RDH1

Anyone know where I could find printed recommended nurse to patient ratios for critical care? I am finding plenty of articles that show that a better nurse-to-patient ratio = higher quality of care and less patient deaths. However, I need something from a credible source (AACN, Joint Commission etc) that have numbers. I have done hours of googling and several more hours accessing peer review journals through paid university access. For example, something that says "fresh CABG should be 1:1 until....." or "examples of 1:1 patients include therapeutic hypothermia, Gift of Life/Organ Donor" etc. Or, examples from certain hospitals would also work (I can't find published sample staffing matrix either). It seems that there is nothing "on paper" that says ICU nurses should only safely have 2 (or less) patients per nurse. I know this is not the reality in many ICUs and many are tripling now which is why I would like to have something substantive on paper as my hospital is looking to implement a different staffing model. What can I show them on paper that proves what types of patients should be singled (1:1), what types of patients can be doubled (1:2) and in what cases would it be safe to triple (probably never lol). I did find the AACN's Synergy Model and some staffing articles from AACN but there were no numbers in it. Thanks!

Thanks! I'm already an RN, but I have no interest in becoming an NP. When I do go for my MSN, I was thinking something in management or along those lines.

Hi all, Ive searched high and low in these forums, but really couldnt find any threads relevant to my situation. I am an RN (ADN) with a Bachelor of Science that I had prior to starting nursing school. I could not afford the accelerated BSN route 2nd degree option, so I had to do the ADN at the time. I am considering bridging straight to a MSN (and have found several programs that bridge RNs to an MSN with a prior BS), but at this time I'm not really sure what Master's degree I would like to pursue. Also, I'm not sure how a bedside nurse with a Master's in Nursing would be perceived as far as being hired goes (I am currently working but in this economy you never know what will happen and when you may need to be job hunting!) Does anyone know of an online program that either: a) is an RN-MSN for those with a BS, but awards a BSN along the way, or b) an RN- BSN for nurses who already have a BS? From the looks of things, I "should" only need a few classes to get my BSN, but looking at the few RN-BSN programs I have seen, they are just as long that I may as well go get my MSN! For several of the RN-MSN programs for people with a prior BS, they only require 3 or 4 bridge courses and then the RN is eligible to apply for the MSN track. And, if a non-nurse with a prior Bachelor degree can become an RN BSN in a 1 year accelerated program, why would it take me just as long, if not longer, if I already have the RN and the BS (therefore the core basic ed requirements) done? Makes no sense lol. Thanks everyone!

I like how Transplant RN's unit does holidays- wish we could implement that at my hospital. Our holiday policy is similar to other previous posters, and it seems like the night shift always gets screwed since our technical holiday is the eve of. Our holidays are grouped into Group 1 and 2, and they rotate each year. For example, my off holiday is Thanksgiving this year, which means I have Thanksgiving Eve off. But since Thanksgiving day isn't considered my holiday, I was scheduled to work, so technically I work on Thanksgiving. Same thing for Christmas, which is my holiday to work. I definitely will be working Christmas Eve, not sure about Christmas day yet as the schedule is not out yet. It is possible I may work both Christmas Eve and Christmas Day. The one thing our managers try to do is that if you work a holiday, you get the day before or day after off. But that doesnt always work our for nightshifters since your "day off prior to holiday" may fall on Dec 23 for example. Not good for travel or family. I would rather have the days lumped together. This "rule" also depends on the needs of the unit and the scheduling needs- it isn't a given and they don't always do it. Oh well. I don't have kids yet so the holidays aren't a huge deal right now, but it is somewhat irritating that your "off holidays" aren't actually on the holiday lol

Hi all, I am a tele nurse who has 1.5 yrs of experience. I've always wanted to work ICU, but unfortunately due to the economy, I had to take the first job that came along, which is on a telemetry floor dealing with a wide range of patients-lots of cardiac/chest pain, active DTs, seizure, etc. Once I hit the one year mark, I started applying for ICU jobs, including in my own hospital system. I've had no luck so far- most want at least 1 year of ICU experience now. It's like my tele experience doesnt count. Other hospitals are on hiring freezes, or are only taking internal applicants for their ICU. I don't know how to make my resume stand out. I have ACLS (it's actually required for our floor). I am also a member of the AACN. I perform as charge and I precept. I do read a lot of critical care books and magazines, but I know that doesnt count. I just want whoever hires me to know that I am willing to put in the study time to be a good ICU nurse. I guess I really don't know what to "advertise" other than general nursing skills. It's not like i get to hang a ton of exciting drips or anything like the ICU does lol. Can anyone think of medsurg/tele skills that would be pertinent to list on an ICU resume? I really like the hospital I work at, so I dont want to leave unless it's for an ICU position. I'm at a small-ish hospital, so our floor is pretty much the progressive care floor even though it's not "labeled" as such. I think if I moved to a stepdown elsewhere there wouldnt be much of a difference than what I do now. I'm also worried that if I stay in medsurg/tele too long, no ICU will want me (seems to be the mentality of some ICU managers that new grads are better for ICU since they dont have bad habits yet?) Tips/thoughts are appreciated in which direction I should take this! Thanks!!

I get mine through Marsh- www.proliability.com. Their customer service was excellent and if you are a new grad nurse you get a discount your first year. I had a bad experience with NSO and I agree with the above poster that their customer service is terrible (at least it was for me).

I currently work this type of schedule and I feel like it is sucking the life out of me, lol. However, I work midnights. Are you working days? I think I would do better on days w/ this type of schedule, but like you, had to take what I could get. Right now, I schedule myself 3 on, 1 off, 5 on, 5 off, and then repeat for the 2nd half of the schedule. This allows me to work the 2 weekends a month that I'm scheduled (I do the 5 off days on my weekend off). Having those 5 days off allows me to feel human again:) I've found that having randomly scheduled days (for example 2 on, 1 off, 3 on, 2 off, etc etc) left me feeling more worn out because if I only have one day off after working, I sleep the whole day and just wasted my day off. Another thing about this is that I always know what days I'm off(for the most part- sometimes a day or two in there will get changed). This makes it easier to schedule appointments, etc. I would love to work 3 12's! Those 5 days in a row are rough and leave me very irritable, but it's worth it for the 5 days off. For the gym, I try to schedule my 8 hr shifts on the days I want to workout/take a class at the gym. Sometimes I get them and sometimes I don't. We "self schedule", but it's done by seniority and unit needs, so I don't always get what I ask for. Good luck!

Ours is 1-8 (days, afternoons) usually with a tech, although one of these pts might be a total care pt (nurse will do all vitals, cbg, bathing, etc). It's rough!

I would really encourage you to think long and hard before you make this change. I am a RDH and an RN. I was an RDH first. I don't know what area you are in, but most every state is oversaturated- worse than the nursing job market. When I graduated 4 years ago, I had to move out of state to find work. Right now, I would be lucky to even find a few hours a week of hygiene work- and I am specially certified in local anesthesia and nitrous oxide administration. If you are even seeing ads in your local paper/craigslist, they are probably for the offices that can't keep staff d/t horrible working conditions. The best offices are found by word of mouth. There is no demand for hygienists, but dentists will tell you there is- they like the market flooded so they can pay their hygienist less d/t supply and demand. In my state, hygiene pay has dropped about $10 per hour in the last couple of years. I have heard of dentists offering new grads $15/hr and they are taking it! Normal hygiene pay in my area is about $30/hr. New nurses make about the same, maybe a few $ less to start out. The dental "chains" are the worst places to work: corporate offices like Aspen, Great Expressions, Sears Dental, Gentle Dental, etc. Even before the economy tanked, the hygiene field was saturated (my state has 14 hygiene schools and only 2 dental schools), and full time jobs were very hard to come by. Most dentists employ several part-timers, so they dont have to pay benefits. As a hygienist, I never had benefits of any kind (no health, vision, PTO, holiday pay, etc). I got sent home early if my schedule fell apart (patients no-showing/cancelling appointments). Sometimes my 24hour work week turned into 12 hours. I would be asked to come in late if my morning appointments cancelled, or take 3 hour unpaid lunches if there was a lull in the middle of the day. This was common amongst my other hygienist friends too. A lot of dentists now want to pay their hygienist "per pt" instead of per hour- that way they are not shelling out money if a patient doesn't show up. My wrist hurt, my back hurt, and my neck hurt, to the point I was seeing a chiropractor/masseuse weekly (it didn't help). I was bored out of my mind my first year in. I didn't have a guaranteed paycheck, and my hygiene pay was only about $2 more per hour than I make as a nurse (actually at my current nursing position, I make a little bit more than I did as a hygienist). They also might try to pay you on production (you get a certain amount of what you produce in a day). This is a good idea in theory, until your whole schedule falls apart and you end up seeing only 2 or 3 pts. Or, all of your 8 pts have insurance plans that reduce the amount that is paid for treatment. Then your production/pay could be very low. Another thing to keep in mind: many states are starting new pilot programs where they are training people on the job with no degree to perform basic simple cleanings, paying them just above minimum wage (supposedly no subgingival scaling, SRP is to be done). http://www.adha.org/profissues/preceptorship/paper.htm has the ADHA's opinion on it. I am wondering if, years down the road, the job of the hygienist will become obsolete. Why would a dentist want to pay and educated professional, when he could get something similar (albeit uneducated and unsafe) for less $? You will be constantly pressured about your production as a hygienist- everything you do will be a billable service, unlike nursing where nursing services are included in the room charge. In one office, I was forced to see double the normal amount of pts (about 20/day instead of 8) with an assistant in order to produce more $ for the dentist. Some dentists were extremely unethical, pressuring me to "sell" products and treatments pts did not need, in order to increase production. I left that office in tears every day. After a while, it gets boring. I was constantly watching the clock, counting the hours until I could go home. It's the same thing, over, and over, and over, etc. Occasionally I would get a really good scaling/root planing or a really good debridement that would keep me entertained, but mostly it was just prophies. And more than one SRP in a day would make me really sore. Don't get me wrong, there is tons of BS in nursing too, but I am grateful to be employed full time, with overtime available if I want it. I still work an occasional 4hr Saturday for a dentist by my house to keep my skills up, but have no desire to go back. Hygiene is not the cushy easy career that many people think it is. The pluses: holidays, weekends (Sundays always) off. Your risk of accidentally killing a pt is near zero, lol. Way less liability. If you have a burning desire to be a hygienist and it is your dream, I say go for it. Otherwise, if you are just doing it for the schedule/pay/etc, it is not worth all the $ you are going to spend and time busting your butt in school (maybe it was just me, but I thought hygiene school was harder than nursing). It is a huge $ investment, especially if you won't be able to find enough work to pay off your loans. Good luck and PM me if you have any questions.

Thank you DaGriffiths. I wish I would've gotten you on the phone yesterday lol. The customer service rep and supervisor at NSO made me feel like I was the idiot when I did not see the sense in what they were telling me. I appreciate you setting this straight so other people in my position won't run into problems with this in the future.

Yep, Marsh was great and the customer service rep was very friendly and seemed to know what she was talking about. It was $68 for a first year grad and covers both my licenses with a 1/3million for hygiene and 1/6 million for RN. So far I think I will be happy with my career shift :)

Well, I actually got a hold of a supervisor at NSO today and she told me the same thing as the first two peons, I mean people, that I talked to earlier in the day. Made no sense to me. She told me I could get rid of my dental hygiene license, and then get a letter sent from the State Board saying that I intend to not to ever renew my license. Umm, no thanks. I'm not planning on potentially taking those boards again and paying all that money if I ever want to do hygiene again! (There are 4 boards in my state to be a hygienist: written, clinical, nitrous, and local anesthesia). I also keep the license active in case I ever get called to sub (several times a year for extra $). And we all know how slow that state licensing boards are processing paperwork..... She also told me that if I wanted the 1mill/6mill coverage for nursing, I would need a letter from my hospital on their letterhead stating that this was a requirement. WTH? They will give the 1mill/6mill coverage to an RN with no other license, but not to me? And I thought it was a good idea not to broadcast at work that I have my own liability coverage, right? I was so frustrated that I applied with Marsh. They cover both my licenses (don't charge extra) and aren't giving me the run around about a cap on my coverage because I hold a hygiene license in addition to an RN one.

Apparently most companies do a license search anyway (according to a rep at another company). So even though NSO knew through my prev. hygienist coverage with HPSO, even a new company could find out. Thanks for the tip for Marsh Affinity. Just spoke with a rep and apparently they don't have this "stupid" rule that NSO does. Coverage is only $12 more per year than NSO :)

I am running into a bit of a problem with NSO. Today I tried to get liability insurance for my first job as an RN (I just graduated in May). I did not know NSO and HPSO were the same thing until after I applied for a quote. I had insurance as a dental hygienist through HPSO, but let it lapse after nursing school. I no longer practice as a hygienist. Well apparently my email matched up with my old account, so I had to call the company to sort things out. I was informed that since I hold the credentials of a hygienist as well as an RN, they had to insure me for both. Whatever, but I told the rep I do not work as a hygienist any longer (I do keep my license active just in case- I do not want to take my boards over again if I let it lapse, and I want the option of going back if I ever need to) . I was then informed that they could only insure me up to the max amount a hygienist could be covered for(1mill/3mill), and not up to the amount an RN would get (1mill/6mill). Of course, they would charge me the RN fee, even though I would only get the benefits of the hygienist coverage. This makes no sense to me. I am not asking to be covered as a hygienist! Why should I get screwed over because I have two professions and not get the full amount? I have way more of a risk of being sued as an RN than I ever would as a hygienist. Any other nurses who have more than one license running into this? NSO is the cheapest, and also gives the new grad discount, so I really would like to go with them if possible. What are some other reputable companies? I did a google search and only really came up with proliability, which charges $114 per year (my quote w/ NSO was only $50). Thanks!