whd13b

#3, give the Lasix. Patient is almost certain to be in fluid overload based on the symtoms presented, as well as patient admitting to having run out of her Lasix. We can also add that no data in the given scenareo mentions how long she has gone without her Lasix, and considering it is mentioned that she is on "high" doses of Lasix at home, even just a few days skipped can severely distrupt her fluid balance and send her into fluid overload.

Travel nursing is a great idea to check out an area as well as different hospitals. It also gives you the time and convenience of being right there if you choose to apply and interview at local hospitals. I have a question though. I'm still undecided as to where I want to move, the Tampa area or the West Palm Beach area. Can you tell me what hospital starts new grads at 29/hr? I have 5 years experience and the idea of a possible starting rate for me at maybe 33 and above is joyous to say the least as most numbers I've been finding put me in the mid to upper 20's for 5 years experience.

I so agree your point! I currently work in NYS (the lower Hudson Valley) making almost 39.00 an hour. It's expesive as hell to live here. Taxes are super high, roadways crumbling, the weather absolutely sucks and there is not much to do on a social level. Although nurse/patient ratios are about 1:6 on days and 1:8 on nights, Med/surg, the acuity of these patients seem to get worse and worse. I just called West Boca Medical Center and with my experience, starting rate would be 29-31 an hour. Is it worth it?? It's looking better and better. I also lived in the West Palm Beach/ Boca area for 8 years, so I know life is not perfect there..it certainly was nice.

I have some real time figures to share with you and hope it helps. I, as well, have been trying to find out average salaries in Florida and eventually had to call actual hospitals to obtain the correct info since what I was reading in the blogs was so "all over the place" with relation to actual figures. From the research that I've compiled, the average staff RN working in a metropolitan region such as West Palm Beach, Ft. Lauderdal etc, will make about 66-67K a year with no specialty, on a med/surg unit. That's about 34 an hour. I just called West Boca Medical Center and spoke with a nursing recruiter and an RN with 5 years experience like I have and telemetry specialty like I have, will start between 29-31 an hour. The RNs are also in 1199 union, a big plus for me as I am currently in the same union workin in NYS. They also offer 401k company match of .50 cents to the every dollar contributed, up to 6% of salary. Hope that gives you some idea of salaries. My advice to you, rather than trying to obtain such specific numbers through blogs, just pick a hospital in the area you want to live and simply call them and speak with their nursing recrtuitment department directly. Good luck!

Thanks for the data! I know many hospitals, especially if they are trying to obtain magnet status, are all pushing for the majority of their RN's to have a BSN. I am currently in pursuit of it as the currennt hospital I work at is in process of becoming magnet, and I will continue as long as my employer will pay for it :)

Wow...that's a pretty decent hourly rate. Thank you! :)

It certainly can be! Then again traffic anywhere in South Florida is horrific, especially during season. I lived in WPB for 5 years and Boca for 3, pre RN days so I have a good idea of the region for home owner or rent purposes but for being an RN..I have no clue..

Wow..thank you so much for the detailed salary and benefit information. Ironic after living in Florida all your life, you seek the north :) And myself growing up in the north, seek the south. I actually love the Hudson Valley region of NYS where I live. It's beautiful here and only 1 hour outside Manhattan. The long, cold, dreary winters though I'm just growing tired of. It's almost impossible to be active during the winter months. I have compared cost of living between the two regions and only thing more expensive in the Hudson Valley are property and school taxes. Food, rent, gas, utilities, and real estate are all pretty similar. Thanks again for the great information :)

That gives me a little bit of an idea so thank you! I'm hoping I can land $28-34 an hour in one of these larger cities. From the research that I've done, Boca Raton and Ft. Lauderdale seem have the highest per hour salary for RN's. Boca Raton is only about 15 minutes south of West Palm Beach, so that could work. I live and work in Middletown which is in Orange County, and considered the lower Hudson Valley :)

Thank you! :)

Thank you for the information! I understand that Florida salaries are lower than NYS which is one of the reasons I'm trying to find out just how low is low :) My focus is Tampa Bay or West Palm Beach as I know these regions pay the highest and I'm familiar with both. I have considered becoming a travel nurse in those areas to get a feel for the regions but before I move, however I still want to find out a basic hourly rate for those regions. Unfortunately staying on per diem for most facilities requires working 2 to 3 weekend shifts per month so I don't see how that could work with working a full time job in Florida Thanks for the information though, it's well appreciated.

I am currently an RN with an Associate degree in nursing and working toward my BSN. I graduated in 2010 and work for a medical center as a float, with focus in med/surg, telemetry/pcu, rehab, bone and joint and occasionally oncology. Nurse patient ratios on day shift are 6/1 in med/surg and 5/1 on telemetry/pcu. I am currently making 36.80 an hour with overtime paid for anything over 12.5 hours per shift or over 40 hours per week. I love my job and where I work but hate living in NYS, primarily the winters. I am researching moving to Florida. I have my options narrowed down to the West Palm Beach or Tampa Bay area. Salaries and working conditions, i.e. nurse patient ratios, have been very difficult for me to acquire. If there is anyone currently working in these locations and in the same areas of care, I would so appreciate any information you could provide. Thanks!

By the way, if $ 3800.00 is the monthly stipend for insurance, you are seriously making out there considering most single pay insurance is about $500.00 per month! The top agencies I've come across, between Highway Hypodermic and other travel nursing websites seem to be Premier Healthcare Professionals, PRCS Healthcare, FlexCare Medical Staffing, Innovative Placements Inc., Trinity Healthcare Staffing, and Talemed. I have read in many a blogs though, it's not just the reputation of the agency but also your rapport with the recruiter. By nature, some will be more intelligent than others, some will be more aggressive than others and so the story goes with any position. I'm currently working with 3 agencies and will soon choose one for assignment.

Wow...you need to email me!! I work at a Middletown hospital as a float and worked Oncology often when I worked nights. I'm on days now and haven't worked your unit in months. :) We should talk about this. I'm pretty close to signing on with an agency!

That's a lot of great retirement investment information! Thanks Ned!

Well if your comparing apples to apples than you should have mentioned a traditional IRA because contributions are pre-tax just like a 401k. The benefit of a Roth? If I invest 10k and it grows to 1 million, I pay NO tax on the growth. Huge benefit. All your contributions toward a 401k is before tax, so any growth (and contributions) are taxed when take payments at retirement. In any event, with both a Roth IRA and Traditional, and CD's, and Bonds and so many other investments, I stand by my statement, that unless there is a company match of at least .50 to the dollar, a 401k is a money pit compared to other investment options. By the way, next time you get a chance, find out what your fees are on your 401k, cause a difference of 1% to 2% is roughly 50k over the course of 30 years with compounding. That's a lot of money. PS ..Not sure how much money you make, but I sure can't afford to contribute more than 17k a year to my retirement. I'm lucky if I am able to get 7k a year in mine. Really fantastic that you have that opportunity, but I don't think the average American is that fortunate.

You're absolutely correct. I was referring more to an individual who has never traveled before. The more flexible you are, the greater your odds for a fantastic assignment, and this, in my opinion should be key for a first assignment. Once experience has been gained (and confidence) than choosing a specific state/city is more realistic. I'm planning on my first travel assignment this August (lots of time to get my eggs in a basket) and my options are Washington, Oregon, Hawaii, the Carolinas, and Georgia. Maybe even Alaska. This leaves me LOTS of options. As I told my recruiter, I want to make sure I'm placed in a hospital that has an excellent reputation first, and then second, in an area I'd love to travel to. As far as reducing your flexibility, I think it can in fact do this. How? Well if you are a first time traveler and are stuck on traveling to California and get your license there before being placed, you are only going to focus on California. That, in my opinion, has hugely decreased your flexibility. You've just closed the door in your mind, of working in 51 other states. Why do this? Aside, no recruiter is going to offer a first time traveler a position where they have to leave in one week. That's just not realistic.

Just re-read it again and I still infer that anything over one year in the same location becomes your new tax base and you can no longer claim the travel expenses. Temporary assignment vs. indefinite assignment. If your assignment or job away from your main place of work is temporary, your tax home does not change. You are considered to be away from home for the whole period you are away from your main place of work. You can deduct your travel expenses if they otherwise qualify for deduction. Generally, a temporary assignment in a single location is one that is realistically expected to last (and does in fact last) for 1 year or less. However, if your assignment or job is indefinite, the location of the assignment or job becomes your new tax home and you cannot deduct your travel expenses while there. An assignment or job in a single location is considered indefinite if it is realistically expected to last for more than 1 year, whether or not it actually lasts for more than 1 year.

Sure looks pretty good to me! However you need to find out A: what your rent is going to be. If its 2000.00 and your stipend is 2000.00, well then there is no money to be made there. Your meals stipend seems generous. Your travel stipend of 700.00 seems fair, but keep in mind, this has to accommodate travel there AND BACK to your home base. Not sure what the 692.00 weekly tax free monies is for, but that seems substantial if it's just part of your pay. 2000.00 completion bonus is a real good thing. All in all, you need to figure out to the best of your "guestimate" what your expenses will come to and what you walk away with. Then add this to your hourly rate that they are paying you and see if it seems fair. I say the more in stipends the give you compared to a base hourly rate, the better, cause anything in stipend form is tax free!! P.S. I don't think completion bonuses are tax free.

Actually one thing many are missing is the fact that the LOWER your hourly rate is, the better for you. Here is why: If they are only paying you $12.25 an hour, that is all you have to pay tax on! I mean ya can't beat that! However to figure out what they are actually paying you per hour, you need to break down how much your rent will be, minus the stipend they are giving you. This might end up adding a substantial dollar amount per hour to your pay. The same with the healthcare bene's. If you already have healthcare and it is costing you $500.00 per month but they give you a stipend of $1000.00, well that's another $500.00 per month you need to break down into your hourly rate. The point is, with all your stipends and allowances, if you can still walk away with 30/40 an hour as a travel nurse, that is excellent because in reality, you'd only be paying taxes on the actual "hourly" rate negotiated. That tax savings could be substantial.

According to the IRS, you can work up to ONE year outside your taxable home base. Working 15 week assignments is a non-issue. Here is a link to the IRS website concerning this. Publication 463 (2012), Travel, Entertainment, Gift, and Car Expenses

From the research that I've done, Florida nursing is a bleak thing. Many travel nurse horror stories I've read have taken place in Florida hospitals and many of the "do not go to" hospitals seem to be in Florida and New Mexico. Now of course there are always exceptions to the rules, however all and all, I would stay clear of Florida unless there is a particular hospital you have in mind that you know is top notch. Just an FYI though, you are picking two of the lowest paying states for nursing, Florida and Texas.

There are no "free" benefits out there to be had. No matter the agency, all either give you a stipend if you have your own benefits, or they allow you to sign up under their insurance, in which case they will include whatever the charge is, in your hourly pay. So for example, if they offer you a hourly rate of $35.00/hr, $ 5.00/hr could be for your health benefits which means you will only actually be getting $30.00/hr in your paycheck. Make sure the numbers are clear to you before you sign on the dotted line. Now, as far as 401k, I've researched dozens of agencies and only one offers a company match, all the others just allow you to contribute to with your own money. DO NOT TO THIS. Never...and I mean never contribute to ANY, and I mean ANY 401k unless there is a company match. Why you ask? Because if you want to open up a retirement account, a ROTH IRA is the only way to go. A Roth IRA you can open up with ANY investment company, Fidelity, Schwab, Merrill Lynch, etc, however a 401k is only through your employer. What does this mean? If you leave that employer or just don't like the investment choices being made by the investment firm your company uses...well tough luck. You cannot withdraw that money in many cases without large penalties. Do you research on this one because 401k's are turning out to be one of the biggest investment scams out there.

Wow..that hourly rate seems very low, however that could work out to your benefit. Here is why: The hourly rate they are quoting you is the "taxable" hourly rate, which for all intensive purposes, you should get as low as possible. Less pay, less tax to pay! Now, as long as the monies left from your stipends (after expenses) contributes enough to your hourly rate to make it worth your while, then you're in great shape. So for instance, if your rent stipend is $3000.00 and your actual rent is only $2000.00, you get to pocket $1000.00 tax free. Add that to your monthly income and works out to approx. $ 6.17 per hour more. See where I'm going with this? Now,as far as YOUR stipend, you left out a few very important details. First off, where in NYC is the job? Manhattan, Brooklyn, the Bronx...where? And where are you willing to live and how far a commute are you willing to make. The reason I'm asking is because monthly rent for a one bedroom can vary from 2000.00 per month up to 8000.00 per month depending on where you are living (and how safe is the neighborhood). Are you willing to live in a studio instead of 1 bedroom, because that could make a big difference in how much of your monthly stipend goes in your pocket and not your landlords. 2nd, you never mentioned how long the assignment is for. Is the 3800.00 for the insurance stipend a "monthly stipend, or is a total stipend for the length of the assignment? Again, that would make a big difference in how much is left over that goes in your pocket as opposed to the insurance company. Keep in mind, RN's that work permanent positions in NYC or Long Island hospitals make upwards of $50/$55 /hr! Just something to compare to.

Unfortunately travel nurse agencies have saturated the market, which makes it daunting when faced with the decision of actually choosing one for your first assignment. Like one poster above mentioned, Talemed, which is rated very highly by Highway Hypodermics, was a horrible agency in her experience. Just do your homework to the best of your ability and go with the majority and be aware that there is still a chance things can go haywire. I've done lots of research on this topic and it seems the same top 5 agencies keep popping up on different websites. They are Premier Healthcare Systems, PRCS Healthcare, FlexCare Medical Staffing, Innovative Placements INC., and Trinity Healthcare Staffing. I'm in the process of interviewing with three of them and will make my decision soon as to which one I will go with. I personally would not get my license prematurely as the more flexible you are with your destination choice, the more valuable you are to the agency. Once a destination is determined, then they will help you gain your licensure in that state. Lastly, go with your gut feeling! If you feel like the recruiter you are working with is giving you the run around, move on to another agency. If when you read your finalized contract, it doesn't make sense, make sure you get it explained. And if it still doesn't seem "right." Do no sign, move on to another agency. In other words, trust your instincts because they usually never steer us wrong. Good luck!