JMBM

I can roll pretty well with a busy team of 8 or 9 patients. This isn't even a hard question. Eight or nine ER patients is too much for an experienced ER nurse to safely handle. Fifteen for a new grad verges on the criminal. Just think, you have all of 4 minutes per hour for each patient, assuming you do no charting, answering the phone or, heaven forbid, using the bathroom. If this is a case of institutional neglect of the ER, the only solution will happen when nurses vote with their feet. After writing my response above, I decided to come back and edit it some. Your statement that you can "roll" with 8-9 patients stuck with me. Thinking one can handle 8-9 true ER (not non-urgent) patients is not a point of pride, it is a tragedy waiting to happen. Any nurse who thinks she/he can safely handle that many acute patients has simply never had their gastric bleed, septic grandma, wheezing kid go south in a hurry, let alone having all three crash at the same time - while you have six other patients to watch/treat. ERs that put nurses in that position are unsafe and nurses who put up with that load are courting disaster.

Alaskans get alot of questions on how it is to live up here. The problem with answering that question is that Alaska is as large as the western third of the contiguous United States. Its kind of like asking what its like to live west of the Rockies. Yes, the north/central part of the state is cold, but much of the midwest is colder than Anchorage and certainly colder than Juneau or Sitka. Anchorage is a small city with malls, theaters, pollution and traffic jams, but its a 30 minute drive to wilderness unlike anything in the lower 48. Yep, its expensive to live here, but less than San Francisco or Washington DC. To get a feel for prices/cost of living, I'd check out the websites for the Anchorage Daily News and Fairbanks News-Miner. If I had to generalize, I'd say the biggest reasons people move back south (alot do) are distance from family and the darkness in winter. These are a big deal for alot of people. If at all possible, I'd recommend a family vacation up here to check it out. (I think spring and fall are the nicest times.)

There is a hospital, Mat-Su Regional, located between Wasilla and Palmer. I don't know their pay scale, but I assume you could get that from them easily. Many people, in fact probably a majority of working people in Wasilla and Palmer, make the commute into Anchorage. It is on 4-6 lane highway. During fall and winter, the drive will be in the dark and often in very tough weather conditions. With gas over $3/gallon, alot of people carpool. One upside is that many Anchorage nurses work 3 12-hour shifts a week, so the drive is not as often.

According to the Providence labor contract with the Alaska Nurses Association, the hourly rate for new grads in 2007 is $25.21. The rate for an RN with one year's experience is $26.16.. In May of 2008, those rates will increase to $26.35 and $27.34, respectively.

Its wonderful that you are interested in ED work, and I absolutely encourage you. I also agree with the earlier respondent who wrote that you should look for opportunities to volunteer or somehow else become involved in an ER as soon as you can. Any of us in the ER have seen many, too many nurses start or transfer in to the ER, then leave in a few months because it is not at all what they thought it would be. One of the prime things you can have on your resume is prior exposure to ER work so you can honestly tell your prospective employer that you know what you're getting in to. (You might also learn that the real-life ER isn't quite your spot.) That being said, I think one of the unique things about ER work is that we see everyone and everything -the old, the young, the recently healthy, the terminally ill, the sober, the intoxicated, the sane and well,,, everyone else. Learn everything you possibly can in school. Especially learn critical care, pathophys, and pediatrics (kids are scary in the ER.) With the exception of care plans and nursing diagnosis', ER work will demand absolutely everything you can learn. So, when you're not taking extra coursework, go stock linen or something in your local ER. Best of luck

The labor contract pay at Providence Hospital in Anchorage for a new RN with no experience is about $25/hr. Providence is the largest hospital in the state and its wage scale is probably about average. To get a feel for Anchorage costs of living, check out the website for the Anchorage Daily News, which is the largest paper in the state. Anchorage as a starting point? Depends on what you like. Over half the people in the state live in or within commuting distance of Anchorage, but that's still only about 400,000 people. Anchorage has many of the amenities (and jobs) you might expect in any small American city and its still easy to get out of town to the "real Alaska". Still, even Anchorage is a world away from Houston in terms of size, weather and geography. I'd advise taking a vacation up here to check out the land before deciding. You might find a great new home, and the worst that could happen is that you'd have a great vacation.

Wow, Barrow? from the East Coast? I worked in Barrow for awhile, albeit quite a few years ago. Barrow is a predominately native town in the Arctic. There is quite a bit of money in Barrow, resulting from the local native corporation's royalty payments on oil. There is also quite a bit of poverty there. Think of a small town on an absolutely flat plain over 300 miles north of the Arctic Circle, surrounded by marsh on two sides and the Arctic Ocean on the other two. Think of a place where -40 degrees is not unusual and the sun disappears for over 2 months a year. It costs more than $600 and takes over an hour to fly to Barrow from Anchorage, the only town in Alaska with over 100,000 people. Think what is costs to buy a quart of milk there. On the other hand, there are deep and fascinating native roots in the town, including an active whale hunt. They even have a new high school football field, although their nearest opponent is over 500 miles away. In short, Barrow is nothing like anything most people have experienced. I'd strongly suggest that you visit before committing to work/live there. You might love it ..... or maybe not.

Actually, the reason I work in the ER/shift I do now is because of the feeling of teamwork - don't believe anyone who says all ER situations are like you describe. In fact, I have found ERs in general to have more of an ethic of teamwork than many other departments. Where else do you have doctors, nurses, techs, RT's, Unit Clerks and anybody with hands pitching together over and over in endlessly changing combinations? That all being said, a culture of teamwork varies from department to department and even from shift to shift within a department. I agree 100% with the writer who said this all comes back to leadership. We have charge nurses who pitch in, seek out ways to help, and do everything possible to encourage teamwork and cooperation. We have a few others who sit at their computers reading the Internet while the nurses in back drown. I love working for the first and avoid the second whenever I can. .... One last note, though. If you like ICU better and are in the ED primarily for the extra pay, transfer out now. The ED is way too stressful and way too different from ICU work. Over time, the money won't be worth it.

The military hospital does employ civilian nurses. I have an RN friend whose in their ICU. His actual employer is the VA.

I was a medic who "came indoors" and was a new grad in the ED. First, your medic experience will be extremely valuable, but perhaps not in the way you think. Sure, the physical skills are great, but its the mental part that will really help - the experience of assessing, ordering tasks and operating under stress in unpredictable situations. Our department has a formal internship program but made it clear they only hired me (as a new grad) due to my medic experience. That being said, some experience on the floors is really valuable, also. In a high volume ED, many of the tasks you do (giving meds, cleaning patients, etc) are ones most nurses learned and perfected on the floors. In the ED, you are constantly juggling, re-prioritizing and doing these tasks at high speed. Imagine pulling out onto an unlimited speed autobahn the first day after you got your drivers license. ...What's the bottom line? EMS experience is wonderful and it'll help you tremendously. Floor experience is wonderful and would help you tremendously. You could join an ED without either, but only if that ED has a formal, working, effective learning/preceptorship program designed to help you get up to speed. Best of luck and welcome to the circus.

To answer the original question - unions are not dependent on state, region, district or even hospital. They exist anywhere a large enough group of employees get together and petition for recognition. Nurses can be union or non-union at hospitals next door to one another or even in the same hospital. Now, as to the responses

Absolutely.

Given your reasons for wanting to leave your current job, I'm not sure why the ED would be better. Certainly, there will be co-workers you like/dislike. If anything, ED personnel tend to have stronger personalities than most. There will be plenty of silly little things you need to do - welcome to nursing. The heart of ED nursing to me is rapid change, adaptability, and multi-tasking. You have to like dealing with near-chaos. You'll see everything from sore throats to sepsis to gunshots to heart attacks to sprained ankles to foreign objects inserted places they weren't meant to be - all in the same shift - sometimes at the same time. And then there will be old Joe, the strong smelling drunk who is back for the 18th time this month and who just soiled the bed, again. You have to like working with a team, sharing work, responsibilites and covering each other. There will be shifts when you spend half your time stocking rooms and others when you don't even get a bathroom break. In many ways, ED work is as near an opposite to ICU as you can get. If you liked the focus, precision and complexity of ICU work, but just don't like the folks and the pace in your department, I'd suggest looking for another ICU or similar department. If you have a secret yearning for chaos, welcome to the ED.

I was (and still am) a medic and am now an RN in an ED. I agree with earlier writers who say that the medic training will help you alittle (and only alittle) in nursing. The EXPERIENCE of working as a medic will help you immensely if you decide to go into nursing. So, in my humble opinion, going right from one school to the next is okay, but I don't think its worth a year of your time, whereas a few years in an ambulance will really be a huge asset. Who knows? You might find working pre-hospital is where you want to be.