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I'm a Care Coordinator in the telemetry unit. The telemetry unit is a cardiac care unit that gets its name from the telemetry machine used to monitor patients' vital signs such as heart rate, muscle activity, and body temperature. Patients are placed on heart monitors that send signals to a computer at the nurses' station.

I have been a nurse for 18 years.

I'm a nurse, but my title is Care Coordinator. My position is between the management level and the floor nurse level of employees.

I work with patients who are suffering from renal failure (kidney failure), are on dialysis in their homes, or need to start dialysis. At the beginning of the day, I have no patients specifically assigned to me. I make rounds with the doctors so that I'm familiar with all of the patients on the floor. On a normal day, this means knowing about 31 patients. I assist doctors and floor nurses with anything they need. I also assist with discharges. If a patient is being placed in an assisted living facility, I work out the details with the facility and a social worker to make sure the patient will be properly cared for. As more patients are admitted throughout the day, I assign them to floor nurses or take them on myself if the nurses have full loads. I am also in charge of coordinating the staffing for the next couple shifts. If there are not enough nurses scheduled, I call the on-call nurses or cover the shift myself. I handle any complaints a family or patient has about a nurse, doctor, or any other grievances.

Last week, we had a woman who needed emergency surgery. She had other things that needed to be taken care of before the surgery could be done, so she was scheduled to be in the O.R. (operating room) at 2:00 p.m. The woman's niece, a nurse at another Des Moines hospital, showed up at 1:00 p.m. and did not want the surgeon assigned to her aunt to perform the surgery. I had to call and take the surgeon off of the case. After three hours, I had talked to seven different surgeons. We arranged for the patient to taken to the hospital where her niece worked. We had a surgeon lined up, an ambulance on the way to get her, and had all of her scans on a disk to send with her. However, when we informed the patient that she would probably have to pay for the ambulance and one of the hospital stays, she didn't want to go. Luckily, a doctor I had called earlier called back and said he could come to our hospital and do the surgery. We watched her for another three hours, but she finally had surgery that night. The family was difficult to work with because it was a time-sensitive situation. It was also hard to call the original surgeon and tell him that the family did not want him to be the one to operate. I don't like doing that sort of thing.

I like to do IVs, because over the years you get really good at them. Usually when I walk into a room, people have been stuck five or six times, and they are sure I'm not going to get it either. And when I get it on the first stick, I walk out looking like a hero.

Nurses must wear navy and white. We can wear patterned scrub tops or different colored shirts, but our jackets and pants have to be navy and white. The dress code is used to help the patients identify who is doing what job. When they come in patients are told that their nurses will be in navy and white, the techs will be in cranberry, etc.

After high school, I attended the University of Northern Iowa (UNI) where I received a Bachelor of Science degree in psychology with a minor in therapeutic recreation in. Then, I moved to Colorado and began working with substance addicts, teaching them leisure activities to replace habits that had brought them to the psychiatric hospital. Three years later, I moved back to Des Moines, Iowa. I began nursing school right after the move. I qualified for an accelerated nursing program at the Iowa Methodist School of Nursing. The program ran for 18 months, and included only three weeks of class time. The rest of the time was spent working in clinical care on two-week rotations in each unit. I am glad I participated in the accelerated program because the immense hands-on clinical practice prepared me to hit the floor and handle a patient load right away. During nursing school, I also worked at here as a health care technician. Since receiving my diploma, I have spent the past 18 years as a nurse here.

In healthcare, people are always in some sort of crisis when you are meeting them for the first time. I've learned how important it is to make them feel like you are there just for them, especially for the first few hours, because they are in such crisis mode that they don't listen the first time. They don't know what the plan is for them being there. They get anxious if they put on their light and someone does not come in the first thirty seconds, because they are afraid that it's going to be like that the whole time they are in the hospital. Whether you are dealing with staff, patients, or families, you cannot over-communicate. You have to keep reassuring the patients and families, because they are not themselves in those situations.

Right now, I'm doing the management succession program. I go to all of the budget programs, and they start to groom you for when people retire from those positions. My plan is a three to five year plan. I'm not sure I want to do management, though. In five years, I might be ready to step away from the direct patient care, but that is the part of nursing that I love, so I'm not sure what my next steps will be yet.

My day starts at 7:00 a.m. It should be over at 3:30 p.m., but I count on being done by 5:00 p.m. I do not start and end my day with a set number of patients like other nurses do, so the time I am finished with my work varies.

The first thing I do when I get to work is to perform rounds with the doctors to see what patients we have on the floor so far. The last thing I do before I leave the hospital is charting.

There really isn't a typical day. Every day is different. On a routine day, I get reports from the night before, deal with any patient complaints, do blood draws and IVs that nurses are having trouble with, and do staffing for the next couple shifts. Then I meet the 15 or 16 patients in my side of the hall, take care of any needs they have, and update their charts. After checking on the patients, I check on the nurses and assign new admissions. I spend the rest of the day admitting patients, assisting nurses, taking over patients that are crashing, and taking care of issues between nurses and doctors that need to be handled.

There is a huge variety, and that is why I like my job. Whatever problems come up become my responsibility, and it is never the same. I get to fly into the room and handle problems, and then I am off to the next thing. Some days, I spend seven hours working with the same patient. Other days, I'll set up homecare for 10 people and do 40 other things. It is always different.

Before becoming a care coordinator, I did work some weekends. Now, however, I usually only work during the week. I try not to work overtime, but depending on my patient load and how many nurses we have staffed on a given day, I do have to work late sometimes.

If you work over 40 hours a week, you receive overtime pay for every hour over that you work. When I am on call, it is $3 an hour for call pay. If they have to call me in, I receive time and a half pay for those hours.

I'm not sure what the typical salary range is, because our hospital has created a team leader program. Salaries are skewed by experience, even within a team leader frame. I think if you were brand new and were in a team leader role, you would start at about $21/hour, and it goes all the way up to $42/hour. People who have been there for over 25 years are at the top end, but they are usually supervisors who fall within the team leader title. For my job specifically, the top of the salary range is probably somewhere from $35,000 to $40,000 a year.

In a hospital, an entry-level nursing position would be a floor nurse, also known as a staff nurse. Floor nurses have a set number of patients each day that they are responsible for.

No.

The fabulous thing about nursing is that every time my children's situation changes, I change my hours to accommodate whenever I need to be home. I don't feel like it interferes with my personal life. If anything, I think it has made me a better mom.

The nursing shortage has not hit the Midwest yet like it has on the coasts. The job is about as stable as it can get right now, because everybody knows a shortage is coming. Our field is feeling the pressure of the shortage now, though, because homecare has gotten so big, and a lot of people are branching out to that sort of work. People who have done hospital nursing for a long time and want to get away from the intensity, but do not want to go to clinic pay, are ending up in the homecare sector and are loving it. There are so many more needs for nurses now. For example, homecare consultants are starting to cover hospitals. They come in and get people set up for whatever homecare needs they have. There are also facilities like assisted living homes that are providing more nursing services than they ever did before, because they are trying to keep people out of nursing homes. So as these possibilities have broadened, in addition to the fact that the pay cut is not as diverse as it used to be, there are a lot more opportunities. You'll find a job if you are a nurse.

We have PTO time, so we have paid time off that we accrue based on the number of hours worked. For example, if I work a 40-hour week, I get about a day and a half (somewhere between 10 and 14 hours) every two weeks that gets applied toward my vacation. It just depends on how many hours we work during a pay period.

I love that each shift is completely unpredictable. I also enjoy the total hero moments, such as when I dart into a room to shock a heart and then hurry off to help the next crumping (failing) patient. Most of the time I'm just swooping in, fixing the problem, and then I'm out. So it's a total hero rush most of the time.

The worst part of my job is charting.

We have computer charting now, which we do not really like. The health system I work for purchased computer documenting when the systems were first coming out. A lot of other people started computer documenting, and then scrapped it because they realized it wasn't quite good enough yet. We are on the third or fourth tweak of the original system we had. For data collection, it is very good, because you can program in what you want to find and you'll get the information easily. For floor nursing, continuity, and finding out easily what a patient looked like four hours ago versus now, it is not easy. Our health system is trying to go to all electronic medical records and get rid of paper charts, but there is more paper in the charts than ever before. All of the doctors are trying to find ways to communicate through the written chart that is always with the patient, because when you get online, you have to flip through all of the screens. Nobody has time for that, especially when a patient's condition is deteriorating. The program is a long-time coming. There are systems out there that work better, but we do not have it yet.

Technology has had a huge impact on the way nurses do their jobs. It has also had a large impact on shift overrun because we can no longer just chart as we go. Everyone does his/her assessments, jots down the information on paper, and then transfers it into the computer later. And later tends to be after shifts are over and everything that needed to be done physically has been handled. On the other hand, things like digital radiology films that can be transmitted to radiologists at home (so they can read them 24 hours a day) are beneficial for patients.

It is growing and shrinking. There is so much more you can do in nursing now, such as the homecare systems, etc., than there used to be available. In theory, as people keep saying, you would expect there to be less people in the hospital and less nurses needed. We are not seeing that yet, though. The hospitals are probably where we will see the nursing shortage, because it is the intense side, and people do not want to do that forever. It is also where change comes fast and on a bigger scale, so people burn out faster.

There is no substitute for experience, especially when you are dealing with people. It is all based on what you see. There is a general pathophysiology knowledge that you come out of school with, but you have not seen all of the weird things that happen and don't know what to anticipate.

People who are interested in the human body and the pathophysiology behind what happens in disease processes would do well in nursing. You also have to be comfortable talking to people on a very personal level. You have to be able to connect with people.

People who are squeamish around needles or blood would not do well in nursing. You get to know strangers on a very intimate level, and if you are not comfortable with that, than nursing would be a horrible job for you. If you aren't comfortable touching people or you are not a good communicator, this would be a hard profession for you.

A little bit of both is important. For example, in our unit, we prefer someone who has been a technician and/or has experience working in a hospital system. Employers look at your Board scores, but they also go a lot on gut instinct. They also have to look at who is willing and can handle the schedule. When people apply, they do not always realize they will have to work two out of three major holidays. The preference of education or experience can also depend on how soon an employer needs to fill the position. For instance, employers who need to fill a position right away might choose a diploma-certified nurse with experience handling a full work load over a nurse who has a Bachelors of Science and Nursing degree, but has spent less time working on a floor.

You can have a diploma, an Associates degree, or a Bachelors of Science and Nursing degree. However, you have to pass the Boards tests before you can practice medicine.

I would recommend starting out with a job in long-term care first. If you survive the nursing home and the total care of patients like that, you'll be fine. Once you get your pre-requisites done and you start doing any clinical time, your first rotation is in long-term care. The reason for doing it that way is that you learn whether you can handle that intensity of care. So I think if people do that kind of work for a summer job, get their 150-hour CNA (Certified Nurse Assistant) certificate, and worked long-term care or as a hospital tech, they would know pretty quickly if this is the field they wanted to continue in. If someone can survive that part and are interested in the rest, then he or she can handle this job.

Get experience early, and make sure that nursing is really what you want to do. If you are interested in nursing and you can physically take care of people, you will be fine. You can never ask too many questions. You want to find another person that you are comfortable with and can ask for advice. It is not a loner profession. Get basic experience, and then try everything you think you might be interested in.