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NRSKarenRN, BSN, RN Moderator 124,958 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,377 (22% Liked) Likes: 13,500

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  • 9:50 am

    Great Job.

    But it just like with any new urgent situation that involves adults in multiple disciplines and multiple children, Chaos Is highly possible. I'm an RN and a police officer who has worked as an SRO for years so I see your senecio from a unique position .
    First establishing your role as the "primary " in this and similar medical emergencies is vital. "Even if feeling get touched". Patient comes first. Now trust me my police side does tend to take led but medical emergencies need health care first .

    Second, all of these other disciplines should instinctively go to their training. (I.E.; teachers and assistants should be assisting in removing children to area away from scene to avoid the panic they experience with fear. Security should be preparing to receive EMS. Admin should be on phone with EMS. Coordinating their arrival and relaying the nurses assessment to medic dispatch in order to insure the proper unit is dispatched. Social workers and counselor need to be with remaining removed students providing care and also with the coordination with admin. , calling parents of the patient child (don't want everyone providing parents with different versions or update intel.)

    Third, radio transmissions need to be limited to Nurse - Admin. Tell everyone to "shut up" . In a nicer but firm way. You can apologize later. Patient comes first. Radio clearance is so vital in an emergency Even police habitually talk over one another and need leadership to advise them to "clear the air unless you have an emergency '
    yes put together a plan but this needs regular drills like a fire drill.

    Great job with deciding to create a action plan for this and similar situations. You are a credit to the profession.
    let me know if you need further assistance, if this response helps!

    Sergeant Nurse

  • 9:50 am

    Regardless of how teachers or administrators respond, the nurse is always in charge of the patient.
    You saved the day in this instance, but you had unnessesary interference. Carve out what is your domain, per your State School Nursing Certificate or Nurse Practice Act, whatever applies where you practice. Educate staff about your role and how it's implemented in your school. Consult other School Nurses to get ideas and create a comprehensive safety, best practice emergency response plan. But don't settle for the back seat of the bus. You really need to have control over the care of the precious children entrusted to you, and you seem to be competent.
    Best wishes.

  • Apr 26

    I'm curious to know how the hospital board representation is structured. Is it exclusively represented by MDs and DOs? Is there mid-level representation? And what was the instigating set of circumstances that led to this decision?

    As others have stated, this action sends a strong negative message to any mid-level provider that they are not part of the "team." This is a cultural problem that supercedes being just a lounge access issue. This would be rather disheartening and while you might be looking at just the lounge access across other facilities and health systems, you might also tap into research showing the strong correlation between employee satisfaction and health outcomes of patients.

    Good luck.

    Darth Practicus, FNP

  • Apr 24

    I know this is a slightly older post, but I will say the only thing that made our staffing change when it got really dangerous was a nurse going to the Joint Commission with documentation of what her shift looked like. If your workload is blatantly unsafe, JCAHO will come down on your facility with a hammer. I work in a 900+ bed regional referral center and we almost lost accreditation last summer because of staffing issues.

    I'm talking a night where one of our sister ICU units had multiple four patient assignments, and filled up the morgue because of inability to properly take care of the patients. Every nurse in my unit had a three patient assignment that night.

    Our amount of staff RNs has not changed dramatically, but now we usually have several travelers with us every night. We didn't have any travelers at all before that person went to JCAHO.

  • Apr 24

    Quote from calivianya
    I know this is a slightly older post, but I will say the only thing that made our staffing change when it got really dangerous was a nurse going to the Joint Commission with documentation of what her shift looked like. If your workload is blatantly unsafe, JCAHO will come down on your facility with a hammer. I work in a 900+ bed regional referral center and we almost lost accreditation last summer because of staffing issues.

    I'm talking a night where one of our sister ICU units had multiple four patient assignments, and filled up the morgue because of inability to properly take care of the patients. Every nurse in my unit had a three patient assignment that night.

    Our amount of staff RNs has not changed dramatically, but now we usually have several travelers with us every night. We didn't have any travelers at all before that person went to JCAHO.
    Kudos to all of you! Yes, internal memos go nowhere. The paper trail only helps if you have someone to show it to. For organizations with no union or other advocate, Joint Commission is the way to go.

  • Apr 24

    Done. Not sure what good it will do. But it's worth a try. Just had a clinical buddy tell me her school popped up just a couple of weeks ago and told the class they decided their entire summer semester needed to be strictly therapy (its a PMHNP program). Ummmm it's April. The summer session starts in May. Luckily she had a few connections and got hers taken care of but several of her classmates are struggling to find placements because they were set up at other places for summer. This madness has got to stop. If a program decides to change the rules mid semester, they should be required to find their students clinical placements. Period.

  • Apr 23

    I was talking about this topic with one of my younger nurse friends. She shared the following comments with me.

    Funny to me that 20 years ago when I graduated with my BSN, I was told that ADN/ LPN programs were being phased out and that minimum entry level nursing positions would soon be BSN. Fast forward 20 years and it appears ADN and LPN programs are going strong.
    I want to start by saying that quality bedside nursing care can be provided no matter the advanced degree or not. As a new graduate, I survived and so did my patients thanks to the care and support and knowledge of many many LPN’s and ADN’s. There are also plenty of not so great nurses out there with various degrees. That being said, there has been much discussion, surveys and studies done regarding the differences in the career of a BSN prepared nurse, LPN, and an ADN prepared nurse. The results of the 2015 allnurses salary survey presented that 39% of respondents held an ADN and 39% held a BSN. As we are about to release the comprehensive 2017 allnurses nursing salary results, we will see where the trends have gone.

    So what’s the big deal...as long as you are an RN? The title of RN whether earned through a Degree or Diploma program will allow you to provide the same level of basic nursing care as we see in hospitals, clinics and doctors offices. The BSN prepared nurse, however, has many more options that require higher responsibilities, therefore higher pay. This is due to the more in-depth coursework in physical and social sciences including public health, nursing research and nursing management. An RN with a BSN can choose a career in nursing education, public health, or clinically focus in specific diseases or adult, pediatric, geriatric care. A BSN is required to be considered for many positions or to further one’s education to focus on speciality care.

    In 2010, the Institute of Medicine introduced new demands on the nursing field when it set a target goal for 80% of all nurses to hold bachelor’s degrees by 2020. This goal was derived from academic research indicating that patients receive better care in hospitals when the majority of nurses hold a BSN or higher. The American Nurses Credentialing Center (ANCC) devised the Magnet Recognition Program to draw attention to top healthcare facilities. This recognition means that 100% of the organization’s nurse managers have a BSN or graduate degree. "Achieving Magnet status also means that there are generally a higher number of nurses holding a BSN degree for jobs in direct patient care. Approximately 50% of all nurses associated with direct patient care in a Magnet-recognized hospital currently have a BSN."

    The 2017 allnurses survey results have shown some slight shifts. In 2017 the percentage of BSN prepared nurses has remained steady at 39% while ADN’s have dropped by 2 percentage points. The number of MSN’s have increased by 1%. Why might this be? Is there a greater demand for advanced practice nurses? Are employers encouraging and/ or supporting advancing degrees? Is retirement a factor in the decrease in ADN’s? As our final results are revealed, new light might be shed on factors influencing the slight shift from last year to this year. Will the trend continue? Are you thinking of furthering your education? We want to hear from you!

    We as nurses should support each other in furthering education, as well as respecting those who have years of bedside experience but might not have higher education degrees. As the field of nursing continues to grow our knowledge base will be required to change to keep up with the technology and level of care.

    The 2017 allnurses salary survey results will be released soon. It will be interesting to see if the interactive survey results show pay differences based on degree as well as location, speciality and gender.

    Villanova University - Hospitals Require Nurses to Have a BSN Degree

    2015 allnurses Salary Survey Results

    NurseJournal - BSN Degree vs RN Differences

  • Apr 22
  • Apr 22

    Quote from Bluebolt
    As he said, this is a "done deal" and is not at all like some hospitals saying they prefer you to have your BSN over your ADN. Most programs have already transitioned or are in the process of transitioning to a doctorate right now. A doctorate will be entry level for practice in 2025, masters level nurses will be grandfathered in but I anticipate pressure to continue on and get their doctorate.

    In reality, the DNP/DNAP CRNA program is the same thing, with a slight variation degree title. You'll learn everything you need to for CRNA practice and will be able to work wherever you want with either. Don't let the "a" in one of the degree titles throw you off, choose whichever doctorate CRNA program that you like, go for that one. I interviewed at a DNAP program and a DNP program and saw no difference at all in the clinical practice, course work or professors.
    The difference in DNAP and DNP goes back to the beginnings of nurse anesthesia programs. Anesthesia programs started as short training programs (3 weeks) and were taught most often through the hospitals or initially by OJT. Then as time progressed the programs became integrated into academic institutions, but not all of the those institutions had schools of nursing. That was the start of the all the different degrees that one can have for nurse anesthesia school. The COA/AANA never made it a requirement for CRNA schools to be affiliated or housed in schools of nursing, and many schools have chosen, for whatever reason, to open CRNA schools outside schools of nursing. The end result of becoming a CRNA is the same, but there is some educational differences.
    The biggest difference between the DNP and DNAP is that the DNAP does not have to follow DNP essentials and the other requirements set up by the AACN. I think the majority of the DNAP programs do address and/or follow the majority of the AACN essentials/requirements, but it isn't mandated and it gives those schools more leeway in classes that are and are not taught.

  • Apr 21

    Quote from Susie2310
    I'm sorry that this happened to you. This must have been a terrible experience.

    I understand the need for malpractice insurance, but I have three questions that perhaps someone will know the answer to in regard to APRN practice, which I have contemplated from time to time: 1) Does the Practice one works for usually cover one's lawsuit expenses, and what typically would be covered? It appears APRN's are employed/working under a variety of different employment arrangements, from self employed to partnerships to employee status, and probably others that I haven't mentioned, where different company and employment laws prevail for the varying situations, and of course these laws would vary from state to state. 2) Does "lawsuit expenses" include sums one is liable for that one's malpractice insurance does not cover, for example settlement costs that are judged to be one's responsibility? or 3) Does this just pertain to expenses such as attorney fees or does this mean other costs in regard to the lawsuit, and if so, what types of costs?

    1. If the ARNP is an employee of the practice or healthcare system, the practice or system generally purchases the malpractice policy that covers all employees of the practice or system. If the ARNP is an independent contractor, or is otherwise not an employee, then the ARNP needs to purchase an individual policy. The malpractice insurance policy pays for the indemnity (amount of any settlement, award or verdict) and expenses (legal costs, expert witness fees, depositions, travel, etc.) that are incurred in defending the lawsuit.

    2. The malpractice policy generally pays for all indemnity and expenses related to the defense of the lawsuit. This would include any indemnity paid because the ARNP committed malpractice. The only notable areas of indemnity that would not be paid by the policy are punitive damages and an award based upon sexual misconduct. It is generally against public policy to have insurance policies cover these areas of indemnity, so the defendant would have to pay for any allocation of damages along these two areas out of pocket. Note that an individual nursing policy also will not pay these two areas of indemnity.

    3. In terms of expenses paid, the actual defense attorney costs are the largest portion paid for by the insurance policy. Other typical expenses include expert witnesses, copies of medical records, deposition costs, travel to take depositions, preparation of trial exhibits, mock jury panels, trial consultants, marketing research, private investigators, video testimony perpetuation, etc. All of this is paid for by the insurance policy. You wish to avoid a policy that has only one set of limits for both indemnity and expense. All the expenses are deducted from the combined policy limits, thus reducing the amount of money available to pay for indemnity. If you have a one million dollar combined limits policy, and $ 200,000 is used for expenses, you only have $ 800,000 to pay for any indemnity award, settlement or verdict.

  • Apr 21

    Speaking as someone who does medical malpractice claims for a living, I endorse these comments. I would also point out that the malpractice insurer, your employer, or the state medical or nursing associations may offer what we call 'second victim' support activities, ranging from speaking with a therapist or peer, to group support meetings. I have run many of these activities, and they can be very helpful.

  • Apr 20

    Hello y'all. At the beginning of the school year I got a new job at a urology office and left my job as a school nurse. After 5 months I put in my 2 weeks because of workplace harassment but I got blessed and immediately got hired in as a pediatric nurse at a doctor's office! Now I am able to lurk around this forum again.

  • Apr 20

    Quote from superking
    Absolutely agreed.But why there is so much difference in salaries?
    I am really beginning to think you are from SDN, but the answer would be politics, marketing, and the billing structure for medical direction.

  • Apr 20

    Quote from superking
    I never meant to underestimate CRNA practice.I just said those words for the applicants of both CRNA and Anesthesia residency.That doctors have way more solid medical knowledge after medical school than nurses after BSN.
    As you have no experience with either one it is a mute point. They both learn to provide anesthesia in their individual school or residency. They both have a slightly different approach to training that leads to similar outcomes. The medical school/residency does not make MDAs a better provider. It does them give a slightly different perspective sometimes, but as I already pointed out the outcomes are the same.

  • Apr 20

    Quote from superking
    For God sake Do not ever compare Anesthesiology residency with CRNA school.There is hell of difference in capabilities of applicants.
    Then tell us those differences. Do you mean I can't provide independent anesthesia to all PS/ASA classifications? I can't provide front line military trauma support as the only anesthesia provider? I can't work as the only anesthesia provider in the hospital? Or maybe you mean that CRNAs can't provide anesthesia for certain types of surgeries?
    Myself and many other CRNAs have done all those things, and we will continue to provide anesthesia in the United States as safely and effectively as our anesthesiologist colleagues all the while continuing to provide the vast majority of anesthetics in the U.S..


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