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ApplePineApple

ApplePineApple

New New Nurse
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ApplePineApple's Latest Activity

  1. ApplePineApple

    Bad signs? New department

    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.
  2. ApplePineApple

    Bad signs? New department

    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?
  3. ApplePineApple

    Bad signs? New department

    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.
  4. ApplePineApple

    Bad signs? New department

    Thanks. I really just need to grin and bear it. The culture isn’t going to change and I’m not there to be friends. I am probably going to be getting a PRN job at my old hospital in the ICU so I can look at that as my actual job and this just does my insurance
  5. ApplePineApple

    Bad signs? New department

    I’m debating about whether this is sketchy. I am good with computers. I like to learn how I can utilize the info to my benefit. I like how to do something/access info. So we have epic and it is a fairly large package close to the top tier. It is not very customizable due to it being a large company that utilizes this package (like over 15 hospitals in a out 2-3 states) and this was maybe 4th to last hospital getting Epic over 5 years ago in the company besides new hospitals opening or merging. So it’s not like it is the first year of epic. They have had it. I use both ED and the flowsheets because I have worked in both trauma centers and ICUs. I have traveled and worked multiple jobs at once. I like the flowsheets because once I memorize the tabs, I can basically chart an entire assessment using tab key and 1-6 keyboard strokes (like pupils 3;r;b populates 3 mm round brisk) instead of moving the mouse around which is slower. However, I do use both about equal to chart assessments. I do my hourly rounding for ED under the ED narrator (like they have a button that populates click boxes like “resting comfortably,” “no distress noted,” call light in reach, snacks, drinks, report called, patient updated, updated on results, etc. They push hourly rounding documentation in the ED like they push pain revaluation scores elsewhere. How do they chart stuff like that? Blank notes. So an ED patient will average 5-18 blank notes in the chart. If I want to look at a prior ER visit, I ignore nursing notes from here because usually they are “patient resting on cot” or “patient in imaging.” Yeah... you have click boxes that can populate the fluff into the ED timeline without clogging up the notes. I’d rather see a note saying what lead to a patient coding or the patient freaked out and ripped the computer monitor off the wall and tried to beat the resident with it. I can see a running note of where it is one nurse note with times and the note has addendums with other info. I also like to know where things are in epic. Each epic is different and they have had this epic for a long time so they should know more about it than me. They don’t. Now, one of the supervisors told me that I am not expected to teach my preceptors and basically just agree with them because I tried to show my preceptor that they have a tab for documenting when the blood reaches the vein. My preceptor said “I don’t need you to show me anything.” Not exactly friendly or open to learning. So I watched him basically butcher the sedation narrator. He did not use a single one step med for 15 doses given of the med and instead typed out the info in blank notes. Not joking. You can literally do 3 or 4 clicks instead of keying out “15 mg of medication given by Dr. Resident” over 15 times. It also adds it to the mar. I use blank notes sometimes in the sedation narrator if they don’t have a comment/blank box built in or something significant needs to be charted. Also, guess this hospital doesn’t require sedation scores/scales when sedating patients? They utilize RASS scores normally. Oh and they’re not allowed to use trauma narrators because they miss too much stuff. Other hospitals in the company that are larger utilize the trauma narrator. I am guessing it is because they free text everything in the trauma narrator too. The charge nurse tried telling me there is no way to access the ekgs once they are submitted so they don’t submit ekgs till respiratory does it once a day at like 2 am. I found the internal website in eight minutes of looking And pulled up the ekg I submitted. Yes, it does not show up to epic if done before the order is in but utilizing the old site you can pull old ekgs. It may be why they don’t print old ekgs anymore? I don’t think they know how to access it. I ask questions like “do we send nebulizers home with pediatric patients” and that leads to blank stares and “wuut?” The RT who worked elsewhere knew that smaller hospitals do that was able to answer that question. There are some practices that make me cringe. It does feel like this hospital has a core that has never worked elsewhere in an ER and so bad habits are passed down. Like the epic charting. It isn’t the first year of epic charting but they’re sold on “this is the way we do it and we will always do it this way” Uh OK. Once upon a time providers did 5 compressions to 2 breaths so should we be doing that still? Should we be inserting foleys into everyone just because they’re admitted? I did come from a magnet hospital that actually researched and tried new things. Before that, I worked at a company that was pushing stuff like decreasing UTIs, pushing nurses to be responsible to identify sepsis, EKGs within 5 minutes, etc. I mean, that hospital system we had info about TPA times and who had the best times. It just makes me worried if the staff is this against knowing how to utilize epic. If we have changes to standards, are they going to change or want to learn versus saying “we always did this.”