Latest Comments by coast2coast

Latest Comments by coast2coast

coast2coast, MSN, NP 7,590 Views

Joined Jul 9, '10. Posts: 404 (42% Liked) Likes: 625

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  • 2
    nursemike and Farawyn like this.

    Quote from Farawyn
    So...it's working?
    every d*mn time! We all have our kryptonite!

  • 2
    Lanilu and beckysue920 like this.

    I see this frequently with psych patients - they want you to engage in a power struggle. Drives me nuts, every single time.

  • 0

    Quote from BCgradnurse
    I worked in a FQHC through the National Health Service in an urban community health center. The facility was really nice, but we were treated a like indentured servants (which we kinda were). The staff (MD, NP, PA) were extremely supportive of each other and it was a wonderful learning experience, but I burnt out fairly quickly. We had to see upwards of 30 patients a day and got 15 minutes per visit, be it a URI or a full physical with Pap. A lot of time was spent waiting for available interpreters, as many of the patients did not speak English. I saw conditions I never would have seen in a suburban primary care practice, but we did n't have the resources to spend time with our patients and do sufficient teaching. I never got out on time, never took a real lunch break, and would spend hours of my free time charting. So, I have mixed feelings about it. I did get my loans paid back, I learned a ton and met some great people, but I had no life for almost 3 years and was always stressed.
    same. Great experience, great coworkers, but I am getting the hell out of dodge when my NELRP contract ends this year. Life is too short to work that hard forever!

  • 0

    PM'd you

  • 0

    Minimum 30 days ... My last position I gave them a 'soft' warning at 6 months and official resignation at 90 days, but that is probably an extreme situation (large patient panel being left and clinic couldn't retain adequate number of providers).

  • 4
    MiniNurseintraining, Alicia777, sailornurse, and 1 other like this.

    There's no way you will see 25+ patients/day and leave at 3pm if this is family practice/primary care. The 'productivity' bonus is a joke, as is lack of benefits. Keep looking.

  • 2
    JustBeachyNurse and elkpark like this.

    No offense was intended, I was merely trying to counter what I see as a widely-held belief that things like legal status are not a routine part of healthcare delivery.

    An acute care example would be someone needing dispo to rehab or skilled nursing. Sure, a patient can come in emergently and by EMTALA be treated, and immigration status I would agree does not impact that emergency treatment, in general. But what do you do with someone who ends up profoundly disabled, but without the income or health insurance to be accepted into some level of rehab? Like any inpatient who overstays their welcome in acute care, the barriers to dispo become a matter of common knowledge and therefore, at times, judgment. It shouldn't impact care but the potential is there.

    I apologize if my original comment seemed to negate your personal experiences, on re-reading I can see how it could come off like that. I just want to engage in a discussion on a topic that I am obviously quite passionate about, not looking to cause offense.

  • 2
    emmy27 and shedevilprincss like this.

    Quote from elkpark
    I'm not aware of any healthcare facility that makes any sort of determination of the immigration status of individuals presenting for care. Everyone has been treated the same and no one has asked about immigration status, in my experience.
    interestingly enough, this is not actually true. Having worked for multiple FQHCs,I can tell you that determination of eligibility for medi-caid/obamacare takes place on site and is an integral part of the workflow of community clinics. Specifically, you need a social security number to apply/ enroll.

    If I see an uninsured patient who needs specialty care, I need to know if that patient will EVER be eligible for insurance - it impacts course of treatment. Patients in DKA, with potential DVTs, or even with plain old chronic abdominal pain - I need to know if you have a (valid) social security number to decide how much I'm willing to try to treat in-house. It's not about denying care, but you have to frank and realistic about what you can offer them. The outcome of this is typically 1 of 2 extremes: cowboy medicine, where you treat patients w serious disease despite incomplete testing/eval, or no treatment at all for chronic but non-life-threatening conditions. So we will try to treat your lupus, even though we aren't rheumatologists and have very few treatment choices, but you are SOL when it comes to chronic back pain, frozen shoulder, or most mental health issues.

    OP, both LA county and the state of California have expanded pieces of medi-caid to cover individuals without legal status. LAC as late as spring 2015 was talking about opening up medi-caid enrollment regardless of status. The reality is the county pays for that healthcare whether or not you grant people eligibility to enroll. So eligibility/enrollment is at least a way of trying to count and characterize that shadow population. I would look for resources out of Cali, possibly also Kaiser which coincidentally is trying to take over the medi-cal market.

    pm me if you would like to know more about the impact of legal status on individual healthcare ... I have war stories 😜

  • 1
    Farawyn likes this.

    Quote from traumaRUs
    I think there is a lot of misunderstanding between RNs who perhaps are not familiar with the APRN role.
    I've been an APRN for 9+ years and I did absolutely love bedside nursing. However, I equally love my roles as provider and prescriber. Like other APRNs have mentioned, I do help pts. My pts are for the most part seriously ill with a much shortened lifespan. I discuss end of life issues almost daily.

    I do provide a service but mostly I provide care.
    this. Any goober with MD behind their name can fling scripts. TLC (which oh by the way might mean the difference between compliance and noncompliance, life and death) is where NPs impact both quantity and quality of life.

    (Name-calling only in the spirit of troll-ish-ness which we seem to have high tolerance for lately)

  • 0

    Best decision I ever made was to leave a doctoral program (pre nursing career). Don't be scared to do what you need to do.

  • 4
    Altra, la_chica_suerte85, cafeaulait, and 1 other like this.

    Brava, brava!



    Quote from GrnTea
    Pediatric Emergency Care:
    January 2013 - Volume 29 - Issue 1 - p 63–66
    doi: 10.1097/PEC.0b013e31827b5427
    Original Articles

    Comparison of Rectal, Axillary, Tympanic, and Temporal Artery Thermometry in the Pediatric Emergency Room

    Batra, Prerna MD; Goyal, Sudhanshu MBBS

  • 2
    emagine and Anna S, RN like this.

    Quote from Anna S, RN
    I don't understand this one- I thought that elevated TSH always indicated hypothyroid. Can someone explain this to me?

    The highest TSH I've ever seen before was 157. Pt very fatigued, low heart rate, low B/P, overweight, and so on.
    he was severely hypothyroid due to med noncompliance due to mania ...

  • 2
    emagine and Not_A_Hat_Person like this.

    Chronic hgb in the 3.5-4.0 range. Dying of metastatic probably rectal dancer, survived almost a year.
    a1c 16.9, very alive and one of my best-behaved diabetics now.
    TSH 490. Manic but definitely alive

    a1c's of 15, systolic BPs in the 200s, and trigs of 3000 sadly become very mundane very quickly in community practice. It's amazing how resilient the human body can be.

  • 2
    Jules A and sadiemae1123 like this.

    I may be too late for this but ... THAT IS WAY TOO LOW! Waaaaaaaaaaaaaaaaaaaay under average for SoCal. New grads in community centers are starting over 90 at multiple locations in metro LA.

    I know you are a new grad and need to get hired, but man oh man I would tell this doc to stuff it and call me when she was ready to discuss a serious salary.

    You will never successfully renegotiate for lost income. Realistically you will do well to get 2-3% per year in most places unless you have an RVU structure in place. When you take the job is really your only moment to get what you want/need.

    anyhow. PM me if you want to discuss the LA market.

    Quote from CocoaLoverFNP
    I was offered a full time job at an IM clinic. I asked for $48 per hour compensation with full benefits because i thought this was reasonable for a new grad in southern CA. The average is $44-46/hr.

    On my second day of orientation, my boss told me that she is going to switch my pay to salary. She said she will offer me 75k per year. I was really shocked!

    I told her that at the hospital, although without benefits, I get paid $52 per hour. Then she said that i shouldn't expect that much because being a nurse is different from being an NP. She also has to train me and that will take time. Then i countered and said i am willing to meet her at $88k. Then she said she can only offer up to $80k. Then i said i also have to make ends meet at home so I will think about it over the weekend.

    Then she said she will call me back this weekend for a final offer.

    Any suggestion or tips on how to handle this negotiation when she calls me back? Should i walk away from a low ball offer? Or is it worth it to get that experience for a year then go? This negotiating acitvity is exhausting! ;-)

    I want to get an offer of at least 86-88k. I am better off working at the weight loss clinic at $60/hr

    Thank you!

  • 3
    RNJill, Jules A, and synaptic like this.

    Never. I have also stopped giving out my direct extension at work and am now directing patients to the receptionist or nursing line.

    99% of my calls and messages could/should be handled by someone else. I found that by my being involved they generally took much longer to resolve and wasted a great deal of time.

    You REALLY, SINCERELY, URGENTLY need to speak to me and only me? You know where I work every day ... If it's not worth making an appointment to you, why on earth should I give you my time off the clock?


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