emrrn915

The only reason that I ask, is that when I worked as a charge nurse several years back I had a student nurse come to let me know that one of her clinical patients needed more insulin since there was not enough for his dose and could I get some? I can not recall why I questioned her (maybe a god thing?) in any case she informed me that the BG was *** and she needed to give the patient 10cc of insulin. I calmly asked her if she planned to kill this gentleman? She gave me a blank stare.... I then spoke to her nursing instructor and she was sent home.. scary thing.. she fully intended to administer that dose, she had the 10cc syringe partially drawn up.. hmm I wonder what 10cc of regular insulin would do to a frail elderly gentleman?? Thankfully I did not have to find out. I am guessing yours was a typo?

I am guessing that the blood sugar was 215, not 21.5??? Please tell us you did not give 6 cc of Insulin....

It can be done but is not without a price. I worked 12 hour night shifts 5 nights a week for 9 months and while I was tired and dead on my feet most of the time I thought things went okay. The price I paid was this.. I have no recollection of my son being 3 years old at all. Was I there? Yes. Did I realize it at the time? No. As I said looking back I truly have very little and foggy memories of that year of his life and I know it is because not only did I work too many hours a week but I worked those hours at night.. I am sure I was a decent mom and he had his dad but I still feel guilty that I wasn't really present even though I was physically there. 12 hour shifts are killer and 12 hour night shifts are worse.. even though I did not realize it at the time, I realize it now... something to consider. It is going to be very mentally draining on a new nurse to work those kind of hours since really nothing will be coming "natural" ...Seasoned nurses at least have gut instinct , experience and rote tasks down so that the brain does not have to work so hard with every little thing.. your husband is not going to have that luxury and he is going to be not only physically tired but mentally tired as well. Having 3-4 patients in clinicals versus 8- however many patients on a night shift are two different animals... I admire the wanting to stay home and wish you luck...

I am just wondering about pay? If all nurses become BSNs I understand that we will all be considered "professionals" by some. I actually consider myself to be a professional now but that is my personal opinion. I highly doubt that if all nurses become BSNs we will see a significant increase in pay/ a significant decrease in patient load. Since nurses make up the masses as far as workers in most healthcare settings how will the hospitals afford to bump up hundreds and hundreds of salaries? The last published article about our hospitals here indicated that out of 3 medical centers only one is in the black. I can only assume this is due to the fact of low reimbursement and lack of insurance amongst the general population. If we are all forced to obtain the BSN, nothing will change, in my opinion. The nurses will still make up the masses and they will be paid the same. The "elite" jobs which now only BSNs are qualified to hold will probably also pay less since every nurse will have the BSN and it will be no big deal. If the issue is forced I would pursue the BSN. I had always anticipated doing so but throughout my career I have not had the need to do it. I have held quite a few non traditional nursing roles and really any extra education that I have pursued has been specific to my position so that I can do the best and have better knowledge of what I am currently doing. I hate the argument and I don't see how it is going to change anything as I said. Do patients and the general public hold the BSN nurse in a higher regard?? We will still be seen as a nurse is a nurse is a nurse we will just all have a BSN If we truly want to be seen as top notch professionals then they need to make the entry requirement Masters level. Master's education seems to invoke a lot of respect but for a variety of reasons that is completely unreasonable and unecessary..

I have read various literature regarding children under the age of 18 being prescribed anti depressants. Some of the literature suggests that there may be a higher suicide ideation in these kids. I am just looking for some input here.. any thoughts??? Thanks

If you'd like to respond, I would like to know: - Age 41 - Experience :14 years - City / State: Spokane Washington - Salary : 82k plus bonus - Benefits: Full - Specialty: Workers Compensation case manager - Shift / Pool: Day - Staff / Agency: Full time

I have been on this site off and on for the last 3-4 years and this argument is so old. I have read many threads regarding the big BSN v ADN debate and mostly they are ridiculous and it remind me high school or possibly even elementary school. When I started school 17 years ago, the BSN was not an option. Not only did I have a small child and a husband but there were no BSN programs within a 100 mi radius of me. Part way through school I did move to an area where I could have entered a BSN program but then I would have had to of crossed the state line which would have meant out of state tuition and from financial standpoint, we just could not do it so I finished with an ADN. Upon finishing my ADN I had 94 college credits. Since that time I have taken some online classes toward a degree in health promotion. Is the BSN better than the ADN or is the ADN better than the BSN??? This I do not know. What I do know is that some of the worst nurses I have worked with have been BSNs and some ADNs. Likewise, some of the best nurses I have worked with have been BSNs and some ADNs. Success in the workplace does not depend on the letters after your name, it is highly individualized. Should BSNs get more money??? IMHO, no. They do the same job as the ADN.. period. The skill and critical thinking is the same.. you are getting paid to care for patients not because of the letters after your name. The only thing that I take issue with in regards to all of this "discussion" is that I am a little tired of hearing what I can not doin the field since I "only" have my ADN. When I worked in the hospital, I was a charge nurse 90 percent of the time. I have worked as a medicare unit manager in a subacute facility and I have also been a community case manager for a disease management program. I currently work in workers compensation as a case manager and I have my own business as a legal nurse consultant which has profitable for the last 5 years. Now... I have read many many post stating that based on my education, I should not be able to do these things. I am here to tell you.. I have done them and I am doing it. As I said before, much of anyone's success in any field depends on the person.. personality, intelligence, motivation. I have always thought I would not post anything in these arguments because it makes no difference to me why anyone chooses which route but I, as I said, I am tired of reading what my limitations are. If there ever comes a day when a BSN is required for me to reach my goals/ dreams I will pursue it..

I do agree with the above poster. Spokane is a smaller city and it does lean to the conservative side. I really think that is because the majority of the population consists of families and middle class. I have noticed that over the last few years there have been lots of improvements to the downtown area and things are slowly becoming more progressive. Someone posted that there isn't any culture here. I disagree with that. On any given weekend you can find theater, music and arts. Not on a large scale mind you, but it is there. What I like is the outdoor element. Drive any which way and you can find a lake to boat/ camp on or a Mountain to ski on. If you are looking for home health postions try: Option care, Gentiva and VNA. I just drove by Option Care yesterday and they have notice on their reader board that they are looking for nurses.

I agree with the last poster make sure you do your research. Personally, I love Spokane and can not imagine living anywhere else. I was born and raised here and I did leave a couple of times for a few years but I have always come back. I have never had a problem securing employment here and have worked a variety of places. Since becoming an RN 14 years ago my wages have increased yearly. I did home health/ home IV therapy for Option Care about 9 years ago and the pay then was 45.00/ open and 35.00 each visit. More recently a GF of mine worked for VNA and if I remember correctly she was paid closer to what you quoted. Not quite that much, but closer, and you have to take into account that the cost of living is most likely lower here than where you are coming from. In the last 7 years my yearly income has never been lower than 60k and I am happy with that. I am currently a worker's compensation nurse case manager for a small independent firm and I also do some LNC work on the side. There are opportunities in Spokane, you just have to go out and get them. IMO, the crime here is not bad at all. I ride the Centenial trail frequently and have lived to tell the tale :-).

I do think that the nurse should inform the patient as you have stated above but rather than say, is this something you'd be willing to let me do.. explain to the patient WHY the Foley is necessary and then ask if they have any questions. There is a reason that each and every intervention is being done. The above statement is not really enough information for the patient either. You have told him/ her what you are going to do and what the foley will do but not why it is being ordered. I have found that if the rational is shared with the patient then they feel comfortable with pretty much everything. Always tell your patient why..the hows and whats are important but the why helps the patient to be confident in what you are doing and that this intervention is necessary/ beneficial in some way or another. We are not pushy there is a rationale behind all that we do.. it is all in the delivery. That being said.. giving patients a choice with each and every intervention is going make things tough. Ultimately they do have a choice but in order to give good medical care , you are going to have to do things to people that are not necessarily something that makes them comfortable... in the above scenario I would tell you, "He** no!! however, if you explained why the Foley was necessary and continued on I would be okay with it even though I would not like it all that much. Some patients may take that to mean that it is optional and they will tell you no.. then you will have to tell them why it is important and possibly drag the MD into the mix etc... I can just hear it... "Well she gave me a choice so it must not be that important"..... Just based on my experience.

Hi Kim I worked for Genex before I went to work with the small local company. It is a good company to work for. Good luck to you!! Erin

Endocrine.. hands down

Hi Ann CCM is the designation that you probably want to get. I am going to have to look at that eventually. I have heard that it is a difficult test so I guess in my free time (LOL) I will study for it. E

Hi Sorry it took me so long to respond to your question. Although I do work from home, I am out a fair amount of the time. If I had to guess I would say out of office 60%, in office 40%. Yes, I go to MD appts with the claimants. I also meet with MDs one on one, go to meet with therapies, meet with attys and meet with employers to work to modify jobs so that the injured worker can go back to work. The job is really different every day so it is hard to describe it. Emails, phone calls, records review, correspondence and faxing are part of my life pretty much every day. I will try to outline (briefly) the pros and cons I have found, Cons: At times things can get a little crazy just depending on your caseload or the intensity of your cases. Dealing with medical providers that have no clue as to the WC laws in your state Malingering/ manipulative claimants from time to time The WC system itself can be a little harrowing at times Pros: A sense of accomplishment pretty much every day Helping injured workers navigate the system Working with really great people Getting to know many of the specialists in my area Having complete control over my own time (mostly). The only thing you are required to do during hours is to go to appts and update adjustors employers etc. All of the paperwork etc can really be done when you want.. ie: crack of dawn or stroke of midnight. In this way, you can coordinate work around life v. the other way around. The other nice thing is that if you have nothing to do.. don't work. Mow the lawn or go shopping. I frequently get dinner going/ do laundry while I am working. This allows for the weekend to be the weekend unless you choose to do some paperwork then. I did work for a large company and now I work for a small ind firm that is well respected in this area. I have good benefits and I have chosen to work on the billable hour meaning that I get a % of all of the billing I generate. I am making nearly double what I made working in the ER and the stress is miniscule compared to it... I have been doing this nearly 5 years and eventually I will most likely go part time. My caseload is usually around 30 which is not too bad but keeps me hopping. The only thing that you need is to be very self motivated. No one looks over your shoulder, youa re essentially your own boss. If you do not do the work the adjustor or employer will not refer cases to you anymore and word seems to get out. So basically you have to stay on track or you cut your own throat. Hope this helps and I apologize for any typos... I am in a hurry this AM Thanks E

Hi I worked in their field case management division but for a subcontractor. When they initially began their disease management program they subcontracted out the field portion but I worked in their system and within their guidelines. I had heard that they cut out the subcontractors and now do the whole thing themselves. If this is the same disease management program that I worked for you will be responsible for assessing and teaching diabetes, heart failure and asthma to medicaid patients? While the theory is a good one.. it was a horrible job (in my experience). I had 180 people on my "list" to find, contact and try to help. The problems that I experiences were that MANY of these people do not have phones, they move around a lot and I could not find them and the MAJORITY have no interest in what you have to say. I would say out of the 180, I possibly made a difference with 10 and that may be a little rose colored. The other issue was that you put info as to what they are on etc etc in the system and that generates form letters to their physicians which essentially tell the MDs how they are not treating their patients based on current ADA, AHA or ALA standards. I dealt with many many many irrate MDs over these letters. NOW... the system was in the new stages so it may be that things have changed. But I found it to be a frustrating and unrewarding job. We had numbers that we HAD to meet ie: 40 contacts per week documented. Good luck... I drove around and looked and looked for people. I would find the address and I was expected to go up and knock on their door...I was in some pretty bad neighborhoods. I lasted a year as did the first 4 of us that started here in Washington and we all left for the same reason... the patients did not want help.... think of the demographic that you are dealing with. Again, the majority do not want anything to do with you and then you have the company telling you that you have to meet the quota and MOST doctors highly annoyed with a company telling them that they are not prescribing and following up the way they should. I hate to sound negative but this was my experience. I now do workers comp case management from home... love that!! I am still part of the health care team and I accomplish something every day. As far as the home office.. locked file cabinet and a shredder.... As I said, they may have changed what they do or maybe this is working with private insurance patients? That may be different. Working with the medicaid population was a nightmare... again not all but definately most. Even those that I was able to educate did not follow through with the receommendations for the most part. I really felt as if I did not do anything for anyone and I do not like that. Good luck Erin