Latest Comments by JTworoger

JTworoger 1,927 Views

Joined May 31, '10 - from 'Poplar Bluff'. JTworoger is a Medical Floor Nurse. He has '10' year(s) of experience and specializes in 'Long Term Care, Medical Surgical, ER'. Posts: 40 (48% Liked) Likes: 45

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  • 1
    LTCNS likes this.

    Quote from LTCNS
    Working in LTC as a MDS Nurse I made $20 per hour. When I worked in a wound care clinic from Nov. 2012-February 2013, I made $17 per hour. I will be starting a new job in a family healthcare clinic next week starting at $17 per hour. The benefits more than make up for the pay cut. I've been a LPN for 18 years. Had to get away from doing MDS for my sanity.
    I feel your pain I was an MDS Coordinator for two years!!

    LPNs do get paid well if they have experience and depending on what State or the "population" of the area they are working in. I work in a rural hospital in Southeast Missouri and make about 18+/hr.

    When I started out I made 11.25/hr. So it just depends...

  • 0

    Your best option is to research more in to. I attempted to do "The College Network" program and it did not work for me at. It was horrifying, but I have also read several people have succeeded with distance learning. If you are really interested in the LPN-RN bridge online, you really should check out http://www.excelsior.edu/. No matter what online "program" you choose, the way I understand is it you will be doing your clinical check-offs with this school. So my advice is to call/talk to these school for more information.

    ALSO: When checking out any College or University, it is also important to see if they are accredited. You can find this information by going to http://ope.ed.gov/accreditation/ and search the school you are looking for. This will tell you if the College is accredited by the US Department of Education.

    Excelsior mentions in there ASN-RN program that this:

    The associate, bachelor's, and master's degree programs in nursing at Excelsior College are accredited by the Accrediting Commission for Education in Nursing (ACEN), formerly known as the National League for Nursing Accrediting Commission (NLNAC), 3343 Peachtree Road NE, Suite 850, Atlanta, GA 30326, telephone: 404-975-5000. The ACEN is a specialized accrediting agency for nursing recognized by the U.S. Secretary of Education and the Council for Higher Education Accreditation (CHEA).

  • 8

    Quote from Hex
    There is no such thing as "Western" medicine, there is no such thing as "alternative" medicine (we all know the old cliche, if it worked it would not need to be called 'alternative').

    There is only science-based, evidence-based medicine. And if you do not believe in it, then I'm a little perplexed as to why you would want to become a nurse at all.
    Science-based, evidence-based medicine is good in theory and practice. It is always good to be to have this perspective. However, holistic modalities exist and are IN FACT more popular then conventional, modern medicine.

    I find it hard to believe that some nurse's feel that holistic medicine is not even worth the mention. Especially since most of us are taught about other modalities of treatments for our patients.

    I have alopecia araeta due to ulcerative colitis flare up and in combination with idiopathic pancreatitis. I received this news yesterday and when the NP gave me the results of my biopsy she said to me that even know there is no modern, conventional medicine that can be prescribed for this that I should try and go to a health foods store and ask them about other modalities.

    Modern medicine is not the answer for everything and it will never be. There are many medications that are on the market today made by pharm companies that were originally plant material. A big example is digoxin. The only difference is chemists have learned to synthesize these products to make them more responsive to certain disease processes.

    Holistic medicine works for some people, just like allopathic medicine works for some people. Its all about the belief systems of our patients.

  • 1
    anotherone likes this.

    Ok, so using the phrase, "trying to talk my patient out of something" was a tad bit misused. I'm not "TALKING" my patient out of anything. I am after all a nurse as one of you guys sorely pointed out. BUT, it is my job to educate my patient. And if my patient asks me, the nurse, a question as to why they are even getting the heparin, I will reply with the knowledge as to which I was trained and educated with through experience and evidence-based practice.

    The hospitalists here at my facility order subq heparin on EVERYONE they admit and its not pre-measured. It could be a 18 year old ambulatory patient here for cellulitis of the arm and subq heparin would still be ordered. Its not a matter of need, its a matter of the pre-made order sheets that the physicians just check mark.. my opinion of course.

    Having to hunt down a nurse just for verification is a complete pain in my rear, I won't state that any differently. I understand that heparin and insulin are high risk drugs that need another nurse to cosign for safety reasons.

    The physicians at our facility have an option to choose alternative treatments, such as SCDs, then treat everyone that walks into the building with subq heparin.

    I heard that DVT prophlaxsis was going to be the new core-measure this year. Has anyone else heard that?

  • 0

    I don't know how it is on other Medical floors, but on the medical floor I currently work on the hospitalist group goes extreme with the subq heparin. The big problem with this is we have to scan another nurse before we can even give the heparin to the patient and that takes large amounts of time to hunt down another nurse in the middle of med-pass.

    If I have an ambulatory patient that gets up and uses the bathroom, since heparin is used as a DVT prophlaxsis, I normally talk them out of the shot. Am I wrong for educating my patients on "WHY" they are getting the heparin shot, or should I be talking them into something they don't techincally need. The heparin shots are only given for "DVT prophlaxsis!"

  • 0

    On my floor we may have up to 9 patients with a CNA or 5 by ourselves
    Wow are you serious? The hospital that I work for just built a new hospital. We now have 7 stories with a department on each floor after the 4th floor. Our hospital layout has its pros and cons.

    1st Floor is ER/Surgery/Outpatient Services
    2nd Floor is: PCU, MICU (Medical), and SICU (Surgical)
    3rd Floor is: Women's Health (OB, GYN, Post Partum, and the baby children.)
    4th Floor is: Surgical Floor/Peds
    5-7 is the Medical floors.

    We have 36 private rooms on each of the 5,6,7th floors.

    ER ratio is 1:2-3 (Depending on acuity.)
    PCU is 1:4
    MICU/SICU 1:2
    Surgical 1:7
    Peds is 1:?? (Depends on the acuity)
    Medical 1:7

    There isn't a day we don't have a CNA, the CNA might have 14+ patients, but we still manage. The nursing sup always tries to give us over 7 patients, but the majority of us stick to our guns and refuse.

    Its not fair to have more patients then you can handle, its YOUR lisences not YOUR managers or CEOs liscences, YOURS.

    There is no possible way the nurse can assess all his/her patients, give medications, call doctors, admit patients, discharge patients, start IVs, give IVPs every other hours for chronic pain seekers without a large patient load and no CNA. I would of quit months ago. lmao

  • 0

    Ok, let me start off by saying that I am only a Licensed Pratical Nurse and I have A LOT of questions and statements to make.

    I have been an LPN for 7 years now and I'm actually enrolled in a college bridge program to obtain my ADN, then will transition to BSN. After I obtain my BSN, I hope to bridge to DNP/ACNP certifications.

    I want to become a DNP/ACNP to better manage my patients in an acute care setting. I currently work on a Medical/Surgical floor and for the most part I like that the atmosphere, but I feel like the FNPs that work here with the PCPs and Hospitalists do not have enough control to effectively manage their patients without the PCPs/Hospitalist stepping in.

    Which is fine, I understand that a FNP is not a MD and in some states require that physician partner.

    Due to the recent recommendations that the entry-level to all clinical specialities will be DNP (or DNAP for CRNAs) do you think the education will eventually change? Let me explain myself. Right now physicians are, for lack of a better term, whimpering with their tails behind their back due to the whole ideal NPs and various other "clinical" specialities will be graduating with a clinical doctorate and most states do not hold restricitions of the NP calling themselves doctors infront of the patients. I do not see this an issue myself as long as the NP acknowledges to the patient what s/he has her doctorate in.
    (Example: If I am a DNP/ACNP, I would address myself as Dr. Soandso and I will be your nurse practioner.

    One of the main issues that I have read in recent months is physicians believe NPs do not receive enough clinical education to even be on par with a MD. Which in some cases I can see as being true, but a NP seems to grow with experience as does a MD.

    I feel like if a DNP had less theory courses and more clinical courses the DNP would hold a higher respected place among physicians that will be our partners in the future of practice. If they are going to seperate the clinical doctorate (DNP) from the academic doctorate (PhD). Then I think they should split the education the same. I agree that some theory is required, but if it takes approximently three-four years after your BSN to become a DNP, then surely the next three and four years of your life isn't going to be theory oriented. Why not make the DNP more clinically oriented by teaching stronger pathophysiology, pharmacology, and dianogstic training. Clinical rotations....

    I can some day the DNP becoming the next physician creditinal just like when the DO emerged.. but that is my opinion....

    Any thoughs?

  • 0

    I need a place to vent and probably some advice....

    I've been a MDS Coordinator for 2 years now, and I do just about every thing.. all portions of the MDS for 70 beds including Med A residents. (Which every bed is lisenced to be a Med A bed.)

    I also do insurance claim forms for varies insurance companies. I got one in today and did it, which this particular one asked for specific MDS related information, which just so happened to be section G. So I coded the insurance form exactly how section G was coded when I did the assessment, which is how your suppose to do code the insurance form.

    My administrator came off the deep end today stating, "Thats not how you do it, I know inusrance claim forms and this isn't it." First off, I wanted to say, if you know the insurance claim forms, then by all means do it yourself.. but I minded my Ps&Qs. I refused to change the form, and he huffed off and said he was going to call the insurance company to make sure it was the correct way to do it.

    The Med A biller and I work as a team, so I went up there and asked what happened about the claim form...

    My administrator, who is NOT a nurse of ANY kind, added information onto the insurance claim form that MY signature and creditials are on and I did NOT approve him to do so...

    Could he get in trouble for altering a document that I signed and placed my nursing creditals on?

  • 0

    Lets also not forget the many other jobs that the MDS Coordinator has to do... audit charts, keep up with wound care, making sure the other nurses are documented like they are suppose to, dealing with insurance claims, talking on the phone with the MDS Program Software company, calling your RAI Coordinator, making sure your assessments are never let, hunting down PT/OT/ST for minutes, attending QA and other department head meetings, going to classes for updates on 3.0...

    Besides my MDS job, I also am over the Medical Records department and I am the Employee health nurse who gives all new hire PPDs, Hep Bs, and do the drug testing for accidents.

    To be honest with you sometimes being an MDS Coordinator as apposed to being a floor nurse is more work. Before I took this job, I would really talk to the Director that is offering the position and really find out more about what it entails.

  • 0

    Jollydog and I have actually been through this conversation before, but I'm going to say it again, but this time in a different perspective because I have actually been through what you are going through right now OP.

    My senior year of High School I took a class called Health Occupations because I knew that I wanted to be a nurse. In this class they certified you as a CNA with your certificate in hand on graduation. When I was accepted into the LPN program, I went to the hospital and actually obtained an ER Tech position.

    The ER Tech position was a very, very good thing for me. Not only did I enjoy most of the work I did but a lot of the nurses where not afraid to teach me when they had something going on with their patients that I was not really familiar with. It also help me develop quick patient assessment skills because I could actually see what was going on in the rooms and I saw how the ER Nurses with experience handled them.

    I felt like I could also tie in what I was learning in nursing with a real world outlook, meaning I could tie in what I was learning and actually apply it with what I seen quickly with working in the ER.

    ER Techs do have different responsbilities then a normal every day CNA, but most of the things I was taugh was OJT and I was not required to anymore schooling, especially since I was already a nursing student. But some of the things that I was taught that I hadn't learned in nursing school at the time was phlebotomy (made me a better IV/blood draw nurse), EKGs (taught me different rthythms and what to look for with acute MIs), and communication skills with the family. (In a Emergency situation such as a code.)

    Working as a ER Tech really paved the say in my education. If you want to be a ER Nurse then go for it, the only thing I will say is some facilities require their new grad nurses to work on a general Med/Surg floor for at least 6 months to a year before transfering to a speciality areas. I had to do this and I wouldn't trade that in for the world. Don't get me wrong I hate working on the floor, but it taught me skills that I would of never learned as a new grad in the ER and for that I was greatful. So that is also something that you might want to consider before you actually take a position in the ER as a new grad.

    Happy schooling!

  • 0

    Quote from bzyadon
    The nursing staff has very poor documentation when it comes to Med A charting. Multiple inservices have been done, but apparently nothing has changed. Our facility requires documentation per shift. I need tips in helping staff understand the importance of this.
    Hi bzyadon,

    I understand your frustrations with documentation, especially when it comes down to Med A charting. My facility is also in the same ball park. I am the MDS Coordinator and have educated my staff on the importance of Med A charting, it just seems like nobody really cares anymore, or "doesn't have the time" to adequately document all that is nessecary. What we have done is created a "Med A" form for each shift to use on a daily basis. This form has just about the same areas as the MDS does, such as, ADLs, Cognitive status, skin issues, and other critical areas that needs to be documented daily on. We finally got our nurses to at least fill out the form, but they still hardly do nothing in the area of a narrative subjective/objective notation on the patient that you wouldn't see from just ticking boxes.

    We have also started a "dot" system to remind the nurses they need to document on specific residents. To give an example: Residents that take antibiotics need to have their temp. taken every shift and documented in their chart with noted absence or apperence of adverse reactions with objective information documented that our treatment is actually getting better. If someone has pneumonia we want to make sure that at least their lungs sound ok and the antibiotics are actually working. We also have a fall/new admission dot to remind the nurses to document daily and every shift on this topic as well.

    We also came to the agreement that if nurses where not keeping up with a vital part of "nursing," such as documentation, then they need to be written up, especially after all the policies that we have developed to help remind the nurses to chart.

    I was a ER nurse for 3 years before taking this position and I have been to court before and let me tell you, I was glad that I documented as well as I did on that specific patient I had to testify on. I really don't think most nurses understand that and but they will the first time something happens and they have to be responsible when they get a subpoena.

    Good Luck!

  • 0

    Ok...

    So you keep hearing all this news on how the government is going to shut down for a couple days plus. If the government shuts down, even if it is just for a couple of days... will this become a problem for medicare and medicaid reinbursment to the nursing home?

    What are your thoughts?

  • 0

    Ok...

    So you keep hearing all this news on how the government is going to shut down for a couple days plus. If the government shuts down, even if it is just for a couple of days... will this become a problem for medicare and medicaid reinbursment to the nursing home?

  • 1
    jollydogg_RN likes this.

    Quote from jollydogg_RN
    For sure, I was not in any way discrediting your opinions. Looking at your experience posted, you have more than me by any means, and are more knowledgeable as an RN. I only disputed the fact that most schools are switching to DNP. In fact, the two programs that I remember switching to DNP of 2013 were online programs only, if you can believe that! I think that was out of 10 or so programs I looked into. You would think it would be the other way around, but I guess not!

    Even at the end of our ADN program, all of our instructors were saying "hurry up and get your NP by 2015 if you don't want to receive a doctorates". I just think its a misconception, and if a school such as Vanderbilt (which is usually up to date on the latest) is saying this, well, I'm sure I could believe them

    You're right as well; it could be awkward for a new nurse in ICU, and as much as I can't stand med/surg, I am thankful for my rough 8-9 month stint in it. It helped me with time management and how to deal with stress and reality shock. I think it seems like the OP has clearly defined goals, and could successfully manage being a nurse nurse in a critical care environment.
    I apologize if I implied I felt like you where discrediting my opinions, I don't feel as if you where doing that at all, so no hard feelings on that part. I know I'm an LPN, but experience as a nurse serves as experience as a nurse. Well rounded nurses who have experience in "entry-level" nursing just seem to have better nursing skills that actually make them better nurses, you even said it yourself with this statement...
    You're right as well; it could be awkward for a new nurse in ICU, and as much as I can't stand med/surg, I am thankful for my rough 8-9 month stint in it. It helped me with time management and how to deal with stress and reality shock.
    Because I do believe you are right on the money when you say it helped with time-management skills and helps you deal with the intial shock of just graduating and getting your feet wet.

    Good post Jolly_Dog, RN. Kudos to you!

  • 1
    jollydogg_RN likes this.

    2015 is still just a proposed timeline where the DNP is being brought forth as the standard for being an NP. Nothing is set in stone. It could come sooner (not likely), or it could come later (most likely). A lot of instructors believe that it will be later because of a lack of health care providers. Requiring a DNP for being an NP would only increase the problem with shortages, in my opinion (and in other's opinions, as well). I went to Vanderbilt's open house in March of this year, and this was brought up several times. Several different instructors made it a point to say that nothing is certain about this "2015" date, although some schools are going to a DNP in anticipation of this date. The majority, however, are not..... just yet.
    I knew that there was some speculation regarding the 2015 date of the NP - DNP situation, that is why I suggested that she completed her BSN program first and check around for degree requirements. And I agree with the above post, if you want to be a ICU Nurse, then go for it. I can only give my opinions based off my experiences and my experience is the better rounded you are as a nurse, the better nurse you will become. I completely agree with the statement that nursing is OJT, its all about the situations and experience you have to deal with as you are working. Every day is a new experience, diease process you haven't taken care of before, and situational structures that place you in awkward situations as times, but that is what defines nursing and makes good nurses.


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