lassenlake

There is actually not a pay cut. Washington pays about $2/hr less however with no state income tax and a lower cost of living its's a gain.

Your resume is far to detailed. Hiring managers know what a med sure nurse does. bullet point your accomplishments, awards etc and get it down to 3/4 page. "Fluff" is a killer of job seekers. No manager worth her or his salt wants fluff. Objective 1-2 lines Education Work History. dates, employer, position key duties (2 lines) Awards Accomplishments Certifications Tell them why they should hire YOU in a 4 line cover letter. If you want advancement state it. If you excel in an area tell it. If you want to move into another area let it be known. Fluff. Seriously? Who has time for fluff. Best of luck..=)

Right. I did that and I am still stunned that a state would charge $100 for one piece of paper. The entire app packet for Washington is $88.00. We plan to leave later this year. It's exceptionally taxed this state.

I'm endorsing to Washington as an RN. Their fee $88. California wants $100 for a one page verification or original licensure. Have I go this right?

In my experience the reasons this role fails is due to being "everything". If you create the role have these nurses have critical care experience and: 1) be aware of the "unstable" pts. where they are who there doctors are. 2) be involved in transports for tests for only these patients. 3) mentor the primary nurse taking care of the patient. 2 nurses one days one nights 24/7 with their own rounding, No getting pulled to do admissions. No getting pulled for the next ICU patient. Forget incentives. Nurses who love challenge will do it.

After 25 years here is what you should answer for yourself: Are you comfortable working with people and helping them? Do you like science and enjoy understanding how things work? Do you have patience and when that runs out do you have more? Would you be willing to work night shift at first (maybe up to several years) Do you thrive on challenges? Start with those. I'm sure others will have more.

Ignore it. Success is the best revenge.

$56.00 hourly day shift ICU/ER. Exceptional health benefits. San Diego, CA 3 Bdr condo $2,700./month

Know your drugs. Here are a few. Dopamine, Dobutamine, Phenylephrine, Levophed, Digoxin, Lasix, Cardizem, Amiodorone. Study these up and down.

Most level I trauma units will be among the most fast paced units. Plan on learning skills which respond to hypovolemia and how to use a level 1 infuser. IV access, changes in skin color and tone, frequent labs and going to and from surgery are frequent in that type of unit. Skills to focus on are assessment of vascular volume, differentiating types of shock and when to sound the alarm for changes in vital signs. If you see neuro trauma patients know the various modes of checking ICP. You must be on top of your game as unlike many ICU's trauma demands frequent emergency assessments and interventions. If the bp falls is the sedation or loss of volume? Hundreds of questions. Stay focused on the top 2 things that can kill your patients and address those continuously throughout your shift.

The maximum rate of the Alaris pump is 999 ml/hr. It would be not possible for the entire bag to be given in the time your post stated. The concentration in Fentanyl is 50mcg/ml. The fact that your patient was ventilated would not have done anything for the resulting blood pressure drop. I find it not believable that the MD was not contacted. The fact that you called the RT who made changes to the vent also is not believable without the MD order. I find your post not consistent with practice.

Your question has to do with being prepared for a crisis in which you may be responsible for handling medications which are typically kept in a crash cart. Most meds are drawn up already in burst a jet syringes (example 1 mg atropine). You should ask for time to look at that cart with a preceptor, make a list of the medications it contains and get to know these meds backwards and forwards. That knowledge will decease your anxiety. Also be aware of the actions you would expect to see and how long it "should" take. So to your question - It is your job to know these medications and after a few times of crisis it would be unacceptable not to know the drugs, how safely to give them and the effects of each medication.

I have not thought of this but where I am floating they ask nurses to cover another nurse to give them a lunch break. This means I (and others) are watching 8 patients. Is this ok? We are not offered any other breaks and there is no "break nurse" Thanks in advance.

Most health personnel including nurses are hire through the Health Area each one is Tribally owned and they hire through the IHS Indian Health Service as well as other sources. Many advertise through like recruiters. Any area you go outside of Anchorage and Fairbanks will be a once in a lifetime trip. The further north above the Arctic Circle the further you will be removed from the amenities people in the lower 48 take for granted. It's said that a person has to be able to fall back on themselves to be successful in these remote areas. There are school plays and performances. Many of the subsistence villages are as they were thousands of years ago save the advent of buildings and electricity. There is mail service. Few if any restaurants, and the food quality is fair. Anything that is heavy at the local market will cost you money. Housing is typically provided by the employer and some charge more than others. Utilities are almost always included. Travel is by small plane only. On some days the weather in winter closes down the area. I think that's remarkable some people find it frightening. Most residents who live year round are highly trained. It is not unusual to find a nurse who is also a paramedic firefighter. Nothing can really prepare you for the remote villages. If you need to be entertained maybe don't try. If you are wanting to see a part of the world before time started on the American Clock then go and soak it in.

You cannot stop them from communicating. If they threaten you contact an attorney. If they don't stop calling you personally file a police report.

Thanks for the thoughtful replies. And no, I was not mismatching details. This was a CT negative (reported by patient) who did not receive tPA. I had a talk with one of our neuro docs on the unit yesterday where interestingly enough we had a tPA pt. They agreed with me and disagreed. If the CT and MRI were negative the Plavix and Lovenox should be given but one should wait until the evidence is in. Since I had no access to the computer or reports, they felt it was prudent to hold. It was interesting here in one study which was quoted by me that Lovenox had a higher incidence of conversion. I notified my agency (I travel to this hospital one day per week to help with a EMR training) and they wanted to share my experience with the hospital. I agreed...but after I leave in four weeks. Again thanks for your educated replies. It has been helpful for me and I hope for others.

It depends on how old your children are. School age children will experience somewhat different experience and that education may be inferior to traditional schools. If you site visit I would make an appointment with the schools and look around. The plus side is that the cultural experience may be truly interesting for your kids. I lived in the Navajo for one year and it was frequently a topic of conversation about the schools and their approach for the parents there.

In this case no a fib was detected on the EKG or telemetry. To say it's narrow by my reading is incorrect. 10-40% of all ischemic infarcts have transformation to bleeding. In my view without increased NIH scores (hourly) holding the Plavix (seriously?), the Lovenox and the Aspirin is prudent. If someone has any idea why after all our training there is no established standard....please let me know.

Yes. As I said my training indicates that anticoagulation is never given after a stroke until the CT and MRI are read and the patient cleared by Neuro. The doctor that ordered the anticoagulation was a hospitalist. At our center (recently listed as a best hospital) some touted magazine....any way in rounds new nurses are grilled about why to hold the aspirin, the lovenox and the heparin and are faulted if they plan to give it. Seems silly why it was ever ordered but the intensivists are hot on this one. Never give anticoagulation. While there is variability by region clearly I did the correct thing. By the end of my shift the patient was asymptomatic. I will really never know if my actions were the "best" but in this case no harm was caused. Nursing is like that no? We try our best given the circumstances damned if we do and damned if we don't. All said, I have to live with myself and I feel very comfortable with the decisions I made. I am truly surprised however that there is so much debate on something so crucial. The studies clearly reveal the conversion is a real risk when anticoagulation is given. The patient did not get worse while I was his nurse and I can live with that.

Yes and thanks. These articles which I saw for the first time show that yes anticoagulation may hurt and lovenox and heparin may be the worst. That said differences clearly exist and I am left wondering why the stroke folks who make rules don't establish which is safest?

This is what I was looking for. Regional differences apply it would appear and the use of anticoagulation after stroke is controversial. It does seem to me that since this patients stroke was not progression and I could neither see the CT or the MRI or the reports it was prudent to hold the anticoagulation. That is my practice where I work regularly and I can't really conceive why anticoagulation would be a priority in a negative CT if there are other methods to keep blood flow. I am somewhat stunned that this would not have been established by the NIH given all the training we do. Anticoagulant therapy for ischemic stroke: A review of literature

That is correct. Negative head CT and whether to give or not give anticoagulation. Here is a specific article to that population I believe. Anticoagulation After Cardioembolic Stroke: To Bridge or Not to Bridge?

To answer your question no...we routinely hold the anticoagulation until the MRI is completed. My "day" job is in a stroke center as well. We apply SCD for anticoagulation effect make the patient NPO and do checks every hour following a CVA. If given TPA we do the checks every 15 minutes for 2 hours. I did not receive a call back from the ordering MD. That unfortunately is quite typical for the hospital in question.

And here. Aspirin, anticoagulants, and hemorrhagic conversion of ischemic infarction: hypothesis and implications. - PubMed - NCBI

I am responding to both comments here. Journal of Cerebral Blood Flow & Metabolism - Hemorrhagic transformation after ischemic stroke in animals and humans