OR Dude

Returning to school, I have found things have changed, and one such change is not being given the time to review incorrect responses on an exam. I find this a very deplorable policy, which has come into existence. I also find it very odd, when the instructor says to the class, "Submit any questions you may have regarding the exam via email," but you have no idea which questions you answered incorrectly, since you were not allowed the time to review your exam. You are simply told, you grade is X, you had # incorrect responses. There is a huge disconnect in this logic, and a huge lack of accountability. How can you trust the school, if it says, you missed # questions, but are not allowed to see the questions you missed? Instead, the school is saying, "Trust us, your grade is X." This invites a lack of accountability, to say nothing about other irregularities. Being a former educator, test review was a cornerstone to learning...such is the phrase, you learn from your mistakes. Yet, how do you learn from your mistakes if your are not allowed to see what they were? The world has changed, and the reason for this lack of exam review is in the name of exam security. Avoiding any discussion regarding the larger issue of security in the world of politics, I believe the guise of security, with regards to this topic of exam review, has gone too far, and does not promote learning. In light of this, I have come to question continuing my academic pursuit at this particular university, or any such school with such a policy. If exam security trumps learning, then the academic mission of learning has failed. Before attending a school, ask if students are allowed to learn from their mistakes, and specifically, if they are allowed to review their incorrect exam responses. I believe it is a mistake to accept a school policy such as the one I described above. I call upon all current and future students to demand exam accountability.

Argo: One other thought. By your own admission, "I was a scrub tech prior to nursing...", essentially supports my fundamental argument. Career advancement, and the foundation of knowledge, in the OR, is rooted in scrubbing, and having scrub experience. You may disagree with 95% of what I am saying, but by your own admission, I would offer, you have 100% validated the foundation of my argument/proposal. Respectfully submitted.

Thank you for your opinion regarding your experience. As for your opinion regarding me, personally, you do not know me, and such opinion has no basis.

With utmost respect, Rose_Queen, the overall trend, over the years, has been a parceling of, once-held, nursing duties to other professions, with the role of scrub, now being more widely held by surgical technicians, instead of nurses. Physical and respiratory therapy were previously performed nursing duties. The trend has been an abdication of nursing duties to other professions. Laws change over time. What is the timeframe for such change? Very debatable. Yet, the trend is well underway regarding the changing role of the registered nurse in the operating room. The scrub role, in many hospitals, has already been relinquished to the surgical technician. A few hospitals continue to utilize registered nurses as scrubs; yet, I would argue, such hospitals are in the minority. Looking at the overall trend of the surgical nurse, I would argue it's merely a matter of time until the role of circulator is also abdicated. Change is the only constant. Laws are not permanent, and neither are registered nurses permanently mandated to serve as circulators. My opinion. No disrespect. Just offering ideas for sake of conversation...particularly for anyone considering a career as a circulator.

I too have seen such manipulation of knowledge...and who may ultimately suffer as a result? The patient. These schisms between scrubs and nurses could be avoided if the OR could be composed entirely of nurses, or as I have suggested, surgical technicians (of course keeping the only advance nurse currently in the OR, the CRNA) instead of creating a factional workforce, which can exist in less than perfect teamwork OR settings. Teamwork, for the sake of the patient, should be the overall goal of an OR workforce, not factional issues such as those you (showmethemoney) have experienced.

Most respectfully, regarding your (springchick 1, ADN) statement, "The RN does not and never has supervised the scrub", I disagree. In many states, in the United States of America, the RN is charged with the duty of supervising the scrub, a.k.a., surgical technician. For example, in Georgia, administrative code title 290 rules of Department of Human Resources states, "...surgical technicians perform scrub functions ONLY under the SUPERVISION of a licensed registered nurse..." I do agree about OR teamwork, and an experienced scrub being more knowledgable about working in the OR than a brand new nurse (new grad), and, I'll add, an experienced nurse who has never worked in the OR... which I believe only further strengthens my point: a registered nurse, working as a circulator, is not needed in the OR; and, linking that point with your statement, "...the strongest scrubs...can help them (new nurses) and answer questions" is another example of where the basis of knowledge lies...not within the RN, but within the scrub. Sorry, but I thought I made myself clear earlier...I am not miserable at my job. I was offering my opinion regarding a registered nurse working as a circulator in the OR. I appreciate your input into this discussion, and I am also glad any misconceptions can be clarified, especially regarding the role of the RN in terms of their supervising duties. Kind of odd for some states, in the United States of America, to require the duty of supervision of a scrub (surgical technician) to an RN, when, I agree with you, "...the strongest scrubs...can help (new nurses) and answer questions" being that, as you stated, "...a scrub tech with years of experience is more knowledgeable about things in the OR..." Thank you.

No disrespect intended...sincerely. Can't compare?...comparisons are made all the time, and made with different parts of the world all the time. Sorry, but I beg to differ.

I'm glad to see a healthy discussion. I would like to add, many see the role of a circulating nurse as being the purview of a registered nurse. However, as I mentioned, look south to our Aussie friends and see the roles reversed...the tech being the circulator, and the scrub being the nurse (registered). The roles are so easily reversed, if only you change your location. It works there. Blood/drug administration (most often done by the advanced nurse in the OR, CRNA, here in the good 'ol USA); and, the other tasks (such as prepping the patient, passing meds/instruments to the sterile field, etc. are done by our Aussie surgical technician brethren. So easily is it to switch roles...which still leads to the conclusion...a registered nurse, serving as circulator, is not needed in the OR. For the 90% of a circulator's duty, yes, I agree, anyone can do, and for the other 10%, the advanced practice nurse, CRNA, is available and more than capable of performing. Let's not be so geocentric...no worries, mates.

I agree working in an OR, wherein you are taught (on the job training) to scrub, provides valuable learning experience. Validating my point...a badge of honor (and insight into the surgical field). And, I'd agree an all nurse OR does provide a more egalitarian OR environment. But my focus was on working strictly as a circulator, and my opinion that the basis of OR nursing is scrubbing, in terms of career advancement. Congratulations to those nurses who receive on the job training as a scrub. Does your training equate to the surgical technician's training from their academic program? That's a personal question, which can only be answered by the individual. Nonetheless, my humble opinion remains: the registered nurse's role is not vital to an operating room. The operating room can exist without a registered nurse, and barring state mandates, surgical technicians can replace a registered nurse in the operating room. Also, if you are a registered nurse, and you want to become a RNFA, surgical nurse practitioner, or OR manager, then it is preferred that you have scrub experience, and preferably having gone to school for surgical technician, then become a registered nurse. On the job training may not provide the background experience to advance into these other career prospects. Thus, scrubbing is the cornerstone to working or advancing in the OR. Thinking of being (working strictly as) a circulator?...Think twice (especially a new grad RN).

Actually, my current work environment is not toxic. I've worked in various ORs. This is my opinion, after working in the OR for over 15 years. Team work? Yes. There is team work. But there is a hierarchy. Do you think as a RN you are equal to the surgeon? Or anesthesia (CRNA)? Or the scrub? Who gives the orders? The hierarchy dictates who gives the orders. That's not toxic. That's the structure or hierarchy of the OR. Respectfully I submit.

Thinking of being a circulator?...(especially for new RN grads)...consider carefully. If you will only circulate, and you will be working in an OR with surgical technicians, or scrubs, who do not have a nursing background, then you may find yourself answering to, not supervising, surgical technicians, who may harbor resentments towards you being "the nurse". In these OR settings, there is often a hierarchy: surgeon, anesthesia (often the CRNA, who is the advance practice nurse, and who knows far more about the patient's vital signs than the RN circulator), then comes the surgical technician, or scrub, and at the bottom of this hierarchy, the RN circulator. In such OR settings, when the surgeon asks, "How is the patient doing?" The surgeon wants anesthesia (CRNA) to provide the information, not the RN circulator, who could possibly not have a clue, especially if said circulator had to leave the room for an instrument, said scrub forgot to pull prior to the surgery. If the patient needs meds, such as for blood pressure, heart rate, etc., the CRNA is the advance practice nurse, and will be administering such drugs. Basically, they are the primary nurse in the room. As a circulator, you will be the secondary nurse. You will be charting, helping position the patient, going get stuff from outside the OR (which was forgotten, or is unexpectedly needed), checking the paperwork (consents, H&P, etc.), and setting up the OR with the scrubs. When the surgeon, CRNA, or scrub politely asks (or yells), "I need...!" It's your job to fulfill their needs...not the other way around. In such OR settings, don't think, "I'm the RN! I'm in charge of this operating room." No. You are not in charge of the operating room. The surgeon is the captain of that ship, or operating room. Then comes anesthesia (usually CRNA). Then the scrub, who is working with the surgeon, and anticipating, or relating the needs of the surgeon. Then comes you...the RN. So why have a RN in the operating room? Because some states mandate their be a RN in the operating room, as a circulator, who may assist (often assisting the CRNA, when the patient crashes) during emergencies. But, laws are not written in stone. Could these state mandates change? Sure. In Australia, the nurse (RN) works in the position as a scrub, and the surgical technician works as the circulator. So do operating rooms need registered nurses (barring state mandates)? In my humble opinion, No. Registered nurses are not needed in the operating room. Surgical technicians can easily perform the duties done by a circulator. They do it in Australia. Just a matter of time, probably, until RNs are phased out of the OR. So, thinking of being a circulator? Consider what career growth and potential you may have. Want to be a RNFA? Your gonna have to learn suturing and instrumentation...scrub work...that's their area of expertise. They don't teach such things in nursing school. Want to be a surgical nurse practitioner? Helps to have scrub experience...otherwise you are in the same position of not knowing the basic suturing and instrumentation. See the trend? Career advancement in the operating room is rooted in knowing how to scrub if you're a RN. Even if you want to be the OR manager. Never scrubbed? Then let's see how much respect you will have among your subordinates. Sure there are all RN ORs, in which even the scrubs are nurses. But scrubbing is the badge of honor. Still thinking of being a circulator? Good luck.

Realizing there are many OR units, and each has their particular idiosyncrasies; yet my current OR is run, if not managed, by scrubs and not nurses. Disclosure: I am a nurse. While the scrubs do very good work in this particular OR, the nurses definitely have little if any input regarding daily assignments, duties, scheduling, etc.. Instead the scrubs oversee this OR. Not the first time I have encountered this power arrangement. Always leaves me wondering, Why even bother having a nurse in the OR? Being a nurse for many years in the OR, I have enjoyed the OR, but the re-occurring power struggle nurse vs. scrub is always ever-present. Sometimes I think nurses should abandon the OR, and many a scrub I have encountered has argued as much in the past. I know there are nurses who may read this and take exception to this proposal of relinquishing OR duties (scrubbing, if some nurses still do, and circulating) to scrub techs. I applaud your defiance to what I have seen as being a trend to a no-nurse OR, in which the nurse is merely a figurehead, secretary, and/or gopher. I've heard of all-nurse ORs, but not in this neck of the woods. I hate leaving the OR. I enjoy the OR. But seeing, and being part of, such a diminished role leaves such an empty feeling at the end of the day. Maybe it's time to go into another area of nursing? Or maybe I should hang up being a nurse, and join the tech ranks? Either which way, it's just sad to see nurses take such a backseat in this "specialty" of nursing.

Without going into specifics, this rep has a history, at our hospital, of being belligerent in actions and words. I've discussed this with other nurses, and the response is, "X is just that way", as if this is the tolerated norm. I was thinking of making a complaint to the nurse manager. I've also considered complaining to this rep's company. Also, I don't know if this rep's professional behavior would be better managed by the nurse manager, or this rep's company. I tend to think that complaining directly to this rep's company would perhaps result in a more demonstrable change of behavior since the rep is directly employed by the company, and they are the ones who have a vested interest in maintaining a professional relationship with our facility. Any other additional thoughts?

Has anyone ever had an instrument representative behave unprofessionally in the OR, and if so, what course of action did you take? Did you present your grievance to the private company the instrument representative was representing or to your hospital's management?

Regarding mandatory flu shots, I'd have to say that I'd prefer these shots not be mandatory, and specifically, I'd rather not have my employment be dependent upon receiving such shots. Personally, I have a family member who recently, just this past week, received the flu shot, and has now developed neurological symptoms. The symptoms began as eye twitches, then they noticed one side of their face appeared to be drooping with unilateral facial paralysis. The first doctor diagnosed Bell's palsy. 24 hours after the initial doctor's visit, my family member began noticing tingling in her extremities, and bilateral facial paralysis (drooping). This began Monday. By Friday, the doctors are beginning to speculate that the initial diagnosis may not be correct. My family member had no pre-exisiting conditions. She ran 5 miles a week, and was healthy as a horse. She's very concerned at this time. The only change in her lifestyle, has been the flu shot.

Thank you for the input. This has been helpful. Admittedly, I overlooked the refresher course list. Perhaps, I also overlooked other aspects of the NC bon's website regarding their competency requirements. Yet, I still believe the requirements, as posted on the NC bon website, could be written with more clarity. I realize I am the only poster on this thread advocating this stance. However, I believe some, not all, of the sentiments I have expressed, are reflected in the NC bon's recognition that there are people who frequently look for more guidance. Hence, the site's linked question of, "Is there guidance from the Board..." I defer to other opinions which have been posted on this thread. I've apologized for coming across as argumentative. I've stated I'd like to discuss this with civility. If I seem hostile, again, I apologize. That's not my intent. As I've stated, maybe the competency requirements can be written more clearly without having to post such a frequently asked question as, "Is there guidance from the Board..." Reading the information put forth by the NC bon, at first glance, does not appear, in my opinion, to be straightforward. I believe the NC bon should re-evaluate this matter. Sincerely.

do i feel entitled to my license? uh, yes. why? because i've invested the time and money (i.e., nursing school/boards and fees). should i not feel entitled to my license? would it be unreasonable for me to have done all that was required and then not feel a sense of entitlement? i think it would be unreasonable to have invested so much and not feel a sense of entitlement. supposing a person went through four years of nursing school, paid their fees, passed boards, completed all the requirements, shouldn't they feel a sense of entitlement? how dare the nc bon require me to put any time or effort into advancing my practice as a nurse? you're getting a bit edgy, huh? i don't have any problem putting forth the time or effort into advancing my practice as a nurse. i've done it for years. hey, if you believe the requirements posted by the nc bon are simple as hell, that's great. but, apparently, the bon knows some people may have doubts (or, maybe they're just nitpicking...maybe, instead, you mean they aren't certain). "you keep going on about how the activities have to "address all four dimensions", please link me to where it says that because i really don't think you read the instructions. again, i don't think you actually read the instructions. no 'activity' has to address all four dimensions. you have to create a learning plan with 1-3 objectives (goals) and each objective (goal) has to relate to one of the four dimensions of practice (professional responsibility or knowledge-based practice or legal/ethical or collaborative practice)." now, this is may be helpful. your understanding is that the objective/goal has to relate to one of the four dimensions, but not the activity. i can see that. but, i'm still concerned about what the nc bon means when they state contact hours cannot be chosen "arbitrarily". what's the standard for chosing "arbitrarily", and if the audit finds your choice of contact hours were chosen "arbitrarily", then what is your recourse? "dude, really. on the job inservices are not and never have been a source of ceus unless your employer arranges to have someone come in to do it. those rules that are "skewed" for favor nursing in academia are very difficult and more time consuming requirements to achieve than 15 hours on online ceus that nursing working in 'front line' positions have to take." i agree. on the job inservices are not and never have been a source of ceus. but, i don't consider the learning that takes place working in "front line" positions to be less difficult or less time consuming than that in the academic workplace. i'd contend that learning on the "front line", in some/many forms, is more difficult and can be more time consuming when they are directly related to a patient's outcome. i think a person would be very concerned to make certain a "front line" nurse has learned their job inservice, as opposed to the academic accuracy of a syllabus. for instance, if a person is receiving an implant in an orthopedic surgery, i'd contend that learning the inservice for proper sterilzation carries more substantive value than the lecture at the local community college. or, an inservice on proper medication dosage administration, say of heparin...don't give the babies adult doses...learn how to identify the medication label properly...remember all the infants several months ago who suffered the consequences? maybe i shouldn't weigh the differences between "front line" nurses and academic nurses. yet, i know, when i'm a patient in the hospital, or my family member is, my nurse's knowledge or learning from inservices has value and meaning. refresher course list...thank you, i overlooked it. yes, 640 hours is less than full-time, and i am very aware of that. you stated after reading the reference link, "...in under an hour completed all the requirements to renew a nc rn license and found free, online ceus accredited by sources approved by the nc bon that satisfied the 3 objectives i wrote for myself." i'm curious which option you chose? since you mentioned online ceus, i'm wondering if you chose the option of completing 15 contact hours? or, was it 30 contact hours? it took you less than 60 minutes to complete all the requirements? did it take you less than 60 minutes to complete the 15 or 30 contact hours? this, i'd like to know. i'll agree the end of the story is to do or renew a national certification. that does seem straightforward, and very clear. thanks for your input into this discussion. sincerely.

I respectfully appreciate your opinions. I'd prefer to think of this as a healthy debate. I apologize for coming across as argumentative. I have strong emotions concerning this issue. I would like to think there are others who want more clarity from the NC bon concerning this issue, and I believe there are (referring to the bon's Frequently Asked Questions link, again). If I've come across as being disrespectful and offensive, then let me know, and I will apologize, since my intention is to remain civil and respectful. Yet, I request, in reference to another post, please support any opinions and refrain from disparagingly terse labels.

Hey, I'm in left field. Okay, why am I in left field? Are you going to explain your reason for referring to me in this manner? Or, are you just going to post an undignified and unprofessional response? Stating that I'm in left field is acceptable. But, not explaining why you think such is the case borders on crude.

You think I'm the only one who finds these competency requirements "mysterious or burdensome"? Read the NC bon frequently asked questions...the bon itself posts a frequently asked question that states, "Is there guidance from the Board about how to do a self-assessment or create a learning plan?" Obviously, the NC bon acknowledges it has had a few more people, than myself, who have doubts or maybe as you'd say, find these competency requirements "mysterious", since they felt compelled to post such a question under the FREQUENTLY ASKED QUESTIONS link. As for getting RN's to think, I do plenty of thinking every day on the job, and I too have completed competency requirements in other states, which consisted of attending conferences, etc. Did I have to think while doing these? Or, was I just going through the motions? Maybe I could say that everyone attending was just sitting there mindlessly going through the motions...motions of what? Thought? As for burdensome, I'll refer you to my other post. Ponder it, then I'll discuss any thoughts you'd like to share. It seems odd to me that you are opposed to the general idea of continuing education for license renewal, but yet, you are proud of NC avoiding the hypocrsiy of other states? So, 49 out of 50 states got it wrong? I like your statement of this is the first time you've heard anyone complain. Seems to me you're portraying me as being on the fringe...a lone dissenter. Maybe you're correct. But, oddly enough, I've talked with others, and similar complaints were offered. I suppose there will always be a few that don't fall into lock and step (like those in 49 other states). But, instead of waving the proud flag of NC bon, maybe I can be one of those who seeks to help the NC bon reduce the number of FREQUENTLY ASKED QUESTIONS. Maybe the competency requirements can be written more clearly without having to post such a frequently asked question as, "Is there guidance from the Board..." Think about it.

Thanks for the reply. I'm still somewhat ticked. I've re-read the NC bon website. It states that the board has identified four dimensions that applies to all types of nursing (professional responsibility, knowledge based practice, legal/ethical practice, and collaborating with others). All four dimensions must be addressed in your learning plan activities. Also, your continuing education activities must be related to your learning goals (slippery slope of subjectiveness, which could be applied at a later audit; that is, you get an audit back stating...Hey, not all of your CE activities were related to your learning goals...it's evident, to the NC bon, that a few of these were chosen "arbitrarily"). So, what are the learning activities? You have the choice (wow, a choice) of eight options. You can get national certification or re-certification by a national credentialing body recognized by the board. (Sounds good. CNOR, I believe would apply. But, I question whether national certification addresses all four dimensions...for example, do certifications directly address the dimension of collaborating with others? Or, is it somehow implied in the certification or certification process?) You can complete 30 contact hours of continuing education activities. (Again, sounds good. But, make certain that these activities address all four dimensions, as stated above. This, in my opinion, is definitely a gray area subject to the NC board's interpretation, in case of audit, as to whether an RN's contact hours addressed all four dimensions. Conceivably, an RN could, in good faith, complete the contact hours, believing they address all four dimensions, only to be told, after audit by the NC bon, that the contact hour(s) did not address ALL four dimensions. Sorry, but after auditing your learning activities, we found that 5 of your contact hours failed your learning goals. Or, better yet, the bon decides that 5 of your contact hours were chosen "arbitrarily".) You can complete a minimum of two semester hours of post-licensure academic ed related to nursing practice. (What exactly does this mean? Two hours of graduate work, for those with a BSN? Two hours towards a BSN, for those without a BSN? This sounds good. If you're in either area, you could claim as a learning goal, "I want to work toward completing my BSN, MSN, etc.). Another option is completion of a board approved refersher course. (Where is the list of these approved refresher courses? Do you have to submit this info to the board and await their approval? How long would it take to get approved? Could be a timing issue.) You can also do fifteen contact hours of continuing education activity and completion of a nursing project as prinicpal or co-principal investigator to include statement of the problem, project objectives, methods, and summary of findings. (Okay...now this one sounds right for all those RN's pulling double shifts to make the payments on those homes that they are in risk of having the bank foreclose. Of course, I'm being facetious, but seriously, how many full-time RN's, particularly those with families, are going to have time to chose this option? Hey, it's a noble option out of the eight to choose from, but realistically, I'm betting there won't be an overwhelming number of takers on this option. Also, are these investigations which include statement of problem, project objectives, methods, and summary of findings subjected to the same standards of academic investigations, say at the graduate level...complete with statistical data and correlations, etc.? Or, may I conduct an informal survey of healthcare workers who go to the crapper and return without washing their hands? I could see that as a statement problem, given how many surgeons who are guilty of this (by the way, does the state of NC require doctors to fulfill comparable competency requirements? Or, can their competency requirements be met on the beaches of Hawaii...paid for by the drug reps? I can see my problem statement: surgeons who spread fecal matter in the OR. Objectives: get them to stop spreading fecal matter in the OR. Methods: Personal observations in the men's room. Summary of findings: Nine out of ten surgeons don't wash their hands after wiping their butts after visiting the restroom eight out of ten times. Will this meet the requirements of this option? Or, do I need empirical statistical data to correlate my personal observations?) Another option is fifteen contact hours of continuing education activities and authoring or co-authoring a published nursing-related article, paper, book, or book chapter. (Again, this option doesn't sound like it would agree with the full-time RN, who's got a family to feed, and another shift to cover to pay this month's bills. Again, this option sounds like it's tailored to the ivory-towered crowd. I mean, heck...I wrote a paper during school that instructors, fortunately, thought I should publish...but, that was during school...when my focus was school...when all that citation, etc. stuff determined whether or not I'd pass the class...when I knew the citation rules such as APA format...not when my focus is on paying the bills.) Yet another option is fifteen contact hours of continuing education activities and developing and conducting nursing education presentation or presentations totaling a minimum of five contact hours for nurses or other health professional to include a copy of program brochure or course syllabi, objectives, content and teaching methods, and date and location of presentation. (Uh...just how much ivory is there in this ivory-towered option? Is this option structured for the average RN? Or, again, is it structured for those RN who are working in the academic setting? Seems to me if you're an RN, working in the academic world, the NC bon has lots of options to renew your license that really just reflects you doing your job anyway...you can renew your license strictly based upon doing the job your being paid to do! How many RN's in the hospital setting have similar options as defined by the NC bon? In fact, the NC bon specifically states that on-the-job training related to new policies, procedures or equipment (you know, the stuff that applies to doing your job in the hospital) is not an accepted continuing education activity. So, you work in the OR. You're given an in-service regarding new sterilzation equipment or techniques. Information that could save someone's life. That activity does not count towards continuing education. But, get a job teaching Nursing 101 at the local community college or university, make out your syllabi, etc., and that does count as an acceptable continuing education activity. Hey, talk about being opportunistic. I mean, most of these NC board members sure have skewed the rules to favor academic nursing versus good old-lifesaving hospital nursing. That sucks!) Lastly, you have the option of fifteen contact hours of continuing education activities and 640 hours of active practice within the previous two years. (Is this really a separate option? I mean, it basically just modifies the thirty contact hours...it's an after thought...like, oh, by the way, if you worked 640 hours during the past two years (i.e., a full-time RN), then you only have to complete fifteen contact hours. How generous. I'd like to apply those in-service hours at the hospital regarding mastering the new sterilzation equipment, etc.,...uh, wait, as stated above, that's not an acceptable continuing education activity. Okay...well, while I was working at NC State, I taught a class on nursing ethics...here's my syllabi and a copy of my lecture...Great! You're approved. We've renewed your RN license. See you at the next annual statewide nursing convention, which will be held from X date to X date. This shouldn't interfere with your summer schedule since school doesn't start back until the week after Labor Day next year. Remember to bring your swimsuit!) Bottom line, I'm for amending these competency requirements. I believe they are not tailored to meet the needs of the average RN. Average is a loaded term, but by average I mean the RN, as I hoped I've repeatedly expressed, who's working full-time, in a hospital/LTC/homehealth care setting/etc.,...where many days/nights are consumed with work, and the next day off is spent taking care of personal home/health. GET REAL NC BON!!!!!!!!!! As I've said, if I'm over-reacting, if I'm on target, or if I'm in left field, I'd like to know what others think. If you read all this, I appreciate your attention. I apologize for any offensive remarks. I hope that this can lead to clarification of the NC competency requirements for RN license renewal, or better yet, amending of the requirements to meet the needs of the average RN. Thanks.

I'd like to renew my NC RN license, but the competency requirements seem ridiculous. Writing a learning plan, which addresses four areas (professional knowledge, collaboration with others, etc.), then addressing these four areas with CEU's or natioinal certification, etc...what's the deal?!!! Why all the obstacles? This is very frustrating, to say the least. NC must have the most, or one of the most, strangest competency requirements for RN license renewal in the nation. To me, it seems, these barriers are designed to limit the number of RNs. I look at all these requirements, and think, "This is ridiculous! This is absolutely ridiculous!" What other areas in the health care profession are subjected to these arcane rules and requirements? Hey North Carolina Board of Nursing...why all the hurdles and hoops for RNs, especially those who have a BSN degree? Heck, why not just require a thesis every two years, complete with appropriately cited references and research? And please, don't give me the, "This is to uphold the professional standards" line...that's a joke. If there's an effort to reform these competency requirements, I'll join the crowd. Heck, these requirements are so burdensome, the NC board of nursing has to put out a webcast video to help explain how to write this learning plan, etc. to meet these competency requirements. That's ridiculous. I'll bet the NC bon is bombarded with questions on a daily basis. Maybe they should make more webcasts or post more frequently asked questions on their website. Or, here's a better idea, reform these competency requirements so you don't have to post a webcast video...make it so that people can read your competency requirements without thinking, "What the frick?" Hey, if anybody has any suggestions, or thinks maybe I'm just making too much of this, I'd like to know...either way. Thanks.

You are so RIGHT! Having a background in Quantum Statistical Analysis, a BS in Nursing, years of study at one of the country's premier business schools, leading to an MBA, over 30 years in the business world, which includes years abroad, navigating the seas of international finance, and working at a hospital which serves the indigent, I can clearly attest to all you have offered. Thank God there are those of us who have the intelligence and experience in dealing with empirical statistical data, which clearly advocates the capitalist monetary theories, which have driven our economic engine to become the greatest country in the world! Unfortunately, there are those who stand in our way, and aim for our ultimate downfall. Some are motivated for political gain, but sadly, most are motivated out of blind ignorance. The burden is heavy, but we are the ones who must stand together to ensure that our great country does not suffer the failings of our European predecessors by succumbing to the false teachings and policies espoused by their former leader, Karl Marx. I for one agree, government bean-counters are in no position to dictate the health care needs of our citizens. Our system of health care is superior to any other country in the world! This is because at the heart of our health care system lies the motivating factor of competition based upon private enterprise. I would much rather deal with a private insurance company, wherein I knew that the service they were offering was based upon the idea of, "The best money can buy." Like you, I started from humble beginnings. A veritable Horatio Alger, Jr. rising from the ashes of the slums to become a self-made millionaire. The empire I acquired in the health care industry was vast, within my niche. But, like you, through no fault of my own, I was struck down by this economic upheaval. I too have returned to nursing, albeit temporarily, until I also have the resources to rebuild my vast financial enterprise, and return to the position of being one of the titans of industry. As I have said, we have been forged by similar forces, and have attained the lofty heights to see what those below us fail to perceive, since, metaphorically, they are unable to distinguish the forest from the trees. As a country, we need to rely on the priniciples that have made us the greatest country in the world. Profit drives business, and competition promotes the greater good. This competition ultimately weeds out the poor performers. The wealthy will always be able to afford the benefits of excellent health care, because they have the money to afford the best care, and should receive the best care, since they have been the most successful in life. It may seem Darwinian to some, but survival of the fittest uplifts the whole of society and purges the weak. Recently, I had a patient in her mid to late 40's. She was receiving care at our facility for cancer. She told me her story of having worked at a local, private hospital for over 20 years. Sadly, she developed cancer, and became too ill to work, which led to her termination of employment. Unable and too ill to find other work, she could no longer afford her private insurance. Finally, she sought care from my hospital, which serves the indigent. As she confided in me, this tragic tale, I comforted her with the knowledge that she had served her country, her community, and her private employer with dignity and respect. Her service was well appreciated, I assured her, and that this misfortune was no fault of her own. Thankfully, she agreed that she had served her purpose in life, and dutifully fulfilled her obligations. After her death, my co-workers and I reflected upon her circumstances. Some suggested that the government should have intervened sooner, and that such a creature as universal health care could have possibly prevented her early demise. Of course, I countered their argument with various economic research data that demonstrated the pitfalls of their thinking. Not being swayed, I finally offered the explanation that her demise was simply her lot in life. Had she attained the personal wealth and fortune to continue making payments to her private insurance company, then perhaps her outcome may have been different. However, I would argue that even in her situation, the system worked remarkably well. Her level of health care was commensurate with her level of income, and hence her value in society. Had she attained a higher level of value in society, then the level of health care would have met her needs, and society's needs, to retain her as a valued member and resource of our society. Some may say this is Darwinian Economics. Yet, as a country, we should come to the realization that scientific research, statistical data, and captialism serves the greater good. Years ago, there was another man, like us, who saw the benefits of science, and believed a society based upon such ideas would ultimately lead to the perfect society with the perfect citizens. Therefore, I salute you comrade, and I stand ready to shoulder your burden as we continue to lead this great nation to becoming that perfect society!

Thank you for the information. I was curious since many jobs are posted with a defined salary range.

I was wondering if nurses working for the VA are paid only a salary, or is there an hourly compensation for overtime? Also, if anyone is familiar with on-call pay for OR nurses (considering location variation). Thank you.