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Job Title Nurse Clinical/UKHC Requisition Number NR12957 Working Title RN/ 7A WEPP / Neuroscience ICU Department Name H7100:Neuroscience Services Work Location Lexington, Ky Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift Must be able to work from two 12 hour shifts each week from 7am-730pm every Saturday and Sunday every weekend. This position is a Weekend Premium Plan (WEPP). Will also be required to work some holidays. Job Summary Registered nurses in the Neuroscience Intensive Care Unit at UK Chandler Hospital provide intensive neurological and neurosurgical care for adult patients ranging from 15 years of age and older. Patient conditions include isolated head trauma, ischemic or hemorrhagic stroke, spinal cord injury, anoxic brain injuries and other diseases of the brain and spinal cord. The RN serves as an important component of the critical care team; responsible for close hemodynamic, medication and ventilator monitoring and treatment of patient complications related to their neurological injury. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 10/28/2024 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Nurse Clinical/UKHC

Job Title Nurse Clinical/UKHC Requisition Number NR12120 Working Title RN/ 7P /Neuroscience ICU Department Name H7100:Neuroscience Services Work Location Lexington, Ky Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift Must be able to work three, 12-hour shifts per week from 7pm until 7:30am; will also be required to work some weekend and holidays. Job Summary Registered nurses in the Neuroscience Intensive Care Unit at UK Chandler Hospital provide intensive neurological and neurosurgical care for adult patients ranging from 15 years of age and older. Patient conditions include isolated head trauma, ischemic or hemorrhagic stroke, spinal cord injury, anoxic brain injuries and other diseases of the brain and spinal cord. The RN serves as an important component of the critical care team; responsible for close hemodynamic, medication and ventilator monitoring and treatment of patient complications related to their neurological injury. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 10/28/2024 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Job Title Nurse Clinical/UKHC Requisition Number NR13176 Working Title Nurse Clinical/ 7A WEPP / Neuroscience Progressive Department Name H7100:Neuroscience Services Work Location Lexington, Ky Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift Must be able to work two 12-hour shifts 7:00am-7:30pm every Saturday and Sunday as part of the Weekend Premium Pay (WEPP) plan, will also be required to work some holidays. Job Summary Registered Nurses on the Neuroscience Progressive care unit at UK Chandler Hospital provide progressive neurological and neurosurgical care for adult patients ranging from 15 years of age and older. Patient conditions include ischemic or hemorrhagic stroke, isolated head trauma, spinal cord injury, spine surgery and other diseases of the brain and spinal cord. The RN serves as an important component of the acute care team; responsible for close monitoring and treatment of patient complications related to their neurological injury. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 10/27/2024 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Job Title Nurse Clinical/UKHC Requisition Number NR12896 Working Title RN/Cardiovascular ICU Department Name H7300: CARDIOVASCULAR Work Location Lexington, KY Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift Must be able to work 36 hour each week, between 11p-730a Monday-Friday; will also be required to work some weekend and holidays. Job Summary Registered Nurses in the CVICU at UK Chandler Hospital provide care primarily to adult patients This unit provides care to patients recovering from surgical procedures which include: heart bypass, post-operative cardiothoracic, heart/lung transplant, and open-heart surgery as well as congestive heart failure, coronary artery disease, cardiogenic shock, and sepsis. Patients’ length of stay can range from overnight to several weeks or months. The unit also has a clinical nurse specialist on-site to provide education, referrals and consultations for staff, patients and their family members. The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 10/27/2024 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

The Division of Business and Community Services at Holyoke Community College is seeking part-time instructors to teach Nursing Assistant/Home Health Aide training courses for workforce training and contract training programs, based on DPH-approved curriculum and in alignment with state regulations. &nbsp;Instructor will prepare students to take and pass the&nbsp;D&amp;S Headmaster&nbsp;state exam. With assistance, the instructor will develop curricula and plan course content, provide lectures and hands-on instruction, and evaluate training effectiveness so that students learn the specific skill sets and knowledge needed to obtain certification and to pursue a career as a nursing assistant/home health aide. Supervises Clinical Rotations at Long-Term Care Facility.The instructor will need to be familiar with current state and federal regulations and will have to keep accurate attendance, grade, and skills information as required by the MA Department of Public Health, or be able to acquire such knowledge. At least one year of experience working in a Long-Term Care Facility as a Registered Nurse is required for lead instructors, and at least one year experience as a teacher, trainer, health care personnel instructor, or direct nurse aide supervisor.&nbsp;Contexts may include working with low income adults; in regional high school settings, with incumbent employees of healthcare providers, and/or other populations with unique needs.REQUIRED: &nbsp;<ul><li>Registered Nurse with current licensure in Massachusetts.</li><li>Ability to teach in online, hybrid or face-to-face settings.</li><li>MUST be available to teach face-to-face in the Holyoke area and/or Quabbin area, including Clinical Rotation supervision at a long-term care facility.</li><li>For lead instructors,&nbsp;minimum one year work experience in a long-term care setting as a Registered Nurse (please identify clearly on resume in order to be considered as a lead instructor).</li><li>One year of prior teaching or training experience; and,</li><li>Commitment to, and demonstrated ability to, work effectively with a diverse faculty, staff &amp; student body.</li></ul> EQUIVALENCY STATEMENT:&nbsp; Applicants who do not meet the qualifications as stated above are encouraged to put in writing precisely how their background and experience have prepared them for the responsibilities of this position. PREFERRED: &nbsp;<ul><li>Post-secondary teaching experience; and,</li><li>Prior DPH instructor approval.</li><li>Experience or knowledge of TMU Nurse Aide testing requirements</li><li>Experience working with diverse populations.</li><li>Qualified to teach CPR/BLS Certification classes.</li><li>Curriculum development or program design experience.</li><li>Bilingual capacity in English and another language.&nbsp;</li></ul>Part-time, Non-Benefited PositionHourly Rate: &nbsp;$65-$70; no benefitsFunding Source: &nbsp;Grant Position open until filled.- All candidates must have legal authorization to work in the United States. HCC is not sponsoring H1B Visa.&nbsp; &nbsp;- Pre-Employment Background check, including Criminal History will be conducted for all positions.

Holyoke Community College

Nurse Aide Instructor (Non-Credit)

<h4>How you will change lives</h4>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.<h4>What you'll be doing</h4>Patient care. You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.Technician Duties. You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.Safety and Quality. You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.PATIENT CARE TECHNICIAN STATE SPECIFIC BOARD OF NURSING REQUIREMENTS California<ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul>Maryland<ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul>New Mexico<ul><li>Must have New Mexico dialysis technician certificate at time of hire OR</li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program OR</li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul>OHIO<ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul>OREGON<ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;

U.S. Renal Care

Dialysis Patient Care Technician

<h4>How you will change lives</h4>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients.&nbsp; The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.What you'll be doingPatient care. &nbsp;You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.Technician Duties. &nbsp;You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.Safety and Quality. &nbsp;You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings. PATIENT CARE TECHNICIAN STATE SPECIFIC BOARD OF NURSING REQUIREMENTS California<ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul>Maryland<ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul>New Mexico<ul><li>Must have New Mexico dialysis technician certificate at time of hire OR</li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program OR</li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul>OHIO<ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul>OREGON<ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;

<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

840 Healthcare / Pharmacy Jobs in United States