bjm

Oh girl, can I relate . I'm an older (48 y/o) and have only been in nursing 3 years. My first year was medical. I actually liked it, I was learning and I worked with some really nice people. But I moved away, took a job at another hospital on the post surgical floor...and it was an absolute nightmare. The disorganization, the lack of staff, and on and on and on, well, I ran those floors until I needed foot surgery. I was out for 4 months, then I went to work for an outpatient surgical center. Well, I got sick in less than 90 days, and ended up in the hosptial for 2 weeks, and when I was better, had no job to go to. I am so fed up with the disorganization, mismanagement, backstabbers, blamers, loafers, and bit**in; but mostly fed up with the understaffing, (which causes more patient and nurse frustration, more opporunity for drug errors, more in-fighting between co-workers and depts), that I have begun to apply for every doctors office I hear about needing a nurse. The thing is, it is hard for an RN to find a job where mostly LVN's are used. I wish you the best. Just wanted you to know, that there are a lot of nurses who are just plain fed up. You know, they say they are worried about a nursing shortage....if they would just give us decent pt/staff ratios, a little more support, and a staff that truly meets everyones needs, THERE WOULD NOT BE A NURSING SHORTAGE.

OK, here is a very honest reply. I will not tell you rather this is for you or not but I will give you something to think about. In this last year, I had to leave work for foot surgery...was out for 5 months. This week, my husband underwent a total knee replacement, and thank God, I am starting back to work on Monday. Love is great, love is grand...but, you also mentioned your future husband as a man who will not be the breadwinner, could not possibly support a wife and family. What if, God forbid, you should become temporarily or even permanently unable to maintain employment? Do you or he have the resources to maintain financial stability like a home, utilities, food, transportation, medical coverage? If not, and this is still ok with you...then ask yourself, would this be ok for your future children? There is absolutely nothing wrong for men to be stay at home dads...there is nothing wrong with moms being stay at home moms. Today, however, both husband and wife need to have the ability to support the family should circumstances present themselves and it become necessary to do so. If, he had the ability to jump into the workforce and support you,children, etc, then I think you'd be happy with what ever decision you made. On the other hand, if, he cannot provide for you and future family, your marriage, and the safety and security of your future children will be at risk. I will also tell you that it is also true that some men (moreso than women) over time become resentful of their spouse being the bread winner, become insecure in their role, and this can manifest itself at home in quarrels to spousal abuse. Might I make a suggestion? Why not graduate, get settled into your career, (a year or two), think about this a little longer...and try to picture different scenarios in your mind, and how they would effect you, him, future children, etc. You may surprise yourself. You may decide it is the right thing to do; on the other hand, you may find after you get settled into your new career and responsibilities, that it would never work. One final question for you to ponder. If he really thinks you are the woman he wants to spend the rest of his life with, to bear his children, etc., wouldn't he want to have the capability of providing for you should he need to? By you asking for advice on this topic tells me that you are already considering the possibility that this may not be the best decision for YOU. I hope that you will wait a while before making a decision...afterall, you have too much going on in your life right now with school, getting started in your career, to be making another life altering decision that you, no doubt, yourself, are having second thoughts about. Good Luck!

Hi dphrn. I start Nov 8th, a start date we agreed upon so that I would not have to reschedule doctors appts I had prior to accepting the position. I would love to keep you posted of how it goes. In the meantime, I would like to ask you 2 questions based upon the info you told me. You said that you do the pre-op and post-op but not the circulating. I won't ask about circulating. Can you tell me what you are repsonsible for in the preop and post op areas? I would appreciate any info you could send my way. I would greatly it and it would help me to prepare mentally during the next week prior to starting. Thanks.

I just left a small hospital b/c they continue to find money for directors, keep inventing new positions for their family members (in magmt positions, of course), and this last year, made supervisor positions, then put them in offices (away from the floor) and I mean away. All day, every day, you never see them (wouldn't matter - they "have to get back to the office" to work on schedules. This is funny, because we don't have a large staff, we are understaffed, and our rotations NEVER change). Our RN's are 1:6 (sometimes 1:8) during the day, and higher at night. But the straw that broke this camels back was: One RN and one LVN per shift and the LVN was not allowed to do IV pushes, not allowed to assess epidurals that require hourly checks (we were surgical floor and most come back with PCA or epidural). Well, between my patients and taking over responsibilities for those things the LVN was not allowed to do...needless to say, my butt never sat down, eating and peeing was out of the question, and after 12 hours, I'd go home, and my body would just tremble and ache with pain as the muscles started to relax. And I'm so serious about not having time to pee. When I finally got home, and got to actually go to the bathroom, my urine was so strong, and my bladder would actually spasm. So, if my nightmare sounds like yours, then honey, all I can say, is you better start putting in applications to another facility, because it isn't going to be any better on the other floors (when one floor operates like that, you can make a few calls to be sure, usually the other floors do to). I have wondered why nurses stay at places like this. I have noticed that most of who stay are those that live so close to the facility, they just put up with it for the commute, or they came straight out of nursing school, and they just don't know any difference. But there are differences...

Dear dphrn, I want to thank you for all of your responses,they have been very honest and helpful. You asked to me let you know my decision. Here it is. I am accepting the position. I do, plan to ask if there will be an opportunity to renegotiate my wage once I am trained in all three areas - after much consideration, I believe this to be a fair question. Still, I believe that this is a wonderful opportunity for me to learn a new area of nursing, work on these new skills, and if nothing else, make me more marketable down the road should I decide at some point to leave this employer. Honestly, though, I'm really hoping that this is something I am going to love. I hope that working with a smaller group of nurses (that don't have to answer to hospital politics) that the work environment will be more conducive to learning, and who knows, maybe even be something enjoyable to look forward to on a day to day basis. Still, on a personal note, I see only positives at this point. I love the benefits package, I love the hours, and I love that it will bring me more professional opportunities to place in my own personal library. Again, thank you for taking the time to visit with me on this subject.

It sound like you are being stretched to learn to many areas med/surg/tele, etc. I would suggest if you are that unhappy, to not give up nursing. Instead, maybe you need to be looking at another area of nursing, or another facility that won't be stretching you in so many different directions. If this area is too busy for you, you may just need a change of job, not career...and remember, hospital work is not for everyone...there are other opportunities out there in nursing besides hospitals, clinics, insurance companies, county jails, major corporations. Don't throw away what you already worked to hard to attain. You became a nurse because you are a caring person...you will find you niche', give yourself time to find it and keep banging on the doors...one will eventually open.

thank you for your response. May I also ask what type of outpt surgery yours is? I plan to talk to them on start day about the possibility of a pay incentive once I become trained in the OR. I think that what be a fair question. Yes the hours do excite me, I do like the benefits package. I see that you are online so, I'm going to take a moment to see if you are in the chat room. Thanks for all your help.

I am curious as to how many years experience you have in nursing...I have 3 years experience,and with their offer at 21.00, I am hoping that you are a more seasoned nurse and that your part of Texas is paying you 28.00 to compensate you for that. I hope you don't mind the personal questions, but it helps me to ascertain if I'm being taken advantage of, or, adequately compensated for my level of experience. Thanks

OK. I have 3 years med/surg background in the hospital. As a new outpatient surgical nurse, the responsibilities are for pre-op, which I can do, I will be crosstrained as circulating nurse and for post op. So, yes, there is some training to take place. My area is south texas if this helps. Appreciate any input you might have regarding expected salary range.

Well, I was 42 when I entered nursing school. I graduated 2 years later, top in my class. I will tell you that I found it very hard and time consuming. Have you heard the saying "get a life", well, as long as you are willing to "not have a life", and be 100% dedicated to achieving your goal, you can do this...BUT...without a doubt, you will need the support 24/7 from those who are closest to you. Without their complete support, you will find yourself pulled in too many directions, and well....you become set up for failure. For two years, my husband was the sole financial support, cooked most of the meals, spent his time off watching tv, doing yard work solo...why? because I was locked up in a spare room with my books and computer studying for that next exam. Once nursing school gets rolling, you can count on having 1-2 major exams per week (each one requires that you pass to maintain your GPA at 2.5 to 2.7) Sounds easy, huh? Well, these exams are meant to challenge you, and you must be prepared...your reading will take 1-2 hours per day, research papers a little time each day, and others...once you get behind, you are lost...there is no catching up. I do not say this to scare you. Honestly, you CAN do this. You just need the tools to succeed...and the biggest tool required of a more "matured adult" is support to give you the time to focus the next two years on school. Is it worth it? YES! I worked med/surg for 3 years...my starting salary was more than I ever made at other job in my life. I was able to get years of debt off our back in less than 2 years...FREEDOM! Today, I am burned out from the hospital life (although, many NURSES thrive and love the hospital), just too old to run those halls 12 hour shifts. Starting next week, I begin my new nursing career in an outpatient surgical center, doing pre-op, sometimes circulating, and some days post op...but now, with 8 hour days. Where else can a man or woman have so many opportunities to change jobs under the same credentials? Nursing does not care what color you are, how old or how young you are...the only thing that matters is that you get your credentials, and then provide safe and honest care. Good luck to you...I hope you receive all the support you'll need. Oh, and one more thing. When you think you just can't do it anymore, (school) just remember, YOU CAN....keep coming back no matter what and before you know it, school will be behind you, and the world will be ahead of you.:roll

I feel bad that some people would refer to an LVN as not really being a nurse. I am an RN myself, and I have worked along side many a LVN that d/t a lot of bedside care years is very quick at noting changes in a pts status. Let me give you the insight of how I believe that attitude has evolved...My understanding is that LVN training mainly focuses on procedures (IV starts, Foleys, etc), whereas RN's training focuses mainly on assessments, noting changes and what those changes mean...ie., Calcium level has gone up, so I know I want to check this pts phosphorus levels, because this pt could go into cardiac difficulties or seizures. Or, his BUN has risen, so I might want to watch that pts urine output for changes in amount, color, as well as notify MD because we may need to change medications that won't be so hard on this guys liver...like stopping something as simple as Tylenol orders. Still, these differences in training do NOT mean that an LVN isn't a nurse. It simply means that there is a difference in training and therefore, there are two types of nursing. This is also why state laws govern what each type of nurse can perform and/or assess. I can give you another example of how this attitude can raise its ugly head. I worked a surgical floor for some time, and policy says that only an RN can assess a pt returning from OR and only an RN can do the hourly checks on an epidural. OK...if I have 6 pts of my own, and the LVN has six, and some of mine and some of hers are coming back from OR (usually with epidurals), guess what happens? I just increased my pt load to my 6, plus the post op assessments on all of hers and mine, plus, hourly checks on my and her pts epidurals. In this scenario, the stress level rises tremendously...and this can very easily cause an RN to resent the LVN. I hope this helps. Maybe the answer is to hire more staff, and utilize it more effectively. Anyway, I'm sorry this has happened to you and congradulations on continuing your education, I wish you well.

Oh yea, I forgot to put in my previous note, when you start your note, Pt received semi fowlers, I forgot to also say, with rails x2 and bed in low position, pt able to voice needs........It is important to address those bed rails and position of bed. If pt falls, the first question that will arise is, was the bed in low position, what rails were in place, what fall percautions were in place. Sorry, see, we all forget an item or two when we are charting.

I would have charted something like this: Shift report received from J. Doe, RN. Pt received in semi fowlers position, a&o x 3, is able to voice needs ( or write needs, or shake head yes/no, etc), VS (fill in #'s), with resp even and nonlabored, denies SOB. S1, S2 auscultated, no murmurs noted, pulses x4 +2, cap refill

You are very fortunate to have only 5 pts. I thought CA was going to lower their ratios to 1:4. Is this not the case. I liked med/surg when I was at one facility but moved and when I worked for another, I got burned out in just a year.

So glad you are not from my state...for a moment I thought we were competing for the same job...just kidding. See my earlier post. I am curious, though, have they discussed pay with you. I'm trying to find any info about outpatient RN hourly pay? Good luck to you.

I am in negotiations regarding salary in taking a position as an RN for a private (group of surgeons) outpatient surgery center. I will be cross training for pre-op, circulating in OR, and PACU. It is M-F, holidays off, 401K and profit sharing, medical/dental paid, and 2 weeks vacation/yr. My question, can anyone tell me what I should be negotiating in hourly wage (regardless of where you are from I would like to know - as I realize CA would probably pay more than South, for example) I was told that 18-22 was the going rate - but then was told that I should expect 22-25.

I worked in on a medical floor at one facility and loved it...had a great TEAMwork of nurses and resources. Then I went to another small facility to the surgical floor. Overworked, underappreciated, understaffed, RAN RAN RAN my feet off until I had to have surgery on my feet. If you didn't like it before, you are NOT, I repeat NOT going to like it any better now. If you are happy where you are STAY there. If you are not happy there, seek something else in nursing. There are a lot of options...but I admit it takes a good while to get a break into some areas, but be persistant and keep applying until you get your break into something new if that's what you need.

I am so sorry that you have been treated badly. Let me give you a story of mine. I went to work for a surgical floor. I was promised x amount of hours per pay period. I was offered a full time position from the then prn position I had, and when I came back to accept, I was told it was being given to an LVN because it would be cheaper, and finally, my hours were cut back and cut back, and I was only scheduled on the days the brand new grad LVN was scheduled so that I could train her to take my hours. Well, don't you know I wanted to walk into that mgrs office, tell her to kiss my azzzzz, and leave! However, instead I went home and thought about this every evening for two weeks until I could think rationally. I trained that LVN - afterall, it wasn't her fault. Then, I put in my two weeks notice and it went something like this. It is with great regret that I am forced to resign my position with xyz hospital. However, as my hours have been drastically reduced due to budget constraints within the dept., I feel confident that you can in turn understand my need to seek other employment in order to meet personal financial demands. Then, (and I wasn't surprised by this) I was told that it wasn't necessary to work out the two weeks, since the new grad was ready to take a full load. This is the sort of thing that happens when you work in a small hospital, and money is spent on managment, leaving very little for staffing. This, of course, does not occur in larger facilities as much because they are finding that it is more cost productive to keep their RN's. My point is, however, that even though your situation is bad (and it is) and you have been treated awful (and you have been), it is so important to give that 2 week notice. Take the time to write and re-write that notice until it says in a professional way exactly what it needs to say. You and they will know your meaning behind your kind words, but they won't be able to put you down as a non-rehire. (and always, always, check out with your HR dept before you leave and be certain that your record concludes that you are in fact eligible for rehire. Even if you NEVER return to that facility, or that city, what you do now, can affect you for a long long time.

I live in Texas too, but in East Texas. I never heard of Group One before. I quickly went to their web site and looked up the employers who are currently on file with them. It appears they are all in the DFW area...thank goodness for that...because from what I read in the other posts, it appears that managers can post negative things about an employee. I wonder how that works..because shouldn't HR be the only dept who can report? and only after any and all disputes have been settled between employee and employer. Shouldn't employer have the obligation to let employee know what will be reported about them? Seems like another big brother with too much power. If any mgr can report without fear of lawsuits, its no wonder all the DFW nurses feel threatened. Something is clearly wrong here.

Two things. You didn't say if you were under contract. If so, you must fulfill the obligations of that contract. Second, you said you are scheduled for the next 2 weeks. If it a regular rotation during that two weeks, then it would prutent for you to fulfill the "standard ethical" obligation of giving your employer a 2 week notice. Let me caution you something most people do not think about. Make sure that you go to your Human Resources dept to turn in your badge (do not turn this over to a supervisor, or dept mgr, etc). At that time, ask to review your personnel file. This is the best time to see what is in it, and to question, add, etc. anything in it. You can't remove anything from it, but you can add to it. Next, stay there and wait while H.R. to process you out and put you into the system as "eligible for rehire". If they tell you that they won't be processing you out for a few days or so, get the date, make an appt to return to review your file again so that you can see for yourself in your file the words "eligible for rehire". This is important because when you apply for other employment down the road and any references are checked, if they are told that you are ineligible for rehire, your prospective employer will not know the circumstances behind it and can only wonder why you have been tagged that way; thus, making it easier to just skip you over and hire someone that checks out as eligible with past employers. Now, getting back to abandoment. If, your work load is unreasonable, say, assigning you to more patients than is safe for your area, then you should be able to claim safe harbor. (go to your facilities policy book that must be kept in an accessible area for you to reference at any time) and look up your dept. and see what is required for staffing and patient ratios. If your assignments are unreasonable, then you (according to my understanding of safe harbor) MUST request from your supervisor additional staff d/t policy requirements. If you are denied, then you can claim "safe harbor". This does not give you the right to walk off the job -that would be abandonment. However, it does give you the right to put in writing at the start of the shift that you are claiming safe harbor d/t stated policy and that you have requested add'l staff but were refused by supervisor...make a copy, give one to supervisor, and then be sure to document document document. Usually, once a nurse claims safe harbor, it isn't too long before staffing needs are met because you have met your legal obligation and they have not. If you need more info about pt abandonment, you can get your States Nurses Act which goes into detail about all of your responsibilities and obligations. Hope this helps.

If it is an elderly pt. I always tell family I need one person who is most familiar with pts meds, routine, etc to stay in the room during data gathering and ask family members to wait in the waiting area and that it may take approx an hour for us to get all the necessary admission orders started - sometimes this works and sometimes it dosen't; however, most facilities do not allow popcorn to be popped on the floors as the odor can be very offensive to often sick, nauseated pts. As far as delivering water for family members, I provide directions to the area where cups can be found, or a water fountain, or the cafeteria. By directing them, they immediately get the message that THEY are not the pt. It is unfortunate that some family members treat hospital staff as if they have come to the Ritz - however, sometimes it becomes necessary to remind them as kindly as possible, that you must get to your tasks of taking care of the rest of your patients and hope that they understand.

Hello, I have recently interviewed for an outpatient surgery facility and it looks pretty good that I may get this position. I'd like to chat with someone "in the know" to get some info prior to accepting or declining position. Anyone available? Thanks:rolleyes: