Latest Comments by NRSKarenRN

NRSKarenRN, BSN, RN Moderator 118,861 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: 27,328 (22% Liked) Likes: 13,414

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    Information on these programs found in Allnurses Pennsylvania Nursing forum.

    Be aware the Philadelphia job market is extremely tight due to yearly flood of new grads. Expect to take ~ 6 months to obtain first position unless apply beyond 5 county Philadelphia area. Best wishes in finding a program that fits you.

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    AJJKRN likes this.

    What a nightmare....All in the name of opiod addiction prevention.... what a nightmare for NJ home health nurses for patients with new acute pain due to fracture, new cancer DX, post surgery, Sickle cell crisis..... will just drive up ER business. Fifteen day limit would be more reasonable. Some PCP in Philly/NJ area have 30+ days before patient can get appointment post hospitalization! Karen

    Philadelphia Inquirer
    Jan 19, 2017
    Andrew Seidman

    Christie set to impose pain pill limits despite N.J. doctors' objections


    TRENTON - Gov. Christie wants to tackle opioid addiction by limiting the number of pills physicians can initially prescribe - an idea experts say could reduce excess supply but may cause some pain patients to go days without medication.

    Christie, a Republican serving the last year of his second term, last week ordered new rules that would limit doctors to writing initial prescriptions for five days' worth of opioid-based medications, down from 30.

    The regulation would apply to patients with acute pain, such as a broken wrist, not those with chronic pain. Following a consultation, either by phone or in person, doctors could prescribe more opioids, such as oxycodone and fentanyl, to acute-care patients....

    ...Half of those who abuse the drugs report getting them from a friend or relative, according to 2013-14 National Survey on Drug Use and Health.

    "Many prescriptions may be written for clinically appropriate purposes and still inadvertently contribute to the epidemic because they go unused and ultimately are given or sold to friends or family members," he said

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    Will be interesting if they allow facetime -- issue is SECURE connection, ability to clarify orders provided, able to verify clinician giving orders. What if wife or significant other involved in healthcare picks up cellphone and texts orders without provider being even aware...

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    vampiregirl and txbornnurse like this.

    Most ECF = Extended Care Facility receive that patient with a decubitus ulcer already developed or identified from inpatient stay at a hospital.

    Case #1: Family member had cardiac arrest post anaphylatic reaction to IV Vancomycin, spent 6weeks intubated in ICU went into rapid A fib anytime turned or BP plumeted. Had redness R buttocks pinpoint opening when finally stabalized sent to telemetry. Upon getting to SNF, wound had opened to stage 3; rehospitaled another facility, now stage 4 with severe protein calorie malnutrition. Discharged to Home care where we used wound vac and decub closed after 6 months including 2 further short hospitalizations.

    Case#2: Healthy father with dementia had 2 episodes diarrhea 1 week apart: sudden onset high temp, confusion, inability walk shows up in ER with Stage 2 gluteal fold decub as unable to properly clean backside. Healed with home care intervention. Stage 2 reoccured as health deteriorated, on Hospice as only wanted to sit, unable to ambulate.

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    ICUman and Susie2310 like this.

    Found at Medscape Medical News
    Ken Terry
    January 06, 2017


    Use of Secure Text Messaging for Patient Care Orders Is Not Acceptable


    Joint Commission Reinstates Ban on Order Texting


    Citing patient safety and workflow issues, the Joint Commission last month restored its ban on the texting of orders in hospitals after consulting with the Centers for Medicare & Medicaid Services (CMS).

    In the December issue of its Perspectives newsletter, the Joint Commission, which accredits hospitals and other healthcare organizations, said that computerized physician order entry (CPOE) should be the preferred method for submitting orders, "as it allows providers to directly enter orders into the electronic health record (EHR). CPOE helps ensure accuracy and allows the provider to view and respond to clinical decision support (CDS) recommendations and alerts."
    If CPOE isn't available to the practitioner at the time of the order, a verbal order is acceptable, the Joint Commission said. Verbal orders should be infrequent and not used for the convenience of the practitioner, the body noted.
    According to the Joint Commission, the impact of secure text orders on patient safety remains unclear, for the following reasons:

    • Placing the burden of entering orders from texts on nurses may increase the burden on them and adversely affect their ability to provide care.
    • Transmission of a texted order, unlike a verbal order, does not allow for real-time clarification and confirmation of the order.
    • If a CDS recommendation or alert is triggered during the order entry process, the nurse would have to contact the ordering practitioner for additional information, which could result in a delay in treatment....
    See JCAHO pdf Clarification: Use of Secure Text Messaging

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    Skilled Nursing Facilities and Assisted Living tend to staff 8hr shifts/5x wk with every other weekend rotation with set schedule Most hospitals in Philadelphia area have 3 -12hr shifts/wk and schedule in 6-8wk blocks of time, many have self scheduling where you can quest shifts you desire to work in 2 week increments. Some facilities require alternating days and nights while others staff all days or all night 12hr shifts.

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    Posting in allnurses Nursing in Canada forum is best chance for advice.

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    Libby1987 and nursel56 like this.

    I am one of the QA nurses staff love to hate. Under Medicare payment is based on FUNCTIONAL deficits listed on the OASIS which needs to match the 485 plan of care. Incontinence IS a functional deficit, can lead to falls and should be listed on every client. I add functional deficit answers to about 90% charts i review.

    I highly suggest you attend an OASIS training workshop or at least check out OASIS Answers website for CMS Q+A sections to understand CMS guidance on answering questions. In speaking with my manager, since I attended a Blueprint for OASIS Accuracy workshop, my clients functional scores have improved as reflected at discharge along with agency's functional scores above state average as reported on CMS website.

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    Once you have been disciplined by BON for working with lapsed license requirements in this case mandatory Continuing Education requirements, it is there permanently.

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    Here.I.Stand, Emergent, and Esme12 like this.

    Please seek assistance from your EAP Program (Employee Assistance Program)

    An example of such a program is Carebridge EAP used by many facilities across the US see NYU's listing of available services. Employee Assistance Program - Carebridge

    Our EAP offers 24hr coverage: 2 phone assistance sessions, 3 Private counseling sessions along with many wellness programs, relocation assistance, myriad of services. Only data collected that HR gets monthly/quarterly contact is type of service EAP provided, no names ever.

    Please call your EAP program NOW to gain some peace of mind....especially prior to speaking with your manager.

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    StellarLeigh likes this.

    tnbutterfly, Thanks for posting this article so allnurses members can respond re denial full CRNA practice authority.

    Per the last paragraph in article:

    The public has 30 days from the final rule’s official publication on Wednesday to weigh in on it. Comments can be submitted here: VA Regulations
    AP44 - Final Rule with Comment Period - Advanced Practice Registered Nurses

    Add your comment by using link at top right corner of VA regulation page

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    Sun7802 likes this.

    According to ACEN, only NJ accredited LPN program is at Union County College.

    NJ is one of the states where it takes awhile to find first nursing position due to glut of graduates except for rural areas.

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    herring_RN likes this.

    98% nurses voted FOR contract.

    Einstein nurses ratify 3-year pact; here's what they got


    Philadelphia Business Journal
    Dec 27, 2016, 7:50am EST
    John George

    ...As part of the new contract, according to PASNAP, Einstein has agreed to hire additional nurses and maintain improved staffing levels. The hospital will put in place new plans to handle spikes in volume and will work with a nurse-led committee to address staffing issues.

    Einstein has also agreed to limit the pulling and reassignment of nurses to specific areas for which they are appropriately trained. Over the course of the three-year contract, the hospital will reduce or eliminate the direct patient assignments of charge nurses.

    In addition, according to PASNAP, the contract calls for undisclosed wage increases and a transparent wage scale based on years of experience. PASNAP said the hospital also agreed to improve the nurses’ health insurance, providing more coverage for nurses and family members who are treated outside of Einstein....

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    Philadelphia Bussiness journal
    Dec. 21, 2016
    john George

    Nurses at another Philadelphia hospital reach tentative deal


    More than 1,000 registered nurses at Einstein Medical Center have reached a tentative agreement.

    The nurses are represented by the Pennsylvania Association of Staff Nurses and Allied Professionals [PASNAP], the Conshohocken-based union they voted to join in April.

    The union will hold ratification meetings on Thursday to allow all Einstein nurses covered by the agreement to vote on the proposed deal. PASNAP officials said details of the contract will be released after ratification....

    ...The nurses at Pottstown Memorial Medical Center also voted to be represented by PASNAP this year, joining in September. Contract negotiations have not yet started at Pottstown Memorial, which is owned by Community Health Systems of Franklin, Tenn.
    It's clear that PASNAP is THE nursing union in the 5 county Philadelphia area now representing ~ 1/3 area hospitals.


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