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FatsWaller BSN, RN, EMT-B

ER/Trauma/Travel ICU/Critical Care Transport
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FatsWaller has 5 years experience as a BSN, RN, EMT-B and specializes in ER/Trauma/Travel ICU/Critical Care Transport.

Pre-Med Bachelors--> Medical Assistant--> EMT and Volunteer Firefighter--> Accelerated BSN--> ER/Trauma RN-->Travel ICU 

FatsWaller's Latest Activity

  1. Hey all, looking for insight or recommendations for online MSN ED. Programs that provide actual grades/GPA. WGU and Capella only do “competency based” and I’ll need a GPA to be able to move on to CRNA one day. Any Help or advice is much appreciated!
  2. FatsWaller

    Hate my new hospital culture 2 days in, is it me?

    Very few protocols, about 5 or 6, of which the majority is just lab work orders. And they do not include very much. The cardiac protocol does not even have an EKG as part of it. And it has been made very clear we are not to initiate the orders if it is suspected the patient will be picked up….not seen…picked up by an MD within 15-20 minutes. And the protocols are never to be initiated once an MD has their name on the patient. Ya this place is odd. No sepsis protocol, no fever protocol, no suspected fracture/obvious deformity protocol, no SOA for a breathing tx protocol, no excessive pain over 7/10 protocol, no hyperglycemic/hypoglycemic protocol, etc. Its sad my rinky dink trauma hospital in Kentucky had more sensible protocols and what not than a place with unlimited resources and clout. Whatever…the job hunt continues haha.
  3. FatsWaller

    Hate my new hospital culture 2 days in, is it me?

    I am glad to know someone else here who has worked there agrees. I know I am not the only one. In fact, it's sad, many of the staff I have talked to say they cannot stand working there and hate. Because so many hate working here the overall attitudes, morale and just environment for lack of a better word...sucks. Many I have spoken to, in fact most, are all new-newish hires within the past few months. I was able to talk to a nurse who had been there for about 6 years and she hates it too but she said turn-around is atrocious and it makes sense why such a "prestigious" well sought after medical center would even require travelers in the first place. They cannot hold onto staff because nobody wants to work there. I would say 3/5 people I've spoken to say they are doing a year "for the resume boost" and getting out. Kind of sad but that's how this place seems to be. My time is too valuable and life is too short for me to work somewhere where not only I am miserable but the vibe/morale is too. Plus, the acuity is so low, I haven't learned but 2 things since working (and its only because I normally don't work with peds. This has taught me to better question the environment and shadow my next position before taking it. I knew this wouldn't be the best fit but didn't think I would dislike it so bad. Haha autonomy!? What autonomy…at this place as an RN you have none. An MD order is required for every single solitary item. I mean seriously. I went from an institution where RNs were able to put in medication orders and just have the doc co-sign (depending on your rapport with the MD) to a place where we are not allowed to get even a verbal order and have to have a placed order to obtain a peripheral line, an EKG (even emergent), a meal. Don't get me wrong, I get that if I wanted autonomy, I should have gone to Med-School but in some circumstances, there has to be a middle. I feel this institution is so restricting that it leads to delay of care, annoys physicians more as they have to be found or called for every RN intervention, and even dangerous in some circumstances. It's odd for ED. I agree though, it's a question I will most definitely be asking from now on. I definitely would love to work at county, in fact I have been trying forever but the damned process is just so slow and convoluted. I know my personality would fit much better with county or perhaps even St. Francis. I just love and thrive with grit, low SES patients, high ED acuity and traumas. So, I need to find my niche here in California and I hope it exists!!
  4. Super quick background on myself, born and raised in California, went to undergrad in Oregon went to RN school in Kentucky. Got a job at a trauma heavy, busy, high acuity Trauma I center following graduation and was thrown right into sick patients, challenging situations and working the trauma bays. I loved it, learned more than I could have imagined, and more importantly loved the environment. The staff were like family, camaraderie was huge, the relationship between the nurses and physicians were top notch with everyone being approachable, involved in the care and decision-making processes. Everyone had each other's back from day one. In all it was a place that was enjoyable to come to work and honestly fun. Now don't get me wrong, I am not painting a picture of some unicorn fairyland environment where everyone was happy go lucky all the time, there were its issues as well, like the standard issues with management and occasional disagreements between RN and RN or MD, but for the most part it was good. I stayed at this hospital for almost two years and finally decided it was time to go home to California. I knew there would be some changes to get used to. Southern California has a lot of trauma centers and volume wouldn't be as high. I expected there to a lot more protocols and stricter rules, it's the most litigious state so I expected some heavily defensive medicine and nursing practices. I got a job at a Level I ER in a very affluent part of Los Angeles. I won't name the name but that provides enough to know which hospital I am talking about for those familiar enough. This wasn't my first choice of hospital, I prefer the gritty, trauma heavy hospitals which this is not, but the pay was extremely generous and the name carries a lot of weight on the resume. I am 2 weeks in and I cannot stand any aspect of it, and I just don't know if it is a California thing or a hospital specific thing. There are so many strict protocols I am afraid to perform even an IV start without the ok of another RN and confirmation there is an MD order to do so. There is zero camaraderie or any form of it within the department. Staff is downright afraid of managers and I have been told that I am not to address management in anyway within my first 2 months of employment as they do not wish to hear from me, only from my preceptor the first 13 shifts and then other staff such as charge RN. Apparently after two months I can approach them but they are not approachable, I am not to be personable with them or joke with them about anything, just more of a robotic interaction is to be expected. Staff does not say hello or want to talk in anyway, they do not seem to enjoy their jobs and honestly very few have any substance. They come in, do the work presented to them in front of their face and leave with minimal interactions. The relationships between RNs and MDs are almost nonexistent and disconnected. Many do not want to/nor need to hear from the RN and verbal/phone orders are not allowed, not sure yet if this is written protocol or just a rule (this is an ER, seriously?). I have been told by travelers (the only staff that is personable and will interact normally), that the place is horrible and miserable, and that RNs throw eachother under the bus at any chance they get. A select few of staff who I have been willing to interact have told me the same and told me that the place allows for almost no RN critical thinking or autonomy and that many lose their skills here. I can definitely see that already now 5 shifts in. Despite being an experienced trauma nurse, I have been told I am "not allowed to touch a trauma patient for at least a year". Honesty I can deal with that (there are almost no traumas anyway) and the rules but I have kept my head down so far but I have watched staff members get chewed out by others for differences in care (not even doing anything wrong just their own way) and for showing even the smallest slip of a personality. Everyone seems to just be a task machine, and there are no interactions with other staff or physicians. Many of the nurses seem to carry a chip on their shoulders and think they are better than other nurses. I have been disgusted with the interactions I've seen with the RNs and the volunteers, transporters, techs, paramedics, emts, and firemen. They treat them like trash and like they are above them and it's not ok. I think many feel they can act this way because they work at a "prestigious" institution, an attitude I do not like. Teams throughout the night are switched an average of 3 times, requiring a complete change in care team and most RNs don't even give a report. You just come back from break and you get assigned a different team. I know there are going to be those out there who say it's a job and this is how it should be and camaraderie isn't something that should exist anyway. That I should show up, keep my head down, be a sheep and work and collect my paycheck and go home but I disagree. If that was the work environment I wanted, I would be working in a cubicle in some office. I have to spend 12 hours a day/4 days a week with these people. They become a second family. Camaraderie is extremely important and I should be able to trust and enjoy those I am working alongside. This was true when I was a firefighter, an EMT and even my last ER job. Overall, I am very unhappy, and I wish I wasn't but I just don't know if this is how every hospital in California is or not. I spoke to some travelers and they all assured me it was not and that this was all very unique to this hospital, (many of which said is their worse assignment they have ever had), but I was just curious if it's me. Should I just stick it out, or find somewhere I click better? I applied for other jobs after my second shift, but I don't want to leave if this is just how every hospital is and I'll just be unhappy at another facility. I would rather take a pay cut and be happy then make what I am with this miserable milieu and group of people.
  5. FatsWaller

    ER vs Trauma Nurse

    My ER is also a trauma 1 hospital, we have a trauma room with 4 bays(stretchers) where our emergent issues roll into. We generally have a "room 9" (trauma room) nurse who is assigned to it at every shift and this nurse runs the trauma from a nursing perspective (gets manual BP, IV access, blood and emergent drugs, tools, etc) and this position just fluctuates and cycles like team assignments. The charge nurse or any available nurse comes in and writes. If more than one trauma/stroke comes in then nurses on the floor just come to the trauma room when the initial buzzer goes off and just fill in where need be. So basically I guess at my ER, we are all trauma nurses. They do provide all the nurses with TNCC within 6 months of hire if they need it, as well has NIHstoke certs, acls, pals and they push CEN.
  6. FatsWaller

    Propofol Dosing in ER

    The ER I work in if the patient isn't adequately sedated by just propofol and the threat of extubation exists then we just tack on fentanyl and versed drip. Same vise versa. I prefer Fentanyl and versed drips and I advocate for it if possible but if its not doing the job we tack on propofol as well, assuming the access exists of course.
  7. I work in a very busy ER that is also a trauma department, and although there is alot of drama, there is also an insane amount of camaraderie. I have noticed ER's and some of the intense or bigger ICU's tend to form bonds along the nurses in a similar sense to that of those in my EMS/FIRE history. I also notice a big difference in which shift. I work nights and many mornings 10-15 of us all go get bloody mary's and mimosas and share crazy stories. The ER docs and even some of the specialists like neurosurgery come too. I think its great opportunities to network and get to know ppl you work with everyday on another level. We all go out fairly often
  8. I would have to describe my Accelerated program the same way as you described yours. Your there for only 12 months so the teacher's don't have time to care about you, drama runs high and the whole year is essentially NCLEX prep course.
  9. FatsWaller

    ER vs ICU with a CRNA focus in the future

    You need to decide what you want and why. Why do you want to go to CRNA School aside from the most common reason (money)? I was in the same boat as you. I went into nursing school thinking I want CRNA and that I would work ICU. ¾ through nursing school it was time to interview for jobs and so I interviewed with a few ICU's and an ER job. I was offered a CVICU job and a Trauma 1 ER job. So the decision had to be made. I knew I needed ICU for CRNA, but I loved the ER. I love the adrenaline, the ‘organized' chaos, the fact that at the start of your shift you don't know what the day has in store for you, and the overall attitude of ER nurses. It is more my style, plus I have an emergency care background. Then the CVICU job fell through and I was actually very sad, and hit a wall. I could have easily got another ICU position, but it made me really think why I wanted CRNA and I realized it was for all the wrong reasons. I didn't really like ICU, it didn't like only having two patients, and I didn't like the intense planning in the morning and the checklist style nursing. Don't get me wrong, you will learn a lot in ICU and you have to be smart, but it's a completely different animal. So if you love ER, do ER. If you know you want CRNA and you've shadowed and you are adamant, then you HAVE to do ICU and probably for quite some time as CRNA competition is stiff. You have to get the hemodynamic experience and even though some ERs do have areas where patients are essentially in an ICU bed, CRNA school wants you to have that experience daily. Sit down and make sure you know what you want and what your passion really is, otherwise you'll be miserable.
  10. FatsWaller

    UCLA Summer 2016 RN New Grad Residency Program

    Those of you from out of state, for my sheer curiosity, why relocate to California? Pay? UCLA's reputation? You want to live in California? I just wonder what peoples reasons are.
  11. I called a few recruiting managers for LA+USC and UCLA and they were confused by entrance exam. They also told me any postings for new nurses will be few and far between. Guess it's back to square one.
  12. May I ask what hospital.
  13. I realize this is a fairly often talked about topic, but I just wanted people's opinions, frustrations, vented feelings, and outlooks. I am from the West coast but found that nursing programs were too saturated and competition too stiff so I opted to move out of state and complete my ABSN. I moved to Kentucky and have less than 27 days until I graduate, but during my time here I found instructors and Nurses scoffing at the idea that I would find a job out in California, Oregon or Washington upon my return. I had no clue about the hardships so many new gradate RNs were facing to even land an opportunity or even find a job in acute care to apply to that didn't say New Grads not Accepted”. I learned quickly the prospects of landing a job in my home state of California was unlikely, but was curious the reason as so many have said there's a nursing shortage”. Now I don't think that's a lie, as I have looked for jobs in California and Oregon, and there is most definitely no shortage, in any department, of job postings for RN's, but with the caveat that you must have 1 year of acute care experience in that specific unit. The sad part is, how does one get this experience? There are new grad RN programs/residencies, but these are a joke. They seem to just be a cover for hospitals to be able to say they are new grad friendly”, but their programs don't even make a dent. Many only have 10-20 spots for thousands of applicants. UCLA's program generally offers around 100-120 spots a year spaced among differing departments, but receives upwards of 5000+ applications, many of whom aren't even from the state to begin with. Other hospitals are similar; one article stated that six hospitals in the Daughters of Charity Health System in Los Angeles aims at hiring 10 new grads (at each hospital) and receives more than 1,000 applications for each position. In Oregon, Portland hospitals are also saturated with experienced nurses. OHSU has history of hiring freezes and only places the opportunity to apply to the new grad program for just seven to 10 days due to the high number of applicants”, similar stories with Legacy Health. Washington hospitals continue the trend. This is leaving thousands of students to come out of school and have nowhere to go. Another caveat is the new grad RN programs are only for those who have been out of school for a year, yet one study showed that 43-48% of newly licensed RNs still did not have jobs within 18 months after graduation. To me that is an insane number. So what happens to these people? They can no longer attempt to get hired through a new grad residency, but will also not be competitive (or even looked at) in the general nursing job pool which requires minimum 1 year (sometimes 2) in acute care. Much of the remaining percentage move to clinical/private settings, nursing homes, rehab clinics, corrections facilities, or have to take a different job all together (CNA, tech, waitress, etc), where they aren't getting acute care RN experience and once again aren't building their resume for the job they really wanted. To top it off, most have loans to pay off within 6 months of graduating, so some type of job is needed. I stated earlier many nurses and professors here in the East South-Central US knew of the difficulties of new grads obtaining jobs out West, but also shared with me their confusion of so many travelers heading out that way, citing if they take so many travelers isn't there a shortage?”. My reasoning was that travelers now must have at least 2 years experience and that looks very appealing to West coast hospitals, thus they would much rather take a seasoned nurse and pay them more (even if temporary), then spend the money and risk to train a new nurse. I looked up articles on the issue but it was difficult to find any written after 2013. It seemed most projected this lack of new grad hires would be forced to end in just a few years, but 3 years later it seems no movement has been made. Many articles cite the recession as a cause. Because so many nurses returned to work who were set to retire, who had left after having children, etc there is now a saturation of experienced nurses and hospitals only want to replace them with experienced nurses. But is this forever possible? A quarter of nurses in the US are over 50, and that is a lot of nurses who at some point WILL have to retire due to age/health or leave due to improved economy. So when all of these nurses leave, will there be another shortage? Will there be a dumping of inexperienced nurses into the hospital setting because there is no other choice? One article predicted in 2020, it would all hit the fan as hundreds of thousands of nurses are set to turn 55-60 then. My solution, I'm staying here in Kentucky at least another year. I landed a job I know I could never get in California as an ER nurse at a University trauma one hospital, and hopefully with a year of that under my belt, I can return home to my family and get a job. For others I'm not sure what the best course of action is. So… What are your thoughts? Are you a new grad who is frustrated and if so tell us about it (can be any part of the country as there may be other areas experiencing similar hurdles I don't know about)? Are you a current RN who landed a job against all odds? What did you do differently? Are you a seasoned RN who sees this issue and agrees, disagrees, or feels differently about it? Any other comments, opinions, ideas, etc?
  14. I have the Saunders book and I dint think it's very good, the questions in it were much simpler than what out Med-Surg instructor asked so It didn't help me that much. Med-Surg Success 2nd edition was more helpful and what more people used in my class.
  15. FatsWaller

    Feeling defeated.. need some hope

    Hey Stategrl, I am in the tail end (28 days left!!!) of my 12 month-ABSN. Its very stress inducing and frustrating but in an ABSN program you gotta just be happy your passing. With 80's you are doing just fine and much better than many. There will always be someone better than you in life so don't let those who seem to just be floating through (I doubt there are many) deter you. I wrote this in response to another student who was interested about grades in our ABSN This program will turn 4.0 students into 2.8 students. There are a lot of people in my classes who had honors and 3.6-3.9 gpa in their undergrad and in this program scrape by with 2.9-3.1 and they are perfectly happy because they are passing.” Take it day by day, each day and each clinical is just another box you can check. I can see the light at the end of the tunnel and looking back now it was a hell of a rough ride, but I am so glad I did it and it was 100% worth it. You will be so glad you did it. Don't let the program beat you down, it's designed to be tough and weed out those who don't want it bad enough. I expected to feel stressed and demotivated but nothing like what happened, my stress actually started to cause health issues, so be sure to take some time (no matter how short) for yourself, and find strategies to cope with stress and anxiety. It will really help. You can do it, 1.5 years is nothing and you'll be done before you know it.
  16. I am a big advocate of flash cards, I love them and they help me. Also you cannot read the books like they tell you to. It's impossible. I'll tell you a secret; I have not bought a single book this past semester, because I don't have time to read chapters 1-22 in a week. I just go off the professor's slides and notes and it's done me well. Prioritize, as in figure out what you need to focus on and what you don't, and shove what you don't aside. For example, one session I had Med Surg II, Pharmacology II, and Healthcare Research. I was struggling in Med-Surg II as the instructor was intense, and my instructors for the other two courses were a little easier going, so guess what got my full and almost undivided attention? I probably put in 80% effort in Med-Surg, 15% in Pharm, and a measly 5% in Research because who cares. It's hard to do that, but sometimes you just have to because the time to equally study for them all just isn't there. Getting good grades is an intersesting subject. As I said in an earlier post above This program will turn 4.0 students into 2.8 students. There are a lot of people in my classes who had honors and 3.6-3.9 gpa in their undergrad and in this program scrape by with 2.9-3.1 and are perfectly happy because they are passing.” I currently have a 3.3, but and I wish it was higher, but I am happy because at least I am graduating. We definitely have a few people who are in the 3.8 range, but I don't think it's because of a difference in study strategies, I think they are just very naturally smart. One girl I know for a fact doesn't study and has a 3.9, she should become a doctor. Most people in the program though, despite coming in wanting at least 3.5's are now just burnt out and over it and just want to pass. It's a common sentiment. I know the dropout rate seems high, but like I said many of these are due to people voluntarily dropping themselves down to the 2 year program or realizing they don't have the time or want to put this strain on their families. Yes some have failed out due to grades and competencies, but not the majority. So I would say first you need to seriously sit down and realize you will have no life for 365 days. It's worth it, I promise, and you'll have some weekends where you can go out and get a drink and have some fun but not like you used to. I don't know your situation, as in family, kids, mortgage; etc… but obviously being single young and having no responsibilities helps a lot, that said, one of my good buddies in the program commutes from Cincinnati for classes and clinical, has a wife and two kids and he will be graduating. I always think if he can do it, I have no excuse. Now as for the pace, to me it's no big deal. I came from the West Coast where we use the quarter system, so my ‘semesters' as y'all ;p like to call them were 10 weeks. In this program the semesters are 9 weeks. So to me it was not a change in pace, to those who were in standard semesters with 16 weeks, they were very surprised and it took adjusting. I personally could not imagine being stuck in a class for 16 weeks, that is wayyyy to slow, and I can barely remember things from the first week in a 9 week quarter. So get used to a midterm the second week (normal for me, apparently insane to others). Its do-able, you just need to want it, and go hard for 1 year. I always viewed it as there was no option for failure. I never thought about the 2-year, I never thought about making a class up and restarting the following year, to me those were not options as I moved solely for the program and I was going to finish in a year. Have that attitude and you will make it. Also be warned, as with any nursing program I'm sure, there will be drama, there will be A LOT OF DRAMA. Do yourself an enormous favor and don't get involved in it, ignore it, do not talk about people, just nod your head and carry on. That will relieve you of tons of stress. I was supposed to volunteer for the orientation but now cannot, but if you're here for it (or any of you are in above comments) feel free to contact me and I wouldn't mind meeting up and telling you how it really is. They like to sugar coat certain aspects and then scare you in the orientation.

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