Huachuca

Hello!, I am currently working in a Cardiac Cath Lab that also does Interventional Radiology Special Procedures. We also have Radiology nurses in a different department. I have worked as an Emergency RN, Flight RN, and Rapid response nurse. I think that getting both degrees is a great idea....but....you have to have working experience to be respected in either. The Rad tech's I work with all have had at least two years of being a Rad Tech before they come to our unit. Then, it takes a special kind of person to learn and entirely new skill, scrubbing in with the doctor. The Rad Tech's scrub (prepare the patient, set up the equipment, run the table, and help the doctor manipulate the equipment . It is a steep learning curb. Both the nurse and the Rad Tech learn how to record the case. SOME facilities let the rad tech medicate the patient......This is where nurses get defensive. We go through years to learn how to medicate and monitor patients, and don't want to be replaced by someone who has just taken a course on a few drugs.( Just being honest here). The Nurse in Radiology/Cath Lab, Special procedures must research the patient's background, get consents, put in orders, sedate the patient, respond to changes in patient condition, and recove the patient. Here is where you MUST have experience. You have to know when to react quickly, and that is not when things have already gone bad. Nust this weekend I worked with a nurse that did not have critical care experience. The patient was scheduled for an emergency pacemaker. It made sense, he had altered mental status, heart rate in the 30's. What she did not take into account was that he had a critically high potassium level of 6.8. He needed to have this addressed YESTERDAY. Before we proceed we needed to tell the physician, who was going to put a permanant pacemaker in him. It turns out, after the man was treated his heart rate improved and he only need a temporary pacemaker until his potassium was completely corrected. So, I support you getting as much education as you can, just remember you need the experience to back it up with. Good Luck

Get your certification in the field you are in now. I am not sure what it is called, but I know there is a certified NICU RN. And since you are studying, and have the EMT already, get your CFRN. It is mostly CCRN with CEN stuff and a little prehospital thrown in. That will make you stand out from other applicants. There is a great online review course taught by Will Wingfield (he started out as a medic then got his RN, and is now a nurse anasthesia. The company I work for requires your CFRN within two years of hire, and last I heard, they were having the new hires take the CFRN quite soon. You can also take the FEMA incident command online courses (HCIS 05, 100,200,800.....a few other) I don't know where you live and if you would be willing to relocate in order to become a flight nurse. If you want to really broaden your chances, transfer to the ER and get ER experience with adults and pediatrics. Maybe there is a pediatric ER in your area. Airmethods requires 3 years of ER and/OR ICU experience. There are remote bases that usually have opening. Commutes are long. Good Luck

Ask yourself if you really want to be in a profession that cares for other people. If you do, then nursing is great. There are plenty of negatives in nursing. We are overworked, underpaid, stressed, eat our own.....you name it. However, in as little as two years, you can have a career that you do anything. You can continually re-invent yourself. You can move and walk into a facility and get a job. Admittedly, you may have to start at the bottom...but watch the news and see how many new grads complain about not being able to get a job after they graduate and having thousands, maybe hundreds of thousands of dollars in school debt. Most places will match your student reimbursement. Nursing school sucks, no two ways about it. But, once you are out working, you are going to realize how easy it was and how many experiences it gave you. It is hard not to get tunnel vision in nursing school. Just stay on top of your studying, don't slack off. Take advantage of those nurses that like to teach during your clinical rotations. Realize that you will NEVER stop studying. School goes on forever for the professional nurse. The thing that keeps me going are the amazing experiences that I have had. I have been on med surg, tele, ED, and flight. I have birthed babies, intubated people, placed IOs, kept people alive, calmed people down...but the most amazing, was helping people die. We are in an unique position. We are able to touch peoples lives in a most intimate way. What I say to you, and to those nurses that are burned out (I have been burned out and burned in my career). If you don't like the job you are in, then find another job. You might need to make yourself more marketable. This means, take additional courses....ALWAYS. Especially if you want to change specialties......Want to go into L& D?....then take NRP or a clase on fetal monitoring. Want to go to the ER? Take ACLS and PALS. Go to the unit educator and ask them if you can attend their unit specific training. This will help you to stand out. Finally, there are jobs that take less out of us, but they are not at rewarding. Good luck

I am a flight nurse that came from an ED background. All of my co-workers that came from ED only wish they had more ICU experience. On the flip side, all the ones that came from the ICU are usually missing maternal/pediatric/L&D. I think your plan to go to the ICU is a great idea. We do a lot of interfacility calls, which means taking a train wreck a long distance. They are intubated, on multible pressors, blood hanging....numerous vent adjustments. I agree with NeoPediRN, focus on getting your advanced certs. You need three years experience before you can apply for flight nurse. If you are in the ICU, get your CCRN, it is tough. At the same time, you could obtain your CFRN, also hard. One piece of advise that I wish I had ignored was to wait two years before I took the advanced cert. The test for CFRN was basically a test for test takers...which is what you are fresh out of nursing school. Good luck.

I tried to send you a PM, but you box it too full!

If you don't mind relocating, I would reccommend signing onto the medical transport websites and look at job opportunites. Airmethods, PHI, Medtrans, are some of the largest. I work in the southwest, and there are always openings for flight nurses. You have all the certs that are required. You need a minimum 3 years critical care/emergency experience. You could also take the CFRN review and get your certification. That is a requirement within you first two years, so if you have it before you even apply, you would stand out. Attend prehospital EMS days. You get a feel for prehospital. One thing they are looking for during an interview, is someone that can work well with others. You are working/sleeping for 24 hour shifts. You have to be a good team memeber. Good Luck

I work in the southwest and drive 120 miles to my base. We have 24 hour shifts. The schedule is 24 hours on/24 hours off/24 hours on....then 5 days off. We have crew quarters to stay in. If you really want to be a flight nurse and don't mind relocating, there are always openings in the west. They are considered hard to fill slots. Once you have worked 18 months, you can transfer. Good Luck

All of our hospitals are having similar issues with exceeding maximum capacity on a regular...and this can be daily basis. My hospital has instituted a hospital wide approach, called Code Purple. When we are holding more than 5 admitted patients (our capacity is around 60 patients, counting hall beds), AND the rack waiting to be seen is loaded, it is announced overhead. Every unit then must accept one additional patient, even if this means the patient is in the hallway upstairs. We stay at this level until the back log is cleared up, which may not happen. The times we are are Code Purple are tracked, and eventually upper management gets called. All this being said, it makes for a dangerous situation for patients and staff. It happens way too often. We have a nursing shortage, but yet, positions are slow to being filled or not filled. Support staff has been cut back. Moral has tanked. I agree that only legislation will change this, because management won't.

I would advise you to take the TNCC. It is a great class to nail down head to toe assessments, regardless of your specialty. Will it open doors for you? Probably not, except that it will show your willingness to continue your education. I precept new grads in the ER as well as nurses that are changing specialties. The TNCC makes you focus on what is the priority.

I want to address all the issues that you have brought up (ie the 22 gauge, the change of pressor, the blood gases, the tests, etc) Here is what happens. I am in a room with 5 other patients, no tech, and one other nurse. I get a report that we have a resp failure coming code three..NO WAIT, they are here. Move one patient to the hall (presto...they are cured...LOL) I am taking report from the medics, while I am trying to get an EKG, another line, Labs....*** the patient coded...now I am running a code.....Well you get the picture. During this cluster...the hospitalist has came in, spoke with my other patient..taken the doctors chart...SOMEHOW, not managed to look at the monitor showing a SBP of 70's...and then leaves with the chart. In the meantime, we are told ww have ANOTHER patient coming that MUST be in the acute care area of the ER... I rarely have a chance to have a sit down with the hospitalist. I am luckyif I can have the entire chart when I need to call report. I DO appreciate that the ICU has no doc in house and they are working their butts off. Here is what I try to do. I try to make sure that every patient I take gets a line and rainbow. If they have ANYTHING that looks suspcious, they get the first set of blood cultures drawn at the same time. They get a foley if they are unconscious, altered or sick. At least now I have urine. We have to get the antibiotic up w/i 4 hours of the patient signing their name triage (when the waits are 6 hours....we are screwed.) and w/i 30 minutes of the doc writing the order. So, what to do if the order was not given to me, or the code ate into the time. They get the antibiotic before the cultures. Now I am screwed whent they do a chart review. As I said, I think we all have it hard right now (floor, ICU, ER) But please forgive me if I have not reviewed the labs, the patient has not been to CT to r/o PE....we are 6th on the list....meaning another 2 hour wait) I can not keep them here longer than 30 minutes waiting for a test. I certainly will keep them on a slow night. What really upsets me is when I call report to the ICU and that nurse has already had time to review the computer chart, including a lot of background I do not have. PLEASE do not hold me responsible for not knowing things beyond the ABC's. I do appreciate that you need a central line, and I will now refuse to send the patient up without one when their pressure is low. This gets me introuble with the management. So you may get a central line, but not a clean patient.

We just had our Joint Commission review and they would have had a fit if they saw contaminated items (ie, specimens) in with meds. I would check their web site.

Times change, areas of the country are different. If someone wants to display their first and last name, that is their option. For myself, I prefer first name only with title (RN, BSN, etc). I am in the southwest, where identify fraud is extremely high. If someone has my first and last name they can obtain my license number from the state board, online. Now they have my place of work and enough personal info to steal my credit. I also have a spouse in law enforcement, as do many other nurses I know. I have different set of concerns from other nurses, in that aspect. Nurses at my hospital have been stalked to their homes by patients. It happens. Doctors where I work tend to have a professional identification and a personal one. They are able to use their practice address (the ER is contracted by an emergency medical group). Married female doctors can use their maiden name and married name. Sure, a driven nut case will be able to find anyone, eventually. If they go to medical records, they are going to need to fill out a form identifying themselves. One nurse that was aggressively stalked and was able to keep that information away from one psych patient. Protecting yourself does not mean you are any less professional any more than locking your doors makes you a whimp. I am not afraid at work all the times, I am careful. I have no problem giving my full name to the little old lady who asks, just as there is no way I will give it to the obnoxious drunk who is hitting on me.

I graduated 1 1/2 years ago from an ADN program, I am 45 years old now, working in the ER. It is great. Nursing school was in most ways easier for me then for my younger classmates, because I had life experience. I have three kids, and had to make some sacrifices to go to school, so I made the most of lecture and clinicals, where as some of the younger students we getting over hangovers, planning dates, showed up late for class,etc. The thing that got some older students in trouble was acting like they knew everything. My advise is to go for it!!! It will be a whole new chapter in your life. Huachuca

I went to the TMC recruitment day, they splash out lots of money...treated all of us to a night at the Tanque Verde Guest Ranch...very nice. They had a "Meet the Managers" reception prior to that. I was looking into going into the ER. The ER rep was ..to put it nicely ...not very impressive. However, just for a look, I was taken on the OR tour by the OR manager. I really liked her, she gave me a great tour and almost had me....If you are interested, definitely have them take you around. When I get burned out at the ER I work at, I just might give it a try.. Huachuca

Thanks for those words of advise. I think I will go to my nurse educator with this because it would be great to be educated about it BEFORE you have to figure it out the hard way. Huachuca