The metric system (Australia).
Distances are measured in meters and kilometers. Speeds are measured in kilometers/hour. Temperatures are measured in celsius or centigrade. Height and length are measured in centimeters. Weight is measured in grams and kilograms. Volumes are measured in milliliters and liters. Nutrition information is measured in kilojoules.
The English or customary system (U.S.).
Distances are measured in feet, yards, and miles. Speeds are measured in miles/hour. Temperatures are measured in Fahrenheit. Height and length are measured in feet and inches. Weight is measured in ounces and pounds. Volumes are measured in fluid ounces, cups, pints, quarts, and gallons. Nutrition information is measured in calories.
Dates in Australia.
The day of the month always comes first, followed by the month, then the year. The 26th of October, 1982 would be written 26 October 1982 or 26/10/1982. The latter would be read and spoken as 26th of the 10th, 1982.
Dates in the U.S.
The month always comes first, followed by the day of the month, then the year. The 26th of October, 1982 would be written as October 26, 1982 or 10/26/1982. The latter would be read and spoken as ten, twenty-six, 1982.
Tax and tip in Australia.
Tax is always included in advertised prices. If something is advertised as $20, whether it is food, clothing, or petrol (gasoline), $20 is how much will be charged. Tipping is not expected for pretty much anything. Waiters make around $20/hour. There are public holiday surcharges for eating at a restaurant on a public holiday, usually about 15%.
Tax and tip in the U.S.
Tax is rarely ever included in advertised prices. I think the reason for this is that merchants feel they are more likely to make a sale if the customer perceives a lower price. Sales tax varies from state to state with the lowest being 5.5 or 6%. Sales tax in Texas is 8.25% and in Northern California is around 11.5%. Tipping is expected by waiters, bartenders, bellhops, taxi drivers, hairdressers, and shuttle drivers if they handle your luggage. It is considered tacky to not tip. Tips for waiters are usually 15-20% and bartenders can expect about $1 per drink. Tips for other professions vary. I think waiters make less than $3/hour, but waiters and bartenders can make a lot of money in tips. Tipping is an incentive for the service person to give good service. The amount of tip is expected to correspond with how good the service is. There are no public holiday surcharges.
Sunday, April 25, 2010
Wednesday, April 21, 2010
Postal Service
The U.S. Postal Service
The U.S. Postal Service is owned and operated by the U.S. government. Post offices have individual listed phone numbers at which they can be contacted. The U.S. Postal Service picks up mail from and delivers mail to private residential mailboxes. Mail is picked up and delivered Monday-Saturday. Post office hours vary, but most open between 7:30 & 9AM Monday-Friday and close between 5 & 6:30PM. Saturdays, they open between 7:30 and 10AM and close between 12noon & 4PM. Some post offices are open Sundays for several hours. The post office is closed for 10 holidays each year. The price of a domestic stamp is 44 cents USD (47 cents AUD). The cost to mail a letter to Australia is 98 cents USD ($1.05 AUD). Mail forwarding is a free service.
Australia Post
Australia Post is a private company. Post offices do not have listed phone numbers. If you want to contact a post office, you have to call the national line. Australia post only delivers mail to private residential mailboxes; it does not pick it up. If you want to mail something, you have to take it to a street mailbox. Mail is picked up and delivered Monday-Friday. Post offices are open 9AM-5PM Monday-Friday and 9AM-12noon on Saturdays. The post office is closed for 11-13 holidays a year, including Good Friday, Easter Saturday, and Easter Monday. The price of a domestic stamp is 55 cents AUD (51 cents USD). The cost to mail a letter to the U.S. is $2.10 AUD ($1.95 USD). The cost of having your mail forwarded is $13.50 for 1 month, $25.50 for 3 months, $37 for 6 months, and $68 AUD for a year ($11.26, $21.27, $30.86, and $56.73 USD).
The U.S. Postal Service is owned and operated by the U.S. government. Post offices have individual listed phone numbers at which they can be contacted. The U.S. Postal Service picks up mail from and delivers mail to private residential mailboxes. Mail is picked up and delivered Monday-Saturday. Post office hours vary, but most open between 7:30 & 9AM Monday-Friday and close between 5 & 6:30PM. Saturdays, they open between 7:30 and 10AM and close between 12noon & 4PM. Some post offices are open Sundays for several hours. The post office is closed for 10 holidays each year. The price of a domestic stamp is 44 cents USD (47 cents AUD). The cost to mail a letter to Australia is 98 cents USD ($1.05 AUD). Mail forwarding is a free service.
Australia Post
Australia Post is a private company. Post offices do not have listed phone numbers. If you want to contact a post office, you have to call the national line. Australia post only delivers mail to private residential mailboxes; it does not pick it up. If you want to mail something, you have to take it to a street mailbox. Mail is picked up and delivered Monday-Friday. Post offices are open 9AM-5PM Monday-Friday and 9AM-12noon on Saturdays. The post office is closed for 11-13 holidays a year, including Good Friday, Easter Saturday, and Easter Monday. The price of a domestic stamp is 55 cents AUD (51 cents USD). The cost to mail a letter to the U.S. is $2.10 AUD ($1.95 USD). The cost of having your mail forwarded is $13.50 for 1 month, $25.50 for 3 months, $37 for 6 months, and $68 AUD for a year ($11.26, $21.27, $30.86, and $56.73 USD).
Saturday, April 17, 2010
Air conditioning, laundry, and store hours
Air conditioning in the U.S.
The vast majority of buildings in the U.S. are air conditioned. This includes houses, apartments, restaurants, stores, churches, businesses, hospitals, trains, etc. The only places I can think of that aren't air conditioned are some of the dorms at my sister's university in Virginia, the camp I worked at in Maine, my friend's apartment in Boston, and all school buses. That's it. The vast majority of air conditioning is central (ducted) air conditioning. The only places you'll find wall air conditioners are in some hotel rooms. Window units can be found in some old buildings that were built before AC was invented. However, even in old buildings, many have had central AC installed.
Air conditioning in Australia
Air conditioning is standard in hospitals, trains, and grocery stores. That's about it. Some houses, apartments, stores, and restaurants have it, but definitely not all. I have only been in 1 house that had central AC. Most air conditioners in houses and apartments are wall air conditioners.
Laundry in the U.S.
Washing machines and dryers are bigger in the U.S. than in Australia. Clothes are always put in the dryer, which has a lint removing function and a wrinkle guard cycle. Clothes come out of the dryer soft and virtually lint and wrinkle free in about 45 minutes. Clotheslines are very rare and come from the first half of the 20th century. Other than my dad, I don't think I've ever met anyone living in the U.S. who hung their clothes on a clothesline to dry. Occasionally in the country, you might see a clothesline, but it's probably being used only because the owner cannot afford a dryer.
Laundry in Australia
Washing machines and dryers are smaller in Australia than in the U.S. Most Australians have dryers, but they rarely ever use them. Clothes are always hung on a clothesline and left to dry. The reason for not using the dryer is to save energy. If the weather is very sunny, clothes might be dry in several hours. If the weather is not very sunny, clothes might still not be dry more than 24 hours after being hung on the line. If the weather is rainy, clothes must be hung on a clothesline under an awning. I've also had to rush out into the sudden rain to frantically take my clothes off the outside line to keep them from getting soaked. Clothes, sheets, and towels are sort of stiff when dried on the line. They must be lint rolled and ironed, and some clothes will still be wrinkled even after they have been ironed.
Store hours in the U.S.
Most grocery stores in the U.S. open at 6 or 7 AM and close at 11PM or midnight 7 days a week. HEB is open until 1AM, and Wal-Mart is open 24 hours a day. Target is open 8AM-10PM everyday except Sunday on which it closes at 9PM. Most stores are open later on Saturdays than any other day of the week. The only days stores are closed completely are Christmas and maybe Thanksgiving, and even then, some stores will still be open.
Store hours in Australia
Woolworth's, one of the 2 major grocery store chains, is open from 8AM -9PM on weekdays, 8AM-5PM on Saturdays, and 9AM-6PM on Sundays. Target opens everday at 9AM except Sundays, on which it opens at 10AM. It closes on Sundays at 4PM, Saturdays at 5PM, Mondays, Tuesdays, Wednesdays, and Fridays at 7PM, and Thursdays at 9PM. I have seen only two 24 hour establishments since I have been in Australia, and both were convenience store type places. On some holidays, like Labor Day, stores are closed completely.
The vast majority of buildings in the U.S. are air conditioned. This includes houses, apartments, restaurants, stores, churches, businesses, hospitals, trains, etc. The only places I can think of that aren't air conditioned are some of the dorms at my sister's university in Virginia, the camp I worked at in Maine, my friend's apartment in Boston, and all school buses. That's it. The vast majority of air conditioning is central (ducted) air conditioning. The only places you'll find wall air conditioners are in some hotel rooms. Window units can be found in some old buildings that were built before AC was invented. However, even in old buildings, many have had central AC installed.
Air conditioning in Australia
Air conditioning is standard in hospitals, trains, and grocery stores. That's about it. Some houses, apartments, stores, and restaurants have it, but definitely not all. I have only been in 1 house that had central AC. Most air conditioners in houses and apartments are wall air conditioners.
Laundry in the U.S.
Washing machines and dryers are bigger in the U.S. than in Australia. Clothes are always put in the dryer, which has a lint removing function and a wrinkle guard cycle. Clothes come out of the dryer soft and virtually lint and wrinkle free in about 45 minutes. Clotheslines are very rare and come from the first half of the 20th century. Other than my dad, I don't think I've ever met anyone living in the U.S. who hung their clothes on a clothesline to dry. Occasionally in the country, you might see a clothesline, but it's probably being used only because the owner cannot afford a dryer.
Laundry in Australia
Washing machines and dryers are smaller in Australia than in the U.S. Most Australians have dryers, but they rarely ever use them. Clothes are always hung on a clothesline and left to dry. The reason for not using the dryer is to save energy. If the weather is very sunny, clothes might be dry in several hours. If the weather is not very sunny, clothes might still not be dry more than 24 hours after being hung on the line. If the weather is rainy, clothes must be hung on a clothesline under an awning. I've also had to rush out into the sudden rain to frantically take my clothes off the outside line to keep them from getting soaked. Clothes, sheets, and towels are sort of stiff when dried on the line. They must be lint rolled and ironed, and some clothes will still be wrinkled even after they have been ironed.
Store hours in the U.S.
Most grocery stores in the U.S. open at 6 or 7 AM and close at 11PM or midnight 7 days a week. HEB is open until 1AM, and Wal-Mart is open 24 hours a day. Target is open 8AM-10PM everyday except Sunday on which it closes at 9PM. Most stores are open later on Saturdays than any other day of the week. The only days stores are closed completely are Christmas and maybe Thanksgiving, and even then, some stores will still be open.
Store hours in Australia
Woolworth's, one of the 2 major grocery store chains, is open from 8AM -9PM on weekdays, 8AM-5PM on Saturdays, and 9AM-6PM on Sundays. Target opens everday at 9AM except Sundays, on which it opens at 10AM. It closes on Sundays at 4PM, Saturdays at 5PM, Mondays, Tuesdays, Wednesdays, and Fridays at 7PM, and Thursdays at 9PM. I have seen only two 24 hour establishments since I have been in Australia, and both were convenience store type places. On some holidays, like Labor Day, stores are closed completely.
Saturday, April 3, 2010
Nursing in the U.S.
Qualifications.
RN. There are 3 courses of study that can lead up to becoming an RN. The first is a diploma in nursing. This is a 3 year hospital based course. This is the way all RN's were originally trained, however there are very few diploma programs still in existance. The second path to becoming an RN is an associate degree in nursing. This is a 2 year course taught at a community college or junior college. More RN's have this degree than any other. The 3rd way to become an RN is a Bachelor of Science in Nursing (BSN). This is a 4 year university degree. Individual courses in physical assessment, nursing research, and community health nursing are part of a BSN program, while I don't think these are included in an associate program. Regardless of course of study, all RN candidates take the same exam. Some nursing positions and hospitals require a BSN. At Scott & White Hospital, BSN's were paid $0.18 more per hour than ADN's, but I don't think there is a pay difference at most hospitals.
LPN or LVN (Licensed Practical or Vocational Nurse). This is a 12 month program. Scope of practice for LVN's varies from state to state and hospital to hospital. In the Texas Nurse Practice Act, there is nothing specifically prohibiting LVN's from performing certain skills; that is left up to the individual hospital. At St. Joseph Medical Center, LVN's could not perform the admission assessment, start a blood transfusion (though they could monitor it once it was started by an RN), or give IV push medications. The same rules applied at Scott & White Hospital, but LVN's were not able to do discharge teaching either. At Washington Hospital Center in Washington, DC, the LPN's performed exactly the same functions as the RN's. Some hospitals do not hire LPN's. LPN's commonly work in clinics and doctors' offices.
CNA (Certified Nursing Assistant). I think this is a 6 week course, though I could be wrong about that. CNA's take all the vital signs (obs), check blood sugars, collect lab specimens, take weights, record intake & output (fluid balance), bathe & clean patients, make beds, feed patients, bring water & snacks, empty bedpans, urinals, & urinary catheters, etc. At the 2 hospitals I worked that did not have phlebotamy teams, the CNA's also drew all the peripheral blood tests.
Competancies. As a new grad, there are certain competancies on which nurses must be checked off. This is fairly informal. The new grad would be checked off by their preceptor. Hospitals do not have policies and procedures for performing basic clinical skills. As an experienced RN, it would be expected that you would know how to perform clinical skills appropriately. There are no competancy check offs for experienced RN's. Chemotherapy certification and Advanced Cardiovascular Life Support are national certifications and are recognized by all hospitals.
Medication checks. Chemotherapy, heparin drips, TPN, and PPN (total and peripheral parenteral nutriton) must be double checked and signed off with another nurse. At some facilities insulin and subcutaneous heparin must be double checked and signed off with another nurse. For narcotics and some sedatives, a second nurse is required to check and sign only if a partial dose is to be given (i.e., 1mg of a 2mg vial is to be given). If the full dose is to be given, a 2nd nurse is not required. Those are the only medications that are required to be double checked with another nurse, at least in the nursing specialties in which I've worked.
Documentation. This varies from hospital to hospital. There is the intake & output (fluid balance chart), physical assessment, nurse's note, care plan, acuity chart, and admission assessment. I probably spend at least 2 hours of each shift in documentation.
Physical assessment. It is the responsibility of the nurse to perform a head to toe physical assessment of the patient every shift. This usually involves the neuro, respiratory, cardiovascular, gastrointestinal, urinary, & integumentary (skin) systems. The nurse is expected to listen to lung, heart, & bowel sounds with a stethoscope. If there is any question of neuro deficiency, the nurse is expected to check the patient's pupils for size & reactivity, test strength in all extremities, & determine level of consciousness.
Supplies. Plastic aprons and safety goggles are not required to be worn for any procedures or skills. The only exception to that might be goggles when dealing with chemotherapy. Isolation gowns are worn when a patient is on contact precautions for MRSA, VRE, c.diff, or pseudomonas. There is both primary & secondary (piggyback) IV tubing. A primary IV fluid will be attached to the primary IV tubing. All other medications (chemo, antibiotics, potassium, antiemetics, etc.) are attached to the piggyback tubing, which is connected to a port (bung) in the primary IV tubing above the point where the primary tubing is in the pump. Both primary & piggyback rates and volumes can be set on the IV pump. Once the piggyback medication is complete, the IV pump automatically switches to run the primary IV fluid. There are no IV flushes to be given and no disconnecting done unless multiple secondary medications are to be given. IV tubing may be disconnected then reconnected to a patient so long as a sterile cap is placed on the end of the IV tubing. Patients are disconnected from IV lines to shower, unless the IV fluid running is something that cannot be interrupted such as chemo, a blood transfusion, or TPN. To access an IV port (bung), it must be swabbed with 1 alcohol wipe. Emesis (kidney) basins are not used for holding supplies. Medications that need to be drawn up are done so on the counter (bench) in the medication room. General waste is not double bagged. Chemo waste might be different. Urinals and bedpans are not reused for multiple patients but are thrown away once the patient is discharged.
Sterile procedures. A central line dressing change is a sterile procedure. All needed supplies come in a prepackaged pack. The entire process takes about 5-10 minutes to do. Accessing port-a-caths and removing PICC lines are not sterile procedures. The handwash prior to doing a central line dressing change is no different than a regular handwash.
Vacation time. The usual amount of PTO (paid time off) is 4 weeks/year. PTO is based on number of hours worked, so the more hours you work, the more PTO you get. There are no monthly rostered days off, and no extra PTO is awarded for shift work or working Sundays.
Sick time. Employees accrue sick time, but at St. Joseph Medical Center, you could not use your sick time until you had already used 3 days of PTO. You also had to have a note from a doctor in order to collect on your sick time. Any sick time remaining when you left the facility was lost. This might be different at other hospitals.
Shifts. Most of the hospitals I have worked at operated on 8 and 12 hour shifts. One hospital offered only 12 hour shifts. Some hospitals have certain floors (wards) that operate on 12 hour shifts only or 8 hour shifts only. Most of the floors (wards) I've worked on are a combination of both. 12 hour day shift is 7A-7:30P, 12 hour night shift is 7P-7:30A, 8 hour day shift is 7A-3:30P, 8 hour evening shift is 3-11:30P, & 8 hour night shift is 11p-7:30A. At St. Joseph Medical Center shifts were 6:30A-7P, 6:30P-7A, 6:30A-3P, 2:30P-11P, & 10:30P-7A. Employees are hired to work a specific shift (i.e., nights only).
Uniforms. Nurses do not wear a uniform as such. All clinical (dealing with patients) nurses wear scrubs. Shorts are not allowed to be worn by hospital employees and would be considered very unprofessional. St. Joseph Medical Center and Scott & White Hospital had color coded scrubs, i.e., all nurses wore royal blue scrubs, all nurse aides wore ceil blue scrubs, all secretaries (administrative officers) wore maroon scrubs, etc. At all the other hospitals I worked, nurses could wear whatever color of scrubs they chose. Most nurses wear tennis shoes (sneakers) or a type of clog made specifically for medical personnel. Shoes can be any color. Most of the places I have worked did not have jewelry restrictions. At St. Joseph Medical Center, earrings were supposed to be no longer than chin level. Wristwatches are the norm. I have seen only 2 nurses besides myself with fob watches.
Unions. There were state nurses unions in New York, Illinois, California, and Massachusetts. I'm sure there are other states with unions too. There was not a district union for DC, but Washington Hospital Center had its own union. There is no nurses union in Texas. At some hospitals, nurses are required to be a member of the union. I know in New York and Boston, some hospitals were union and others were not. Unions do not provide indemnity (malpractice) insurance. I think the union dues for the Massachusetts nurses union were $700-$800/year, but I'm not sure of that.
Licensure. State-by-state. There is something called the Nurse Licensure Compact, of which 23 states are a part. A nurse who received their first nursing license in a compact state may legally practice nursing in any other compact state without having to obtain a license there. However, for nurses who received their first license in a non-compact state, if they want to work in compact states, they have to obtain a license in each compact state in which they want to work. I find this defeats the purpose of the compact. Luckily, my first license was in a compact state. Requirements for licensure vary state to state. I think the least expensive license fee I paid was $50 for Illinois, and the most expensive was $250-$300 for DC. The shortest wait time was 2 weeks for Hawaii, and the longest was 8 months for Illinois. Some of the requirements for licensure are fingerprinting, nursing school transcripts, verification from nursing school, and license verification from every other state of licensure. Licenses must be renewed every 3 years in New York and every 2 years in other states. Nurses must obtain a certain number of hours of continuing education for licensure renewal.
Beds and baths. Nurses rarely make beds or give baths, and when they do, it is usually helping the CNA. CNA's make the beds and give the baths.
OB nurses. Obstetrical nursing is a semester long course taught in each nursing school. Nurses can specialize in labor & delivery, postpartum (mother/baby), and antepartum. Midwives are fairly rare and have a very similar role to that of an OB doctor.
Washington Hospital Center, Washington, DC. Traveling nurse pay rate =$33/h + housing. There were no shift diffs or weekend diffs for traveling nurses. I received holiday pay for working Thanksgiving. Full time for traveling nurses was three 12h shifts/week. Full time for regular staff was two 12 & two 8 hour shifts/week. At least half of your shifts had to be evenings or nights. There was a weekend crew who worked two 12 hour shifts every Sat./Sun. & were paid for 36 hours. I had to work about 2 weekend shifts every 3 weeks. Max patient:nurse ratio was 4:1 for the resource (charge) nurse & 6:1 for everyone else. For a 34 bed unit, there were usually no more than 2 CNA's, and quite often only 1 or none. Other than taking vital signs, bathing patients, and making beds, most usual CNA responsibilites fell on the nurse. IV & phlebotamy team.
Mount Sinai Medical Center, New York, NY. Traveling nurse pay rate = $32/h + housing. There were no shift diffs or weekend diffs for traveling nurses. Full time was three 12h shifts each week with a fourth 12h shift every 4th week. I had to work about 1 weekend shift every 3 weeks. Nurses were responsible for checking all blood sugars. There was no IV or phlebotamy team or respiratory therapists. No max patient:nurse ratio. Usually 5 or 6:1 on days and 6 or 7:1 on nights. The most I ever had was 7 on days and 9 very briefly on nights.
University of Chicago Hospitals, Chicago, IL. Traveling nurse pay rate = $26.75/h (2008) & $25/h (2009). Evening, nite, & weekend day diff = $2/h (2008) & $1/h (2009). Evening & nite weekend diff = $4/h (2008) & $2/h (2009). I received holiday pay for working Thanksgiving. Full time = three 12h or five 8h shifts/week. Every other Sat./Sun. mandatory. Phlebotamy team. Max patient:nurse ratio was 5:1.
Mills-Peninsula Hospital, Burlingame, CA. Traveling nurse pay rate = $26/h + housing + $273/week for meals. No weekend diff for traveling nurses. New grad staff nurse pay rate = $44/h. Full time = five 8 hour shifts/week. Every other Sat./Sun. mandatory. Nurses check all blood sugars & do all dressing changes including wound vac dressings. Phlebotamy team. Max patient:nurse ratio was 5:1.
Brigham & Women's Hospital, Boston, MA. Traveling nurse pay rate = $19.25/h + housing + $245/week for meals. No shift diff or weekend diff for traveling nurses. For regular staff, Columbus Day & Veteran's Day received holiday pay. For regular staff, any hours worked after a 12 hour shift were paid double time. Full time = three 12h or five 8h shifts/week. Max patient: nurse ratio from 7A-11P 3:1 & from 11P-7A 4:1. IV team & phlebotamy team.
RN. There are 3 courses of study that can lead up to becoming an RN. The first is a diploma in nursing. This is a 3 year hospital based course. This is the way all RN's were originally trained, however there are very few diploma programs still in existance. The second path to becoming an RN is an associate degree in nursing. This is a 2 year course taught at a community college or junior college. More RN's have this degree than any other. The 3rd way to become an RN is a Bachelor of Science in Nursing (BSN). This is a 4 year university degree. Individual courses in physical assessment, nursing research, and community health nursing are part of a BSN program, while I don't think these are included in an associate program. Regardless of course of study, all RN candidates take the same exam. Some nursing positions and hospitals require a BSN. At Scott & White Hospital, BSN's were paid $0.18 more per hour than ADN's, but I don't think there is a pay difference at most hospitals.
LPN or LVN (Licensed Practical or Vocational Nurse). This is a 12 month program. Scope of practice for LVN's varies from state to state and hospital to hospital. In the Texas Nurse Practice Act, there is nothing specifically prohibiting LVN's from performing certain skills; that is left up to the individual hospital. At St. Joseph Medical Center, LVN's could not perform the admission assessment, start a blood transfusion (though they could monitor it once it was started by an RN), or give IV push medications. The same rules applied at Scott & White Hospital, but LVN's were not able to do discharge teaching either. At Washington Hospital Center in Washington, DC, the LPN's performed exactly the same functions as the RN's. Some hospitals do not hire LPN's. LPN's commonly work in clinics and doctors' offices.
CNA (Certified Nursing Assistant). I think this is a 6 week course, though I could be wrong about that. CNA's take all the vital signs (obs), check blood sugars, collect lab specimens, take weights, record intake & output (fluid balance), bathe & clean patients, make beds, feed patients, bring water & snacks, empty bedpans, urinals, & urinary catheters, etc. At the 2 hospitals I worked that did not have phlebotamy teams, the CNA's also drew all the peripheral blood tests.
Competancies. As a new grad, there are certain competancies on which nurses must be checked off. This is fairly informal. The new grad would be checked off by their preceptor. Hospitals do not have policies and procedures for performing basic clinical skills. As an experienced RN, it would be expected that you would know how to perform clinical skills appropriately. There are no competancy check offs for experienced RN's. Chemotherapy certification and Advanced Cardiovascular Life Support are national certifications and are recognized by all hospitals.
Medication checks. Chemotherapy, heparin drips, TPN, and PPN (total and peripheral parenteral nutriton) must be double checked and signed off with another nurse. At some facilities insulin and subcutaneous heparin must be double checked and signed off with another nurse. For narcotics and some sedatives, a second nurse is required to check and sign only if a partial dose is to be given (i.e., 1mg of a 2mg vial is to be given). If the full dose is to be given, a 2nd nurse is not required. Those are the only medications that are required to be double checked with another nurse, at least in the nursing specialties in which I've worked.
Documentation. This varies from hospital to hospital. There is the intake & output (fluid balance chart), physical assessment, nurse's note, care plan, acuity chart, and admission assessment. I probably spend at least 2 hours of each shift in documentation.
Physical assessment. It is the responsibility of the nurse to perform a head to toe physical assessment of the patient every shift. This usually involves the neuro, respiratory, cardiovascular, gastrointestinal, urinary, & integumentary (skin) systems. The nurse is expected to listen to lung, heart, & bowel sounds with a stethoscope. If there is any question of neuro deficiency, the nurse is expected to check the patient's pupils for size & reactivity, test strength in all extremities, & determine level of consciousness.
Technology. Most medications are kept in a medication machine called Pyxis, Accudose, or Omnicell. The machine is operated by a touch screen computer. The nurse enters the patient's name then chooses from the list of that patient's medications. A drawer containing the medication opens. Most hospitals are at least partially if not completely computerized when it comes to documentation. Vital signs (obs), nursing assessments, intake & output (fluid balance), medication administration, progress notes, doctors' orders, etc. are computerized. All patient armbands and blood labels are printed from a computer.
Supplies. Plastic aprons and safety goggles are not required to be worn for any procedures or skills. The only exception to that might be goggles when dealing with chemotherapy. Isolation gowns are worn when a patient is on contact precautions for MRSA, VRE, c.diff, or pseudomonas. There is both primary & secondary (piggyback) IV tubing. A primary IV fluid will be attached to the primary IV tubing. All other medications (chemo, antibiotics, potassium, antiemetics, etc.) are attached to the piggyback tubing, which is connected to a port (bung) in the primary IV tubing above the point where the primary tubing is in the pump. Both primary & piggyback rates and volumes can be set on the IV pump. Once the piggyback medication is complete, the IV pump automatically switches to run the primary IV fluid. There are no IV flushes to be given and no disconnecting done unless multiple secondary medications are to be given. IV tubing may be disconnected then reconnected to a patient so long as a sterile cap is placed on the end of the IV tubing. Patients are disconnected from IV lines to shower, unless the IV fluid running is something that cannot be interrupted such as chemo, a blood transfusion, or TPN. To access an IV port (bung), it must be swabbed with 1 alcohol wipe. Emesis (kidney) basins are not used for holding supplies. Medications that need to be drawn up are done so on the counter (bench) in the medication room. General waste is not double bagged. Chemo waste might be different. Urinals and bedpans are not reused for multiple patients but are thrown away once the patient is discharged.
Sterile procedures. A central line dressing change is a sterile procedure. All needed supplies come in a prepackaged pack. The entire process takes about 5-10 minutes to do. Accessing port-a-caths and removing PICC lines are not sterile procedures. The handwash prior to doing a central line dressing change is no different than a regular handwash.
Vacation time. The usual amount of PTO (paid time off) is 4 weeks/year. PTO is based on number of hours worked, so the more hours you work, the more PTO you get. There are no monthly rostered days off, and no extra PTO is awarded for shift work or working Sundays.
Sick time. Employees accrue sick time, but at St. Joseph Medical Center, you could not use your sick time until you had already used 3 days of PTO. You also had to have a note from a doctor in order to collect on your sick time. Any sick time remaining when you left the facility was lost. This might be different at other hospitals.
Shifts. Most of the hospitals I have worked at operated on 8 and 12 hour shifts. One hospital offered only 12 hour shifts. Some hospitals have certain floors (wards) that operate on 12 hour shifts only or 8 hour shifts only. Most of the floors (wards) I've worked on are a combination of both. 12 hour day shift is 7A-7:30P, 12 hour night shift is 7P-7:30A, 8 hour day shift is 7A-3:30P, 8 hour evening shift is 3-11:30P, & 8 hour night shift is 11p-7:30A. At St. Joseph Medical Center shifts were 6:30A-7P, 6:30P-7A, 6:30A-3P, 2:30P-11P, & 10:30P-7A. Employees are hired to work a specific shift (i.e., nights only).
Uniforms. Nurses do not wear a uniform as such. All clinical (dealing with patients) nurses wear scrubs. Shorts are not allowed to be worn by hospital employees and would be considered very unprofessional. St. Joseph Medical Center and Scott & White Hospital had color coded scrubs, i.e., all nurses wore royal blue scrubs, all nurse aides wore ceil blue scrubs, all secretaries (administrative officers) wore maroon scrubs, etc. At all the other hospitals I worked, nurses could wear whatever color of scrubs they chose. Most nurses wear tennis shoes (sneakers) or a type of clog made specifically for medical personnel. Shoes can be any color. Most of the places I have worked did not have jewelry restrictions. At St. Joseph Medical Center, earrings were supposed to be no longer than chin level. Wristwatches are the norm. I have seen only 2 nurses besides myself with fob watches.
Unions. There were state nurses unions in New York, Illinois, California, and Massachusetts. I'm sure there are other states with unions too. There was not a district union for DC, but Washington Hospital Center had its own union. There is no nurses union in Texas. At some hospitals, nurses are required to be a member of the union. I know in New York and Boston, some hospitals were union and others were not. Unions do not provide indemnity (malpractice) insurance. I think the union dues for the Massachusetts nurses union were $700-$800/year, but I'm not sure of that.
Licensure. State-by-state. There is something called the Nurse Licensure Compact, of which 23 states are a part. A nurse who received their first nursing license in a compact state may legally practice nursing in any other compact state without having to obtain a license there. However, for nurses who received their first license in a non-compact state, if they want to work in compact states, they have to obtain a license in each compact state in which they want to work. I find this defeats the purpose of the compact. Luckily, my first license was in a compact state. Requirements for licensure vary state to state. I think the least expensive license fee I paid was $50 for Illinois, and the most expensive was $250-$300 for DC. The shortest wait time was 2 weeks for Hawaii, and the longest was 8 months for Illinois. Some of the requirements for licensure are fingerprinting, nursing school transcripts, verification from nursing school, and license verification from every other state of licensure. Licenses must be renewed every 3 years in New York and every 2 years in other states. Nurses must obtain a certain number of hours of continuing education for licensure renewal.
Beds and baths. Nurses rarely make beds or give baths, and when they do, it is usually helping the CNA. CNA's make the beds and give the baths.
OB nurses. Obstetrical nursing is a semester long course taught in each nursing school. Nurses can specialize in labor & delivery, postpartum (mother/baby), and antepartum. Midwives are fairly rare and have a very similar role to that of an OB doctor.
Holiday pay. Time & a half for all holidays.
Patient to nurse ratios, pay rates, hours, etc. vary from hospital to hospital even in the U.S. These are the hospitals I've worked at in a nutshell.
Washington Hospital Center, Washington, DC. Traveling nurse pay rate =$33/h + housing. There were no shift diffs or weekend diffs for traveling nurses. I received holiday pay for working Thanksgiving. Full time for traveling nurses was three 12h shifts/week. Full time for regular staff was two 12 & two 8 hour shifts/week. At least half of your shifts had to be evenings or nights. There was a weekend crew who worked two 12 hour shifts every Sat./Sun. & were paid for 36 hours. I had to work about 2 weekend shifts every 3 weeks. Max patient:nurse ratio was 4:1 for the resource (charge) nurse & 6:1 for everyone else. For a 34 bed unit, there were usually no more than 2 CNA's, and quite often only 1 or none. Other than taking vital signs, bathing patients, and making beds, most usual CNA responsibilites fell on the nurse. IV & phlebotamy team.
Mount Sinai Medical Center, New York, NY. Traveling nurse pay rate = $32/h + housing. There were no shift diffs or weekend diffs for traveling nurses. Full time was three 12h shifts each week with a fourth 12h shift every 4th week. I had to work about 1 weekend shift every 3 weeks. Nurses were responsible for checking all blood sugars. There was no IV or phlebotamy team or respiratory therapists. No max patient:nurse ratio. Usually 5 or 6:1 on days and 6 or 7:1 on nights. The most I ever had was 7 on days and 9 very briefly on nights.
University of Chicago Hospitals, Chicago, IL. Traveling nurse pay rate = $26.75/h (2008) & $25/h (2009). Evening, nite, & weekend day diff = $2/h (2008) & $1/h (2009). Evening & nite weekend diff = $4/h (2008) & $2/h (2009). I received holiday pay for working Thanksgiving. Full time = three 12h or five 8h shifts/week. Every other Sat./Sun. mandatory. Phlebotamy team. Max patient:nurse ratio was 5:1.
Mills-Peninsula Hospital, Burlingame, CA. Traveling nurse pay rate = $26/h + housing + $273/week for meals. No weekend diff for traveling nurses. New grad staff nurse pay rate = $44/h. Full time = five 8 hour shifts/week. Every other Sat./Sun. mandatory. Nurses check all blood sugars & do all dressing changes including wound vac dressings. Phlebotamy team. Max patient:nurse ratio was 5:1.
Brigham & Women's Hospital, Boston, MA. Traveling nurse pay rate = $19.25/h + housing + $245/week for meals. No shift diff or weekend diff for traveling nurses. For regular staff, Columbus Day & Veteran's Day received holiday pay. For regular staff, any hours worked after a 12 hour shift were paid double time. Full time = three 12h or five 8h shifts/week. Max patient: nurse ratio from 7A-11P 3:1 & from 11P-7A 4:1. IV team & phlebotamy team.
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