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.

There are three civilian and one military general hospitals in Anchorage. There is also a civilian hospital 40 miles north in Palmer. In Anchorage, Providence Alaska Medical Center is the largest hospital in the state and part of the Providence chain. Alaska Regional Hospital is about 3 miles away and is slightly smaller. Both are nice, relatively new facilities in nice parts of town. Each have their advocates and critics, but neither could be considered bad places to work. Alaska Native Medical Center is a public health hospital exclusively for native Americans. It is a magnet facility, teaching hospital and has recently made local news by banning smoking not only inside but also on its entire campus of parking lots, green areas, etc. Elmendorf Air Force Base has a small hospital and I don't know if they use travelers. To the north, Mat-Su Regional is a brand new for-profit hospital in Palmer. It has only been open a year and reputedly has some growing pains. Still, it is a beautiful facility in a nice, small town.

Really? I've always found ER to be extremely realistic. Why, just last week, we had a helicopter crash on our ambulance bay, squishing the director of the department. Good thing it happened on Tuesday, because the day before we had a patient drive a stolen tank up to the ER and a hazardous waste spill in triage. Luckily, all the doctors were around, since they are usually out intubating people in crushed buildings and doing emergency C-sections in wrecked ambulances. Of course, when they are here, the docs are really busy. Yesterday, we had a trauma with four docs in the room, cutting off clothes, putting in IVs (even before the cart stopped rolling), pushing meds. Luckily, that gave me time to run around looking for consent forms, especially since I'm the only nurse ever there, except our token Hispanic, black and gay nurses who don't talk much. We won't be around long, though. We nurses are dying to either marry a doc and have kids or become one of the docs, so we can do real medicine and stop cleaning up derelicts all day. Besides, we could use some fresh docs. The ones we have are always too busy sleeping with one another or off sitting at the bedside of a patient for a few hours.......Seriously, ER has been on a downhill slide for years, dropping into freefall, quickly becoming yet another doctor soap opera, the only difference being a slightly more grudgy set than the others. This is television, after all, meant for the lowest common denominator. So, grab the popcorn, pop a cold one and dial in Greys Anatomy since I like my soap operas straight.

don't do it. If you are planning on one of the jobs being an ER job right out of school - DON'T DO IT. An ER is a fast-paced, high stress environment. Starting there is never easy. Starting there right out of school is even harder. Starting there right out of school plus carrying another full time job is .....well, insane.

As you might have seen in other posts, trying to describe Alaska is kind of a big project. It is as large as the western third of the US. Asking for a favorite place here is like asking what your favorite town is west of the Mississippi. It all depends on what you are looking for. Let's start with the basics. The southeastern panhandle has the small city/towns of Wrangell, Ketchikan, Juneau and Sitka - small city/towns located on the water with economies based on fishing and lumber (Juneau is, of course, the capital). The climate leans more towards rain than snow. Southcentral is the center of population with Anchorage and the smaller on-the-road communities of Palmer, Wasilla, Kenai, Soldotna, Homer and Seward. There is a new hospital in Palmer and small hospital/medical centers in Soldotna, Homer and Seward. Kenai/Soldotna, Homer and Seward are on or near the ocean and their economies are based on fishing and tourism. Palmer/Wasilla is north of and accessible to Anchorage. There is excellent stream fishing there and a new hospital in Palmer. Anchorage has the largest hospitals and half the state's population. Its not much different from any small northern city in the lower 48. There's a small hospital in Kodiak, and the fishing on that island is world famous. Fairbanks has a small hospital there a couple of military medical facilities. Fairbanks is a very laid back, friendly place that gets seriously cold in the winter. The "bush" communities are those off the highway grid. Several, including Dillingham, Bethel, Nome, Kotzebue and Barrow, have medical centers. I'd check out the Alaska Emergency Nurses Assn website, which lists all the hospitals and their websites. I would strongly recommend a traveler contract up here if you aren't sure.

I work in an ED. I know its hard, annemarieRN. Almost all of our nurses have worked on the floors and we know precisely how much it sucks to have an admit roll in at 1850. Its really tempting to lash out at the person who handed you the admit - be it the ED or PACU nurse. Now, there may be a few inconsiderate ED nurses out there who don't care about your shift change, but in almost every single case, the problem is not the nurse downstairs. In our shop, if we have an admit that falls sometime after 1830, we do our best to drag our feet until after 1930 to give the new shift a chance to get their feet under them. But just as TazziRN and RunnerRN have said, sometimes we just have no choice. We can't stop the ambulances from coming or the people from walking in the door. So why does an admit arrive at 1800 when a bed was ready at 1530? Nine times out of ten, it is due to the doc. We request a bed as soon as we know the patient will be admitted. However, we can't move the patient until the doctor writes admit orders. Many times, the admitting doc or resident on duty comes down, examines the patient, then spends 45 minutes writing orders - all after the bed was ready. The orders might then require emergent treatments or changes to prior treatments - things that need to be done before the patient goes up. Then three more chest pains roll in. All while the bed is ready. In the meantime, the charge nurse is yelling at you to get that patient upstairs to open the bed. Believe me, if we could have handed you that patient at 1530, we would have, but sometimes it just doesn't happen. So, annemarie, if an ED or PACU nurse is jamming you at shift change due to lack of consideration, I'm really sorry and that nurse needs an attitude correction. However, please know that most of us understand your situation and only hit you at shift change if patient care absolutely demands it.

Wouldn't leave it for the world. Here in Los Anchorage, we got about 6 inches of snow for Halloween. We're running single digit temperatures at night under a clear sky. A moose chowed down on our apple trees the other night and another one was hanging around the hospital entrance, forcing me to go find another door. Gotta go out and put the studded tires on.

I agree with swartzRN, as the years go by, I carry less and less. Of course, our rooms all have supply carts, so stuff is close at hand, usually. I'm down to 2 pens, a few alcohol wipes, a carpujet, a tiny drug guide and trauma shears. If I'm thinking when I come in, I'll tuck in a ziplock with a couple bucks for the coffee cart. I usually have a small daypack at the nursing station with a few personal items, spare pens and a bigger drug book (in case the one in the med room develops legs.)

Way back when, I started with a fanny pack, then went to a smaller fanny pack, then went to multi-pocketed scrubs, now I'm down to carrying 2 pens, a couple alcohol wipes and a tiny drug book in one pocket and trauma shears in the other or tucked into my waistband. I do have a little daysack sitting under the nursing station with a few spare pens, notepad, tea bags, aspirin and a big drug book (in case the one is missing from the med room.) Of course, I work in an ER, where all the rooms have supply carts with IV stuff, 4x4's, etc. I'm sure it'd be different in a unit without stuff close at hand.

Actually, you should be scared, alittle. Any experienced ER nurse will tell you that the day you stop being alittle scared is the day the ER turns around and bites you in the rear. ...... Seriously, if the hospital has a good training program, you'll have plenty of time to get a feel for the work and decide if its for you.

It seems to me that folks are mixing up several concepts. First, there is the "if we wear white, patients will know who is the nurse" concept. I work in a busy ER. I always introduce myself and show my name tag when I come in and then again when I finish my assessment and turn to leave. With the exception of patients with altered levels of consciousness, I've never had a patient fail to grasp that I was the nurse. Even if that weren't the case, any color scrub, so long as its consistent, would equally identify the nurse. There is nothing unique about white for identification purposes except the "old days" of the pillow-fluffing, "eat all your vegetables", bedpan carrying stereotype.....Okay, if the patient already knows who the nurse is, will white make us more respectable? Not without attitude. You could wear white, purple, pink, BDU's or a moon suit and if you act like a doormat, you'll get treated that way. In contrast, we've all seen that overweight, short grandmothery RN with big hair and little glasses in teddy bear scrubs who can wade into a chaotic code and in five minutes have it straightened out with the doctor asking her how to proceed. As cops say, its all in the eyes and tone of voice. Okay, if the patient already knows who the nurse is and the nurse has a professional attitude, will a uniform help make us more respectable? I haven't seen any studies, but from my experience (in white-required, certain color required, no restrictions), white had zero effect over navy or royal scrubs and I can't feel any difference even over printed scrubs. Now, if wearing white helps you feel more professional, by all means wear it. Mine went into the donation bin.