Jerry 75

Hi, Looking into Correctional Nursing have 16 years exp in ER plus Psych and Triage. -Are ICE facilities any better or worse then county or state Prisons to work in? -As an RN in a Correctional facility do you start many IV's? Are many pt's on AB drips? -If you have a pt. with Chest Pain do you monitor, keep and treat or treat and ship out? -What level pt's are sent out to a hospital? -What is it like working with the guards? Do they protect you?

Hi, Out of work now and thinking about a specialty that I can feel comfortable in. Been an RN for around 31 years 16 in ER, a few in Psych, and Telephone Triage. Looking for something where I can spend time with my Pt. without having to push meds and mess with IV's and drawing blood all day. How often are you having to access Hickman or other ports in Hospice? What route are meds given? Are these pot's still receiving all their daily routine meds or only meds for pain? When pt. is on comfort care is it vi IV or IM meds? I was looking at a Triage Hospice Nurse job but they want 4pm-4am. What is your role as a Triage nurse that goes to house? Are you doing the same wound care and assessment as a home care Nurse?

Sounds interesting in ER there is hardy ever time to deal with Patients emotional needs just no time. As a matter of fact that is frowned upon. Just get them in and out "Treat em and street em! For my self someone who is very into empowerment and building trust with my patients, and taking the time to listen to a Patient it becomes very conflicting to me!@

I got treated there once seemed like a nice little place to work. Has anybody worked or working there now? What are the capabilities of the facility? How do you get hired there?

Do you work 12's or 8hr shifts? Nurse Patient Ratio? Do you have time to spend with your patients or task oriented with allot of clinical stuff Like IV's and meds and blood tests? Are you required to pray with your patients? What type of staffing besides RN work with your guys? What situations are most stressful to you in your specialty? I work ER and wonder if you guys wind up overloaded as much as we do most of the time?

In regards to mfill4545 Abuse situation. SomEthing I believe that will benefit you would be either an EAP program or any group therapy that deals with Nurses. People who have undergone similar abuses at the hands of dysfunctional Nurses. It would provide you with a frame work to see how others have dealt with similar situations and also to see that it is a survivable even and you can work thru it and continue in a high paying field NURSING!

You went true PTSD the Preceptor made you relive past trauma from Coach. Either the bullying, harassment programs at your facility are inadequate or not being applied. But to see a teacher/Preceptor acting in such a manner is inexcuseable. I looked up def of Preceptor An expert or specialist, who gives practical experience and training to a student, especially of medicine or nursing. I didn't see harrassment nor condecending, nor belittleing behavior as part of that description! For my own style I am extremly confrontational when nessesary but not in work enviornment. But only after I have exhasted being assertive and I have a long fuse but after a point better off stayuing out of my way. But it takes a long time to get me there!

My most recentNursing experience x 9 years has been as Advice Nurse / Telephone Triage. Planning now on return to probably UC orED. Had worked ED x 14 years in the past. and 2 years Psych Charge. Concerned about low starting pay or not being accepted back into Nursing d/t long timeout of bedside nursing. I plan on taking a 2 month Nursing RE entry refresher then getting my ACLS andTNCC and PALS. I have total of 27 years experience as RN. Will that refresher and updating of certifications be enough to open doors for entry to ER Nursing?

I totally agree with @trai1971 Respect for colleagues should be taught in Nursing school. It amazes me thatrespect, professionalism, compassion, sensitivity has to be taught! You wouldthink that those would be some of the basic qualities of a person who wants tobe a Nurse or Doctor but obviously it is not! Speaking on the subject of respect I have noticed over the past 9 years that my interactions with MD's seem to be much more Civil, respectful and pleasant. I hardly ever run into rude Docs on my phone consult. Used to be "Why are you calling me for this" "Doc I am calling you not because I want to, and not because I don't know what to do but rather because I am compelled to get your permission as perpolicy. Now are you willing to assist me or not? Having said that the incidence of such encounters has become very rare! At least from what I have experienced. I wonder if they are teaching interpersonal skills and manners to MD's inschool now! How I wish that were the case 28 years ago when I started out in Nursing, a timewhen MD's temper tantrums were common place in the Emergency room A Jamaican Charge Nurse of mine used to say. There are 6 words that open every door with ease "Thank you mam and if you please" Getting back to complaining about troublesome colleagues. All you have to do is mention Sexual harassment,Religious harassment, Racial or Ethnic Harassment or discussion about any personal medical problems you have= HIPAA violation and that troublemaker willbe history!

In Your Face Sadly enough when you have exhausted your resources to stop the harassment you may have to wind up becoming the aggressor. I had the displeasure of being provoked by a very annoying co worker who just would not stop messing with me even after asking for change in a very well mannered gentlemanly way numerous times, evenspeaking to the supervisor did nothing "Oh that's just the way he is don't let it bother you" but he was spoken to by Super Finally I was fed up took him into a supplyroom and gave him the Stink eye and told him Don't you ever pull this"*&&%" again or I will"(($*$)&". So the only way I could shut this clown down was to intimidate him to the point that he was petrified of me and started shaking., But my encounter with him proved to be fruitful. The behavior never occurred again!

To me itseems as though Male co workers are much more confrontational and relentlesswith their bullying. They seem to take pride in embarrassing one and other,demeaning each other, ridiculing. Female Co workers seem to be less overt with this behavior (at least in myeyes) although they can be just as rude and incessant with their attacks. It isvery childish, non productive behavior that should never be tolerated in theworkplace environment. It causes distraction from your assignment, destroysteam work and causes the victim discomfort. Now a day's quite a few Hospitals have compliance departments to whom you mayreports such behaviors anonymously! And the supervisors will be contacted andhave to respond to the complaint and people can be fired over this. Harassment of any type whether Religious, Sexual, Racial, Ethnic should neverbe tolerated and supervisors when aware of this should nip it in the bud! I shouldbe able to ask for change once and that should suffice to make you cease anddesist with your annoying behavior. Youhsould show enought respect and consideration for me to knok it off. I should not have to get angry, enraged norescalate to the point it might get physical Thosewho Harass at work are garbage who should be removed from the work area.

I had some questions RE Nursing jobs as USPHS Nurse Has anyone worked as a Nurse for this agency in California? -Do you get a stable loction to work at or can you be moved around to different locations? -Do you respond to disasters in different parts of US? -Can you enter the agency with AS degree in Nursing? -How similar to Military is the Job? -I read something about "Basic Training" What does that consist of and how long is it? -How do salaries compare to other Nursing Job wages? -How do you get to higher pay grades? Is it by time on or written tests? -When are you obligated to wear formal uniform? -Are you given a Government G grade? Thank-You!!

In this system does anyone but a Nurse pass Meds? Does an officer remain with you during all prisoner contacts? How long an orientation do you get? Do you have a code cart available or at least AED? Have you ever been assaulted by a Prisoner?

Thanks for your help but doesn't answer my question. Will just call them in the Am !

I gotta fill out some paperwork and need to know if United Nurses of California has a Local Number like some other unions do like local 30 or something like that? All the years I have been a member do not remember any local number? If any brother Nurses are out there please try and answer this for me! Thanks!!

Off Course he can be Septic with just a fever but we are still obligated to go thru the entire protocol to see if any other symptoms are present

Yeah the more history that you have of present illness the better you will be to make a more accurate your final disposition

I am usually pretty good at diffusing angry Patients. But most of the problems arise with the meddlesome nosey, control issue husband, wives, and relatives and neighboors who insist on talking for the Patient and are demanding and argue with you. If the Pt. is adult and conscious and can speak I want to talk directly to him! I don't need a fricken shift report from you! I had this one jerk/looser pain in the Ass who was arguing with me because the Surgeon never called the Pt. back and giving me this threatening "you better do something for her crap" I told him if I cannot speak to the pt. and triage her directly I will not be able to help her. This jerk continues arguing I tell him put the phone down now and let me speak to the Patient! Your are delaying her getting care! He puts her back on and triage her our interaction is professional and pleasant I know what she needs and will get it taken cre of. She ws a post op ab surgery with minimal bleeding that is controlled. I advised her I would call SOD for her gave her good call back If's I contacted the SOD gave him my spiel and called her back within 5 minutes. Jerko answers the phone arguing again wanting to complain about me. These are the useless *******s that really take away form the time we want to give the Patient! The jerk just wanted to fight with someone. I triaged her and got the info she needed in less then 15 minutes and jerko hubby is still angry! Go Figure

It's all about streamlining the triage process and reducing time on the phone to take more calls. It is an assembly line in which you get allot of crap for interjecting your own questions. The belief is that everything you have to ask will be found in the protocol you choose and that the "Automatic Computer generated disposition will be the correct one!

I had a Supervisor advise me that I was asking to many of my own questions and that it was not nesessary to ask what the Pt's diagnosis was when seen by the Doctor earlier today. To me that is ********! It is very relevant! Why streamline your history taking and miss something very relevant?

Yeah allot of teching to do out there! Especially paramaters for what is normal and what is not. Well at what temperature should I scoop him up and run him into the Emergency room? Well not at 99 degrees the temp that you called about it is not even a fever! Call us first let us access his condition before you run any where. There parents run into any UC without calling first then find the UC doesn't accept their insurance instead of just calling us first. Then they wind up arguing with us about it.

Yeah just like in ED- with Telephone Triage Patients can be a real pain in the ASS, deliberate and difficult. Lack of understanding is not always the problem quite often the patients are just pain deliberate and nasty and provocative.

i talk to the daughter about her 86 year old pinay nanay, all she knows is that nanay called her earlier and didn't feel good and had a fast her beat and nothing more. caller not with patient. i request moms number and call her directly. it is 1am i can just picture this frail lady waking up to my call, taking off her bi pap, putting in her dentures, tumbling out of bed, running to the phone which is downstairs (old people for some unknown reason tend to live upstairs) then loosing her balance and tripping and rolling down the steps and crash landing on the bottom. hopefully she is a modern day gal and sleeps with a blue tooth on her ear (over her hearing aid). soooooo nanay picks up the phone in this faint filipina voice with a gentle paranaque accent kumusta? i tell her who i am and we begin to discuss how she is feeling. very sweet pleasant lady. she speaks very slowly and although work is really a "pain in the ass about time frames on calls" i spend time with her and don't rush her. she has a hx of htn and 2 days ago was taken of corgard and placed on lisinoproil and hctz. tonight she said she experienced episodes of rapid heart rate which abatted on their own and are absent at time of call. i asked if she had any trouble breathing supine and she replied yes x 2 days. when i questioned her about pedal edema she replied that she had that also for 2 days. our magnificent computer program for brain dead nurses reccomends ed (as if i couldn't come up with the same dispo). i give ther the "as a nurse i don't diagnose based on your symptoms i reccomend ed spiel" her response hindi! ayoko! seems liike lola ain't buying it! i explain in laymans terms the significance of new rapid heart beat, new med within past week, orthopnea, pedal edema and mature age. i allow her time for this info to sink in do you understand what i am telling you? do you have any questions? ayoko! i even offer to try and get an ambulance for her thru my hospital system. no go! faget about it! i read her the riot act, give good call backs and encourage her to call back for any questions or problems or if she should change her mind. she thanks me for calling her back. i tell her it was an honor to take care of her walang anuman, tulag na! but with this not so young gal i really wish she had gone to the ed

in the telephone triage field we don't have stethoscopes, ekg machines nor sat meters instead out tools are the computer and the phone. when our tools malfunction or are not operating at peak performance it effects our productivity, and can and does cause us physical harm. i know of many of my collegues who have sustained injury thru phone use at work. many don't even realize that they have been injured, others minimize their injuries and others are afraid to file a comp report for fear of rreprisal from management. just look how often we get static on our phones or back ground noise or yelloing or loud argumentative patients. we also get occasional shrieking sound spikes or barely audible calls but full of other static noise, repetative beep tones etc., 4) acoustic shock is a growing problem in workplace environments where headsets find extensive use, such as call centers and switchboards. during each day, a headset user may hear whistles, feedback, high-pitched fax/modem sounds and even loud hang-ups from irate customers. 1) so what is acoustic shock anyway? put simply, it is a phenomenon that can occur when unannounced sounds - ones that are materially different to normal speech - travel through a telephone line or a web interface in the space of under 16 milliseconds, and in to the headset. these sounds may be characterized as having a specific tone (frequency) or a very fast rise in the 'peak energy' of the sound, so resembling a bang or clang. the resulting symptoms include pain and tinnitus. it can also cause hypersensitivity to sounds (hyperacusis) among other problems. when i looked into this acoustic shock issue i was not aware of how many people had been injured in this way. look at the following stats: 2) to-date more than $17 million has been paid out world-wide in claims and this is set to grow if employers do not get to grips with the problem 5) call center noise hazards place operators at riskacoustic shock is a sudden spike of noise; a hazard faced by 1 million call center operators. it can lead to physical problems such as tinnitus, and emotional problems, such as anxiety and depression. research by the uk's health and safety executive (hse) showed 30 percent of call center employees interviewed claimed symptoms of acoustic shock. potentially this suggests that 300,000 uk operators may be acoustic shock victims. 2) acoustic shock in headset wearers: the medical and legal view the physiological effects: the evidence collected by interview and measurement to-date has identified certain characteristics that can give rise to an acoustic shock injury. some examples might include: * signal breaks resulting in white noise or shriek type noises * loud bangs or clangs, a function of a phone being dropped. * lightning strikes. * in an emergency response environment the presence of loud obtrusive alarm sounds * the increase in malicious calls involving whistles being blown down the line etc. * misdialing into modem type lines. such noises are termed 'acoustic shrieks' or acoustic shocks. on their own such events are most likely to give rise to short term effects like tinnitus and reflex pain. however, if such events are poorly handled within the workplace then far more serious issues arise. there is already evidence that once a person has experienced an acoustic shock event they become more aware that this could happen again. this may not seem especially important but such anxiety can give rise to changes in behavior that can have very serious consequences. once a person is 'sensitized' the fear of another event can start to affect their performance and their ability to do their job. this can lead further to noise hyper sensitivity that can seriously undermine their ability to do their job. if no action is taken, this will develop further into anxiety based depression. the problem here is this; an event that starts as an acoustic shock episode with fairly broad symptoms can, if not properly managed, develop into a full-blown mental illness. the link between anxiety developing into depression is documented in libraries of literature. the issue here is that this progression is independent of the initial trigger. so one can see that a key component of any control strategy or company policy is to make sure that you never allow an acoustic shock experience to get to the anxiety stage. there are many different s & s of acoustic shock as illustrated in the table below in a table prepared by janice c. milhinch phd,audiologist 3) as table 2 indicates, headaches and physical sensations of numbness, a burning feeling in the ear or face, tingling, a warm or hot ear or face, a feeling of pressure or fullness in the ear, and an echo or hollow feeling in the ear were frequently reported. in cases of moderate to severe acoustic shocks, operators typically described the acoustic incident as "like being hit over the head" or "stabbed in the ear." some operators became tearful, began to shake, and several hours after the trauma, developed fatigue and slept for an unusually lengthy period. in a significant number of cases, pain and unusual sensations consistently recurred when the individual experienced any moderately loud sound, similar in pitch to the acoustic incident itself. psychological symptoms included anxiety and depression, anger, feelings of vulnerability, and persistent hypervigilance. the data also showed that individuals who had experienced more than one acoustic shock were more likely to have most severe symptoms and a longer recovery time. so whats being done by government and big business to prevent acoustic shock injuries? below is a table from the european union's noise at work directive 4) recent acoustic shock legislation the european union's noise at work directive, effective since february 15, 2006, documents new rules for protecting on-the-job hearing and draws increased worldwide attention to these problems. the directive basically deals with two types of noise-induced hearing damages: 1. acoustic shock, and 2. excessive noise exposure during a work day. up to 80dba, the employer has no obligations. between 80dba and 85dba, the employer should offer hearing protection and education. for levels exceeding 85db, employees must be provided with (and wear) hearing-protection equipment. the directive also sets a limit to the sudden loud sounds associated with acoustic shock. the limit is 135dba, which is comparable to standing next to an airplane taking off. references 1) acoustic shock the facts you need to know article is from "the call center helper"-http://www.callcentrehelper.com/acoustic-shock-the-facts-you-need-to-know-43.htm 2) acoustic shock in headset wearers: the medical and legal view by by paul jenkins http://www.connectionsmagazine.com/papers/6/14.pdf 3) acoustic shock injury: real or imaginary? janice c. milhinch phd, audiologist, melbourne, australia 6/17/2002 https://www.audiologyonline.com/articles/article_detail.asp?article_id=351 4) regulatory commissions sound off about acoustic shock by david coode, on semiconducter--edn, 3/31/2008 http://www.edn.com/article/ca6545956.html 5) call center noise hazards place operators at risk nov 5, 2004 12:00 am, by sandy smith, ehs magazine http://ehstoday.com/news/ehs_imp_37279/ i would like to hear from nurses who have or might have incurred sound related injuries from their headsets. i hope you all reported the incidents. i would also like to her form those who sustained injury and did not report it

I wonder whether most of us TMS gain weight-loose weight or stay the same weight after moving out of the Call center to your home and go REMOTE!!!!! To me the Call Center had to many bad dietary choices. They have a Soda machine, Candy Machine and some other crap. And there is so much food in that place! Cakes and Candy and other non nutritional fattening junk and then people are always bringing in more junk food to share with each other and further fatten each other up. When I used to go to work I felt as though I was attending a meeting at Over Eaters Annonymous Meeting! There is an outbreak of obesity and poor health there. I mean we are all about promoting health to others and yet we can't follow the example that we set for others! I don't like being around such an unhealthy environment. I think they should remove all vending machines and if work wants to celebrate birthdays and stuff bring in fresh fruit or other healthy foods. Put in a treadmill and rowing machine in place of the garbage machines Any way at home I am not near any of that crap food nor the poor eating habits of others. My self I lost allot of weight at home but then again I am a competitive athlete. So I ask you fellow TMS have you lost or gained weight since being out of that unhealthy work enviornment?? MICHAEL