ghostcat

We have all RNs in our department and we do all the things you named. I'm confused, if the techs do all that, what do the RN's do?

Thanks! All this helps. When I was asking about where you admit/discharge I was asking for a strictly space (square footage) reason. The hospital GI clinic where I currently work has only stretchers - we admit the patient into a stretcher, start their IV, roll them down the hall to the procedure room, do the procedure on the stretcher, wheel them back to where they started and discharge them from the stretcher after their recovery time is up (1 hour from sedation time). This takes up more room then chairs (even lounge chairs) would, but I can't visualize getting the patients to and from the procedure. The processing question was in relation to cleaning the scopes - do the nurses do it, or do you have techs? Thanks again!

One of our doctors is looking into starting a freestanding endoscopy clinic and has approached me to manage it. I currently work with him in a hospital based outpatient GI unit. I have alot of questions about how to staff for the best care and patient flow, as well as how to keep the patients moving through safely, but also efficiently. This is in Canada, so I am especially interested if anyone has experience with doing this in Canada. We are looking at having 2 procedure rooms with a mix of doctors using the space. Some specific questions I have thought of: Do you have all RNs or a mix of RN and LPN? How many staff member? Do you admit patients in chairs, then walk to procedure room? If so, how do you get them to recovery area? (The hospital where I currently work admits pts on stretchers and they stay on it until they are discharged. How many scopes per room are typically done in a day? Who does your processing? Thanks all!

Has anyone completed the BC Provincial Nominee Program process in the last year or 2? I'm wondering what the realistic timeframe is we should expect. I've hear everything from 6 month to a year. We just sent in all the paperwork to my employer, who promises to get there part done quickly and sent on to HealthMatch BC.... I have heard that it might be a little quicker since we are already living here (have work visas)and we are immigrating from the States. We are antsy because we want to buy a house and can't get a loan with less than 10% down without our Permanent Residence, and because our 16 year old daughter can't get a job because she can't have both a study and work visa. To any nuse just starting the immigration process - if you have a full time job offer, just do the Provincial Nominee Program from the start. It will save you money and headaches in the long run. The rep frolm HealthMatch BC advised me to get the work visa first - she said it would be quicker, but it took 6 months! And because we will have to renew them, it will end up costing us almost $1000!!

OK, so we're going up this weekend to see the above-mentioned houses, as well as another we got a line on that we really are interested in. Question - the house appears to be on the Musqueam reserve, by UBC. Does anyone have any experience living in that area? What with the university, the park and all the golf courses it seems like it should be nice, and we've heard good things about Point Grey Secondary which, I believe, is where our daughter would go. We've been to Kerrisdale and UBC, but never really in the Musqueam/Southlands area.

Unfortunately this is only part of the process. You MUST have a work visa to work in Canada (as someone from another country). I too thought I only had to be approved for my temporary license, and was ecstatic the day that came through. The I found out about the rest. I had to get a job offer - not really a problem because there are LOTS of nursing jobs in BC, but I wanted a job somewhere I would actually want to work! Then I had to apply for my work visa. I was told it would take 6-8 weeks to process - it actually took 9 weeks. I just received mine, and we're planning on moving September 1. And yes, the employers know about and understand this timeframe. You will also have to get a medical exam and this has to be done by an approved doctor. Also, plan on spending some $$'s - It is $150 (can) for the work visa, my medical exam was $486, and I just realized I need to send in the $460 (can) for the exam with my temporary license paperwork, plus $31/month for my temporary license! I don't remember how much I had to pay CRNBC... You have to REALLY want to do this. It has taken me about 1.5 years. You can get alot of information from these sites: http://www.cic.gc.ca/english/index.html http://www.healthmatchbc.org/ http://www.crnbc.ca/ Good luck! You can contact me if you have more ??'s

I guess I should have specified - we won't be buying a house, at least not yet. We will be renting. Since we are moving from the states, and I am on a work visa, we want to make sure we all like it as much as we think before that big a commitment. We have looked (online) at many rentals, and driven around in all sorts of neighborhoods when up there. It is just hard to get a real feeling for an area driving around. Rents for a whole house seem to be fairly comparable to the area we are now. Obviously we would love to have more for less, but we have 2 large-ish dogs which makes it harder. I have checked the "trip planner" on translink and both houses we have been considering in New Westminster and North Surrey are well-served at the times of day I would be travelling. Our daughter will be in 10th grade, so we are more interested in secondary schools than elementary schools.What our concerns are:CrimeNeighborhood atmosphere (we want friendly neighbors, being foreigners!)School quality/safetyGood area for dog walking/playing

I have a job at BC Womens, and would like to be able to commute on transit - that is one attraction of the New West and Surrey locations - it would be a relatively quick commute on skytrain and short bus. We have looked around in Coquitlam (my husband's cousin lives there) but it seems like a really long commute. We want to be close enough to the city to go in for things - we are urban people!

I finally have everything in hand (work visa, etc) and my family and I are planning on moving up to Vancouver from Oregon. We are now looking for a place to live, and haven't been really thrilled with the places we've seen IN Vancouver so we are looking outside the city. We've found a couple of places and I'm looking at neighborhoods. One is in Queensborough, and one is in Surrey. I've heard things about Surrey and I was leery at first, but this is the very northern tip, right across from New Westminster, so I wasn't sure. With the price of gas what it is, and needing all our $'s to move, we can't waste trips up there! Thanks for all input!

Are nurse anesthetists used at all in Canada - if so, are there educational programs in BC??

Our radiology department will use an existing IV for contrast depending on the type of exam being done. If they need to use their power injector they need an AC line, but they will use an existing one if the pt has one. They call the floor to check on what the pt has for access before sending for them, and the floor RN will call the IV nurse if the pt needs a different site. In Oregon it has to be a RN starting the IV. I think that what usually happens with infusion pumps is that they are turned off and the tubing is disconnected for the site to be used by someone in radiology, and left unhooked until the patient is returned to the floor, unless the patient needs to be hooked back up right away and then a RN is called (either rad RN, IV RN or floor RN). I think any patients that come from ICU/CCU have an RN with them, but I work in IV not Rad so I don't know for sure.

Does anyone know anything about Langley hospital, and am I remembering correctly that I have heard on this forum to stay away from Surrey Memorial?? Thanks!

1) ONLY NS!! We use 10cc for a routine flush, 20cc after a blood draw. 2) Change sites every 4 days (96 hours). We just changed this year from 72h - it was investigated by our Infectious Disease department after we came to them with the fact that many facilities were changing to this. Recent studies have shown that every 96 hours is safe and (obviously) leaves the patient with less tissue trauma. 3) No, too pricey for us. We (the IV nurses) either wear an apron with our supplies in it or carry a plastic tray. 4) Yes, we use chlorhexadine - if you are in the position to, lobby for the swabsticks - softer for patient's skin and you can easily clean a large area. We use the larger (3cc?) sponges for cleaning PICCs and CVLs. 5) No, I don't have any... I could show them some in real life though! 6) I depends on the med/fluid and the degree - whether it is truly just an infiltrate or a phlebitis. Sometimes heat and definitely watch it.

I think the rep from whatever company makes the PICCs you are using (Bard or ??) could tell you the specs for their product. I know that our radiology won't use a PICC line for contrast with their power injector, but honestly I don't know what rate that runs at. Bard does now make a "power PICC" that is said to safe to use with this, but we of course don't have them! Also, the anesthesiologists won't use them - they want fluid to run in fast on gravity and it just won't (usually) with a PICC.

Thanks canuckeh! I've been keeping an eye on craigs list, even though I don't think we'll be moving for a few more months. The only area I've been told to stay away from in Surrey. I was wondering about Richmond, but I couldn't figure out how easy it would be to get to work, so it's good to know about the bus and future skytrain. My 14 yo might actually forgive us for moving that far away from the city if she would be able to take the skytrain in! Of course, we still have to find someone who will let us bring our dogs... but we've always found something!

Sort of on the same topic - I have been offered a job at BC Womens & Childrens and will be moving up from Oregon in August. I would like to be able to commute easily, and prefereably without a car, and we will need to rent at first. We have 2 dogs... Does anyone have any suggestions of areas to look in that would be commutable and dog-friendly?

No stupid questions here! Yes, it is fine. What always seems odd to me, and what I did yesterday, is giving heparin in one line and packed cells in the other. It was a post-OHS guy, so I guess they don't want clots!

OK, I am a US nurse in the process of moving to Canada.... so granted I know relatively nothing about nursing in Canada yet (not really the reason we're moving), but I want to caution everyone about the "grass is always greener" syndrome. There is a broad spectrum of healthcare and healthcare facilities in the US. One thing it has been very hard to explain to people in Canada is how US hospitals, clinics, etc... are all owned by corporations. Some are "for-profit", some are "non-profit" (ha ha!) but they are all corporations, and all hospitals are run as businesses with money as the bottom line. They all spout their "mission" and brag about how much charity care they provide, but at the end of the day the CEO makes a bonus based on how much $$'s they save the company. Often the people actually running the system are business people, not medical people, and know nothing about medicine. Our CEO made a 6 million dollar bonus this year, but we were told in December that we had to conserve office supplies because there was no more $'s in the budget this year for them, and this week we've been told there is a linen shortage, so only use what is necessary. And we are in union negotiations arguing about a 5% salary increase and better retirement benefits (ours suck!). There are also alot of government controls over healthcare in the US (odd to me, since the government keeps saying they don't want to manage healthcare). There is a government agency that accredits healthcare facilities (JCAHO). They think of new hoops for us to jump thorough every year, and every year hospitals spend thousands (at least) dollars modifying facilities to comply with these regulations so they can be accredited. You don't have to be accredited to operate, but..... well, you get the idea. Don't put too much stock in the magnet status either. Our facility got magnet status several years ago, and have been renewed. It is basically a designation that says that your hospital is an attractive place for nurses to work. Well, in our facility 90% of the nurses are dissatisfied with more than 2 aspects of their work environment, and as I said the current union negotiations are not going well. It's all politics.... I have worked many places. I have no illusion that things will be perfect in Canada, but I worry about the people on this list who think they will move to the US and find huge salaries (I will make about the same in Canada as here), sunshine everywhere, great working conditions, supportive employers and great benefits. It is truly hit and miss. I wish some of you would stay in Canada and maybe together we could improve the things that aren't working there!

One more thing... on our IV team we have a policy: 2 sticks per nurse. After 2 sticks with no luck you're going to start to have confidence issues, no matter how good you are, and the patient will too. I just say "2 pokes is my limit, your veins are tougher than me! I'm going to have another nurse come and see you though!" The patients seem to appreciate it.

It just takes time and lots & lots of practice. I was also one who believed she was bad at IV's... and now I'm an IV nurse. Some advice - confidence - it's easy to believe that you will again not get the IV, but try to believe instead that you will. Go slow, when you get a little flash, wait for a second and make sure that your chamber continues to fill, then lower your angle, slowly advance a little more and gently side your catheter into the vein. If you meet resistance when you try to advance the catheter, STOP! Wait for 10 seconds or so and try again. Veins spasm when they are poked (go figure!) and you have to sometimes let that pass before you can thread a catheter. My other advice is try to use hand veins if they are large and straight. Even though you sometimes see those big ropy arm veins that tempt you, they tend to roll and get away. If you are friends with a nurse that is good at IV's maybe you could practice a couple on them and get direct feedback. I would let someone do that on me! Don't give up!!

I got a job offer at BC Women's today! I'm so happy - one more hurdle over on the way to Canada! Now the work permit... I've heard good things about the place - hope it's ok. It's kind of wierd taking a job long-distance...

To answer your first question - yes, if there was ever a lawsuit that involved an infection with the IV as a possible cause, anyone who wasn't following your facility policy relating to IV starts and dressing is vulnerable in that suit. Your facilities policies and procedures are there to protect you as well as the patient. To answer your second question - tegaderm is actually not very damaging to skin and not too hard to remove. If I have someone who says they have sensitive skin I will use Cavilon skin prep (comes in little packets like alcohol wipes) under the dressing, and if I am having trouble removing it, or the patient says it is painful to remove, then I use adhesive remover. What is more damaging to skin is tape - and paper tape is some of the worst. After 24 hours it almost bonds with the skin. It is good for people with allergies, but not with fragile skin. We just started using a new tape, and I can't remember what it's called - I'll look tommorow. We did extensive research and trial to find this tape though.

You can also remind them that the cost of tegaderm is MUCh less than the cost of a lawsuit for pericarditis from an infected IV.

Did the patient have a peripheral IV or a central line. Patient's with CVL's and open-ended PICCs can get air emboli if the cap on the end (for example the CLC2000 that we use) gets loose and comes off. I've always understood that it's very difficult for someone to get an air embolism from a PIV. Someone would have to be pushing a syringe of air in, or so it seems.

yxj124 you might want to contact healthmatch bc (they havde a website) - I thought from what I had read on the immigration website that it went sort of like that. Somewhere I missed the part about the work permit. Healthmatch will walk you through the process after you have been "approved" by CRNBC. "The nonimmigrant NAFTA Professional (TN) visa allows citizens of Canada and Mexico, as NAFTA professionals to work in the United States." (http://travel.state.gov/visa/temp/types/types_1274.html) "The North American Free Trade Agreement (NAFTA) established a TN nonimmigrant visa category for Canadian and Mexican citizens. The TN category enables Canadian citizens (not landed immigrants) and Mexican citizens to be admitted to the United States to temporarily engage in "business activities at a professional level" in certain fields, for one or more specific employers." (http://web.mit.edu/scholars/administrators/tn.html) "When a foreign-trained Registered Nurse or Registered Psychiatric Nurse has received an offer of full-time employment with a British Columbia health employer, the employer and nurse will fill out the necessary application forms for Immigration. A nurse may come to Canada to work under a temporary work visa for a period of one year or apply for a permanent resident visa through the B.C. Provincial Nominee Program with the support of the employer. After making every reasonable effort to hire a qualified and available Canadian or Permanent Resident, the employer will submit an application on your behalf to Human Resources and Skills Development Canada (HRSDC). If the employer's application is approved, your employer will provide you with a validation letter. At that time you may apply to your nearest Canadian Consulate for a temporary work permit. Foreign-trained nurses governed under an international trade agreement with Canada (such as NAFTA) may apply with their job offers directly to the CIC at their nearest Canadian embassy, high commission, or consulate for a temporary work permit without the need for HRSDC validation. A medical examination will be required for all foreign-trained nurses before a work permit is issued. A temporary work permit is usually renewable annually. From the time of application to CIC to the issuance of the work permit, the processing time will vary, but usually takes a minimum of four months. If you have a partner who would like to work in British Columbia, Citizenship and Immigration Canada (CIC) will issue a temporary work permit to your spouse because you are a highly skilled temporary foreign worker in demand in Canada. More detailed information can be obtained from the Citizenship and Immigration Canada website at www.cic.gc.ca." (http://www.healthmatchbc.org/hmbc_nurses.asp?pageid=630) In other words the only benefit NAFTA gives us, as US citizens going to Canada, is that we don't have to wait for the process of having our job offer approved by HRSDC. The process to get the temporary work permit is still 4-6 months though.:icon_sad: