Dempster

My own records related to work. POs and Neg reviews and practice, history while there. I know it's their property, but it was a little suprising not to be given copies of paperwork I was given (and lost) in the first place. I'm sure it's a CYA thing, but the policy just about implies that HR or whomever isn't well equipped with common sense.---Nevermind, I've worked with my share of idiots. We all have. As far as your medical record goes, HIPPA doesn't even require a photo ID. Forms are not necessary, unless a facility was voluntarily written a letter in leu of computers or in case of deafness when Medical Records is asked to copy the pt's record. The pt does not have to discuss the chart with the doc, nurse, manager, HR, Medical Records, or even the Executive Board of Director. The pt may ask, but docs are not to be told no more than once. The case could be made for a billable visit, if so. The pt must be made aware of billing BEFORE billed in such case. Depending on the facilities technology, records can be printed from room by doc, or at checkout. If records are old and in storage, 30 days to get them to pt max. Email is perfectly acceptable. CDs, SD cards, sticks are allowed if compatable with tech. If you want to sit and quietly use your phone to take a pick of each page in record, that is perfectly acceptable unless it is disruptive or puts other pts or their info to be likely copied to pic. You have the right to look at the original digital or paper record, and still obtain copy. If sent by mail a flat $6.50 charge is fine, but so is an itemized bill to show cost of each peice of paper, envelope, & stamp. You only have to call, email, write, post card, or verbalize that you want a copy and the pt chooses the method. If company doesn't have computers, or any other access method wished by the pt, a hard copy has to be provided. If not mailed, there is no charge (unless it's a 20 pounder). HIPPA guidelines show how to legally charge for this. The chart should be available to pt at the earliest possible convenience. If you are on-line, 30 days to shoot an email or attempt to charge for it should be reported. Psych records are different, especially if it would cause emotional harm, suicidality, or cause someone to get hurt. A visit can be given only to a pt after a named person that reported behviors or info that was meant to be private. This person has to legally be informed and have time to get a restraining order if need be. The same would go for someone the pt talked about, depending on the conversation. The chart should be as convenient as possible. It's really good when you need an itemized bill, or if you have a chronic illness. Knowing your labs, test results, and history may help in understanding one's own disease process and lead to better outcomes. That's why it's "Portable." It is your chart as well as theirs. It also allows for misinformation to be caught, discussed with provider and ammeded. You have the right to fight this in court if doc denies a mistake you feel exists. HHS.gov as HIPPA info for providers, 3rd parties, insurance companies, and a lot of facts not well known.

Without an AED, her cardiac rhythm cannot truly be known, even by checking pulse. I agree there should be no breaths or stops for pulse checks. Perfusion, perfusion, perfusion. RBCs normally complete their job every min. The iron hemes carry an Oxygen. So that's 2 tiny doses of O2, however there are around somewhere b/t 260 to 300 MILLION iron+oxygen bonds (hemoglobin). The cells are flattened-discoid in shape, thereby increasing surface area and easier to get all those O2 molecules to vital organs. FYI: They are flexible sponges when they pick up O2. They carry A LOT of oxygen this way and get into tiny vessels like they do yoga. However, the last thing to worry about during a code or with CPR on someone put in your path that day (Fate) is their capillaries. Capillary refill doesn't apply in such a moment. So you have millions of hemoglobin molecules in a single RBC, and depending on sex and size (and comorbidities) we have about 25 TRILLION RBC, give or take a few TRILLION. Plus RBCs are continuously, non-stop pump out Retics that are "adults" in about a week. When under extreme conditions, like an MI, RBCs pull off magic tricks to keep vessels dilated and flexible, while releasing other substances that constrict vessels in extremities, keeping vital organs top priority. ATP (clot-buster) is also released when the body is in shock. I love A&P and as you might see, I'm a dork. This is ultimately why you keep pumping until you pass out or they come to and push you off! It sounds like this girl's situation had to have caused AMS which gives you legal protection until she is oriented to self and situation, then you might get charged with Assault and Battery. This does not apply when an ambulance takes you to an ER. If you don't make sense or aren't awake and fully oriented, legal liability is (should be) removed by "Implied Consent." Similarly, if you voluntarily commit yourself, you also give "Implied Consent." You may think it's time to go home, but doc says no way and changes your status to "Involuntary" by way of AMS. Ok, so all that was to help explain compression only CPR. Plus, your other cells are getting funky. It doesn't take long AT ALL for standing blood to clot, despite the RBCs Atp magic. You may end up with a clot to your pt's lungs, brain, or branch of vessels in an already sick heart. I've seen this too many times, but they lived (mostly) and now have a life-threatening condition from clots. No matter what the outcome, the fact that CPR was ever attempted makes you a Life Saver. Better to be a little heavy handed to pump the heart, than not. I'm sure you did fine though, esp bc females generally are easier to compress than males (just my experience). You don't try to break ribs, but imagine pressing down really close to them. At some point, esp if in ER, ICU, or on Code Team, you will almost definitely break a rib or few r/t osteoporosis, age, size and density of bones. Think about their musculature as you do your split second head to toe by your senses only. Greater muscle size and tone would lead you to think that bones are stronger. A petite elderly, white lady with skin sliding over her skeletal frame will most likely be broke and bruised- Better broken and bruised than dead. That girl lived until an ambulance arrived. You did something right for a sudden fall with respiratory dysfunction. Surely if her CNS may be a cause; if not, her CNS became involved. Thats a whole lot of failing organ systems girl! Be proud! Dempster- Too many years of experience, starting out as an ADN, BSN, FNP-BC with PICC Line Cert from Vanderbilt, and some teaching in Community Health and Med/Surg I and II, guest lecturing, and tutoring/mentoring from the very beginning. -"What a long, strange trip it's been." - Grateful Dead

Check airway for obvious obstruction and if there isn't anything blocking her throat, start compressions. Absolutely no breaths. It keeps the blood circulating to the brain and other vital organs. This method has decreased death rate of CPR recipient and decreases damage to organs, like the brain which has outcomes that show less brain damage. for example. Same rhythm and depth. I've seen some crazy things, but that girl needed to take that EMS to the freaking ER for all types of scans, diagnostic procedures, drug screening, and a cornucopia of lab tests. I can think of several likely problems ranging from "inconvenient" to "confess your sins" bc she is about to catch the Jesus Buss.

She and her family are so ignorant. Dear Lord. Probably wanted to avoid a bill. Nonsensical crap goes thru some minds instead of the ******* obvious.

Check airway for obvious obstruction and if there isn't anything blocking her throat, start compressions. Absolutely no breaths. It keeps the blood circulating to the brain and other vital organs. This method has decreased death rate of CPR recipient and decreases damage to organs, like the brain which has outcomes that show less brain damage. for example. Same rhythm and depth. I've seen some crazy things, but that girl needed to take that EMS to the freaking ER for all types of scans, diagnostic procedures, drug screening, and a cornucopia of lab tests. I can think of several likely problems ranging from "inconvenient" to "confess your sins" bc she is about to catch the Jesus Buss.

They have to get a subpoena where I am. I just sent for a subpoena to obtain my own "permanent record." Crazy.

So true about the nuances and ways of getting the message across. Sadly, this has happened to me and I've seen office managers do it to others simply bc they are upset about the inconvenience of having to hire someone else. I always make sure to put down references I trust. Most places that I've worked make the person contact HR. So, don't piss off HR, lol

That depends. Great mother and father- aide/helper at home. Parents were horrible and abusive. Definitely a facility that the state choses for them. You see these sweet old ladies and just love them, but her kids are just ****** and miss holidays and simple request for new underwear. I garauntee you, she was horrible to them. Not always I'm sure, but most cases.

I've been "let go" before, but I include the work reference. Gaps aren't good. Put SAHM down if you really haven't been working, or put down any community services, like volunteering to fill the space. Then if asked, you say that you felt compelled or a calling that you needed to fulfill to help others. You did this until the right, fulfilling, and interesting job became available! It is illegal for any work place to give information other than start date and end date. It is a BIG deal. Also, this has happened a few times to me, businesses are not allowed to ask if you have children! If you are a mother or gaurdian of dependent children, you are less likely to get the job. Sexism sucks.

It is illegal in some states not to go in to work at a hospital or fire station, etc. It's under "abandonment" and "direllection of duty." It sucks. In the future, you will need to call your manager and explain that you cannot get to work. She may have already contacted responders with chained tires that will come get you. If not, call the Sheriff's Office or Police station and Fire Station. They should have the means or at least contact info to people who have been assigned to get staff to the hospitals. If they will not help you, ask them to put it in writing (CYA). Doesn't matter about your tires. New or old tires, you for whatever reason cannot (but wants to!) get to work. You would not pay for this service. Also, bring a small overnight bag. You will probably be staying until the weather lets up. Not working! Don't ever let anyone guilt you or intimidate you to "help out" when your clocked out. If this info, or related info, was not made available to you and you cannot find the policy (if you were ever told about it), you can fight for your job back. Then quit and list reasons. Your boss will want to fire you, but really can't be that obvious about it. You should have time to put in the required notice. Go to the top if need be, but go back, and then quit on your own terms or forcefully "request" to transfer floors/ Unit. It's not about the $ or being "a child." That was just ugly. Most of us are proud of how far we have come from where we started. I've been homeless, had rusted out cars with crap transmissions, oil and radiator leaks, AND tires. How are you going to become more independent, savvy, professional, and confident without starting somewhere. You need to learn until you die. Learn from your mistakes and from others. Look everything up after you talk with your more experienced colleague. Never trust anyone who knows all the answers- they are less likely to keep up with new ideas and current literature or even lead you to someone who probably has the answer. This is true in life, not just nursing. Haha! In 1998 I was in school and waiting tables at an Outback. It was New Year's Eve and I had plans. Plus, there was that Y2K thing. I was not going to work on New Years 99'. I was broke. Sharing a old, crap jeep, and was scraping by. I quit mid-shift. Childish- Yup. Responsible?- Nooo Worth it? DEFINITELY Sorry!

You are a hero. It may be the job, but it doesn't change your super hero status. I've had to climb onto the bed, straddle the pt doing CPR as he was being rushed out of surgery and into ICU. No one dies in the OR! I've broken ribs. Called an all clear not knowing my 8+ month pregnant belly was touhing the pt. Thank God for observant colleages! It's different outside of the medical setting. Family leaves the room, instead of begging and pleading and wailing. The teen fractured his skull (to put it mildly) and was paralized from the very obvious neck down. He was dead and I brought him back. My boys were in the car, one of them goes to the same school as the 16 yo girl and just barely 18 yo boy who jumped out of the car. I've had so many pts that should have been DNRs and pts with DNRs, but the entire family insists it be ignored. I do believe in miracles don't I? Ugh, I was told by the only other provider in this little mountain hospital ER that "Dead people don't sue, but famllies do." I hate ethics, but love saving someone that isn't ready or meant to go yet. Good for you!

Last time I checked, something like 80% of general practitioners treat mental illness. Mental health care, access, Insurance to go to the nicer place in the state (sometime's there are 3 in my state), post-psych ward follow-up in the US, and community outreach for the 1 out of 4 (at least) that will be diagnosed with a mental illness in their life-time, and the pyscho-social help for family and friends. Not to mention the public health, outreach, and education for our communities, counties, states, and country. It's easier to go to prison for years, than get long-term care like they had at places like Dorthea Dix in NC that was shut down. Some of us are getting the message through! In NC, you can hand your variety of drugs over and tell him that you need shelter, food, or just help getting off drugs. Most likely an opiate now-a-days. My last office manager actually sat me down and discussed how to increase my monthly patients. Monthly- pain pills, diet pills, anxiolytics.... People get hooked, bc the brain is lazy. It would rather make you feel pain that should no longer be there, than actually release dopamine the old way it used to do. This, itself, is a mental illness bc it changes your brain chemistry and pathways in the brain. The rest are in prison, or self medicating on the street. They'd rather sleep outside than risk strangers and scabies in a shelter. Try to commit someone- but, do it on a Friday if possible so they stay more than 1-2 days after downing a bottle of Xanax. There are not enough psych professionals. It can be hard. Behaviors that are directed by a sick brain start looking oppositional, defiant, and devious. You start to get pissed when they act out or try to guilt you. It's hard. It's rewarding for so many afflicted, there friends, and families. They will quit meds despite having a medical background, very knowledgeable, and very intelligent. Mental illness could give a F@k about your fancy education or lack of, or how smart or gifted you are (higher suicide rate with higher education and IQ, generally). We need you in psych. Prepare though. Study in depth about personality disorders, mental illness, and addiction. Don't listen to your new coworkers about the patients. It's a high burnout area. Look at treatment holistically. Know that you may be the first person to treat them like they are human and not dangerous a weirdo. Remind them and ask them about their strengths, not just the crappiness of disease. This may sound strange, but, ask what about their condition is a strength, helps them see the world like no other, and makes them a good type of interesting- many with hallucinations will mourn the sounds and visuals that were special to them. Not all hallucinations are dangerous, but most people don't hallucinate and therefore understand why some of them would feel like a huge loss, like losing a hand or foot. Know your meds and side-effects, good mouth checking, and know all the hiding places. You don't have to get an education in psych to make a bigger difference. Read and study new literature/ studies. Set an example for your coworkers and back it up with research and known outcomes. I'm a little passionate about mental health care! Do it! If you want to be a psych nurse, find a mentor if you can. All of this will help you as you get your advanced degree, even when you find out that some things you learned in the unit are wrong and have to be changed! I wish you the best and pray more people follow this path helping pts and family, decreasing crime, educating and breaking through the stigma. That is better, but not good enough. You will be treating the most difficult diseases plaguing your pts. Treating the pt's brain, the most important and least understood organ. You are a super-hero!

Out in the mid and western, northern states, NPs practice 100% independently. They aren't stripped of skills or medications that the are educated about and use appropriately. There isn't a doc that considers you an extension of him. It's nice to bounce off thoughts with another provider. We all do it. I've called former docs and NPs that I trust for certain things that are up their alley. I do the same for them. In Knoxville, TN, a practitioner (pretty sure CRNA) partnered with one or two others to open an Anesthesiology clinic. They hired most of the anesthesiologists and CRNAs in Knox and surrounding counties. I think one of them worked PRN for giggles, but mostly they just raked in money. It was more than enough for overhead and such. It was brilliant. They inspire me! Screw opening my own family practice. Maybe one day I'll open up a specialty clinic and hire medical practitioners that will work out amongst the area!

Medical professionals are the worst, especially the worst patients. Plus we try not to, but we diagnose our kids and may even write them an antibiotic if needed. The more letters behind your name- the greater the God Complex.

The ultimate "F U" down South. I'm from the Carolinas and that's a devious way to tell people how stupid they are (if not from South). They just think you are a Southern Belle, lol! I completely get the sending kids to school sick ordeal from both perspectives. My oldest has had to do "credit recovery" for four years to go on to the next grade despite A average in AP and Duel Credit classes. He has problems though and has to see his NP monthly. Sure you get a note, but that doesn't cover the last week of hell or what the side effects of his med change will be this time. My youngest has GI issues w a history of Pancreatic Insuf. Was treated for Crohn's, but IDK. It could be a bowel tick. Tics and Tourette Syndrome (tics run in the family, but only myself and cousin have Tourette's (not bad at all right now). Between being ashamed and depressed because of his teachers telling him to stop disturbing the class (not as nice as that though), plus his seizure med that zombied him and made us late, he missed school. The youngest with bowel disorder goes to the bathroom 3-5 times on a good day. The most I've counted was 19. AND- all that doesn't count viruses or strep and what-not. Two kids with straight As and one with all As and 1 B. I'm not taking my kids to the doc office to pick up germs to piggy back their cold. I know what's wrong. It doesn't take a medical professional to know that there is jack for it. I just keep treating them like I was, pay a co-pay, and add up to three boys onto a overbooked provider. Kids should go to school and not have home school suggested because of chronic, but serious, disorders that more than take up sick days. If they were only running a low-grade late at night and early in the morning, I'm guilty. So guilty. I'm sorry. Sometimes it simply an autoimmune flare with fever. It's like being between a rock and a hard place. It's a public school and getting people to understand the situation is frustrating. All but one (burned out) school nurse understood. "It's the law," they say, even though they are all honor roll, debate club, environmental club, are politically active-seriously, Library Quiz Team, Mock Court, music lessons on good days, Gifted and Talented Academics and the Gifted and Talented Art Program. There is more! It already sounds like I'm bragging about my boys; I am. They aren't perfect, but make the grades, extracurriculars, and community service. A lot of kids need to be at school to keep up, get away from home, and have at least one decent meal, but some kids are outliers. They don't need Credit Recovery, summer school, or arrest threats for their parents. IDK, teachers that don't mock a kid with Tourette's, give kids with known bowel disease (7 formed stools in all of his 12 years), or people that don't force the teen with a severe stammer that developed over 2 days after a mood stabilizer. Either he thought my son was faking it (painfully and embarrassingly) and he wanted to humiliate him, or this science teacher doesn't understand that our most important organ is the one we know the least about. In that case, or even if he was faking (not normal anyways) he wanted to humiliate him by causing even more attention to the palsy-like symptoms and extreme stammer. My son went to school like that so that he wouldn't get into trouble. Ugh, anyways, God bless their hearts.

As a man or a woman, I would not want to be in the room with any student. They are tall 3 year olds, but with crazy hormones, and "ride emotional elevators) up and down all day. Even the sweet ones- you don't want someone with a perverted mind coming up with a version of it all. Safety is huge. I have a Junior in HS and a 6 & 7th grader. A kid that brought a gun to school last year (said he was afraid of bullies) brought in a full clip. The went on lockdown. Only found the clip (probably the back-up clip), as he could have hidden the gun anywhere (roof, behind something, bush, etc). It was horrifying. The police swept the school and searched all the other students. He wanted to send a message of intimidation, or worse. It was the same day that the kiddos in FL went back to school. No accident! Anyways, you need a cheap plastic wedge for the door. Hold it open a little- just enough, and also be able to quickly shut your door and replace the wedge. All rooms should have them to put under door as a way to buy time when a sociopath shoots the lock out or otherwise tries to get in. It's a tough spot to be in. Protect yourself and reputation. That is the greater risk. But! Be ready for any type of emergency. Dempster, FNP