OncoRN84

I don't know that nursing is "better" in California. But I can tell you my experience in moving from Ohio to California. Now, keep in mind that I never worked ICU in Ohio, I worked Step-down but the patients that we had in step-down were more than ICU worthy (I now realize this.) We had a 4:1 and 5:1 (depending on short staffing ect..) and we ran pretty much every gtt possible, besides levo. We even did insulin drips. As a new nurse, I seriously thought that's just how things were everywhere. Also, we had no CNAs or even a monitor tech. Hell, I didn't even know there was such a thing until I moved to California. However, I obtained invaluable experience on that unit. Yes, it was hard but I am so glad that I started there. Nurses have mandated patient ratios in California, this is true. You will, as an ICU nurse have a 2:1 ratio. If you have a hypothermia, CRRT, IABP- 1:1. I recently moved to ICU from oncology/medsurg/bariatrics. We had a 5:1 ratio with chemotherapy infusions. I work in a mixed ICU- we have different ICUs, but the patients get jumbled around, so even if you are in trauma- you might end up with 2 cardiac patients. It just is what it is. Some hospitals have lift teams, though, as always, they are not there at night. I work in a hospital with a very strong union. I do not know that all facilities abide by the laws and staffing regulations as closely as mine. I would hope that they do. We have break relief RNs, a transport nurse and a rapid response nurse, however, this is when we are ideally staffed. As we all know, many times that is not the case. And unfortunately, no- there is not always help all the time. Sometimes, things just go to hell in a handbasket for multiple patients at a time and well, you just do the best you can. A few strange things about nursing in California- It almost seemed like I had stepped back in time. Now, this was over 10 years ago, but I went from online orders entirely with CPOE in Ohio back to handwritten orders in California. Things that we were doing clinically in Ohio before I left (again, over 10 years ago) are just now starting to catch on. I really thought that medicine would be more progressive out here, but it was not. Also, I came from a decent sized teaching hospital (600+ beds) and the physicians and nurses worked as a team. I was shocked at the poor behavior and rude nature of the physicians out here. I work at a much smaller hospital now (350 beds) so maybe that has something to do with it? The culture was very hard to adjust to. I love living here but it is definitely a different culture in general. I work with some people that hate it in California and cannot wait to move away because the area does not represent their values personally. However, it is a big state and very versatile. You could probably find what you want if you look. If you have the ability and years of experience, I would suggest travel nursing. You can really get a feel for a hospital and the area. I would suggest this only after a solid 2-3 years of experience and a good level of comfort. Good luck!!

Ditto the forgotten patient dream. I think everyone has that one. I used to have one where I come home and the patients are all over my apartment. There was even a med cart in the living room. I haven't had that one in a while. The most recent was the hospital is on fire and we"re running, closing doors. Finally, there is no where left to run and the windows are locked shut. I look over and see the flames licking the oblong window of the stairwell and resign myself to my fate. All the while, thinking how much I hated my management position and missed patient care. I have since applied for a transfer.

This is horrid and DOES NOT encourage a culture of safety. This encourages people to hide errors which most likely are systematic. I am so sorry for anyone that has had to endure this process. I would probably quit if it were me.

That first year will make or break you but your judgement sounds reasonable. I really wouldn't be terribly concerned about that pressure for an hd patient awaiting dialysis that morning. Be kind to yourself! Normally, I hold meds until dialysis is over as it will drop their pressure anyway. It sounds like the attending and nephro need to talk to ensure more consistent care. It'll get better- I promise you- tincture of time....

I sure would. Is it perfect, no. Should you do it just for money? - hell no. The current climate is extremely trying, however, the caring for actual human beings is the part that matters. An old director I had (my Cali momma) once told me- remember to take away one good experience with your patient each day. Forget the rest- the admin, the bs, red tape, etc. That one moment for that patient mattered a lot.

I don't really care for littman scopes. I have always had adc cardio. I have one with a thumb grip that I love. My first one walked away about 3 years ago, I bought the same one. You may be able to hear just fine through a littman but they just aren't that great to me.

This is not discrimination. If you dragged me to HR for this, let me tell you- I would be less than thrilled. That is a serious threat, lest you forget. You were off, on a leave. If you have no standing transfer in progress- your manager has no obligation to hunt you down if something happens and they need a day RN. This has nothing to do with your child. In fact, maybe you should consider that the entire unit does not revolve solely around your needs alone?