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.

So really they are looking to reduce the RNs and increase ratios? It doesn’t sound like there is clearly defined roles. I think one is supposed to be assessments/tasks and another is like meds/some other tasks. Zone nursing never works in my experience in the ED which is the closest I can think of

Try and find a part-time clinic? Honestly? If you are not looking for midwifery the clinic and your experience is probably more useful in many ways than a L&D job. A good program and preceptors should be able to train you with no regard to your experience.

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

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.”

Are the styrofoam cups like 3 oz? Are they guzzling water or something? How are their sodium levels? Maybe bring two cups and save a trip next time.

A little late but I had TNCC + ITLS 8 months before, read the society’s red book, and listened to a few of Solheim’s TCRN (I think a month pass) lectures. The year before I did study the whatever surface and air book for the CTRN and had solheim’s CEN lectures (free from work). So those may have helped me.

My preceptor and I argued over charting in the ED. Basically, the culture here is instead of using click boxes you just write blank notes in epic for everything including your hourly rounding. Not a single running note but blank notes. As in patient sleeping for five hours? Make that five notes. Oh and add another one for the tray you ordered. So say when I want to look at a previous ER visit, I have ten nursing notes which is crap info to wad through to find out the patient flipped out and broke a computer (an example). So today we didn’t see eye to eye to charting that the company specifically developed for this problem. Basically, to fix it company added Y value to epic to solve the problem. They did this at least 2019 if not earlier due to new standards. So anyway, he got mad and I asked him to come back so I could show him what I was talking about. He said, “I don’t need you to show me anything in epic.” Well, later I watched him use the sedation narrator. Not sure who trained him but I have never seen someone butcher a sedation narrator as bad. One benefit is the one step meds. Well, not sure if he knows what that is. Every med push documented as a blank note. I get you have to use blank notes but uh, everything was a blank note besides the arrival and time out. Sure some things need to be blank notes if the company doesn’t populate them but we’re talking 15 pushes of a medication and each one a blank note. 99% sure he made more work for himself. Oh and not sure who audits the charts but other ERs I worked in they required some sort of sedation scale to ensure the patient wasn’t overly sedated and to help track return to baseline. Not a single one charted. But hey, he knows epic! edit: this hospital system has had epic for almost a decade. This nurse is also younger than me. They also are not allowed to use the trauma narrator for traumas like other hospitals in the system use because they missed things. I am guessing the blank notes have something to do it with it.