tippeny

Thank you for the reply. This is a Military Treatment Facility (MTF) not VA. There seems to be a lot of confusion and no one seems to have any answers where I work.

I'm no sure how the ADN to BSN will affect things, but the step increases are automatic in the GS system. The first couple of increases are yearly, then they go to every 2 years, then to every 3 years. Just Google GS step increase and you will find lots of info. Below is from the opm.gov website. "Within-grade step increases are based on an acceptable level of performance and longevity (waiting periods of 1 year at steps 1-3, 2 years at steps 4-6, and 3 years at steps 7-9). It normally takes 18 years to advance from step 1 to step 10 within a single GS grade if an employee remains in that single grade." I would think that going from ADN to BSN would be a GRADE increase, not just a simple step increase. It might not be automatic though- it would have to be an option in your PD (position description) such as GS0610 grades 5-8; some jobs aren't eligible for an increase in grade. Depends on the facility and how the job description is written. Hope that helps a little! Best of Luck!

I manage a section at a military clinic and I have a wonderful LPN who would like to go to school to earn their RN degree. Does anyone know of any programs out there that would allow a nurse to earn their RN and maintain employment? I have been told (unofficially by colleagues) that the nurse would need to leave the GS system, get at least a year of RN experience under their belt, then reapply for open RN jobs. I know there has to be some way to retain valuable employees in an organization while allowing them to further their careers. I have been searching online and hitting nothing but dead ends. *** I have reached out to our HR department but I have heard nothing back, which doesn't surprise me in the least. (sigh)

Our GI doc likes to use a Simethicone rinse to get rid of bubbles in the colon. He will tell the GI tech how much, but I am looking for something written that recommends a specific concentration of simethicone for this use. I'm coming up empty handed. Does anyone have anything? Thanks! ***I know SGNA doesn't recommend using Simethicone.

I would also think that 5 minutes is super fast in regards to infection control as well. That doesn’t allow much to time wipe down the room/equipment and allow for an adequate dwell and drying time for a number of products.

I work in an outpatient clinic and we do routine colonoscopies and EGDs. I don’t have a specific script, but we have a checklist for our follow-up calls. Basically we are asking if they are experiencing any pain (if so, get a pain score); are they tolerating PO (can they eat/drink); are they able to void; are they getting back to their normal activities. I don’t always ask things the same way each time, but that is the info I am trying to gather. Be prepared for patients to ask questions about their procedure, findings, when to expect a return to normal bowel movements, random abdominal pain (which is often the reason why they came in for a colon in the first place- some folks think that the procedure will magically make the pain go away). Hope that helps a bit!

Hoping someone on here could answer a general question regarding the probationary period of new government empolyees. If a nurse has previously held a gov job and completed their probationary period, do they have ANOTHER probationary period at a new gov job? Let’s say going from a VA position to GS or vice versa? Asking for a friend...

Thank you for all of the comments. They really are helpful. I have engaged senior leadership as well as HR, so everyone is aware. I have had a sit down with the employee to let them know of the deficiencies and have a written record of the conversation. I have basically been told by HR that I can terminate if I want and to let them know so they can be of assistance. I suppose what is holding me back is the fact that it took a while to hire the employee in the first place and it will leave our unit back at being short staffed. I have been working full time clinically and trying to squeeze a myriad of managing duties into the cracks. Having this RN on board will (eventually) lighten my load. I work in a government facility, so hiring people is a painfully slow process- it can take over 6 months sometimes from when the job is first posted. I keep trying to rationalize why I should keep her: she is doing some things well (after many weeks); she is actually trying to improve; maybe she has a learning disability (ADHD?); we need the staff.... Thank you for letting me vent and think out loud a bit!

I am relatively new to the management side of things. I have a new(er) employee who is still in a probationary period and they are just not picking things up very quickly. We are in a clinic setting and this nurse has been here for over 5 months and has been working with one provider for well over 6 weeks. Their documentation is full of errors every day, to the point where I look over every thing they document on every patient, every day, every time, to make sure there are no errors. And there always are! They have trained with 4 different, experienced, nurses and have access to many different resources. The rest of the nurses in the clinic are also aware of the errors, as they bring them to me constantly, so this is affecting morale as well. How do you know when to let someone go? I have never had to "fire" someone before, so of course I'm not comfortable with the idea. But at this point, I feel this nurse should be able to work independently and not need to be babysat every day. (nurse is an RN, btw)

I work with a gastroenterologist who only does Colons & EGDs. We mostly use conscious sedation as our patients are typically healthy. For the less healthy folks (high BMI, cardiac problems, PTSD, anxiety, etc) we use CRNAs and MAC (protocol). When I am in the room doing conscious sedation (RN) we also have a GI tech. They are responsible for assisting the doc with equipment (biopsies, polypectomies, tattoos, lifts, clips...) while I am giving the sedation, taking vitals q5 min, labeling specimens, and such. The GI techs also do the HLD (high level disinfection) of the scopes and order/maintain equipment. RNs also recover the patient afterwards. Our facility tried to have the CRNAs take over and do all sedation. Our facility also does outpatient ortho, urology, podiatry, optical.... procedures. In the end, they didn’t have the staffing to support us. Their plan, however, was to also have a float nurse in the room to label specimens. I have no clue what else the RN would have done, besides stand there filled with boredom!

We do have a RRT where I work but it doesn't seem at ALL efficient to me! They overhead page- sometimes code purple, sometimes Rapid Response, sometimes code BLUE!!- but the response time is very lagging. A crash cart is brought (just in case) even though most are patients who vagal from vaccinations or blood draws; an MD, nurse (RN or LPN) and anesthesiologist are on the team but they are coming from all different areas of the clinic; and our overhead paging system can't even be heard from all patient rooms (of the door is closed). It's a very nice idea, but just not executed well. In my opinion, in a facility full of doctors & nurses there is no real need for an RRT as we all are required to have BLS (many of us have ACLS as well) and we send everyone who really needs help out 911 anyway.

The specialty clinic that I work in is overhauling how we treat patients who vagal in the clinic. We see derm, GYN, and GI patients and have at least 2 or 3 patients each week who vagal after minor procedures (IUD insertion, skin biopsy, etc). We typically grab an ice pack, lie the patient back, grab a set of vitals and BG, and wait for it to pass. But earlier this week we had an anxious RN grab an IV kit and talk about calling 911. The patient had a punch biopsy, was small in stature, not dehydrated, and did not loose consciousness. Vitals and BG were normal. Mind you, there were also MDs just standing around watching her spin in circles. Does anyone have guidelines or an SOP, aside from calling 911 or rapid response, for patients who simply vagal or have a pre-syncopal episode? Thanks!

Stressful? Absolutely! Worth it? Absolutely! My experience as a school nurse was that there was a fairly steep learning curve the first year- just like any new job. But like the previous posters said, you are the only medical professional in the building. My days were filled with an enormous amount of paperwork, meetings to attend (504, IEP, student services team, attendance...), deadlines to meet, the occasional true emergencies in the building, daily meds, lots of emotional issues to handle with the kids (I was in a Middle School)... There were many days I didn't eat lunch until the drive home. And I was even blessed to have an amazing Health Assistant in my school who saw the majority of kids who came into the Health Room. But it was such a rewarding job and I would recommend it to anyone looking for a change from 12-hour, non-stop, hair-pulling shifts at the bedside.

You didn't mention what kind of school you are at (or did I miss it?) When I was at my middle school, the kids were fairly independent. They could work calculations, dial up insulin (all had pens or pumps) and self administer. They were, however, required to have the dosages calculated by me (the RN). That being said, if the kid was responsible I would talk with the parent and student to see what they were comfortable with and get it in writing or email from mom/dad. The responsible kids were allowed to go solo and had to call the HR at lunch time/snack time, etc, to give me their numbers and I would do the calculation and verify the dose before they self administered. Just like if there were standing in my HR. The teacher in charge was made aware of the arrangements so there would be no confusion/questions on the day of the trip. For the irresponsible kids, they had to have someone with them to make sure they didn't flake out.

Our middle school did send and email and told the teachers at the beginning of the year during a staff meeting that the Health Room hours were from 9:00-3:00 (school was open from 8:45-3:25). We explained that the times before/after those were for kids with medications, our diabetics students, and emergencies only. Emails were sent throughout the year to gently remind teachers. If a kid showed up outside those times, we would ask them why they were there and decide whether or not they would stay. We did turn kids away- headache, vague stomach ache, random pain with no swelling or sign of injury- and remind them that they were about to go home and that there was nothing we could do for them. The early birds were told they could call home if they felt that badly, or to go to class and if they needed to come back during open hours, please do. Most didn't come back.