NorthER,RN

You're not rambling Nicmac- just thinking out loud and trying to find a place for yourself after all of the hard work that has gone into your career. I hope that you don't mind if I put my 2 cents in here . Did you have a favourite instructor/professor at the college/university where you got your degree - would you consider contacting them for a lunch meeting (people usually are more chatty when there is food involved). I was thinking that perhaps someone from outside of the system of hospital nursing can help you to find your place - or at least give you some new ideas to consider. Have you thought about working as a sales rep, or perhaps you could just go through the specialty nursing forums here on Allnurses and see if there is any place that looks interesting. Perhaps you could start reading nursing journals from the library at your old college to see if there is something that interests you - informatics certainly is changing the face of nursing and there are conventions every year in the US and Canada about computers in nursing. I have found that a smaller hospital has actually given me a lot more freedom - I work ICU/ER - we are all able to switch shifts and we cover for each other - especially when we feel a bit hard done by - I don't care too much about working weekends - no husband or kids - but for those who do, we swap off - and no words from management or staffing when we do - they know that they would have really big problems if they did make a comment.... I wish you all the best - it sounds as though you really tried to make a go of nursing - take heart. There is a place out there for you! :icon_hug: Rae

hi. i just need a chance to vent - and to hear what other nurses have to say. i have been working in a small rural hospital in northern bc. i love the place and really enjoy the work in the er - have learned a lot, work with great staff, get all the overtime i could ask for, have a nice place to live, etc... i came here a year ago and thought that i would end up retiring here - yep, that nice - and quite a change for someone who has never lived at one address for longer than 3 years! the job was a maternity leave placement - and the contract for it ended on august 2. since i began the job almost a year ago the don has promised that she would create or find a full time permanent position for me. for the first 6 months i didn't stress too much about it, but then each time that i saw her i began to ask what was happening, and of course the answer was always just what i wanted to hear... and then i asked for a new contract in writing - or at least evidence that there would be a permanent job to post for... nothing. it was as though i had left the planet. so i looked around and applied for another position and got it - it's just an awesome job doing flight nursing in the north - the far north. my written contract in the er came to an end on august 2nd - and i called to say that regardless of the 16 shifts that i had been booked for in august that i would not be able to work after the 2nd - if anything happened in the er any lawyer in the world would want to know why i was working if there wasn't even a contract between the hospital and myself. holy moly! so now, because i basically blackmailed them, i have a letter extending my contract until into september, and a job in the er has been posted - but it's only another 6 month position. now i really feel that i have done my part to stay by encouraging my boss and her boss to find a way to keep me here as was promised! (we are ssssoooo short nurses - great if you want the big paycheques, but we are ssssssssooooo tired) but another 6 months of messing around trying to get into a permanent full time position is just going to make me even nuttier than i am right now - i haven't been sleeping well, i've been sad about leaving, and maybe a bit distressed about being lied to. so now i need to prepare for the flight nursing position, pack and move on with my life and my don is annoyed because she feels that she has worked hard to keep me here. i guess that the moral of this story for those people like myself who believe what they are promised when they accept a position is: if anyone promises you something that you really think is important - especially when you first accept a job - get it in writing! no matter how nice the person is, how you're afraid that it might make you appear "pushy", and how concerned you are about offending the person making the promise, get it in writing. lesson learned and now i am off into the wild blue yonder - older and wiser.

Thanks ERNurse - it's a saying that often comes to mind when I'm trying to do several very important things at once (chest compressions, suctioning, bagging - you know) and someone asks when the doctor is going to see them about that toenail that's been bothering them for 5 weeks and they're going on holidays today and why can't they get any help - yep nothing like a little chuckle to help us through the day, right?

How about: A lack of planning and foresight on your part does not necessarily constitute an Emergency on our part. :rotfl:

Hi Dave, Like you I used to have a lot of compassion for drunks - particularly those in their teens, early 20's. I work in a rural setting in a small hospital, and we all agree that without ETOH we would likely not have very much work at all. Between the young girls who drink too much and can't stop vomiting to incredible violence (we have a guy we had to vent last night because he had been so badly beaten by his drunk relative - had his pelvis fractured and a collapsed lung among the long list of injuries). We can call the police to take them to cells if they are stable, but mostly I tend to keep them around until they can walk - if they are in their teens I usually call family to pick them up - if the family member is sober enough to come and get them. However, now I am very quick to get them into adult diapers - I just got tired of cleaning up urine. Some nurses won't bother - they say that they want the people to go home in urine soaked clothes - as if that's going to stop them the next time they have money and access to ETOH. Some docs don't order IV's but I usually push for them - the young ones generally don't need thiamine or multivites - the older ones do. If they do aspirate I want a line in - and these days it isn't just ETOH it's usually some chemicals too.... I find that I am much more brisk with them than I am with others who come in looking for a bit of help - I really don't need to listen to the excuses. We have cards with the number of AA on them and I give those out when I discharge them - other nurses can't be bothered it seems. The ones that I have the hardest time of all with are the older women - my mom was an alcoholic and I find that I kind of freeze up. It's such a shame. So Dave, all I've done is share my feelings of distress - when you were the one looking for help. I guess that I just don't know. Guess they have to reach the bottom and make their own decisions, and in the mean time we just patch them up and send them back out - maybe they'll figure it out. We do our best to provide the emergent care that they need - and the rest is up to them. All the best Rae

Thank you Bijou - you are too kind. I had the worst preceptor in the world - she asked for a student nurse to precept because "the work was too much for one person alone". She yelled at patients (this was on a spinal cord trauma ward) and was not very nice at all. Remember, there is always something to learn - even if it is how not to do something. Now I try to encourage all of those around me - some find it strange, but I know that we all have our challenges in life. I believe that you nursing students and first year grads are so strong just to have come this far. You know and do as much as family doctors did in the 60's. You may cry when you get home. You may rage at the cruelty of the world. But in the place that you work, you make a terrific difference, just by being calm and human. Any kindness and compassion that you have for those who are in your care will blossom. What I love about these forums is that we all come here to know that we are not alone in the struggle to provide compassionate, competent care. Rae

Hi Trish, I believe that your age and your calmness will actually help you to become a fine ER nurse. I graduated when I was 45, and have trained and worked in a lot of areas since then (I'm now 50). I now work ER and I find that my calm manner helps people, both those that I work with and those that I care for, to also take a deep breath and just deal with the situation. Because of what you have experienced in your life you may find that you have a bit more compassion and understanding for those around you - it may not show up right away as you deal with the stresses of the new job, but your patients will see it. Please don't let those nurses who graduated 20 years ago scare you - sure they've seen a lot, but you are there because as an adult you made up your mind to work hard and get there. Your knowledge is current, and you will likely be more interested in increasing your knowledge by reading journals and asking questions. No one expects you to know everything. And remember, most of what shows up in ER is not an actual emergent problem - and any of the really exciting stuff will be taken over by the more experienced nurses. Just watch and learn - take courses such as ENPC, PALS, ACLS, TNCC as they happen, and enjoy. All the very best, Rae

Hello again - I just thought that I would toss this thread back into the mix. I have gotten the job that I wanted in Yellowknife, in the North West Territories - yep, I will be freezing my behind off in the frozen North. I have accepted a flight nurse position - love to fly, love the critical care, love having to be resourceful, and it sounds as though there is a lot of training in this position. So, if there is anyone who has lived where the permafrost is, please let me know of your experiences. Actually the weather in Yellowknife today is warmer and sunnier than where I am on the west coast!

Hi. I'm currently working in BC and thinking of moving to Yellowknife or to one of the nursing stations in NWT. I'm looking for someone who is working in the NWT to answer some questions for me - about the hospital in Yellowknife, the stresses and strains, the good parts of living in a northern community, the cost of living, and so forth. If you've got any stories to share, I'd love to hear them, .

I have learned that a call to the doc at 0300 will not get you the same quality of response as one at 1500. I have learned that when the fan is covered in faeces and the doc has not responded in an appropriate manner (maybe because it is 0300) that the doc will direct the fan away from him/her self (do you think that it might be at the nurse?). I have learned that no matter how many tattoos and piercings a person might have that stitches and IM's will always elicit whimpers - no matter the skill or level of freezing. I have learned that a night in ER that does not involve stabbings and drunks and general craziness can revert back to zoo status just by someone saying, "Gee, it sure is QUIET tonight". I have learned that I work with really great nurses and docs in our little hospital and that no matter what or how many come through the door that we will all do our best - and that is a great thing to know.

I work ER now and nothing really seems to gross me out - and granted it's not nice to see CSF or brains or blood or pus or vomit or feces, but hey, it just doesn't trouble me - I just focus on the job at hand. But- you know the old joke that about "I'm not being bothered by the sight of blood- unless it's my own"? Had bilateral arthroscopies done 10 days ago - was out walking last Saturday and a large quantity of synovial fluid started to drain from one of the wounds -in public, while I was wearing shorts - now that grossed me out.

I came back from Saudi Arabia 7 months ago - and actually you don't need to be Muslim to work in the Middle East. Try www.medhunters.com to look for some jobs - I know that King Faisal Specialist Hospital in Riyadh is offering improved wages and hire on bonuses as they are quite desperate for western RNs. There are jobs in Dubai, however the more lucrative work is in Saudi Arabia. Try Helen Ziegler again - send off your resume - they want 2 years of experience in your specialty and they are more impressed by larger urban hospitals than smaller rural centres. I really enjoyed my time in Saudi, and made some very good friends. The job wasn't a great fit for me, however I do consider returning from time to time -

Hi Papaya, I wonder if you might like to just give them a phone call - and find out if there are any other hold ups that you need to address. They're all finished with this years registration stuff (we register every year for March 1). Why not let them know that your job is waiting for you and your registration (which may or may not be a slight exaggeration) and, if all else fails, take a drive across the border and come and visit them. They do respond well to people dropping by. Good luck.

If you're planning on working in British Columbia, you're already on track Abdominal - when the RNABC gets your paper work they will advise you on any concerns - I know that staff that have come here with a diploma in nursing rather than a degree may not have enough maternal/paeds experience - perhaps with your degree you will meet the requirements - they'll let you know. I hope that you get a chance to email the staff at healthmatch and let them know that you've got questions and that you're in the process of licensing with the RNABC - the Canadian requirements and exam are actually a standard across all of the provinces, although we do have to register with in the province that you work. While you're waiting for your registration and getting your visa and stuff together hopefully you'll be working in Australia and getting more experience. I hope that the staff at the Canadian embassy/consulate in Australia have been helpful about what is required for immigration.I sure wish you all of the best. Study hard and finish up well at home, maybe work for a while where you are comfortable and think about a future here in beautiful BC.

Hello! Thank you for considering Canada - I think that you will find that the hospital in Victoria has a lot of vacancies and that they will go to great lengths to help you out in emigrating to Canada. You could go to www.healthmatchbc.org and have a look at the vacancies and then contact the staff at healthmatch to see what the hospital will offer to support you in this new environment. I know that the vacancies all request experience, however we are very short of nurses and I think that you will find that you are quite welcome, especially with the LPN experience behind you. On my return to Canada from Saudi I spoke with Donna at healthmatch and she found me work in Emerg (which I really wanted) even though I am a CCU / ICU nurse with no experience in ER. My new hospital went out of their way to provide me with a solid basis to do my job well - and I know that Donna worked hard to find me every thing on my wish list! I know that it is a big jump to come to a new country, so I hope that you know that you will be welcome. If you're looking for more information, please feel free to pm me,

Hi Froggylegs - I believe that you are doing the right thing by listening to the patient and accepting his choice as being the one that matters. Indeed, rather than being paternalistic by just going ahead and doing whatever it is that other nurses may impose upon powerless patients, you might just be the only one that asks him about what he wants which makes you a . However, please, please remember to document every single refusal and how you informed the doctor that the patient refused his medication. I've often had doctors tell me to do something which the patient has already refused and then had second thoughts once I told them that I will not lie to my patients. They are then more likely to speak to the patient and come up with alternatives. IMHO I think that behaviour like this helps to take away the powerlessness and hopelessness that people feel when things are just imposed on them. Thanks for being an advocate for your patients.

Hi NursingDiva. It would be wonderful to welcome another nurse to BC. For information on how to start go to www.rnabc.com (Registered Nurses Association of British Columbia) - there is lots of information there on what steps you will need to take in order to be registered. There is an exam, however it is much less intense than the NCLEX, and more information about the exam can be found at www.cna-nurses.ca which is the Canadian Nurses Association which does the registration for all nurses in Canada - that will give you more information about where and when the exam is held. There is a web site for taking a pre-exam that the cna site will direct you to, as well as more information about the study guide book and cd-rom that will help you to prepare.I wish you all the best in what ever you do. Maybe we'll meet out kayaking or on the slopes!

Thank you all very much. In my little hospital we use Troponin T markers which are not as accurate as Trop I which I am used to. I wanted to learn more about CK/CKMB ratios and now I have thanks to you.:yelclap: You'll make me look good! Thanks.

Hi Nurse004. You could try their website at: www.cna-nurses.ca You could also search for your provinical nurses' web site, or try a search under nursing unions and your province. Good luck!

Hello Nurse004. I am a Canadian registered nurse and I would like to offer a few suggestions. I don't know what province you have your interim certificate from, and obviously I don't know where you did you training, but if the company or the hospital that employed you informed the College of Nurses, or the Registered Nurses Association in your province that you were having problems meeting standards then you will need to show that you now meet the standards. I don't think that you have much choice in this matter. If they feel that 10 months is enough time to show them that you are working up to standards as an RN then you have 10 months to show that you are capable. You could make an appointment with your licencing body to find out more; perhaps there were more problems than with 1 med given and not signed for. If you are concerned about not having the same duties as an RN, perhaps you could accept that and do your best as a grad nurse. You may just need to have fewer responsibilities so that you can improve in other areas. If you are concerned about your level of pay, perhaps you could make an agreement with your employer to give you some of the difference as backpay once you have completed your time successfully as a grad nurse. If you want to make an issue of this you could speak to your union representative for your job site. You may find that there were other concerns and you may feel that you are content with the status quo. In the mean time, recognise this as one more opportunity for learning and deal with it gracefully. Hopefully as you gain in knowledge and strength as a good nurse you will be glad for this chance.

I am rather shocked! I know that we Canadians may seem pretty easy going here, (maybe even a bit socialist....) but I cannot imagine that Americans (Home of the Free) would allow a law that would permit or encourage a health care provider to discriminate on the grounds that they don't like a person's way of life. What century are we in? I have worked in hospitals outside of Canada, and lived as an itinerant in other countries so I am not a person without the understanding that each country has different values and ways and means of treating their citizens. However, it's hard for me to understand a health care system that does not provide care for everyone regardless of where they are on the social ladder. It just seems sort of like 1939 in Germany and some of the laws that were enacted that made sense to the Germans of that era. What's next, pink triangles on every gay person's clothes? I thought we knew better... In rereading this, I know that it sounds pretty strong - and perhaps because I am Canadian you may feel that I have no right to comment, however, as the United States goes, so goes Canada (it just takes us a while to catch up). My mom is American and she, my father and my brother all live in the US, so I do hear many sides to each argument. I just wonder what is next... and if I do not stand up for my brothers and sisters, then when they come for me, who will stand up for me....

Hey Bonnie, don't give up - there are great nurses out there. For the average overstretched, tired, burned out nurse who stays in the job for the money and the benefits, students are thought of as just one more problem dropped on them by management. Some may know that they don't have the skills and knowledge that they need to adequately support you and so they are distressed and fearful that if something goes wrong that they won't be able to cope. You and I both know that this is WRONG. You are part of the solution, but unfortunately they don't see that. Yes, it takes a bit of time to explain things, but when a nurse feels that she/he is too busy to even swallow their own saliva because of workload, it's hard to make the effort. I was an older student, having already had "another life", and to have RNs rolling their eyes as I took the time to ensure that what I did was right, really hurt. Thank God for the kindness of some instructors and nurses who supported us. Please just give them a bit of a break, and resolve not to become like them. These same RNs will be your colleagues, depressing as it may seem, but I hope that you will be able to rise above their unpleasant behaviours and help them to see that you are the solution to short staffing and increased workload and that they just need to help you get through your schooling. Good luck!

Thank you all very much, and thank you Nurse First for looking those two books up for me. I have read Leanne Olson's A Cruel Paradise: Journals of an international relief worker (1999); she was a Canadian ER nurse who spent time in Bosnia and Africa. She and her husband left MSF and were very unhappy with this organization. I just thought that I'd try to get something that was just a bit more personal than propaganda if you know what I mean. I'm not getting any younger, and somehow I want to do something that makes a difference beyond working in a country where people some how don't get it - we have an excellent health care system here, but somehow people feel entitled to so much more. We are so rich here in the west, and I have lived and travelled in countries that are so poor, that it would be good to go somewhere where clean water is not taken for granted, and no one gets distressed that there isn't enough ice in it. Thanks again for all of your comments.

Hi! Is there anyone out there who has experience with MSF? I'm looking for more information about the personal experiences of nurses - the web sites are good, but I'm sure that like all organizations there is a bias to their information. Thanks.

Thanks Athomas and Zacarias: - I went back to the books for this Critical Care Nursing 2nd edition, chapter 26: "Blood pressure is determined by cardiac output (blood flow) and the resistance to flow or total peripheral resistance. Simply put, arterial pressure equals cardiac output times total peripheral resistance. Total peripheral resistance is the sum of resistance in all vascular beds. Direct determinants of arterial pressure include cardiac output, aortic impedence and vascular resistance". "Indirect determinants that maintain control of arterial pressure are the autonomic nervous system, hormonal regulation, the renin-angiotensin pressor system, and the volume of extracellular fluid." When the blood pressure is inadequate to maintain sufficient blood flow through the kidneys, as may have initially happened, the juxtaglomerular cells of the kidney secrete renin which through the angiotensin presor system acts as a powerful vascoconstrictor. The autonomic nervous system's mechanisms for control of arterial pressure include the baroceptor reflex, the chemoreceptor reflex and the central nervous system ischemic mechanism.... When arterial pressure is too low, the baroreceptor reflex system creates the opposite effect, resulting in a rise in blood pressure." Once there is a critical degree of hypertension there are 2 pathways. 1. Local effects such as prostaglandins, free radicals, etc. lead to endothelial damage which leads to platelet deposition which causes an increase in mitogenic and migration factors which increases myointimal proliferation which leads to a further rise in blood pressure and vascular damage. 2. systemic effects such as renin-angiotensin pathways, catechol and vasopressin leads to pressure natriuresis which leads to hypovolemia and a further increase in vasopressors and a further rise in blood pressure and vascular damage. So this is where my concern re: decreasing output relating to his heart block, decreased volume status came from. But, having gone through pages of brilliant, concentrated stuff.... Was the guy taking cold medicine? Lots of those meds are a no no for hypertensive people. That, plus the essential hypertension may have been a problem. Was he obese? Was he a smoker, what were his lipids like, what was his previous cardiac status... so while I was off checking out the zebras, there was a horse. Thanks for the opportunity to read and think.