MBRN4

Hi NREMT-P/ RN, i did come into this position with a year of transport experience. I was fortunate enough to have gained an enormous amount of experience from the top ranked Childrens Hospital in the US. There we had a policy that one could be sent an any call at any time provided ones expected return time would be no longer than 1 hour after the end of ones shift. So if my shift is supposed to end at 7:30p and a call comes in at 5 and it's a 5 hour RT (estmating a bedside time of an hour) that call would be defered to the next shift unless we as a team decided to go- it was def not forced upon us. Granted one could never know how long the bedside time would be or any unforeseen circumstances and that is part of the job of a transport nurse/emtp. We would get out late, and by late I mean 9, maybe 2x a month. What I was saying before isn't that it's unfair but unSAFE- very different then unfair. I guess I see the difference between working at the top ranked hospital that truly does care for it's patients and staff and hospitals that aren't/don't. While hospitals needs to make money I don't think it should be at the expense of patient safety. Again, I see the difference in those instituitions that put patient safety above all else and those that put $$ b4 all else. In the end excellent care & excellent service - which both are centered around patient safety, is what brings new clients, referrals, return clients and therefore money. Patient Safety is and should be our main concern. I think fighting for what's right is terribly more important than just barely making it, or doing it cuz that's how it's always been. Thank you for your input.

Hi bubbles. It definitely would be helpful if I could sleep. The back of the ambulance is not made for comfort in the slightest. On the way to pick up a patient I could theoretically take a cat nap, if my partner does not mind/have an issue with it. But honestly we should be preparing for our soon to be patient. A lot of our "travel time" is driving from the nearest airpot to the hospital and back and then again once we get back to the states. I think our definitions of stable are a bit different. My definition of stable includes those that would be in an ICU- intubated, dopa, epi gtts, milrinone, etc. Those patients still require preparation and every 15 minute vital signs/frequent monitoring. Yes they can crash and burn at any time especially with altitude changes but typically they have been stable on their current therapy for a few days at least (for out of the country flights). We are not allowed to rest or sleep during our down time. As a matter of fact people seem to be watching us- as we ate our lunch in the cafeteria for about 25- 30minutes someone thought that was more than enough time and reported us to the manager. We r NOT provided resting quarters and are expected to be working at all times (projects, committees, cleaning, organizing, help in the ICUs, etc) if I just sat around (or slept) waiting for a call to come in then I could see where working a 20-24 hour shift might not be that bad. That is not the job I interviewed for. Oh and just to clarify I did not misunderstand, as I have done this job elsewhere, I was not informed. I do believe it is the managers job to disclose something like that. Why post a job for 36hours part time. When it's clearly not. Thank you for your input.

Thank you all so much for your responses and ideas. I have not yet contacted the BON, but I will at least try! I was thinking about OSHA however they seem to deal with materials and substances etc., I will probably give them a try as well- can't hurt. I realize that one may think my dog is the main issue and he is AN issue, however my main concern is accidently killing a child because I was so tired I could not think straight. We all know medication errors are made when we are healthy and awake can you imagine being up for 24 hours having to think about coding a kid on your own. Doctors do not come with us on transports. Its me and my equally as tired Medic. SWS RN- back to my dog- I have a friendly 100lbs rottweiler so the "grandma" you are referring too might not take to my pup as eagerly as she would a Yorkie. I can try for the dog walker but it doesn't help the main issue- only alleviates my worry of my pup. I have been in the actual "unit" for 3 weeks- in the three week time 2 of my 9 shifts would have been 20 hours (I declined to them), 6 of them I have worked 14-16.5 hours and 1 shift I actually got out on time. Not quite what I am used to or desire. nurse mandalyn- the team I work with is awesome! which makes the 16.5 hour shifts better. They absolutely hate working that many hours. One of the nurses has been on the team for 23 years- I have watched her cry every week from pure exhaustion. One week she worked 123 hours- ONE WEEK, most weeks she works 80hours. She stood up for herself the other day and said she wasn't going to go on a late, lengthy transport and got herself into a bit of trouble. Altra- HEMS might be like that, I wouldn't know since I don't do EMS. I only do interfacility transports. And at my previous employer, also interfacility transports, we worked max 13.5 hours in a shift. Multicollinearity- I will never forgive myself if I injure a patient since I know better than to work long shifts. Losing my license, would have far worse financial effects on my life than quitting and not paying my bills til I found another job. Thank you everyone for everyones suggestions. I have a lot to weigh. You all gave me food for thought. I hope I can make the best decision.

I am a PHRN. I studied very hard and took the exam. Pennsylvania requires it even for interfacility transports and non-EMS. In the Commonwealth of PA requires any and all ambulances to stop at an accident scene therefore all ambulances must have an EMT/EMT-P or PHRN. To be considered a critical care transport team one must have a nurse therefore a PHRN is needed in PA. It can widen your scope of practice in your area if you have medical command. However, limitations and extensions of your scope of practice are set by your medical command.

My puppy and I recently moved from the northeast to Florida for a job. My current positions is a nurse with the Emergency Transport Team for a hospital in south Florida. A little bit about what I do: I pick up kids from other hospitals in an ambulance, helicopter or airplane (we do international calls as well- think Jamaica, St Croix, etc.) and bring them back to the hospital I work for. I do NOT do scene work or 911 calls. Sometimes the kids are sick but most of the time they are stable and coming for a second opinion or because the other hospital doesn't have pediatrics. A lot of the calls are non-emergent. Upon starting my new job in a new state with a new apartment lease, I'm made aware that I will be expected and required to work 20+ hours in a shift. It happens frequently where the nurse and paramedic as a team must work 24 hours or more. If the insurance is approved at 5:00pm for a child in Jamaica, the day shift is expected to go still even though it's at least an 8 hour round trip if everything goes well. If it doesn't go well- which it ended up not going well as Jamaican ambulance drivers in Jamaica did not want to go to that part of town the hospital was in because it was too dangerous, it may take 12 hours. Or ones plane can break down at any point and one may be stranded overnight. Obviously the patient must be stable in order for him/her to make an 8 hour transport. Why can't the nightshift team do the transport at 7:00p when they come in? The answer I received: because you still have 2 hours left in your shift. If you don't want to work the hours you need to resign. This teams policy states you must work 20 hours in one shift if you are asked to do so. If you work 24 or more hours in a shift you can come in late the next day if you are scheduled to work. I think from a safety perspective- safety for everyone me, my license, the patient, my dog at home this is incredibly unsafe and unacceptable. My former employer in the Northeast had a limit of one hour after ones shift- so if the transport was predicted to take you beyond 8:30p then the transport was delayed until the next shift. I've looked into florida labor laws- they basically have no laws. One can work 24hours a day x 7 days if you follow Florida Labor Laws. The Federal laws are no help either. The ANA has made a statement that a nurse has a MORAL obligation to decline an assignment if you are tired (exhausted). However the basis of morals is not going to work with my employer. I went to human resources. They did not gasp in horror as I expected when I told them this was going on. "so you don't want to work 20hours a shift?" I asked for a transfer to another department: "well it hasn't been 6months, I don't think we can do that." I don't know what to do. I moved myself down here, the hospital gave me a $3000.00 relocation bonus that I must repay if I leave within the first 12months and I signed a 1 year lease on my apartment- they are not forgiving here and will not allow someone else to take over the payments. I have been looking for other jobs but it's slim pickings and the pay will cause me to file bankruptcy. Does anyone have any ideas? Thank you so much for any and all ideas!

No I did not know about the hours before starting. My boss did not disclose that information during the interview. If she would have I would have turned down the offer right then and there. I didn't know places existed that cared so little about pt safety and employee safety.

Hello all, My puppy and I recently moved from the northeast to Florida for a job. My current positions is a nurse with the Emergency Transport Team for a hospital in south Florida. A little bit about what I do: I pick up kids from other hospitals in an ambulance, helicopter or airplane (we do international calls as well- think Jamaica, St Croix, etc.) and bring them back to the hospital I work for. I do NOT do scene work or 911 calls. Sometimes the kids are sick but most of the time they are stable and coming for a second opinion or because the other hospital doesn't have pediatrics. A lot of the calls are non-emergent. Upon starting my new job in a new state with a new apartment lease, I'm made aware that I will be expected and required to work 20+ hours in a shift. It happens frequently where the nurse and paramedic as a team must work 24 hours or more. If the insurance is approved at 5:00pm for a child in Jamaica, the day shift is expected to go still even though it's at least an 8 hour round trip if everything goes well. If it doesn't go well- which it ended up not going well as Jamaican ambulance drivers in Jamaica did not want to go to that part of town the hospital was in because it was too dangerous, it may take 12 hours. Or ones plane can break down at any point and one may be stranded overnight. Obviously the patient must be stable in order for him/her to make an 8 hour transport. Why can't the nightshift team do the transport at 7:00p when they come in? The answer I received: because you still have 2 hours left in your shift. If you don't want to work the hours you need to resign. This teams policy states you must work 20 hours in one shift if you are asked to do so. If you work 24 or more hours in a shift you can come in late the next day if you are scheduled to work. I think from a safety perspective- safety for everyone me, my license, the patient, my dog at home this is incredibly unsafe and unacceptable. My former employer in the Northeast had a limit of one hour after ones shift- so if the transport was predicted to take you beyond 8:30p then the transport was delayed until the next shift. I've looked into florida labor laws- they basically have no laws. One can work 24hours a day x 7 days if you follow Florida Labor Laws. The Federal laws are no help either. The ANA has made a statement that a nurse has a MORAL obligation to decline an assignment if you are tired (exhausted). However the basis of morals is not going to work with my employer. I went to human resources. They did not gasp in horror as I expected when I told them this was going on. "so you don't want to work 20hours a shift?" I asked for a transfer to another department: "well it hasn't been 6months, I don't think we can do that." I don't know what to do. I moved myself down here, the hospital gave me a $3000.00 relocation bonus that I must repay if I leave within the first 12months and I signed a 1 year lease on my apartment- they are not forgiving here and will not allow someone else to take over the payments. I have been looking for other jobs but it's slim pickings and the pay will cause me to file bankruptcy. Does anyone have any ideas? Thank you so much for any and all ideas!

Hello all, My puppy and I recently moved from the northeast to Florida for a job. My current positions is a nurse with the Emergency Transport Team for a hospital in south Florida. A little bit about what I do: I pick up kids from other hospitals in an ambulance, helicopter or airplane (we do international calls as well- think Jamaica, St Croix, etc.) and bring them back to the hospital I work for. I do NOT do scene work or 911 calls. Sometimes the kids are sick but most of the time they are stable and coming for a second opinion or because the other hospital doesn't have pediatrics. A lot of the calls are non-emergent. Upon starting my new job in a new state with a new apartment lease, I'm made aware that I will be expected and required to work 20+ hours in a shift. It happens frequently where the nurse and paramedic as a team must work 24 hours or more. If the insurance is approved at 5:00pm for a child in Jamaica, the day shift is expected to go still even though it's at least an 8 hour round trip if everything goes well. If it doesn't go well- which it ended up not going well as Jamaican ambulance drivers in Jamaica did not want to go to that part of town the hospital was in because it was too dangerous, it may take 12 hours. Or ones plane can break down at any point and one may be stranded overnight. Obviously the patient must be stable in order for him/her to make an 8 hour transport. Why can't the nightshirt team do the transport at 7:00p when they come in? The answer I received: because you still have 2 hours left in your shift. If you don't want to work the hours you need to resign. This teams policy states you must work 20 hours in one shift if you are asked to do so. If you work 24 or more hours in a shift you can come in late the next day if you are scheduled to work. I think from a safety perspective- safety for everyone me, my license, the patient, my dog at home this is incredibly unsafe and unacceptable. My former employer in the Northeast had a limit of one hour after ones shift- so if the transport was predicted to take you beyond 8:30p then the transport was delayed until the next shift. I've looked into florida labor laws- they basically have no laws. One can work 24hours a day x 7 days if you follow Florida Labor Laws. The Federal laws are no help either. The ANA has made a statement that a nurse has a MORAL obligation to decline an assignment if you are tired (exhausted). However the basis of morals is not going to work with my employer. I went to human resources. They did not gasp in horror as I expected when I told them this was going on. "so you don't want to work 20hours a shift?" I asked for a transfer to another department: "well it hasn't been 6months, I don't think we can do that." I don't know what to do. I moved myself down here, the hospital gave me a $3000.00 relocation bonus that I must repay if I leave within the first 12months and I signed a 1 year lease on my apartment- they are not forgiving here and will not allow someone else to take over the payments. I have been looking for other jobs but it's slim pickings and the pay will cause me to file bankruptcy. Does anyone have any ideas? Thank you so much for any and all ideas!

..NSO

This nose b4 mouth, mouth b4 nose was probably made up a nurse a very loooooooong time ago that just keeps coming back. Your mouth and your nose are both non sterile- so does it really matter which one is suctioned first...no. The only possible rational is that upon startling an adult pt with nares suctioning, the pt can aspirate any oral secretions in their mouth. However I don't believe any of us would just walk up to a pt and sxn their nose without tellin them so it shouldn't be a suprise (*unless neurologically compromised) In infants and children we suction oral then nare due to the risk of aspiration. But I have yet to hear of anyone getting aspiration pneumonia, or worse yet..died! because the nurse suctioned the nares b4 the mouth.