fromtheheartRN

Interesting. What about cases that involve discrepancies with SOC functional status? In order to improve STAR ratings and reimbursement?

Ha! I have been doing OASIS for six plus years. All the sudden, in last six months, when my company's STAR ratings go low, I have been doing EVERYTHING wrong! Get tons of returned corrections that I do not agree with and have never gotten before. Rating people "dependent" in toileting ONLY because they rate their pain 7/10. Even had to go through "remedial training," though I am a preceptor. Verges on Medicare fraud, IMO. Trying to make patients look like they are worse in the SOC, only to get higher STAR ratings, or more pay. I can't tell which. Possibly both. Depends on the company, I guess. Frankly, I am very disappointed in mine. As is apparent. Looking elsewhere.

It certainly wasn't what I signed up for. Worse than the hospital schedule now. Used to be good and flexible when I started. Things have definitely changed. I document sometimes until 9 PM almost every night and wake at 4 AM just to manage case management, write notes to call the MD offices when they open, make sure I don't miss anything. Geesh. No Clinical Manager support for weekend emergencies either. They used to go out in case of emergency. Not any more. They call the patient and tell them to go to ER. WTH? We are supposed to be preventing that! I am actively looking for a better opportunity.

I have worked for my current employer for over 6 years. Started out being guaranteed salary with expectation of obtaining at least a certain amount of points. Expectation was ONE Saturday a month and ONE Sunday every two months, rotation of on call for evenings seven nights in a row every seven weeks. Many changes have driven the company to needing us to be on call from Fri eve to Mon morning twice in a seven week period. Effectively working more than one weekend a month. The weekends are not strictly for "on call" anymore. We generally have a FULL schedule for revisits , SOC's and ROC's. PLUS the PRN's for any emergency visits. We have been told that any weekend revisit (for whatever reason), will not be covered by the scheduled weekend nurse anymore, beginning immediately, and any revisit needed will need to be covered by the RN on the case. This means that if QOD or QD wound care is required, we will be forced to work 6 or 7 days a week, EVERY week! How can this be legal? They, supposedly, tried to hire a Baylor nurse, but were not successful (for at least the last four years, I am told). We are no longer guaranteed salary, we are pay per visit. I love the company, but am fairly burned out working so many weekends to begin with, and now this new requirement will tip me over the edge. I believe that if a wound REQUIRES more frequent changes (per best practice) we are obliged to provide it per MD order, but shouldn't require the RN to work his/her otherwise scheduled says off. If my week was somehow slow, I don't mind doing the weekend visits. But if I already worked 50 hours and seeing 30 for the week, I definitely have a problem with it. This new change was decided by non clinical office people, BTW. Again, can this be legal?

Yep--cover your ass The way it relates to tests is mainly when an MD orders them for reason CYA only.

I have been an RN for three + years. At the same hospital-same floor since graduation. I love bedside nursing and am always looking for ways to grow and learn. I am certified in my specialty and I am a relief charge for our 40 bed unit. I have always prided myself on good relationships with my colleagues, and have been commended by same as someone they can count on to help whenever someone has a pt. emergency or just when a nurse gets over-loaded. I am known to be calm and able to get things done. I frequently get personal notes from the hospital nursing director telling me that I am a valued member of the staff because of various reasons (patient comments, my certification, and fellow staff comments, etc). I volunteered to go to nightshift for the summer last year because they didn't have a charge for Wed nights--as well as our part-time charge calling off most of the time. In other words, I did them a favor. I also do a nightshift occasionally when they are short. This has been voluntary on my part. I have even volunteered to go home early on days so I could cover for an unexpected shortage the same night. Where am I going with this? About six-seven months ago, I decided that I needed a change--more specifically in days of work. Due to family stuff, I wanted to find a position that would allow me to be home every weekend. I informed the director of our floor that I would be looking at opportunities. They seemed (at that time) to be genuinely supportive of me. I have had two interviews since (I have been very picky on types of positions), but did not get hired. Then came an opportunity to NOT leave my hospital--a position that sounded absolutely PERFECT for me! I was excited about it-and very confident about landing it. I emailed my director to let them know. The next day I was on the floor, I was called into the office. Door shut, and was asked if I have been 'stressed lately.' The conversation that followed had me in tears. I was told that I am not good at organizing while in the charge position, I cannot handle emergencies effectively, I over-utilize techs, and generally do not seem to know things that I should know. Okay, I am not infallible. I admit that sometimes I do not know EVERYTHING about all 40 patients, and that I have not been able to get a system down when I am charge during the week. But, I haven't been charge very often--maybe 6 times in the last 6 months. She disagreed--but I wasn't going to argue at that point (I have since looked it up--and I am right about how many times). Anyway, she basically said that I wouldn't be able to do the job because of all these (faults) I have. And, oh BTW, we recently had 4 of our very strong RN's leave for other opportunities and there just isn't anyone on staff right now that is ready/willing to take on the charge role to take my place. And we are short staffed. I recently got placed in my own weekend as charge--so they would be in a jam if I left. I left the office in tears--could NOT believe what I was hearing. So my question is: When I go to my next interviews, how do I explain to them that I do not want them to contact my current employer? And, should I call the other places back who did interview me and ask them about how my references were? I know it is illegal for an employer to ask anything more than absenteeism and "would you hire this person back?" But we all know in the real world that this is not the case. Right now I feel unsupported and manipulated and generally want to give my 2 weeks right now--job or no job. I won't do that, but that's how I feel. Please advise.

RAD = Reactive Airway Disease (newer umbrella term for asthma/COPD) OK--What is CYA? -regarding tests.

I was just mentioning to hubby last night that I needed a new scope--I have severe tinnitus AND hearing loss (result of job in a former life). I have been using a Master Cardiology-which has served me well until lately-I guess my hearing loss is getting worse-right along with the tinnitus. I went online right after reading the posts--the 3000 is on sale at stethoscope dot com. Hopefully I will be able to hear those faint rales and murmurs again SOON!

Need more feedback, please

I had another colleague tell me about a situation, and I'd like some feedback--good-bad-indifferent--I'm open. The nurse was called into the unit director's office, handed some EKG strips, and two regular, common meds (not narcs--or even a med that would be wanted by anyone seeking drugs--OTC, inexpensive stuff). The director said, "These were found on the top shelf of the area you were working this day. Can you tell me about them?" Of course leaving meds out is never right, but the nurse stated that he/she would have placed them in a pt med drawer. The strips were his/hers, but were not placed in the chart because the CNA that day already pulled strips and placed those in the chart (nurse's explanation). They were 'extra.' Both the strips and the meds were found in an area that not just anyone would see--unless they were looking. The nurse admitted to probably leaving the strips there-but not the meds. My question/concern is: if I were deep cleaning and found these items, I would have returned the meds to the pharm, and would have brought the strips to the ward clerk to be given to medical records (if the patient/s were no longer there). So we are both wondering--why would somebody (presumably) take these benign items to the director and ask that she follow it up? Maybe because the director was concerned that if the nurse left these there, he/she could also leave narcs out as well? I argue that, because everyone knows that narcs MUST be accounted for-and you could LOSE YOUR JOB if any of them were traced to you--and they were not given. Sounds petty to me, and smells bad of someone out to bring trouble for the nurse-or ANY nurse-in question. This is one of our very BEST nurses! While I am not saying that leaving stuff out is OK, but why would someone make a huge stink about it? I mean, come on! They weren't narcs! And a simple look at the chart could have shown that there were strips posted already. Neither item was in a place that could be readily seen by anyone--so while I know that it's bad for JHACO, the charts are always MORE available. And, incidentally, the admin also said, "Pulling meds from the PIXUS and not giving them is 'creating a fraudulent charge' for the pt." Made it sound, to this nurse in question, like he/she had committed a crime, which she/he could be severely punished for. As a matter of fact, a nurse was fired about 3 months ago for some pretty shady sounding accusations. She had worked there as staff, charge, and house supervisor for about 20 years. Hard worker, diligent, and liked a great deal by everyone. Also..and I need to find this out, I believe that a patient is ONLY charged for meds that are documented as 'given'-not simply 'checked out' from the unit PIXUS. If true, then that statement would have been used as a scare tactic only--why? To document 'a problem'?' Don't get me wrong, I do not think the nurse's actions were OK-by any means, it just smells funny. Sure, the director was right in 'following up,' but was it necessary to launch a 'full investigation?' What do you think?

I was put in charge of Nurses Week celebration on our unit. I am up for the fun, but I need ideas. I have some myself, but I always let my small ones turn into giant undertakings! Is there anyone here who enjoyed a memorable celebration on their units? I would appreciate any ideas that you can share. We have about a hundred employees...60 are RNs. I would like to include everyone in some way...including the Unit Sec's. We work 12's (7-7), and need to get something together that would work with both shifts. I am not even sure if my director will allow a budget for me (ice cream social, maybe some small gifts for a drawing??) I want to make it special....this will be our first celebration of it's kind!!! Thanks for your help!

crump: verb: In ambulance jargon, to die on the way to the hospital, has been used to describe computer crashes in hospitals too. Example: The driver is hurt pretty bad, he'll probably crump on the way.

CVA= cerebral vascular accident SAH= secretion of antidiuretic hormone ICH= intracranial hemorrhage IICP= increased intracranial pressure

I agree with Tazzi. The ER I worked in prior to my current job did exactly that. It is a huge task to take on when you are attempting to show and convince that adding a float nurse will improve patient safety as well as be cost effective at the same time. Unfortunately, managers MUST look at the latter. Pt safety (in a perfect world) SHOULD come first, but the reality is the financial bottom line. Things to consider including: What is the turn over rate? How much does it cost to train a new RN in your ER? How many sick calls? How many injuries and cost of lost time from work due to on the job injuries--directly or indirectly resulting from a heavy workload? Of course include the Pt safety aspect, but the holder of the purse strings will be looking at the cost first. Make your case very strong...something that they just can't refuse. You need to show either no increase in cost long term or even a reduction in cost. Look for studies in journal articles. Talk to RNs in other ERs and find out how they made the change and what the impact has been (turnover, moral, sick calls, etc). You might consider talking with a dept manager about how they financially justified adding an additional position. If you can present a solid case WITH verifiable support to back it, it will not be easy for them to refuse. I would definately enlist and delegate every staff member you are able to who cares about your staffing (probably everyone?). I wouldn't attempt it on your own. With a lot of thought, much planning, and ample researching, you are bound to succeed. And to sum up Tazzi's thoughts...keep it professional. I applaud your efforts and the willingness to step up and initiate change! Good luck!

Thank you! Perfect---I do not know how I missed these resources on aacn! MUCH help!