turtlesRcool

Based on the brief glimpse you've provided into your life, I think you should go for it. You already work in a hospital. You see how fast-paced it is. You see how difficult some patients/families/staff members can be. Okay, your patients are babies, so they're probably not being mean to you, but still. You've been at it for 3 years, and you still like it. That says something about how you will cope as a nurse. Some student nurses have no idea what the reality of floor nursing is like, and they are stressed beyond belief when they find themselves expected to function in an environment that is far different from the ideal NCLEX scenarios. For others, it's the wear and tear of trying to do their best for their patients, but being unable to give them the care the patients deserve due to poor staffing ratios, unresponsive colleagues, lack of equipment, etc. But not every workplace is like that. Most people who genuinely enjoy caring for people in a medical environment can be happy as nurses if they find the right job for them. The key is to be flexible and be willing to try different roles. Fortunately, nurses have more options as to where/how they work than PCTs do. You might stay in a hospital or you might transition to something else. If it's too stressful for you inpatient, you can always move to a doctor's office or procedural area. Once you've got a year or two under your belt in a facility, you can venture out into home care or hospice. The pay isn't as good outpatient, but an outpatient RN is going to be making more than an inpatient PCT, so you'll still be ahead. Plus, you say you don't want to be a PCT forever, but it doesn't seem like you have another career path vying with nursing. If you came on here and said you are torn between nursing and, say, accounting, we might tell you to try accounting and see how you like it. But in your case, there's nothing else you have a strong desire to try. So why not try nursing? To me it seems like if you don't pursue your RN, you'll just stay a PCT, and you started your OP saying you want more than that.

Have you thought about going into an outpatient setting or a procedural area? With your ICU experience, you might be a strong candidate for something like cath lab. There are also RN jobs in low(er) stress areas that can be located within the hospital setting like outpatient infusion, radiation oncology, ambulatory surgery, etc. where most of the patients are stable and are usually there for less than a full shift.

I think high vaccination rates are going to be the key. I recently had COVID, like a lot of people I know with Omicron surging over the past month or so. But it was basically a cold. That was the experience for pretty much everyone I knew. The only one who had stronger symptoms was my 13-year-old who fell into the gap of being vaccinated last Spring, but being too young for the booster when he got sick. He had fever, chills, body aches, and didn't really get out of bed for two days. But then he bounced back. The people who are still getting seriously sick, by and large, are the unvaccinated. At this point, at least in most developed countries, that's mostly their choice. My sympathies remain with those who genuinely can't be vaccinated for medical reasons or whose underlying health is such that vaccines don't confer much, if any, protection. They will always be in danger of serious illness unless the virus mutates to something much less pernicious. In certain settings, such as health care, I don't know when we'll go back to treating patients without masks on. I wish Denmark well in its endeavors. I would love to see them prove it's safe, and then see the rest of us follow.

I was thinking something similar. Grief is a funny thing. It just pops up where it wants to, sometimes when you're not expecting it at all. Or maybe you expect it, but the intensity takes your breath away. My guess is that this nurse "knew" she would have COVID patients, but knowing something in your head can be really different from experiencing it in the moment. The whole situation sounds unfortunate, but there are no villains here. The nurse seemed to be doing her best (she got overwhelmed and broke down in tears, but she didn't pull an attitude or refuse the assignment). The staff tried to support her as best they could in the moment, but had to prioritize safe patient assignments. I don't think there was really anything that could have been done differently in the moment. With COVID still all around, it was inevitable that one day she'd have her first COVID patient, and no way she could have really prepared for how hard it hit her. Sometimes we just have to go through awkward and difficult situations on our grief journeys. Hopefully, the nurse made it through the shift, and was able to regroup before the next.

I think you take it one step at a time. Get the first hospital job. Med-surge or whatever is on offer. Some hospitals have the grad residency programs; others just have you on orientation for 12-ish weeks. Hospitals typically do one or the other, so just apply for whatever your desired hospital does. Next, spend that first year or two laying down a really solid foundation. The first year is so important, and the learning curve can be steep. Nursing school doesn't really prepare you for what floor nursing is like. Per diem and travel contracts really expect that you are going to be able to hit the ground running, so they're not something you're going to be doing for at least a year or two. By then, you'll have a better idea of what you want and what you don't. Travel contracts can be fast money, but they're hard work, no security, and could be a problem if you need to be home for your teens. I know you're in good shape and can do the job well, but age discrimination is real. You're probably coming up on an age where nurse managers would think twice about offering you a permanent full-time position. I think @amoLucia is right to say that job security is probably going to be an important consideration. Whether you pursue it through a state/federal health system or just through a solid hospital (hopefully one with a good union), you want to make sure you're locked into something that will allow you to work until YOU are ready to stop.

Sounds like a dumpster fire. Also sounds like a lot of shifts in a lot of hospitals these days. If you want to be helpful, then just help. Don't focus on getting in on a "big" skill. Show that you are willing to work, and you'll find things to do. It doesn't have to be complicated. If there's something that you know how to do (like ADLs) then do it. Maybe there's a call light going off, and you can take a patient to the bathroom. Maybe there's a patient who has been incontinent and needs a linen change. Maybe there's a patient who needs to be fed. Is this your first time at clinicals? What have you learned how to do that doesn't require the floor RN to stop and teach or oversee you? Do that. Based on what you copied and pasted, you can easily answer some of the call lights. Assuming your instructor is there with you, you might be able to ask if the instructor would supervise you doing the dressings for the nurse. If you've learned to use a bladder scanner, you could do that. If you haven't learned to use it, you could ask your instructor to give you (and maybe a few others from your group) a lesson in it. The floor RN would probably be really happy to have the instructor do that for him/her. I'm not suggesting that you spend your whole semester working as a CNA. But as a floor nurse, taking time to coach a student, teach a student, or even narrate what I'm doing for a student slows me down. If I'm overwhelmed, I simply won't have the time because I have to prioritize my patients over the students. But if you can take some of the burden off the floor nurses, then that frees up time for them to be able to teach/show you something more interesting. You can also learn important information while engaged in ADLs. Sometime an aide will alert me to skin breakdown because they're bathing and toileting the patients.

I feel like the title of the thread posts a false dichotomy - either you're a money-grubbing mercenary or a selfless angel. In the real world, most of us are motivated by more than one thing. This job is time away from my family, wear and tear on my body and mind, and eats up a fair bit of gas in the hour+ I commute each shift. I've invested years of study (and tuition payments) as well as on-the-job learning to become a safe and effective nurse. I want to be compensated for those things. This is my career; I'm not a volunteer, and I'm not ashamed of that. Anyone who wants to do something "from the heart" with no financial motivation should go lead a scout troop, or coach little league, or stock shelves at a food pantry, or clean litter boxes at a cat rescue. Not kidding - those people are awesome! But they're typically doing it a few hours here and a few hours there. I'm working full time. Now, I also happen to like being a nurse. I like the challenge of putting together the clinical picture, and figuring out what a patient needs. I'm naturally a curious person, and feel like I'm always learning something. I love seeing people get better. I find fulfillment in helping patients and their families navigate difficult situations, like transitioning to end-of-life care. I am amused by the antics of some of my patients (not always in the moment), and my kids beg me to retell stories of the ridiculous things patients have done and said. I love the camaraderie of my colleagues and the teamwork that sustains us, even when we're short staffed and everything's a bit of a dumpster fire. But no matter how much fulfillment I find in my job, if it weren't actual, paid employment, I would not be dragging my tired self out of bed before dawn day after day, week after week, year after year. I would not leave my cozy house for a white-knuckled drive through a snowstorm bad enough for the governor to shut down the highway to all but essential personnel. I would not ask my family to celebrate holidays on an alternative schedule because I have to work. Honestly, I think neither mercenaries nor martyrs have what it takes for the long haul. Most of us stick with it because of a mix of fulfillment and payment. There are more profitable jobs out there, but I stay in nursing because I like the work. There are more enjoyable ways to spend my time, but I stay in nursing because I like the paycheck. The two motivations don't cancel each other out; they enhance each other.

I just want to point out that you are almost certainly earning more than $60 for an extra shift. If you're not, it's because your pay is low, not because you taxes are high. The US has a progressive taxation system, so even if OT bumps you up into a new tax bracket, you are only taxed the higher rate on the part of your pay that goes into the higher bracket; it doesn't make your entire income taxable at that level. There is absolutely no scenario in which you would owe $1100 in taxes while earning only an extra $60. None. You may have had more pay taken out of your check if you worked a lot of OT in one pay session, because the automated payroll might be tricked into thinking your base income is higher, but you'll get the extra withholdings back at tax time. In the US if you're single, the first $10,275 is taxed at 10%, regardless of if your annual income is 10K or 10 million. Then from $10,276-41,775 is taxed at 12%. From $41,446-$89,075 is taxed at 22%. So if you usually earn under $41,775, but overtime brings you up to $42,000, you are only paying the 22% on the $225 that is in the next bracket. Assuming your usual income is between $41,446 and $89,075, and stays between those numbers, your OT will be taxed no differently than your regular pay with the max at 22%. Even if you do go over $89,076, your tax rate for your pay over that threshold is only 2% higher (24% for everything over $89,075). Granted, there are various state income taxes, which might bump it up depending on your location, but, again, you will be taxed at the same rate as you are taxed for your regular earnings. There's not some crazy OT penalty that gobbles up like 90% of your wages.

I think the OP was more about floor nurse to floor nurse. ER is a whole different beast. Our ER doesn't even do verbal report to the floor. We use an SBAR form that has limited use, so I mostly look at the chart before a patient comes up. That said, some things like last BM are really useful on the floor. I realize that most patients are not in the ED long enough to worry about if the patient is having BMs or not, and I don't expect to hear about it from you. But as a floor nurse, it's helpful to me to know if a patient who has been there for a few days is pooping or not. I want know if I should pull that PRN miralax with the morning meds to save me a trip back to the med room. Lots of people get off their routine because they're not up and moving as much, and a lot of them are on opioids. Also, the BMs are often charted by the CNAs, and some of them just...don't. Or they had a busy shift and haven't finished their charting, so the info isn't in the EMR yet. The information you find useful for you to care for a patient for a few hours in the ED is different from the information I find useful caring for a patient over several days or weeks. I think the type of EMR used also plays a role. I don't know about Epic, but Cerner can be cumbersome, and the IV info isn't with the rest of the assessment. Personally, I don't really care beyond knowing if there's working access or not and central vs PIV. But it actually is a lot faster if the off-going RN tells me than if I have to look it up. Finally, our shift reports became bedside shift reports a few years ago because someone somewhere decided they increase patient involvement and satisfaction. I find them to be a pain and a time suck, but if I'm forced to do report verbally, I at least want it to contain the info I need so I'm not doing verbal shift report and then having to go looking through the chart. It already takes an hour to do hand off (because we are supposed to to 2 RN skin check on each patient as well), and I guarantee I'll get a phone call or someone wanting to know something about a patient before I'm finished with that, and I haven't had time to comb the EMR also.

Do the ABSN. It will get you prepared to be a bedside nurse, and from there you can figure out what you want to do. If you don't have any RN experience under your belt, going directly to NP is terrifying. Unlike MD/DO training, NPs are just kinda let loose after they pass their boards, and expected to know what they are doing. The reason NP programs require you to choose your specialty from the start is because the role of NP is much more specialized/narrow than MD; if you are a pediatric NP, you are not a psych NP. There's no "general" NP. If you went to medical school, you'd get 4 years of general med school before you pick a direction to go in for residency (and then possibly specialize further with a fellowship). If you go NP, you don't have that flexibility because it's a much shorter education and you are going directly to the type of practitioner you want to be. Family NP is pretty broad, but because of that, you will be expected to have a really broad range of knowledge/skill, which is hard to come by if you have no RN experience. There are ABSN programs that have some master's courses built in, which allow for an easier bridge to master's (UCONN does this), but most direct-entry MSNs are going to specialize early.

The world needs good outpatient nurses, too. I think there's a misconception that only acute nurses are "real" nurses, and nothing could be farther from the truth. I'm usually an inpatient nurse, temporarily working outpatient, and it's been a really big learning curve. It's not harder, exactly, just really different. It's no less valuable to the patients I'm working with. So, if you're interested in outpatient, go for it. That said, after you have worked exclusively outpatient, it might be hard to get another inpatient job. But is that career suicide? Only if you WANT go go back inpatient. If you want to keep that door open, you can always stay PRN, as others have suggested. It will keep your inpatient skills up to date, and give you an "in" if you decide outpatient isn't what you want. But if you do that and decide you just REALLY don't want to do bedside, there's absolutely nothing at all wrong with that. Go and be an awesome family practice nurse!

Yes, I'm also seeing the people who are not immunocompromised and are fully vaccinated (including booster for those immunized >5 months ago) are more likely to be admitted WITH COVID than FOR COVID. Unfortunately, we have to use the same isolation precautions for the unvaccinated person on 60L/min heated high flow as we use for the COVID positive but vaccinated little old lady there with a fracture after a fall, even though she's not on a lick of supplemental O2. Those with incidental COVID positivity do take up more resources than those who don't require isolation, so total COVID numbers are useful in that sense, but don't really let you know how "bad" COVID itself is this wave. Staffing is another issue. We are still very short staffed, and I don't know how much is influx of patients and how much is lack of staff. Some combo I expect. The vaccine mandate went into effect back in October, so basically all employees have at least the first series, but breakthroughs happen. We are not allowed to work COVID+, and our hospital has mandated that all staff members with patient contact wear an N95 or KN95. Unlike wearing the fit-tested N95 to protect us from COVID+ patients, this is for 'source control' to minimize the chances of a staff member unknowingly passing COVID to a patient, which apparently has happened. Our community vaccination rates are really good, but the positivity rates are still through the roof with mild cases, and it can be hard to find tests. Two of my kids are COVID+ now, but my hospital won't test me unless I experience symptoms, so we're all wearing masks in the house and I'm wearing an N95 whenever we're in the same room, and doing serial home tests. So far, I've been negative twice, and have another kit hoarded to test before I go back to work on Tuesday. Frankly, I was kind of hoping/expecting employee health to give me a PCR when I called to let them know about the exposure, but it looks like I'm on my own here. Sigh. It feels like every time we think we're getting ahead of it, COVID comes and knocks us back down. Still, we're better off than the Spring of 2020 when we had refrigerated trucks for morgue overflow. I just have to keep reminding myself of how much we've learned and how many more resources we have than when we started.

I think the dominant variety is location dependent. We're seeing the northeast getting battered by Omicron. Fortunately New England has some of the best vaccination rates in the country, so the increased positivity rates aren't completely overwhelming us. But the hospitals are definitely full, and I've been getting texts for EVERY.SINGLE.SHIFT for two weeks now offering double incentive pay to pick up. People boarding in the ED because no inpatient beds. You get the picture. Home tests are sold out everywhere, and crazy lines to try to get rapid tests at clinics.

That would really, really annoy me. I make plans based on the assumption that I'm going to be working my assigned shift. I would not appreciate being scheduled when I'm not needed. If you're scheduling extra people, that means people are not getting to properly make plans with their families. I don't WANT to work holidays, but if I'm scheduled, I'll plan my family's gathering for a different time. Don't make me plan the gathering for an alternate time unnecessarily.

Peds, OB, and Psych were all jammed into a Summer in my program. I think we did 5 weeks each. It's kind of a blur. Having children definitely helped with Peds and OB for me, but I imagine it was pretty much all new for those without kids and some of the guys. It's definitely a lot in a short period.

Exactly! Unions aren't magic. They can't keep someone from being fired for cause. All they can do is ensure the employer follows due process. If management wants someone gone, they need to do their jobs and document the necessary evidence to make that happen. Unions are made up of other employees, and they usually do want the lazy and incompetent coworkers gone. But unions fight because they want the process to be followed (which usually involves warnings and improvement plans), so the dismissal is fair and the system remains intact so good workers can't be unfairly terminated by a manager with a grudge. It annoys me to no end when people blame unions for the shortcomings of lazy management.

This is my hospital. A few years ago, one nurse lost her holiday pay for calling out on a surrounding shift, despite finding another nurse to cover it for her. That was the first I'd heard of the rule; I made sure to read my contract a little better after that.

Okay, but in my health system everyone is either vaccinated or had a medical exemption (which were apparently extremely hard to come by). In some places this might not be the case, but at my hospital it's a reasonable assumption.

I don't think there's a particular obligation to share individual vaccination status, or any health-related information with patients. Not divulging that information when asked is perfectly acceptable. But there are many people who DO feel comfortable sharing not only vaccination status, but other aspects of their lives as a way of making connections and inspiring trust in our patients. It's up to us to decide how much we want to share. I expect patients to sometimes ask, and I frame my answers based on my own comfort level, experience, and the particular situation. I don't feel there's any expectation on me one way or another in regards to my personal information. Just yesterday, I was putting a foley into a patient who said it hurt when I was spreading her labia. I said, 'I know. I'm sorry. I'll be as quick as I can." She said, "How do you know? Have you had this done?" I told her yes (without giving any other details). She said, "okay then," and let me continue. If I'd never had a foley, or didn't want to divulge, I could have said something like, "I've done this many times, and absolutely believe my patients who have told me it's uncomfortable. That's why I try to be as gentle as possible, but I know sometimes the process will hurt." Providing comfort and reassurance doesn't have to be at the expense of personal privacy. One benefit of health systems mandating vaccines has been to avoid putting us in the position of discussing our individual circumstances with patients. At this point, patients just assume we're all vaccinated.

There is a LOT that is political about easy access to crap that makes us sick. Big Agriculture is a powerful lobby. Our federal government heavily subsidizes the commodity crops (rice, cotton, soybeans, wheat, corn - hello high fructose corn syrup), and the biggest producers are far more likely to receive subsidies than small family farms. Shelf-stable crap full of fats, salt, and sweeteners costs less than fresh fruit and vegetables because we, the taxpayers, pay for it to be cheaper to make a twinkie than grow a tomato. So that's what poor people buy - it's cheap, tastes good, fills you up, and takes little time to make when you're juggling multiple minimum wage jobs. Then there's the legacy of urban planning, which was often both racist and classist. Many people live in 'food deserts' where they're shopping at the corner bodega because there's no supermarket in the neighborhood. I really can't blame anyone for being overwhelmed by the logistics of taking public transport to a real grocery store and then lugging a full shopping trip worth of stuff back on a bus. The poor also pay more per item for most things because they can't buy in bulk, so they get stuck in a cycle of paying more for basic necessities because they have to buy the smallest packages (and it's not like you can just forego food or diapers for a few weeks while you save up for the bigger packages where the price per item might only be half as much). If you make it harder and more expensive to buy carrots than cheetos, you are incentivizing poor food 'choices.' Low-income people are more likely to live near pollution (again, urban planners who put highways right through poor, often black, neighborhoods), increasing the incidence of asthma. Old building are less likely to be up to code and may harbor vermin, mold, and lead paint. Remember the lead (and other problems) in Flint's water supply? You will never convince me that state officials would have dismissed all those complaints about water making people sick if the complainers had been white and middle class. Ingesting lead is something that can literally change the life trajectory of a child, and 9,000 kids in Flint were subjected to lead in their drinking water for 18 months, while state officials insisted the water was safe, even when it was visibly brown and malodorous. It's not that poor people CAN'T make healthy choices, but let's not kid ourselves that the deck isn't stacked against them. Personal responsibility is important, but it's disingenuous to create a system that puts millions of people at a disadvantage and then blames them for not overcoming obstacles the system has placed in their path. Saying something is political isn't just about blaming a particular party or candidate; it's about acknowledging that our entire political system (local, state, and federal) and multiple agencies (including FDA, EPA, etc.) make decisions that impact people's health. Saying people "are responsible for their own predicaments" is far too simplistic to be accurate in most cases.

Interesting conversation. A few days ago, one of my colleagues told me about a patient who was recently transferred to her unit from ICU after being made comfort measures only (rapid progression of a non-COVID disease process, but I forget exactly what). Well, transport arrives with the patient, and goes to settle patient into the room, and comes out saying the patient isn't breathing or responding. At just that moment, family members come around the corner, hear the conversation, and that's how they learn their loved one apparently died during the brief transport from one unit to another. They then decide they want an autopsy. On a CMO patient. The nurse had no idea how such a thing was to be handled, and basically arced it up to management to deal with, so I don't know how the story ends. I understand the shock of it, and the desire for answers, but I really don't think the coroner was likely to get involved in this one.

We've been required to wear eye protection (goggles or face shield) for all patient interactions for a few months now, basically from when Delta started spiking. I don't think it's necessary, but it's not my hill to die on either. It's a mild annoyance, not a major inconvenience. I already wear glasses, so an extra wrap around is no big deal.

Taking the original post at face value only... Try telehealth. One of our oncology nurses lined up a telehealth job when her medical exemption request was denied. She told me she isn't afraid of COVID, but I'm pretty sure most oncology patients are. She is an excellent nurse, and I'm sad to see her go, but telehealth is a more appropriate setting than inpatient oncology for an unvaccinated nurse.

I think you need to get more detailed information on what the jobs entail. Apply to both. If you get interviews for both positions, that's a great way to get a fuller description of the units and ask questions. If they're interested in you, they might allow you to shadow or at least visit the unit to get a feel for the place.

This is the criteria of who is kicked out of the program. But I think OP is looking for a rubric for readmitting those students who reapply. Who deserves another chance and who should be told to go elsewhere? And why? There are many different reasons people have for their failure, so it makes sense to have criteria for determining who might be successful if given another chance. Like, do you take into consideration how low the fail was? Does failing by 1 point merit another chance, but failing by 10 points is a lost cause? Do you consider health problems (mental or physical) that might have contributed to poor performance? If so, what documentation do you look for, and how far can/should you go to determine the candidate is healthy enough to try again? Do you consider situational stressors (death in the family, abusive relationship, etc.) mitigating circumstances? Do you require a candidate to make a case for why s/he would be successful, if given another chance, and what would you expect to see in that plan? Of course, it's important to look at a candidate holistically, too, because a rubric might not catch everything. But if you don't have clear criteria at baseline, you're just going by your overall gut feeling about people, which opens the door to inconsistency in decision making.