WindwardOahuRN

Queens has hired quite a few EXPERIENCED RN's lately. They are pulling from the huge pool of very experienced former HMC nurses who were displaced by the closings of HMC West and HMC East. Since Queens has recently purchased HMC West and the tentative re-opening is set for next Spring I imagine that there will be some hope for an increase in job opportunities here. But still....not much hope for mainland wannabe-transfers. The slots will be filled by the local new-grad-RN-unit secretaries/nurses aides/etc, who have been waiting in anguish for such opportunities. They will be hired first, over those from other geographical areas. Which, IMOH, is as it should be.

That pay scale is four years old....

LOL---all I can tell you is that I personally have worked in the NE where we received 2.5X pay for holidays and I knew of many others that had the same perk. Perhaps it's a thing of the past. Congrats on a contract that gives you that in HI---just think it's strange that after working here for over a decade and having worked at two HNA-contract hospitals here I've never heard of it. Can you possible share the name of the facility that has such a contract? I might just be inspired to head on over there. :heartbeat IME union contracts here fall far short of what I got at union hospitals on the mainland. Travel nurse jobs, BTW, do seem to pay less than staff positions, especially in areas that are in high demand. Not many travel jobs here in Hawaii anymore, though, but years ago we were swimming in travel nurses. Have you looked at the Sacramento area? I have a friend who relocated there and her base pay is way over $50/hr. Very experienced ICU nurse---maybe that's why? SoCal pays less than other areas of California, BTW. This is a few years old so the pay now is higher but it gives you an idea of what the California pay scale is (ignore the first part and scroll down to the actual pay rate table---I think that first part might be a "dream" contract): 101 salaries | National Nurses United Also, UCLA has their current contract online, EXCEPT for the wage table (darn!!), including premium holidays---interesting reading: University of California Human Resources and Benefits - At Your Service

>>Many of the hospitals are unionized and their pay scale is very strict. Holiday is usually very good. For example, Thanksgiving/Xmas/NYE are 2 1/2 times hourly pay. Thats $125/hr. Well over $1000 for a 12 hr shift. I've never seen that kind of pay for a holiday here---where do they pay double-time-and-a-half for a holiday? IME it's time-and-a half. 1.5 times regular pay. There are five holidays per year where premium pay is earned according to HNA contracts---New Year's, Memorial Day, Fourth of July, Thanksgiving, and Christmas. Mainland nursing jobs with a good union routinely have at least 10-12 holidays at, yes, double-time-and-a-half. It would be nice to know that someone here gets that kind of holiday pay but I'm not sure it's possible in Hawaii.

Yes...without those who walked the picket lines during the last strike we would be in pretty poor shape now. We fought for it and we deserve it, more so now than ever before. Nursing is a tough road, in so many ways. For all those who scoff at union efforts? I'd like to show them my pay scale info from ten years ago and ask them if they think we'd have gotten any further than those numbers without the help of the Union. Congrats on your luck in the job hunt and best wishes for success!

Well, when a post is put up on this forum I guess one should expect that there will be varying opinions regarding the post. It's a public forum and that's going to happen. No, I don't think the patient was properly managed, but that's just my opinion, of course. Hopefully the OP learned from the experience but judging from the accusational title of the thread I have to wonder. I have to say that the choice of words for that title kinda floored me. I consider that title really "harsh." Now let's talk a bit more about "harsh." Let me tell you what would have happened had the team been unable to bring the patient back and she had died. There would have been an inquiry into why this happened. It would have been classified as a sentinel event, maybe even an ME case. And yes, they would have pointed the finger of blame at the nurse. Why? Because, in the end, you are the final clearing house as far as the care of your patient goes. Not sedated enough? It's up to you to advocate for the patient. It's easy to blame the nurse---easy target for the docs, the families, and risk management. "Busy" is not an excuse. Again, it may be a reality but it just does not fly as an excuse. This is the tough, tough reality of nursing but especially critical care nursing where things happen so quickly and the consequences of not comprehending the possible enormity of even seemingly insignificant signs can be fatal. If you think my previous post is "harsh" you should see what happens during a sentinel event investigation. No, I've never been directly involved in one but I've seen what happens and it is not pretty. The blame is very often heaped neatly upon the primary nurse, especially in ICU where the patient/nurse ratio is what it is. There are ways to adequately sedate a patient during the weaning phase. As previously stated, it's a skill. From tiny doses of ativan to the use of Precedex, it's done on a regular basis. Again, fentanyl is NOT a sedative. Yes, it can make a patient dopey but that is not sedation. Fentanyl can also cause nightmares and anxiety. If a patient says they are not in pain but they are agitated, don't go up on the fentanyl simply because it is the gtt that happens to be hanging there---go get an order for an anxiolytic. I've had versed, propofol, and fentanyl running at the same time on quite a few patients (and then added Precedex in anticipation of extubation). They all do different things and it's a balancing act but you really can get your patient to a state where they are comfortable and the stress on their bodies is reduced immensely. I've noticed that nurses that are new to the ICU, especially, are hesitant to titrate up their sedation and pain med gtts. I guess the fear of overdoing it is always present but sedation and pain relief are very important parts of taking care of ICU patients. Inadequate sedation and/or pain relief can lead to increased ICP, increased bleeding, MI's and, as the OP knows firsthand, can even end up causing a Code Blue. I'm not sure if the "new to ICU" nurse is a factor here, not knowing either Tiger or Cait, and forgive me if I have read you guys wrong but I sensed that in your posts. Yes, both the nurses and the patient had a crappy day but the patient could have died. I would say that the patient's near-death trumps whatever happened to the staff in the Crappy Day contest.

>>She was sedated with a fentanyl drip The patient was clearly not adequately sedated. Fentanyl is not a sedative. Tied up, tubes in every available orifice, and being told that "you're going to die" if you don't stop doing something you're probably not even aware you're doing. Sounds like the patient had an even rougher day than the staff..... :-( Agree with the previous poster who said administering proper sedation is a skill. I really think it is beyond awful to not sedate a patient properly in the ICU and I see it all the time. You come in, the patient's heart rate is through the roof, they're straining against the restraints, diaphoretic, bucking the vent. You look at the drips and the propofol or ativan or versed is at a piddly rate and the order clearly allows for room to titrate up. The excuse for not going up? "Oh, I didn't want his blood pressure to drop" or "he's okay as long as you talk to him" or "as long as he is asleep he's fine." Straining and bucking and just plain terror puts a lot of stress on an already stressed body. Just pisses me off. Think of yourself or a loved one in that situation and act accordingly.

Just a quick clarification---no offense meant to the new grads out there. But there is a huge learning curve and it takes time to develop skills. New grads need the support of experienced nurses, not just other new grads. It's just not fair to anyone---the patients, the experienced nurses, and the new grads themselves. Yes, lately I have seen more of a trend towards hiring experienced nurses over new grads. For a while we were having one new grad class after another and putting the grads out on the floors and units in large numbers but not now. Good luck to everyone out there who is looking for a job. It's sad to hear that people have worked so hard to get through school and now are faced with joblessness....

The bottom line is, like it or not, the bottom line---or so was the popular thinking. Cheaper is better/more cost-effective/the way to go. New grads are/were cheap, compared to experienced nurses. Life was good/cheap until the kim chee started to hit the fan. Lo and behold, it became apparent that experienced nurses actually functioned better/more safely than new grads. Did it change things? Nope. The units and floors are over-saturated with new grads. Yes, it seemed like a good idea at the time, bottom-line-wise. But the fabric was wearing thin and starting to tear. You simply can NOT expect a floor/unit that is top-heavy with inexperienced nurses to function as well as a unit that has a preponderence of experiences RN's. Book learning is simply no substitute for experience. IME? The docs are getting upset. Mistakes are mounting. Families are starting to complain. Lawsuits? Yep. Lower patient satisfaction scores? Yep. And again, IME? Experienced nurses are starting to pull away from the unit mentality and going for the "every man for himself" mentality. Why? Self-preservation. Sad? Yes, Understandable? Again...yes.

I had massive experience before entering ICU. It is so refreshing to read that a new grad would consider him/her self "dangerous" when entering an ICU situation. So many feel that they are uniquely equipped for such a venture. Pardon my French but---b*******. Get your initial experience as a floor nurse. Dealing with patients, families, docs----so many important lessons to learn. BTW---the CCRN designation is basically b******* now, IMHO. Years ago, it meant something. Now? No. I know nurses with the CCRN designation that I would not trust to take care of my dog. And I love my dog.

It can vary greatly. At other hospitals in which I worked the nurses were expected to do a lot more than where I am now. Some hospitals allow for greater autonomy and encourage critical thinking, some do not. It saddens me, actually, to see what a task-monkey I'm now expected to be. Pardon the vent...sigh.... You have to go with the flow, wherever you are. Doing more than you are "allowed" will get your butt in the fire. In ICU you will always be expected to titrate gtts as per order.

LOL---I was about to post just the same thing when I read the above. Welcome. This is the stuff that you probably thought would never happen to you because you are a caring good nurse. Doesn't matter---it happens to the best of us. The bedside nurse is at the bottom of the food chain, there for the rest of the world to chew up and spit out when they need a scapegoat. Nursing is very often a totally thankless job. From administration to management to other departments to families to co-workers---it just never ends. Oh, I forgot---we get "NURSES WEEK" (or day or whatever) once a year to show how thankful they are for all that we do. That, of course, applies only to the day shift, LOL. Sometimes it boils down to just knowing that you are doing your personal best, keeping your patients safe, and yes, rolling with the punches. Do your twelve hours to the best of your ability and go home. Don't expect any kudos and if you do get some, fine. Life as a nurse is DEFINITELY not one of those Johnson & Johnson commercials (oh YUCK).

So, basically, it's a nothing. 'Nuff said.

Temp over 107F. Neurotrauma. The patient was toast and did not survive. Highest survived temp? Somewhere above 105F. Pt survived intact. Full blown AIDS patient.

It's generally not well regarded to tack on references to a resume. Keep it short and sweet, adding "references upon request" at the end. Recruiters know all the tricks and games people play with applications and resumes. They also know that pretty much all new grads can get references from their instructors and perhaps a few nurse friends. Unless specifically requested leave the references for later. List your education (tack on any special awards you may have received), your experience, your skills and certifications. Listing special courses you may have taken (EKG, for example) might get you a teensy edge over someone who hasn't listed anything. Keep the resume to one simple page. Nurse recruiters are being bombarded on a daily basis with tons of applications. Odds are they assign you to one desk pile or another by the middle of the first page. Good luck and just keep swimming!