classicaldreams

Ned, Most nurses in PA do not belong to a union and haven't gained many benefits, if any at all, despite advocacy by the unions. The strike staffing argument has been made for years but I don't see the benefit in PA, so I think that argument is self-serving on the part of unions. IR and Cath Lab Techs make as much money (and sometimes more) than RNs. Compact exists for physicians in 23 states, with pending legislation in PA. Compact licensure is here and more states have joined and/or have support for legislation in their states. The old model of restricting a license to one state no longer serves nurses, employers, or patients. .

Compact Licensure is pending in PA. It passed the Senate last week 50-0. We need nurses to write their state representatives in support so the House will vote on it. Are you with me? You can write your state representative by using this form. Only takes a few minutes and your voice could make a difference! https://nursecompact.com/take-action.htm

NedRN, Thanks for the update and your efforts. BTW, googled your name and found the IC forum. Thank you. Some great information. Classicaldreams

Michlynn, I'm preparing to travel this fall and have bookmarked the following for future reference. Have you checked any of these links? Hotel Engine - HotelEngine.com Find Corporate housing for Traveling Nurses and other medical professionals throughout the United States here InnerCity Residences Short-Term Rentals and Furnished Apartments For Rent - CorporateHousing.com Serviced Apartments, Furnished Housing & Apartment Finder by ExecuStay Travel Nurse Housing - The Gypsy Nurse http://www.furnishedfinder.com/members/map.aspx Classicaldreams

NedRN, Thank you again for the information. Will google you as suggested! I know it is possible, so planning while learning the travel nursing ropes will hopefully help me land in a better financial place. Yes, going 1099 seems to give me the headaches without the benefits, except for the marketing aspect of it, which perhaps could be more difficult than I imagine. Professional Credentialing Services in Nashville TN processes the endorsement license for MA. I'm a ICU nurse, so thought MA's recent 1:2 ratio mandate would have benefits. Summer on Nantucket would be great and flying to Boston is cheap from the NE corridor. Boston is a great city, but no thanks in the winter. NE cities in the winter are not fun, they just don't know what to do with the snow. Again, thanks for you insights. Classicaldreams

NedRN, That sounds very interesting! Thought about contacting some of those livescan mobile facilities, but instead decided to just fly to Sacramento and do it all in person. I want to start traveling asap. I'm busy doing my homework and plan to have several state licenses in hand before starting. Just feel like it gives me more control and options in negotiating. Received my NJ license today and it only took two weeks. So now I'm just trying to decide what other states to apply for endorsement. Already applied to WA. A MA license costs $275, so I'm a bit hesitant to shell out that kind of money without a contract in hand. I'm staying away from TX for now. (I don't live in a compact state.) I operated as an IC, LLC years ago, prior to my nursing experience, and it really nags me the way these agencies do business. Honestly, there has to be a better way, I just haven't really figured it out yet. Do you know if the conference addresses travel nursing as an IC? While I'll go with agencies for now, I just know the whole business model will eat at me. Classicaldreams

Hi NedRN, Yes, I've read about CA verification, so that is why I'm applying now to AZ, MA, and WA, to avoid that whole waiting on CA mess. NJ has three different checklists to complete for license endorsement, all three being different. I had to consolidation them all before submitting. Received a notice from them yesterday that I had left out two items. Called them today and, of course, they have them and was told to ignore the notice. This is New Jersey after all. Thanks for the info about Medscape CEUs. Classicaldreams

Hello, Sorry for the late reply. I was locked out of my account for a week. Just a quick update. Looks like Needles, CA, is the closest livescan station from Vegas. Here are my notes; Needles Sheriff Colorado River Station Needles CA 92336 909-326-9200 Per telephone conversation, bring $64.00 in cash. Cash only. Recommends making appt., even as late as day before. However, I have decided to fly to Sacramento for 48 hours before attending the conference. Will apply in person. Anyone's experience or recommendations would be greatly appreciated. My husband and I are making this a business/vaca trip. We will be celebrating 30 years together during the trip! (No, we won't be in the air on our anniversary, so no media reports of a travel nurse cited for inappropriate behavior while flying. At 30 years, I'm sure a bystander's view of us on our anniversary would be considered inappropriate or maybe just plain awkard!) I've also applied with the traveling VA Corp, although I don't expect to travel with them anytime this year. From what I have read, the process can take a long time. Just deciding now on what other state licenses I should obtain. I understand that CA license verification is a slow process, so I want to get my other licenses in now. I'm thinking about AZ, WA, and MA. I'm licensed in PA and my license in NJ is pending. FYI, spoke to NJ today, endorsement is taking two to three months. Thank you for the encouragement. See you in Vegas next month! I'm excited to start this new journey! Classicaldreams

Ned, Thanks for the info. I plan to take everything with me so I can overnight it in Vegas after the LiveScan is completed. Will be sure to send receipt. Looks like the Bartow Sheriff's Dept. does LiveScan. Will confirm here after I call them tomorrow. Only drawback I see is I must still send a check. I'm sure it must clear before processing. Too bad they don't accept credit card numbers. Classicaldreams

I'm happy to say I've registered for the Vegas Traveler's Conference. Very much looking forward to it! I also thought about renting a car and driving to Barstow California for my live scan while in Vegas. Anyone ever done that? Would be great if there was a mobile service set up at the conference, but perhaps they can't cross state lines. Classicaldreams

Hi vanurse1022, Thank you for the list! How do you know if the job is day or night shift? How has your housing been? No, I don't work for the VA. Just knew someone who did and he had quite the story to tell. I'm in a Philly hospital right now. You keep talking about the pay and benefits, any info on that would be greatly appreciated! Best, Classicaldreams

VAnurse1022, Yes, please e-mail me a list. Thank you! Are you driving to all these destinations? Do you rent a car if you fly? Have a soft spot for our vets, but was hesitant because of the horror stories I've heard about the Philly VA, and of course the other stories about the VA admin in the media. What has your experience been with the work environment? Patient safety is a big concern for me. I would be seeking mainly ICU positions, but have some skills in other units too. I like the idea of travel but not having to learn a new charting system, policies and procedures, every 13 weeks. Seems like a great way to transition into travel nursing. Sincerely, Classicaldreams

Hello NedRN, I just wanted to thank you for the enormous amount of information you have provided here over the years. Thank you! I'm a fairly seasoned RN (10 years) in a city ICU and I am officially read to embark on my travel journeys! Was researching travel nursing in 2007, and then 2008 came along. So I have been watching and waiting since. Just wanted to thank you for all of years of advice you have given to newbies and seasoned travel nurses. I'm excited and nervous, but thanks to travelers like you, I'm feeling more confident about this next new adventure! All the best, Classicaldreams

Hi VAnurse1022, I am ready to start travelling after 10 years in the ICU. Have thought about travelling through the VA for years, so will complete the application today. How long have you been with them and where have you gone? What is housing like? Would appreciate any insights you can give. They don't advertise much and their website is terribly out of date. (red flag?) Sincerely, Classicaldreams

I have to agree with the OP. What drivel and you have to pay for it too! This whole BSN is bs. I have a BA and did that type of stuff many years ago. Sure, it was helpful and interesting 30 years ago. It is insulting, at this age, to pay to produce such nonsense so I can be a better bedside nurse. Experience is by far the better teacher. Lesson learned. If I must obtain the dreaded BSN, ask to see more than just course names.

You could of restrained him while on the bipap. We do this for a few hours until family comes in to help. COPDers need several hours on a bipap to reverse a bad ABG. Did anyone do a Chest X-ray to assess for CHF/pleural effusions? Sometimes these patients get fluid overload in the hospital or a worsening pneumonia. Very treatable. Really your RRT should have been doing these things. Classicaldreams

TonyaM73, Sounds like you had a team approach, and everyone was on board, so job well done. The process can be time consuming, so kudos to you, as I'm sure it was stressful. But you did the right thing, everyone was on board. Sounds like you did a thorough job. For whatever reason, the nurse and doctor the day before should have had the DNR signed, but been there, done that. Discussions happen, and for a lot of patients and their families, they want a few days to think about it. I try to stress that the decision can be overturned at any time, but with end-stage lung disease, they may not be given days to think about it. If something happens, we assume full code status. I would just be careful about the validity of AAO x 3 with a poor ABG. Don't know how well that would stand up in court. And don't worry about your petty co-worker and her/his comments. They are a dime a dozen. Be confident in your abilities to assess the situation and give responsibility to those who should own it. Classicaldreams

Leslie, I agree, 55 mg in an hour is not unreasonable for a hospice patient or perhaps those who are opiate naive, but on what this poster wrote, this sounds like malpractice. Was this nurse repeatedly bolusing him over the course of an hour?" So if the nurse came in every 20 minutes (not unreasonable), that's almost 20 mg every 20 minutes. Like I wrote, I've had families request that I just give more morphine and get it over with. Unethical. Patient should be comfortable, but watching the dying process can be uncomfortable. The family has to use us and others to lean on for comfort. Sorry, this post really bothered me. Talk about a way to undermine our clinical judgment. That's all I need for families, mgt., doctors, and JACHO breathing down my neck on stuff like this. Classicaldreams "He did not die of hypoxia, he died because his nurse gave him 55mg of morphine in an hour. I am sooo grateful she did because he was air hungry and it would have taken hours for him to pass had she not kept coming in the room and saying "he looks a bit uncomfortable, how about a little more morphine?" I knew what she was doing and she knew what she was doing."

55 mg MSO4 in an hour? I've had families ask me to do this kind of thing and I refused. I don't let the patient suffer, but this is malpractice and unethical. Can you imagine if the media and SBON hears about this? What was this nurse thinking? Classicaldreams

Dear TonyaM73, Just coming from a RRT perspective, do you know the results of the blood gas and his/her history well? Was it the patient's attending that signed the DNR and how thorough were they in their assessment of the situation? I always ask questions of the attending to rule out any patient confusion or if there is a sudden change in mental status. (Attendings should know their patients!) Quality care by attendings varies tremendously, and if not already done, I'll talk with the family, as they often know the conversations around DNR/prognosis. (Always scary if the patient doesn't know their attending in the hospital or if the family is clueless.) Cover your bases if yesterday the patient didn't want hospice/DNR and today they are refusing care. There is a reason. Patient's can have cerebral events, poor ABGs, pneumonia, etc. Doesn't take much to send a COPDer over the edge. If there is any question as to the patient's decision-making capacity to sign a DNR, I would repeatedly ask to tube them, and then deal with the prognosis in the ICU. That is part of our job, and don't let any burnt-out critical care nurse tell you otherwise. The patient is sedated and made comfortable and then it is up to the ICU team/attending and the CCRN to help the family on deciding future care (extubation without re-intubation) or trach and peg with long-term sub-acute care. Many families, after seeing their loved one tubed without successful weaning, accept a poor prognosis and will go forward on more humane care. I understand you are on a Meg/Surg floor, and you may not have the opportunity to know your patients as well as we do in the ICU (my RRT experience). I'm just suggesting, and hopefully it is helpful, to use your critical care nurse's experience--as we see this all the time! CCRNs can be a valuable resource as they know how to thoroughly cut through this kind of situation and see the outcomes. Perhaps having the confidence that you used a team approach (you, your charge nurse, the RRT, the patient and the patient's family) will help in the future. Classicaldreams

Hey crna1982 just wanted to thank you for the info. It did help. The patient was a TBI, so trusting his movements was part of my concern. Classicaldreams

Thanks for the reply. Yes, it was ordered to loop at 15. But seems to me a dangerous practice to leave it unclamped, considering the patient was not sedated, and it's only purpose was for therapy. Thoughts????

Hey all you neuro nurses. I have a question that is haunting me. I worked with a TBI patient in a trauma ICU a few weeks ago. Patient was s/p cranie, readmitted from rehab after change in mental status. Discovered his VP shunt was infected. VP shunt was revised with ventriculostomy inserted for drainage/intrathecal therapy. ICPs never monitored that I know of. Patient is better know, but intrathecal therapy continues, so the ventric remains in. They were using Codmans, but I felt uncomfortable knowing that all his CSF could drain out of her head without any alarms alerting me or any sort of value shut off. Eyeballing was the only guarantee that everything was safe. Order was to leave the drain open post therapy. Does AANN say anything about this sort of practice? Thank you!!

You are welcome. After a few years, it is interesting to look back over your development as a new nurse. You'll learn to tune out those negative comments that aren't valid and learn from those comments that have merit. I once worked with a brillant surgeon who took incredible risks. Sometimes those risks had amazing, positive, against the odds results. Other times those risks had deadly outcomes and resulted in a lot of pain and suffering. Of course, as a nurse, I don't take on risks like that surgeon, but there are occasions when I make decisions that have some element of risk. My point is, after a few years, you will have the confidence to make choices that are considered risky. Others may criticize you for your decisions, but ultimately it is you who must live with the outcomes. You'll come to master more of the science and time management of the ICU. After that comes the art, and for me, that is where the true challenge lies. Best wishes, Classicaldreams

Kudos for you! You are not alone. Some of us feel this way too. I still cry, some times out of fear and some times out of empathy. Classicaldreams