Emergency RN, BSN, RN, EMT-B 8,507 Views
Joined: May 24, '06;
Posts: 570 (65% Liked)
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UPDATE! So I hired a great lawyer, I'm doing alcohol outpatient treatment twice a week for 3 months, 16 hours of community service, and a breatalyzer in my car for at least 6 months then it gets dismissed..the TX BON approved me to take NCLEX with no stipulations against my license or further investigation. Lesson learned and it worked out for the best!
There's an excellent article in the UCLA Law Review that speaks to how accommodating patients' racial preference in their providers contrast to existing laws. The case in this interesting thread is apparently more common than assumed. Though this article focused on the patient-physician relationship, I think it applies to patient-nurse relationships too. With this lawsuit looming and having read the article, it appears that the current widespread practice of accommodating patient's wish stands on strong grounds after the author's legal analysis. I am interested on the outcome of this lawsuit only because if the nurse is victorious, it will be an unlikely precedent.
The article can be found here: http://www.uclalawreview.org/pdf/60-2-3.pdf
I added to my Tweet that CBS didn't even mention the word "nurse" or "nurses" in their coverage of the evacuation, saying that their consulting "doctor" was on the scene and "doctors and medical students" were doing the evacuations. Not once. Shame on them.
Stephen Colbert gave a wonderful shout out to nurses at NYU Hospital on his TV show The Colbert Report on Wednesday October 31, 2012.
I'd like to single out some heroes, okay, like the nurses at NYU hospital. After the hospital generators failed, these nurses carried twenty newborns down nine flights of stairs wall manually operating respirators
Just also wanted to say that according to published news/financial reports while NS-LIJ is doing well (it is one of the few NY state healthcare systems in decent if not flush with cash, afterall they paid for the Lenox Hill deal by writing a check with no debt involved IIRC), Lenox Hill hospital itself is a work in progress/another matter.
While losses aren't what they were leading up to the potential closure a few years back, the place still isn't 100% out of the red. LH also is still having problems with physicans leaving.
On another note NS-LIJ is still going ahead with plans for the new urgent care center on part of the former Saint Vinny's site (O'Toole Building). According to the same published financial report the land itself is worth about 54 million USD.
National Nurse United/will help... NNU Stands Behind Lenox Hill RNs on Fair Contract to Protect Patient Care | National Nurses United
... good news from Texas http://www.nationalnursesunited.org/...-nnu-in-decis/
Graduation is in 3 months, so taking the NCLEX is a few weeks after that. I got a DWI this past Saturday and court is Friday...can they kick me out of school for getting a DWI? Can the BON prevent me from taking the NCLEX? Is there additional paperwork or hoops I have to jump through now? I'm getting a lawyer hopefully tomorrow but I'm really scared I scrwed up my whole nursing career before it even begins..
(and yes, I've learned....I feel like a ****** person for getting a DWI, I could've hurt someone or my self and the guilt is killing me.....)
strange aneurysm around the aortic root, closest surgeon who would accept the case was 1000+ miles away (Baylor). He exsanguinated right in front of us as we were loading him into the plane, gone in less than 3 sec.
young child needed a heart transplant (and successfully received it). his cardiac silhouette filled the cxr. he was so fatigued that his lips would turn blue and his hr increased 200+ just lifting his arm for a bp cuff or sat probe.
and flyingscot, I've also coded someone and ran into them a few days later in the grocery store holding a case of budweiser and carton of marlboros. nothing like getting a new lease on life!!
1. Abdominal compartment syndrome in a 12 year old. Tragic outcome on that one. 2. Mesenteric venous thrombus resulting in ischemia and necrosis of the entire large and small intestine caused by BCP's. Also tragic outcome. 3.Old guy. Full arrest in the field, completely smurfed from the chest up. No cardiac activity on US after multiple rounds. Asystole on monitor. Went in to do morgue care 30 minutes after code called and ALL care stopped. Ears now pink and patient with slow but spontaneous respirations. Saw him 3 days later outside smoking!
During the process of orienting to the post, we had a presentation at the Army Education Center about using our Tuition Assistance (TA) dollars. I listened with interest because I knew I wanted to get started on my MSN as soon as I could. I learned that the Army has a website, GoArmyEd.com, that service members can access for tuition information, requesting access to TA, finding information about schools, etc. I asked my CNOIC about the process of getting access to my tuition dollars, but he wasn't sure; I told him I'd blaze the path and get back to him. For some reason I had it in my head that I couldn't access my tuition dollars for a couple of years after commissioning, but that's not true. I think if a person is going to apply to go to school full-time as an active duty member, that is when you have to wait a couple of years, but I don't know that for sure. Anyway, I created my account on GoArmyEd.com and started looking at the website for guidance.
I was pleased to find out that I was eligible for $4,500 in reimbursement per fiscal year. Jackpot! I also discovered that GoArmyEd has relationships with many schools -- designated as eArmyU institutions -- that make it easy to take classes; a soldier student enrolls in classes through the GoArmyEd website, and the Army pays the money directly to the soldier's chosen school. Soldiers cannot receive TA for the same or a lower educational level than a degree they currently hold (e.g., I cannot get TA to complete another Bachelors degree because I already have one). TA is also not authorized for programs beyond a Masters degree.
Soldier students also have to complete a Tuition Assistance Statement of Understanding (TA SOU) every year. For soldiers with rank E-6 and below, their commanders must also sign the form. For E-7s and above and officers, we may sign our own form. This form must be re-signed and re-uploaded or submitted annually, and soldiers will receive email reminders 90 days prior to the TA SOU due date. One thing that the Education Center speaker stressed to us during our information session was that, without the renewed TA SOU, students will NOT receive their TA funding, and class requests will be denied. Basically, the TA SOU ensures that students are aware of their obligations in return for the TA dollars. For every class we take for which we receive TA dollars, active duty folks incur another two year of Active Duty Service Obligation (ADSO) from the end point of that class. So for example, if my last class were to finish in January 2013, I would have to remain in the Army until January 2015, or I'd owe Uncle Sam a pro-rated refund. At the time of initially applying for TA dollars, soldiers must have at least two years of time remaining on their currently duty obligation in order to receive TA funding, something I discovered because I was mis-coded in a database and it was showing I had less than two years remaining. Because I've only been in about 7 months of my initial 4 years of active obligation, I knew that wasn't correct!
First I looked for an MSN program. I decided I'd pursue an MSN with an education focus. There are many schools that participate in the eArmyU program, and I noticed that Excelsior College was one of them. I knew that their per-credit-hour price for active duty military grad students was purposefully right at the maximum that the Army will cover, $250 per credit hour, meaning the only money out of my pocket for each class would be spent on books and not on bridging a gap in tuition coverage. The Army didn't cover the application or enrollment fees, but those were relatively inexpensive. I attended Excelsior's ADN program, so I knew they'd have the transcripts already for three of my four degrees. I was also familiar with their class software, policies, and procedures, so it was an easy choice to go back to my "RN roots" for my MSN. I had my BSN transcripts sent, applied to the MSN program, and was accepted and all set within a couple of weeks. I have to take a total of 11 classes or 39 credits for the MSN, which comes out to $9,750 ... a veritable bargain at active duty pricing!
Once I picked my "home" school and degree program, I applied for my TA using the GoArmyEd common application. I had to write a brief paragraph detailing which degree I was seeking to pursue, which school I wanted to attend, and why I wanted to pursue this degree. Easy enough. My TA dollars were approved in less than a week.
For schools that are part of the eArmyU system, you cannot enroll for classes directly with the college if you want to use TA dollars to pay for tuition; enrollment is done through the GoArmyEd website. Also, soldier students are required to have a Servicemembers Opportunity Colleges Army Degree (SOCAD) Student Agreement (SA) or documented degree plan uploaded to the GoArmyEd Student Record prior to the end of the second class at one's home college, or after taking 6 credits through GoArmyEd. I immediately requested Excelsior upload my SOCAD SA/Degree Plan, and that was done pretty quickly.
GoArmyEd has an easy online enrollment application that runs on the PeopleSoft platform. The site will also indicate if a class is not automatically approved for TA dollars, and it will warn you in huge red letters if something isn't covered by TA. One of my MSN requirements is a graduate-level elective, and because the class I chose isn't part of the nursing series, I had to first submit a help desk ticket with details and justification to request an exception. I have to commend the GoArmyEd help desk -- they are easily the most responsive and speedy help desk I have ever had to bother! I submitted my request for enrollment exception and had it granted the very next day. Too easy!
I am currently entering week 13 of 15 in my first class, NUR 502: Theoretical Foundations of Nursing Practice, which started in early September. I started MLS 667: Cultural Diversity in the Workplace at the beginning of November, and it's just an 8-week class (the only one in my entire degree plan that isn't 15 weeks long). I'm finding that having a bit of overlap in which I'm in two courses at one time isn't too much of a hardship, as long as I don't procrastinate! Books are running about $100 per class, give or take; I buy them used for less, of course! The Army has picked up the remainder of the tab, and I've registered for NUR 512: Professional Role Development and Ethics, which starts the first week of January. I intend to register in January for another class that starts in March, NUR 531: Health Care Delivery Systems: Political, Social, and Economic Influences, resulting in a little two-class overlap again. Hopefully it won't be too much with my other collateral duties as they're shaping up, but I think I can manage. I did always like to stay busy.
PT, PT ... how I love and hate PT! I just completed my semi-annual Army Physical Fitness Test (APFT) during the last week of October, and I was very happy to pass with a decent margin and score. I had been working hard on my sit-ups -- my Achilles heel to be sure! -- and I completed that portion of the PT test without too much pain or torture, and actually felt an improvement. This was the first APFT in which I wasn't too terribly worried about passing the whole enchilada, a nice change from my previous stress levels where the APFT is concerned. Did I still stress about it? Sure I did! That's how I roll, and I am far from being a PT stud. I continue to be a work in progress.
And how is this for irony? I am the oldest Army Nurse Corps officer in my department, but I'm also the only one that had to take the PT test! Everyone else has a temporary profile for one thing or another, so I was flying solo. No pressure, right?! Haha. I felt like I had to make a good showing to represent my nurses! My medics were proud of me for doing as well as I did, and my senior medic/shift leader even came back to run the last few hundred yards with me to support me when I was sucking wind at the end of my two miles.
I used a couple of apps on my phone to improve my sit-ups and push-ups -- the apps are from Rittr Labs, and they help you reach however many continuous sit-ups and push-ups you want to do. My push-ups are already pretty good, but I figured they could use improvement as well. My current daily regimen involves running a mile on the treadmill (at the gym or at home -- I have a lovely Sole treadmill in our exercise room at the house, great investment!), and then doing sit-ups and push-ups on alternating days. Even on my workdays I have time to get this in before I go to work; it takes me a total of 15-20 minutes to complete everything, and if I have time, I run further than a mile. I feel so great when I work out daily!
Another thing I didn't realize was that running shoes have a pretty short lifespan, and even more so if you're running on them every day. I bought my last pair of shoes, Reebok Runtones, about a year ago, and it is recommended (probably by the running shoe industry, haha) to get new shoes every 6 months. After I'd run about 9 days in a row, I started to notice some heel pain. I figured it was time for a new pair of running shoes (and my husband pointed out that perhaps I also needed a day off from running!), so I bought a nice new pair of Nikes, the In Season TR model with a comfy footbed. And by the way, military folks, if you're not in the habit of asking at every store for a military discount, start doing that! As an active duty newbie, I used to forget. But a lot of stores give us discounts, and my running shoes were 20% off at the sporting goods store where I bought them!
I'm happy to report that my heels are pain-free once again in my new shoes. I also discovered that Rittr Labs has apps for squats and pull-ups, so I'm going to incorporate those into my workouts as well. I especially need to work on the pull-ups, because the Army is currently test-driving a revamped APFT and they are considering adding dead-hang pull-ups. Oh boy. The new test information can be found here: http://www.armytimes.com/news/2011/0...ew-pt-030411w/ with a follow-on story about more changes here: http://www.armytimes.com/news/2011/0...anding-091011/. I don't know when it'll happen, or if, or even what the standards will be for my gender and age group, but I want to be prepared. Even though there is no formal PT for our department, we are expected to work out on our own; the fact that some are not doing it is reflected in unsuccessful APFT attempts. Consistency is a huge factor. I promised our excellent leadership at Ft. Sam Houston that I wouldn't be a member of the four-mile club (just doing the two two-mile PT tests a year), and I meant it. Fitness is and will always be a defining factor in the Army, and commitment to fitness is just as important as commitment to service; you cannot have one without the other.
That's enough for today ... it's time to go running!
What medical information was revealed?
Since when is a name private medical information?
Us nurses are such criminals aren't we.. :icon_roll
I really had no idea what to expect from working in an Army ER, but I suspected it wouldn't be much different than any other ER. I knew just from my experience with various ERs in the northern and northwestern Virginia area that most ERs had similar patient demographics and similar ... patient "challenges," shall we say?
One thing that is markedly different from my old ER: the average age of my patients in the Army ER has dropped dramatically. One would also assume that because of the younger age range, these are healthy people, but that is not always the case. I have stopped in the middle of several shifts and thought to myself, "Wow, we see some really sick people here!" Though I am thankful for the younger demographic, because I can recall shifts during which the average age of my patients was about 95, and they were all very sick or trying to climb out of bed.
We also see some extraordinary numbers in our small Army ER. When I was first in contact with the head nurse and started asking typical questions about the ER (number of beds, nurse to patient ratio, number of daily visits, etc.), I thought her answer for the number of patients seen daily was a typographical error. We average more than 100 visits daily in our few beds -- we have 11 beds in the main ER, then 4 beds/rooms in our urgent care/fast track area that are only open for about 12 hours a day, so for the most part, we're pushing big numbers through the main 11 beds. I am still scratching my head over this, after coming from an ER of 15 beds where seeing 75 patients in a day felt like the seventh level of hell. The only thing I can figure is that maybe it's because we don't really slow down at night, and we are usually running the entire shift. But I adore my night shift people! My RN coworkers and medics rock, and I am grateful to work with such a team. When I left my ER in Virginia, my biggest regret was leaving my fabulous team -- these were the people that raised me as a nurse over the years, as it were; they even gave me an beer stein as a farewell gift that has "Raised By [Facility Name]" engraved in the glass. I thought I'd never find such a great group of coworkers again, and I'm happy to say that I was wrong. Not to say I don't miss my Virginia peeps, but the sadness is lessened by the awesomeness of my new peeps.
And Army healthcare in the ER ... well, it's free. Really. No money exchanges hands anywhere in our ER, no copay, nada. People who are eligible for care (active duty and their family members, eligible retirees and family members, reservists or national guard on orders, etc.) don't pay a dime to come to the ER. It's like a frequent flyer's dream! It also leads to abuse of the ER, for sure, but often these patients aren't able to get in to see their primary care managers (PCMs), or it's the middle of the night and they're having acute symptoms. I get it. And you know what? I'm fine with it. I joined the Army Nurse Corps to care for soldiers and their family members, and I am getting what I asked for, and then some! We see a lot of pediatric patients, and with the post-deployment baby boom, a ton of OB patients as well. Greater than 20 weeks and they go right upstairs to L&D if they have a pregnancy-related complaint, but we keep the less than 20-weekers, and there are a lot of them. Military people seem to like making large families!
And this is interesting -- we can turn away civilian patients who are not eligible for care, as long as they aren't presenting with a life threat. That was weird for me one night in triage to tell a patient that we weren't going to see him for his minor complaint. He was on post with a group of contractors for some kind of conference, and his coworkers told him he needed to go to the ER for this minor issue. He was prior service, but was not eligible for care in a military treatment facility. I learned that even though he has insurance, he would still get an enormous bill that his insurance would not likely cover. Once he heard that, he thanked me for my time and beat feet out the door. Granted, if that same guy showed up with chest pain, we wouldn't even have had the conversation; we'd see him, no question.
The military system has its flaws, but overall I have to say my experience as both a nurse and a patient has been good. No, I have not been a patient in my own ER, but I was able to get in to see my PCM for my periodic health assessment in a timely manner. Also, the pharmacy is great -- a patient can pick up prescriptions almost as soon as the doctor enters the order in the computer, and guess how much prescriptions cost? That's right -- nothing! Medications are free. The first time my husband and I went to pick up a 90-day supply of one of his regular medications, I kept waiting for someone to ask us for money. Pretty strange!
Am I still glad I joined the Army Nurse Corps? Absolutely. I am loving it! At the tail end of a shift spent in the "penalty box," AKA triage, I am not quite as cheerful, but no regrets ... proud to wear the uniform! I just kinda wish I could wear scrubs in the ER, though.
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