Fmc

imperial... you there?

You know, I've been thinking... (UH-oh !!!) :uhoh21:

So many of your questions could.. perhaps SHOULD be directed to the upper management of those you advocate for.. rather than staff directly caring for these patients... many of these staff who are employed by different companies. Why not contact the company representative or regional manager of those patients and direct some of these questions to them?

I'm not being snide in this,truly.. I am being serious. While there ARE some generic questions that we can readily answer, many of your more specific questions or concerns perhaps should be taken to the company itself.. this might help you more in the long run.

I understand that you are advocating for your patient(s), but in doing so, you seem to tip the balance only in favor of the patient, and fail to give the staff the benefit of the doubt... and while this may well not be intentional, it is rather disconcerting.

You must remember that this is a nursing message board, and it can be tiring to have someone from the outside questioning our every move and motive.

Again, no disrespect or harm intended here, just been pondering this.

Thoughts?

The 'UltraCare Open House' is on April 13th in my unit in Massachusetts, but I can't go because I have a doctor's appointment. The nurses handed out UltraCare t-shirts to all of the patients on my shift this afternoon... the nurses have special "UltraCare" scrubs that they have to wear for the open house. Am I imagining things, or is this just like the Mickey Mouse Club? :chuckle

I'm upset that I will miss my chance to FINALLY hear what UltraCare is... because after a year's worth of propaganda pamphlets, I still don't know!

The 'UltraCare Open House' is on April 13th in my unit in Massachusetts, but I can't go because I have a doctor's appointment. The nurses handed out UltraCare t-shirts to all of the patients on my shift this afternoon... the nurses have special "UltraCare" scrubs that they have to wear for the open house. Am I imagining things, or is this just like the Mickey Mouse Club? :chuckle

I'm upset that I will miss my chance to FINALLY hear what UltraCare is... because after a year's worth of propaganda pamphlets, I still don't know!

baahahaha !!! :rotfl:

You mean you didn't have to do all those CDs and quizzes??? Sheeesh.. how did YOU luck out? :chuckle

Our open house is on the 12th. Whoopdedoo !

I was surprised that this was being done during work hours.. but, after hearing about the consent that was needed to be signed by patients, I am wondering if they will be taking pictures as that is what the consent said.. that fmc could use pictures or any taped verbal statements for their advertising and pat would not be renumerated, nor could sue in the future for renumeration. I just think that is interesting. IT is like the patients are on exhibit. As if staff does not have enough to do..

I have been thinking in all my 30 yrs of healthcare experience I have only once been asked what I think and that was in a management position. However, I did, during staff meetings and individual 1 to 1's ask my staff what they thought would improve deliveyr of care.. Personally, I tihnk it is terrible that the industry does not take feedback from nurses. Do they not realize it is the nurses that are d ealing at the level whereby they can give input that is realistic and sensible, along with what is best for patient. ANother thing that is most bothersome is such that when a medical director of a large company, i.e. Dr Lazarus of FMC, or any others does not understand the nursing problems and putting patients in jeopary,,, what is wrong with this patient. I truly believe that once the upper crust experiences what it is like to have a family member or significant other on dialysis, or in a critical situation, will they, maybe, perhaps, understand and realize what it is all about.

Our shift got TOLD to sign those 'consent forms' today-- you HAD to sign them even if you didn't want to have your picture taken... the nurse wrote "No pictures or video' on top of the forms. Also, what in the heck do they want our addresses for?! No way was I providing that info. At least two other patients in my section also refused to have their pictures taken. I had heard that screens would be put in front of non-consenting patients when the photographers are there-- well, our unit only has three screens, and I'm sure there are more than three 'dissenters' in there! They're gonna have to get more screens! :chuckle

It's bad enough I have to be gawked at by everyone's visitors while I'm on the machine... I'm not going to be a trained monkey for a bunch of strangers, too! If they really gave a damn about their patients, they'd have this little shindig on a Sunday when we're not sitting there as a captive audience!

They want us to "Experience Excellence" ? Well, I'm experiencing something, but it ain't Excellence... it starts with a 'b' and ends with a 't'! :)

The 'consent and release' states... "This consent is not restricted by time or geographic limitation................."

For those of you who are not aware of this 'consent and release' that was given patients to sign without explanation..........'''

I.................hereby grant to National Medical Care, Inc., its parent, subsidiaries, affiliates, and agents (the "Company") the absolute right and permission to use, publish, broadcast, and copyright my voice recording, name picture, and likeness, or anything made from it, in any manner or media whatsoever for purposes of advertising or trade in promoting and publicizing hte Company, including without limitation the Company's UltraCare@ brand and its locations, items, goods or services.

1. I agree that any voice recording, picture or likeness of me, or anything made from it created by the Company is owned by the Company.

2. I agree that I do not have to approve how the Company uses my voice recording, name, picture, and likeness, or anything made from it and that I will not be paid (now or ever) for my persmission to use my voice recording, name, picture, and likeness, or anything made from it. I agree to not to sue the Company for using my voice recording, name, picture, and likeness, or anythning made from it or due to any alteration, distortion, or illusionary effect, or use in any composite form (incluuding, without limitation, a lawsuit based upon invasion of privacy, defamation, or right of publicity).

Looks like FMC sure did cover their behinds. Saw this on another board, found it very interesting, also. Is this taking advantage of patients?

Am curious if anyone knows. Does the UltraCare program say that one staff can cannulate one patient, if the patient so chooses to have a certain staff. I saw a post regarding this situation and was curious.

J'nette: I appreciate your responses and oh yes, these have been addressed with those at higher levels, often. As a matter of fact, one patient, as a direct result of her addressing a specific problem encountered direct retaliation and was told 'if ya don't like it leave"..........:) sorry to burst your bubble :)

Yes, they're covering their behinds, as would ANY company. There is nothing deceptive or illegal about this. As said before, this is nothing new.. this is done all the time for advertising by all kinds of companies, medical or other.

They might have some sort of "TV Spot" in mind, who knows?

Where they might use a clinic background, and "satisfied customers".. hence the use of voice and "illusionary effects". I don't think there is anything sinister in this, it's just more advertising. They might want to produce brochures,etc. No, I don't think it's taking advantage of patients as it remains their right to refuse to be involved at any level. That is why the consent forms were passed out. They have the right to refuse.

No, there is nothing in Ultra Care that promises patients their own personal "favorites" when it comes to cannulating or any other part of their care. Nor should there be. It simply is not feesible to start playing favorites, for just as soon as you do this for one, the rest of the group will all be demanding the same. This is why we rotate sides each week. This has proven to be beneficial for both the staffmembers AND the patients.

Suppose I have difficulty sticking one particular patient. While it can be temporarily unpleasant for the patient, if I never go back to stick him/her, I will never have the opportunity to "get it right"... there's that certain "feel".. you just "know" when suddenly you've got it down. Each patient's site is different, and you have to work with them to know just how to cannulate that person. Sometimes it takes no time at all to get to know how that person is best cannulated, other times it takes awhile before you've got it down.

But we must ALL know how to best cannulate ALL patients, as the same staff is not always there. His/her "favorite" staff member might be off that day, or on vacation for several weeks.. then what? It just doesn't work that way. We rotate patients weekly for a purpose, and that is to learn and get comfortable with ALL accesses, as well as all patients.

We as staff are expected to treat ALL our patients with equal respect and dignity (even though some are not our "favorites"), and can't just pick and choose to care only for certain ones.. it goes both ways.

If I don't get the opportunity to work with a site that is posing a challenge to me, how am I going to become efficient at it? And what if I'm the only one available to stick that person someday? Then what?

Ultra Care will eventually (well, so they say...I'll beleive it when I see it) team up.. meaning, have "teams" that will provide care to one set of patients for 3-6 months. That way the assigned staff will be able to work with them, focus on them, and follow their progress more closely. Each staff "team" will have assigned patients and will form a patient/staff team. After so many months they will rotate again. But even this will not assure any patient that he/she will not have other staffmembers cannulating him/her from time to time, as it is not possible to have one particular staffmember there at all times.

Just as we don't pick and choose our nurses when we are hospitalized, we don't play favorites at dialysis.. be it staff OR patients. :)

oops! One other thing..

I don't know the specifics of the patient situatuation you referred to when the patient was told he/she could "leave and go elsewhere to dialyze".

But I can assure you that patients, too, sign a contract regarding their care, and THEIR responsibilities in that care, and what is expected of them, and how things are run at said facility. And how staff are to be treated as well.

There ARE cases in which patients CAN be a royal pain in the u-know-what for various reasons..and if these are totally unreasonable requests, or the patient is verbally abusive to staff, direspectful, or in other ways noncompliant, yes, the facility DOES have the right to terminate the contract with said patient and ask that he/she find another facility at which to dialyze.. and this is backed up by the medical director.

It is not a one time offense, it is a rather lengthy procedure with many checks and balances to give the patient every opportunity to have his reasonable needs met, but it said patient proves to be disruptive or disrespectful or noncompliant, then it affects the entire dialysis community in this facility and will not be tolerated.

As I said.. I don't know the specifics in your situation, but it is not unheard of to ask a patient to dialyze elsewhere.

Regarding the patients requesting specific people "stick"them, it is an issue best not inititiated in any unit. Those patients won't travel (since they can't take their tech or RN with them) which can be a problem for their families and their own "self".

Yes, bottom line is the patient CAN refuse to have someone else "stick" them, but that can result in NO dialysis that day. Obviously their choice.

In my opinion, the whole idea of one group of staff taking care of one group of patients for months is not a good one. In theory, it sounds good, but when it comes down to it, it will possibly create staffing issues... What if I want off work on a Monday, Wednesday, or Friday and my "group of patients" runs then? Will I be denied my time off? Second, the more people who are familiar with a patient or group of patients will definately benefit the patient in the long-run. As I used to tell my patients, the more people who know how to cannulate your graft or fistula it is better for you. The more independent we can make patients the better off they are as well as we are! Another thing, familarity breeds contempt. Patients who have the same care giver for a long period of time are more inclined to speak negatively toward that nurse than one they are not quite so familiar with.

Here is an idea- since everyone of the staff members are tooooo busy to do anything but keep their heads above water on any day, how about having a nurse case manager for the patients in the clinic. This nurse would not ever be expected to do hands on care of the patient regarding the dialysis treatment, no matter how short staffed the unit is (because, believe me they will try to suck the nurse into this!), this nurse would be responsible for looking at the patient from a holistic perspective. They would utilize a format that would look at all of the areas that are monitored from an outcome perspective, plus they would be aware of any spiritual, psychological, emotional or other physical issues that the patient is having. This nurse could (in conjunction with the other disciplines in the facility) make referrals to appropriate other professionals. This case manager would be part of care plan meetings, cqi, etc.

Unfortunately, since most of the for profit facilities expect the charge nurse or clinic manager to perform these duties (which is impossible), and they do not want to pay for this nurse (who could improve their patient outcomes tremendously), we, as professionals who care need to take this concept to the upper management of the individual companies.

Okay, enough words for now.

leeleigh

I don't think in my lifetime that we will see corporate doing a case mgr due to cost effectiveness for the upper big wigs. Saturday, went in to unit when dropping off a patient and observed staff working so hard, along with one stating they could not get additional staff due to budget. So, do the top big wiggies really understand what goes into a treatment and the staff that are needed? I am not so sure.

Ultra Care - I have been trying to find on the internet, as well as several of our clients asking for written document stating what ultra care is and we have only received the marketing/public relations written information. If any of you know the specifics related to delivery of care, besides single use, clearance, etc etc.. appreciate it. Back to single sticker. I thought I had read whereby a patient requested a certain staff, due to better sticker, that it was part of ultra care to comply with request. thx.

I thought I had read whereby a patient requested a certain staff, due to better sticker, that it was part of ultra care to comply with request. thx.

Nope.. not anywhere stated in Ultra Care. Nor does it benefit the patient OR the staff. Just as leeleigh stated above.

If one patient can request this, what's to stop the others from doing the same? And where does that lead? We have to have some cohesion in running these txs. and the timing of them due to appt. times, etc. What if 12 pts. all prefer the same "sticker" ? What if just a FEW prefer one sticker? What if that staff member is already busy cannulating her patients, she can't just tell her own patinets to hold, and go run over to the other to stick him/her. And to "permanently" request one staff member won't get it either, because this same staff member must rotate and cannulate others as well.. not to mention she has days off (is she supposed to not take time off wher that particular patient is dialyzing? What about her vacations, etc?) Surely you can see how this is so NOT feesilble?

It just does NOT work that way.. cannot, nor will a clinic allow it. Upon OCCASION.. if one staffmember is having difficulty sticking a patient for some reason, that staff will of her own volition ask another staff to come over and give it a shot.. as we do not wish to cause our patients harm or pain.. or damage their access. We all do this from time to time. That's FINE.

I remember having one lady I had the absolute hardest time with.. I dreaded seeing her walk through the door when she was on my "side".. and I know she felt the sameway ! :uhoh21:

But after about a month of not giving up and continuously working with her as often as I could, I figured out her "stick".. it was just a "wierd" one, all there is to it. Ever since then I have never had a problem cannulating her.. ever. Right in, smooth as silk.

There was another lady who had scarring in her access, and it was like you needed a maulhammer to get it cannulated. She asked for one specific nurse who had it downpat... all the others (including our clinical mgr.) had difficulties with it. It was politely explained to her by our clinical mgr. that we simply could not accomodate her in her request, as it would throw off everyone's schedule.. that we have to have some sort of routine or it throws everything else off. Not only that, but it is not fair to that nurse to always have this patient to stick as well. It works both ways. The "favoritism" scenario is NOT one you ever wish to propagate.. it serves noone.

By the way.. we now are ALL able to stick this patient I mentioned above. That benefits ALL. :)