JSJones,RN

"JSJones - I can tell you've been on the Rez for a while since the describe Farmington and Flagstaff as the "big cities":D" I know!!! Came here for a "13 week" assignment in July of 2011 and keep extending! Plan to leave in May but who knows!

Sarahc331: Your information is good however, I filed as 'part-year' resident in both states. I didn't claim a "permanent address" in VA which is my home state. I don't think I stated that in my last post. Since I don't have anything major in my name that is registered in the state of VA, I don't really have to claim a permanent residency there. Technically my home is in VA but my work home or 'tax home' is not. According to the IRS website, "Generally, your tax home is the entire city or general area where your main place of business or work is located, regardless of where you maintain your family home." I filed my taxes in the states in which I worked in. The hospital I am at now utilizes a lot of travel nurses and most of those have been traveling for years and all say that they only file in the states they have worked in. My taxes along with the two others I travel with have been approved by both federal and state. As far as the 'tax advantage' program some companies offer, it is a marketing slogan, that is it! As per the traveltax website: "Tax Advantage is an industry marketing slogan for a travel reimbursement policy used by some companies. Any employer having employees that travel in the course of their work, can reimburse for expenses incurred while the employee is away from home. The reimbursements given to the employee are tax free provided there is a tax home and duplication of expenses. It is all perfectly legal. The "advantage" in the practice is that since this sum of money is a reimbursement rather than earned wages, it does not get assessed social security and medicare taxes, saving both the employee and employer 7.5% of that sum." So even though my company doesn't advertise a "tax advantage" program, they still pay us the same way and are allowed to because of the law. Using that advertisement is just a marketing slogan. The CPA that filed our taxes has been doing this for 25 years and on average files 400-450 person's taxes every year. (A lot of which are travel professionals) I am very confident he knows what he is doing and he guarantees his work. If I am auditted or my taxes are rejected (which they've already been accepted), he stands behind his work for no additional charge. I too was nervous starting out as a travel nurse because of tax issues. I worried about filing for weeks after receiving my W-2s. Doing my own research on the internet caused a lot more stress than I needed. There's a lot of information out there and filtering through it can be a headache to figure out what it actually the truth and what are the opinions of others. Talking to a CPA who has many years experience relieved my anxiety and stress.

We use hydralazine quite a bit in the ER I work in. Labetalol is an ok choice...I tend to think metoprolol works better...but if their HR is in the 30's, I doubt I would choose a beta blocker. If you're going to treat an asymptomatic pressure, however I agree with previous posts, that you're not going to treat an asymptomatic pt with a systolic of 180-190, but if you choose to, why not ask for clonidine? Its PO and works fast and well. There is a chance it can decrease their HR a little but usually not by much. (Nitropaste is also a choice but again, careful with the HR) And don't you always love those certain floors who refuse to accept until the ER completes all their demanded tasks? Some floors are ridiculous! (know that was off original topic....but same story no matter where you work seems like!)

So a little update.... I just finished filing my taxes....didn't use the website I previously recommended but instead went to a CPA locally who does several co-workers' taxes. Anyhow, I originally went to the CPA only for a consult because I was so nervous/worried. When I attempted to file them on my own online, I ended up owing more to my state, the awesome Commonwealth of VA (sarcastically speaking of course), where I had only worked 1.5 months and only about an eighth of my income for year was made, but I owed them more than I was getting back from Federal. The CPA filed me as a part time resident in both states, AZ and VA. I now am getting a refund instead of paying in. He said that it doesn't truly matter where your permanent address especially if you don't have a home in your name and bills in your name there at that permanent residence. I know there are so many things you can look up on the internet, believe me I spent hours looking around and stressing, and I still like the traveltax.com website because their answers were great, but I can't tell you how relieved I was after meeting this CPA and he had my taxes done and submitted with in half an hour. My new outlook.....CPAs don't try to do our job and I won't attempt their job anymore even as simple as some of the online programs make it seem.

I am a travel nurse in an IHS facility in Kayenta, AZ. I started here in July of 2011 with in the intention of completing the standard 13 weeks and moving on to another location. Well...its now February 2012 and I/we are still here! (We=3 old friends who travel together)....It did take about a month or so to adjust to the area, ie. having to drive a minimum of 1.5 hours to get to a decent grocery store or even a Wal-Mart, lol. As far as cultural differences, there a lot of cultural differences. I work with an amazing group of people who are mainly Native American/Navajo and have been awesome with helping us understand the do's and don'ts. (ie. first day here we were taught to point only with our lips and not our hands because the later way is rude, also death is a really touchy subject that is to be only addressed by certain people in a certain manner.) As long as you go into a place like this with an open mind and realize that you aren't there to change certain ways they do things and don't judge but embrace the culture, I doubt you'll ever have a problem. Sure there are always some elders, grandpas and grandmas as they are addressed by everyone, that tell you they don't speak english but only Navajo, just because you are non-native but I have never had anyone here on the reservation be down right rude to me. As far as being accepted by patients and the community, this particular hospital has a lot of travellers including physcians so its nothing new to them. IHS is a government facility so it can be slightly difficult but once you get the hang of things, it becomes no different than anywhere else. The majority of the care is free to Native Americans so the ER is utilized as a big primary care source which is not optimal for the nurse ER lovers but you get used to it. But on the flip side, we are the only facility for miles so we get the traumas here, stabalize and ship them out. More often than not my patients have been very interested in my background and what the East coast is like, since I'm from Virginia. We have been invited to a few ceremonies which were all very interesting and truly great experiences. We have made friendships here like no other place before that will surely last a life time! I also agree with 'bagladyrn' that if you are looking for a true reservation experience, Gallup may not be the best option. However if you don't think you'd be able to handle the major cultural differences and don't like living in the really rural areas, it may be a great place for you. Kayenta for example, is kind of far from the bigger cities like Farmington or Flagstaff, but the drive to and from those places is always beautiful. We also live about 20 minutes for the very beautiful Monument Valley, about 80 miles from the famous Four Corners Monument where AZ, NM,CO, and UT all come together, about 1 hour from the South Rim of the Grand Canyon, and of course one of my favorite.... only about a 5 hour drive to Las Vegas, NV! The reservation is 'dry' so if you're a drinker, probably not going to like it as much as an off reservation assignment. That being said, I have worked at a few trauma centers and I have taken care of more drunk patients and more assault and batteries here on the reservation than ever before! Got to love the boot leggers! Every Wednesday there is a huge flea market where you can buy hand made crafts, jewelry and also eat traditional food varieties such as fry bread, mutton stew or mutton sandwich or one of the more interesting... blood sausauge! Eitherway, sorry for the small novel but when we first started here we weren't very sure we were going to make it here but we stuck it out and it has been the most memorable and best assignment yet! Good Luck! ( Sorry I didn't realize how long this was until I posted it....)

It completely depends on the patient and your situation. I have taken care of a lot of women who could care less as long as they are treated with respect and dignity. As a young male nurse, its usually me who is uncomfortable in these situations, yes, I am a professional and have had the appropriate training and can perform the needed tasks as well as any female (no offense), but I am still slightly uncomfortable doing certain things without a female coworker present. As much as we'd like to deny it, we still work in a world that is predominantly female, and some patients are just more comfortable with a female taking care of their personal needs. Always ask your patient first, they'll usually freely tell you if they aren't comfortable...but when in doubt, have a female present as a witness, it shouldn't bother you and if something does arise later on, you have someone on oyur side!

I, am a young nurse, at age 24 now, I've been a RN for 4 years. I am treated like the 'know-nothing youngster' everyday but like other responses have noted, I take advantage of the knowledge I receive from the seasoned nurses. It takes time to prove yourself but when that day happens, you have a built a relationship with the older crew that isn't describable! You have taken their knowledge and used it to establish yourself and usually they appreciate that as much as you do. Never take for granted the insight the seasoned nurses provide for they are our foundation! I can admittedly say too, I enjoy the attention! I bond a lot easier and quicker with the older generation because I respect them! My advice to you, try to absorb all the insight and knowledge you can from them, it'll make you a better person and nurse!

I have been a travel nurse on the Navajo Reservation in northern AZ for about 9 months and can that I have grown so much as nurse! There have been a few patients, but you'll have those anywhere, that upset me, but overall I have had only good experiences here!

would probably have to say pleurisy due to the length of recover and pain associated with the recovery. That being said, the risks of the recovery for a tonsillectomy are greater than those of pleurisy.

I think it may be!! I grew up on a farm and have seen a lot of pigs with this same condition! lol

I have been and ER nurse for only a few years and want to personally apologize for the way you were talked to. I also want to say that not all of us think the way the nurse you gave report to and VISEDRN do. You absolutely did the right thing by sending your pt to the ER. I guess some may say that I am confused as what I consider as emergent. Sure a glucose would've been nice but we can look over that. A patient with a fever of 101 who was given an appropriate antipyretic, such as APAP PO, and an hour later their temp is now 103?? That doesn't concern some nurses? To answer a previous question posed by VISEDRN, if my child had a fever that didn't respond to appropriate antipyretics, and the child was symptomatic, I would absolutely bring them to the ER. Should I wait until the febrile seizure to do so? As far as the labs and XRays being done out-patiently, that is completely acceptable for the stable patient. However, a patient with a temp of 103 and SpO2 of 82% with audible crackles doesn't exactly fit that category. For those who don't think the patient deserved a bed at your ER, let me change the scenario a little: You're on your way to your grandfather's or grandmother's for a visit, upon entering their residence, you find them in the bathroom with nausea and vomiting, they tell you they've taken APAP an hour earlier but when you assess their temp its 103, you hear audible wheezes without a stethoscope and they're slightly cyanotic (as I'm sure one with a SpO2 of 82% was)....would you call 911 and request them to be sent to the local ER? Or would you say "You'll be fine, take some Motrin, try putting some Tylenol up your rectum, cough...etc" As for me, I live with my Grandmother who is a hemiplegic due to previous CVA, have a 92 year Grandfather who is in great health for his age, and if either one of them were in this very situation, I'm pretty sure I'd have them evaluated by a ERMD. LTC/SNFs are so understaffed and until you're in their position, you shouldn't form a judgement based on the 'quality' of report you've received! I know how frustrating it can be to take care of some geriatric people however, I also understand that when someone who sees these people everyday calls me because they are concerned and know that something isn't right, its my job to assist in the diagnosing and treatment even if that only involves a simple assessment (part of holistic tx=assurance) because when you call to give report back to that LTC/SNF nurse (which I hope you wouldn't consider that a waste of your valuable time), they're going to appreciate knowing that their patient is okay. My mom, a RN, worked LTC/SNF for years as did I, as a CNA, and we developed relationships with our patients far beyond what ERRNs understand. They become some sort of a family. I, now a ERRN, miss that certain relationship as now I get to see my patients for a few hours if that. OP, you did a great job! I can only hope that the RN you gave report to was just having a bad, though I highly doubt it. Some ERRNs forget that working in an ER isn't always about the MVCs and the excitement of trauma, its about caring for those in need. I agree that a big portion of our clientele's perception of true emergencies is false, however who are we to belittle them and tell them to go home and call their PCP in the am?

No, there isn't a requirement of hours to be completed prior to taking TNCC. I took it about 4 months after I graduated and did fine, was actually asked to assist with teaching the next class offered later that month. However, the ER I worked in at the time required you to work in the department for a year before you could join the Trauma Team. I agreed and continue to agree with that policy. Being the Primary Nurse during a trauma takes a lot skill and confidence and experience is the only way to gain that. I was allowed to work as the recorder during traumas my first year which was very beneficial.

No problem! Good Luck!

I traveled to Katy, TX which is about 20 minutes outside of Houston. I loved it there! We drove to Galvestine Beach a few times which is about 1.5 hours south. We used a company by the name of Traveler's Haven for housing and they put us in a very nice fully furnished apartment on the 10th hole of a golf course with 2 pools and fitness center. We could be in downtown Houston in about 40 minutes depending on traffic. The nursing company we use is Liquid Agents Healthcare. Not a very well known company yet but I have been with them for a year now and have had no problems. Their home base is in Plano, TX and they have a lot of assignments in TX.

No, you are not a hypocrite! What I have experienced, is that the older the patient is the harder the recovery is. Usually the biggest risk comes 7 to 10 days post-op and that risk is hemorrhage at the surgical site. Listen to your doc and follow all post op instructions and you'll be fine! I had an appendectomy two years ago and that was the first surgery I've ever had besides my wisdom teeth extractions and I was very nervous. They gave me Ativan and Versed in pre-op and all my fears were gone! lol...To answer your other question, yes, continue your education! Being a nurse usually helps to alleviate some of the common fears associated with surgery but it doesn't take all the anxiety and fear away! Good Luck!