ApplePineApple

Cost is usually a major factor. A decade ago, it was far cheaper to get a BSN at a partner state school then a MSN. I had probably 10k saved and the cost saving was anywhere from 5k to 25k depending on how many credits were added to a MSN bridge and the cost per graduate credit hour.

Well, turns out it is not policy and they do allow people to view charts with healthcare records. I am concerned about some of the responses here though. It doesn't seem like you guys would be providing adequate care. This is probably laws have changed and EMR release the records sooner.

A nurse is probably trying to *** me because the hospital screwed up pretty badly and so now he claims he cannot let me review the last note the physician/resident wrote during rounds or review lab work with me. It literally takes 10 minutes. He said they make even patients use mychart. I am listed on the paperwork they provided for POA as an alternate. The way the document is worded is that alternates have access to medical documents and patient records immediately if he cannot make decisions. This is from the state and the hospital had us fill it out. I do know that we are pissed about multiple botched procedures. Like I am pretty forgiving but I honestly feel like they almost killed him. I have a tad bit feeling that day shift RN may have made notes and hid them from the patient mychart as facility allows nurses to hide notes. I do feel better about the prognosis as it probably is fixed and I am impressed with the attending note analyzing some potential fever causes. Anyway, is this a policy at your hospitals? That patients and their POAs cannot access medical records or review it with the nurse? they are claiming that patients cannot review the notes or lab work either. No policy provided. I'm threatening tomorrow to make the resident come down in the morning and read off every lab value to me as the nurse said he could see if the resident would review it with me.

Thanks! They also apparently had zeroed the EVD wrong too since they were discussing it

So can you monitor accurately and drain at the same time? Does it depend on a brand? I was always told it was one or the other but this place swears you can do both.

I work for a top ER that held patients precovid. We did an admission screen at I think 24 hours. Or were supposed to. They linked into the ER narrator so I wouldn’t whine too much about it because epic can link anything depending on if they have a good package. And it may be worse in the ED narrator. So saying it isn’t in the ER narrator is kinda pointless because they can add it in if their package allows them It is easier to think of the narrators as shells or skins to cover the inpatient charting. 90% of what one charts in the ED narrator shows up on inpatient side. In most places, I can figure out anything to chart in the flow sheets. Sometimes I am quicker in the flow sheets by using keyboard tabs

Perfect world? Yes. Realistically? How is the ER staffed?

It depends. Some hospitals were like that pre-covid if they are a big name. Now? Everyone is having that because nurses are quitting and traveling

What are your facilities’ policies? how many staff members? How many are providers or RNs? What roles do each staff member have? For example, apparently it can be nurse, physician, and RT for a sedation and reduction. Every other place I have been there is one nurse to monitor and one nurse to task (meds/supplies/help with procedure/blown IV/suction) and RT for airway. Basically I would be in charge of documenting, monitoring, and doing tasks. Oh and I also was in quick care where no one else was stationed (not even a provider)

So the issue is that each place can customize EPIC to their own set up and I have no experience with the surgery side. Like 90% of it will be the same in say ED or flowsheets but the locations and details may be different. Like one includes LDAs on their assessment pages so I don’t need to go to another page but another one has a special wound that doesn’t create a LDA in their assessment. The online or in person training can be useful but if the facility is already live, they cut the training down to bare minimum to be honest. The best bet is to play around in the live arena to learn where things are.

It’s not really advanced for somethings like how to use single one step meds in the sedation narrator to accurately chart dose, when, route, and administration instead of hand typing out every single med push and then signing off a large dose of meds later on. Does that count as falsifying the med record technically if they chart In the MAR say 100 mcg of fentanyl at 3 pm given by the nurse when it was given 25 mcg at 1:15, 50 at 2, and 25 at 2:20 by the resident (just example of meds) instead of a single push?

I took the previous exam style in 2019. I have to say I used the same book although I think mine may have been a previous edition. I felt like sepsis was everywhere. I also was shocked at the amount of questions about cardiac output. I kinda took it on a whim so I didn’t prepare as much as I should have. I decided to take it and then realized I wanted to do it before my vacation.

I’m sure CT will love the cdiff patients next to their cabg patients.

I don’t know, I feel like pushing patient satisfaction scores may trigger a negative reaction in me. However, pushing the ability to look at your patient and using them as a visual reminder is beneficial.

When company B went live, some of the staff talked a little bit about this company (A). I remember B saying it was a disaster and that the doctors rebelled successfully so the entire corporate education had to be redone so nurses could enter orders for them such as when patients were admitted. That has been phased out thankfully from what I have seen due to NPs for the hospitalist group and they have internal medicine residents at company A. I do know company B higher ups pissed off doctors when they basically told them to “go f themselves, go to company A because nurses are not putting in admission orders.” We were yelled at day 1 because “they took my orders yesterday!” A lot of people quit admitting patients directly too at company B. But yeah, I guess B had a very in depth epic training program whereas A may have floundered when they went live. I wanted to go into informatics but I wasn’t sure if I could make a living in the immediate area after everyone transitioned so I guess learning about how things are charted and work has been an interest. It also amuses me to figure out how different epics are set up and how companies do things so different. When I worked at hospital C (different region from A but part of the company so same epic) I always joked that the company broke epic because of their set up but I understood they can’t just change it on a whim due to the number of players. I do think they built their shell like 15+ years ago with minor updates. Like their ED shell uses features I have not seen other large users utilize like the announcements. Thanks for posting. It is helping me to see things in perspective that I don’t know how it was originally and I was pretty lucky back in the day when company B went live. Like they had extra time explaining why the sedation narrator existed. My last hospital just added the sedation narrator with almost no education and I remember multiple neuro nurses watching me and asking about it during a ventric insertion because I told the NP not to order random meds for the sedation, we’ll document in real time with the orders/pushes.