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  1. 8mpg

    Is Becoming A NP Worth It?

    My reasons why I question going for a Nurse Practitioner license. Working with some seasoned nurses in the ER over the last couple of years, they make more than starting NP's do. Two doctors and a nurse who did recruit and hiring for a couple of years all stated that it was not worth it. If I don't jump on the bandwagon right away...the rumors of the dreaded 2015 DNP may come true The DRAWBACKS: Increased liability without enough pay Overworked and underpaid for their work. In our ER, the PA's do most of the work while the physicians kick back PA's are preferred in hospital settings (which is my major interest...though I'm sure an office setting will be great later in life) Again...financial. They did not agree that 2.5 years of schooling was worth a mediocre increase in salary (even long term). They collectively felt that working a 4th 12hr shift each week was better than spending another 2.5 years an lots of money for an NP degree. The POSITIVES: Increased autonomy I can do a full time NP program and still work There are 2 great NP programs near me (TWU and UTA) I believe I can get in without to much hassle In state tuition is affordable Self satisfaction I understand that financial compensation is not all there is to a job thought it is a necessity. Increased autonomy is very important to me and the main reason I would like an advanced practice degree. Med school would be great, but being hundreds of thousands of dollars in debt and taking 4 years off is not appealing to me. So to the current NP's... would you NOT get your degree if you had to do it again. Was it worth it more than just personal satisfaction? Do you enjoy your setting?
  2. 8mpg

    Venting online.

    I see lots of people here vent and I think this is a great place to do it, lots of support etc. The question I have is the legalities of expressing work situations and how a board of nursing may interpret it. The Texas BON says: "unprofessional or dishonorable conduct that, in the board's opinion, is likely to deceive, defraud,or injure a patient or the public;" While I dont think venting necessarily will cause harm to a patient or public, could the board say that venting our frustrations would be considered deceiving the public. I know this is far stretched but a discussion I was having a work with a co-worker who was worried that it could be.
  3. 8mpg

    Venting online.

    The thought would be causing fear of incompetent healthcare professionals . I think it is far stretched but with our court systems these days, you never know. A completely non-HIPAA or identifying a facility shouldnt be a big deal in my mind. Also, by typing anything on the internet, you can almost guarantee you are identifying yourself. Your IP address is easily reversed. Posting from home would be a dead giveaway if the board were ever upset and were to subpoena allnurses.com for IP information.
  4. It seems that hospitals across the country are now going on a rampage to raise HCAHPS scores to secure their CMS (Medicare/Medicaid) reimbursements. Working for a large "for profit" hospital network, we are under the microscope as bedside nurses to increase patient satisfaction from admit to discharge. With the new scrutiny of the government with the value based healthcare initiative as part of the Affordable Care Act (aka Obamacare) the nurses are affected daily in their scope of practice and treatment of their patients. With areas of HCAHPS such as pain management, these situations appear to be a "lose-lose" situation in which the patients often do not feel their pain is adequately treated and physicians are reluctant to prescribe more potent and higher dosages of narcotics. In the hospital in which I work, management has asked which doctors are the ones that are not prescribing to satisfy the patients pain goal. Their idea is to simply pressure the physicians group from the administrative side to increase HCAHPS scores. This is a clear violation in my mind against what medicine is all about. The separation of physician and hospital is there to increase patient outcomes by reducing unneeded expenses. The physicians are liable for their practice and have the discretion to treat patients in which they feel is proper. HCAHPS is a flawed system in which the government has decided to base their hospital reimbursement on. This would be much like going in to a local grocery store and sating you will only pay 90% of your bill due to the dissatisfaction of the cashiers attitude. Patient satisfaction should not have a bearing on reimbursement of their healthcare costs. This makes no sense. You can cure a patient of cancer and the family may have thought the hospital could have been cleaner, the discharge paperwork was not enough explanation, doctor didnt meet the pain goal of zero, etc. We have had emergent CABG surgeries and patients are upset due to having any pain after a cracked chest. Until we fixed this new flawed system, many of us nurses will be affected daily. We will lose staff, lose incentive, lose bonuses, etc. Is anyone else upset about this? This alone has me reconsidering nursing all together. Maybe lobbying would be better career against this nonsense.
  5. 8mpg

    ACNP without research, theory, etc

    Im looking for a program like UPenn or similar without 25% of your NP education dedicated to classes that will not benefit you as much as more patho, skills, assessment, etc. Im in Texas and the local ACNP program (UTA) has 9 hours of the 48 hours of education dedicated to classes (while might help you become more well rounded) will not necessarily help you in day to day practice. At UTA you have to take: Nursing Research, Nursing Theory, and Research and Theory Application. 20% of your education dedicated to something you wont use in your everyday practice. Anyone know of a good program like UPenn or Vanderbuilt that focuses on the patient care side?
  6. I must be thankful for attentive nurses like you with your long tenure of experience. You have figured out the inner fiscal workings of hospital networks nationwide. With your keen fiscal sense, you have single handedly uncovered one of the biggest healthcare frauds among us. In your extensive 5 months of medsurg nursing you have been able to adequately research and conclude (through 3 blind samples of hospitals nationwide) the general consensus and accurate representation of all the hospitals in the US that the average training is 6 weeks. Through your excellent deductive reasoning you have found that a hospital cannot spend "thousands" of dollars on training employees and that you are a prime example of how $6000+ does not equate to "thousands" of dollars in training. Through your extensive knowledge of healthcare insurance and premiums you have concluded that the average healthcare policy is based on that of yourself (28ish year old) and that every person out there can have a healthcare policy for $500 or less a month. You have also concluded that it makes more sense for healthcare (may as well broaden it to all industries) that it makes more sense to pay hyper-inflated prices for healthcare premiums for their employees to third party insurance companies to have a greater deduction. Im sure your reasoning is it is much better to pay $100 rather than $50 for a product so you can eliminate the $14 in tax savings. I guess Romney should have given another $5M to charity to save $450,000. We should not think about other stipulations that corporations must pay for their employees such as income tax contributions, employment tax, 401k contributions, PTO, life insurance, etc. These are not raw costs of having a new hire employee and they should not be considered. We should also exclude liability of untrained nurses. Thank you for your excellent research study and definitive conclusion that hospitals cannot spend much money on training new graduates. You have greatly excelled in your 5 month tenure and should be CNO by next week.
  7. lol... Ignorant seems correct. Again, your single instance at your hospital with your single age and health status is simply bogus. Please look into many hospitals such as Parkland which has an amazing education system in which some departments get 6 months of straight classroom education then orientation to the unit. You are simply arguing to be correct. You do not want to take any information given to you by people who have been a nurse longer than you (18 months?) with a little more experience in these areas. Again with your first job, you need to realize every situation is not yours. Until you let your guard down and listen to some others insight, you will simply bang your head against the wall arguing a mute point.
  8. Im sorry to say it but there are many times that it is better to do nothing. As a previous EMT and having been on accident scenes, it is often better people not get involved and allow the properly trained people handle the situation. Many nurses dont know that holding Cspine is important. They feel like they need to get someone out of the car. Causing a person to become para/quadriplegic due to ignorance is not a good idea. Many jump into a situation without regard to scene safety. Many nurses while intentions are good, may not have emergency training. I can tell you from seeing how often out own nursing staff freezes during a code.
  9. I feel like there is a lot of ignorance by the original poster and he just wants to be right. To take yourself and compare it to the rest of the nursing population is not a good idea. Just because you are a healthy 28 year old, that doesnt mean every other nurse is. My fiance is 27 and her previous policy that went Cobra while switching jobs was $800/month. Her current employer pays $700/month and she pays nothing out of pocket. Cobra insurance numbers are not made up. Your example of 6 weeks of training is a very low figure. My hospital does 10-12 weeks for most new grads in easier departments such as med/surg. Our critical care staff is 16-20 weeks. They also have to farm out some of their education to other hospitals as they dont have the full critical care educators in house. Combined with turn over rates, healthcare, 401k, taxes, etc. the company can spend $15-20k easy.
  10. 8mpg

    Weird, but missing my old state's nurses union!

    Im sorry you feel that way. I work with 3 nurses from California in my small ICU and they all say they are much better off here. One gal just moved here and said she paid $10k in state taxes last year on top of all the FICA, SS, Medicare, etc PLUS sales tax. Her take home income was around the 50% mark after all deductions including union dues. Im not sure where you are in Texas but a gallon of milk is no where near $4 a gallon. Im payin $2.50. Parts of california just topped $5 per gallon if you didnt see that in the newspaper where the state government switched early to winter grade fuel to make it cheaper. I just paid $3.35/gal. Also, when houses are soooo expensive in California they entertain 60 year mortgages and interest only mortgages, this is not something done in Texas due to the low cost of living. Yes, we have the same basic federally mandated taxes. We do have sales tax but we do not pay property tax on top of it. Paying state tax and 9.75% sales tax in California can eat you up.
  11. 8mpg

    Weird, but missing my old state's nurses union!

    You dont need a union..you need a staff with a backbone. Many hospitals have nurse practice councils, staffing effectiveness groups, etc that must be used for good purpose. Track the days and problems on paper. Have your evidence and paper trail. Complaining among your coworkers doesnt get anything fixed. I am like the poster above where we run bare minimum staff with total patient care (we draw our own labs, baths, etc) and we do just fine. If we have to triple once and a while we work together. There are much worse things out there at other hospitals where you start tripled. Check into your state employment laws. Im not sure about Ohio, but in TX its overtime after 40hrs. So we are scheduled 3 12's and will get 8 hours of overtime if we worked a 4th day. It usually is more due to the fact we never work 12 hours it ends up being 12.5-13 depending on how long report takes. Im not sure why you need a tech with 2 patients most of the time. You cannot compare any California pay to most places in the US as they pay insanely high due to extreme costs of living. Also, you dump your money into the union from every paycheck. Also in California you pay state tax, sales tax, federal income tax, social security, medicare, etc. Im sure the difference in pay is made up by not paying the California insane tax. Oh, and to give you a little context, midwest states and states like Oklahoma have RN's making $17-18/hr. These nurses will triple all day long in ICU, take 7-8 on medsurg, 4-5 REAL PCU with cardiac drips. So make sure you think about it when you say how horrible your job is.
  12. My simple answer is... if you dont know what you are doing, dont do anything
  13. 8mpg

    New Grads in DFW...what are you earning?

    grades shouldnt ever be considered. I have friends that prove high grades does not mean good nurse.
  14. 8mpg

    New Grad Pay in Texas?

    DFW area HCA faciltiy was $22.85 new grad. $3.30 night dif, $4 weekend (something like that)
  15. 8mpg

    RN or LVN

    I woudlnt ever get my LVN. RN is the only way to go. LVNs are underpaid, overworked and work many jobs people dont really want (nursing home, ltac, etc).
  16. 8mpg

    How do you handle an admission?

    Pain never killed anyone...Not saying you should not treat it, but you should know their vitals before giving dilaudid. Dont need a slightly hypotensive patient come crashing down because you didnt pay attention. Admissions are not a big deal and most people freak out over them for no reason. Get the settled, vitals, assessment, then history. Unless there are some crazy stat orders, I wouldnt worry too much about them on a med/surg floor. A quick glance wouldnt hurt before the patient gets to you. At shift change, (we change at 7) if the patient comes after 6, settle the patient, get vitals and see if they need something. Oncoming shift will do admit history and assessment.
  17. 8mpg

    Anxiety of nursing

    The stuff gets repetitious.. a code blue is a code blue. Standard ACLS is the starting point. Trauma and Emergency departments sound awesome but it is often the same thing over and over. You will learn your bearings and the standard protocols to start and treat the patients.
  18. 8mpg

    Y-site versus Piggyback

    I will stereotypically run multiple pumps and "Y" site medications on the port just above the distal end that connects to the IV catheter. This allows for minimal mixing and for the least amount of time before picked up by the body. As said above, you must watch out about tubing. When connecting a piggyback on the pump and running the two on the same line, dont forget increasing the speed will push the current medication into the patient faster. Our pump tubing (primary) is 14cc with 7cc secondary tubing that would piggyback onto the main medication. When using cardiac drugs or drugs such as insulin, you can quickly overdose your patient. This happens to everyone once and you will learn quickly. I believe that using the hub above the distal end is much safer due to having 1cc of a concentrated primary drug pushed in faster than you want. Having an epi drip push in 14cc because you added a levophed piggyback will skyrocket pressures. I personally wouldnt worry to much about medications such as zosyn and lasix personally but would run them on spearate pumps if possible. Dont forget, when giving a small amount of medication (say 50cc of flagyl) 14cc will stay in the tubing thus resulting in a 28% less medication than they were supposed to get.
  19. 8mpg

    Confused about nursing school!!

    With a surplus of new graduates, many hospitals are wanting people with experience and not have to fork out $15k in training. Someone who can hit the ground running. It is much harder these days for a new grad to get a job...
  20. No one wants to pay the "losers" (sorry for the lack of a better term). This unpaid internship is simply to weed out the cream of the crop and offer those positions. Hospitals are BUSINESSES and until you realize they are, you will never like what they do. I have seen it with my own eyes...a hospital takes in a random person they thought would do well... Spend $15k over 3 months of training to find out they cannot handle the job and the person quits. That is money wasted.
  21. check out indeed.com Lots of the DFW area hospitals are posting residencys/internships for new grads. Im sure its the same in Houston
  22. 8mpg

    Losing confidence....

    Ahh...the school way vs the real way. Just tough through it. Skills will fall by the wayside. To me, skills was all memorization of the steps and hitting the highlights. Have confidence in what you do and act like it is no big deal. If you slip up, the teacher rarely questions the confident students. The people who pause at every step cause concern by the teacher and watch much closer.
  23. 8mpg

    RRT and/or Code Equipment/Supplies

    Our hospital has crash carts in all departments. Other than that, you just need some intelligent nurses. Our hospital does not allow any medications without an order outside of acls.
  24. Grow thicker skin.. ultimately the patient care is the nurses responsibility anyways.

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