Rekkashinorei, BSN, DNP 1,710 Views
Joined: Oct 21, '09;
Posts: 11 (36% Liked)
; Likes: 17
Emergency Medicine NP
Thanks for the kind words - I am due to renew my malpractice insurance soon and yes I have 1/6 million coverage. Yes, although I don't plan to use it, I look at it just like I look at my homeowners or auto insurance. My car is paid for, yet I still carry full coverage as it would cost me more money to replace it from ground zero without the help of insurance.
I respectfully disagree with Risk Manager and have taken the advice of my attorney. I do appreciate the opposing viewpoint and respect their experience, its just my experience has been different.
I am not TraumaRUS, but as the risk manager who does this sort of thing for a living, here are my thoughts:
First, did you read my article and do you still think it is necessary to buy your own policy: http://allnurses.com/general-nursing...sk-999441.html
Second, the difference between $ 1/3 million and $ 1/6 million is only the aggregate policy limits. For $ 1/3 million, CNA will pay up to $ 1 million for any one claim, and up to $ 3 million for all of your claims in any one policy year. For $1/6 million, CNA will pay up to $ 1 million for any one claim and up to $ 6 million for all of your claims in any one policy year. The chances that you would ever have a malpractice claim that is not covered by your employer, and is therefore covered by your own individual policy is extremely small. The chance that you would have more than one paid claim covered by your own individual policy in any one year is even smaller. The chance that you would have so many paid claims in any one year as to make you grateful that you bought $ 6 million as opposed to $ 3 million in aggregate coverage is probably about one in a trillion. That would mean that you screwed up so bad and so frequently that CNA paid $ 6 million for all your cases in just one policy year, and if that happens, I am pretty confident that you will not have a license since it would have been stripped away by the BON. Probably the more compelling reason to get your own policy is the 'licensure defense' coverage, which provides up to $ 25,000 reimbursement of defense legal fees that you incur in an actual complaint against your license by the BON. Note that it must be an actual complaint to trigger the 'licensure defense' coverage: BON investigations do not trigger coverage and you get no reimbursement of defense legal fees for an investigation. Feel free to post here or send me a PM if you have any other questions.
Reading these boards as long as I have you come to recognize the members who are in the same boat as you are career wise. I had a realization this week and wanted to share.
I have survived my first week as a FNP. This week was more like clinicals as in I'd see a patient and then go in with my MD for the day or we'd go in together and I'd take the lead on questioning and assessment. Thankfully all of the doctors around me are very supportive and knew I understood the new graduate nerves.
Did I know everything? No. Did I know every treatment? No. Did I at least ask the right questions and get in the same ball park? Yes.
Example: headache for almost 2 years. I asked the right questions, did my assessment, and figured the headache was somehow related to neck issues. MD figured occipital neuralgia. Did I know what that meant? No. But had I gone and done a little research (if the MD was not there) I'm sure I could have come to that diagnosis after researching it afterwards. I at least knew it didn't fit a migraine, cluster, or tension headache so more research or consultation was needed.
I'm trying to keep in mind that school does NOT teach us everything. It teaches us to be SAFE as new health care providers.
If many of you are like I am you want to be right. You want to know the answer and fix everybody on the first try. I have been told time and time again it won't happen every time and I'm finally starting to realize it (early on thankfully).
I'm looking forward to these next few weeks in becoming more independent!!
To others feeling the way I have: you are not alone!!!
Well I took the position. the contract is en route. We shall see
I'm hoping you haven't been too put off by the negative comments you've received. All too often, my colleagues get defensive and suspicious of young people who commit no worse crime than displaying a lot of energy and enthusiasm for their future careers in nursing. They expect you to know everything before you have had a chance to get out there and learn. I am really happy that you are considering a career in anesthesia, and I'm glad you're bringing so much positive energy to the pursuit.
You're past academic success proves you are smart, so I'm sure you could improve your performance if you were to slow things down a bit. If you are still serious about a career in anesthesia, you might want to speak to your academic counselor about the possibility of converting to a traditional BSN program. If you stop the bleeding now, step back, take a breath, take a lot fewer classes per term and kick ass on your exams in a traditional program, you will have something impressive to show to the grad school admissions committees later on. You will also have a good story to tell, since you'll be able to show them you had the maturity to assess your situation and take some dramatic steps to improve it.
You will still have to face tough questions from them (e.g. "Accelerated BSN programs are hard, but grad school -- especially in anesthesia -- is a lot harder, so please tell us why you think you can hack it even though you couldn't hack the accelerated BSN program"). But I'd rather have you answer that question with a set of good grades from a traditional program than explain a more mediocre performance in a completed accelerated program.
The idea is that you want to have some good strengths to play off against any weaknesses in your application. I would even recommend that you take a couple of grad school classes after you finish your BSN just to show them that you can do grad level work without problems. But that's for further down the line. For now, I'd say focus on recalibrating your academic progress through a slower, traditional program, go work hard as a nurse for a couple of years and then get ready to apply to anesthesia school if you're still committed to it at that point.
Missy, I can relate to your situation somewhat. I was a very good student as an undergrad, but I wasn't the type who could ace a ton of classes in one semester. I always took the minimum number of classes and made sure I had time to excel in each of them. It wasn't until later on, after I finished my first degree and went out into the world and worked for awhile, that I was able to return to school and kick butt in an accelerated BSN program for second degree students (my first degree was in Latin American Studies, of all things). From there, it wasn't too hard to convince the admissions committee that my range of experiences in school and work proved I'd do well in anesthesia school. Your story will be different, but you will still be able to make a strong case if you make good decisions from here on out.
Don't let the haters hold you back. Just keep in mind that grad schools know what they want and it's up to you to make the choices necessary to give them what they want.
Hope this helps! If you have any further questions, just let me know.
Have you read this blog here on allnurses yet?
This is MY vent for the day. If you are a person who thinks that becoming a nurse is the quick-fix to your personal situation, please realize that being a nurse requires more than intelligence (it CERTAINLY DOES), and ability to get good grades.
You have to care.
And I mean A LOT.
I'm tired of reading threads about people with or without advanced degrees trying to "speed through" so that they can get to the "top" specialties without even THINKING about their impact on the lives of people.
I don't hear the "I want to be a good nurse."
All I hear is "HOW FAST CAN I BE A CRNA??????? or NP????"
You know what else I hear????
ME, ME, ME, ME, ME.
Anyone care about the PATIENT?????????
Anesthesia is not for everyone, that is the plain simple truth.
When I was a program director, one of the hardest things I had to do was dismiss students from the program. The reasons usually were not academic, but were related to difficulty learning clinical skills, inability or understand the politics of the operating room or rigid thinking regarding anesthesia techniques.
Now that the admission requirements are more rigid, students are comfortable with many of technical aspects of one to one patient care and with ventilators and tubes.
As a CRNA, I have seen some mediocre colleagues (the ones you wouldn't request for family members) and I have seen some spectacular anesthetists. This is probably no different from any profession.
As a legal consultant, I have seen some really bad practice, usually by CRNAs who have become complacent, have not kept up with current practices or have substance abuse issues.
As you know, I love anesthesia, but it is not a profession for anyone who doesn't like it. You have to be comfortable in the anesthesia environment, like patient care a lot and be willing to participate in life-long learning.
We are an elite profession with an excellent professional organization, AANA and have an amazing history. But, if you need a lot of direction, not comfortable making your own decisions or have difficulty dealing with stressful situations, you need to reconsider anesthesia.
....... CRNA's bring to the playing field more than just anesthesia, they are nurses too!
CRNA is an advanced practice role for nurses. I am not a CRNA, but am a CNS (another APN role).
I agree with others that prior to choosing an APN role, you need some type of experience as an RN and then some shadowing time with a CRNA. It would be a real drag to go through all the work of getting into CRNA school and then you decide it is not for you.
To be honest, you need some RN experience before deciding on an APN role. Otherwise, you do risk the possibility of being "locked into" one role over the other.
To MSPCRNA - just curious, what is your educational background? The military? A couple of years ago while working in the ER, I had the good fortune to meet a wonderful nurse who was a CRNA who had her training during the Vietnam era - she was absolutely someone who I really admired and did a great job too. What impressed me most was that she was a nurse first, then a CRNA. I think CRNA's bring to the playing field more than just anesthesia, they are nurses too!
Here are the tuition figures for Samuel Merritt University in Oakland, California:
2010-2011 Tuition and Fees | Samuel Merritt University
Here is a flyer I got from one of the informational meetings
certified registered nurse anesthetists (crnas) at a glance
nurse anesthetists have been providing anesthesia care to patients in the united states for nearly 150 years. crnas administer approximately 30 million anesthetics to patients in the united states each year.
what is the role of an individual crna?
a crna takes care of a patient’s anesthesia needs before, during and after surgery or the delivery of a baby by:
In our ED, it's not uncommon for us to see inmates from the local adult detention center. They are always accompanied by deputies, meaning they need a more private room because of the size of their entourage and propensity for associated drama-either the patients themselves being unruly, or the irresistible urge other patients or family members feel to become spectators to the patient's situation. So even with a potentially high-acuity patient, it's not uncommon for inmates to be placed on the fast track side of the ED where the rooms are private.
One such patient came into one of my fast track rooms as the first patient of my shift, transported by county EMS. From the beginning, it became apparent that jail personnel suspected this patient of faking stroke symptoms to get out of jail. It wasn't overtly stated, of course, but the disbelief could be heard in the tones of voices. Because we'd recently had a patient with similar symptoms from the jail who was found to be ultimately faking symptoms for a little "vacation from incarceration," skepticism was running high.
Such skepticism resulted in a five-hour difference between the time of the patient's onset of symptoms and complaint to jail personnel to the time the patient hit my ED bed. The paramedic who brought the patient in expressed skepticism as well, but there was something about this patient that kept my index of suspicion very high-I just had the feeling that the issue was genuine, and I took swift action in getting our physician into the room. After a rapid assessment (and noting that my patient was also very hypertensive), we had the patient over to the CT scanner and on the table within just minutes of arrival. There was just something in the way that my patient's left arm looked-not just flaccid, but with the hand almost contracted inward-that told me it was real. I'm glad I went with my instincts.
As it turns out, my patient had untreated hypertension and had stopped taking a prescribed beta blocker a year previously, and now had an intracerebral hemorrhage. I administered meds to lower my patient's pressure a bit without dropping it too fast, while our team leader and secretary worked on the unique logistical challenge of flying a prisoner and a deputy with a sidearm by helicopter to a local Level 1 with neurosurgeons on staff.
Then, for my patient, the last straw: the deputies refused to allow my patient to call or contact family so that they could be aware of what was transpiring. My patient wore a look of fear; whereas the deputies seemed to have no grasp of the severity of the situation and my patient's condition, my patient certainly did. After discussing this turn of events with my team leader, I went into my patient's room and got the phone number my patient wanted to call. With my patient's permission, I called my patient's elderly parents and apprised them of the situation.
I understand that the deputies have rules about contact and allowing people to know when a prisoner is going to be in transit or out of incarceration; of course, this is a perfect time for friends and/or family to plan a jailbreak. However, I felt that, given my patient's situation, contacting my patient's family would help give my patient some peace of mind. And, as my patient noted (sense of humor perfectly intact), my patient's entire left side was useless, eliminating the chances that my patient would (or could!) run anywhere.
As the helicopter crew packaged my patient, I told my patient that I'd contacted family, as requested. My patient thanked me tearfully, and told me that sometimes people need just one person like me to be on their side. While I'm sure the deputies were not happy with me (with good reason, certainly), I chose to act for what I perceived to be the best interests of my patient, who had already been treated poorly; I thought my patient deserved just one break that day.
Ironically, my last patient of that same shift was a younger person who came in complaining of dizziness and hypertension. This patient had stopped taking beta blockers prescribed for known hypertension five days earlier. This patient told me the beta blocker made this patient feel funny, and that the patient's spouse "nags" the patient to take it. So I said, "Your spouse is right; let me tell you a little story," and I told this patient (without going into too much detail, of course) about my earlier bleed patient who had stopped taking a beta blocker, which just happened to be the same beta blocker prescribed for this patient. This patient was horrified, saying, "I need my left side!" I said, "You also need your right side, and your whole brain." This patient was so utterly flabbergasted, it was nearly comical-either this patient had never grasped what had been related by physicians about the potential dangers of untreated hypertension, or this patient had been in denial and wasn't open to the teaching at the time. The patient said, "Oh my God, I'll never not take my medicine again." When it came time for me to leave at the end of my shift, I went into the patient's room to tell the patient about the nurse who'd be taking over for me, and to wish this patient well. The patient told me that they'd always remember me, and that they would definitely be taking their blood pressure medication. And as many times as we've all heard patients lay claim to future compliance, saying, "Oh yes, I'll take my medicine from now on," I saw the look on this patient's face and believed it.
In just one day in the ED, I felt as though I'd made a difference in the lives of two patients with very similar stories, and what could have been similar outcomes down the road. I think this was the first time I truly experienced the power of nursing. I work with so many nurses who are the type of nurse who is so memorable, that a person who is fortunate enough to be in their capable, caring hands will always remember them and what they did for them during what is sometimes the worst time of a patient's life. That is the kind of nurse I aspire to be, and in this moment, I became that nurse.
One of my very first patients off orientation as a new graduate nurse was named Ida (name changed for obvious privacy reasons). Ida was a morbidly obese lady in her early 70s. Ida came to us from an understaffed and unsafe local nursing home. She had type II diabetes and as a result had necrotic toes on her feet. Infections were common in her feet, and they tried relentlessly to treat in the nursing home. But one of the sad things about state run nursing homes are the not so good doctors that oversee too many patients. Her doctor put her on some pretty heavy duty antibiotics which ended up being toxic to her kidneys and landed her in Acute Renal Failure. On top of everything else, Ida was developing pneumonia from being bedridden for so long.
I walk into Ida's room on the first day I was assigned to her and she just gave me a hollow look. I smiled, introduced myself, and informed her I would be taking care of her for the day.
"Ida, I'd like to do a quick assessment on you to see how you're doing, is that alright?"
"Okay," she answered me in a raspy voice. I would go through my assessment noting extreme edema, coarse breath sounds, and a fungal rash on her skin. I pull out her pharmacy of morning meds and go through each one with her, dropping them in the medicine cup one by one.
"Alright Ida, can you take your morning meds for me?"
"Why, not Ida?"
"Not now, later. In a few minutes."
A few minutes passes. "how about now Ida?"
"Okay." I place the first pill in her applesauce and try to give it. "No, Please. Not now, later." It circulated like this all day. I never got one pill in her.
Ida was not able to move on her own, therefore we needed to turn her every two hours. With Ida being a rather large lady, we needed three nurses to attempt to budge her. It was awful trying to move her and Ida wanted nothing of it. She would scream and yell every time we would touch her, "No, please. No, Please. NO, PLEASE! NOOOO, PLEEEEEAAAASE!" But we had no choice but to do this every two hours so she wouldn't develop painful bed sores. It was harder and harder to find other nurses every two hours to help me turn her. Nobody wanted to deal with her screaming, thrashing, and hitting if they didn't absolutely have to.
Ida also kept spiking really high blood pressures one day I was caring for her with pressures in the 190s/110s. After receiving orders for IV anti-hypertensives, I had to check her BP every 15 minutes due to its potency. I came into put the cuff on her. "No, Please."
"Ida, I need to keep track of you pressures so they don't fall dangerously low."
"NO PLEASE. I'm done, no more. I don't like it. NO PLEASE!" I placed the cuff on her anyways. She screamed and shrieked when the cuff inflated. I held her hand and attempted to console her but she wanted nothing of it. She repeated this every 15 minutes when I needed to retake her pressures.
On the third day I took care of her, she was beginning to get dirty and unhygienic. She refused her bath everyday from the CNA and did so that day as well. I told the CNA not to worry about her, and that I would get her cleaned up today. I filled up a pink tub with hot water and soap, place a couple of washcloths in the basin, and swung some towels over my shoulder to dry her off with.
"No, NO BATH! I don't want it!"
"Ida, I need to clean you up, you are getting sweaty, dirty, and uncomfortable and this will make you feel better. I promise this is for comfort, you will feel better."
"No, no, please." But she said this with less force this time so I took my chance and got in there and stated cleaning. Once we got into it, she accepted it more and let me. She however still did scream when I had to lift her arms, get between her legs, or clean under her fat folds. I was trying to make conversation with her throughout the bath, but she wanted nothing of it and ignored all my friendly advances. Finally to break the awkward silence, I turned the TV in her room on. She immediately turned her attention to it realizing it was there for the first time.
"Ida, do you want to want to watch this station?" She shook her head, so I changed stations until we got to an old game show. "How about this Ida?" She nodded her head. "You like game shows?" She nodded her head again. "Ida, what is your favorite game show?" I didn't expect her to answer.
"Let's Make A Deal," she croaked. I was flabbergasted. After three days of yelling at me and ignoring me, she was connecting with me on a friendly human level. It was at that point I no longer viewed her as a combative difficult patient, I saw all the humanity and suffering within her. There was a real woman in there that had been broken by her terrible situation.
Ida didn't communicate with me any further for the rest of my time with her. She didn't communicate with anyone. Doctors would come into her room and ask her questions and she would just ignore them, or lead them around in circles. The doctors would then look to me for answers, not that I had any. I knew Ida didn't want to live anymore; she didn't want any more treatment and tried to be my patient's advocate and communicate that to them.
Ida never married, and only had one living niece. She came in and visited with her one day for a mere 15 minutes. She couldn't handle seeing her Aunt in such an awful situation. She stayed only long enough to give her blessing as her power of attorney for a DNR/DNI order.
A few days later when I had a different patient assignment, I walked by her room and noticed that it was occupied by a different patient. I figured they discharged her back to her nursing home and didn't think anything else of it.
The next day at during lunch time I was flipping through the local newspaper. I happened along the obituaries and noticed a familiar name. There was Ida, written that she died at the hospital two days prior. I was floored and couldn't believe that she passed a mere day after I cared for her. When talking to the charge nurse who knew of this, she informed me that Ida took one look at her nurse stated that she was done with everything turned her head to the other side of the pillow and died.
I was sad, but knew that was what she wanted most. Sometimes patients die; actually they all do at one time or another. Ida was an important learning experience my first week off orientation and is just one of the many sad stories I've come across everyday during my short time so far in this profession. It has made me a stronger nurse and I will carry Ida's story with me always.
Choosing nursing as an undergraduate degree was largely to heed my father’s wisdom. It was later on that I learned the vocation nursing truly is. Nursing provided a knowledge that was rewarding and unmistakably focused on the individual’s needs at the bedside. Practicing nursing day in and day out made it practically challenging to see that there was a different world out there and that the focus can shift.
Moving to America provided a rich ground to explore ways to be effective in more ways than one, without having to give up nursing altogether.
I was ecstatic to learn that nurses in America, with the proper investment, can apply their skills and knowledge in a myriad of ways!
It was then that the University of California San Francisco gave me the opportunity to be a part of their Master of Science in Nursing program, specializing in Clinical Research Management. It was a natural fit for my desired transition to become more involved on a larger scale in public health by way of clinical research, and specifically in drug safety and pharmacovigilance – collecting, reporting, reviewing, and aggregating safety data for products that will later on, if approved by regulatory authorities, be used by the public at large.
After doing this for a number of years, I now have the desire to learn how to quantitatively make sense of the data and effectively communicate findings to the stakeholders including our patients, regulatory authorities, and scientific community.
Enter: MPH with specialty in epidemiology...and I just might pursue this soon. I envision applying epidemiological methods to pharmacological issues I meet in clinical trials, e.g., pharmacovigilance, drug utilization, effectiveness comparisons, and adverse event monitoring.
Collaborating with colleagues, this education will allow me to conduct benefit-risk assessments of a molecule or drug which will be important in building the product’s safety profile that clinicians will use in their practice and streamline or build appropriate risk management programs. I will be able to contribute to the design of studies estimating the probability of a product’s beneficial effects in special populations like the elderly or HIV patients; or conduct a Phase IV study to identify post-marketing issues that could not be evident while the product is being studied in a limited and strict protocol environment; or data mining a registry housing information on pregnant women who have been exposed to HIV – all, of course, under strict subject protection guidelines. This is application of nursing in a global setting.
I imagine this and other opportunities to further one’s reach beyond bedside are not only available here in the land of opportunity, but elsewhere as well.
I, however, feel that America, despite its imperfections, is indeed one that nurtures and values individuals as well as groups and societies to pursue and protect life, liberty, and happiness.
Cheers to my colleagues worldwide who focus on individual care as well as to those making a difference in the global scene!
That is not correct. I am in New Mexico and I do not have any physician involvement as we have completely independent practice. I am in a practice that is NP owned. The formula I sent the BON is my formulary. I do not have a medical director.
You are not required to have any physician supervision at all.
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