cadeusus2004

Many medical institutions will gladly discuss with you your priorities and needs. They need nurses. Many female RNs have the same- or like- situation as yours. Perhaps your instructors can give you good advice. Don't be afraid to ask. There is flex time, night shift, agency (though they want experienced nurses), Per Diem and you may even try private duty. The Red Cross may have openings for Blood Center or Pheresis. The VNA is very hard work, but it takes visiting nursing very seriously and can discuss with you what your options are. Being a male who grew up with a widowed RN trying to raise kids, I was saddled, as was my sister (also a RN and mother who had responsibility for raising her children and taking care of a disabled husband), with a great deal of responsibility in almost raising ourselves. We were taught, early on, to feed ourselves, do our own laundry, work to make our own money, schedule our own lives and contribute to the family in every way we could. We learned to bear independence with proper responsibility. We had to be close to one another and work as a team. It didn't hurt us one bit. When we went out unto the world in our late teens (I at 17 in the military service and my sister with marriage), we were ready. We knew reality and thanked our mother for those opportunities. Nowadays parents many times feel that they must carry the entire weight of raising their children without letting their children learn to help raise themselves, gain in maturity and independence, pay for their own mistakes and provide for their own opportunities. (I baby sat my sister when I was only seven and I think I did pretty good considering my ignorance. Other children in our poor neighborhood did, too. It was kind of natural and we didn't think it was unusual at all. It was the way things were. We didn't even recognize we were poor. All the neighborhood kids were.) But, things have changed. If you are married then the reality is that your spouse will have to bear maybe a greater burden. But, if he can't be a good father and daddy, I don't know what to say. He'll just have to 'knuckle under' like you. If you aren't maried, don't think a boyfriend will be happy to help you do it. Its a very bad mistake. And, it certainly doesn't hurt if you try and get whatever help you can from wherever you can. There are always sharing friendships to find in your church (if you belong to one), the government, relatives or whoever you can get to help. Nothing is simple. And things always get harder except that your resourcefulness helps you make it seem a bit easier. As the British Air Force states: Per Ardua ad Astra (Lt: "through adversity to the stars")

Berta, OK. I'm approaching 60. I know there are a lot of us that are in Nursing and working Geriatrics/Rehab. I think we are in a transition where we are seeing our former generation (The WWII) going out, with our help, and are now starting to take care of our own generation, and even the "Next Generation-ers" (our childrens' own ages of 35 and so). In our Boomer segement of nurses, the kids are long gone and they have kids approaching teenhood. We are not winding down, just staying in at our way, the way and the places we want. There have been some problems: Many hospitals, seeing our advanced ages, are not willing to hire us (yeah, I know its illegal, but it'd take a class action suit to change even one place, and the Justice Dept. is not the fastest or most enthusiastic about taking on our cases. That's life, I guess). But, we can get into nursing homes and rehab facilites where most of the nurses are now LPNs and are there, among other things, to do the things their licenses will not permit them- like pronouncements, IV pushes, debridments, installing IV lines and those sorts of things. We can also get Geriatric and Alzhiemers specialty certifications. And, for the most part, the hours are still in 8 hr. shifts. Since I now only work agency, it is even better. I call my own shots, can avoid the politics, make more shift money and make my own schedules. I'm like a travelling musician in that I have a booking agent who gets work for me and schedules me. If the client is happy with my "gig" they might invite me back. Its a win-win situation from where I stand, though not with the security of a "regular job at a hospital" a la Bob Dylan's 'working on Maggies Farm.' Change is good. This way I'll never have to stop working until they pry my license out of my cold dead hands. And, I get to have retirement and SS, too. Did you hear what a nurse a year ago did? He is the first person to kyak the complete circumference of Tristan da Cunha, the most isolated place (island) on earth? The natives weren't too pleased and the island administrator wanted to jail him, except the jail hadn't been used in 20yrs. and the admin. was at the local pub too drunk to go out on a rescue mission- and the jail was already filled with marine equipment. So, they just wrapped up our shivering comrade with a blanket and fed him toddys and congratulated him on his idiotic accomplishment. He made the London Times (he's a British nurse). He could have foundered, drowned or been eaten by sharks. Cowabunga!

Hey Allen, Welcome to the site. What's your tune?

Imagin916 How in blazes the experienced one got through that year of M/S I'll never know. How she got put in ER is even more perplexing. I don't know what to say about it. Experience, or what we call it, has some pitfalls. One of them is the mindset. If she carries a real M/S mindset with her and hangs onto it, it will be tough to change. Another problem is bad habits. In the service it was proven that new recruits who had never held a rifle usually scored better than those who had had prior experience with them. Why? The hunters and civilian marksmen had developed certain personal habits that did not translate well into combat fire. (I had to take some of my own troops and retrain them on how to use the combat weapons. Those bad habits die really hard. I tried really hard and most passed muster. I feel bad the rest didn't because they would be of no help in a fire fight. I made sure the results were in their service jackets, hoping they would get only guard duty assignments. I just hope I didn't get anyone killed.) The "Dump" factor will always be with us. "dump her on ER and we will not have to deal with her anymore." Some Nurse/Managers think that way. I feel sorry you had to be the goat. So, don't be shy. Get the "Experienced" one out of there. Keep the new grad with no bad habits or bad mindset. Train her the way you need. I can guarantee your super will agree with you and act accordingly. But, there is still hope. On downtime, instead of letting this one sit there and play "Weakest Link" or "Poker" on the computer, have her review her priorities, find out what is bugging her and fix it, if you can. If you can't, she's gotta go. Pronto. Before her confusion kills someone or screws up the whole team. You have several things on your side: 1. There are docs around to go to. 2. The super is there. 3. The team is there for support. 4. The procedures manual is right there. 5. You are there. Finally, the rules of professional collegiality dictate that you must help out. You, as a specialist RN, have a duty to teach and train and share, and also evaluate and act accordingly. Here is one last thing: She, and only she, has the responsibility to recognize when she cannot truly hack the routine. she must be honest enough with herself. She must recognize her limitations- and act in a professional manner. and, if that means getting out, then she must. (I had to do it once. This self-realization is a strength, not a weakness, and a sign of wisdom and maturity.) Good luck.

As one who sometimes makes long replies, I would like to add a short one: When I was a Nueroscience Nurse I held ER nurses in highest regard, and still do. They worked WITH us, and us them, to save lives. I would simply like to salute them as colleagues.

I wanted to add something. Please look at your contract. If it mentions your preference and its commitment to that, in writing, they must abide by it. However, most of these contracts seem to have a bit that says, "wherever needed" or some such. One thing you might be able to do is contact that administrator who presented the contract and have her sign an affidavit saying she promised you your ER. (whether she had the power to promise it or not, she had the power to present the contract and agreed to your terms. I think this is called a "tacit" agreement. Unless you can prove it, I think you would have a tough time. If she did not have the power to negotiate it and you signed it, it may prove misrepresentation and therefore could indeed void the contract altogether. And, since she doesn't work for them anymore, she might just delight in helping you with such a legal statement. Please see a lawyer or check with the local Legal Aid Society. Who knows: You may have a "slam dunk" here.

Zipster, Come on in and welcome to the family. The food is good, the place is warm, there is plenty of love, and we fight a lot. I have discovered what the greatest word in any language is: "Home".

NearlyERRN, Play it safe. All you want to do is graduate. this professor could hurt you and I think he or she is being very uncollegial about the whole thing. Best to keep your mouth shut, your eyes down, do what she says, be nice and make it through. She (he) may, however, feel so strongly about you becoming a well-rounded RN that she or he is insulted that you are externing at another ER. (either way, she or he is there to prepare you for the exam and the life of a RN, not to ruin your dreams). Some instructors think you will need their recommendations and references. You don't. I've never used one of them and most nurses don't either. (But, back in my day, rebels were everywhere and I was just one of them. Peace, Love, Spare change.) Most hospitals, if they know their school contractees don't want to stay and the RN says she just cannot do Med/Surg, will make other offers. Admins have MBAs and MHAs and don't know squat about Nursing. And don't care about anything but their corporate careers. And the bottom line. The hospital where you are externing, if they want you that badly and you get along that well, they may be willing to help you out. It seems they need you worse than your contracting hospital. You know how I feel. I still think you need some Med/Surg experience. You could do it for awhile and then go to your manager and say you cannot stand the type of work. You do this after a year on the floor. Its usually minimum requirement for entry into a specialty. She (He) may go to bat for you to ER. (No manager in his or her right mind wants a nurse on the unit who is unhappy there and doesn't under any circumstances want to be there anymore.) You can always just stand pat. The hospital doesn't own your license; You do. It can't even threaten to take it. I can, though, sue, which is a civil issue, not having anything to do with the BORN. If your contract was not a school loan, look into bankruptcy, though your financial reputation will be totally ruined and you have to pay 15% of your outstanding dbts before you can even file. If you have money for a lawyer, get some legal advice. I hear contracts are renegotiated all the time. In the meantime, please get your Prof. CPR, ACLS and PALS. Most ACLS instructors are ER nurses. You may not need PALS or ACLS on a Med/Surg floor, but it will help. You will need them in ER. Sometimes hospitals will make threats. "We will not give you a recommendation". (so what) "You'll never work in the town again." (untrue) "You are dishonest." (not so it you let them know how you feel. Besides, they might try to find a way to fire you after you've been hired.) Do remember though, you have made a contract. If they will abide your needs, you should do all you can to honor it. You must be totally honest and forthcoming. Your goal right now is to get that ticket. That, to me, should be your only present goal. Good luck.

Continuing on the worldwide front: A few years ago the World Health Organization rated the best ER teams in the world. The winner, get this, was the Havana General ER. I saw them in action on a video about ER operations. They do more with what they have than any group I've ever seen. And they are outstanding in Pedi trauma. Che Guevara, a physician himself, had said that, children, not the the troops or anyone else, should come first when it came to medical care. (Great doctor. Great speaker. Great charismatic. Lousy administrator and a rank stupido in guerilla warfare. It took his buddy, a lawyer named Fidel Castro, to do the real stuff.) You know, we could sure use some of those Cuban ER people around here. Anyone questioning my politics should know that I am a registered Republican who votes, for the most part, Independently. For anyone who likes revolutionary figures, I recommend the Canadian movie starring Donald Sutherland, "Dr. Bethune" (He was a physician to the whores and indigent workers of Detroit, surgeon in the Long March of the Chinese Revolution and died there because no one would sell him any antibiotics; He died of gangrene from a surgical cut on his forefinger.) Another doctor, Armand Hammer, the American industrialist, helped save the new Soviet Union from mass starvation by sending millions of bushels of wheat, oats and barley, and was a friend of Vladimir "Lenin" Ullyanov. His father was a communist and Armand maintained an apartment in Moscow to the day he died. Sister Elizabeth Kinney, an Australian nurse, was the founder of what we know today as Physical Therapy. Had not President Franklin Roosevelt had her therapies he would have, for the rest of his life, been bed ridden with the ravages of polio. A movie was made about her and how the medical establishment thought she was a kook. You see, it comes from everywhere. "You say you want a revolution. Well, you know, We all want to change the world. "---But when it comes to death and destruction, You know, my brother, you can count me out. 'Cause you know, its gonna be all right, yeah--" -John Lennon, "Revolution #9"

fab4fan, Gear! "Baby you can drive my car, And maybe I'll love you. Beep, Beep, 'm, Beep, Beep, Yeah!" Now there is a philosophical song if I ever heard one. The best from the best.

Dear Headhurt, Then there, in ER, is where you belong. "Quite right. You're bloody well right. You know you got the right to say" -Supertramp

I have to work tonight, but I thought I'd add something. Mexico has for a long time been the training ground for American medical students, particularly at University of Guadalahara. Its a great medical school and has many grants from U.S. companies. Graduate students from there pass their boards and practice here as do many Mexican physicians. It has a long association with the Pan American Health Association and much research comes out of it concerning tropical diseases. There are other countries that supply us with physicians, particularly India. Most physicians specializing in plastic and reconstructive surgery study in Rio Dejaniero, Brazil. Ask any plastic surgeon where he studied and he or she will certainly mention Rio. Patients come from all over the world to have their work done there. Nurses from India already have degress and then study at the National Health Services schools. All speak English and most also speak their native Hindi, Urdu, some also Arabic or Farsi. they are exceptionally well-educated. Russian doctors, on the other hand, do not do so well here. Because their training is much different than ours, they must receive extra study or, like a few I know, end up being CNAs (What a waste. I know a pediatrician who works as a CNA in Framiningham. she says: "They say I don't know enough".) Irish, English, Scottish and German Nurses know a great deal, but it seems Canada wants them more than we do. they all have national health care and I can only guess that is the reason. The fact is that health care is "internationalizing" and the companies over here know it. They are taking advantage. They offer these nurses, all single and female, portage over here, set them up in living quarters, arrange for their transporation, train them to pass the exams and make them sign very long term contracts. In many cases it is near indentured servitude. The company holds the means to the "Green Card". (don't do right? Back to old country). I cannot begin to tell you how many Irish nurses practice in places like South Boston. Great nurses, by the way. the large hospital conglomerates have their international ties and are recruiting like mad, especially in long term and rehabilitation care. There is a clause in the Immigration Act that says that if a person is enough of note or has a skill that is sufficiently needed, he or she can immigrate immediately with no waiting. Nursing is one of those. and don't think the big boys don't know about it. Next, we'll be converting to Euros. (the Euro is now worth $1.25) What will we do?

ERJulie and Hogan, the term "Code Green" is used when a care provider is in immenent danger from a patient or the clinical environment. In mental health facilities it used to be called a "Mayday". The book, "Code Green: Money-Driven Hospitals and the Dismantling of Nursing" by Dana Beth weinberg (ISBN 0-80143-9809), 5/2003, $24.95 is about our current crisis. Call it the "Octopus" for our generation. It applies both to the term and the conditions outlined in the book. Far from being a conspiracy, this is an open and ongoing project by the 'for profit' health care industry to take over all aspects, including drugs, hospitals, clinics, insurance, native employment, "green card" employment, hospital supplies and even the Fair Wage and Labor Act, consolidate and maximize profits and destroy worker organization. Its aim is the implementing the extremes of the Objectivism. I think even Ayn Rand would have objected, equating its nemisis as the totalitarian structure in "We The Living", because that is where it is headed. I doubt that Congress will have the guts to apply itself to stop this "Trust" before it is too late. The "Health Care Trust" may be our greatest enemy. We cannot turn our heads away from the fact that the very head of the Federal Reserve is none other than the head of Rand's famous "Collective", Dr. Alan Greenspan. Others involved in this effort include Sen. Trist, MD, of Tennessee- whose family owns, for the most part, the hospital gargantua, HCA, in lockstep with Kaiser Permanente and Tenet. The whole thing is quite a tangled web of ownership, consolidations, partnerships, interconnected demand and supply backed-up by both the increasing need of the public for health care services and the expoding medical-pharmaceutical industry. For the Service portion of the industry: Nurses, techs, pharmacists, food service, custodial, management, transport, engineering, science and research, they are presently hard-put to keep up with the demand. Ergo, immigration and the new relaxaions on immigration are hoped by both government and industry to help solve this problem. somew countries have become so alarmed by the drain on their own medical professional pools that they have shut down emigration of both nurses and physicians (The Phillipines is an example. Ireland will soon follow.) Entering our system, they will make less and cost less, and have no power. The "Green Card" rules. (And these are excellent fully qualified professionals). With the new "amnesty", Mexico sends its workers to the US. Already, its GNP base is "Green Card"ers sending monies back to Mexico and Americans seeking cheaper drugs and services. Brazil has already followed. Others are Ghana, Haiti, Nigeria and Kenya. They have qualified workers willing and able. Many, though, are illegal. I have no doubt an immigrant worker "amnesty" will be forthcoming for them. More later.

I can think of no greater philosophers of our times than the various musicians we all listened to. In our generation when "the music mattered" (well, the words, anyway), so, after skipping a generation, again, the music again matters., about life, our perceptions of it, the lessons learned, the emotions, the seriousness of it all, gives me great happiness. I, again have some kinship with the younger generations. My quotes have some meaning. If I ran a Nursing School, two of the courses I would implement would be "Songs In The Key Of Life" and "Lyrical Philosophy". I'd want my students to be able to connect with humanity and how it works and how certain artists interpreted it, from James Brown, Dave Matthews, Steeley Dan, Supertamp, Stevie, Wonder, Frank Zappa (a course in itself), The Beatles, Smashing Pumpkins, Blues Travellers, The Levellers, Billy Bragg ( and we want to add even more). In literature, I would definitely include as much of Emily Dickenson, D.H. Lawrence, Maya Angelou, Robert Burns, Patti Smith (her music, too), Voltairine DeCleyre, Simone Weil (and others you choose). Sometime in the 1970s certain medical schools realized that mathematics, engineering and science backgrounds were insufficient to the upcoming and necessary Humanistic (patient inclusive) approach. They had been training physicians with immense technical knowledge, but with little connection to the emotional and spiritual needs of the patient. The leaders of this movement were not the physisicans, but the Nurse Philosophers. I was part of that movement and taught at U. Mass. Medical School under this new model. What exciting times. We gathered around us the most brilliant minds of the era: John C. Lilly, Richard Alpert, Robert Gass, Melvin Krant, Dame Cicely Saunders, teachers at the Naropa Institute and Esalan, The Hudson Institute, Jon Kabbat-Zinn, Saki Santorelli and a slue of others. We did have our detractors. I am happy to mention that this model became (or was already in use by Nursing) absorbed by the medical community- in some areas- and in others not so much; ER and OR missed much. they determined it did not, by and large, fit their medical milieus. I think it will be particularly hard for them to do so unless those who are now entering these specialties, bring it and practice it in the clinical situation. I see the greatest sabateur to this Humanistic "patient centered" model is increased clinical patient loading and the increased clinical stress of overwork and understaffing. (In the ideal "primary care" model for Humanistic Medicine, the patient load was a maximum of 5:1 Today we are seeing mininums of 8:1 and maximums of 12 and 15:1, not only unsafe and unrealistic, but anti-humanistic. The patient is turned into an instrument of commodity and production for profit. I urge everyone who can to read the new book: "Code Green".

Everyone, Well, I don't have to elaborate. But do I use "cheat sheets", a calculator, the "Portable RN" and carry a brandy new 2004 Drug manual? You bet. TPN? Well, in ER you wouldn't have to know it unless someone came to you on it, and there are a lot of docs around, usually, to help out. On a Med/Surg unit you will deal with TPN, and lipids and electrolyte solutions, etc. I'm of the old Socratic school that says: "the man who knows he knows nothing is truly wise." By the way: The Acrimonium really is: "There are no stupid questions, just a lot of stupid people to ask them." (This includes me). LOL Right On.

To All, If you are considering a career in LTC, here a a few things that may make collegiality better: Join NGNA (National Geriatric Nurses Association). They have an online test and certifications. The august American Geriatric Association has a special place for RNs. Like Pediatrics and Neonatal, Geriatrics is a field all its own and its patients are much different from other "medical stages of life". (ie: the typical Geriatric patient's liver has 25-50% clearance rate of the adult. That is why we wouldn't give as much morphine or other drugs) Next, LTC is the fastest growing medical industry in America, and with our Boomers coming in right now, its just going to geet bigger. Geriatric diabetes is rampant as in Parkinsons and cardiac. Pain and symptom control is a huge part LTC. Multiple diagnoses is the most common aspect. We handle seizures, respiratory (big issue), Parkinsonian, Alzheimers, Psychiatric, Pain control, nutritional issues, GTs, lots of infections (URIs, UTIs, Cellulitis, Diabetic foot and leg infections, decubiti, fungal infections, VRE, MRSA, flu and eye and ear infections). We also handle factures, dehydration (big issue), behavioral issues and deal with families a great deal, measures, sensory and perceptual problems, failure to thrive issues, gastro-intestinal issues, DNRs, death pronouncements, referrals, consults, skin assessments, respiratory assessments, trach care, ROM, patient safety (big issue), many, many new meds, perotonial dialysis and others. This why Med/Surg practice is important. Medication reactions is always an issue because these patients are taking so many meds which may interfere with each other, and allergies. We do a lot. Hygiene issues are something we are fanatical about. Prevention is huge. And we are the most scrutinized part of Nursing there is. Backside: Medicare and Medicae costs and the current Nursing reimbusement caps keep salaries low and the nursing shortage hits us maybe the hardest. Added to that, most LTC companies are 'for profit' and can play very dirty supply, pay and staffing games. Psychologically, many nurses feel that LTC is "bottom of the barrel" and most nurses don't particularly want to be presented everyday with their own oncoming or projected infirmities. I don't find it a problem, but would fight like hell to keep myself out of one of these facilities. (Maybe I'd just, when the time comes and my Cherokee blood overtakes me, just walk out into the winter woods to let nature have me. some family members have done it.) The spiritual issue is very large. Understanding that helps. Only in hospice and palliative care have I found like issues. The nurse can participate if he or she is careful and respectful. Cultural issues are also big. Gypsies can die in our sun room or, if it is feasible, outside. Jews want the Kiddush. Moslems want the Suraic rites. Catholics want Communion and unction, etc. You will want to know them all. No more room.

You see, what slows things down is the arcaine nature of many LTC facilities which make you do a full set of pages before we send. I at least try to get the Page 2 done right away and copy off the MARs, RXs and any new orders. I also grab another person to help me. When the EMTs come, we are near ready. Then, I call ER. I always make sure I call ER and tell them what and who they're going to get. I think they appreciate it. Its worked so far. And, if they have a DNR order, I send that, too, and I always send the face page. Its a lot of scrambling, but its gotta be done. ER folks: Tell me how we could make things even better for the patient- and you.

Hogan4736, That's OK. Yeah, irks me if a person comes in and starts with the "Do you know who I am?" routine. Me? First thing I say is "Please help me, I'm dehydrated and have hyperhydrosis." I usually get (from somewhere in the background), "Again, Jim?"

Hogan4736, Where I live its a bit tough to do. Everyone here already knows I'm a RN, so I can't very well hide it. some of them I work with. Some of them I graduated with. Besides, the local hospitals are the best ones around. And, I don't really see any reason to keep something I'm very proud of a secret- and I'd never tell them I'm something I'm not. Its just not the thing to do in an emergency situation, especially if they ask what my job is or where I am employed. I can't find any sense in it. Sorry you were offended. None meant. Please re-read my letter and you might see what the exact import of my letter is (I was responding to New Grads In The ER). Its OK with me whatever you want to do. More power to you.

ERJulie, You sure have the fear thing right. Hanging your tail out over the edge and pushing that outer envelope is exhilarating. You gotta have the fear, the urgency factor. But, when I did it I always knew I had to have the clearest focus. When I was doing it and I was with a particular patient I'd say. "Now this is the only case right now. This is the case. There is no other case." and bfore each shift I'd pray: "God, please don't let me screw up." I didn't work with new grads and didn't trust them. I had been doing heavy Med/Surg and Neuro Acute and they, too, were scary. In fact, in the back of my mind, no matter how I practice, the fear is still there and I think it is one of my best friends. I see other specialites where new grads have that fear and I think it is good for them. I appreciate from you that my perspective is not the only one. I think I've altered my opinion somewhat. (come to think of it, when I've been a ER patient, I never once asked "How long you been doing this?" The nurses treating me knew I was one of them and were tough on me and made me focus on cooperation with treatment. Pain and confusion when I'm very ill in the ER is always a tough nut and I've somehow learned to help my caregivers out and be thankful. And, I'm glad they didn't blab my condition to others in the hospital so it wouldn't get me in trouble with admin or my colleagues- I have hyperhydrosis and diabetes incipidis and can get into trouble really fast and not (can't) know it. Thank you for your insight and thank you all for your great care. You have what we used to call in the USAF "The Right Stuff".

Larry, I was commenting on the specific case. You are, however, correct. The ting is to nip the sucker in the bud as hard and fast as you can. When I was in the service I came down really hard on bullies since they destroy the team and the mission. sometimes you have to use the "baboon hierarchy" approach, though its not for every case. One cannot be timid in dealing with this. Watchout, though: Some of these people will try to gete back by sabatoge of the patient (cutting g-tubes at their bases, changing IV rate flows, placing patients in bed so they will fall, undoing dressings, pulling duragesic patches off patients and falsely reporting vital signs so that they hope the nurse will go into crisis mode. I make assignments so I can track the behavior of a CNA or the other nurse and go and check back regularly- by the way, G-tube splits are ragged, cuts are clean. Check your patches early and tell the CNAs you have and to look for the patches and don't disturb them. If they are gone it is the CNA's fault. And, don't, whatever there is to do, show any fear. And stay chilly. and Write 'em up and follow-up. Remember to praise good CNAs for their fine work. There is a time to be a royal SOB and another to be the understanding guide. But no screwing around on this one. the leader leads. (Lots of good books on how to handle bullies: One is called "How To Handle Bullies In The Workplace". There are also courses on it. Look online.) (Yep. I've been through this number before a few times. Always won.)

Dear Mayo, While agree the purpose was originally supposed to make for easy identification of specialty areas- and is supposed to be, unfortunately many have somehow managed to assign more exclusive and competitive meanings to it. That is why in certain places they have returned to white. It just caused too much division. Pretty sad. White, nor any other color (say black) is stupid. I had mentioned that it makes the adult, particularly the elderly LTC patient, more easily identify us as nurses. Many LTC facilities require it being worn. I have the same problem with some uniforms with all the equipment I carry around during a shift. Since I am a male I do two things: I wear white suspenders. I also wear the short consultation coat which has a lot of pockets. there are some really stylish ones at various uniform shops and in the catalogues. The white suspenders are hard to find. Also, I wear the British style Nurse watch, that upside down watch that is worn kind of like a medal. Its very practical. Welch-Allyn makes this super light sphyg. Only one tube with bulb. Ny penlight uses AAAs and has a Xenon bulb. Very light. I think C. Crane company still carries an LED type light wich is not only virtually unbreakable, but very light. But, it is also quite expensive. But none of these replace my scissors, clamps, pens, quick references or my palm pilot (they just have to make those lighter) with scanner. Personally, I love the color Kelly green. It stays looking clean. I wore it for years in Neuro. (Its also called Neuro Green). and, like I say, the patterened ones for Pedi and perhaps in OP are nice. Psych has reasons for not wearing uniforms. But, I say "no" to using it for rank. That's an invitation to trouble. The services have everyone wear the same colors as do other "team" professions. Of course, if you work agency like I do, you can and might want wear any color you want so long as the client approves. See, I'm not so hard and fast after all.

Rane330, Write 'em up. They are there for the patients, not themselves or their assuming friendships. You, on the other hand, have nothing to lose but a bad job. I am usually very casual about staff. They know what they have to do and know they have to do it. If they balk I tell them, "You doesn't has to like it; You just has to do it." No excuses. I have also said, "You are working under my license and I worked for it, not you." If I catch a nurse or a CNA verbally or physically abusing a patient, I first make sure the patient is safe. Then, I separate the aggressor from the clinical area. Immediately. Then I make sure I tell my supervisor that I am reporting it to the BON as I am obligated to do. Then I report it in all detail and keep a copy for myself and my insurance company who has nasty lawyers just waiting to eat my enemies for breakfast. These are cases of blatant patient abuse. You don't have options. I report the LPN, the CNA and the facility. If the DON tells you not to do it, report him or her. If the administrator does the same, report him. The more the merrier. Hell hath no fury like the Accreditation Review Board coming down on a facility. (My late wife, an RN, was on the Board and was called "the Ax". She closed down three facilities in one day.) You will not lose your license. You did the right thing. You can go work someplace else. And if you really think the CNA will cover for the LPN, you will be surprised how friendships dissolve under the scrutiny of the law. If the CNA is from another country, it will happen all the quicker. Bye Bye Green Card. Hello, Old Country. Hell, they'll be blaming each other for the French Revolution. The facility will fire them out of a cannon. Meanwhile, you can go out and get a real job. Don't Pussy Foot. You, your license and your patients come first. Simple, huh? (by the way, make sure you get copies of all your incident reports and make sure you document everything, in the chart. Obliterating patient documentation is a federal felony. When the family lawyer sees it, its gonna be double fun in court. Oh. cover your tail with your graphic description of the interventions. You may end up in court. But just what is that NSO insurance there for, anyway? Besides, the nurse gets tagged less than 1% of the time for malpractice.) How do I know? I did it.

I'm too old to be jumpting through any hoops anymore and have been in nursing too long to bore the socks off you. 1. Jog security. Here you have it. Its the most needed. With my Boomer generation coming up, it'll figure in like a tidal wave. 2. Salary: The Coastal Northeast and Northwest are up, the Midlands are down. The North is up and the South is down. 3. A&P(8 cr), Chem I&II(8 cr), Micro (4 cr), Nutrition(3cr), Developmental Psych(3cr), Ethics (3 cr), Stats(4 cr), Eng I&II (6cr), Soc (3 or 6 cr), College Math (3 or 6 cr), Biology (4 cr), History (6 cr), Lit (3 or 6 cr) ans whatever else the school you apply to wants. Clears the way. (I majored in Physics and Thermodynamic Engineering. I didn't want to work in nuclear power plants. Hello, Nursing). 4. After umpteen years (I'm almost 60) in Nursing, if someone asked me if I'd do it again, I'd have to say "Yes". But, if you are looking for easier work and can get it, more pay and can get it, less hassle and can get it, better security and can get it, and you don't have the fire in the belly that it takes to be a RN, please, please, please, go somewhere else. We are needy, not desperate. We have a saying: "There are two types of people who don't go into RN training; those who are too smart and those who are too stupid."

Imagin916. Hope my letter didn't disturb you. I seems you are the exception- and kudos all round. You are in the groove unlike so many. You have the fire. Great going! I must recognize you as a colleague. But, just between you and me, you know as well as I, most can't cut the mustard right out of the gate. They have to learn, to season, to adjust. For the few, like you, it's "natch'll". You have the Right Stuff. There is only one thing I want to warn you of and that is the dreaded "ER Attitude". Most of our colleagues don't understand it and we should pay more attention to it. I know we get in the groove and do the "St. Elsewhere" thing. We can be pretty abrupt. But, we have to try and at least understand that when a nurse from, say, a detox facility, a nursing home, a rehab facility or a nurse doing home care calls, we treat them with the same ethical collegiality we would wish for ourselves. God knows I've been on both ends. (I once actually caught myself from saying, "Why don't you send us something besides your trash?" Every patient is precious and human. I felt so bad about it afterward. What in hell was I thinking?) I still am convinced that the vast majority of new grads belong in an internship of Med/Surg for at least a year. That way they can decide what specialty they are drawn to. I'd also want them to do a bit of CCU or Telemetry before applying to ER. and, I'd first look to see if they had ACLS. With an ER jammed with very sick people it's just too hard to split myself off as teacher and ER Nurse at the same time. Guess I'm just Old School. Hang 'em high.