vanlo001

I absolutely never meant to take away from the fact that there are hard working RNs in every state and find that response odd. I've worked in many states and each group of nurses stood out in a special way. Nurses are incredibly gifted people who touch the lives of many and every nurse should be compensated appropriately for the intensive work they do. Kudos to you for pointing out that fact.

There's an LVN on my unit who graduated, found no jobs, and now works as a CNA. New grad RNs are also having an incredibly hard time. Maybe applying for CNA position will get you in the door. Yeah, it's not about the grades. It's not fair, but it is the reality. Perhaps calling staff that Precepted you and asking if they'd recommend you or if there's openings. I do believe this trend will turn around but who knows when.

19 years, no one that was named in a suit or called to court, once I received a letter from a hospital where I worked that said my accurate and complete documentation of an event that led to restraining an alcoholic man led to the case being dismissed but I wasn't named in the suit and I think it is rare that individuals are named in suits. I do know one nurse who gave a bag of insulin like an antibiotic. The patient didn't die or have immediate injury. The nurse transferred off the unit to a less acute area. No action was taken against her license. I know three nurses who collaborated in a cover up of a narcotic mistake, two of whom falsified documentation of the narcotic record were reported to the board of nursing. There was no accusation that they took the drugs but they admitted falsifying the record to cover up for the mistake. I'm not sure if they lost their license for good or were reprimanded.

Thanks Caliotter- but once you work here it is hard to walk away from the dedicated and hardworking nurses.

Top 10 reasons CRONA nurses must reject the hospitals "last, best, final offer". 10. The sign on bonus was specifically included to blind members to the hospitals ultimate agenda. It is a smooth move that plays on everyone's fears in hopes of dividing CRONA members. Even if we reject the proposal the sign on bonus rema...ins in play. April 1st is not the date we strike- it is the date our contract expires, but only CRONA members can decide to strike. 9. The PNDP remains unattainable for the majority of nurses. The application process is time consuming. Put aside the flaws of the point system, to prepare the documents for your application and to submit it to the manager then come in for an interview before the board and to have to do this each year is unrealistic. Once you earn you CN III or CN IV the duration of your status should be 2 years. 8. The point system is undervalued still. We must see some movement on the point values. We no doubt need a more effective PNDP but there is still much room to make this an attainable and realistic point system for the highly skilled nurses at LPCH. For example, 500 hours as resource RN should be worth more than 2 points. 7. The application for Clinical nurse III should be automatic if all the points are met, and approval dome by the unit manager. The sheer numbers of RNs who meet qualifications for clinical nurse IIIs and IVs would make it impossible for the committee to approve applications in the timeframes they have alotted. If we aren't able to meet with the committee than we can not be promoted. 6. The corrective action portion of the PNDP must be removed. Anyone of us at any given time could be given a corrective action. Under their last, best, offer that would mean you would be demoted to clinical nurse II, and ineligible to move up for 2 years. If you have never had a corrective action you haven't been a nurse long enough. It can and will happen at the discretion of those in management. 5. The PTO/ATO take-aways and the establishment of the extended sick leave "bank" is a way to "say" they are giving us leave hours knowing that it's almost impossible for most nurses to use their extended sick leave bank. You must first be absent so many days before you can touch this ESL "bank". Just because SEIU and other hospital employees have settled for this does not justify us having to step into this model, which is less than our current system. 4. We are the backbone of the hospital. We assist doctors in residency and in varying levels of schooling in the care of our complex patients. Our professional knowledge and care needs to be acknowledge. We already make less than other hospitals and our dedication to this hospital shows we are not just in it for the money. But we are professionals. The wage proposals are the minimum we should expect especially in light of the proposed PNDP. 3. Retirement. The retirement plan is far behind most other hospitals plans. We in the medical profession should have some assurance that if we commit ourselves to the care of others than we will be taken care of when we retire. If they are going to stick with the matching program they could fo better. 2. We should receive a bonus because the hospital has failed to offer us a fair contract despite the diligent efforts of our CRONA team. We should unite and show support for our union that stands by us and defends us in corrective actions. Ask why the hospital is talking directly to members yet failing to negotiate at the table. It is because they hope to divide the union We deserved to be presented with an equitable contract and their attempts at a last, best, final offer should be met with a resounding NO. 1. THIS IS ONLY THEIR BEST AND FINAL OFFER IF WE LET IT BE. They can and will return to the bargaining table if we as a union reject their proposal. They are counting on the ratification bonus dividing us. Do not let that happen. A united vote is a powerful vote. Vote no to their proposal, force them back to the table, and walk away with that bonus when we have a contract that fairly awards the bedside nurse for their skill and expertise.

I struggled with this question too. I'm in school now for my MSN/MBA. My advisor told me I could do the same thing with a BSN/MBA that I woulddo withMSN/MBA andit would take half the time (and half the cost). He explained his sister was doing IT implementation in the hospital with a BSN/MBA and had no trouble finding work. However for me I wanted to leave the door open for executive management in hospitals which requires the MSN and I wanted to have the option to teach which also usually requires the MSN. Ultimately it's all about options to me. I have theclinical background but I want choices for career advancement and I felt like the MSN/MBA offered me the most flexibility. In addition to other options already mentioned you could Own your own business offering a product or service, start a travel nurse company, work in many different types of med supplycompanies or work your way up the corporate ladder in the hospital.

Where do u work sunny Calif? U can just say the state and what part or the hospital name if your comfortable. That seems a very strict ladder. Are the roles for RN 4s different than the RN 2 or 3?

Is there a preferred experience requirement? At least one year of experience on hospital in the specialty area they are looking for. I'd recommend at least 2 years of experience because travel nursing is not easy. You need to quickly assimilate to a new facility with minimal orientation. Which nursing specialties traveling nurses needed for? All specialties. Med surg is a strong base. But virtually every specialty is needed at different times. How do you go about picking an agency that is right for you? I would apply to several companies and go with the company that offers the contract where you want to go or with the terms you find attractive. Different companies offer different packages but basically thet are all very similar. Travel companies are paid to provide experienced qualified nurses out of this money a certain amount goes to the traveler as salary. One big question to ask is are your shifts guarenteed. Sometimes in low census the traveler is first cancelled and if shifts aren't guarenteed they may be without pay. You want guarenteed shifts- this means your paid regardless of census. How long are typical contracts with travel agencies? 13 weeks. They can be anywhere from 8 weeks to 26 weeks and you may extend if they ask you to extend. How long are typical travel assignments? Your contract is only as long as your travel assignment. Once you complete your contract you may go with another agency, sign on for a permanent staff And any other information you have to offer....

How does your hospital recognize nurses. Most places I have start new nurses at RN I, advance nurses to RN IIs automatically then you must perform some leadership or committee roles to earn the RN III and IV. How does your institution do it? Do any institutions require a bachelors degee to advance past RN II?

I have oriented to countless jobs in countless states so I speak from experience: bite your tongue. Observe how they do it and even if you feel you know a better way now us not the time to bring it up. Orientation is the time for you to learn how they do it. After orientation you can do it the way you feel best as long as it doesn't interfere with safe patient care. Orienting to a new job is hard. One of my favorite sayings is "Where others see obstacles, I choose to see opportunities". You can't create change if you are viewed as a know it all who is not receptive to the accepted way of doing things. You can try changing things after you have been there awhile but for now pick your battles get your job done and put a smile on your face even when you don't want to. IMHO.

I have always hated the term Strong vs. Weak. However as a charge RN it is essential when planning staffing to consider skill mixes in order to even things out. You may not hear the term weak because we do not use that term to people directly. However it would be a sign of potential if you helped out with the personthat has the sickest patient. And maybe you do. Certainly there are areas where there are cliques and the sickest patients go to the "strong" nurses and the annoying patients go to "weak" nurses. This of course is a set up for failure because if all you ever have is stable patients and then all the sudden there is sick calls and you end up with the sickest patient of course you will have questions and need reinforcements. We all have strengths and weakness. Getting your certification will definitely help. Mirroring behaviors you see in charge nurses you admire will also help. At our facility the charge nurses are developing a Clark-Sweeney Clinical Performance Tool. We will be evaluating staff nurses based on Patient assessment, clinical judgement, patient teaching, teamwork, etc. There are levels from novice-0 to expert- 5. Each spot has a measurable goal and based on this you get a total score that rates you. The purpose is not punitive but to get an accurate reflection of where nurses are based on measurable criteria. U can then schedule people accurately and those nurses that are novices will need to advance (or not) and those that perform above par will need to maintain that level by measurable outcomes and not who is friends with who.

It sounds like you have all the steps down. Perhaps someone else has advice but rest assured you more you do your job the easier and less stressful it becomes and these calcs will become second nature as well. Best of luck.

Are you talking about figuring mg/kg/minute or something like that or how figure out 50mg/kg when you have a patient who is 10kg and the vial is 100mg/ml. I'm just not sure what types of tips you are looking for. I'd be glad to help I've done nicu PICU peds for a long time so it's something I do routinely.

I think it is great that you want to recognize your preceptor. The foundation you receive from a preceptor is irreplaceable. I would go with a small gift- a nice dr grip pen, a gift card for a scrubs store, a card with a handwritten message. The letter of acknowledgement is one of the best gifts for the preceptor. Recognizing those nurses that stand out is key. We have rose awards and annual nursing awards. Consider one of these modes of recognition if your facility gas them.

Your nursing license is on the line here. Think of it that way. When a patients discharged the meds need to go. Either with the patient or back to pharmacy. If it's still hanging out when the patient is readmitted I would send those narcs back to the pharmacy and have new ones reissued or save that script and give them to the patient on discharge with this next discharge. This is a serious infraction (having narcotics laying around for discharged patients). There should be a policy fir the handling of narcotics fir residents and what to do on discharge. If there is not encourage your facility to create one.

Your question is so vague... Just look up each drug your giving for recommended dosing. Understand how todo the math....

Good job.

Oh my. Oh my. New grads take years to become proficient. Talk to a couple of nurses just off orientation they a scared s*it-less. And if they are not their ego is so big they don't realize what a liability they are. I love new grads. I love teaching new nurses. I love young nurses and appreciate their breath of fresh air. But don't get arrogant. "I saw a woman that has worked 35+ years in the NICU the alarms started going crazy for her baby, the "new grad" was the one that responded in the nick of time to save her baby, while she was still struggling to get out of her chair." Really?? Some experienced nurses are out of shape that doesn't make them less worthy. And that's exactly the type of thought processes that these people are talking about. Hiring experienced nurses is solid financial sense. They can hire this years new grads after someone else has trained them. Really. You don't know what you don't know. There articles out there that talk about evidenced based practice and how by the time it's researched and published it's out of date. We get new grads want jobs and I'm sure this glut will pass just as it has in the past. But your not helping the cause by thinking your the answer to the universe. Nursings been around a LONG time. Gone through numerous shortages. This will turn around too but take some of these womens advice. Respect those who cane before you and be grateful and give back to the hospital that invests in you.

Well that's interesting about the discrepency. We use buretrols with any drip medications (heparin, lasix, dopamine) and chemotherapy drugs that infuse over 24 hours. We also find our chemo infusions lasting 25 to 26 hours which is a huge issue when you are involved in COG studies. We thought initially it was due to adding of the drug to iv bags and not accounting for the overfill. Now it looks as if the standard ivf bag contains a variable amount of ivf solution. This prompts us to have to adjust the infusionrate based on the amount left in the buretrol so if there's a 150cc left and it's running at 10cc/hr and it should be done in 12 hours we will take 150 divide by 12 and run the rest of infusion at 12.5cc/hr. Not optimal but what we must do to get the infusion in in the allotted time. Without the buretrol it would be hard to know the exact amount left in the bag.

I've used it in a few situations and it works if you know what to include under each heading. I'm sure you all know the deal behind it. It was developed at kaiser when it was noted that doctors are more factual and direct in their reports while nurses are more verbose and descriptive. It's supposed to be a wAy to get just the facts and only the facts. It rolled out in our PICU and we have the sheets and we give report just as we used to. ((we gave a pretty detailed report)). We are now on my new unit rolling out relationship based care. If you've been in the game long enough you just roll your eyes. But SBAR: situation. Ms jones is a 78 yo admitted with shortness of breath and diagnosed with community acquired pneumonia. Background: she lives in a nursing home and has a history of stroke 5 yrs ago with moderate deficits in speech and left sided weakness. She smoked for 20 yrs but quit in 94. Assessment: she is alert and oriented with a slight slur to her speech. Her vss, cap refil good lung sounds coorifice but unlabored on 2l via basal cannula. She takes a regular diet but hasn't been eating or drinking much for last 2 days. She has a20 gauge PIV with D51/2ns at 100ml/hr. Her urine output is good and labs are on the chart. Recommendations: watch her urine output. Encourage pos. Increase o2 to jeep says greater than 90% she's to use her IS QID and out of bed as tolerated TID. It's not bad like I said you just must conn through the chart and know your patient so you can pass on relevant info.

In that particular situation I might have just gone it alone especially if my biggest obstacle was that I didn't know where half the supplies were. Are the residents the same? If they were I wouldn't have demanded an orientation day. In the case that dethung Luke your experienced happened to me, I would do my best and close my eyes and be reassured by the fact that it's only 8 hours vibe floated as a per diem nurse to units as diverse as mom/baby, burn unit, and NICU when my homeunit was PICU. In particular the mom/baby nurses were crazy ******* with all sorts of gripes. They took it out on me or those around them all day long. You come to a point in your career where you realize it's not all about you. These women are ******* cuz they are old, worn down, downtrodden, often working with floats under managers they feel are unsupportive. Should they take it out on you. No. Is it your job to change the world. No. You set up your personal boundaries. I always sound contrite if I do something wrong. I smile and I'm attentive and I try to warm the hearts of these women and undoubtedly they lay down all their frustrations. I wish you the best of luck and I'm glad you have thus forum to vent.

It's an excellent way to buy a house or save up for a dream vacation. I've worked two fulltime jobs and it is doable but you do sacrifice. I found after a couple of years I need time for me even if it's just cooking a nice meal, taking a walk, and watching my fav shows on the DVR. I stopped when I returned to school for my BSN. I'm not ruling it out though for the future. *warning* though. The more you work the more you spend. I was never home so I went out to eat or bought take out alot. I'd buy that $200 purse cuz I could. Have a plan for why you're doing this or else the money just slips away.

Typical. Be grateful u have your job still. Reflect on what u could do better and how u plan toprevent yhos from happening in future.

Your post doesn't make a lot of sense.

Thanks palmo RN. I appreciate your feedback. I am looking for how anybody handles their new diagnosis teaching and I appreciate your response. Independent of this I'll be doing a whole evidenced based change product but it's interesting to see how other places go about doing teaching. It's such a heart stopping event to havecyour child or yourself be diagnosed with cancer.