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strawberryluv, BSN, RN 6,989 Views

Joined Oct 8, '09 - from 'New Jersey'. Posts: 711 (32% Liked) Likes: 403

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  • Nov 13

    1. Donald Trump says that we all have the right to affordable, quality healthcare, and he has a plan, a great plan. For one, I'm super curious about this 'great plan' and I can't wait to see what it is. Mind you, I totally don't think it exists, and I don't think he realizes all the intricacies involved, but I'm looking forward to finding out.

    2. Things will go like they are. Actual poor people, the disabled, and the elderly end up with halfway decent socialized medicine subsidized largely by the middle class. YAY Medicare/Medicaid. We've had this limited socialized healthcare my whole life. By we, I mean this country, because I don't get ****.

    3. Rich people will continue to get whatever healthcare they want, because they can afford it with or without insurance.

    4. The middle class gets poorer by paying for government subsidies that don't actually benefit them, and continues to struggle to afford their medical expenditures all around. The majority of us end up with high deductible health plans that MAY benefit us once we reach our max out of pocket (until you realize that your max out of pocket does not cover prescription drug costs, costs of 'elective procedures', and a bunch of other even more ridiculous things. There is no real max out of pocket. They will let you spend as much as you are willing and/or able to.

    And vent time? Obama said my PCP and GYN yearly check ups and pap smears have to be covered by any plan that I choose. I went to my PCP for the first time in several years. I wasn't sick, but I figured, what the hell, it's free, right? No, his office managed to bill me for a physical as well as a well visit (for the same 20 minute appointment?) so yeah, one of those two got covered, the other didn't, and I still paid over 100 dollars for my yearly visit. My doctor's cash rate is $94. It would have been cheaper for me to lie and tell my PCP that I don't have insurance when I visited his office, and paid the cash rate. Let's all let that one reverberate a little bit.

    Because years ago we made it illegal to turn away a woman in active labor in the Emergency Room, that has somehow spun completely out of control to the point where we are not allowed to turn away any street urchin that stumbles into the ER weekly for their weekly fall/non-cardiac chest pain/dilaudid fix/attention/turkey sandwich, and we are penalized if it's not the BEST DAMN TURKEY SANDWICH they have EVER ENJOYED, WITH A SMILE, and WITHIN 15 minutes of arrival. Our country spends too much on healthcare because we don't know where to draw the line, and we can't support our Nurses and Doctors, the front-line experts if you will, so they practice CYA medicine with a smile. I admitted a patient last night with an 'NSTEMI' (read: anxiety. No bump in enzymes after 12h and 2 sets in ED, no EKG changes). She received a 2 view CXR ($400+) and head CT ($1,200) in Emergency room. She received a 2 day ICU stay (4k/day). She received a cardiac catheterization ($9,200) that was not clinically indicated. She has bullied her way into a MRI for a subacute, incidental finding on her CT scan (neurosurgery said she didn't need an MRI). Anyway, another $1,200. So that's a minimum of $16,000 that this one woman racked up in 2 days. Don't worry, she won't be paying it. The best part? She comes every 2 weeks. So even when she's just turned away from the ER after repeating labs, cxr, and head ct EVERY TWO WEEKS, that's $1,600 for the ER visit plus $1,600 in testing. $3,200 a visit. Multiply that by her average 25 visits over the last year: $80k in unnecessary visits to the ER and SOME of the testing that they do on her every damn time. So even if she only managed to get admitted once this year (and I know it was at least 3 times but now I'm just getting mad) our total tax burden for this one individual is around $100k YEARLY. And there is NOTHING MEDICALLY WRONG WITH HER EXCEPT SHE NEEDS A VALIUM (but doesn't have access to a PCP to give her some). All I want is to see my PCP for 20 minutes once a year, but I pay more to do that than this fine individual. If you'll excuse me now, I need a valium. Or the whole bottle.

  • Oct 28

    LTC has been a good place for me to land, so far. I worked on a busy Med-Surg floor for 4 months after I passed my NCLEX, and I absolutely hated it, to the point where I quit without giving notice. I had 8 total care patients, usually no CNA and supervisors that were unapproachable at best.

    Now I work on a busy rehab floor with anywhere from 11-15 residents. Residents w/total hips, paralysis, chemotherapy, radiation, terminal cancer, on hospice, etc. are the norm. So are PICC lines, nephrostomy tubes, Foley catheters, traches, etc. I love it, not because it's any easier but because I get to know the residents and their families. I have a general idea of what to expect when I come in. Things like new admits, falls and residents needing to be sent can (and usually does) happen during my shift, but it makes my med pass and day-to-day tasks easier when I know the resident and their family. They know what to expect, as well. The work environment is completely different, too: I always have 1 CNA, though usually 2, and even my more "hands off" supervisors will not hesitate to jump in and help out when I'm swamped. Most of them are the types that I can call with any question, no matter how "dumb" it may be, and they'll either have an answer or they'll be able to point me in the right direction of an answer.

    A good floor/unit for a new grad is one that understands that you're a new grad. It kind of sounds like the last place you worked wasn't a great fit for you. Don't be afraid to try out LTC. I've learned more about the human body and nursing in LTC than I did at the hospital, though I still use those 4 months of experience to care for my residents who are there for short term rehab. Keep the things you've learned. Best of luck with your future job!

  • Oct 28

    Home health is the new Med Surg, but working alone.

  • Oct 17

    We genuinely worry and care about our patients that it often consumes us. When a patient codes or expires, we are crushed. I once had a patient who got stuck at least 15 times by various staff members, including physicians, to get IV access. The patient took those sticks like a champ, but I still went home and boo-hooed because I hated to see him go through that. We hurt when our patients hurt.
    To me, this is the root cause of your issues.

    Personally, I do not worry about my patients. I assess them and intervene as I'm able. After that, I accept that things will run their course and I do not fret about it.

    When a patient dies, I generally remains dispassionately detached from the occurrence. I have had a couple of experiences with children that have made me sad and for which I've shed some tears but even then, I keep it at an arm's length... and I am never 'crushed' because I don't let myself care too much about it... because... this is my *job* and my job is to provide nursing care, not to become emotionally connected to what's happening. Sometimes I do begin to care more than I should and I actively nip it in the bud.

    And I certainly do not hurt when my patients hurt, even when we must poke them time and again, or when urology struggles to place a catheter, or difficult intubations, or chest tube insertions, or all the other invasive and painful things that we do to patients in order to treat them.

    I always recognize my role and that is of the professional nurse who is being paid to provide a service, one which I take very seriously and strive to perform at the highest level. My heart is my own and is reserved for my personal life.

    I would encourage you to seek counseling in an effort to learn to separate yourself from your work.

    Nursing is not a calling nor a mission; nursing is a job... and one which will chew you up if you get too close to it.

    Professional detachment...

  • Sep 14

    This is not intended to have you question your choices or for me to one-up anyone. I'd like to share the twists and turns on my nursing path.

    At age 22, I graduated with a liberal arts degree. No jobs. At age 25, I entered a highly-respected ASN program at an urban university.

    Failed first-semester A&P (liberal arts backgrounds don't always translate to strong science study skills). Repeated full A&P course the following summer and rematriculated.

    Earned a D+ in Med-Surg III, and my Peds instructor didn't like me. Sat out a year, got a full-time job as a nursing assistant on a Med-Surg unit in an urban hospital. (Pre the days of CNAs).

    Graduated at age 28, a year later than my cohort. Started working Med-Surg; recruited to ICU within 5 months.

    My hospital had full tuition benefits. At age 33, I switched to 12-hour weekend nights, and entered an RN-MSN program at my previous university. Graduated as a CNS at age 36.

    Spent 2 years working off my obligation to my employer who had no CNS position for me to fill.

    At age 38, started full-time PhD study at a highly-ranked research-intensive university; awarded PhD in Nursing at age 44. Began faculty research and teaching role; continued research with elderly ICU survivors.

    Returned to school to pursue a post-master's NP at age 45. Became an NP, in addition to research and teaching role, at age 47. Love my gero patients!

    Married and raised a family during these years.

    The beauty of Nursing is that you often can bend it and shape it to fit your life circumstances. Was it easy - not always. Has it been interesting - yes and yes. Did my family support my continuing quest for increased knowledge to always provide better and better care for patients - yes. Grumbly at times - yes.

    You want to take life by the horns and do your best to make things happen. If you are passive, life will pass you by.

    Nursing, with all its bumps and bruises, is the BEST profession for those who are inquisitive and feel a call to caring.

    Take it from an old-timer. My family has my back. My patients keep me centered, and my students keep me young.

  • Sep 7

    I am just over here trying to figure out where LTC pays more than ICU...

  • Sep 4

    Hi Nurse Beth,

    I am currently in a hospital leadership position but I'm thinking of leaving this position to pursue a clinical career. After being in nursing administration, I'm not sure that this is the best career path for me. I'm sure many people in nursing administration go through these same challenges. I have about 25-30 more years before I retire, so I thought that now might be a good time to switch over. Any thoughts or insight?



    Dear Not Sure of Career Path,

    Thanks for your great question

    I would say....switch.

    The first and primary reason is that you are unsure. When you are doing what you should be doing, you do not generally feel unsure at the core. You may get tired, experience ups and downs, or have disappointments, but overall you are fulfilled and are at peace.

    Being effective and successful in a role (such as leadership) does not necessarily mean it's your destiny. It means you are multi talented. Many leadership skills are transferable to different roles. Your skills, honed during your leadership time, will help you succeed on a new trajectory.

    The second reason is that you do not want to live with regrets. It’s scary to venture into a new career path because there are no guarantees and none of us know the future. But it’s worse to never try than to try and not succeed. Trying and going for it is succeeding.

    You are smart to be aware of and consider the timing in your career. Essentially by switching tracks, you are starting over and you may have a bit of time/ground/finances to make up- but it's all good in that you bring all your experience to the table in whatever career path you choose.

    One of the awesome things about nursing is the incredible amount of options available. Really, the only thing that limits us is ourselves.

    So spread your wings and fly….and be an inspiration to all of us.

    Best wishes,

    Nurse Beth

  • Sep 4

    You know it's going to be a bad night when you walk onto the floor and the charge nurse looks at you and says, "OH, THANK GOD YOU ARE HERE."

  • Sep 4

    When you ask who the intensivist is for the night and the day charge says "Dr. Doom!"

  • Sep 4

    Back when I worked the floor, I knew my shift would be a hot mess when a patient would announce, "I am going to die tonight. I am ready to be with the Lord."

    While these patients usually did not die, they almost always experienced a change in condition that could not be handled by the resources on our floor. This caused the night to be horrid.

  • Aug 21

    It was never a calling or childhood dream of mine either. I chose nursing because it was practical -- and because I wanted to have a career that contributed positively to the world. While I wasn't particularly passionate about nursing, I knew I wouldn't be happy doing something that hurt people for a living -- like make cigarettes, or lured people into wasting their money, or was somehow sleazy, etc. I was seeking a career that would be respectable and do good things.

    I also viewed nursing as a flexible career -- with many different possible career paths. I could do direct patient care as a staff nurse, part-time or full time, teach, be an administrator, do research, be an NP, etc. I would have lots of choices -- and as an 18 year old, I was not ready to make a commitment to any one career. I thought that majoring in nursing would be a way to delay that decision, giving me a general field that I could then narrow down as I got older and my needs & preferences developed.

    But while I was not passionate about nursing or "called," -- I was committed to doing a good job and to fulfilling my obligations to the patients, my co-workers, and my employers. I believe that committed is more important for success than the passion or "calling" that some people claim to have.

  • Aug 21

    Nursing was never a passion, childhood dream, or higher calling of mine. I entered the nursing profession as a practical means to an end. It has provided me with the flexibility, stable income, career mobility, and educational advancement I desire.

    As an aside, I was raised by two parents who worked mind-numbing manual labor jobs for a living. Their financial situation was precarious and always on the edge. However, the door to better job opportunities and higher pay had been closed off to them because they had no education beyond a high school diploma.

    Since I grew up without many middle class comforts, I wanted a career pathway that provided stability and a certain standard of living without taking up too much of my personal time. Nursing was the answer.

  • Aug 21

    Job security, a lot of options for advancement, good pay.

  • Aug 21

    In all honesty, with a school that only has 1 class meeting and 1 clinical per week, I'd be concerned about how well they will prepare you. How is their NCLEX pass rate? And are you someone who is going to be self-motivated to teach yourself as needed?

    And, yes, you will be preparing care plans on your patients. There is a lot more to nursing than just following doctors orders. There are times when you need to call the doctor and tell them what your patient needs. And there will be times where you see a doctor's order and need to question it for your patient's safety. The doctor orders it, but you are the last line of defense between the patient and the med/intervention, and you will be liable if you cause that patient harm, even if you were following a dr. order. Critical thinking is imperative.

    As far as care plans, you will probably start out with just one patient per day early on, and then as you progress through the program, that number will increase.

    Good luck!

  • Aug 21

    How hard is nursing school? I think the answer to this question depends on the individual's intellectual aptitude and prior learning experiences.

    Some people to the right of the bell curve will think nursing school is easy, while those to the left of the curve will feel it's the hardest feat they've undertaken.

    Most people in the middle of the curve will be somewhat challenged by the time constraints and new ways of thinking presented in nursing school, and will neither consider it 'easy' nor the 'hardest thing ever.'


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