AllyRN82

To everyone who did not hear back from Medical City- consider it a blessing. After being a nurse for 5 years, and venturing out of Medical City, I can say I did most of my learning from other hospitals. They are crotchety old nurses with crotchety old doctors set in their ways. It's not a supportive environment, and honestly a terrible way to start your career. I stayed 4 years too long, and would hate to see any of you make the same mistakes. Baylor University Medical Center was the best, most educational, most supportive internship and career. I am now traveling and absolutely love it. Most of my experience and education came after my time at Medical City Dallas. Please stay positive about your nursing journey, and don't waste one more minute on Medical City Dallas.

I'm not exactly sure where to post this, but I am a traveler, so I thought it'd be appropriate here. It doesn't relate to travel nursing specifically, so I understand if it gets moved. I had a pt with several complications from a spinal surgery a few years ago. This pt has had several years of uncontrolled pain. This pt was admitted requiring vent (this pt is trached) assistance. The narcotics this pt was receiving at home were quite the heavy doses. When this pt was admitted, those meds were stopped. This pt ultimately began to withdrawal requiring more time in the ICU on the vent. The narcotics were slowly reintroduced. This pt turned out to be very sensitive to narcotics, and would become apneic as a result during vent weans. The pain was still a huge issue, but a tricky one because of this pt's response to narcs. One step toward better pain control was the fentanyl patch was increased. When the nurse who applied the patch scanned it, they were prompted to select a time for it to be removed, which is typically 72 hours, but this nurse accidentally checked 12 hours. When I came on that night, I had noticed this pt's PRN pain meds had also been increased. When I got the alert from the eMAR system to remove the fentanyl patch, I did. It wasn't something I just did because a computer told me. I thought it very strange, and went through the thought process in my head: "ok. This patch was just increased today, but so were the PRN meds. Maybe they really only wanted to increase the patch for 12 hours and try again tomorrow." Without giving away too many details, this pt's body weight is not very high. It seemed like a reasonable thing, so I felt ok about removing said patch. I did give frequent pain meds later that night, but it wasn't anything too unusual for the pt and the poor pain management that was already present. Apparently, the pt went 3 days without a patch, as it didn't alert the following nurses until it was due again. With this pt requiring increased pain medication, the MDs increased the patch again. Correct, the patch was not on to increase a dose from. That nurse realized that when they went to apply the increased dose and remove the old one (that I had taken off 3 days before). I am called later basically being given all the blame for this incident, that I should have put more thought and critical thinking into that situation before removing the patch. That I should have spoken with the MDs about what the new pain plan was after removing the patch. I assumed increasing her PRN meds and trialing the patch dose was the plan, so I didn't question. The blame is being put all on me, and I'm not ok with that. I will take my part in this, but to tell me I didn't think it through was insulting. I was tried to be frightened into just how horrible my act was: "if that nurse had put that increased dose patch on that pt, it could have been fatal." Yes, I accept responsibility for it, but please don't bully me about it, and it wasn't all just me. Plus, as a nurse, during my assessment, I look everywhere for patches, even if they're not ordered for one- I scan their bodies looking for one, along with my skin assessment. It was evident the following nurses don't make that part of their assessment, and I think it's a very important part of an assessment. There was another incident not but a week before this. Pt was bradying down, dropping pressures, losing consciousness, basically precoding. I ran in to help the nurse, was handed an amp (out of the box, ready to go) was told it was atropine and to give it. The pt's hr was dropping dropping dropping 20s. I pushed half and waited, nothing was happening, so I pushed half again. Pressures shoot to 200s, hr 170s. Turns out I had pushed epi. Again, all the blame was put on me. I completely accept responsibility for my part in it, but I was also handed a vial from the nurse being told it was atropine. I understand I'm the ultimate last check, but in precode/code situations, I don't do that when someone is handing me meds that are vital to being given. I will no longer trust that someone is giving me the right drug in those situations, and it's made me even more vigilant than I was before. The pt wasn't harmed, and it was a huge lesson for me. But I don't feel all the blame should be placed on me. As a traveler, you all know our voices are rarely heard. It's near impossible to defend yourself against their loyal staff of 20+ years. Does anyone have any suggestions on how I handle this? These are resulting in "important meetings" that I have to be a part of, by myself. I truly have accepted my responsibility in all of these incidents, and have learned valuable lessons, but I don't know if I can stomach a verbal lashing when I wasn't the sole offender. Thank you so much for listening. I know this is long. I hope everyone has a great day :)

I'm hardcore nights, also. Ever since I was a kid, I'd be awake into the wee hours of the morning. When I started working nights 7 years ago, after many years of being forced to function during the day, I thought I'd died and gone to heaven. I'm at my best during the night, and I know it's not like that for most of the dayshift people. It's perfectly ok to switch to days. I think it'd be hazardous to try to force these nightshift hours any longer for you; for your health and the safety of your patients. I hope you're able to get a dayshift position soon! Good luck!

That's about the extent of all my orientations, and they keep getting shorter and less informative. It's imperative to have more experience.

I thought I'd be able to pick a location and just go, but that's been difficult. I seem to luck out each time, and get my chosen location, but it was especially difficult this past time (~September). I wanted east coast, specifically Boston, but nothing was coming up. It was rough, but something eventually opened. I went 4 weeks without pay, though (in between assignments). I haven't been doing this since 2008, so I'm not sure how much it has changed, but this past time was different than getting my other assignments. Oh yeah, I'm ICU.

I contacted the Massachusetts board of nursing directly. They transferred me to the appropriate people, and I was informed to send in my misspelled license and they would correct it. After exactly 21 days (that's the amount of time they say it will take to get to you, and that's how long mine took), I got it in the mail and overnighted it back to the address they gave me. It was corrected with the MA board of nursing within 24 hours, and I now have a valid license. I'm not sure about the contact information for Illinois board of nursing, but I found MA board of nursing contact info on their website. I just did a search for their nursing board and it was the first link on the search results. I hope that's a helpful answer.

My best friend I am traveling with has 1.5 years ICU experience in a level I hospital and 4 years in med-surg. I have 5 years in ICU at level I and II hospitals. We are trying to find assignments together and that's been difficult solely because of her "lack of experience". A lot of places have upped the ante and are looking for 3 years ICU experience minimum. I completely agree with waiting for that extra experience. You won't have hardly any resources on the unit once you're on an assignment, they are fully expecting you to be able to take whatever is handed to you. In my 3 assignments, I have always had the busiest, slightly tougher assignments. I almost always have the code bed and get some clustered mess of a code. They expect you to be wonder woman, as they're interested in treating their full-time staff better. It is good, better experience being a traveler and being exposed to a lot, but I feel without my relatively little experience of 5 years, I wouldn't feel as confident with what I'm doing. I am also CCRN and would recommend at least obtaining that before you begin traveling, as you're already planning. It sounds like you have a great plan, but I don't think switching to a level I hospital will change anything. They are more interested in the years of experience rather than where you got them. I'm not trying to discourage you, I am only sharing what I've experienced so far with traveling.

I got two written references from that assignment and I have several from my current assignment. So it's not even worth the battle? On one hand, I'm thinking, 'fight it', but on the other, I'm thinking I really don't care to ever work for HCA or Parallon again anyway. I appreciate your input. Thank you for your response.

I'm a traveler looking to begin my 3rd assignment. With my last assignment, I got someone to cover my last shift for a steroid epidural I needed to pretty emergently get for my back. My shift was covered, have it all in writing from the nurse who was willing to work that shift for me (on the official forms from the hospital), and the charge nurses and nurse managers were aware. Now, trying to get my 3rd assignment, I find out that hospital deemed me not rehireable due to not finishing my contract. Unfortunately, it's an HCA facility and the staffing agency is Parallon (formerly All About Staffing), making up for a lot of the travel opportunities out there. I'm completely ok with never working for HCA again, as they're horrible, in my opinion. Worked with them for 4 years and did a travel assignment with them, so I think my opinion is valid. Anyway, I would prefer to get this settled and not be on my record. Does anyone have any suggestions, as this information is very inaccurate and is causing trouble for landing my next assignment. Thank you!

Thank you for the info! Massachusetts board of nursing severely botched my name, didn't see it until my license came in the mail. This is delaying my assignment in MA, so looks like I'll be trying for it in the Spring! Thanks to the idget who misspelled my name! It was an error on their end- they even pulled out my original application to make sure it wasn't me who misspelled it (yeah, after 30 years, I forgot how to spell my name! haha).

This sounds like an awful situation. I know what it's like to work in that type of environment, and it's not right. I wish I knew a way out of it for you, and for when I get in situations like this. I tried to get an assignment in DC and was actually warned by my recruiter that there's a hospital there where they're losing half their contracts because of work conditions such as what you're mentioning, and he advised I not take the contract. I am wondering if it's the same assignment. Regardless, you are in the contract at this time. The assignment I had like this, I kept my head down and my mind focused on the end date. It came soon enough and I got the heck out of dodge. You're taking all the right steps, and I admire your ambition to seek advice for encouraging help from your team. Best of luck to you.

Hi LaurenBlair, I am looking for an assignment in Boston, will be my 3rd assignment, and I'm finding the same type of pay rates. I was surprised with Boston, as I've made far more at my other assignments, but Boston's so great, I think I may accept. Yes, it's with the housing included. I attempted to find my own housing in Boston, but everything I found was outrageous. Best of luck to you!

Most travel agencies I spoke with before deciding to work with the one I am with say it is a requirement to have 1-2 years of experience in the field you are looking to travel in.

:ancong!: yang rn!!! i know i'm about a week late, but i'm still proud like it was today :d:d i can't wait to read all of your exciting stories from er even if i read them a month later :chuckle

congratulations yang on your internship!!!!!!!!!!!! :yeah: i don't live too far from where you'll work... missb08- if you have melton as a choice for first semester, choose her as number one. she's such an amazing, supportive, intelligent person. i had darensberg (sp?) in my first semester and it was like a train wreck 24/7 but she was sweet and wanted the best for her students unlike her colleagues i.e. galloway, in my opinion.

Jaxia - you will do so well on NCLEX! Lecture in 4th semester is nothing like the NCLEX...lecture in none of the semesters is nothing like the NCLEX...don't worry about it. I've been there and it really was not worth my worry

:yeah:congratulations jaxia!! i'll be waiting to hear how your interview goes, yang. i'm sure you'll go where you need to be it's so exciting hearing about everyone's success! i like to get that excitement for nursing going again after the day-in-and-day-out feeling comes over me every once in a while and i can usually get my fix in here! fun- are you starting to enjoy any particular type of surgery?

I hope everyone is doing well! I'm so glad to see everyone moving on and almost at graduation!!!! yin yang- I saw that you have an interview at MCD next week in the ER. That's very exciting! I work up in the ICU just one floor above the ER in the same building. I think the ER here is a great one. It is a level 3 which is far from Parkland's ER, but I don't mind that part. We get ER patients sometimes but I've never officially worked in the ER. The ER Interns I took ACLS with were loving it in the ER. I wish I had more information to give you about the ER. If you have any specific questions, just ask and hopefully I can help you. Good luck with your interview! I got hired October 2nd of last year so it seems like they're doing the interviews around the same time. Let us know how things turn out! Maybe I'll be seeing you around the hallways here Katie- how's OB? Are you still working all of the time?

Congratulations DreamBelieveSucceed!!!! I hope you are having fun doing some celebrating!!! :yeah::yeah:

OH NO!!!! PBDS is horrible!!!!!!!!! Uuugh....yeah- study for it now...I wish I would have known to study for it. They just sprung it on us...

WAHOOOOOOO!!!!!!!! Congratulations!!!!!!!!!!!!!!!!! The nursing world just got one amazing nurse! :yeah::bow::w00t::w00t::nmbrn::nmbrn::hpygrp::urck:

SECOND 16 hour shift, Katie? No way!!!! Wow!!!!! I'd love to see that paycheck

YAY Mi'Shelle!!! It's all over!!! I'm so glad you're so confident. It's so not worth the worry I experienced!!! I can't wait to hear!! It sounds like you both passed!!!! :yeah:

congratulations dreambelievesucceed!!!!! you're in a much better state of my mind then i was when i finished nclex! that's awesome!!!!! mi'shelle- good luck tomorrow!!!!!!!!!!!!!!!!!!! you can do it!!!!!!!!!! :yeah::yeah:

Awesome!!! That's about when I plan on going...Fall '09 or Spring '10....I just want to enjoy life right now....it's so nice to get to enjoy my husband and my family and friends. :bowingpur