RedBait

This is entirely correct. Pay and differentials are driven by and reflect the local market. They are NOT recognition of persons or their contributions or their jobs.

This is not an either/or situation. While the code progresses, an emergency c/section would be set up (there would be preparations to receive a poorly perfused preemie, as well). This is a very high drama situation, as you can well imagine!

I learned to start IV's in the '70's. And when, in the 80's we began to use Universal Precautions, I complained that I couldn't feel the vein and blah, blah, blah. A surgeon friend pointed out that if a surgeon can appreciate the facial nerve with gloves on, I could certainly feel a vein. I began by wearing sterile gloves for the best fit. In no time at all, I was completely comfortable doing any and all procedures in gloves. Now, I can wear any old gloves, any old size. I also said I could never start IV's without a Jelco, which is what I learned on. Needless to say, in these nearly 30 years, I have worked with and around a half dozen different brands and styles of angiocaths. If it is a choice between getting it on the first stick and exposing yourself to blood borne virus, learn to get it on the first stick with gloves. It is not a question of either/or. Really, it isn't.

CCRN means something. It means your nursing care "reflects an integration of knowledge, skills, experience and attitudes necessary to meet the needs of patients and families." Getting around the rules is not one of the desired qualities. This is the wrong gestalt. What are you thinking? How would you reply to a person who asks if there is a way to get around the clinical hours required to sit for nursing boards?

Quote: "A frequent med error made by the patient is to over use Timoptic drops. Timoptic (Isoptin) is the sam drug as verapamil and over use will cause heart block. I can't even begin to say how often I have seen patients needing temporary pacemakers to deal with this self administered drug error. " Timoptic (timolol) and Isoptin (verapamil) are NOT the same drug. Timolol is a beta-adrenergic receptor blocker and verapamil is a calcium channel blocker. Timoptic is the brand name of the topical ophthalmic preparation of timolol. Isoptin is one brand name of verapamil, an oral medication.

Bullous pemphigoid (BP) is a chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes. BP is a chronic inflammatory disease. If untreated, the disease can persist for months or years, with periods of spontaneous remissions and exacerbations. In most patients who are treated, BP remits within 1.5-5 years. Patients with aggressive or widespread disease, those requiring high doses of corticosteroids and immunosuppressive agents, and those with underlying medical problems have increased morbidity and risk of death. Because the average age at onset of BP is about 65 years, patients with BP frequently have other comorbid conditions that are common in elderly persons, thus making them more vulnerable to the adverse effects of corticosteroids and immunosuppressive agents. Treatment is directed at reducing the inflammatory response and autoantibody production. Although target-specific therapy is the holy grail for immunodermatologists, non-target-specific treatments are currently used. The most commonly used medications are anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone) and immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide). A recent article from Europe provided evidence that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids. This information was taken from an article found on eMedicine.com. It took me less than a minute to go there and search their database. It is a free site and contains massive amounts of information on medicine, disease, and drug therapies. Research is a good habit for a professional.

TV programs like ER promote/support just such a notion. If you wonder what you might do to change this, go to

First of all, don't give up this soon. It takes every bit of a year to be a free standing citizen in a new unit when first out of school...maybe more. The learning curve is very steep, the bedside is different than the classroom (I'm sure you know that well) and today's nursing programs are very thin on bedside hours. (I had more than 3200 bedside hours when I was graduated in 1976.) It is a tough job to learn the realities of bedside care and develop organizational skills at the same time. That said, you will learn them. Just give it a little more time. I have worked ICU for more than 22 years, and the only time I ever could count on a real lunch break was on units that build it in to the shift. We report off to a nurse, designated at the time of patient assignments, and leave the floor for an hour. Even on the night shift, we close the break room door. At the end of the hour...switch. Brief breaks for the bathroom, or just to take a deep breath...use the smokers on the unit as your models, don't they always manage to get away, you get away, too.

i wear calzuro clogs. they are rubber and go in the washing machine (they can be autoclaved). you can google them and see a variety of places to purchase online...i paid $60 delivered. but...you need to be comfortable in clogs.

You need a job in a CCU! Not trying to be glib. It would be more than useful to have spent at least a year working on a med/surg floor. It is worthwhile to have your basic nursing skills and organizational strategies down pat, critical care builds on a base of these skills. It would be more than useful to have spent some time working on a telemetry unit to aide your comfort around monitoring equipment. But, once you are hired, you will begin a preceptorship that will give you time to learn. If you would like a sample of the things you will be expected to master, surf around the AACN.org and SCCM.org, these are the major critical care organizations. If the unit that interests you, doesn't promise you support for your learning, find another unit. Critical care is a most rewarding field, I have worked ICU for 22 years and I have learned something almost every shift.

First of all, the origins of this thread are in the recent presidential elections right here in the US. We are not discussing the world, we are discussing this little corner of the world. Don't lose the frame of reference, it is important. As to the actions of many moral Jews, many moral people of all faiths and beliefs do not donate, I imagine, since only a few of those who might, do donate. The Jews I know (and that includes every member of my family and all my friends), are willing to donate...I have not discussed receiving. As an ICU nurse of several decades, I have had many discussions about the importance of organ donation (as well as the importance of having a designated power of attorney for healthcare decisions). I do not suggest it is immoral to refuse to donate. I merely claim there is not a religious basis for this refusal. And, once again, I hope those who will not donate, will refuse to receive.

Actually, in the Judeo-Christian world that we live in, here in the US, there are NOT many cultures and religions that don't believe in organ donation. In the 80's and 90's I attended many national Critical Care conferences that included distinguished panels of rabbis, priests, and ministers of many denominations that all agreed that there is no scriptural teaching that forbids cadaveric organ donation, and much moral and ethical writing to support it. That doesn't require anyone to donate. But I would hope that those who would not donate, also choose not to receive. JMHO

It seems to me that the difference lies in that here on allnurses, we are acting as individual persons without moral or ethical standards to uphold, other than our own personal ones. At work, we are paid for our professional services and operate in a therapeutic milieu and are obligated to forego our personal needs for a patient/family centered needs base. Do you want me whispering in your dying ear that there is no afterlife or heaven and I hope you have made your life worthwhile and not wasted it waiting for a greater reward?

Your hospital has a list as part of Policy & Procedure. Unless you work ICU, where the patients are monitored, you may assume that NO meds are IV push.

Thanks so much for the complete and concise review of blood and blood products administration. I would only add, that when you have a particularly fragile patient, one with a history of flash pulmonary edema, for example; get an order for the blood bank to split the unit which will buy you a little more time. You could give the first half in two hours and then wait to pick up the second half until diuresis can be accomplished. The blood itself cannot go in slower, because opening the unit to repackage it reduces it's "safe" life, just like pooling units does, but you can space out the delivery times and minimize the risk of overload. In theory, it could be divided into three or four aliquots, but I have only seen two.

I am a hospital prepared diploma RN who trained for a blue collar job, makes good blue collar money (about $100K/yr with OT opportunities and special work agreements), is happy on my feet for 12 hours a night in the ICU, is as proficient at wiping bottoms and making beds as running an IABP (or all at once!), demands and gets a collegial relationship with all on the team, and has learned and honed my skill every day of the 28 years since I was graduated. I never go home clean, my scrubs are too full of my job to wear in my car, my shoes never walk in my house. What master's prepared nurse will do my job? How many master's prepared nurses do my job now? Let's get real, I have learned my skills by my own drive, I have respect because I have earned it, I am part of the team because I insist on being part of the team. It's an internal thing, not a piece of paper. And the work is hard work (and important work), ask anyone who is in the first year out of school. Nurses don't need more external anything, we need to get off our collective behinds and become political activists in our own cause. Start by reading the threads in the political forums on Allnurses. Don't fail to know the candidates (especially locally), vote and make sure your elected officials know how you feel about issues important to you and to nursing. Do not mistake the edge of the rut for the horizon!

Don't forget to look at CRNA employment at Tripler. The fed gov pays the highest prevailing wage and on Oahu, a 25% cost of living allowance that is fed tax free (for me, that adds about 35% to my usable income). Tripler hires RN's direct. When you are ready, email me privately and I'll give you the name of the person to call, it changes periodically. I live in a very big house that I could not afford to buy, but I can afford to rent (about $1000 a mo/$260K of market value). I live on the East side of the island and up on a ridge with a view of both ocean and mountain and cool evening breezes. I'm a former Chicagoan, so I value the mountain view...well, it's a mountain to me! I also can see Diamond Head in the distance. The bus system is truly fab. It goes everywhere and many can take advantage of the Express Bus. I work nights and weekends (night diff at Tripler is 10% and weekend diff is an additional 25% of base) so traffic is only half the issue for me that is for others. The morning commute home is pretty bad coming through downtown, but I go Windward where the traffic is nominal in my direction and the beauty is endless (or am I high on tired?). It takes me the same amount of time but is safer for me than the slow stop and go of the downtown route. Costco and Sam's are here, but you will find the farmers' markets a very good value, and the fish and produce in the Chinatown area are good and cheap (relatively speaking). Fuel is leveling out at $2.25 for reg. Home schooling is popular here and you can connect to many families that do it. The haoli issues exist, I've not had trouble on the street (but I'm a pretty harmless looking grandmother) or the beach. I have friends who have been made to feel very unwelcome as RN's in some hospitals, but Tripler is not local. The military has issues with the locals (I take care of some of the worst ones in Tripler ICU), but drunk is always part of it. There is lots more, when you're ready, please email me. Charlene Taymor [email protected]

Well, I admit, I had to look back at my post LOL. I meant, in my obscure little way, was that in the beginning we might think one route of entry is better than another, but in 20 years we will all have probably seen and done it all and our training beginnings will be long behind us. BTW, I have not been held back from management opportunities. I have not moved into management because I'm not a manager and don't want to be one (I make way more money than any of my managers because I can take advantage of overtime and special pay incentives). I have taken a strong role in staff development, however. I'm 60 and no retirement in sight for me. My pensions, social security, and individual investments would produce about 50% of my present income. If I could live on 50% of my income, I would be doing it now! No, I will have to continue to work in order to support the lifestyle I choose to live. I'm just not a simple girl...but I am willing to pay for it myself...and I do get to do something I love and am very good at...that's pretty lucky.

Of course, you took the NCLEX-PN, not the NCLEX-RN (taking the same NCLEX as everone else), but I wonder what state has so many nurses they can exclude LPN's? As for "stereotypes" for LPN's, I work for the fed gov at a military hospital and LPN's there are of every description. I did not know there was a type. I am an RN, I work ICU, I have a diploma, no degree of any kind, I have 22 years of ICU experience, I work with LPN's, but we do not do exactly the same job.

I have been a nurse since 1974 and I have never signed anything, not a contract, not a work agreement, nothing, and I don't know anyone who signed anything, either. Moreover, I have lived in "at will" states which means they can hire me because they like the color of my hair and fire me when they no longer like it. The only limits are those regs of the OEO and ADA: age, race, sex, ethnicity, disability, etc. But, technically, the number of pierces that are visible, as only one example, could be a deal breaker.Check out the laws and regulations that apply to you in the state that you practice. You should be more than familiar with them, and the Human Resources P&P of your institution. I got job offers in writing, to include job title, start date and hourly rate of pay. It didn't promise me 1+1/2 overtime pay, it didn't say I wouldn't float, it didn't guarantee me hours if the patient census/acuity fell. My overtime pay status was governed by the FLSA and it is those regs that are now changing. Try this website for info from the "mouth" of the DOL: http://www.dol.gov/esa/regs/compliance/whd/fairpay/main.htm Before you feel sure you are going to be compensated for overtime work, be sure you can define "exempt" in your case.

Where is your preceptor? Where is your manager? It sounds like you have been tossed into your assignments alone and without assigned supervision. You might feel better and do better with a more formal, more supervised, internship-like transition from student to independent practitioner. Look for a more structured program for new grads. Talk to your manager and see if your hospital has such a program. Look at other hospitals in your area. But stop torturing yourself and cheating your patients. This road will lead you to despair. Don't deny yourself a good shot at a wonderfully satisfying profession. You've put in the study, now find the best transition to patient care for you. Don't delay.

Actually, there are several good studies (one paid for by the Robert Wood Johnson Foundation) that suggest that working environment issues are driving nurses in droves from the profession. Two years ago, I heard that fully 30% of all RN's under 30Y/O were planning to leave nursing by the end of that year...not the bedside...altogether. What all this boils down to (IMHO), is that people choose nursing because it is a well thought of profession by the general public. Nursing school certainly must still fill your head with the importance of the work. Then you hit the floor...the patients and their families vent their frustration with the system on you, the doctors treat you like a fixture without a brain, and the hospital treats you like meat...expensive meat, at that. No wonder nurses run for the door!

I work in ICU where most of my patients are on several high powered antibiotics (gorillacillin) and their natural flora is pretty much gone which makes them susceptible to yeast infection. Powder is starch. Yeast eat starch. I don't use powder.

When I did barb coma, the patient was 1:1...continuous EEG to monitor burst suppression and titration of barbs, PA catheter for hemodynamic monitoring, usually pressors titrated to cardiac index, vent with close pCO2 management, careful maintenance of euthermia, probably a devastated family at the bedside...yup, that's a 1:1 in my book.

I am familiar with the notion of lightening the barbs every day and seeing what the ICP does...you can always put them down again. I once heard a trauma doc say that more than five to seven days only produces more patients in a vegetative state, but, in practice, I have not seen a limit set and kept. What happened to your patient who was down for almost three weeks?