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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.

Hi there - I'm looking at per diem positions - hourly rates, no benefits, no guaranteed hours, hired directly by the health system rather than through an agency. These are the rates I've seen, wondering if others have more info: HonorHealth: $42 (offered for obs at Deer Valley) Valleywise: $43-$45 (posted publicly), both for hospital and outpatient Circle the City (serving homeless patients at respite center) $40 Anyone know about: Banner inpatient/outpatient? Mayo inpatient/outpatient? Has anyone even picked up a PRN position lately? Seems like everyone who wants short-term or non-full-time employment is working as a traveler for the big $$$ these days.

Last year I had a few with mild sore throat or runny nose, no other symptoms.

I've received a call for an interview at a small hospital in a town of ~5,000 near the US border in southeastern BC. I've only worked at big urban hospitals and public health settings (in the US), so this would be a big change. However, I'm looking for a change, and definitely wanting to relocate. I'm open to a small town but have a million questions! Firstly, where and how do you find housing? Living an hour away and commuting in the snow would not be my first choice, and a quick Google search for houses or apartments for rent yields...literally nothing. My understanding is that the standard hospital schedule for Canadian nurses is two days, two nights consecutively (not common to rotate shifts in the US, let alone flipping days/nights every week) - how on earth do you manage that? And any advice from folks who live and work in town this size, in a small hospital of maybe 20 total beds? What do you like about it? The idea of having to handle ANYthing that comes in - not just the little slice of work that's mine in a place staffed with specialists 24/7 - is a little terrifying.

You need to go through two different processes: 1) getting licensed and getting a job, and 2) getting immigration status to be able to work and live in Canada, if you're not already a citizen or permanent resident. Getting your license in BC, if you're licensed and/or educated in the US, will likely take at least a year. You can't start the process until you finish your education (and then since it's going to take a long time, it would be smart to start working in the US meanwhile) There's a bunch of threads on here about how to do it, but basically you pay a bunch of money, gather and submit a bunch of documents from your school, any nursing jobs, personal info etc. It's evaluated by a service called NNAS. They decide if it's comparable to a Canadian nursing education, or if you need to take more training or tests first. They make a report, which is sent to BCCNM (the BC licensing board for nurses) - and then they look at the report and decide whether you can get the license, or whether you need more training or tests. When they say you're ready, you pay their fees and sign up. Getting immigration permission will depend on your situation. If family members are in Canada, you may be able to get a visa that way. I'm not an expert but I believe that many routes to immigration are competitive - it can be expensive, take years, or be completely impossible for some. It depends on your situation and your connections to Canada. You can read about options on the CIC website. Good luck!

Yes, we'll try for Express Entry although I'm not sure we'll actually ever get invited - we both have master's degrees and I have years of RN experience, but we don't have Canadian work/school experience or relatives, and we lose all the points for age (we're 50). But CELPIP is the only thing we're missing to apply, so going to schedule that. Good luck to us all!

I am an RN who did a 16 month accelerated BSN in the United States. I just got approved for licensure in British Columbia (Canada) without any extra classes or tests required. Be warned though: the licensing process took over a year, and of course it's a completely separate process to get a visa or residency status.

I hope your meeting went well. Happy to tell you that BCCNM quickly confirmed that I met the language requirement; I paid the $$$ and submitted the application officially, and I got my assessment back in less than a week: "Your nursing knowledge, skills and abilities have been assessed as substantially equivalent to the entry level competencies expected of a new B.C. nursing graduate." All they're requiring is a background check - I don't have to do NCAS or take any more classes. Now, onward to dealing with immigration (I don't have residency or a work visa yet), yikes.

Hi there - I just got my NNAS report back this week - I started the application a year ago, and my documents have been complete since January. I was fortunate in that my school seemed to be experienced with these requests; I didn't get even one question about the paperwork. I've heard from others that getting the school to not just fill out the form, but also send detailed syllabi (which they should have on file) may help. The other thing that's unfamiliar to them is breaking down credit hours into actual hours - but, you probably know that. My problem was employer verifications. Many American hospitals have outsourced employment verification to third parties. These companies are for-profits that require subscription fees to release info; they often have incomplete or incorrect data and no ability to correct anything, plus they will only send out reports in their own format (I.e. they are not going to handwrite the NNAS form or answer those specific questions). I had to call one of my former employers and basically beg a secretary to help me, because the third-party verification company only had one year of my work hours on file. Another employer just refused; I got no credit for hours at that job. After all that, I did finally get "comparable"! I'm now applying for license in BC and hoping this gets easier. Good luck to you

My general process, assuming no one's doing anything unsafe: Get the audience out (including unnecessary staff). Extra people are not good for drama-seekers, and not good for people who are panicked and overstimulated. Only one person should talk to the patient. Don't let people stand/loom over the patient or make comments. Get down to his/her level yourself. Introduce yourself, ask permission to do a quick physical check. Wait to get OK. Listen to lungs/heart and check O2 sats. If everything's OK, verbalize findings "excellent, just need one finger, I'm checking your oxygen. Your brain and body are getting plenty of oxygen. Now I'll check your lungs. You'll feel the stethoscope here. Very good. I know you're short of breath but don't worry, your lungs sound good. It's OK to slow down your breathing now, I'll keep an eye on you." (If nothing else, this reassures admin) Give reassurance and two safe choices that you can offer: "I'm going to be with you until you feel better. Do you want to rest here, or would you like to get some air in the courtyard?" No other questions, no longer statements. WAIT for answers longer than you think, you might sit quietly for a what feels like forever. Other things that I try to remember You don't have to fix anything. If everyone's safe, it's OK. Panic passes, no matter what you do, so just being there is fine. Sometimes I tell kids this! "This terrible feeling is like a big wave, it can knock you over for a minute, but then little by little it rolls away and leaves you safe on the beach." When they're out of the full blown panic, I'll try techniques folks have mentioned above. If I know they're working on coping skills, I'll offer their preferred strategies: "I'd like to help you use a coping skill, should we try music or breathing?" Some kids do better with just decreased stimuli. I have a room in my office with.a recliner and a dim light - I will say, "would it help if you had a quiet, private place to regroup? Yes? Here's a glass of water. I'm right outside if you need me. I'll check on you in 10 minutes." (of course this is presuming no self-harm behavior, and that I can discreetly keep an eye on them). Sometimes I'll ask where their anxiety is (1-10) before and after. No one teaches us this stuff in nursing school! I just try to project kindness, confidence, and a neutral tone. Practice helps. You can do it ?

Hahahaha even in HS, I have one shelf of "ice packs" (which are wet paper towels frozen in a small bag) for the "injuries," and a separate shelf of ice packs for the injuries. I haul all the ice from another building, so the situation needs to be iceworthy!!