mwboswell

Absolutely - HAPPY ER NURSES WEEK to all of us! It's our turn to shine and be recognized!!!! Thanks for everyone's sacrifices and hard work! Know that even though it doesn't feel like you might not have ever made a difference - sometimes the biggest difference goes unaknowledged! Keep up the good work! -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification & Your Local ENA"

Two points here. 1) This is not a real "question" - I've seen this before, it's just an "evaluation" question. It's really designed to get information about YOU and your thinking, not a right or wrong answer. We use this sometimes to get personality assessments while putting the nurse in the comfort zone of dealing with things they routinely do. 2) The WORST answer would be "go ask the MD/NP/PA"..... 3) The BEST answer is if you are able to think of a worst case scenario for each, assume they have it, and mention what you expect the interventions/diagnostics would be. 4) But again, this is not a real question with a real answer - it's more about listening to you and assessing your thinking: do you do more independent nursing processes or dependent. -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification & Your Local ENA"

Thanks "astn", (I don't recognize you - were you in one of my classes?) Anyways -maybe my initial post could have been worded better. I'm not being "slothful" nor do I need "spoon feeding". I'm not looking for a job for myself, I'm looking to see what resources the flightnurse community uses or finds useful for their job searches (besides flightweb). I'm looking for ways to network and share information with the flightRNs and wondering where they are currently getting information from. As I'm not presently in the flight job market myself, the things I'd be searching for might differ from what others are doing for their own research. Hope that helps clarify a bit! PS: no, its not my "primary" income, just part time. More of a labor of love to help others! Stay safe! -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN certification and your local ENA"

Yep, these kinds of visits are typically not "Emergencies" - and believe me the patient know's that it's not an "life or death" emergency, but it is "their emergency" (I guess)...... Once the Emergency Staff come to realize that it's an Emergency Department in name only, and that actually today's ED is more of a 24 hour urgent care clinic that "oh-by-the-way-also-treats-some-life-or-death-stuff", then the easier it is for that staff to find job satisfaction. The use of the ED for non-emergent stuff isn't going to go away any time soon. AND the hospital isn't going to make any huge changes to divert non-emergency patients...on the contrary - the hospital/system WILL make moves to try to capture MORE patients (or at least a steady stream of patients) as a revenue stream.... Oh, I know, you say "a lot of these patients don't pay"....well, yes, that's true, but then you just cast a bigger net to get more paying patients also. AND some of those patients that "don't pay" eventually have to get admitted to the hospital for a REAL problem. When they do, even if they are uninsured, typically your hospital social work dept (or similar) will work with the patient to get them some welfare assistance/insurance so they BECOME a payor and they can back-bill medicaid or medicare. The ED really is the gateway to the hospital for admissions for "non-routine" patients (IE: nonscheduled admits)....it doesn't seem like it but truly the ED has it's place in keeping your hospital doors open and the power bill (and the staff salaries) paid. It's just easier to accept when you look at it that way. That being said, I know there are different types of hospitals across the US and some hospitals (critical access, rural etc) seldom admit at all as they may not have the capacity, BUT, I betcha' your small hospitals, have agreements with the bigger one's that accept their patients and in essence the smaller hospitals become "feeder streams" to the bigger ones - AND all those transfers (or at least most of them) are for admission to the bigger hospital, and for the most part admission = revenue. -Mark Boswell MSN FNP-BC CEN CFRN CTRN NREMT-P "Support CEN Certification and your local ENA"

When you show up for your "appt" time, you are still triaged the same way and there are higher priority patients then you, you have to wait. Some programs offer you a refund of your appt "fee", others may have other built in "remorse" protocols for when they can't deliver. However, know that the software is designed to consider things like time of day, seasonal variations, holiday patterns, current patient mix, current "hold times" etc etc etc -so there is a margin of "flex" built into the appt scheduling to try and also "shift" some of the non urgent cases to a slower time period; in this case, it may be a beneficial thing. -Mark Boswell MSN FNP-BC CEN CFRN CTRN NREMT-P "Support CEN Certification and your local ENA"

Absolutely! I just heard not too long ago (might have even been on this BB), The reason people will wait 6-8-10 or more hours in an ED to be seen is b/c it's NEVER as long as the wait for an actual doctor's appt in an office! -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and Your Local ENA"

Your auto insurance covers your medical evaluation and treatment at time of injury not medicare. 1 rule of medicine: don't do the test if it doesn't change the treatment. In other words if you already know what you're going to do to treat the patient, then the test is unnecessary. Unless they thought "fractures" they wouldn't bother with the tests. Too many times tests are done just to appease patients. (just like un-necessary Rx's for things like "sinuses" [no abx indicated for sinuses first line]) -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and Your Local ENA"

Quick question - have you all taken an official ENA/BCEN practice test yet? I'll type another reply later today with more info. but if you can tell me about the results of a practice test, I can help you better. -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and your local ENA"

Back to the OP (Roy).... Lots of issues here. Here's my personal observations on a few points.... Yes, problem with access for both insured and uninsured, BUT, I have seen different communities with different solutions. In my current community, we have 5 local "free clinics" for the uninsured. granted you have to show up at 10am and wait in line, but you do get a "primary" doctor "home" to follow your chronic condition. I have seen HUNDREDS of patients that use this system reliably and responsibly for their chronic conditions (HTN, DM, Chol etc, etc)...AND because it's a "free" clinic for uninsured, they also have a on site pharmacy AND specialists (a few) will rotate through there monthly (all staff: clerks, med techs, nurses, md's are VOLUNTEERS). Also if the pt needs some labs or specialty testing, the free clinic is plugged into the big hospital system here and have arrangements to get testing (MRI, CT etc) at a reduced or charity rate. Our community also has a couple of "faith based" free clinics too that work similarly - it is a "mission" work for a couple of big churches. We also have some middle-of-the-road clinics where the fees are based on a sliding income scale, kinda like for the "working poor" -they operate similar to the free clinics. I must note that all the above are funded substantially by charity grants, foundations, corporate donations, individual philanthropists and community organizations such as United Way (think about that next time the United Way campaign comes to town!) Another part of the problem is as one poster said "I'm healthy, I don't need a Dr" (even though they have insurance)....Yep I can see that, but this is where education needs to come in. They need to know about health maintenance (at ANY age), as well as just having a Dr so if you need something, it's not like starting from scratch. Also with a good PCP, sometimes you don't need an appt - just aphone call will do sometimes. Maybe an Abx call in Rx, or some advice if they need to go to ER or not; things like that - but you GOT to have that relationship first. Oh, and while shopping for a PCP; it's a VERY appropriate question to ask at your first visit about will they do same-day or next day work in visits for acute problems. You need to know this when you start going to a MD as this becomes your alternative to the ED for non-life-or-death problems. A "good" MD, will have some time each day left open for call ins or work ins. Or if your "good" MD is with a group of Md's in one practice, then each day one of them may only schedule for half a day and leave the rest open for "ESTABLISHED" patients of the group practice. Interesting discussion. Thanks! -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and your local ENA"

However, some of those "refills" (non schedule II) can be refilled up to a year depending if the PCP writes refill x12. I'm guilty - I haven't seen my PCP for over 9 months now, and I'm still using the same refill monthly PPI Rx. So a current Rx doesn't nec mean they have seen a MD for some time. -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and your local ENA"

Hi chyna016 - Thanks for your post - I found it to be useful. yes, next time I fly, I'll ask the crew if I can see what they got; when would be a good time to do this, while boarding or be the last one off (If i'm not in a rush to catch a connecting flight?) I don't identify myself before boarding, but when I step on board, I have a business card with my name, credentials and contact information, and on the back I write my seat number and hand it to the attendant I pass at the front, saying, "in case you need anything, I'm a paramedic" and I hand them the card showing them my seat number - They have always accepted it (sometimes a little confused) with a very energetic "thank you!"... So, that being said, let me ask you this... If a medical emergency came up, AND, I had already identified myself to them when I boarded, would they discretely approach me and tell me of the "situation" or would they page overhead "Mr So-and-so" or "is there a doctor on board"? Second question - would it be more useful upon initially introducing myself to the crew to say I'm a paramedic or a emergency nurse practitioner? (I'm both). I have always said paramedic, b/c I figure everyone knows what a medic is, but not everyone knows what a NP is...yet. Advice? Thanks! -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and your local ENA"

Agreed that the price is more than the traditional methods (ampule, draw up, administer), however I think from the aspect of safety (IE: less chance to give a wrong dose, less chance to hurt self on glass ampule, speed of availability etc)...AND...in the bigger scope of things, considering the full price of a routine ER visit I don't know that $100 for an epi pen (with the aforementioned safety/benefits) really makes a difference. I'm just saying. -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and Your Local ENA"

Yes, all NSAIDS are limited in pregnancy. Toradol (ketorolac) is a "C" in 1st and 2nd trimesters and "D" in 3rd trimester. ...however, besides that fact, ANY female pt who has the possibility of even getting a prescription at d/c, should have a documented pregnancy test. There are few category "A" (IE: safe) meds in pregnancy. So even when they come in w/o an abdominal problem, just the fact that your MD/NP/PA might write a Rx - go ahead and get the preg test. It only takes one bad outcome to make a bad day. -Mark Boswell MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P "Support CEN Certification and Your Local ENA"

No booth, just an attendee trying to get some CEUs

My hat is off to you! You truly get it - unlike a LOT of admin/mgr types. Yes, people are so "hippa-paranoid" they have morphed it in to something it was never intended to be and I DOUBT many of the admins/mgrs that implement these "hippa-cratic" policies have never read the original legislation! Also, I'm afraid many of the Hippa-compliant consultnant firms are mere hippa-fear-mongerers doing nothing but ensuring their continued contracts to provide hippa-compliance servicees! NEWSFLASH: as Nurses, we have ALWAYS been legally bound to patient privacy! Hippa didn't change a thing for us at the bedside. GREAT POST!