Claire825

We are discussing acuity based staffing on our unit, and whether we should be considered ‘step down’, particularly in regards to some of the specialty patients we accept. We are officially deemed ‘med-surg’, except when residents sign their notes as ‘ICU’ (confusing, huh?). We take as little as POD#1 CABG/Valves/heart transplants, PA catheters (Swan-gantz catheters), post-Cath lab (including TR bands and femoral sheath pulls), an array of cardiac drips including remodulin, NTG and dopamine, and LVAD patients. We all take a critical care course and are ACLS cerified. We are fairly strict about a 4:1 ratio, with hardly any deviation from this ratio (never 5:1, basically never 3:1 unless you just had a discharge). We only have one mandatory assessment charted per day. We are trying to argue that some of these patients, particular fresh open hearts and SWANs would be on true ‘step down’ units or the ICU at other hospitals. Do any other facilities take these patients outside the ICU, and if so, what are your ratios? Do you think those ratios are safe at your own facilities? Any information or input is appreciated, as well as any literature references. I can find very few scholarly articles and very little consistency about the definition of a ‘step down’ unit, the types of patients that should be on them, and the recommended nurse:patient ratio on these units. Thank you!

Thanks for the information, all of that was great!

"But sir, medicare doesn't cover discharges through the roof"

So I have scoured this website for months and looking at threads about Philadelphia's hospitals, but they are all years out of date. So I'm testing the waters with one more, hope that's okay! I'm planning a move to Philadelphia. In fact, I've wanted to move to Philadelphia for years but it seems like something has always come up and this may finally be my time (fingers crossed). My background: I have my BSN and ~21 months experience on a cardiac PCU at a large magnet hospital in another state. I'm interested in moving into another cardiac focused unit, preogressive or CCU as the heart is what makes me tick (haha, get it?), at (hopefully) another Magnet hospital, or at least a large teaching hospital. I'm also interested in eventually advancing my education. I have some concerns about finances, moving to a more expensive part of the country potentially without much of an increase in pay, or worse, risking not getting a job. So here are my questions: 1. (most important) Is it reasonable to think I could get a job at one of the hospitals in Philadelphia? 2. Do those hospitals, if not magnet, treat their nurses reasonably well in terms of staff ratios, educational opportunities, and support staff? I did interview at Hahneman about a year ago when I started considering leaving my job, and did think not having aids sounded a bit rough 3. What range of compensation should I reasonably expect? I'm not expecting wealth and riches by any means, that's not why I got into nursing, but looking at apartments around Philadelphia and taking into account student loans payments etc, will it be reasonable to support myself and set some aside? Really, any information on the main hospitals in Philadelphia (Penn Medicine, Temple, Thomas Jefferson, Hahnemann etc) would be appreciated in terms of charting system, ratios, general impressions of working there, compensation, benefits and I'm sure would be appreciated by anyone else looking to move to Philadelphia. Thank you in advance!

I was just posting to check if anyone has any updates on the Philadelphia job market. I'm graduating with my BSN in December from a second degree program and was wondering if the hiring freezes on hospitals had generally been lifted in the city (or even how hiring is within a forty minute radius). I have experience as a CNA, three years as a medication technician and decent grades, but I'm aware that these things might add up to a big fat zero if the market just isn't there. Any input on who's hiring, what hospitals you all like working for, or general advice for a newby would be appreciated.

I have my own way to remember the cranial nerves. It might be confusing to some but I like it since it uses more than just the first letter of the pneumonic (with the "oh oh oh" I got the order of the first three nerves confused)... Old-Olfactory Operas-Optic Occurred-Oculomotor To-Trochlear Try-Trigeminal And-Abducens Feature-Facial Very-Vesticulocochlear Glorious-Glossopharyngeal Vagabond-Vagus Singing-Spinal Accesory Hippos-Hypoglossal Maybe there's another person like me who might find this useful. :)

Little known fact: Al Capone was terrified of needles

My hobby #187: Posing as a nurse and seeing how long it takes patients to formalize a complaint

Thank you and good luck to everybody!

Nurse Ratched cleans out her inventory

"Babies of all sizes need their flu shots"

I got in!!! I'm actually working in a foreign country right now so my boyfriend's mother (who is currently receiving my mail) emailed me with a scan of the acceptance letter. My boyfriend woke me up at 6:30 AM when he saw the message from her on skype and just said there was good news in my email and I needed to wake up. I was jumping up and down for ten minutes after I read it. It is my top choice program, and the only one I had applied to because I was so dead set on going. I'd love to talk with some of the other students who will be attending in the fall and I can't wait to meet you all. To those who are still waiting, don't lose hope. I'm pretty sure this is just one batch of acceptance letters and more will be mailed soon. The secretary, Ms. Boger, kept telling me not to expect news until March when I emailed her to ask about my application, and I have a feeling that is when they make most of the decisions.