PHM

Hi Cindy, "Ni Hau Ma?" Interesting you ask this. Which hospital are you at? I just returned from 3 weeks in Feng Yuan, Taiwan. We were there to visit my mother-in-law and for the last week she had been admitted to Feng Yuan Hospital for a high fever and leg infection. I was surprised to find the nurse patient ratio on the med-surg floor was routinely 1:13 on dayshift and 1:20 on nightshift. I was impressed by the staff and the doctors who cared for her. Our floor is a combination step-down and pulmonary floor. Dayshift ratios are typically 1:5 for stepdown and 1:7 for pulmonary. Night shift stepdown is still 1:5 but pumonary can go as high as 1:8. LPNs are used in the same capacity as RNs, but require certification in some areas and are supervised/co-signed by an RN on assessments. Hope this helps, Phil RN

Don't think it's something that changed over the years. Just like in the general public, there are rude and obnoxious patients. Combine that with illness infliction, general problems stewing at home (marriage, debt, etc) and you indeed become the focal point for any "unloading." I've also had a few runs of groups of intolerable patients. Simply treat them the best I can and pray the next day or rotation will bring something better. I actually feel challenged by people like this and lay on the compassion, kindness and patience to see if it changes them. Sometimes it does absolutely nothing. I've learned to simply smile during times of patients' ranting and/or complaining and complete the task at hand. Return later to see if things have changed. If the day's just progressing horribly, I feel it's just one of those rotations that will get better with time and know in my heart that not everyone can do this type of nursing. And, I just suck it up. Best of luck Phil

Many many new grads "hate" Med/Surg before they even "really" know what it's all about. They may think they know how the whole thing works based on their nursing school experience, but they really "know" very little. I also felt the same way, but instead of following the path of many classmates who bolted to ICUs, infusion centers, etc., I decided to also "give it my first year." A little over 3 years and I'm still where I started, by choice. Primarily a Stepdown unit with an extraordinary variety of cases, I remained where I'm at because of excellent co-workers who have mutual trust, who will help each other at the drop of a dime, and who are, for the most part, dedicated to their profession. We have nurses who've been on associated Med/Surg units for many years, not because they couldn't work in an ICU or ER, but because this is exactly where they want to remain. They prefer the fast pace, critical decision-making, muti-tasking environment and primarily, the patient/family interaction. I'll go out on a limb here and say your Mom's perspective of Med/Surg may have been skewed by her pre-assessment of what was to come in Med/Surg and her Orientation only put the icing on the cake. I'm fortunate my military skills took control on graduation and told me to "suck it up" and take a tough road to start nursing. I've met many fine dedicated nurses who are very satisfied with Med/Surg . . .just like those who went to ICU or anywhere else. I feel I'm well prepared for just about anything and, more importantly, fully cognizant of the quality of any future Orientation I might experience at other nursing levels (i.e. separate the facts from the BS). Best of luck to you, but don't be to quick to scratch Med/Surg off your list . . .you might be missing a a part of nursing you would've excelled and enjoyed. Good luck, Phil

Hi, What's the PRN rate for CRMC, if you don't mind (RN with 3 years experience working Stepdown and Pulmonary floors) Thanks

I agree with going to an optometrist for progressive glasses and especially for an eye exam, if you haven't had one lately. I went for years with reading glasses only to find that my distant vision wasn't as good as I thought it was (quite clear to me but had depth perception problems). Like most, I adapted and "tricked" my brain into thinking I was fine with distant vision. Ended up getting progressive no-line lightweight bifocals. They take a day or two to get used to (first feel awkward and uncomfortable, but you soon adjust) but now I leave them on for 12 hrs straight and don't even think about them. Best of luck

Water temp is 57 right now but think you'll have pretty nice weather next week. I'm an avid windsurfer and even tho it's pretty cool when it's cloudy, I've only worn a full wetsuit once this year (wear a shortie, instead). I'll be in Hawaii next week. Hope you enjoy your break down here. Watch the ETOH.

I agree, and thanks Nurseguy for a great reply. Guess you could sense my frustration in the post. I am, of course, aware the bottom line is all-important in business/management, but one would think that for the very reasons you cited (errors, stress, turnover) plus long-term litigation insurance and risk, etc a correction in the right direction would eventually take place. I also find it contradictory that management's annual bonuses are based on cost-savings . . which of course come from keeping ratios high. It almost make me laugh, as well, when leadership kicks out rhetoric wondering why nurses leave the profession early. I like many, will probably opt out in the next year, or two. Sad to see a profession that on one hand is so rewarding places it's members at such high risk for lawsuits and associated health factors (stress, et al) all due to factors indirectly linked to something beyond their control. Thanks for you inputs.

Know this is a sore subject at many facilities, but why isn't there more discussion in nursing journals, papers, etc.? We hear about various drug incidents, nurse negligence, malpractice, etc., how investigations revealed failures to follow protocol, nursing standards, etc (human errors in most cases, imho), and how nurses were disciplined/de-licensed/fired. Is a ridiculously high nurse-patient ratio ever determined to be a causative factor? I've been to staff briefings on employee satisfaction surveys where the employer cites pay and staff friendliness as major employee grievances, but they won't ever ever mention the NP ratio mismatch. Managers will then boldly ask why staff retention is so difficult. I've previously mentioned ratios as a (if not "the") major reason for both retention problems and/or the majority of "incidents" not only locally but probably nationally, and it's like talking to a vacuum. Maybe I should become a medical malpractice ambulance chaser. I know I wouldn't waste much of my time poring over charts and documentation. I'd delineate the causative factors, cite the human error involved and then go straight at the throats of management for "negligence in proper staffing." Anyone know of facilities in Florida (my only area of interest right now) where the NP ratio actually matters to employers??? Phil

Would be interesting to see when she was here. And again, I'm sure "inexpensive" is relative. What bothers many people here is the cost of living has long out-stripped the salaries. Panama City Beach is mostly at or close to minimum wage jobs and many have had to quit (couldn't afford the housing) or businesses have rented homes and shacked up many employees in single houses (currently a local uproar due to increased noise, congestion, ETOH problems, etc). BMC (the big hospital) is also the primary provider of indigent care. The census' of both hospitals has risen dramatically just in the last two years. I did my clinicals at Gulf Coast and know several nurses there. They also have a pretty heavy patient load and also take some indigent care. Don't think it will make much difference which one you go to. That being said, been in PC about 15 years and still love the place. Crime rate is pretty low with most crime being in isolated areas. Cheers

Hi Barry, Hope I didn't scare you with the COLA info for this area. Just wanted to give some a reality check due to the recent cost hikes compared to what some might remember. Apartments are still an affordable option and although city and county officials are meeting with developers for "affordable" housing alternatives, things will take awhile to turn around. I live in Callaway (nearby PC) and one developer here is working on two or three very affordable home areas. Pre-fabbed two story housing units, energy efficient, hurricane coded, etc starting at $139K. I scoffed when I first saw the ads, but driving by one area I was actually impressed. So things are changing. Unfortunately, BSN won't do much paywise. Think it's a dollar more per hour. MSN gets you $2/hr unless it's changed recently. Of course, either degree qualifies you for greater opportunity anywhere in your nursing career. Not sure who you emailed at BMC for info, but I'd call 850-769-1511 and ask for employment or the nurse recruiter. Best of luck

I'd also commend you for facing up to your reaction to stress. I would suggest further that everyone reacts differently to stress, has different ways of coping and overcoming it. You may feel a bit stressed and worried how you will perform as a nurse, but you just don't know until you get into it. I was pretty worried about working the Med Surg floor (as were most of my classmates---who ran over each other's backs to get into an ICU with a couple of patients rather than the usual six) but figured an ICU environment with "critical" patients would be even worse. Initially, it was stressful indeed, but you quickly learn and refine time management and organizational skills and the stress level pretty much wanes (except for a few choice moments). I'm really happy where I am now (Stepdown) and really encourage to just get into nursing for all the reasons you probably are considering it. Like all of us, you'll adjust, refine your skills and find it very rewarding. Good luck to you.

Not sure where you're taking your ACLS but our facility provides you with a book complete with the CD. Unlike previous classes where most didn't even pickup a book or fill out the pretest given to them when they signed up, it's different now (at least for us). We pick the book up BEFORE class (up to about a month before), and are REQUIRED to have completed the written pretest and the two activities on the CD (bring printed completion CD test to class). ACLS book is much easier than previous editions and algorythms are actually a bit easier to digest. Meds are simpler and the whole routine is geared toward common sense important actions that we can initially provide. Without too much verbage the book often points out to rationale why they changed this or that. Just read the book, do the CD and have a little confidence. Afterall, as someone mentioned, your preparation will probably have you at least a good way ahead of the remainder in class. And . . .good luck.

Great comments, "Lady. . ." All are true. Bottom line: for as long as they can take in GNs from the local colleges and start them at this pay . . nothing will change. And . . .the cost of living will not likely decrease anytime soon. That being said, it's still a great area, has all I need and more. Oh . . .existing on low pay . . .I'm retired military.

I work at Bay Medical here in PC. Did my clinicals at GCMC and my daughter (RRT) worked there for a few years. Pay is the same throughout the area (low). New RNs start around $16 and PRNers make a flat $27 regardless of experience. Of course, shift differentials, etc will add on to this. From what I've heard, GCMC is a pretty good. NP ratios, I've heard, are comparative to ours (6 to 7 per nurse and higher at night). I enjoyed my clinicals while there and found everyone helpful and friendly. Good luck,

You might find more responses and/or interest in the "Nursing Student" Forum than on this one. Best of luck