thinkin' about it

First, I want to be sure if you don't want to read all the post, please at least read this: Please, please job-shadow some nurses before you stop what you're doing to become one. There is NO other way to see exactly what nurses do, and most people don't have a clue until they're already in nursing school, or worse, already finished. Nursing is a frustrating, often thankless, spine-building, back-breaking, meaningful, rewarding helluva job. If it's for you, we'd love to have you. Please go into it with your eyes wide open. If you don't know any nurses to shadow, call some area hospitals and ask the receptionist to put you through to nursing education, then tell nursing education that you are considering going to nursing school and you'd like to shadow a nurse. They can set this up for you. Do it several times and you'll have some good ideas about whether you'd like to pursue this. A tidbit from my experience, though....you will miss some of the brainy aspects to the job with shadowing, because you'll see tasks and physical things: empty catheter, listen to lungs, chart assessment, etc., but you won't hear the thoughts the nurse is having (was urine output ok for the last 4 hours, since patient is septic; did lungs sound as clear as previous, and should I just watch him or go ahead and call doctor or get chest x-ray and ABG per protocol, have I documented this thoroughly). If shadowing seems dull, it's because you won't get the full scope of the intellectual challenge until you're the one doing it. Don't let this scare you away. It's a very thought-intense, challenging field, and you can't just do what you're told by a doctor like on TV. We problem solve constantly. Steve, Here are my opinions (I've copied and pasted your questions, with my answers).... -How does one choose the area of nursing the work in? (I.e. Neonatal, surgical, ER.) Is it a bid process? No, it's not a bid process. If you have the qualifications, you apply for a job in the area you want, and a manager picks someone to hire. In some places, like where nurses are unionized, the manager may have to pick from in-house staff first vs. hiring a new grad, etc., but generally, you pick an area you want to work in and look for job postings there, then get an interview, and the manager picks whoever they want. No bidding the way pilots bid on specific assignments. Also, once you have an RN or LPN license, you are qualified to work in any of these areas. It is not like with doctors where say, you're an obstetrician, you can't just go work as a cardiologist the next day. With nursing, you really can work on obstetrics and then decide one day to seek work in oncology. People do it every day. You'd have to do orientation, but lots of your skills and experience and judgment would remain with you, and you wouldn't need huge amounts of time to make the leap. One of the best things about being an RN is knowing you could always try something new if you wanted, and go right back if it doesn't work (of course, if the job market cooperates). -Is there a difference in job duties between a RN with an ASN vs. BSN? -Also is a salary difference between the two? Typically no on both questions. If you have an ASN or a BSN, and you get an RN license, you will be paid the same and have the same job duties. Also, some older nurses still have diplomas rather than degrees because they became a nurse at a hospital-based program years ago, rather than a college program; college programs are pretty much the only option now. Anyway, the point is, it is the RN license, not the degree itself, that gives you the authority to practice nursing. Sort of like a degree in aviation....it isn't about the degree, but the certificate or rating that allows you to fly certain planes for certain purposes in certain conditions. That being said, more and more employers prefer BSN, and it's pretty typical to require a BSN for management positions, and maybe even an MSN past a certain level. You are wise to pursue a BSN at some point, as it may open doors in the future. For starting out, it probably makes no big difference in opportunities or pay. -What is the ballpark starting salary I can expect? (for RN): This is tough to say for sure, because it really does vary quite a bit from place to place. Try salary.com. I've found that, if anything, most nurses I know make a bit more than their estimates for my area. But I will give you some numbers to chew....these are based on what I've learned about pay in many areas of the U.S. I think just about all RN's are starting out at least in the low to mid-40's ($40,0000/year, minimum, for full time). I rarely see starting pay of less than $20 or so/hour, with some cities/states making considerably more. Lots of nurses, even starting out, can make significantly more than this. Floor nurses are almost always paid per hour with complicated pay scales. Usually, night shift and weekends will be paid more per hour, and some places will pay more starting at 3pm, due to the preference of people to work from 7am-3pm. So if you're working a shift overnight or in the evening and it's a weekend, you'll probably be getting your base pay, plus extra to work an off-shift, plus extra to work a weekend. It may be closer to $25-30/hr. for that shift. So, over the course of a year, you can make much more by working off-shifts and some weekends, plus some holidays, and perhaps some overtime or shifts where management pays a bonus because they need someone to fill in on short notice. Some units have plenty of overtime available if you want to work it, some will make you work it, and some don't have it at all. I know floor nurses who probably make mid-40's a year and some with lots of experience who make over $100,000/year. I know nurses who probably make right at their base pay (work 7am-3pm, never pick up extra shifts, don't do weekends), and I know some who make half again their base pay annually by working nights and picking up extra shifts. Sorry to go overboard on the details, but I just wanted you to know why you will see such varying numbers when you look up nursing salaries. It's hard to pinpoint. Sorry this is so long, but I have some time and I thought I'd give someone some real thoughts and info. I answered your specific questions, but I wanted to give you my thoughts as well.....sort of my answers to questions you'd ask if you'd known to ask them: Nursing can be a very good career for people with families in a number of ways. For one, there are many shifts available, so lots of nurses are able to find a niche that works with their schedules. Also, probably because nursing is dominated by care-giving females, taking leave when you have a baby or to take care of a sick relative is not frowned on the way it might be in some fields. Like flying, nursing is not something you usually take home with you. It can be daunting when you're there, but your time at home is your time. Most floor nurses work 12-hour shifts, so this may cut into family time. Some nurses prefer working 3 12-hour shifts per week, though, because it gives you more days off. The downside to nursing when you have a family is that you usually have to work at least some holidays (it varies unit to unit how many and which ones each year) and probably some weekends and maybe nights. Also, as long as you are a floor nurse, you will probably work some schedule that is not 9-5 Mon-Fri. This can work for you or against you. But compared to the schedule you have now, it probably sounds pretty good. As far as nursing school, I'd check out the nursing schools you'd like to consider and contact an admissions counselor or academic counselor in the nursing department as soon as possible. The schools may have lots of online info., too, but the counselor can give you specifics of what classes you need as pre-req's and what grades you need in them. Often, schools will post minimum acceptable GPA's for pre-req's but not tell you, realistically, what you need to get in. If they will let you apply with a 2.5, that doesn't mean you don't really need a 3.8 to be seriously considered. Nursing school admissions are sometimes very competitive, especially recently. Nursing school can be pretty challenging. It's a lot of info. and questions on exams often ask for you to take objective info. and apply it in a really subjective way. I found nursing school exams definitely doable but more difficult than, say, a biology exam, because it's much less straightforward. Some people love nursing school, though, but in the end, as long as you pass and get through it, you'll be able to take a state board test to become a licensed nurse. My thoughts on LPN first if RN is your goal: I'd look around at local healthcare facilities because some of them have programs where you can work as an LPN while studying for your RN, and they pay for the RN program with a commitment from you to work there for a while when you finish. Some also have programs where you work as an RN with an ASN and the hospital pays for your BSN. If you can't find a program like this, I'd think going straight for your RN would be the way to go, if that's what you really want to do. Just my opinion, though. I don't know if you have any college degree already, but if so, there are colleges now that are offering second-degree programs for people who want to become RN's and already have a bachelor's degree in something else. You take some pre-req's and then take only nursing classes for maybe 1 1/2-2 years and have a BSN at the end. If you already have a bachelor's, that could be a good option if it's offered in your area. Sorry this post is so long. I hope you got some new info. from it. Best of luck in whatever you decide!

In my opinion, it's beyond stressful. Far, far, far beyond. You can be completely innocent and still get sued. You can bend over backwards for someone and still have a complaint made about you. You can go to school for years and years, be at the top of your class, and do ongoing education, and still be belittled because you aren't an MD. Nurses get blamed for so many things we have no control over, like how quickly food gets delivered from the kitchen, or how well housekeeping cleans the room, or how old the building is, or what someone's diagnosis means. When the doctor tells the patient (or family) something they don't want to hear, they then leave the room. You're there for oh, about 12-13 hours, in which the blame gets placed squarely on your shoulders. Although it's no excuse for being outright rude or overly demanding, many, many people you will encounter as a nurse are under extreme stress. So are you, but they are allowed to show it. There will be times when people say things to you, or in a way, that in most other jobs, you'd never put up with it. But nurses are often expected to be punching bags for others. It's often a physically and emotionally draining job. And there's no room for error. There aren't many jobs where a mistake can literally kill someone. But some of those jobs, for example, air traffic control, are insulated from the emotional stress of dealing directly with the people the job serves. They work in an office-type setting due to the concentration required and must work only a few hours and then are mandated to take a break (and no, I'm not saying their job is easy). Contrast that with nursing, where you may go 12 or more hours without a break and have constant interruptions, enormous lists of tasks to complete, family member after family member after rude doctor making demands (and then there's the paperwork). You may not have a risk of killing as many people at once, but it's still life or death. Sorry, I had reservations about posting this, because I know that it sounds negative, but I wanted to tell you the truth as I see it. I answered the question at hand. Ask what's good about nursing, and there are some answers to that, too.

posted by ruby vee: "i work in an icu, and we're within our scope to do this -- but i'd tell the prescriber just as soon as i saw them. and you're right -- i could be in trouble, too, if the prescriber wanted to make trouble." i just want to be sure i understand. do your policies actually support writing a doctor's order when you haven't spoken to a doctor in person or on the phone? because that seems to be what the issue is here. i'm not talking about writing something as a nursing protocol, because there are written protocols to cover some things the doctors have agreed they don't want to be called on, like a stat ekg for chest pain. that's not the question, though. i'm talking about writing something as a verbal or telephone order, as is the issue with the op? how are you within your scope to do this, even in icu? i know it happens, but it was my understanding it is outside the scope of practice, plus dishonest because it's stating you spoke to a doctor you never spoke to. i really mean no disrespect. i'm just curious.

posted by ruby vee: "i might have done the same thing if i knew for sure the patient could handle the po med, and if i knew the doctor well. but then i've had 30 years (plus) of exprience, and you've had a couple of months. you've probably seen the experienced nurses around you do the same thing, but you're not in a position to do that. so you goofed. not big time, but you shouldn't have done that, and it could come back and bite you in the butt." sorry, ruby, i respect your knowledge and many years of experience.....but.....in the eyes of the law and honesty, you are just as wrong in doing this as a new grad. in addition, every time you do this, you are making things more difficult for newer nurses and nursing in general, as doctors come to expect this from nurses, because they are being coddled by nurses who are easing their burden by practicing outside their scope of practice. so, you are also not in a position to do this. legally, there's no gray area here.

Sorry about your day. I think it's an even tougher situation since you float, because you probably don't know the politics of the unit well (which sucks, but we all know the difference between real leaders who maybe could've helped and the leaders on paper). Anyway, the only thing I would have done differently is to go ahead and write the order for the sitter, even if you knew one wasn't available. If something came down the pipe about it later, you'd get blamed for not taking down an order the doc stated, plus making it clear in the chart that you tried your best to get the sitter...for example, documenting order for sitter per MD but none available. You sound like a great nurse who did the best you could in a lousy situation. Yes, it seems like it would be cheaper to get a sitter than worry about the liability...and the cost of the IV's/lines he was pulling, and the cost of the X-ray or CT when he falls and may hurt himself, and so on.

Newsflash, this just in. Obnoxious, rude, condescending doctors.....film at 11.

I do think there is a healthcare bubble. However, I don't quite see it the same as the op described. I think we are still on the upswing. Despite the recent global economic downturn, we have generally seen healthcare grow and grow over the past few years. There are new hospitals, new wings, expanding roles for many healthcare workers. Things have taken a step back recently, but assuming the economy overall recovers in a couple of years (a big if), baby boomers will continue to add to an aging population. The timeframe I'm looking at for the bubble to burst is when the baby boomers really die off in large numbers. Regardless of any other variables involved, a rapid lowering of the average age of Americans will decrease healthcare needs. I worry not about nursing jobs in the next five years, but about 20 years from now.

My nursing school pulled this kind of crap all the time....last minute time changes, power plays, etc. Unfortunately, I don't know how to change to system unless you're part of it. It's likely the dean would have backed the instructor anyway. I don't know what you could have done. I believe nursing schools sometimes (can't say always, I don't know) try to initiate students by being as difficult and b****y as possible. It's like, we suffered, so now you will, too. Ok, flame away.:wink2:

I have done this, both days and nights, and it is right for you to have some questions/reservations, because weekends can really suck the life out of you, and you will miss important time with your significant other. I would disagree, however, about the advice you've received regarding "thinking long and hard" before trying it, assuming it will be easy to go back and work more typical hours if you don't like weekends only. It may not be so easy to have another opportunity to try the weekends, because these shifts fill up fast at some facilities. I'd say if you want to, try it, and you can always go back. That being said, I have some things for you to think about regarding weekends-only positions...... How exactly will you be paid? Do you get a percentage of the usual base pay you make, a shift differential, or the same base pay for every nurse working weekends? Make sure you know the details. Also, experience may or may not make a difference in how you are paid. Some facilities pay all weekend staff the same regardless of experience. Look closely at who you will be working with. Unlike most other nursing jobs, if your unit is staffed on the weekend with only weekend staff, you may be working with the same people ALL THE TIME. This may be a good thing. Or not. If you pick up hours outside of your weekend commitment, how will you be paid for those hours? How will you accrue vacation time? This may not work the same way for weekend staff. How much vacation time can you take? You may not need as many days off because two days will be your whole week, but some facilities are very strict about how/when weekend staff can use their vacation. Also, be sure you know if seniority is a factor and how long before a vacation you need to put in for the time off. How will it work if you call in sick? Likely, you won't be able to call in as many times as you can if you are regular staff, because it's harder for them to find a replacement on the weekend. You should know this going in. Are you required to attend meetings, education or other work activities during the week? This may affect baby-sitting or other plans. I'd ask the staff, not just managers. I don't think people who always work M-F days necessarily realize how often other staff have to come in on their off times to do extra things, because if you're already there, it doesn't register as "extra." Are the people you see socially available at other times besides the weekend? If all your family get-togethers are on weekends and everyone you know works bankers' hours, working weekends may become very socially isolating for you. If, on the other hand, you have retired relatives and go out with other nurses, weekends may work fine for you. How will the holiday schedule work for you as a weekender? You may be required to work just as many holidays as your full-time counterparts, and I find that working on holidays, while part of our jobs, is that much harder when you already work every weekend. Socially, it's very difficult. Realize that your interactions with patients, doctors, and families are very different on weekends. Sometimes weekends are more laid-back, and this can be good. However, the doctors who round are often the on-call doctors and may not be a patient's regular doctor. Some of them try to avoid speaking with families and are in a rush because of their increased workload. Some do not want to make big decisions because it is not "their" patient. This can be stressful for everyone. Also, weekends are huge for visitors, because this is when most people are off work. This is especially the case if you'll be working weekend days. Depending on your facility, admissions and discharges may work differently on the weekend. For example, people may only be admitted with emergencies or held for discharge so their regular doctor can see them or they can undergo testing on Monday morning. Just some things to think about. Does the facility/unit have as much staff/support staff on the weekends? Sometimes, facilities try to operate with just a skeleton staff on weekends, forgoing secretaries, aides, transportation staff, supply departments, even in-house testing staff in some departments? It can be harder to get things done, and you need to know who/where your resources are. Do not underestimate how difficult it will be to find time with a significant other who works Mon-Fri, especially long hours like you stated. This may work out for you, but remember, too, that even if you work weekend days, you won't want to be out late on Fri or Sat night, and this can make things even more difficult. Anyway, I don't want to be too negative here, because I've done this shift before and will again, but I wanted you to have some food for thought in how the shift might affect your life.

I completely disagree with the idea that a good sign-on bonus definitely means a crappy workplace. A few years ago I got a sign-on bonus package worth between 15 and 20 thousand. It included a one-time payment, payback of some student loans, and a couple other things. It required a 2-year commitment with a choice of units in several hospitals (you could switch units or hospitals in the 2 years and not pay it back). Despite being done with the commitment, I still work on the same original unit. I say go for it! My hospital has since gotten rid of this bonus. I think I was just in the right place at the right time.

This thought (that the OP had) has occurred to me. However, this doesn't bother me. I'd just as soon be a bit distant and formal with most of the doctors. I'm not talking unfriendly, I have just been burned before by mean doctors and don't care to make friends with them the way some nurses do. What does bug me is when nurses with Ph.D.'s aren't called Dr. Soandso unless they prefer not to be. I don't know if anyone else has experienced this, but at the nursing school I attended, the doctoral nurses were generally called by their first names, presumably because they worked with doctors and those were the "real doctors." I have a previous degree before going into nursing, and we ALWAYS called our professors with a doctorate Dr. Soandso. Why is it different with nursing?

"If you're in nursing solely for the money, you're not really in it for the right reasons. Yes, with overtime and all that you may make some extra as you've pointed out yourself. But is it really worth it to be so worn out at the end? If you are looking for an easy job that will net you a lot of money, I'm afraid nursing is not the place!" Is the above for real??? Seriously? Why so hostile toward one of our own for wanting to make money? :argue: The op's profile states RN-diploma, so I'm going to assume that this person is not asking if nursing is the way to make tons of money easily but rather is already a nurse wondering how to make as much money as possible quickly....like the post said. Also, a nurse wanting to max out the money he/she receives has not necessarily gone into nursing for the wrong reasons. If you're already going to be doing quality patient care, what's wrong with wanting to be paid well for it? I, for one, am sick of this whole image of the self-sacrificing nurse who dare not ask to be well paid for his/her professional services, lest she/he not care enough for the patients. Everyone else tries to get paid well for their jobs; why shouldn't we? This does not take away from patient care. Sorry for the rant. Anyway, to answer the question at hand, I think doing some agency nursing might be a way to pick up more money. Also, travel nursing generally pays very well, and it's possible to do this for a short time, if you wish. Or you could try picking up overtime or getting a prn job at a secondary facility besides your main job, so that you can get more hours. As long as your life allows it, and you're well-rested enough to perform your job well, I say go for it!

Oh, too bad they aren't just in the ER. You probably get more of them, but we get them for 12 hours in a row, then often come back and have. them. again. for. 12. more. hours. 3. times. in. a. row. UGH!!! Anway, funny post and oh, so true!

"my opinion only, if you cant handle these duties for the alloted 12 hours what makes you think you can handle these and the others that go along with being a nurse? I dont mean to sound rude,sorry if I do... but this is reality. " A bit harsh. I, for one, don't believe you have to enjoy being a nursing assistant to enjoy being a nurse. To go back to the original poster's questions, I don't think that you will learn that much about being a nurse by being a PCA (or CNA, or whatever your facility calls nursing assistants). I believe that nursing assistants are VERY important. However, I would never want their job for more than a temporary time frame. And I speak from experience, as I was a Certified Nursing Assistant for a while several years before I went to nursing school (and had several jobs in between...didn't go straight from CNA to nursing school). Anyway, my point is that, sugar coat it if you like, but being a nursing assistant is often a grueling, thankless, physically difficult, low-paying job. Add to that the fact that holidays, weekends, nights, 12-hour shifts, are often the norm, and it's easy to see why burnout is high. Please don't flame me, because I'm NOT saying that aides aren't important, only pointing out some of the difficulties of the job. If anything, I respect aides even more because of how challenging their job is. And I speak from a position of having done this job before. I found it grueling, demanding, and physically difficult. The thing I did like about it was the close interaction with patients/residents. All the above being said, nursing itself (as an RN) has many of the same challenges; however, you are generally given much more pay, self-direction, and decision-making. The downside is that you also have MUCH more responsibility/accountability. I don't believe that as a PCA you will see the broad scope of things a nurse does, even as a staff nurse. You will, however, learn a lot about hard work, compassion, and basic nursing tasks. If you are truly interested in becoming a nurse, I suggest you shadow some nurses. If you do, be sure to do so in multiple settings, different shifts, etc. In short, I would not recommend using a PCA position to learn whether one would like to become a nurse (not sure if that was your plan or not). However, it could be an ok job to get your foot in the door while attending nursing school, and to learn some more about the field if you are already in school. Just please don't use what you learn as a PCA to decide whether or not to become a nurse in the first place. I thought being a CNA meant I'd know what being an RN was like, and I was wrong.

Congratulations, and welcome to nursing!!! I hope you enjoy your first job. Your question resonates with me quite a bit, as I have worked night-shift on my current unit for several years. Personality-wise, I am a good fit for night shift and did very well on it (with 2 12's and 2 8's a week, plus picking up extra)....until I had a baby. And it wasn't the pregnancy for me that was the tough part. I was more tired than usual, understandably, but had no morning sickness...only some nausea from heartburn, but I enjoyed being pregnant more than many women. Anyway, the problem I am currently having is coping with the bizarre sleeping patterns on night-shift while caring for my baby (who is a little over a year). In short, night shift was fine for me while pregnant, but it's the caring for a baby while keeping crazy hours that I find to be the problem. However, this was my first child, so you are going to have more experience and it may help you. I think you will discover quickly whether night shift is a good fit for you. I prefer night shift (had a brief stint on days late in my pregnancy) but can no longer cope with it the way I did before I had a baby and could therefore sleep whenever I wanted. Thus, I am switching to days a few months from now. Just my experience. Hope it helps.