peeps79

I may not have all the facts but shouldn't we consider the wage tax Philadelphia has above and beyond regular taxes... I've read that there is this 4% tax to all wages with neighbouring towns only 1 -2%... could this explain UPENN and other Philadelphia hospitals being highest paid in the region? To compensate for this? or am I totally clueless?

But this is related to telling patients information. It resulted in a 2 Day fight between me and a doctor (chief of Surgery) but I won both the support of the nurses and the patient. A concerned patient having abdominal surgery (major abdominal surgery) was concerned about not passing gas and her abdomen being distended. I noticed and confirmed that she was right and that we will talk with the MD and see what he says. As I was saying that, he walked right in and started talking with the pt. She became flustered (as some do ) and wasn't asking her important question, so I made sure to mention it to the MD. He did a half assed attempt at looking at her and then said that she wasn't walking enough and using too much pain medicine. He (in front of the patient) accused the nurses of bad care and told her that she needed to start walking more. He had failed to realise that SHE WAS walking often and not using much pain medicine unless she really needed it. He brushed off her concern and then out side, (I followed him outside to talk further with him as I could see he upset her) proceeded to tell me not to give her bad news, that we shouldn't tell her when things go wrong (even though he was very concerned about her abdomen too). Well, I was LIVID!!! I went back into her room and found her crying because she was all confused over what was going on and what she was 'doing wrong'. I spent 1/2 an hour with her, explaining how her intestines worked, giving her a run down (in layman's terms) of what to expect and ways to help her along and when to be alarmed and when not to. She was an intelligent woman and very dedicated to her health (which is rare where I work) and all she needed was some big picture with little details to complete it. to Sum up... she ended up having problems that the MD needed to correct, but she was alot more calm about it this time round because she had a little education behind it. I fully support giving education to patients who are ready to receive it. If I remember correctly, you are a nurse? You certainly would be ready to handle ALL information. I wish you luck in the future.

Providence RI. Small State with BIG Shortage. Opportunity to work mucho overtime.

Thanks everyone for your interesting and informative advice. I'm now realizing that this practice is not something that is universal, and that hospitals may have differing policies on that matter. It certainly has made me think more. I guess there was no clear answer for that one. Thanks again

She loves her Grandfather. I would have responded with compassion and said the words that I would have wanted to hear had I been in her situation; "I will do my best" Which I said. But that's the point entirely. Aren't we NOT supposed to be in that situation? I clearly remember a professor telling me that when we as nurses have any connection to a patient while we are on duty, we are to make arrangements to have another nurse care for them, lest our emotional feelings for the patient interfere with our rationality. Turns out he was waaaay more ill than she told us. He had an unstable AA and on the ekg, showed A-flutter (she had made the statement that he had a tremor from a previous stroke which altered his ekg readings, but when up on our unit no evidence of tremor was there). He ended up needing another unit all together. What in her report made you believe that the other patients in the ER were not getting the best of care? My concern was the manner in which she spoke with both me and the secretary. She yelled at the secretary, refusing to wait to give report (I was involved in a blood transfusion at the time) and then while I was on the phone, she was speaking in a hurried, scattered (but detailed) report, curtly telling me that she'll be up there later to check on us and I'd better take care of him. I did end up asking her if she would be ok working for the rest of the shift, and she replied with a sigh "I'll have to be". And I know for a fact I would behave like that if my grandparents came through the door. The way she was presenting herself led me to think she was very concerned for her Grandpa (as she should be) but to the point where she wasn't functioning at her best as a nurse. This would not have been the time or the place to say anything. I would not have know what the circumstances were in the ER and I am not her supervisor nor her judge. With such little information other than what was given in report, I would have minded my own business and focused my energy on providing for my patients. Then later, after reflecting on the days events, make a decision on how I will handle the day when I may be required, by circumstance, to care for my loved one. But that's the point again. I was taught that it is very unprofessional to take care of family members while working. I am aware that I am not her supervisor and judge but it doesn't mean that we as nurses are not ethically accountable to eachother for professional practice. I know there is an appropriate way to handle this. Saying nothing when I AM concerned doesn't seem right. I'm sure that other nurses have used a compassionate yet firm approach to express concern about this before. I'm seeking the most effective way to approach this. I was focusing my energy on my patients (he was one of them!) and when he arrived for me to take care of, his care was compromised by being on the wrong unit. What's done is done. but I'd still like more input. Thank you, for your reply.

I did a search and couldn't find any advice. I learned in nursing school that taking care of family members while working in the hospital is a conflict of interest, (and understandably so. I myself would show favoritism to a family member in my care if in that situation). My story goes like this: I received report from a nurse in the ER who was sending her Grandfather up to a Med/Surg unit after she had been taking care of him. I knew right away this was a conflict of interest. This nurse also said these words to me in a hostile (or frantic it was difficult to tell) manner "I'll be up to check on him tonight. take good care of him" Her report was detailed yet she sounded stressed out/hurried on the phone and was very curt towards me. I took report but was at a loss for words about what to say to this nurse about the concern I had for the others she was looking after while he was there. What would you do/say in that situation? I don't have the policy/procedure manual of my hospital here. Do ER nurses have different policies in this situation? (figuring that they all rotate the triage, walk-in, Trauma areas, they'd eventually HAVE? to take care of the loved one?) thanks for advice

I've seen disregard for universal precautions... in both Canada and the US. I agree, it's the Company, not the country.

In Canada, where I worked before. the Union set up a shift rotation that meant you could only rotate D/E or D/N all 8 hour shifts. I thought that was difficult... Now, in the US (but also unionized) I work Days, evenings, nights and a Combination of 12 and 8 hours (some weeks I may only work 3 12 hours others its 1 12 hours and 3 8 hours. other weeks it's 4 or 5 day shifts. I hate it. I hate what I've become because of it. I'm depressed moody and lethargic. I'm gaining weight by the week and I've become the heaviest and most unhappy I've ever been. I'm too tired to do anything other than sleep, most days. I would love to go back to either days/evenings or days/nights. At least I would have one consistent 8 hour period in which I could sleep. Thanks for letting me rant!

I've had experience. Mostly with finger surgery. Where I am though, the MD's are the ones that apply the leeches and the nurses just dispose of them (in an alcohol vial) when they fall off. I've noticed that dressings are always applied after a leech therapy. we are to soak this dressing in heparin solution to prevent coagulation of the "feeding site". really weird. Cool though!

The Visa screen and NCLEX are 2 different things. The NCLEX is the National Board. once you write it and pass, the State that you receive your liscence from has it on file that you passed the NCLEX every time you have to verify your liscence to some one. The Visa Screen is Separate, from a separate company, costs additional money and for everyone trained outside the US (I know, I am currently going through this). You apply for this separately, and they will ask you to mail a paper to the State where you received your liscence originally. The state will mail it to CGFNS and this will tell them that you have Passed the NCLEX. From there, they will evaluate you, along with your other documents and mail you a Visa Screen Certificate. hope this helps

I'm a 12 hour and 8 hour rotator. I LOVE 12 hour days and 12 hour evenings (11a-11p) I absolutely DETEST 12 hour nights. I feel like I'm putting everything I have into being there and at the end of the day I'm exhausted. I have fount that working 8 hours has me sleeping right after a shift, just like a 12 hour does. it feels the same to me.

Kinda funny that this topic is on here.... and right when I've come off work with a story to tell. First my Background. I'm from Canada and am living in the States (have been for 2 years) on a Visa. I have always feared to leave the "safety" of the Canadian system. I love it. I love how even the down and out can have physiotherapy for their outpatient care, and there are several social/health programs that people are put into that support whatever ailments they have... it's really quite relieving. Yes, we do have the problem of time there, but patients (whether they are upper or lower class) are taken care of as equals. The difference I noticed with people here with no insurance is that they are left to fend for themselves with dressing changes and supplies until the next follow up appointment... until now... I dicharged a patient 3 hours ago who had jaw surgery for cancer. This patient had no insurance. He would require Tube feedings every 6 hours at home through his PEG (not to mention the care that goes with having one), dressing changes to his old Tracheostomy site, and his donor site from his skin graft. He was spanish/english speaking and working on a visa permit. He would have to receive radiation, chemotherapy. After teaching him administration of Tubefeeding, dressing changes and care of PEG's, this person was given a (HUGE) supply of dressings from the hospital as well as solution to clean each site. syringes to flush, tube feeding bags. the Dietician came up and gave him a crate of tube feeding product and the Social worker came up to help arrange for the Chemotherapy to take place, stating that he would have rides to the hospital for all these appointments, and could obtain more supplies there. Not only that, but because he had contributed to Social Security (I think it's called that here) he may be eligible for a disability claim. All this for a guy with no insurance.... Amazing eh? Anyways I felt very comfortable dicharging him, knowing that he'd be followed up by all these people here... Despite the scary rumors/concerns that exist.... American healthcare system is doing a fine job there.

To answer the original question... Yes! I would move back to Canada in a heartbeat if I were to start a Family. I have lived in Rhode Island for 2 years from Alberta and I can see a significant difference... I think I've pinned it... It's all about survival. Back in Canada I felt secure, taken care of, and didn't really have to worry about the basics. Health was paid for, kids have a great standardized (through out the country) education, that's affordable (though taxes are higher in Canada) and the crime rate is super low. EVEN THE HOMELESS had resourses availible to them if they wanted! In the State where I live, I sense that it's all about Survival of me and my loved ones. I gotta shell out money for this and that and plan, plan, plan for the worst! I feel uneasy here. There's an increased feeling of hostility, and I could be totally off my rocker but, I wouldn't be surprised if it was based on fear and the protection of self. Just my 2 cents. I should also add that I have enjoyed all the friends I've made here and have been happy to have all the opportunities availible to me here! So I just have to weigh my options.:)

I studied for both very close together. I remember clearly that I was more stressed about the NCLEX (I'm canadian) because I wasn't sure about the education differences. I remember they were very different from eachother (I wrote the Canadian exam in Alberta and it was a full day for 2 actual tests (lunch break in between). I wrote my NCLEX in Montana and it was all computer based, and I couldn't go back and change answers. As far as the questions were concerned, the CRNE questions were broader in scope, questioning more on Critical thinking skills and how you would use your nursing knowledge to remedy familiar and unfamiliar situations. The medication questions focused more on drug Classes than actual names, as names of medication can change all the time (ie. Gravol aka Dimenhydrinate is known as Dramamine in USA and so forth). The NCLEX was specific to disease and the treatments of it, Drugs, drug names and specific drug side effects, and also delegation to nursing assistants (There was NONE of that delegation stuff on my Canadian exam). My opinion is that if you can get past the nitty gritty details of the NCLEX, you are a shoe-in for the Canadian exam, (which also had community needs and education as an emphasis). I studied harder for the NCLEX than ANY test I've ever written and STILL came out feeling like I was an idiot! Good luck to all who take both. It'll be a stressful time of study but well worth it!

thanks so much for the info.