kcmylorn 8,237 Views
Joined Oct 15, '10.
Posts: 1,097 (69% Liked)
ACA goes into in effect in 2014. It states all will have/ obtain health insurance based in ones ability to pay/income. Sliding scale fees, in effect mostly now. What's not to understand
If one can afford the full policy rate based on ones income. Then that is what one will pay. Will need paystubs as proof.
State exchanges will be set up- some states already have these exchanges in place. Insurance companies - Blue Cross/BlueSheild( called: MHP of what ever state), United healthcare( calls it: community and state), Americhoice( I am not familar with their "brand'). These are HMO's or managed cares. And based on where you fit in income wise- that is the company you are 'assigned' to.
These policies are given at a discounted rate based on ones ability to pay; need a paystub as proof of income or lack of.. If a patient is unemployed and collects unemployment, need the unemplyment stub as proof, they are paying a discounted insurance premimum fee based on their unemployment income( a sliding scale)- could be $50/month could be $100/mo etc. there are co-pays: again based on the patient's income- $10/visit to primary, $20/visit etc. If the patient is working a minimum wage job or any job, which is what is happening now( many people are taking any job they can find, are overqualified for the jobs they found and are working and it pays more than unemployment and were part of the unemployment numbers), where no insurance/health benefits are offered- they too qualify for this. I believe employers, through the ACA, are being given incentives to participate in offering employees in these jobs health care bene's, in the form of being participants in the reduced rate plans. Bottom line: Less of a drain on the states charity care and medicaid because that is the other alternative if no ACA.
Here is where my skeptism comes in- but it is not with the ACA, it is with the insurance companies. If these insurance companies can afford( and profit) to offer discounted insurance plans/ why have they, in the past and continue to charge other individuals a higher rate. How about, that is called the amounts of profit margin in the insurance industry!! These insurance rates have been negotiable for YEARS, long before ACA! This is not new with the ACA. When a patient with example BC/BS is hospitalized, the hospital contracts/negotiates with the insurance company to reimburse at set rate. That insurance company still makes a profit or they wouldn't do it!!
If one doesn't qualify and can not afford any of the above plans- They can go to the "free clinics either public health or hospital owned, or at a private community based health center/ clinic. If they go to the private owned CBHC- they are "self Pay"- they go to the primary and are self pay/out of pocket. The fee for the visit is determined based on what the patient can pay for that visit- could be $10; could be $60.
If they need to go to the hospital then it's charity care- which is a state fund, and an account set up for a patient at a certain hospital, meaning: that patient has met with the financial councelors at Hospital A, if that patient has charity care set up at hospital A, then if that patient 'needs' to go to the hospital, that patient goes to hospital A not hospital B. An active MI needs to go to the hospital- they go to hospital A where their account is set up. 'Needs to go" is not an 'elective' knee replacement does not "need" to go to the hospital/surgery. Charity care will not pay for the elective hospitalization or the surgery.
Medicaid one must qualify for. it is my understanding that if an adult qualifies for medicaid- that patient will only receive medicaid for 5 years. and then they are dropped if they do not requalify. Children are different- the state has Children's funding(CHIPS) in place up until the child is 18yr old.
IMHO, ACA is a way to control, if not stop, the price goughing by the insurance companies and those astronomical premiums that have priced people out of health care. If the insurance companies can afford to offer lower cost plans now with ACA( ordered by law), what the h*** were they doing all these years??? Why were so many people in this country without insurance, neglected their health until it was so bad they needed the expensive ED, thus admissions to ICU or were running to the ED for garbage complaints!!! I think ACA is the axe that feel on these big profits and people dying and mamed needless in the name of money.
Check out the federal Dept of Health and Human Services website: i think i read that people who paid those higher premium rates will be receiving a rebate.
ACA has other issues addressed: can not drop for chronic disease states, charging or denials for pre exisitng, college age kids on parents policies until age 26.
Vicky-This is a fantastic article and long over due. I have been on the recipient end of what you describe many times at age 56yr with 30 years acute care bedside experience.I have managed to sustain employment in nursing for the past 4 years with temporary- time limited positions that I knew from the start they were only 3 months and 6 months, perdeim agency here and there and the Immunization Clinics every Sept - Dec. All of which have been at a significantly lower pay rate that what I had been at in the hospital and my peers were making in my area. Don't get me wrong- I too sent out hundreds of application for full time positions. No feed back other than rejection letters and this is the one I found the most laughable: It was for a GYN oncology floor at a university hospital- I have 18 years oncology experience; they said "I didn't have the experience they were looking for" What ever does that mean! Yes, my DOB was a required field on the application.
I have had to file bankruptcy to keep my home and have had no health insurance. I have no chronic health issues but as the result of no health insurance, I fear that day is coming soon. My healthcare consists of taking tylenol and OTC remedies and asking peers to take my BP.
I might offer some suggestion for those fellow older nurses who find themselves in this position thanks to corporate America healthcare CEO's and the twisted minded nursing administrators who wish to follow them and reject their nursing ethics- of "Do No Harm"; These are what tid bits I have picked up finding temp positions in the Public Health Arena;
Finding medical care- check out the free public health clinics, or the FQHC's( sliding scale) they offer primary care, some offer dental and vision. In working these clinics- I have found these clinics patient populations are filled with patient's with jobs who just don't have heathcare. Not just drug addicts and skid row bums. These clinics have financial counselors who can determine if you qualify for Medicaid, or the state's low cost health insurance plan and/ or "Sharing the Care" prescription med plan( meds are free of charge if you qualify) Walmart meds are $4.00.Some of these health centers have providers who only see patient's with no insurance.
If you are unemployed- no matter what, go to the Unemployment office near you- do not take the nursing manager's word or all the myths associated with why you can't collect, Checkit out from the people that really know.
Apply for the energy credit programs through your electric and gas company- in some states they give energy credit off your bill based on income
Don't be afraid to file for bankruptcy. a Chapter 13 will protect the assets you have unless you want to give them up. There are places called 'Community Law Project" who are lawyers who serve the public pro bono( take on income qualifing cases for no fee) and are paid through the state. an indivisual can file Bankruptcy on line for free and this kind of filling is called Pro Se- that is what I did. All instruction and legal filling jargon and a handbook is on line and downloadable. I have not found the federal court or the judge to be either hospital, underhanded or discriminatory but quite the opposite. Case in point: when I filed, I found a vehicle listed on my creditors that was clearly not mine and the amount owed I would be responsible for paying. I asked the judge that since this vehicle was on my papers, and I would be paying for it, that I wanted this vehicle and asked the who in the court system was going to obtain the keys and drive it to my house. needless to say- it was removed from my paper work quickly.
Nurtition- some Walmarts have fresh vegs and fruit at reasonable prices, check out the mom and pop road side stands, farmers markets, bottom dollars, aldi's. Cheap foods have alot of salt and cholesterol in them.
Trim your house hold bills a smuch as you can- shut off the cable TV with all the fancy pay channels, swap out fawcet and fixtures for low flow( saves on water and sewer) shut off lights in the rooms you are not using.
My belief is: Since Corporate America Healthcare CEO's have proclaimed they don't want us old Baby Boomers around and we are no longer employable due to our age- I am 56yr old. Medicare starts at 65yr for full coverage- that is alot of years to wait for Medicare. This is my contingency plan. let those CEO's keep on working- they can support me!!
I would never put I was fired on an application. I would use the other suggestion from above- I also was fired on 2 occasions and both were for reporting harassment - this is something else you never do in nursing if you want to keep your job. I don't care how much is posted or written about on the subject. The nursing profession and the healthcare industry doe not deal competently with harassment issues.
I reported a physician for sexual harassment- I was taunted and tormented from that day forward. Now they have a name for it- retalliation which is also not recognized in healthcare. The best thing to do in this case is remember that the physican is more prized than the nurse, look for another job and put your real reason for leaving in writing the last day you are there- this too may get you placed do not rehire.
The next termination was when I reported a female lesbian CNA( which no one knew about, including myself) for harassing/discriminating against a male Vietnamese RN. She called him stupid every chance she got and refused to help him with his patients( call lights). I quietly reported it as insubordination issues and name calling to the VP of nursing. Nothing was done. It continued and escalated. She was in the lunch room recruiting all the other CNA's not to help him and flat out refused to help him in my presence one day( blatant insubordination). I spoke up. She lied when I reported it to the NM and I was fired. I told the truth on a job application in my subsequence search. I was questioned about this and again told the truth during the interview, needless to say- I did not get hired. I was told by that hiring NM"maybe she(my former NM) didn't know what to do( about the situation). That's one hellva excuse. So we don't know what to do and fire the nurse for reporting it! I wrote a 65 page letter of complaint to the EEO and the state's dept of labor who went in and investigated the insident with the CNA that's when I found out she was gay( the reason for her actions toward this male RN but was taken out on the patients) and I was told, cried like a baby to the state investigators. The hospital rewrote it's discrimation policy and beefed up it's workplace harassment education for orientation- Big deal. It didn't help me. I was 8 months without a job, no unemployment, my savings are gone because of it. I took temp positions and agency jobs to get it past my work history. Not to mention filing bankruptcy to save my home. It has been a nightmare. What ever you write on those application NEVER write the truth!! Honest and integrety in nursing gets you nowhere but unemployed, almost unemployable and broke. I have found out the hard way- nursing can write all those pretty flowery phrases about caring are only for advertising hype, but it's true code of ethics is like those of the "good ol boys", the unwritten rules.
Do all these PTB who are pushing for all this advanced degrees in nursing, think this is going to make all this go away?? Is this so now the CNA's destroying the career of the plain old RN they can now destroy the career of an MSN. From what I read the push is for MSN- yes at the bedside. How many MSN's are going to be at the bedside putting up with the insubordination and disrespectful lip from a bunch of CNA's refusing to do their jobs and go wipe butt themselves. I have had MSN's say to me" I got an MSN so I don't have to wipe butt" Clinical nursing at it's finest!!
Allowing psych patient's the upper hand- talk about Bedlam. Who's crazier these days, the patient's or the management?
As for Mr Hot Shot family member- seek legal advice or try going to his medical board of ethics. If he's a public figure- report him to the government in your state- "this is how Dr. So and So has been behaving. Is he mentally and ethically competent to hold the position he holds?" Just a thought. Document, document, document. Date and time and exact words
trulefty-I think if you supported your nursing colleages- in celebrating their gains for their contract and strength in solidarity., You wouldn't even be asking your original question, nor would you be bouncing around the country HOPING for your next paycheck and figuring out how to weather the dry spells of unemployement. If nursing stood together and KEPT their nose in other nurses job politics; there wouldn't be uphill battles trying to hold on to salaries, benefits, retirements, safety standards of practice and staffing regulations. There might even be a narrower bridge in salary range from state to state, in stead of nurses in the south making $15-20/ $30,000- $40,000/yr and Calif @$100,000/yr. With the number of nurses in this country- if we all stood with each other instead of some against - corporate healthcare would not have gained it's abusive power. This upper hand is dangerous to nursing practice- as we have all come to see with this strike in Sutter. Corporate healthcare IS controlling our practice through staffing numbers and disciplinary actions. This upper handed bullying cost a patient their life because an multimillion dollar BOOB/Ass++++ with no nursing knowledge, no Nursing or medical license gave the OK to hire a new inexperienced nurse( I'm sure this was not the only one on this assignment) from a nursing agency that he didn't check out for creditiblity,and didn't have a clue how to go about checking competency or even what the competencies were or should be - just "get me "x" # of nurses fast, the cheaper the better" and as a result, his poor judgement, poor leadership, lack of nursing knowledge and expertise caused a sentinel event that he will worm his way out of. He too is in way over his head. These MBA's( if he is even that) DO NOT belong in healthcare. This insident is a perfect example.
If nurses stood together there would be no exploitation of a licensed inexperienced nurse(s) Shows all right there how corporate healthcare devalues the license of a nurse. This exploitation has happened more than with this strike. Look at all the complaints and posts here on this site of new grads and older nurses being terminated/fired for going to lunch, not reporting off, clocking out issues, not documenting in 300 places, and any other 'crack head charges' these ding-a-lings can think of. There wouldn't be so much job dissatisfaction. The patient/nurse ratios wouldn't be stretched to the limit. Nursing management would be held accountable for thier hiding in their office while these practice and staffing issues were occuring. Nurses wouldn't be handed early retirement packages at the ripe old age of 50(yes, I said 50 not 65). Corporate healthcare is ignoring the federal Labor laws (not just collective bargaining agreements but Federal Government Labor Laws). They are making this country unrecognizable, setting it back decades for their own personal greed and arrogance- they want to play God. Couldn't make it in med schoolor nursing so they are going to take the patient care decision making power away from those of us who did.
Nursing would be treated like licensed professionals instead of "a dime a dozen" and we may even be able to get rid of the multi million dollar CEO and his board of mistrustee and board of dicktaters that are sucking the healthcare system's funds dry. Hospitals might not have to close due to lack of funds. One employee might not be collecting millions in a salary each year and that money could be put back into the healthcare sysytem. There may even be access to care when people have the begininning stages of illness instead of waiting for disease to progress to 'can't ignore' level. Your looking for strike work keeps feeding a very diseased greedy machine at a lot of peoples expense.
The answer to this- Maybe MR CEO should learn how to get along with his co-workers(his nurses) and be a team player.
No, Mr Fry, I don't live in California- I live on the opposite coast. We have your kind over here too - so fire me!!!!!!!!!! I work for the federal government- Mr Obama is my boss.
After 32 years of acute care bedside nursing and seeing the way things are going with the corporate disease influencing and drowning out the core values of nursing - all I want to do is get out of nursing and go do something else until I retire- 10 years I really don't care any more what they do. Nursing has become so vile anddisgusting it sickens me.
This has gone way too far. It is none of these bast***Ds business if we smoke,have genital herpes( does the administration play on sexual relations being part of your job description??) a PT test for a civilian job(what is that all about?? are these civilian heathcare systems now deploying people into war-making you combat ready) This extent of the medical hx is a total invasion of privacy.Put on that medical hx you have been "female castrated- Grade IV" and feel they should have the same. The point is DO not work for these lunatics. Or in return demand their spouse and themselves publically publish EVERY sexual encounter(especially if it's out of wedlock), partner, abortion, STD every questionable cough, sneeze or fart they have ever done. and especially fart- if they have done it in public- they need to be put up to public humiliation!!! This is outrageous. This is a total lack/loss of personal privacy. If you don't mind me asking- how old are you?? All I can say is this is gone way too far- it's gone way to far with the nicotine test and bank/ financial disclosures.!!!!!!!!!!!!!!!!!!!!!!!The company you are applying to needs to be reported to a GOVERNMENT regulatory commission on personal privacy rights. That is no DREAM job- it's will be a nightmare!!!!!!!!!!!!!!!!!! If they do hire you- you will not be allowed to leave your home with out first getting their approval. even if it's to church(they may disagree with the church you attend or the store you go to- they may have holdings in another retailer and will look on this as disloyalty/ high treason.) Sounds like these people are "fockered up". The affrontary, the gaul, the nerve. How disgusting.
Yes!! nurses get fired alot. It's not always for things that would make sence for a nurse to be fired over- drug diversion, call outs, gross incompetence. Nursing is the flavor of the month club. If the 'IT' clique likes you- your in, when they don't like you- your out. And it can be for the those life crucial things like- you know more than they do (aka. you threaten the poor little dears) you are more experinced than they are(aka. you threaten those poor little dears) your patients like you( aka those poor little dears are not liked by their patients but that becomes your problem not theirs. als insecurity, jealousy) But don't get me wrong, they do dress it up where it looks and sounds legit. They scrutinize. everything that you do: examples: you don't 'fit'in( aka- the IT group is a bunch of inexperienced dumb a** and haven't a clue what your explaining to them. Case in point: a non diabetic, vascular, dialysis pt with hypoglycemic episodes for 2 weeks who the IT group figured and stated "She's does that all the time!!" When you dare to ask the Doctor, turns out the patient is septic, Doctor sends pt to the MICU stat.) You don't document the way they do ( you document LATE ENTRY @*** and the dissertation of events. You are picked apart like a peice of meat. But when you document like you are talking to a bunch of simpletons because you are so damn pi***d you get rave reviews on you documentation), your med timing is not the same as their(aka: you could take longer because you ask more questions or see a side effect they have missed for DAYs- pt is behaving strangly because their TOXIC, your doomed, screwed and unemployed), perhaps you care about your work( aka the It group doesn't and you make them look bad, so your gone before that happens. US vs HER/HIM) and the list goes on and on and gets longer as you are in nursing longer. Oh yes. Nurses get fired more than should be and for more reason than something legit.( this makes the IT group feel like they have done 'do diligence', like they are actively participating in the manatory reporting process. Like they will receive a Bronzed Turd Pin for their accomplishment. Yes nurses get fired more so than other professions. Why because Nursing attrack mostly women who feel inadequate about themselves and this boosts their fragile fair egos- The helping profession, "I'm a Nurse" As evidence by- allowing other professions/diciplines/fields come in, take over nursing, create a disaster and leave with bank accounts worth millions. If you look at the turmoil nursing is in these days- the evidence of this are abundantly abound. Like a bunch of Wedding Planners who can't decise on a theme for 1 Wedding, Too Many Cooks Spoil The Broth!! I have had Doctors say to me- Nursing creates it's own problems. How very true.
Corrected spelling before the Bronze Turd recipients flame me. More important to spell correctly also in nursing.
Union is not all about pay and compensation- they protect workers from "at will" and "that time of managment's monthly menstral cycle" terminations. There guidelines, which are the state department of labor LAWS, that management has to follow to terminate an employee. That is why when one goes to file an unemployment claim, they are scheduled to speak with an investigator who asks the terminated/fired employee why they were terminated and what happened. These investigators must go home every day laughing their butts off at some of these managers, and other times may want to wring their bloody necks for contributing to the unemployment rates and the economic state of this country.
The managment can call it anything they want- their favorite is "misconduct" that employER has to prove it was ligitimate misconduct- a deliberate act of defiance- usually something very serious- stealing, workplace violence. If an employEE was expected to do something and it didn't get done through no fault of the emploEE- that is not misconduct but managment will claim it is either becasue they are down right mean and don't like someone for what ever reason or the manager is the dumbest thing on 2 feet- that is what the investigator wants to know- did the managment make supplies avail, enough personnel avail to get it done, reasonable amount of time to get it done- if not then that is on the management/ aka poor managment practices not the fired employee.And to that end- the employEE collects unemployment and the manamgement/EmployER has to shell out $15,000 in my state for that unemployment claim.( good for their stupid butts) There are alot of other issues that managment labels as the employEE's poor performance and misconduct- that"under the law" are not. But managment tries to get away with it. The union stops this before it get's this far. If a CNA refuses to do as requested from a certain nurse or nurses and the nurse gets written up because the task doesn't get done or the nurse is constantly getting into overtime because the nurse has to"do it their self" and managment writes up the nurse for excessive OT or terminates that nurse and the CNA remains employeed- that gets look at by the union who goes to the manager and questions the manager- why didn't YOU do your job!! That is why managment doesn't like unions- they have to do their jobs!!
The union also has written rules in the contract against "floating to floors" that nurses should not be floated to- a jeapordy of their license issue. Without a union, a manager can float a nurse anywhere they please to make" thier" numbers look good and not have to call another nurse in/pay the called in nurse aka saving money for the "hospital" aka Kissing administration's backside and making the manager look good come manager bonus time but all the while jeapordizing the nurses license(your liveihood) and patient safety!! Who gets theeir license taken away if a mistake is made- not the manager. The manager gets monitarily rewarded for crunching the numbers!! and the nurse looses their license!! That is an example of the NURSE manager thinking they are this business mogal and forgetting they too have a NURSing license. That is why I advocate sueing the CEO who creates this climate to insure his/her own payday- the deepest pockets but most over looked and therfore the most negligent. Make these morons take responsibility for their (business) decsions.
There is whole myriad of events that the unions put a stop to.
If there were more unions in nursing there would not be alot of these horrendous posts of insidents that happen we are reading about on this site.
Nursing is in the state it is in because there is not enough unions to stop the outside interference- the short staffing, the unemployment in nursing, the excluding of the older nurses, the lack of decent pay for the services and responsibilities we render, the"dumbing down of our very existance, the handing over of OUR skills to UAP's which will gradually make us extinct- in some states there only has to be "ONE" RN on a floor, who do all think that RN is going to be. Some lonely little staff nurse. Heck NO! It's going to be the Unit Manager!!! They are purging themselves of all the staff nurses to have 1 big kohonna- The Unit manager, who has no experience in bedside care. The only butt they have been up is the CEO and adminstration's. The "Yes, man/woman" It's "staff nurse a cide"
From being a union nurse for 18 years( 1985-2002) and watching our working conditions improve during that time-
STAFFING NUMBERS observed BY MANAGEMENT according to acuity, if our census went over a certain number, we got an extra nurse, we were not scorned and,
treated like the dirt on managment's boots, we were talked to differently, our professional opinnions mattered to our nursing managment),
our pay increased( $12/hr- $32/hr not bad for 18 years, we had shift diffs, charge pay, weekend diff's, OT because of the staffing according to the acuity- nurses were called in to work and actually wanted to work because they wanted to help the other nurses on their unit out- there's a novel thought!!),
our retirement benefits improve( although at that time I was still in my 30's and not caring about retirement).
Comparing it the non union poop holes I've worked in since then:
- the disrespect make me want to spit in their faces,
the infighting is hell to even be able to concentrate in. No wonder so many mistakes are made and so many omissions- who can think straight with all this discord.
CNA's performing licensed nurses tasks- check out the other thread where CNA put oxygen on a patient with out telling the nurse about the low pulse ox. The CNA's stating "do it yourself", it's become an insane assylum run by business degrees. The care is down right S****Y. Stop expounding on quality care there is none anymore.
This customer service kiss butt crap is for the birds- I'm all for treating patients with respect and dignity no matter what but this "scripted nonsense"( ADAIT or some such rot, that you don't even get out in a resaurant much less post op throwing up all over the place) has got to go. So now we have ADAIT and crappy care!!
I seriously don't think that there are going to be any older experienced nurse left in nursing once economically thing get just a tad better. I hear more and more each day of older experienced nurses taking non nursing courses in the community colleges to get out of nursing- I being one of them!!! And the younger nurses are getting into these courses also- so where is that leaving the care of these patient's??? "Mr CEO- don you gloves, you got work(real work) to do!!"
The above is so true- when a nurse witnesses or knows of a questionable situation, that nurse can count on being terminated or given a rough time to encourage him/her to quit(forced resignation). That's another example up for the Bronze Turd award. I guess in that situation- like the mob does- keep the witnessed event to yourself. I wonder if that comes under pt advocacy?
Nursing doesn't know about the Whistlerblower act. To nursing a whistle blower is some one who waves their hands and directs traffic
I'm an RN working in a family practice clinic in the medical home model. This is my first time working primary care after being a bedside RN in hospital enviornments for 30 years. I love the clinic. I was so fed up with the way hospitals are run.I don't like the way older experienced nurses are treated by management. I couldn't tolerate them any more. I worked many areas in hospitals over the years- med/surg.oncology(18 yrs)/tele(7yrs) cadiac surgical stepdown(2yrs) endoscopy(1 yr)/sameday surg(2yrs)ICU/CCU(6months)neuro(1yr), LTC (7months). Ive worked staff and agency- both travel and perdeim.
The medical home model is like the way pediatricians offices have been run for years(If you have kids- you know what I mean)If your child was not acutely ill- you did your mommy thing with OTC's, if the OTC's were not working you called the office- spoke with the PNP who decided if you needed to be seen and when, either that day or next day or week later, If they were acutely injured or ill( broken bone, bleeding/stitches- you went right to the ED) All care or decisions go through the primary provider then get referred out to specialists.This is triage-
Triage is what the RN's do @ the clinic I work at. Only RN's are legally allowed to triage. This is what is called t-con's or telephone consults. This is the bulk of our work load and it's over the phone. These t-con's are either symptom based, referrals, or medication refils. The symptome based can be anything from a runny nose or a profuse nose bleed. The Rn has to determine why- this is why this takes an RN an alot of experience. You must know what questions to ask, what sx go with what condition. You have to be able to hear what the patient is NOT telling you and you must ask- because you are on the phone and can't see them. There are protocals(standards of practice, some clinics have computer software on their computers with list of questions to ask like a receipe some do not(my clinic doesn't) Then you make a decision based on what you decide the patient is telling you- runny nose, what did they try at home, how long has it been going on, do they need an appt in 24hr or can they wait up to 7 days. Is the nose bleed because they have a hx of HTN, are they on meds, did they take their meds- they need to goto the ED immediately. Remember these are clinics- primary care clinics- no ED equipment for codes, we call 911. Referral based t-cons: the RN can put in the referral to the appropriate specialty if the patient has been seen for this problem and the provider just forgot to enter it in the computer. If this is a new problem and the patient has not been deen by the provider for it, then they need an appt. As the RN you have to decide, again, is this urgent, emergent or can it wait for a routine appt.( wanting a dermatology referral for acne lazer treatments are not an urgent or emergent condition!) Medication refils: Most medication refils are only done until the patient has their next appt- HTN, oral Hypoglycemics. No Way Do WE EVER fill controlled substances over the phone( including lyrica, ambien, even tramadol)- that patient needs an appt!!
We also have "walk-in Nurse clinic's- only for sore throat's, URI or UTI's(although the most infuriating part of the job is the 'check in' clerk's who make everyone who walk's through the door sound like they fit into one of these walk in and the patient's come in with fake coughing and runny noses and want us to think they are dying = manipulation( lots of this going on), so the patient doesn't have to wait for an appt. As the nurse walk in - the RN sees the patient instead of the doc. we do Vital signs, do a symptom based only assessment(if complaining of URI- listen to lungs, sore throat look in throat, get a throat swab), run our findings by the doc who is busy with the every 15 min. appt patient's who did call and wait for an appt.The doc will ginve us verbal orders, we enter them into the computer, do teaching with the patient- hand washing, cough and runny nose hygeine, fluids, rest and discharge them from the clinic.
The Rn's are utilized like APN's without prescriptive priviledges( which is why I love it)
Our clinic has Women's Health(GYN), mental health, peds, family(adult health. I have been filling in for the peds nurse when she is out. I am being moved to peds in the next few weeks( another new speciality for me in my old age) My saying is: since they kicked us old RN's out of the hospitals because we were too expensive- I don't want to hear any S**T as to "How come you can do all that" This is what happens when they kick us old nurses out of the hospital- we just become more diverse. So I will be able to add- primary care/clinic/doctor's office/ telephone triage- adult and peds.!!! Slave away all you new nurses!!!``
The pay right now for me is not good- it is $13/hr less than what my payscale would be in the hospital. I am grossely unpaid. This is what nurses are calling underemployed. I am hoping Obama care fixes the payscale for primary nurses- this is community/public health. You have to be able to fly alone and know what your doing. You must know your pathophysiology, pharmacology and assessment skills. You must be able to critically think and be solid at decision making. You have to like patient teaching beyond a pre written dischagre instruction handed to a pt in the hospital- the nursing instruction that is given comes from a vast personal data bank.
This is just my experience and I hope this answers your questions.
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