palkie

Hi Susan! I am currently working with a recruiter at Soliant Health Care. I HAVE NOT YET SIGNED WITH THIS COMPANY MYSELF!! BUT... A longtime co-worker of mine who has been traveling for several years gave me her recruiter name with Soliant - actually over a year ago! I spoke to this recruiter then regarding local contracts, but school simply did not allow me to work as this would have required. I've had to quit school due to rising DEBT!! I am now traveling to help dig out of that debt. The co-worker I mentioned is STILL working for Soliant more than TWO YEARS after she started - to me that is a great recommendation, as I respect her very much as a nurse, and I know she likely did her homework on travel companies. I do not yet know if I will sign with Soliant, I'll post my experience later if I do, but I do know this recruiter is very excited, and seems to be working very hard to place me where I will be happy. It may simply come down to where assignments are, and what they pay - I also prefer shorter 8 week contracts, and not all companies have these. Good luck to you, and I'll also be watching for any more info on Soliant!

Beg very politely to disagree - the federal government publishes per diem rates in all areas of the US. And the "per diem" rate I'm speaking of is for the amount allowed by the US Government/IRS PER DAY (or per diem) for lodging, meals, and incidentals -while working away from home. If you go to irs.gov you will see that "per diem rates" is one of the most requested pages or sites. Click on this and you will be taken to pages where these rates and amounts set by CONUS are listed for everywhere in the US. If they are NOT specifically posted as being 'different' - meaning lower or higher than the 'standard' then they are the 'standard rate' which is posted at the beginning of the lists. You must look carefully, these rates are updated and DO change every 6 months, BUT - PER DIEM is the DAILY AMOUNT ALLOWED FOR COMBINED LODGING (whether you use it for your apartment, hotel, or camper space rental - it DOES NOT MATTER - it is an amount based on cost of living in the area!) MEALS AND INCIDENTALS. If I remember correctly as of July 2008, the MINIMUM OR STANDARD AMOUNT allowed for ANYWHERE IN THE US is $109.00 PER DAY. Multiply that by 7 days for weekly, 30 for monthly. Some cities have per diem allowable rates as high as $168.00 per day! Now good luck getting a company to pay you that, and NOT drop your HOURLY TAXABLE RATE to (YES!!) a RED FLAG hourly salary of $10-$15 per hour! But the Federal Government and the IRS ALLOW companies to pay employees who travel UP TO the rates published. (again the charts show these amounts both broken down into lodging, meals, and incidentals - and totaled for a daily allowed per diem or what we call travel nurses call our "stipend" rate.) I AGREE with you WHOLEHEARTEDLY that everyone should check with their tax advisor, however, this information IS available to anyone who wishes to look at it. I found it and had huge arguments with recruiters because the amount of stipend in some places SHOULD have been over $700 per WEEK, yet they were offering $1200 per MONTH!! (My theory - and it is only that - a theory - is that some of the larger companies have package deals with Real Estate Management companies all over the US. Perhaps they pay a flat fee for a certain number of apartments. So when a company will not pay the full stipend, it is because they can actually get corporate housing for you much cheaper than the 'going' rate, so of course it saves them money - or they MAKE more money - IF you choose company housing over maximum stipend.) Again - these per diem rates are amounts the Federal Government allows business travelers to be paid while working away from home! If the traveler - whether nurse, salesman, or company president chooses to stay at the local homeless shelter, in a tent, or at the most expensive 5 star hotel - the AMOUNT ALLOWED FOR A COMPANY TO PAY YOU - AND FOR YOU TO RECEIVE STAYS THE SAME! AND YOU ALSO CANNOT BE PENALIZED FOR RECEIVING THE MAXIMUM PUBLISHED AMOUNT. If for some ODD reason - you ARE paid MORE than the published maximum rate - yes!!! You will be taxed on any amount OVER THE PUBLISHED MAXIMUM - no matter HOW many receipts you have! So - get as much as you can per hour - AND if you want to find your own housing - look at irs.gov for per diem rates, and make sure you are not being paid more stipend than is allowed. Also make sure you aren't being ripped off and paid way less than allowed!! Or simply take company housing. Additionally, there should be NO deductions EVER from ANYONE'S payroll check that are not authorized by the payee, such as insurance, or payroll deduction for savings, etc. (State or federal ordered garnishments are of course excluded.) Anyone who is having ANYTHING deducted from their check that they DID NOT AUTHORIZE should contact the Federal Wage and Hour Comission, or the EEOC, or other agency they can think of - I'm not sure which would be the proper authority - I just know there is one!! Seriously - check out the website - it is VERY CLEAR ON PER DIEM RATES.

original post: if any of the four kind rns who responded to my plea for help and info yesterday - thanks again! today went well, though i felt a lump in my throat when i first went in and saw the cvvh machine with a huge double-lumen line coming out of the subclavian, plus two picc lines, each triple lumen with seven concurrent iv drips, foley draining the worst-colored urine i've ever seen, mechanical ventilation, septic beyond belief, and for flavor, a completely open abdominal cavity, with a incision from xiphoid to pelvis, covered only with what looked like a sheet of plastic wrap over it (waiting for preliminary closure in the or), with four jp drains in various areas. you were all right - he was truly a sick man - i'm assigned to him tomorrow, but i'm afraid he won't survive the or this afternoon. thanks again, all of you! tutored, are you sure you are not in the trauma unit i used to work in?? seriously, i thought we were the only ones with transparent abdomens - or "guts hanging out" as i like to call it -usually gunshot wounds to the abdomen. sorry, i realize i sound like one of those old 'hard' uncaring nurses. i'm really not - it's a defense mechanism that builds over the years. i really hope your patient can turn a corner and get better, or if not, at least die with dignity and no suffering. and my heart goes out to you as a new nurse dealing with all this for the first time. try not to be overwhelmed, but y'know, it's ok if you are - even very seasoned nurses can be intimidated or worn down by very sick patients. i commend you for sticking with this patient, and for caring, but i would also say take care of yourself and don't feel guilty if you need a break from this super-sick one and need to switch patients for a couple of days. again, good luck to you and to your patient and his family.

arv- first, let me say that i completely, totally disagree with the whole idea of "gotta have med-surg before icu or er" baloney. i've heard it for years - since i was in school, and i'm sorry to everyone who's for it, but poo, poo, poo, on that!!! i hated med-surg in school, i wanted er, but when i got out of school the ed i wanted wasn't hiring anymore new grads. so i checked out the icus. well, our hospital's sicu handled transplants (kidney, liver, lung), surgical, trauma, and burn patients. wow! i was sold, and fortunately they were hiring new grads. i loved it. sure, i was terrified for a year (maybe more!!) but they trained me well, and i never killed anybody!! our hospital also offered - and still does - critical care classes for all new icu nurses. they have changed it several times over the years (i started over 15 years ago!) but it is still a good program. they also have had several critical care nurse intern programs. with those, you work in 3 or 4 icus over several months, then pick which one suits you best. your critical care university sounds a little like the intern program, which has been very successful. i'd either take this opportunity, or just take a job in er or icu if that's what you really want, and if they hire new grads. oh yeah, later i was glad to be in icu instead of er. i realized it just 'worked' for me - i was a much better icu nurse, than i would have been an er nurse - but that's just me. i stayed in the sicu for 5 years, only moving when they opened a new specialized trauma/burn intensive care, because i found that i gravitated to those patients, and trauma and burns was my real love. i stayed there another 10 years. i've never worked med-surg; i became a charge nurse, and i've seen many, many new grads turn into fabulous icu nurses. you just have to be on your toes, absorb everything you can, always, always continue to learn - never, ever think you know it all! and ask questions!! there are no stupid questions!! really. good luck - i say go for it!!

In response to: I have a question. I have a bachelors in healthcare administration and I am going back to school for my adn is this wise or should I do a BSN? Can I get any management positions with an adn and my bachelors in healthcare administration? I'm not really sure, but I don't think the adn will give you any more opportunities than your bachelor's in HCA. I could be wrong, but I am returning to school because I found my opportunities somewhat limited by my adn. Don't get me wrong, I love bedside nursing, I'm just getting older, a little burnt out and needed a change. I worked for a university hospital, and found that most positions required a BSN or at least a bachelor's in some field. Why are you considering the ADN? Can you not find work with your current degree? Unless you want to be a nurse - at the bedside - I really don't see what good this will do you. If you want a management position, I suggest a master's in your field or at least a BSN. There are some programs that will allow an msn with an adn and a bs in another field - but most are like crna or something where you would need experience as a nurse also. Hope this helps at all...

Hi and good luck to all you students out there! I've worked in icus for 15 years. Started in surgical, moved to trauma/burn when they opened one. I loved it, still do, but there were some changes, i'm getting older, so i've gone back to school. Here's my advice... Just pay attention when you do your clinicals and get a 'feel' for what you like and what you don't... Then precept anywhere and everywhere you can! That will help you get an idea of what's for you. If you can't precept in all the places you think you might like, see if you can just unofficially 'trail/hang out' with a nurse in whatever unit or area you are interested in. You might be surprised. As long as you are not doing patient care, (which would mean you'd have to be "official" or "approved") most nurses love to tell about their jobs. Ask your instructors, ask nurses where you do clinicals, ask everyone; where you might do this and who with - we've had many students 'visit' our unit to get a feel for it. As a charge nurse, i never turned anyone down - again - as long as they stuck to just observing. Also, sometimes it is easier to do this on night shift, where there are fewer administrators, fewer ancillary disciplines (physical therapy, dietary, occupational therapy, etc.) who have to see patients and may take up the nurses time - therefore a night shift nurse might be more willing to let you tag along or hang out for a while. I'm not saying you should do this at night, and 'sneak' around - definitely get approval from a charge nurse or manager - just that sometimes it is more likely to be allowed, or that you will find a willing nurse at night. Also, when you get ready to work, and interview, ask for a tour of several units. You might just feel 'right' in one of them. I did. The sicu just felt right for me, for many reasons, and it stayed my home for 5 years. Also remember! There is no shame in admitting a job simply is not right for you!! You may think you'll love something, then get part way thru your orientation and realize you hate it, or you are in over your head, or you're bored to death. Tell someone as soon as you realize this!! Very likely, the administration will be glad you spoke up, and will try to place you somewhere more suited to you. They'd rather do this than have you quit after a month and have wasted big $$ on your training!! As for staying away from hospitals because they are too stressful... That may be very true for some, but some of us thrive on a little faster pace. Personally, i'd fall asleep (or become very lazy) without very sick patients to care for - but that's just me. We all have our niche, and somehow you'll all find yours. Good luck to you all!

no way. really. now i am an adn/rn and darned proud of it. i worked in high-acuity icus for 15 years. now - because i am old and tired - and because they finally came up with a real bridge program for rn to msn, i've gone back to school for my msn-educator track. now, i'm getting federal loan money to go to school to teach nursing school (they 'forgive' part of the loan if you teach for four years) - at the associate degree level. nursing schools are already turning away students by the thousands, and many teachers are at or near retirement age, so it will only get worse. there is no way to do away with the adn/asn nurse, or to require those with that degree to go back and get a bachelor's. if anything - associate degree rns would be 'grandfathered' in, but trust me, this will not happen. there are not enough nurses now to take care of patients. do away with adns and then you really have a healthcare crisis. no one is going to push for that. ok, now after saying all that, let me say - again as a proud adn-rn - that going back to school was quite the eye-opener for me. turns out all those years i worked - i thought - as a professional - i wasn't - well according to 'academia' anyway. yeah. right. whatever. they say the entry-level "professional" nurse is the bsn. ok. sure. i've learned to keep my mouth shut, i'd like to stay in school, not get kicked out for telling them they're wrong. i've worked as a charge nurse, a preceptor of new nurses, etc. give me an adn any day! they are ready to work, to take care of patients, and to be there - at the bedside - where they are most needed. and they don't expect to be the nurse manager after 6 months either. that's the problem with the so-called "professional" nurse - they don't want to touch a patient!!! so, when i'm done with school, i'm going to teach at the associate degree level. teach nurses to be nurses. yeah, ok, i gotta have a master's to do it, i'll get one. but i am, was, and always will be a 'professional'. because nursing is a profession. oh, yeah, i noticed in a thread somewhere (now i can't find it again!) that someone said there was no way to get a master's without having a bachelor's. wrong. new programs!! i'm doing it. now, if i screw up and don't finish - i'll have nothing. (except of course the associates i already have, and my rn license!) but, it is a master's program; i am an adn, and i will never be awarded a bachelor's degree. keep your eyes open, there will be more of these coming. because they need more advance degree nurses, so they're fast-tracking adns to a master's. so, get a bachelor's or master's if you want, but nobody is going to require it.

most nurses in our hospital still call this cvvhd - continuous veno-venous hemodialysis, because that is what the older machines were called. depending on where you work and the speed at which they upgrade their technology, you may actually be using crrt. our hospital uses machines made by prisma, and it stands for continious renal replacement therapy. it is the same thing - an "artificial" kidney that takes over for patients in renal failure. it causes less major swings in patient acuity due to the 'continuous' factor than intermittent hemodialysis and is very good for icu patients. yes, it is possible, even likely that your patient may be sick, even very sick - but it is possible they may be relatively stable. i have used these machines (even the old honking dinosaurs) for over 14 years. patients on these newer machines do much better than in the past. we have also had patients on them who really were really very stable, although at our facility we try our best to make these 1:1 nurse/patient ratio assignments whenever possible. it takes a while to get the hang of writing down all the numbers every hour, and can get busy if your line (access) is not patent, but certainly you will have help - a preceptor or someone who can show you the ropes, right? ask all the questions you can. there are no stupid questions! and anyone who says otherwise is an idiot, so stay away from them!! (haha!) much more stupid not to ask! and yes, unfortunately some nurses do eat the young, so beware - but keep asking, and you will find someone who will help you and guide you. we're not all bad! good luck!