in travel allowances, and there are not plentifull. Be careful because one of the suggested places is someone who looks VERY qualified but is not even a CPA and the site looks VERY nurse traveler friendly. For each state you work you will need to file a return, as well as keep good records, as well as copies of your contracts. You can even write off your mileage driven to and from work, but it needs to have specific details. The IRS website, although cumbersome, gives excellent examples of what they require for record keeping. If you switch out assignments, one with housing included (lower hourly rate but lower taxes), and then take the housing stipend yourself on another, this will create more record keeping. Also you need to satisfy two of the three criteria for a home base to even qualify for the lower housing tax, and many people do this wrong, by thinking using a family or friends address of residency covers them and it does NOT in the eyes of the IRS. So be VERY careful, as that 15% tax break you can claim, can be pulled from you if audited, and penalties apply. The IRS site is VERY clear on what satisfies a home base and what does not. An example is that my husband and I live apart, although I am not on his lease, I pay him 500/month for housing costs in the form of a check. My bank is local to that address. I am a registered voter there and vote. My vehicle is registered and inspected to that address. So I can prove not only an address, but actual ties to it. So I prove two of the three requirements. The third is actually working in the "home state", which I do not. Not doing so once a year is a huge red flag, and I need those documents and proof to ensure a "home base" for the tax break for the IRS. It is very detailed, and you need a certified CPA that is experienced in travel requirements. Not simply a company that says they are. Be very cautious! Keep a folder of your travel and assignment contract for each one, with receipts. Good luck, hope this helped.

it does matter as with reentry loops, especially the aflutters, they can be easily fixed with an electophysiology intervention. a flutters are an "easy" one line burn. so heck yeah, i try to identify the specific rhythm because treatment is different if you are looking at options in an area where the ventricular rate is stable as well as hemodynamics. atrial flutter is easily cured, i can't imagine a cardiologist not caring either way, seems crazy to me. most cardiologists i work with don't call an ep specialist stat, but they will look at reentry loop treatment differently. when the patient is stable, you have this luxury though.

What about UNC ? Have a few OCD peers look at your resume, you may have something basic out of place or omitted. These above facilities are looking for traveler nurses in several of their ICU areas. Charlotte university, the hospital in fayetteville and Lumberton were hiring travelers too. I know you don't want a travel job, just sharing that there are ICU needs in these facilities. As a travel nurse, I am watching north carolina and virginia openings closely, so this is recent information!

real life example, prior to computerized md order entry. long story not so short, two cv surgeons, in a specific small open heart unit. standing orders exist, yet not all circumstances are covered. i call the surgeon on call, doc 1 for a transfusion order, get one, transfuse. pt. with low cardiac index goes into failure, despite 4 hour prolonged transfusion, need lasix, kidneys are crap. call for lasix, get the order, pt. goes into acute renal failure, adjust meds next morning rounds with primary doc. pt. is simply crashing out due to multiple co-morbidities. doc 2 comes in, the primary and is really ticked at the management of orders, doesn't agree with them and demands that he wouldn't approve and i knew that. i have three pages of phone orders from doc 1, whom after morning rounds and an entire night of updates sees the demise of the patient. he denies ever giving any phone orders to me. almost lost my job and was reported by that doc 1 and 2 to the bon for practicing medicine without a licence. my employer did as well and then withdrew after internal review, thanks so much there. (these two doc's hate each other and play off each other to save their behinds as we have learned). luckily, my employer who through thorough investigation and a long suspension which i was repayed for, believed my peers recollection of hearing my repeating orderson the phone and cleared my name. as a result, i refused to take any phone orders from either without another rn listening in who co-signed. then it became a standard for that unit, not a policy, but all rn's had another who's ear to the phone listening took phone orders. so no, you don't have to do anything wrong to be reported to the bon. without good peers, whom stuck their necks out for me in a tight knit relationship driven unit, there was no way to saved me. there is no way the bon would have sided with me without them, nor would have my employer. this example split the unit, nurse against nurse in one doc's favor over another and we went through hell. nurses didn't trust certain others, the doc's demanded only certain nurses they "trusted" care for their patients... it was pure hell. it can happen for reasons beyond your control and it does. this is one simple example of the politics of nursing, where it is safer to leave then stay. i was knee deep in quick sand before i learned it first hand, i thought i was one of the "untouchables", until it happened to me. my worry is there of more like me out there in similar situations now, thinking that it can't happen to them.

I don't know if I am breaking any rules by mentioning companies... so if I am please delete, and I'm sorry. I am with Novapro, who is a "sister" company of cross country. One of the two recently had a few postings for buffalo, my home town. The caveat is that your "specialty" is what matters. There are so few in buffalo due to the oversaturation of available nurses. I'm an ICU nurse that does ER and transplant with EP and some cath lab, so I'm looking for a wide variety and don't pay attention to specific roles as I have several. I grew up in buffalo and miss it very much, in the summer, LOL! Also consider Rochester, Strong and community are only 45 minutes on interstate 90 from Buffalo. Remember that your home base address needs to be about 45 miles out as a crow flies to get housing. So if you live in the city of Buffalo, consider intellestaff for local staffing. I have used them and had access to all the catholic system and kolidia systems. Had a ton of work. Good luck.

Working in the ER last night. Everything comes in threes. Had three Lacs to the head from drinking and bar fighting.. might not seem like much, but the drunken drama and tetorifice shot fears were enough to send me to the bar after work. 20, drunk at a bar and all about drama as you pick a fight? Don't dare whine about lidocaine injects for your stitches because we can do them without, and when you are head to toe tats and dare to tell me about your fear of needles, I'm drooling at the 16 gauge... Just sharing..

These folks are going to have greater access to medicaid, or have lower cost plans available to them. Thee illegal will continue to clog up the ER for basic care.