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Thank you everyone! I’m still trying to figure out how to reply to each individually. I plan on orienting at a local hospital next year. The last thing I want is to work with COVID positive patients again. I will continue working in LTC when I travel out of state. Thank you! Cissy

Hi I am a skilled RN in long-term care and skilled nursing. I have been in the field for eight years. I work Perdiem as an agency nurse locally. I have also traveled out of state during the pandemic. I want to jump in to MedSurg as a traveler. Do you think it’s possible for a skilled RN to get my feet wet in MedSurg via my first MedSurg contract? LOL I’m asking, due to a decrease in contracts for long-term care in the state I want to work which is California. I’m used to having 25 patients, some with Alzheimer’s some long-term care. Multiple issues during a shift. I almost think MedSurg might be a relief. Any insight is appreciated Cissy

WOW!! Thank you so much. Haha, I’m thinking I have it made here as a local travel nurse. No hassles, excellent income and more. I’m still going to investigate. Time will tell the rest of the story.

I currently work for three separate travel agencies in Cape Cod. As you have said, it’s good to have a back up if one agency cancels me. I filled out an application for Nursfly and I see several other agencies listed. You are saying to contact one or two others working with the same facility? Is it cost effective to maintain my primary residence? This is the only thing keeping me from leaving local agencies to travel the world as a nurse. I only work in LTC and skilled nursing. thank you for your insight!

WOW!! Awesome info NedRN. I live in Mass I am a per diem local travel nurse. I make between 38 and $42 an hour. I have a residence here in Massachusetts. I recently filled out an application for NurseFly have you heard of them?

Hi fellow nurses I am in the middle of applying to nurse fly. It’s a healthcare staffing agency with dozens of travel positions across the map. Any advice on whether I should look for my own housing or let the agency?

I have been thinking of this seriously for a year. I am applying to Nursfly soon. My name is Cissy. I’d love to correspond.

Yes I realize Dee and I are just doesn’t mean do not treat . His most said transferred to hospital. Skilled nursing facilities frown on transferring patients out. However, this patient needed to be diuresis therefore he needed to go out. I was simply hoping that he would at least be admitted overnight so that my transferring him seem legit. Does this make sense.?His most said transferred to hospital. Skilled nursing facilities frown on transferring patients out. However, this patient needed to be diuresis therefore he needed to go out. I was simply hoping that he would at least be admitted overnight so that my transferring him seem legit. Does this make sense.?

Hi nurse community I need some nursing knowledge from seasoned nurses. Crack down on transfers to hospital. Scenario 72 year old IDDM, Copd, CHF, Afib HTN squamous cell lung cancer to name a few CKD this patient was not on a single diuretic. I understand he most likely wasn’t on Lasix due to his kidney disease. However, he wasn’t on torsemide either. First time I met this gentleman. During morning care he seem to be having some respiratory discomfort. That time I didn’t check his O2 sats and continue to monitor. During morning care he seem to be short of breath. At that time is O2 sats were 93% on RA. Went along with my med pass. I got to his room to administer his medications checked his blood pressure and his O2 sats. Blood pressure was 90/58, heart rate fluctuating between 70 and 120. Both extremities with +2 to 3 pitting Adema. No air exchange entire right lobe. Diminished in the left lobe. Alert and oriented times three. I reviewed his medications and noticed he wasn’t on Lasix. I looked at his history and noticed he had renal disease. I talked with the unit manager about why he wasn’t on a diuretic, question torsemide Long story short he continued to decline quickly. O2 sats dropped to 74%. I put on O2 at 2 L up to 76%. Went in search for a non-re breather there wasn’t one. I asked the staff member to please get a nonrebreather. Call the doctor. The doctor came in 15 minutes later(must have been close). He placed his stethoscope on his chest for about 15 seconds and then walked out of the room. I gave him all my assessments. He went out and looked over the chart and talked with the unit manager. Meanwhile the patient was on 15 L and his Satz were 60% Blood pressure 102/50 heart rate from 70 to 130. No nausea, skin pale. The doctor says to transfer to the hospital. The patient is a DNR. I’m walking out the door at 4 o’clock and incomes my patient in no distress. I guess you could say I was surprised to say the least. Skilled nursing facilities frown on transfers to the hospital. I tried all nursing interventions before I really felt he needed to go as well as the doctor. I’m thinking that they must’ve given him diuretics which stabilized his respiratory and cardiac status. Any thoughts? Sorry for any typos cissy

Thank you so much for the good information!

I need help understanding all the different wound dressings on the market. I work in a skilled nursing facility with many different dressings that I'm on familiar with. I'd really like to become more knowledgeable about wound care management without paying $100s of dollars. Any suggestions? thank you Cissy

If you can afford to take a refresher course I would take it. You can do this!! Trust me. You won't regret giving it your best shot.

I'm on the right track. I also looked up glucagon administration which was very helpful. I realize that the facility has policies but I didn't have access to it today . I'm going to do a little bit more investigation. I would very much appreciate your taking the time to respond!

Hi fellow nurses Our unit was informed tomorrow that we will be having a mock code for an unresponsive patient due to hypoglycemia. I work in a long term skilled nursing and rehabilitation faculty. Last Friday is 66-year-old female died from a hypoglycemic reaction. A nurse was suspended and now our facility is under fire. I am fairly new nurse as well as agency. Can anyone simplify step-by-step. So I don't flounder tomorrow? Thank you so much

Hello group, I cannot seem to find the answer to this question regarding Hemoccult testing. The question is (Hemoccult testing cannot be performed on the incontinent resident)? One more. If frank blood is produced in the bowel movement o be sampled, (It is still appropriate to continue testing)? Thanks guys Cissy

Great to hear this! I hope I am one of the fortunate ones to transition quickly. Any advice on what I should be googling to prepare me for wounds and IVs?

Hello fellow nurses. I have been a travel nurse for a little over a year, mostly in LTC and sub acute care facilities. I want and need to acquire more skills so that I can travel out of state to the hospital setting. I will start out with two evening shifts per week to get my feet wet. I am a bit nervous about caring for patients just out of ICU, vented, central lines, wound vac ect. I have had some experience with all but the vents. Any thoughts or advice? Thanks!

Hi All, At the present time I am a perdiem agency nurse which I am really enjoying. I have always wanted to travel out of state. I need to earn a higher income so that I can one day buy a home again. I also want to see the world. Has anyone done travel nursing here? If so, have you ever traveled to California? I live in Ma. Before I go through the process and pay the fees to obtain a license I thought I should gather more information to help me make this decision. thanks everybody

I had a similar experience at my first Long term care (Geri-psych) as a new RN. The whole time I worked there, which was a little over a year, I was often overwhelmed. I had about 8 days of orientation to the unit. Their were several bully nurses who worked there for 20 plus years and enjoyed pushing me around because " I believer, my being an RN and them being an LPN put a tag on me. They were jelous but also saw that I laced experience in this field. The worst job as a nurse I ever had. I ran out of that place. There was an event that lead up to my leaving that involved what the "DON" said was a violation of HIPPA. Long story. I definitely learned from this scary situation. I was almost put on suspension. Long story. Hang in there. Take what you can from this position. If you find it's too much though, I would look for another job until you finish your BSN. Unless ou are almost done. Do you agree?

I am so very thankful. I will definitely use a. portion to help those in need

I am amazed at the difference in pay for a per diem nurse! I almost cried when I went to my first interview as an RN 3 years ago at a long term care facility. I was offered a $1 more an hour than I was making as an LPN. I had to start my career in long term care due to the fact that I was a new grad with no acute care experience. Anyway, a series of events led me to run from where I was working because I valued my license which was in jeopardy. The best decision I mad in my nursing career thus far. I then went into the office care setting. I was offered 26 an hour. Still not what I considered to be a good salary for an RN. I ended up leaving there because it wasn't a good fit and the computer system was much to advanced for me. Long story short, I decided to give per diem nursing a whirl. I have been able to hold onto insurance provided by the state after I lost my last job 2 years ago. This allowed me to pursuit this career choice. I was apprehensive at first, knowing I would venture into facilities with new people ect. However, the pay was substantially more. I am making $34 and was just told about a job that pays $41. Holy cow I feel so very thankful. All the years "9" I spent killing myself to get through nursing school have finally paid off. It almost feels to good to be true. I am now valued in my role in each facility go work at. The last two jobs almost caused me to leave the nursing field because I felt my clinical skills were lacking. I am so thankful and encourage other nurses who are not happy as a staff member to give per diem nursing a try.

Hi My name is Cissy. I am about to embark on per diem nursing. I have been an RN for 2 years with 15 months experience in ger-psych long term care. I left my last position and have decided to try per diem nursing. I am confident at this time I can swing the challenges but I am concerned about not having any sort of orientation. Are per diem nurses usually welcomed by the staff? Is it appropriate for me to call each facility prior to my taking on hours to see if I can be oriented for a couple of hours? Thanks a bunch

Problem is, I have not home health experience. I am ready to throw in the towel on nursing. Either that or take my sweet time while collecting to find the right fit. Thank you!

I lost this position. I was not able to master the computer system and was let go. I have no idea which direction to turn.

Hi I really need some support and direction. I became an LPN at 43, worked at a great facility Cancer Care outpatient, loved it. After I became an RN I relocated and took a position I though I would be successful at as a new RN. Wrong, I lasted 14 months and left on not so good terms because I was not able to deal with the stress and management was not supportive. I did perdiem with Provant ( flu clinics) which I loved. Landed a great job at a physicians practice ( not your average office) Ten different locations, decent wage but I was not able to master the eclinical software and was let go after 7 weeks, 5 of which was spent on training. I am almost 50 and have no idea which way to go. i don't want to take the first thing, my confidence is shaken. There is so much out there but I do not have the skill level required for most of the hospital setting jobs or travel nursing. I'm thinking of per diem in long term care or Home Health, any thoughts? Thank you so much