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I have heard of sign on bonuses of $10,000-15,000 in Texas. These are in the Rio Grande Valley of Texas. They don't mention it in their advertisements but to survive you need a good handle on Spanish. Tu habla espanol? It is a very rural area, in the hottest part of the state because it is so far south and along the Mexico border. In addition, they are speciality areas like ICU, ER, and OR. Dallas and Houston are more than 8 hours away. San Antonio or Corpus Christi, more nationally recognized cities, are about 4 hours away. The best part is South Padre is about 1.5 hour drive from Mc Allen. I met a home health nurse who loves it there.

The way the original posting was listed I took the OP to mean it was an either/or answer. I didn't realize that the NCLEX has matching now. It has been a long time. A recent CVA patient's consuming food should be under the assessment of an RN. For this reason, I excluded it as my original either/or answer. If it is an ideal situtation where this has already occurred then the LVN would be assigned the CVA patient because she has the technical experience to feed patients with difficulty swallowing and has to perform to a higher standard than a UAP. The UAP assignment would remain unchanged.

Kileen would be the closest town for the programs listed in another posting. Ft Hood is very big. To me it is a great area of Texas. It is considered Texas Hill Country. A lot of different culture backgrounds there with a lot of farming. The area has grown considerably in the past 25 years. Gatesville, Texas is not far from Ft Hood. It is north of Ft Hood. I recall as a kid seeing tanks go across the highway. An in-law relative went to an LVN school there in the 80s but I do not know if it is still there. I know there is a hospital there. You might check out the cities Kileen and Gatesville because it will give you an idea of the communities and might have links. Try nursing+school+city in some searches. Best of luck!

i worked inpatient neurology for more years than i care to remember. licensed and non-licensed staff could do both of the things listed below. licensed and non-licensed staff were taught what they needed to know before doing either. for example, how much "thick-it" to mix with food and how much food to put on spoon.this was before the term "delegated tasks" became prominant in statues related to nursing practice. the patient suspected of tb wore a special mask and was transported to radiology. these mask have limited time of effectiveness. at the hospital i worked a licensed nurse, usually the primary care nurse, went down with these patients in case there were complications. more recently, i saw portable machines brought into a patient's room who was bed bound. the machine was left in the ante room after utilization for decontamination. to me, this is prioritization and nursing assessment. active tb indicates afb smears are positive with m. tuberculosis bacilli. the radiographic imagine will hopefully show cavitation in the chest. the sputum is the primary specimen used to determine effectiveness of treatment. the recent cva, cerebral vascular accident, leads me to believe this patient needs the r.n. the most for assessment regarding neurologic impact on patient's ability to consume food including how thick it needs to be, quantity of food bolus can tolerate, ability to use an extremity to participate in feeding self and establishing a plan of care which includes lpn and uap once the patient has stabilized. my answer is delegate to lpn or uap the transport active tb person to radiology.

This is directed to people who are already school nurses. To reply to this posting, after you click reply, please delete all words that do not apply to you. Insert your responses where appropriate. Have fun! Use color if you like. Comments are welcome, especially which educational level of students you prefer to work with and why. What is your level of education? 1. Non-licensed 2. LPN/LVN 3. RN (associate or diploma) 4. RN (BS/BSN) 5. RN (Master's not in nursing) 6. RN (Master's in nursing, not NP or CNS) 7. RN (Master's in nursing, NP/CNS) 8. RN (Doctorate not in nursing) 9. RN (Doctorate in nursing) Include years in any area and current location with number of years 1. Elementary 2. Middle School 3. High School 4. College 5. University What is your student population size? How many students do you see in an average day? How many people staff you school clinic and their educational level or role? What made you decide to stay in the educational level of students you work with? I just thought it might be fun to hear from each other before we jump back into the trenches again.

At least here, you can work in a school setting as a NP with prescriptive authority through a joint venture between the school district and the county hospital system. The salary market is based on the hospital because these nurses, NP, are employed by the Harris County Hospital District. They can be designated primary care practioners on their medicaid or CHIPS plans. They are overseen by a physician but there seems to be significant more autonomy and is away from the politics of the hospital. Some clinical experience might be useful before pursuing NP but it is truely a personal decision.

When I worked in the OR the hospital administration wanted our turnover times between cases to be 15-20 minutes. This was for major surgeries. The outpatient surgery area was supposed to turnover in 7-10 minutes. Of course, there was blame at each other all over as to causes in delay of turnover times. The result was the nurses in the Main OR came up with a data collection tool as to cause of delay in turn over time. The tool included surgery start time, stop time, surgeon's name, and procedure but no patient information . It made more paperwork for the circulating nurse but eventually helped identify the problem areas. Some of the choices were surgeon, anesthesia, instruments not available/ready (we did a lot of flashing of instruments), patient, prior case ran over, and delayed from pre-admitting. The form started in pre-admiting so they could document if the patient was late to the hospital. All the doctors were aware these forms were being used. They were still being used when I left the OR. Before I left the OR manager began giving incentives to those who, one circulating nurse and one scrub tech/nurse per month, had the best average turnover time. At the very least, the manager has something to go to administration with when they complain about turnover being too slow. One of the good things that came from this was they were considering down sizing non-licensed staff. The OR manager was able to show the difference in turnover times when a non-licensed staff was off for a week of vacation and not replaced to "normal staffing days". This resulted in no loss of non-licensed staff and now they replace them even using overtime staff. After this study, they tried to have two floating nurses to help turn rooms over and relieve staff for breaks and lunches. Good Luck!

I guess I am confused about the staffing in your OR and the patient status at end of case. The majority of the cases I had the patient was breathing on his/her own at the time of placement on the stretcher for transport. Once on the stretcher, anesthesia was almost always (95%) ready to take immediately to recovery/PACU. While the circulator was taking the patient to recovery, non-licensed staff cleaned the room. For 8 major ORs, 2 urology rooms and 1 lithotripsy room there were 3 non-licensed staff. In addition, there were two anesthesia non-licensed personal. One was designated for CVS. What was important to the hospital was having the operating rooms occupied the majority of the day because this increased revenue. The goal was 15-20 minutes turnover time. Depending on the case it ranged from 11 -23. Big neurosurgery cases usually took the longest. Our ORs, non-teaching hospital except LVNs and Scrub Tech schools, had scheduled cases from 7:30 a.m. to 6:00 p.m. There were frequent add ons so in addition to 7-3 staff for the 10+ rooms there were 2 teams scheduled to 11 p.m. and 1-2 teams scheduled 7a - 7p. The CVS team, 7-3, scheduling was independent of general surgery. During the turnover time, the scrub nurse/tech would take instruments to decontamination, get instruments for the next case, use the rest room if needed, and set up for the next case. Each case's supplies was in the room in seperate containers at the beginning of the day to expedite turnover. The circulating nurse would give report to PACU on post-op patient, interview and do consents for new patient, return to OR to confirm have supplies/instruments needed, help finish opening supplies/instruments, get missing supplies/instruments, confirm or do anesthesia turnover, do count with scrub nurse/tech, return to Pre-op to confirm patient has been seen by surgeon and anesthesia, and take to OR when surgeon/anesthesia ready. Keep in mind the above is based on good staffing days. There were times I mopped floors, took trash out, scrubbed in, counted with floaters while a scrub tech/nurse took a break. In addition, this turnover time between major surgeries was very stressful for a newbie. I dreamed of roller skates but even if I had them I knew I was proficient on them. A good scrub tech/nurse is GOLD! If you work together and help them you can be a great team. If they know their stuff then no instruments or supplies will be missing even in an emergency. If they don't or they want to make you miserable you will be running for stuff. Especially, in the beginning I had scrub techs (male) and a surgeon send me for things repeatedly. One was an OTIS. This was their OR joke. There is an elevator manufacturer called OTIS. Late, I think it was an orthopedic sales rep who told me the scrub tech and surgeon were wrong because there is an instrument called an OTIS. If you are not as busy as we were then I can see how you may not have non-licensed personal to help with turnovers. Good Luck to you!

During my period in the OR I never had a bad outcome regarding operative sites. During my periOperative course we were taught the surgeon is responsible for identifying the operative site. This was a sticking point with some surgeons and myself because they would not mark the site. If I could not get the physician to mark the site then I would ask the patient to mark the site. Everyone I asked, smiled. Many added, at least I know he will cut the right one. Within months of finishing the periOperative training, the hospital came up with a policy regarding operative site identification. We were told it was taken from a statute (state specific I am sure). The policy designated the physician as the medical person to mark the operative site with a permanent marker. Even with the policy there were many resistant surgeons. If the proper procedures are utilized then a wrong site operation should not occur. Of course, you have to have the right patient. You must confirm with the patient what the operative procedure will be including site. The consent must be consistent with the patient's understanding of the operative procedure. The surgeon confirms with the patient what operation is going to be done. This is all done prior to any medication. Once the patient gets into the operating room, the circulating nurse and scrub tech/nurse must confirm with the doctor and anesthesia the operative procedure including site. Where I worked there was an Expo Board for sponge counts etc. The operative procedure was also listed on this board. You incident is the exact reason why this area was a sticking point for me with surgeons. I had heard case law before where the surgeon and anesthesia were not assigned any blame. As one who does not want to put my nursing license at risk, I took a firm position regarding the surgeon identifying the surgery site. I tried to be present when the surgeon saw the patient to witness the confirmation between surgeon and patient but this was not always possible. This position will put you at odds with some surgeons so maybe someone else has better ideas. Do you have a periOperative nursing book? This is imperative because you are responsible for your nursing actions. Good Luck!

At the time I did my stent in the OR I had more than 19 years of experience in nursing. I thought I had stepped into the dark ages. As a nurse aide I remember being yanked from out of a doorway by the head nurse because Dr. ****** would be coming out of the room "any minute" and "nothing is to be in his path". I saw more hugging and kissing among my peers and some doctors than I had ever seen in a bar. Some surgeons and male scrub nurses would talk derogatory about women. Foul language was the norm. There were surgeons who got whatever they wanted and could treat you any way they wanted. Least I forget, answering an orthopedic surgeon's cell phone any time I was in his case because he "didn't want to miss any calls". I could understand if he had a patient that was going bad but that would be handled by medical. In addition, like you I had a physician, an anesthesiologist, slap me on my right scapula so hard it was stinging for 15 minutes. I deliberated as to what to do but by the end of the shift I did speak with the Head Nurse. She asked me what I wanted done. I said for it to never happen again! I never spoke with Risk Management. I didn't want to bring charges because I already felt uncomfortable with all these people, their behaviors and felt this would stir up more problems for me. Little did I realize, it would be shared with the other doctors and eventually down to my peers through the grapevine. Needless to say, I even had a surgeon say I don't want you to accuse me of hitting you. In contrast, I always saw the surgeons treat the PACU nurses professionally. My impression for what it is worth regarding some Surgeons/Anthesiologist: 1) tend to be narcasistic 2) boarder on hyper or mania Decide for you what you want! I can tell you from experience, grievance is just something on paper to be compliant with regulations. Even when you are right, the system, peers, and physicians can make your going to work extremely difficult and miserable. I wish you the best!

Looks resolved. The wonders of learning...

Looks like things have changed even from when I was in the hospital. I am only about 10 years your junior but I remember when a person's word meant something. Within 10 years of the oil bust I think the healthcare system became more deceptive like business systems. At this point, about 20 years since the oil bust, I think it has become as blatant deceptive. I feel your frustration, especially, since I would be in your shoes if I chose to return to an acute medical surgical hospital setting. Also, over prolonged periods of frustration I do mis-speak so I understand. Now that the NCLEX is over, my suggestion is for you focus on your goal of completing the refresher course and forget the age discrimination. It is not worth worrying over, especially, since it would be difficult to prove considering your history of not being in the active nursing force. We can all here recognize it for what it is. Consider the pleasure it can give you at the end of the refresher course to also (e.g.; like the young ones) leave this unit!!! HELLO??? No one wants a manager who is a blatant in your face LIAR! Of course, leave on good terms but secretly laugh as you walk out the door in December. BTW - I don't know if your area is like here but the job advertisements tend to drop after Thanksgiving and pick up again around February. There may be available jobs during that period but maybe not the one you want so don't be discouraged if that happens. Best of Luck!

Where I worked in psych they used plastic. I was new to psych so there were some clinical things I had not seen or considered. Now I am of the opinion whether it is metal or plastic utensils they should be counted. That was not the policy or practice of this facility. Amazingly, I had a young schziophrenic patient find a novel place to hide a plastic knife. She was also a self mutilator because the voices told her to do it. She would cut her arms, legs and stomach. After she was found to have cut herself a room search per doctor's order was done but nothing was found. It took us about 6 hours to figure out where she hid the utensil. Off topic - I had another schziophrenic patient who found comfort in having rock in her pockets. She would pick them up during smoking breaks. There was one psych tech for 14 PICU patients. Eventually, I saw her solution to our confiscating and redirecting her from putting in her pockets. Guess where she started carrying them? In both cases, they hid them in the lady parts. Good Luck!

Since this surgeon was of the opinion he was a god, it was directed to management who eventually took care of it.

I guess A&P may be weeding courses but I really think it is more likely the physiology portion. Anatomy is straight memorization. Physiology is understanding how things work. I saw many students complete the first semester of A&P but there was only about half the class after the mid-term of the second semester.