nicholaa2

I think it depends on your hospital. I work in an "acute care" hospital and this is the difference for me evening vs. night: The night shift on a "good night" means you have plenty of time to do pretty much whatever people do with free time. The patients are sleeping and you only have basic documentation and chart reviews to do. When things do get crazy, they get REALLY crazy and trying to admit someone at 3 in the morning if they aren't wide awake and manic is hard - especially since I'm on a gero-psych unit and the elderly have odd sleep times as it is. PLUS the elderly have tons of sundowners and often have nights/days mixed up and so they're trying to get out of bed, confused, etc. Evening shift = patients still awake and needy, families coming in and being demanding, doctors still finalizing rounds and writing orders, typically a MUCH busier shift for me - non-stop movement and very little "free time", admissions come up the most this shift and the evening goes a lot faster, but I am often feeling a little more frenzied at the end of the shift. I think however that if I could work evenings, I would - but unfortunately evening shift isn't a great shift for being a mom, which is why I have chosen to be a third shift nurse. I would love to sleep in late (still sleeping the night) and not have to be up for an early shift. OH - but the pay differential is always nice too... more money and overall less work, but as many have said, you run the potential of having a messed up sleep cycle and supposedly we "age" faster working nights.

Hi all, I'm considering a change from psych nursing to dialysis nursing, but I wanted to see what clinical skills are expected to be a quality dialysis nurse providing OP renal care. The job description seems VERY vague: "The registered nurse is responsible for performing patient assessments, establishing care plans, advising patients and their families, implementing and evaluating nursing treatment, and administering medications." What's a typical shift like? Do you start IVs or do most patients have their access already? Is it more being able to monitor vital signs and understand fluctuations from baseline? I'd love to hear what a typical 8-hour OP Dialysis RN shift might be like (granted, I understand no two shifts are the same!) Thanks in advance :)

Thanks to both of you, and Ned, your posts are always so chock full of good information! I am just worried that when I see my per diem rate for this county on the IRS website as $77 + 46 ($123/day) that even if you multiply it by 7 and divide by 5 (5 days of 8 hours), that comes to $172.20 a day and they were quoting me $228.16 as their per diem rate. That and laying out the $8/hour actual wage rate and I can't help but think they are skirting some laws somewhere. I know a 50-mile radius isn't set in stone, but that also worries me since most times I would be commuting back and forth to my apartment where I currently live (which is I believe is considered my "tax home") - it doesn't seem like I am even really qualifying myself to receive the travel nurse reimbursement if I am not staying up in the city where I am working. UGH - so, I emailed the recruiter and questioned these figures and she sent me back another proposal with a new amount if I wasn't going to be a "travel nurse": [TABLE=width: 100%] [TR] [TD=class: cellLabel]"Gross" Shift Pay:[/TD] [TD=class: cellText]$292.80 [/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel]"Net" Shift Pay:[/TD] [TD=class: cellText]$279.82[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel](Per Diem):[/TD] [TD=class: cellText]$162.96[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel](Taxable Wages):[/TD] [TD=class: cellText]$99.84[/TD] [/TR] [/TABLE] *My compensation package is based on the fact that I have Not selected the option to 'relocate' during this assignment. So now I would be making $12.48 an hour (oh big difference there!) and the per diem still seems higher than IRS guidelines even though it says I am not "relocating" Why do I still feel like the company is somehow taking more of a % than they should be? Or that they're skirting the laws? Maybe it's my psych nurse experience giving me paranoia... but I just don't like seeing an hourly rate like that. I make $30/hour at my permanent job or $240/shift with PTO and benefits, and this contract with wage and per diem would only have me at $36.60/hour without PTO, no real benefits, no guarantee for extension and I would be driving 75 more miles round-trip which if I could IRS charge the mileage, ends up almost negating the $6/hour increase over my current pay rate, not even considering the actual drive TIME 75 miles adds. This just doesn't seem like it's really that much better of an offer than my current/permanent position. I think they're holding out on me :)

It's so funny I just came across your post because I too am a psych nurse and I do love it, but I have grown increasingly frustrated with the way my floor is run (i.e. management/physicians) and I have started researching dialysis nursing as a possibility. I also do not have actual med-surg floor experience, but my psych floor is the ECT/gero-psych floor, so there are a lot of patients with medical co-morbidities and so I do feel I'm not just a pill pusher/paper trail girl. Have you made any decisions? I'd like to know what you ended up doing :)

As I research travel nursing and read this forum and all the information on compensation, I can't help but be afraid of accepting a contract just because the overall numbers look good, especially since I have always had simple tax filings with no fear of audit. The job I was currently looking at appears to be one of the "too good to be true" positions, so I wanted to put the figures out there and post the comments the recruiter made to me to see what the experienced travel nurses have to say. [TABLE=width: 100%] [TR] [TD=class: payHdr, colspan: 2]Contract Shift Pay Detail[/TD] [TD=class: payHdr, colspan: 2][/TD] [/TR] [TR] [TD=colspan: 2][/TD] [TD=colspan: 2][/TD] [/TR] [TR] [TD=class: cellLabel]"Gross" Shift Pay:[/TD] [TD=class: cellText]$292.80[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel]"Net" Shift Pay:[/TD] [TD=class: cellText]$284.40[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel](Per Diem):[/TD] [TD=class: cellText]$228.16[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [TR] [TD=class: cellLabel](Taxable Wages):[/TD] [TD=class: cellText]$64.64[/TD] [TD=class: cellLabel][/TD] [TD=class: cellText][/TD] [/TR] [/TABLE] Additional Benefit: You will receive a healthcare stipend of $358.80 for this contract paid out at $0.69 per hour. *My compensation package is based on the fact that I have selected the option to 'relocate' during this assignment. (I am not relocating, I would be driving ~95 miles round trip daily) Those figures are for 13 weeks, 8 hours a day, 5 shifts a week and as I told the recruiter, it looks like I am only making $8 an hour officially because the majority of the money being paid to me would be per diem and not taxable wages - one of the "too good to be true" offers. I was under the impression that the per diem couldn't go above the federal rate, which for this county is $77 lodging, $46 incidentals - but maybe I don't understand the rules. I do tend to over-worry about everything, but I keep reading if it sounds too good to be true, it probably is... so I am hoping I can get some info, tho I am reading through the help posts here again to try to decipher it.) Here are some quotes from her: "They tell us how much per diem we can pay in a week and divide it by the number of shifts" "For 5 days of work you will get two deposits one for the wage amount 64.64 x 5 $323,20 - $228.16 x 5 1140.80" (So here she is saying I only get $8.08/hour and the rest is per diem. I don't like hearing that...) "Lawyers worked it on based on what we can do via the IRS and we have been paying this way for over 17 years." "We have never had a nurse audited we have nurses that have been working for us for over 10 years they file their income tax " -- I actually went and filed an application directly with the facility because I feel that this agency really is trying to sneak around the IRS and pay less taxes and I don't want to be the one that ends up with the tax liability and audit.

I work on a geri-psych floor and you basically get the "best" (depends if this is your cup of tea, then yes, best is probably the right word) of both worlds -- an elderly patient with the standard plethora of medical co-morbidities and then mental health issues - or more likely dementia / Alzheimers on top of their medical concerns. 9 times out of 10, my elderly patient does not have any other mental health issues other than dementia/Alzheimers and it is very frustrating for those of us who really wanted to work psych with a "cure/fix" (such as depression, bi-polar) and sadly, there is no cure for dementia/Alzheimers. It's just continual re-orientation, re-directioning and watching patients who don't even know their name or how to go to the bathroom anymore and make sure they don't fall with every step they take or they don't wander into the room of a young, hallucinating/psychotic patient. (Obviously I am looking to get OUT of geri-psych, so take my words with a grain of salt...)

I have become so frustrated lately because it seems like many of my patients are not being appropriately diagnosed or treated. I know I'm not a psychiatrist and of course do not have the ability to diagnose, but when I have long-term patients (100+ days) and repeated frequent fliers in an "acute care" treatment facility, I can't help but begin to think these patients are being played for monetary purposes and insurance billing. I work on an ECT floor, and I always thought that ECT was typically left as the last resort measure for treatment, but I see people being admitted for their first psych breakdown, and the doctors are often in a huge a rush to get them to agree to ECT without even attempting medication stabilization and therapy. I see patients getting ECT that suffer from dementia/Alzheimers/are 85+ years old, and I am told they get ECT only to control their level of violence/agitation. I see people who clearly are borderline or another personality II disorder and they too are getting ECT with NO IMPROVEMENT after weeks and weeks of treatment because they aren't getting the in-depth behavior therapies that are so needed. I see patients who clearly do NOT have mental capacity and the ECT staff rushes in and gets consent to treat and off those people go to get zap zapped and I can't help but think that they have no idea what they just consented to do. How on earth do I not go crazy myself? I literally cry when I get home out of the frustrations of feeling like I can't do anything and these people keep returning time and time again - wanting (and getting) their narcotics, their benzos, their sense of entitlement and demands being met - all because they've got insurance and can pay. (Okay - thanks for letting me vent - please, any suggestions would be greatly appreciated)

You make a lot of wonderful points, but what we have to remember as nurses is that we are not the prescribers, not the doctors responsible for deciding what prn medications to order/give and our patients typically know exactly what meds they have available and how they are able to manipulate the staff to get their meds (acting out, threatening, other personality II responses, etc.) Quite often these patients are also somaticizing so much that they really have created legitimate pain and anxiety from getting themselves all worked up and yes, often it would take a prn that we know will not officially "fix" their complaints, but rather fix their somatic symptoms. My issue... see a post I am about to write - is that I am getting so frustrated with acute inpatient facilities rushing to over-medicate or over-treat the mentally ill patient (such as jumping right to ECT), especially on patients that clearly need therapy more than anything else. I mean really, can a borderline personality patient be fixed by giving them bi-lateral ECT 20 times? Hardly... Yet, I am seeing this more and more - guessing since ECT is such a $$ making venture. It really is a pick your battles scenario, especially if you don't have the support from the rest of the staff at setting limits and/or the options for secluding/stopping a patient that is willing to pretty much do anything to get the meds they're seeking.

Thanks everyone for your answers. I spent all last night up and reading this forum and going to a variety of mentioned sites to look into options. I may definitely be able/willing to do the 2-week cycle (Th/Fri/Sat - Sun/Mon/Tues on) - and I am also talking to some travel nursing groups that place in 2 hospitals that I could theoretically commute to for the 8-13 week assignments (if I can stomach 1.5-2 hour drive times - uff!) I have given my name/information to a few of the recruiters listed on a travel nursing central site and let them know exactly what it is I am looking for and who knows, maybe I will be able to make my dream come true :) I'll keep everyone updated.

I should have considered that orientation would be obviously a huge time killer - ugh, what mind-numbingly boring material. I'm not sure the ex-husband would ever agree to changing the custody agreement to do 2-weeks on, 2-weeks off, so I am beginning to think I just might not be able to do this for a few more years yet. I guess what I was hoping to do in a perfect traveling world for me specifically is to have a hospital be willing to have me there every other week. I could work a week, come back for a week to be a mom and work per diem at my local hospital - and then go back and work another week at the same hospital, etc. Yeah... not a likely option. I'm sure I'm just dreaming. But oh how I wish...

With the influx of opportunities in travel nursing, I was curious to see if there has also been an increasing need for more variety in assignment lengths to be able to fulfill the ever-changing scheduling nightmare many of us professional parents encounter. I have custody of my children every other week, requiring me to maintain a residence in their school district so they can maintain educational continuity, but for the weeks I don't have them, I would love to be able to pick up and go to a variety of locations to work for that week, but it seems like most travel assignments are still at least 8 weeks if not the standard 13-week. Anyone know of 1-week long opportunities or a company that is very flexible in helping traveling nurses find their dream jobs? Thanks!

Took the test Monday, kept trying the trick and kept getting the message saying that I couldn't re-register. Paid the $7.95 fee just now and it said I passed.

I don't know how you guys even remember what kinds of questions you had. As soon as the screen shut off for me at like 85 questions, I couldn't have told you a single question that was on there. All I know is that they seemed to be *harder* than the Kaplan questions. I had 0 math calculations, no dragging the events and putting them in order, no clicking on a picture. I think I only had 1 or 2 SATA. But, when it didn't shut off at 75, I really did get a heightened level of anxiety set in. Came home, went to Pearson website, saw that it was "Delivered", and so I tried the trick, and it's saying it can't be processed, so I am keeping my fingers crossed. Will check the NY BoN tomorrow and see if my name is up. Thank goodness for reassuring forums like this one!

Well, I got 85 questions and it shut off. I tried the "Pearson Trick" and went to the website to register to take the test again, and I got the message saying that I couldn't. Supposedly that's a good sign. I will keep checking both that trick, and seeing if the BoN posted my license. (Wasn't up yet, but it is after 5 pm afterall) Thanks for the moral support!

Warning: This post is mostly me just ranting. I feel better that I can post my complaints here where some people might understand and feel my pain.. :) --------- I've never been someone that's gotten overly anxious about exams. I had to take like 5 or 6 exams to pass the NTE (teaching exam) and then do similar tests specifically for NYS. But, here I am, my NCLEX is Monday at 2 pm, and I'm completely freaking out. I'm so frustrated by Kaplan, that part of me thinks I should just stop studying. How much more can I possibly learn in 2 days by crash studying? I can't score consistently on anything I am doing. I've done qtrainers 1-4 so far and 2 qbanks. I've gotten 65, 53, 56, 52 on the qtrainers and 58s on both qbanks. But the problem is, nothing stands out as being an area that really needs help more than another because if I get an 80 on the Pharm section on one test, the next test will be a 47 - and then back to the 70s, and then the 50s. If I did great on the Pharm section, then I did badly on the Health Promo (or whatever else). But the scores are up/down/up/down - I just don't get it... And then this last question... I don't get how a woman who is "newly diagnosed with lupus" and is asking about getting pregnant has Kaplan saying the correct answer is the nurse asks her how long she's been in remission... If she's newly diagnosed, how can she also be in remission? *scratching head* Oh well, I am reviewing, reviewing, reviewing... and more questions. What else can I do? :-/