RN Randy

For those unfortunate enough to have to work, not qualifying for a loan, school is tough, and even tougher based on the amount of work one has to do outside of school. I'm so sorry your life has been so easy as to make you think nursing is the toughest thing going. It isn't. Oh, and you're usually not the one making life/death decisions, it's a team effort in most places. To the point; I attended an ASN program at a community college and worked my way through. It sucked for sure and would have been much easier had I done it back when daddy was willing to pay for it, but I just call it another feather in my character hat. Anyway, our class usually starts with around 70 and graduates about 60. NCLEX passage rates are 98-100% with the average testee reporting 80-90 questions at exam. My NCLEX was 76 questions at cutoff, but again, I had a family to support and the only options were to work and try to make it, or just don't go at all. I chose to work and go. I suggest practice with the HESI, or similar exam as much as possible, as many times as possible. rb

I have to say that customer service is indeed an overkill, based on the fact that as mentioned before, people expect too much from anyone, or any agency, all the time. Not just hospitals. People who live 'normal/average' lives demand special/above average treatment in all things from not paying a lot for a new muffler, to healthcare. As someone else said "We're spoiled". This society has become so complacent and dull-minded that we watch TV shows like "Survivorman" and think that guy is "crazy" and doing "insane" things. Kids think meat comes from Wal-Mart or IGA, and that milk is made just like any other commercial beverage. To kill a turkey or chicken for dinner is ghastly and risking the wrath of PETA. If the technological world fell apart, people would be found lying in fields of grain and grazing cows, having starved to death. It seems the *demands* of the average person can be somewhat selfish and unrealistic. If we only had people in the hospital that *needed* to be there, healthcare would not be so lucrative a career. It's a hospital, not a hotel. You don't need 24hr observation for your hangnail, and you don't need dilaudid for your headache. But since your lawyer can prove that you *do* need these things, we all get to enjoy higher costs, higher taxes and the list goes on. It's the way things are. Changing them would require teamwork on an impossible scale, attempting mission impossible, and the end result would be lower costs, lower incomes, quality health care, and just enough money for corporate kings to live an expensive, posh life, but without all the world travel and private jets. So as you can see, it's a nice thought, but find better uses for your time. I've no trouble being kind, diligent, responsible, ethical, honest, advocate, etc. But I draw the line at pampering for the sake of ego and corporate America's fear of it's own subjects. To submit to that is to say I am willing to be an indentured servant to the masters of money. I'd rather volunteer in a third-world country and let them support my needs. It would be a better deal in the end. Sorry for the rant... lol...

Hmm... been reading this thread... sounds like any other day in the eastern appalachian mountains. LOL. However; when something needs said, it usually gets said... from both sides! Our families bring sleeping bags and blow-up mattresses though, and usually sleep in the lobby and various waiting rooms in every chair and corner. Sometimes it's impossible to even walk through a waiting room. They either hover like worried mothers or shoot each other in the head.

Get on the net or anywhere really, and find yourself a "non-disclosure agreement" form, and DO NOT EVER EVER EVER...even hint at your ideas to anyone that hasn't signed on the line. Then pray they steal your idea... LOL... Seriously, the guy with the submitted paperwork is the guy that gets credit, period. Also, I hear invention companies are mostly scams... they end up with the majority of the money and credit for "making it happen", as posted above.

Hi and thanks for the reply. Well, at the time, I was trying to find a way to get PICC's away from travelling IR guys. Most of our small hospitals use them. Hospitals all have their own Rad Dept, but not IR equipment. Hence, the roving road show. I was in the process of training and trying to get experience. Not something easily done in an area where people routinely confuse PICC nurses for residents; as *just a nurse* wouldn't be doing such a thing. You have to understand the mentality of local folks in the backwoods. At smaller hospitals, nurses still drop their charts and move out of the way when a doc comes in the nurses station looking for a chart or chair; and only when the doc finds what he wants and chooses a chair do they all then sit again. If someone doesn't notice; people will call their attention and point to the 'holy one', letting them know to bow out. It makes me ill just thinking about it. So, when a doc; especially a high-dollar IR operation with their own truck says "we want" well, They Get. As for PICC's, it's like any other skill; and you get out what you put in. I'm a quick study, especially on skills and equipment so it seemed a perfect fit for me. However; when the hospital says "IR will pull out if we upset them and we need their service. We're willing to take the loss or pay the difference in PICC insertion, if it makes the IR guys happy.", then whatcha gonna do?

Wow, just skimming this thread... Looks like it should have been titled "Are you a punk, peckerhead, or both? Please let us know!" Sheesh. I'll tell ya something, it's "guys" that give us men a bad name. To the OP, See all those punk posts? Those are the people you don't want to be if you want respect. Those guys mistake people's flat indifference or preference not to 'engage' a cocky punk in dispute, for respect. I'm middle age, average Christ-following, ever-so-human, laugh-at-everyone-and-everything kind of family man. I've never had a real problem at work because I make sure I know my job, and always offer respect to most of my colleagues. (There will always be a few that you just get tired of hearing, and write off.) In the medical field, you'll be respected for who you are and what kind of job you do, no matter your gender. I've never worked for a place that offers salaries independently; meaning "here is the pay for this job, take it or leave it.". when dealing with hospitals and organizations. It may be different for private docs and what-not, I dunno. Anyway, the point is, do a good job and you will have no troubles. Offer respect, be respectful; generally receive it in return. Usually co-workers and patients are your friends and appreciate you. It's the bad apples, crazy families and most of administration that make you want to pop the top section of an IV pole and start bashing skulls, (much like any other job I assume). LOL.

Yup, looks exactly like the uniforms the females in WV wear.... The school denied the petition for scrubs; saying that scrubs were not only confusing for the ID between nurse/student, but also unprofessional in appearance. However; I believe they did give in to a long white waisted top and white slacks as an 'option'. I think they looked less vintage than the good ol' stereotype. Then there's this: Be thankful you aren't required to wear a cap!

Hello, just have a quick inquiry: I live in a rural area and I'm interested in PICC insertion. I'd be happy doing contracts. I'd be happy starting PICC teams in a couple small hospitals and "make" myself a job. I have access to several small hospitals, say 100-150 beds each. ALL of them appear to use a contracted IR service that rolls in a mobile unit, once/twice a week or so. The IR service does the PICC lines for the hospitals. When I contacted the IR service, in regard to either employment/contract or to just get basic info; they pretty much told me that they don't feel a nurse should be dabbling in the physician's arena by inserting central lines, and that if I thought I could take anything from them, to have at it. Seems they will threaten to cancel their IR contract with the facility if anyone tries to muscle in on their turf, so to speak. Yes, I just said they suggested they'll drop a multi-million-dollar contract over [the 100 PICCs] they claim to do per year. And it does exactly what they want it to do. It makes the administration say "no, thanks, go away." when I approach the hospital about saving money. Second problem is even worse... Contacting the local LTC and SNF operations netted this: "Um, we mostly use LPN's and we certainly won't let them touch deep lines. Besides, why would a patient have a PICC outside of an ICU? Certainly not here." So any advice on how to approach those massive problems? It looks like a sewn-up, po-dunk, slam-dunk to me.... never gonna happen, unless I'm missing something really silly. However; there is the hope of one city hospital that might be a candidate for a PICC team if I can show them how to make it work. Any help appreciated! thanks, rb

Huh? Ok, so how about what chair was she sitting in? The charge nurse's? Was she hindering the CN from doing something, and did said CN give her a dirty look, which caused her to lose focus and not really realize what time it was? SO, the real question is: what do you call a boomerang that doesn't work....? A stick. Now if I only had a dead horse... :)

Well, I usually agree with your posts, but I'm gonna call you on this one. It was a newbie mistake with a rude dude, not a rude nurse. [if she did this continually, yeah, maybe he could be frustrated or whatever, but STILL... two rudes don't make a right.] It's just plain childish to have fits like that. You can say anything you want to convey your desire to be let alone, but this yelling/tantrum thing I just don't get, and never will. rb

er..... did you even read the OP? A new nurse said it was 'policy to clarify meds on admission'... HOW do you get 'policy to call the doc immediately, regardless of the hour' out of that... ?? The rest of us got: 'I'm new and we have to do a med rec on new admits and I was afraid to not fill out every box because [insert reason]'. You know, new-nurse-ophobia... ? It's pretty common. Sounds like any other facility admit. Do a med rec.... find the missing pieces. An old nurse would have just snagged it elsewhere at some point. A simple noob mistake that happened to fall into the lap of an emotional moron. Either way, it's not even the point or the question, so let's not call the kettle black so quickly.

There's a saying about buying a flashlight to carry in the prison, and I always have to laugh when I see those super-size Maglites... It goes: 'When choosing a flashlight, try to imagine what it will feel like as it goes up your a$$.' Same goes for personality. Good advice is to imagine who around you is most likely to end up with a flashlight in their butt during the riot, and don't be like them. rb

I just got here, so don't blame me... lol. If it matters now: 1. Who cares what they're there for? Usually, knowing will only serve to either cause you to show sympathy or bias. But for completion... federal is usually drugs, and lower levels are usually assault, theft, drugs, prob. violations, etc. 2. The acronyms. HIV/AIDS, TB, MRSA, COPD, IDDM/DM, Hep/abc, etc.... 3. I guess that depends on the facility... but clinic is clinic anywhere. 7-3, 8-4, no weekends or holidays. 4. Again, per facility. It will depend on what 'level' they are, or choose to be, whether they have an infirmary and how staffed they are for docs/specialties, and the pop. will be admitted to suit. Some take only bandaids, others might take stage 4 decubitus. 5. Pay depends as well. Figure most inmates you see 'working' make less than a buck an hour, unless they're doing something special or part of a specific program, then they can make 2 or 3 an hour or there about. 6. Comissary works like any other store. Some track inmates and what they can/can't buy based on various criteria. [ie; inmates in the infirmary cannot purchase OTC meds, or whatever, until released back to GP, etc.] Things like that. It's far from complete or applicable to every facility, but hope that helps.

LOL, Sharon... robi-d... wow. Two words come to mind... "eaten alive." My life's experiences have taught me that when someone begins yelling - decrease your tone and remain calm, and most of all, know which common items make the best weapons! :) rb PS: I always call physicians 'sir' or 'ma'am'. Doctors reap what they sow. [Having a doctorate in medicine doth not a physician make.] Respect is *earned* not owed.

Sorry, then. Let's just call them all the "I'm suffering" face. And Sometimes? When is withdrawl not.. at the least.. uncomfortable? What bugs me here is the hipocracy... The only way to stop withdrawl pain [in the mind of the addict] is to administer the required substance. Or is it? So... suffer through or get the drug... You patient says he's having 10/10 pain... quick, grab your narcs before he loses consciousness... Thus far, Several people have posted as witness to placebo effectiveness.... Oh, that's right.. I was responding to a question about a placebo being useful or ethical... how did we get here? Again? ... And here, you are correct, we part ways like celebrity divorce. Dependancy doesn't equal addiction? Sorry, but that's about as clear as mud. HOWEVER; you make my point crystal clear; the need is relief.... and if a placebo relieves... GAME OVER. ..... we would STILL have seekers. .... nothing to argue here except that the ethical use of placebo's is the topic, once again, not addiction and defense of drug dependancy. Finally, the point. And yep, we disagree. I said, and will always say, start at the bottom and work your way up. Saline and M&M's can save lives if the recipient believes they are life-saving. Yet another reason I prefer the DO over the MD, but that's another topic too, isn't it? And for violating trust...? The pt trusts me to fix the problem. If I do [whatever] to fix the problem, where's the violaton? So I guess you've never told a patient in trouble that "Everything will be alright."?? I know you have; and my question is, who the heck do you think you are???? You don't know that, and you can't promise that. [reference your own comment about being the Almighty] Talk about violation of trust. That's like you saying "I would *never* steal." Sure you would. You just haven't been presented with the right circumstances to rationalize your decision. Holy moly... I agree! haha. rb

Wow, my bad.... I didn't realize this was all about *you*.... ????? [but thanks for a perfect example.] Oh, and if you have a sec.... please... point out where I: a) said I wouldn't treat anyone's pain, b) said someone didn't need to be in the hospital, c) passed judgement on someone, d) said I know what people live with, e) said pain wasn't present, .....and I'll be happy to re-word it. Maisy, you're last post also confounds me... it says "yes, there are seekers, but the system is broke, and it's our fault, so we should change it but until then, continue to give drugs and effect change..." What does that even mean???? And the part about a good healthcare system being seeker-free?? OMG... I'm sorry to offend, but that statement is simply absurd. as always, peace, love and joy! LOL. rb

Man, what a long and liberal thread. It never ceases to amaze me how people want to preach about "can't see someone's pain" then proceed to describe the 'pain face' that goes away when the narcs flow, and use that as their "proof"... are you serious??? One liberal's pain face is another conservative's withdrawl face. And yes, withdrawl hurts. Bummer. If "lying" to you fixes your problem, then I'm a liar and proud of it. I get so tired of 10/10 pain... you know, "the worst pain you can imagine".. while kicked back reading, watching TV or worse, up in the hall throwing a fit. Seems the worst pain some can imagine is a stubbed toe. I imagine if I'm in 10/10 pain, conversation might be impossible, let alone arguing over drugs. My answer to the OP? "ABSOLUTELY!" Start low and move up. Dilaudid-on-tap is not the answer to everything. It's whatever works. If saline cures you, then you're cured. Like it or not. Sheesh.

I'd have to agree on that one as well. Learn to be a nurse first, then seek out a specialty. Clinic, nursing home, long-term care, and even ER or ICU... that kind of thing will give you a good idea of what to expect. You can go from band-aid tech to code team leader within an hour.

Well... lemme see... Melting down an MDI sleeve would probably net one pretty short and skinny shank. I'd be more afraid of a pencil in their hands. Plus, take a minute and think of all the plastic combs, shaving razors and whatnot that are already in use. On the MDI front, Jeepgirl... TrueGem is apparantly having a problem with availability of a med across a long way. If an IM gets shot over to z-block and the meds are kept near a-block, it will be a long time coming before the med gets hoofed down there to them. That is the real issue. So in that instance it may be easier for them to pop out a new inhaler. It isn't about germs or HHN's vs MDI's. However; her facility is indeed facing a definite flow and storage problem. I hope they can find a solution! On a federal level, we have compressors in metal cages mounted on the walls, and the IM's just do their own nebs at the wall station, just like home care. Prescribed meds are kept on person. I'm not sure what to suggest to 'gem except to let the IM keep the plastic. good luck to you all! rb

Well.. glad to try and help, but it kind of sounds like you're stuck in the big grinder of corporate meetings. No luck there, for sure. Your root problem appears to be med access, not germs. I'd keep that in mind when I pushed for changes. Just an idea for a temp fix.... let the IM keep the plastic, and the nurses can carry a couple popular inhaler canisters? Hope you find a viable solution. rb

Understand... however; I still have to refer back to 'single use disposable'. As for dishes and 'scopes, they are not manufactured with disposablilty in mind, and are made of different polymers suited for multiple use. It isn't about germs at all. Cidex has lived it's useful life and won't be much trouble in one's butt on a scope, but when you consider that cidex in the tiny orifice of an inhaler nozzle becomes ethylene glycol [antifreeze] when mixed with water, and God knows what else when mixed with meds and propellants and is inhaled..? Cidex is good only for NON-disposable items made with materials that were made for and can handle such abuse. Are you running your cidex-ed items through an approved dryer/dehumidifier after soaking? I bet not. If you were, you'd see the inhaler crumble after a short while. Single use is single use. They're just not made for cleaning and JCAHO will bust you for it. Best bet is to just bring the assigned inhaler to the IM instead of grabbing a new one, and get with your mgmt and push for inhalers for asthmatics to be kept on person. Good luck! rb

Yeah, exactly... LOL. I just re-read that and realized that someone in that facility apparently figured out that reuse of the single-use disposable is wrong, [JCAHO is doing rounds about now...] but instead of using nebs as would be expected, they are still going to order one-time MDI's, toss the plastic, shoot the canister to the pharmacy which will return it to the supplier for credit, [so the prison appears to save money] and drive up costs even more... talk about bilking the taxpayers! MDI's are only cheaper for chronic use in the long run, and I've never seen anyone order one for a single dose either. Gem, is that some standing protocol, or is somebody actually ordering that? Perplexed.... ?? rb

Um... what knucklehead thinks that a one-time treatment with an inhaler is the best plan of care anyway? For a single treatment, acute care should be with a disposable hand-held nebulizer. When the acute condition ends, toss the neb. Only when and if the condition becomes chronic, would you switch to the MDI, after proper training and return demonstration of ability. The thing to remember is that not all pt's have the inspiratory capacity or coordination ability to properly use an MDI. If grandpa's vital capacity is only 500ml, then 3/4 of the medication deposition will be in the pulmonary deadspace and do zero good. Shove an inhaler in someone's mouth once a year and they will either inhale too quick, not hold their breath at max inspiration, or whatever, causing high particle deposition in the oropharynx, and/or little to no deposition in the parenchyma, and probably exhale the rest. But to climb down off my soapbox and get to the point... Read the side of the box. It says Single Patient Use. Reuse of disposables is a big fat no-no. You are throwing them away because they are used by said single patient. MDI's are not for single treatment use. Period. Your mid-levels or phys needs to start ordering nebs for single treatments. Also, from the scientific point of view, continuted use and cleaning of a disposable item will degrade the plastic and nozzle thus increasing medication particle size outside specs and also affect deposition in the airway. Again, a useless practice. Either way, it's a lose/lose situation from a legal standpoint, and a proper patient care standpoint. However;

Hey, which prison? I'm at FMC Lexington, and we really need nurses, so keep on top of that app! For your investigation, it is more of a security clearance than a background, so it will be in-depth, and usually takes about 8 months or so to complete. Your lifestyle, credit report and loyalty to your country are big issues, especially these days. Federal investigators will visit your friends, neighbors and family face to face to discuss your personal life and their impressions of you. If you are a normal/average US citizen, you'll be given a conditional employment offer after a quick background, [pending official clearance results of course], and be on 1 year probationary status while you work and wait. There is no polygraph, but you will meet with the psychologist for a quick quiz during your panel interviews. There is only one key. HONESTY in ALL aspects. Be sure to tell them about any pot smoking or drug use, law suits, thefts, arrests, job troubles, neighbor troubles, drunken stupidity, or whatever.... in honest detail, and you'll be fine. They don't care so much what you did, but they do care if you're willing to lie about it. You won't be working around weekend drunk drivers, you'll be around federal witnesses, old mafia, celebrities, high-level gang officers, Terrorists [Git'mo may be closing and guess who will get 'em?] and other threats to national security so they want to know if someone has a reason or ability to blackmail you for anything. You can only be blackmailed if you are trying to hide something. So if you have nothing to hide, no matter how embarrassing, then you'll be fine. Your credit will be checked deeper than your job history. [people in credit trouble are usually in need of money, which many of our millionaire inmates can supply rather easily in exchange for....?] SO, If you are behind $20 on your $369 Rent-A-Center account, you will not be hired until you fix it, and prove it is current. So to put it in short. Unless you got fired for something you can be jailed for, blackmailed for, or otherwise threaten security with, forget about it. Don't think about it as some company hiring someone they want to be sure is a 'good' employee; it is the US Government hiring someone to guard prisoners they're caring for. Someone that could potentially be a traitor committing treason against the United States of America, or help support terrorism by whatever means, cause international unrest, etc. Getting fired over a simple mistake, a personality conflict, or poor choice of words to your boss is rather trivial in the big picture. EMAIL me if you need any help with the process or questions. I don't check PM much here. rb

No doubt. And women act like wild cats in heat. They lay spread out butt naked, masturbating during count, stand in corners with a hand down their pants that they then pull out and lick a finger at you, "forget" to close doors, and some just walk up and open their robe saying "You want some of this, don't you?" .... and to the hole they go... immediately. The trick is to not ignore it, squelch it immediately, and it will stop immediately. Strangely enough, some even come and apologize once they get out. It's quite an interesting job. rb