drivesbarefoot

Our unit is unlike any other inpatient acute unit I’ve worked at in the past mainly because we continue to run newly started ESRD and AKI patients as outpatients who have been discharged. (Our unit is part of the hospital, we hospital staff and not run by either of the big 2). The ESRD patients and sometimes AKI patients eventually get placed in outpatient units but it sometimes takes weeks and even months. When our acute inpatient load gets heavy, it makes for a difficult day to say the least because we have our resident outpatients. Plus our site manager needs to spend so much time working on outpatient placement, monitoring URRs and other chronic monthly labs, care plans, etc but yet is expected be a resource, do patient care every day she works and also take call. We had 9 full time RNs but because of all the challenges with healthcare in general these past couple of years, we are down to 3 core staff RNs and utilize travelers. We also have a great group of LPNs and CHTs. We are about to lose another core staff RN (in this case our site manager who has managed to do a great job but is at the end of her rope) and this will definitely throw us into crisis staffing. I’m curious, anyone in acutes run outpatients as their “home” unit until placement? And what are your site managers typical duties in a “normal” acute inpatient unit that doesn’t run outpatients? Also, are there any independent hospitals that offer great incentive call pay? Sorry this got long and thanks for your response in advance!

I had the covid vaccine and am not anti-vax. But the healthcare staff I know of who have chosen, at this time, not to get the vaccination have made their choice based mostly on the fact the manufacturing drug companies of the vaccine and the hospital have no liability if injured by the vaccine. They feel it’s just too new. Other mandated vaccines have been around a long time with short term and long term adverse reactions well known. Others had a bad experience with vaccine #1 aside from the usual common reactions and afraid to get #2, one example is Bell’s palsy after the 1st vaccine, and another person had Guillain-Barré after a flu vaccine so she feels she’s sensitive to another potential autoimmune reaction. Either may have happened anyway for some other reason, but they are afraid and I totally emphasize with them. Now being mandated, it doesn’t seem right to force people to get a vaccine they have made the decision not to receive at this time. For me this isn’t about the vaccine so much as it is about how this is opening the door for many other mandates down the road. That’s what scares me the most.

Many years ago I had an elderly gentleman and reminded him he must save his bowel movements and explained about the “hat” we had placed in the toilet and to call when he did. The shift was almost over and he hadn’t called about it. He was a little forgetful and I thought maybe he forgot to call or whatever. I went into his bathroom and he had stool in the hat but also a little in an empty coffee cup, a bowl, a plate and some neatly wrapped up in a napkin, all balanced precariously around the bathroom. Compared to other stories here this one is pretty mild!

I'm a traveler and my last two assignments were great! But these were NOT the big two, that changes everything it seems. My first assignment I had up to 10 patients and 3 techs. I was responsible for doing pre and post assessments, double checking machine settings and passing meds. When it was put on or takeoff time I helped put patients on or off and when the enivitable problems cropped up there was a dedicated charge nurse who doesn't have a patient assignment and is available to help with an emergency. My next assignment I'm responsible for never more than 8 patients and again I'm expected to jump in and help take patients on and off but it's not in a mad rush manner, and no one seems to be running around like crazy trying to keep up and not get behind, everyone pitches in. Then I do assessments and pass meds. It's relatively low stress because once again there is a charge nurse who is able to lend a hand for problems that come up and both places had awesome PCTs. There is plenty of time to get the work needing to be done and we always are able to take a break. There is even time to sit down and catch up on charting in a normal non stressed manner. When I worked for the big D and then the big F it didn't work that way. There was "the wave" model of putting patients on so it seemed like put on time and takeoff time lasted for hours, there was never any lull to regroup and get your next rest, catch up on orders or paperwork before things started happening again. This makes for very long and exhausting days when by the time you go home you don't have the satisfied feeling of "I had a good day!.... ever. That extra paperwork never got done during a normal day. Nurses were coming in on their days off to catch up on POC's and other extraneous stuff we were expected to do on a monthly basis. it seems the nonprofit hospital run outpatient and inpatient places are the best places to work. As a traveler if I can keep going and not ever have to work for the big two ever again I think I'll remain happy in dialysis.

As an RN in dialysis, there have been times I need to do bleach, and yes you do get spattered with bleach at times. For me it usually ends up at the bottom of my pant legs. It always seemed to happen when I was wearing new scrubs too! Since bleaching is usually scheduled for a certain day of the week, I just make sure on those days I wear white pants. No big deal getting bleach splatters then.

It's the same for me, I kind of pigeon-holed myself into the dialysis specialty and have applied for other jobs but no luck. I work in acutes and I do love it, never get bored with it because you don't have the same day twice. Stressful... Yes! What helped me is I cut down the hours I work. That combined with low census days has helped tremendously. I still get benefits. If you are willing to take a $10/hr pay cut, maybe cutting down hours will be the break you need and you will find you still do like dialysis. After doing it for so long you are an expert and have so much to offer! Cutting down hours helped me clear my head a bit and now I have a much better work/life balance.

I'm curious about acute nurses who are contracted to cover multiple hospitals. What is the farthest distance you could end up driving to go to work, and what is your call response time for the distant ones? Also, does you company pay you travel time and mileage when you have to go to a distant hospital? How many hospitals do you cover and how many nurses are on call each evening/weekend? Just wondering because we may have to start driving to another hospital which is an hour away. No one asked us if we were on board for that, they just assumed we would do it and now the contract is signed.

They run big, the pants are too short for me but I'm tall and have to wear size tall with any scrubs.

Good point, NedRN! I hadn't thought about how it wouldn't cost extra for the facility. I know some fellow nurses my age tried to switch jobs or specialties but despite all their experience and excellent employment history, were not hired - most likely because with their experience they would be paid more. I'm really excited about the travelling possibility hoping things work out and I'll be doing it soon. I'm ready!

Hi all, I'm considering travel nursing as it's something I always wanted to do. My field is dialysis doing acutes and I used to work at a place where we had lots of travelers filling in and I always loved hearing about the places they had worked because I like to travel too! It's kind of been on my bucket list. My kids are grown and I'm not married, it's just me now and I feel like taking off and doing this. I'm 56 years old, don't feel my age has limited me the least in my job and I have many years experience in my field. I'm just curious if there are many older travelers out there.

Concentrate on finishing school, don't look for another job right now. Stress is not worth it. You want to be there for your family and you want to finish school with your full attention geared toward that right now. Adding a job to the mix, and especially if you consider taking any nursing job - there is the adjustment to a new job which could possibly use up every last reserve you have, not to mention if you take a job that really isn't what you are interested in but take it just to have a job. It isn't worth it! I know because I have stretched myself too thin and now I'm not able to be fully present and there for the people I love at home or do my best job at work. I have two jobs... took an extra nursing job I didn't think I'd like... big mistake. Plus I feel I'm internalizing this stress and it will affect my health. You don't want that to happen. Just stick with what you are doing and when it comes time to find a job after you graduate, you will be fresh and new, motivated and future employers will recognize that.

This was so touching I have tears running down my face. Thank you for sharing this wonderful experience.

This isn't really a ghost story but something that happened that's a bit supernatural. I had a patient in the hospital that had a liver transplant with lots of complications but things were turning around in her favor. She had an elderly mother in her 80's and it was hard to see what this devoted mother was going through with all her daughter's complications. I had the patient that night and made my final rounds before the next shift came out of report. This patient was doing fine, she had an NG amoung other things and everything was fine there. I went to sit at the desk and the phone rang at 11:30 pm the minute I sat down. It was the patient's mother and I thought it was very strange for her to be calling at that hour. She asked "is my daughter doing ok? I just woke up and thought I'd call. I'm sorry to bother you nurses this time of night." I had just been in the room and assured her that her daughter was doing well. However I went to check on her daughter because I had a weird hunch something was wrong. I walked in the room and saw immediately her NG bottle was full of bright red blood. If the mother hadn't called I would not have gone in the room one more time and the next nurse might have rounded on her last since she was at the end of the hall. This patient ended up pulling through that and eventually went home in good shape.

This was a number of years ago so I can't remember exactly what this patient had going on, but I do remember he was a DNR and had cancer. He was afebrile at the beginning of my shift and had been afebrile previously. Judging by respirations he was not going to last more than an hour at most. He had no family there or anyone who was coming and I held his hand. His hand suddenly became quite noticeably very hot - I checked an AXILLARY T and it was 107! Then he expired very shortly after that. I often wonder if other nurses have ever noticed right before their patient died, this kind of thing happened.

Anyone wanting dialysis experience, check out Alaska. It seems they always have an RN opening and they will consider new grads. I don't know what new grad pay is, but I was up to 37/hr when I left, and then $41 when I went back to work for a few months w.o benefits that time. Alaska doesn't take out state tax, plus if you work anything over 8 hrs its time and a half in the clinics for anything beyond 8 hrs. Doesn't matter if you work only one day that week and not 40 hrs. Anything above 8 hrs is time and a half! That extra $ sure comes in handy... The hospital pays up to $48/hr in acutes.