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If you're thinking about moving from a union state (like Minnesota, California, New York etc) to North Carolina to be a nurse, tread carefully. Have you looked into the salaries there? I started as a nurse in Durham NC a few years ago, and the pay was absolutely terrible even considering the lower cost of living. Also, in addition to mandatory OT, you might also be stuck with rotating day/night shifts, being floated to units where you have no idea what you're doing, having your PTO days cancelled - they can ldo just about anything they want. Don't take that employer statement as "just a formality." You shouldn't apply for jobs there unless you're actually willing to do it (or have no choice). The PTO and benefits are also probably worse than what you're getting now. Not to be overly gloomy but if you've always been in union facilities and union-friendly states, you may be very unpleasantly surprised in North Carolina (or any states in that region, actually).

Yep, they've been all valid tests (same experience here, it's really 7-8 drops needed, and the solution always runs out before the kits!!)

I know, it's crazy. I was convinced it had to be a bad box of the BinaxNow tests...but, nope, we switched boxes with the same results. Not expired, haven't been out in the heat or anything. And the ones coming back *positive* (the pooled tests) are mostly done by students - the follow up ones coming back *negative* are all done by RNs - all of us are doing firm vigorous twirls. Having a budget/supplies for PCR testing would be logical, but I suspect it's not possible here. I guess the options are for the school nurse to re-test for the next day or two, or to call parents and send them out for PCR.

Thanks for this!

@Jedrnurse No, the setup for staffing (the schools get funding for outside help) is two consecutive days. So on day 1, collect the pooled specimens; get the results overnight; day 2 is for antigen followup on positive pools. I don't think they have the ability to staff for a third day - the school nurse would have to do it, and they're already so overwhelmed.

@k1p1ssk Interesting! Ours are all nasal swabs though (Concentric by Gingko also).

I've been helping a school doing pooled testing (through Concentric). The protocol is to do pooled tests that are couriered to a lab for PCR, and then we follow up on any positive pools with individual antigen tests (BinaxNow) in the hopes of immediately figuring out who triggered the result. We've had positive pools by PCR multiple times, only to have every single antigen test in that pool come back negative. In one case, one of the students became symptomatic two days later, so I assume she was brewing an infection and just didn't have enough virus in her nares to trigger a positive result. But on all the other ones - nada. We've double checked the expiration etc on the Binax Now, tried using a different box of tests to immediately re-test students, triple-checked the protocol, had the nurses collect the samples rather than the students, meticulously rechecked every step of the process in place...but, nothing. Positive PCR, negative antigen. I would expect this to happen sometimes just due to the difference in sensitivity between the two tests, as in the situation I described above, but I wouldn't expect it to happen almost every week. I wouldn't expect those all to be false positive PCRs. And the pools coming back positive do NOT include any kids with a COVID diagnosis within the last three months, so I don't think we're catching coronavirus RNA scraps from a previous infection. It's really frustrating, and the school is questioning whether it's even worth the time/money to test. There's not a way for the BinaxNow swabs to reflex to PCR testing - they'd have to send all the kids home to PCR test in clinics or pharmacies. This makes sense conceptually and clinically, but is also likely to seriously erode parent support for the in-school testing. Is this a common problem? Does someone else use a better protocol? How about you @JenTheSchoolRN?

I'm curious about where you live? Because in my area (AZ) they are begging for school nurses just about everywhere. Definitely no need to get extra certs or take a grantwriting class to be a competitive candidate here. There are shortages always, but this year it's crazy - so many people retired or quit due to COVID.

I've been trying to get a outpatient job for a while, and have finally succeeded in getting hired in an internal medicine primary care clinic. The staff is just RNs, doctors, a receptionist, and a manager (no MAs or LPNs). I know I'll be helping the docs with Epic inboxes, voice mails, setting up needed scripts for them to sign off, and similar administrative-type tasks I'll need to learn in training. I know I'll be rooming, going over histories, turning over rooms, giving vaccinations. I would guess that a lot of patients in this particular clinic are older adults, and I would expect to see CHF and other heart disease, kidney or liver disease, hypertension, GI and respiratory complaints, the regular bread-and-butter stuff. What else do you do in this type of setting? What will I need to know? Just trying to think of how to prepare.

oh h*ll no! "Ma'am, I invite you to do so. Virtually every district in this state has multiple openings for nurses; in fact there are a critical number of unfilled positions. You too can enjoy these conversations for this salary!"

Thanks for the info, that's helpful! I already got the BC license - it took about a year and a half for me. I guess I was lucky. I passed on this particular job, for more than one reason. Among other things, most of my experience is in public health rather than acute care - not sure I'm willing to go back to any hospital in any country, let alone a setup with that rotating day/night schedule (which still seems unnecessarily painful to me, but kudos to the hearty Canadians who can handle it).

I even wore them for a while as a school nurse!. I had never used one before COVID, and I was surprised at how practical it was to have all my hair tucked in. No breakage from n95 elastic straps ripping out hair, no hair falling in my eyes, and no headaches from tight ponytails or buns.

I am not an ICU nurse and never have been - so maybe I don't know what I'm talking about - but I'm pretty sure that you're fine. At least where I live, there is a desperate shortage of hospital nurses and especially ICU nurses, even ICU nurses with relatively short experience like yours. That's probably why they're "allowing" you to go PRN with less than a year of experience. THEY need YOU, not the other way around! My experience is in public health and schools. My last hospital experience was 3+ years ago. When I briefly got the idea to apply for hospital jobs recently (I quickly changed my mind!), the only questions they asked were, do you have a license and are you breathing? Recruiters are desperate. I don't think you need to apologize for how many (or few) shifts you plan to pick up. I don't think you need to apologize if you're looking for another job. Take care of your family situation, and work the amount that fits your life even if it's only the minimum required for PRN status. It's very unlikely that other employers in the future are going to demand to know how many hours you worked. They're going to see "ICU," and you will likely have many options available to you.

I do this also. And I absolutely do not tolerate adults yelling at me. I will say ONCE, calmly: "I promise that I will never swear or yell at you, even if we disagree. And if you continue to swear and yell, I will have to hang up." And if they do it again, I hang up. I let admin know what happened, and I move on. I'm really nice to people, as I'm sure you are too. I don't do passive-aggressive stuff, or sarcasm, or anything else that's rude but not provably unprofessional. I don't provoke people. I am willing to live and let live, with respect to all sorts of beliefs and behaviors I don't agree with (outside of dangerous, reportable, etc). So if they're going to cross that line into abusive behavior, it's zero tolerance from me. Not going to waste my breath or my tears. Don't take it personal - there is just a certain percentage of people who will act out this way, because it has worked for them.

Five of the eight nurses in my school district left after the 2020-21 year. Not the same kind of stress or acuity that hospital nurses are facing, but there is nothing fun about parents screaming against masks and vaccines while you spend literally all day quarantining and contact tracing, in PPE you bought yourself.