Ambiguphobia

NYC ER RN. We opened up 6 more ICUs, closed down psych, peds, surgical services and converted those to med/surg. Several nights ago, I was on my own with 6 ICU patients who were all unstable, vented, and on multiple drips that we are short on so the risk of it running out by the time pharmacy had it ready was very real. And it just so no happens that I did run out of several drips which nearly killed three of them. Also, I had 6 ER patients on top of the ICU case load. At one time -- I wish I could say this patient load was what I cared for throughout my 12.5 hour shift, but no, this was at a single point in time. No techs, no other nurses. Everyone has covid. We are not keeping people 6 feet away from each other. Not that we ever did, but also because it's just physically impossible. We aren't putting people in individual rooms because we use those rooms to intubate everyone. We are low on ventilators and using super old school ones that I've never seen before. ICU patients are in my ER for over 100 hours sometimes before they finally get a bed upstairs. Then the floors refuse report because they are "overwhelmed" by their patient load. If you are a floor nurse - STOP THIS NONSENSE. We are MORE overwhelmed because there is NO maximum on ER nurse patient ratios. PATIENTS DO NOT STOP COMING IN, WE SEE MORE PATIENTS THAN YOU CAN IMAGINE. At least floor nurses have a maximum amount of beds before they are full. I have never seen this much death. I am not taking breaks. My management literally begs us all to do any number of hours for overtime because we are dropping like flies with coronavirus (I already had it and took 2 weeks off). Everyone is so tired, with headaches, and our faces are bruised from the masks. The floors are full of rapid responses and codes. The ER does not call the code phone line to announce it because it happens too much. Our morgue truck is full and bodies don't fit, so we leave them outside on the ground next to the truck while we wait for a replacement. These trucks hold 100 bodies each. Everyone that dies is dying alone. I no longer feel emotion as I tell my patient to call their loved ones on the phone because that might be the last time. I have to put all my emotions aside because otherwise, I'd be a crying mess all day at work, and that's not what I want my patients last view to be, before we sedate/paralyze, and intubate. Yes, this is very, very real.

Gotta agree here. I find it hilarious when people whine about having 6 patients. NYC RN with an average load of 1:20 on just my last shift. Have gone up to 30s with several critical patients in hallways and chairs, no monitors, lack of life saving meds readily available, etc. No ICU RNs get pulled to come help with criticals. So I've had 25 "regular" patients who are awaiting workup, disposition, admission to med/surg floors, then I also have 5-10 critical/stepdown/tele patients that need monitors at the same time. Then you have your CNAs and techs pulled to do 1:1s (sometimes they do 1:3s due to lack of staff...) on SI/HI/safety patients so you are getting yelled at by all sides of family members and friends who say their grandma or whoever has wet the bed for the 10th time in the past two hours. You also get the people who constantly ask for food and try to garner your sympathy by saying they haven't eaten in 12 hours. It gets real bad. I've had an idiot literally pull the curtain to tell me her mother pooped again while I was performing CPR. She then complained that I took too long to get to her mother and that I was giving her an attitude when I told her to go back to her room while we were coding the patient. Had a sickler follow me to trauma bay and tell me she should get priority over our cardiac arrest and that her Dilaudid was due 10 minutes ago. As for the poster saying that they know someone that says we don't do "real" nursing - that's just totally untrue. Residents are available to help, but they have their own 6-10 patients each. I dare anyone to work in an NYC ER and say that we don't do real nursing. The types of patients we see vary from minute to minute, from shift to shift. Sometimes you'll have 30 drunks. Other times, you'll have an MVA pileup so you have 5 traumas called at once. Other nights, you relish in the fact that you only have 12 patients with none of them going to a critical unit, and you breathe a sigh of relief that you've finished passing their medications and possibly have caught up on drawing all their bl As bad as it sounds, I truly love being an ER nurse.

Had a young adult call for EMS to pick them up because they choked while drinking water, with no continued ill effects afterward. During ED course, continued to ask me for water and food. Ridiculous.

This has got to be a joke. You were inappropriate by escalating it. You know how when people tell their side of a conversation - they'll downplay how they were and they'll demonize the person. The actual conversation was probably even more benign than this. You might have too much free time on your hands if this gets you bothered.

I'm just browsing through the comments and lamenting over how nice the ratios are outside of NYC. My last shift, I started with 18 patients to myself, all level 3s and up. 4s and 5s are sent to fast track/smart rooms with NPs and PAs. This is totally typical, too. The worst ratio I ever had was 1:27, all level 3+. We get one tech or nursing assistant, and one medical assistant to help between roughly 50 patients. Most of the time the tech/NA gets sent to sit on a 1:1, so we are stuck doing tech work and RN work. It's getting exhausting. But, alas, I love NYC, so I'm stuck with this absurd ratio.

Yeah, I was born and raised in NYC, never left. I guess I'm used to working with the incredible costs here and getting by more easily than a transplant would. While I can live decently on my own salary, I have to say that my husband makes more than double what I do. Many of my co-workers live comfortably on the same salary, as singles totally ready to mingle :)

No OT required in NYC private hospitals. I'm making >100k/year as a staff ED nurse. 36 hour weeks. This is due to night differential and CEN differential. Decently high COL though, but my family is living very comfortably.

They don't care about how high the Teas score is; the only factor is whether or not you passed their minimum required score. Your GPA is barely competitive. My group in spring of 2013 stopped accepting at 3.76. but remember, it's only the GPA for their four pre requisite classes. They don't do cumulative GPA for admission. Also, keep in mind, out of the original 72 that began in spring 2013, only 13 other students that started alongside myself graduated on time (2 years duration). A lot of other people had to do one class at a time to raise their passing chances.

Still waiting on the OP to reply that this was a joke post.

"I'm allergic to morphine. And tramadol. And percocet. And vicodin. What's that medication for pain that starts with a 'D?' It goes through the IV, I think. I think it's pronounced, 'dinodood.' Right? Oh yeah, dilaudid. That's it." "WHAT? The doctor wants to give me 2mg? 2mg doesn't work for me, my pain is 10/10 right now. *laughs at TV and takes bite out of fast food order* Have them change it to 4MG through the IV for Q4H." (yes, they say Q-4-H! Not "every 4 hours") "I also get itchy when I get it. I need benadryl, but not the pill. That one doesn't work fast enough and it doesn't help with the itchiness. No, it has to be 50mg and Q4H with the dilaudid, too." "Oh, I also get nauseated when I have dilaudid, so I have to have the medication that makes me not sick." "Make sure you push dilaudid, benadryl, and then zofran. It can't be in another order. It has to be this order, or it doesn't work." *calls for nurse at 30 minutes before next pain meds due* "You remember that I have medication in 30 minutes, right?" *calls at 20 minutes prior to meds due* "You gotta get that medication ready. My pain is 10/10 again. Can you give me medications a few minutes earlier?" *calls at 5, 4, 3, 2, 1 minutes prior* "YOU'RE LATE WITH MY MEDICATIONS, MY PAIN IS SO INTENSE RIGHT NOW. I NEED A BREAKTHROUGH DOSE SOON, TELL THE DOCTOR NOW." "I'M CALLING THE SUPERVISOR ON YOU BECAUSE YOU WERE 10 MINUTES LATE WITH MY PAIN MEDICATIONS. I DON'T CARE ABOUT THE DEAD PATIENT, THEY'RE DEAD ALREADY. I'M HERE IN SEVERE PAIN. YOU CAN'T IGNORE ME." Rinse and repeat. This has literally happened. Several times. I wish I was joking.

Unfortunately, there's a lot of backtracking and repetition. There are care plans to write, as well as ticking off boxes to show performance of an assessment on the patient. Down the list for the assessment, we often run into the same exact question (eg; pts ability to urinate [incontinent], problems with urination [incontinent], pt voiding at this time? [incontinent]). Then, as we make a care plan for the pt, we check off more boxes to indicate they are incontinent, and say what we are doing to prevent skin breakdown. BUT during the skin breakdown section of the assessment, we tick off boxes that say what we did already (turn pt, clean as needed, provide barrier lotions, use incontinence devices, etc.). Nurses have to stay late, sometimes for hours, to continue documenting, so they don't get in trouble. It has become pretty insane!

Working at a 1:8 patient load here. It becomes pretty hectic because we get a lot of transfers/discharges/admits during the overnight shifts. So a 1:8 patient load can quickly double, and this is in a hospital. Oh boy, the charting when this happens....

My program had a lot of older students (30+ age group). They graduated, and are having trouble finding jobs. Then again, our market is the most highly saturated other than California. I haven't noticed a single person over 35 working in a hospital based setting from my graduating group. Age discrimination is a real thing, and it is extremely unfair to those that had work towards a life they wish to have.

I live 1 hour away from the hospital that I work for right now. A few of my classmates have to travel 1.5 hours to get to work at non-hospital jobs. Applying for 20+ jobs is nothing, my fellow classmates and I applied for several hundred. Do not be picky with what you apply to. Apply even if it says experience preferred. I also went in person to several dozen, some hospitals and clinics I went to twice. I was hired on the spot for 2 per diem jobs which I still hold. It took 5 months to get a hospital job - I had no connections, but they really liked that I didn't just sit all day and do nothing. I got my ACLS, PALS, NRP, IV certification, NIH SS certification while job hunting. Even with just an Associates degree, I was hired because I tirelessly worked on getting hired. I enrolled in a BSN program as soon as I got my RN license. The NIH SS is free to do online, and will be another step up on your resume. Take out a loan if you have to, and apply all over the country. Relocate if necessary. Get your advanced certifications. Most of my fellow graduating classmates are still unemployed and those with jobs are severely underemployed. It has been 1 year since graduation for us, too. When job hunting, you have to ask yourself if you are truly doing your absolute best and if you've exhausted ALL of your options. I've noticed that a lot of people here that look for jobs expect one to land in their lap without doing the legwork. I see that a lot with former classmates who complain and ask how I was hired, but then they don't do anything beyond applying for jobs online and being severely selective. Go to your hospitals and healthcare centers. Dialysis centers often look for new nurses. Mental health based programs need RNs. Check out state programs and local government jobs. Use LinkedIn, message hiring managers. You can do this.

I got a job with a fresh new grad with just my ADN this year. I was accepted at NYMH. I speak several foreign languages (self taught, there is a competency exam you need to take to verify), got my advanced certs (ACLS, PALS, NRP, etc.), and enrolled in a BSN program. Salary is 77k + 6k night diff, so 83k starting, its set to go up over the next few years. Lot of overtime available, too. Benefits are fantastic, pretaxed transit/commuter cards, HSA, great health insurance. VERY supportive nursing staff and management is always open door. Lots of teamwork and recognition here. Definitely a place I would recommend you try for. On the other hand, I also have friends that work at LTCs in Brooklyn and Manhattan. Pay is approximately 50k/year, highest I've heard is 65k/year. I walked into an LTC before my hospital job, got offered a position on the spot, took a tour of the facility, and walked right out. The nurse:patient ratio there was 1:36, with two techs/assistants on the floor. If you're desperate, then I would say try to work at an SNF/LTC, but try to avoid them if they seem dangerous during a walkthrough. A lot of my graduating classmates have been extremely picky, though, and have not found a job in 9 months because they refuse to even try nursing homes. Only 6 of us have found employment in hospitals, 4 had to move out of state (NC and TX, great opportunities if you are open to traveling), and only 1 person other than myself have ended up in a hospital. We were similar in that we did not stagnate during our job searches and continued to gain certifications and did CEUs which we brought up in cover letters and then brought portfolios to our interviews. Neither of us had connections to the hospitals, either. Good luck!