3dogs1cat

I had a pt's daughter come to the ED telling me she had given her father his third nitro and he was still having chest pain. I asked her where her father was and she said in the lobby. I had no patients pending so asked for his name. She gave it. I went looking for the chart. I tracked it down to walk-in clinic. The complaint for walk in was cough, runny, nose and chest pain with cough. I went to my charge and asked what he thought we should do since the daughter was so insistent. He told me to go to talk to the walk-in doc. Could not get a hold her talked to her nurse. Her nurse said if he was taking nitro he should go to the E.D. (I already thought this myself but was trying not to step on senior nurses toes). I was going out to reassess the patient when I ran into the triage nurse. I asked her why she thought this was appropriate for walk-in. This nurse is awesome so it would surprise me that she would triage someone like this to walk-in if in fact he was having chest pain indicated of heart attack. She told that the patient came in by himself and basically complained of cold symptoms he did give a history of a heart attack 3 months ago but that he said this did not feel like that at all. He did not take the nitro when he was triaged. I pulled the patient into triage. I know that this patient is fluent in English because I have treated him before but the daughter refused to let him speak English. She was doing all the talking and explained why she thought this was his diagnosis. I told her I needed for him to tell what was wrong with him since I was recieving so many conflicting stories. I asked for a medical interpreter so that I could get the complaint straight from the patient. He ended telling us runny nose, cough, and epigastric pain. The daughter started screaming at me and telling me she was nurse and that I was a racist. It was so frustrating. I could care less about her. I need to know what is wrong with the patient. She is not a nurse by the way. She apparently has come into our facility several times and raised hell when her family was not seen in immediately through the E.D. for things that could wait for an appt or could go through our walk-in clinic. But it's not the point. I feel like I got caught in this woman's frustrations with her own inability to become a nurse. Allegedly she had worked at our facility sometime ago as an NA but could not pass the first semester of nursing school. I know that she was scared for her father but she can't just go around lying about people's symptoms so that they get through faster. So anyway, the charge nurse that told me to reassess the patient and to get the complaint from the patient. Backed the daughter up when he saw that she was writing people up. The EKG, the labs, the echo, the x-ray, the u/s. All came back normal but because this lady wrote me up...the doctor elected to send the patient on 50,000 flight to a higher level of care. His only abnormal lab was a alk phos of 146?! Now, I am afraid I will be expected to write an apology. I am so ****** because I first tried to help this lady and her father to ensure he got the appropriate care. Second, my charge instructed me to follow these procedures even though for customer service reasons I knew it would be easier just to pull the guy back do the work-up and send his ass home. Instead, we spent all this money that could have been used on other patients who might need elective surgeries and the such to make this woman feel better about her assessment skills. Grrrrr. I feel even worse that the meditation and relaxation techniques I have been working on and trying to let things at work bother me is not effective. Any suggestions from people? It's okay if you tell me I was a jerk. But that guy would have still been sitting in the lobby if it had not been for me trying to give good customer service. :banghead::banghead:

I actually enjoyed being a CNA while in nursing school. The most awesome thing in the world was to be praised by nurses and really feel like your work helped the patient and the staff. I have not had as much praise as a RN but the encouragement I recieved from the nurses I worked with made it worth it. You can at least take the class and see if it something you would enjoy. Good Luck.

Do all of the recruiting companies jump right on you when you fill out the application? I am reading the boards and seeing that everyone is talking about how competitive it is right now. Valley Healthcare Systems seems to have a lot of job openings and are eager to have me. However, I only have 2.5 years experience which is totally dedicated in the ED. I have BLS, ACLS, PALS, TNCC, ALSO, and FHM certifications. I have heard some bad things from the boards about TRS. Has anyone heard of Valley Healthcare Systems?? Is there anything I should know about contracting with either of these two companies. Thanks for your help!

My advice to you as a new grad coming into IHS is to come in with an open mind and flexibility. I can't speak for all of the facilities but it is not the same as the private sector. If you are lucky, you will get an awesome preceptor if not...You will be looking things up and figuring it out on your own. They are trying to facilitate the Vermont Nursing Internship Program (VNIP) or whatever is called but it is not going so well in some places. I have a friend who started in the ED at Fort Defiance as a pretty inexperienced nurse. She loves it. Give it a try, it really makes you grow as a person and as nurse to work out here! P.S. Who ever said that GIMC is in the heart of the Navajo Reservation missed the whole other side of the rez to the west! Gallup is a border town. It is not on the reservation.

Thank you for the info! I am hoping there are jobs available! Starting to apply for travel and contract agencies at the moment.

I am planning to leave my current position soon and wondering what job opportunities there are in Austin. I have 2.5 years of experience in the ED. Because I am at a rural ED I have helped deliver babies, assist with rescuscitation from 2 hours old to 100+. I have ACLS, PALS, TNCC, Certification in Fetal Heart Monitoring, Advanced Life Support in Obstetrics. I am pretty diverse, I have even helped write policies and procedures. I also have a bachelors in Psychology and have experience with working with kids with mental health and learning problems. What is there in Austin? My fiancee has his heart set on moving there and is hoping that though it might be a tough job market as soon as the economy swings back up there will be plenty of tech/game jobs for him. Anyone married to or know tech people? The houses all seem very reasonable compared to what we were looking for in the Seattle area. Is Austin dog friendly? We have 3! We do not have kids but are planning with in two years. What is the average pay? Any help will be greatly appreciated. :redpinkhe

I work at a rural IHS facility. I love the Commission Corps but I am prior civilian with no military experience. Being rural means: going to the mall is 3 hours away, you have one grocery store that has limited supplies which means you go 3 hours away with a cooler to get food that you are used to, you live 6 hours from an airport that does not cost you an extra 300 dollars to fly out of, and all of your friends are people you work with. On the positive side, you save loads of money, learn how to be self-reliant, have loads of natural beauty around and do things you might not do if you lived in the city such as gardening, scrapbooking, and going back to school. If you have kids or are single, these are two tough situations because the schools are not the best and there may not be any single people you would be interested in dating because you work with most of them. Rural IHS as a corps member means that you are short staffed a lot and when you have an emergency situation you really have to think on your feet. I would not change this experience in my life but you need to be forewarned that even if you live in a "small town" now. This is totally different. I have lived in a rural area for over two years now and just starting to feel comfortable with it.

I was put on a limited tour of duty when commissioned related to taking Zoloft a long time ago (1999). My time is coming up for the tour to be over and I want to stay in..however, since being commissioned I developed Celiac Disease. I was in the Corps when diagnosed. I even deployed on the gluten free diet and made it for 16 days during last seasons hurricanes. No offense, but I know some people who are always on medical restrictions, always on sick leave, who are seriously obese and they have kept all of them. I have also heard rumors there are several officers with Celiac Disease but I have not met any of them. Does anyone know the steps I need to take for review on a limited tour of duty? I have exceeded my benchmarks for the corps and have outstanding references for my actual job. March marks my 6 months before the end of the tour. Anyone in the USPHS have some info they can give me. I am pretty anxious about this because there are several things going on in my life that would be need to be put on Plan B if they plan to give me the boot i.e. my wedding and finishing graduate school. I want to be prepared if I am probably not going to get it. Thanks.

Thank you wtbcrna! I don't think the USUHS website is real user friendly. Are you in CRNA school there or went there? I work in a rural ED and sedate people under the doctors supervision for intubation, conscious sedation for procedures, etc.. For whatever reason, I am good at it and like doing it. It's in the back of my mind.

I would just like to say you are an excellent writer! Also, I feel that as nurses we are so blessed (even though it doesn't seem like it) to be there to share the most intimate parts of peoples lives and help them! I work in the ED and we see miscarriages alot. I haven't really seen an actual fetal demise but I will definitely try to remember to be compassionate. We do deliver babies out here because we do not have an ob/gyn since we are not an actual hospital but these things are going to be important anywhere. I think sometimes it is easy to put up a defense in the ED with early miscarriages because we have to let nature take it's course but we can give emotional support and advocate for pain management. Anyway, thank you!!

We are a uniformed service not military. We always say, "We are the Surgeon General's Corps". You should check us out just so when you see people in the area with a little different uniform you know who they are. :) www.usphs.gov A large amount of our people are in the D.C. area. Where do you recommend living? Do you rent or own your house?

I am in the Commission Corps of the USPHS. I don't know that I could get in the Army! I am RN,BSN. Alot of people I work with have encouraged me to become a MD but I love nursing alot. I was thinking NP but some of the ones I work with depend on the MD so much I don't understand why they are NPs. Dorkolicious I see you live in Silver Spring, MD...How do you like it?

My only concern now is that if I go there then I will be lowered back to O-1 and I am going to make O-3 in January. I have four years in now and know that the time in school works toward retirement. Just shopping around for schools and my next assignment in the Commission Corps.

Bureau of Prisons and Immigration are both considered hazardous duty. For some reason I can not find the 2009 benchmark document on our professional advisory website but here is the 2008: http://dcp.psc.gov/promotion_pages_08/PY08_Nur_Benchmarks.pdf.

Where are you in AZ? I'm here doing a payback. Looking for suggestions for my next assignment.