CV CNS CCRN

Should nurses have the RIGHT to strike? Absolutely. Should businesses/hospitals have the same right not to rehire them? It is food for discussion.

Many Thanks, Zambesi! CV CNS CCRN

I am very interested in how different hospitals are handling the transporting of Tele patients off the unit for tests. Do you require a Tele RN to go with monitor and meds, just a monitor, no RN, no nurse, a transporter, a tele tech, no monitor, no meds, or what? There seem to be as many different ways and combinations of ways this is done, and it is quite variable from organization to organization. If you take them off telemetry, do you get a routine order on admission "may be off telemetry for tests" or is doe PRN each time they have to take a road trip? This is a hot topic in my organization, as I suspect it is in many. Please give me your practice. And although we would ALL prefer to see it be a credentialed RN doing the transporting, I am more interested is what is actually HAPPENING at your organizaitons. Thanks in advance. CV CNS CCRN

As someone who has hired WAY over a hundred critical care nurses over the last twenty years, I can tell you that one of the characteristics I value mose in an ICU nurse is FLEXIBILITY!!! Things change in a heartbeat (no pun intended) in ICU's, and it is ESSENTIAL to be able to "go with the flow", change assignments, do whatever is needed to support our patients. I would much rather have a nurse as an employee and team member who is a little bet less expert in her skills, but way more flexible.

I just left UNCH. The stories you hear about the huge shift diffs at UNC are true. More or less. What they may have left out is that the diffs there are by what they call pay plans. Each pay plan is a bit different, and there are limited numbers of most of them. They vary inrequirements, and are somewhat complicated. My expectation is to see them eliminated in the not too distant future. But for now, they DO offer VERY attractive differentials... some of the highest I have ever seen. Call Karen in nursing recruitment and she can give you to full details. She is thte Director of nursing recruitment. Good luck.

I hvae one relative and two close friends who have had the Roux en Y procedure. I recovered each of them in their post discharge recovery at home. None has had significant problems. The worst we saw was a wound infection at the site of a surgical drain. That was quickly identified and antibiotics started. Each of these individuals is not over a year post op. Each has lost 90-150 pounds. Each eats nearly anything they want, only in smaller amounts. But like the posting previously, they eat what a normal "slender" person would eat. Two of the three were brittle diabetics. One was on 40 u insulin BID and three oral meds. She is now totally diet controlled. The other takes only a small dose oral hypoglycemic. All three have BP and labs WNL. Yes, the recovery was not pleasant. None of these three has diarrhea, excessive flatus, or regualr vomiting. Each would do it again in a heartbeat. The risk of death is roughly half that of coronary bypass surgery, which is 2/100. Each of these individuals is happier than I have ever seen them. This is trruly a life altering procedure, and is not for everyone. I believe one of the best chances of success is thorough pre-operative counseling, teaching, and FINDING A SURGEON WHO DOES A LOT OF THESE PROCEDURES. Each of my relatives and friends were able to have it done laparoscopically, but that is not always the case. Find a surgeon who has done AT A MINIMUM 50-60 of these procedures and who will discuss his complication rate with you frankly. According to my case manager pal, more and more insurance companies are beginning to pay for these procedures. I saw one piece in the news a few weeks ago that said that several people were going to be funded by their insurers to have WLS, then followed for the next 10-20 years to see if the lessened cost of treating the results of obesity were more or less than the cost of the procedure. If a patient has DM, hypertension, arthritis, high lipids, etc. I can almost guarantee that the money saved from not having to treat these co morbidities so aggressively will more than pay for the cost of the surgery, over time. Not to mention those who progress to dialysis, amputations, blindness, etc., etc. I cannot speak from personal experience, but from my three friends' perspectives, they could not be happier, and are great advocates for the procedue, the Roux en Y specifically. I do not have the same faith in other procedures. There are a lot of horror stories on the internet, but as one person before me noted, the surgery is ONLY a tool.... the success is largely in the hands of the individual for compliance. Just one person's humble opinion....

1) Leave the organization 2) Demand an exit interview with the Director of HR if there is one 3) Send a letter of concern to the State Board of Nursing 4) If there is a nurses' union, report this to them And... it does not matter whether or not this is a corporate facility. Money is not a dirty word. It is what pays our salaries and enables us to have a means to deliver patient care. And issues like this can occur in any type of facility. Good luck!

As both a practitioner and an administrator, I suspect that EVERY nurse that comes into your facility, whether traveler, regular staff or agency, has to have some kind of DOCUMENTED skills check list. Either with his/her agency or else on file in you staffing office. Ask for a copy of this to be FAX'ed to you, given to you, or ask the agency nurse to fill out another one and sign and date it. Do not then assign this individual anything that is beyond their stated competency This is not nearly as realible as demonstrated competency of course, but if you do this, keep a copy and give a copy to your manager next day along with your documentation that this was not an appropriate nurse to assign to critical care, they will get it before long. Alternatively, perhaps some of the patients may be able to have their status downgraded if appropriate to more clearly reflect the actual type of nursing care they need, which may be appropriately given from the agency book. In my opinion, you did the right thing, but did not take it far enough. ALWAYS go on written record with the shift supervisor that you are protesting the assignment of the non-qualified individual. KEEP A COPY. Good luck, and thanks for looking out for your patients.

Fergus51, I LOVEDED your response. Not only do families like to see that kind of thing, but so, I assure you, do expert witnesses such as myself

Consult your CNO, or VP/Nursing. He/she can tell you exactly how the hours are calculated in your organization.

I suspect this rather etreme policy resulted from one mishap. This is likely a knee jerk reaction to prevent it from occuring again. Surely someone from nursing must have participated in creation of this policy change? That would be a good place to start looking for the rationale. I would streer clear of any close personal "die on the hill" type of statements until you know for sure the "lay of the land", so to speak.