mountainnurse

Does anyone know if we were able to qualify for an individual policy and have continuous coverage during the next 3 months if the new policy I get at my new job would be able to deny coverage based on pre-existing conditions? If so this might be a less expensive option....

Thanks everyone... We will just have to bite the bullet and pay the $$ for a few months. The good news is I will be making more money and the cost of living is significantly lower so it will be do-able for a little while. Do I ask HR about COBRA at the job I am leaving, or the job I am getting?

Hi everyone! I am curious if anyone out there has used COBRA to bridge their health insurance between jobs. I have been offered a great new job closer to my family and my husband and I are moving the 1st of next month. Both of us are young and had no health problems so had planned on getting major medical insurance only for the next 3 months until my new insurance kicks in.....BUT.... My husband just injured his back playing soccer and has a pars fracture . he is going to need a CT and MRI and bracing and PT for the next 3-4 months. If that doesn't work he needs surgery. We don't want to risk him getting denied coverage based on a pre-existing condition so we are thinking COBRA is the best option. Does anyone have any advice? How do we apply and how much should we expect to pay? The most important thing to us is that he is treated well for this injury and that the insurance is continual. Any thoughts are greatly appreciated!

Thanks for everyone's replies. I think I will try to speak to her and try to find some resolution between us and if she is not receptive then I will ask her to sit down with one of our CN or admin and figure it out. I am not sure if the CN talked to her about it since it was CRAZY busy that night and there were a lot of other things going on in addition to this situation but I felt like she should have. I don't think it will come to me having to leave the unit because of her. We are a very busy ER and have lots of staff so hopefully we can work together more peacefully and avoid each other in the meantime.

I have been working at this hospital for 1 year and from the very first day I met this person it has been clear from her end that we are not going to be friends. She was very cold when I attempted to get to know her, and commonly rolled her eyes while I was talking. I realize that I am not going to get along with everyone, and I figured she had some issue with me being a new grad and just let it go. She has lots of friends on our unit and so do I and at first we just ignored each other. The problem is I feel like lately I have to let something go every time I am unfortunate enough to work in close proximity with her. She is rude and condescending and it seems to be escalating. The last time I worked with her we had a situation with a pt and a code was called. The pt condition improved by the time she had come over and in the middle of this situation she proceeded to tell me that I should not have called a code (pt was not breathing) all of this while several people including my charge nurse were trying to help the pt. A couple people asked what her problem with me is, and I have no idea! We never even talk to each other unless we absolutely have to and I am always pleasant and professional. Instead of helping us with the pt, she stood there and degraded me on exactly why she thought I shouldn't have called the code in a non constructive manner. I tried not to react, but I am sure I snapped back. At this point I feel like it has gone beyond just not liking each other and has begun to affect pt care and I need to say something to her, but I am not sure how to approach the situation. I don't need her to be my friend I just want to have a professional working relationship. should I sit down with her and try to clear the air?

Where I work we always have two nurses, MD at the bedside, crash cart at the bedside and in certain cases pads placed on the pt's chest. The adenosine is pushed rapidly into the closest port, ideally in an AC vein and immediately followed by a 20 ml NS flush and in addition running NS fluids and the pt's arm is lifted to facilitate delivery.

Our ER calls security when a patient is placed on an 8 hour hold and within minutes a security officer is at the bedside. The problem is what happens next. A recent policy change states that the security officer is not allowed to touch the patient so if the patient attempts to leave we have to stand back (unless they have given us a valid reason to restrain them), allow them to walk out and then call the police to pick the patient up. Many of our psychiatric/detox patients have no medical insurance and come in grossly intoxicated so while they wait to get medically cleared to get a psychiatric evaluation the police leave. The next step is placement in a psychiatric facility. If they have insurance we have to wait until their alcohol level is less than 150 for an eval and then for a bed in a nearby facility. Our county psychiatric facility is overwhelmed and patients with no insurance end up staying in our ER for days (the most I have seen is four days). This is not an appropriate situation for the patient who needs a different level and type of care which we are not equipped to offer being in a busy ER with medical patients with immediate need. They are often forgotten and/or ignored (not on purpose) and are a strain on our ER resources when they return every other day to repeat the process over and over again. As to your question, your hospital should provide security or a sitter as you physically cannot be there 1:1 with the psych patients if you have other patient assignments, so it is an unsafe situation for both your patients and yourself.

I work in the ER and a patient came in from a SNF with an infected fistula with an opening to the lower abdomen. When we removed the bandage, the weight of my hand above the opening caused purulent drainage to POUR out:eek: and quickly run down in between her labia before I could grab 4x4's next to me and stop it. Without forcing it, the wound drained about 800 ml and the smell was unbearable. I had to get a mask and leave the room several times to stop myself from vomiting. The only blessing was that the pt thankfully was totally unaware of what was going on due to advanced Alzheimer's. This among the long list of disgusting things I have seen and done still is at the top for me for some reason, I think partly because I was totally unprepared for what was underneath the dressing.

I am a new grad working in the ED and while I was nervous about the skills I hadn't had much practice with, I got plenty of time to practice with my preceptor and if something comes up that I have never done before, my co-workers are ALWAYS there to help. I am now after 4 months finding that I wish my nursing clinicals had focused less on the paperwork and more on the patient care. I go home everyday and reflect on my day, what did I do right, what do i feel good about, and what do I feel like I could have done better. I find the times that I feel like I could have done better are when I get overwhelmed with heavy patients or have to watch over my partners patients in addition to mine while they transport a patient to ICU or CT or MRI. ( I always ask for help and never forget about patient safety) After the first few semesters the paperwork got very repetitive and it felt like we were jumping through hoops with more emphasis on APA formatting than actual content. I actually had a clinical instructor tell me he didn't read my careplans anymore because he knew they would be perfect. I wish my clinical instructors would have pushed us out of our comfort zones to take on more patients as they felt we were safe to do so. I have gotten great feedback from my charge nurses and patients, but had I not done a preceptorship in the ED in my last semester of nursing school I don't think I would have been able to do it. For example, we would do our pre-planning the day before clinicals, writing 30+ page care plans with pathophysiology of each co-morbidity down to the cellular level, nursing diagnoses with interventions and rationales, serial labs and descriptions of the abnormal values, med tables with action, rationale, side effects, contraindications, interventions and administration guidelines, and different variations depending on the area (med-surg, critical care, peds, etc). We would generally take 2 patients, except in critical care where we took only one patient (and had longer care plans). These care plans took about 16 hours to complete. This all helped immensely to put together the big picture and see how all the comorbidities affected the patient and their treatment, and for me being in the ED, how to assess patients, what questions to ask, etc. NOW FOR MY POINT If we came in on the day of our clinical and were not able to take the patient for some reason (discharged, too many students with one nurse, etc) we would have to choose a new patient and write another care plan instead of caring for the patient. I see the point to the paperwork, but in our limited clinical time I do not see the benefit in doing more paperwork instead of getting the experience you cannot get from books. I know it takes time and I don't think that nursing school has to get us completely ready, but something my mother told me sticks with me. She was a nurse for 37 years and went to a hospital run school where she worked for the hospital during school. She noticed that as nursing schools moved from the hospitals to the classroom that new grads were less and less prepared for actual nursing. I feel like we needed more clinical time. (I was in a BSN program if you need to know)

toothache x 30 minutes brought in by medics, nothing wrong with the tooth, he later admitted he was bored and wanted to get out of the house

My school has integrated the ATI tests into our core classes as our final exams. We had to take the comprehensive ATI before graduating and pass with a 95% probability rate of passing NCLEX (I think this translates somewhere in the high 60% range). If we pass we are placed in a two week review course and if we don't pass we are placed in a month long review course for the NCLEX. Ultimately they are preparing you for taking your boards and I am grateful for that. However, I do think it is unfair of them to change the requirements on you so late in the game. If you have not already taken this test I recommend studying from the Saunders NCLEX review book. This is how I studied for all of the tests and I did very well on all of them and passed the BKAT (critical care general knowledge test) for the hospital I will be employed at after graduation. Good luck, at this point complaining may not get you too far, so I would start preparing so you will do well.

Interesting... ISFJ here, so according to this I am in the right profession!

HI, I am doing a case study for my last semester of nursing school and I am looking to see what connection there is between spontaneous pneumothorax and metastatic lung cancer. I need to find articles in nursing journals to back up my research from textbooks and would appreciate and recomendations you can offer... Thanks!

I know how that feels Thanks for the advice, I definitely have been seeking out other experiences and the other nurses have been warm and extremely helpful. I have so much respect for the nursing profession and most of the nurses I have worked with through my program have been exceptional, so I am not going to be influenced by her behavior. And I know now the type of nurse I DO NOT want to be! I hope that sometime down the road I have the opportunity to work with students and can make their experience a positive and productive one! Now I just have to find the best solution to my current situation. Thanks again for everyone's input, since this is my first preceptorship I did not know what to expect...

Thanks for everyone's input. Triagethis, I don't see your response, did you mean to write something else?

I can't thank you enough for your thoughtful advice. I will most certainly discuss the best course of action with my instructor. We have been taught to voice concerns with the individual with whom we have a problem, should I let her know how I am feeling that we are not a good fit and see if she is willing to change her tune? Or should I tell her I plan on finding another nurse to work with? I would appreciate any opinions anyone has on how to handle this situation with dignity. I know that conflict resolution is something I will need to learn and I guess I am getting an early lesson.

Thank you for the advice. I will speak with my instructor on Monday, she is really great so hopefully she can give me some guidance. I agree that I need a good preceptor. This is soooo disappointing to me because I have been looking forward to this experience for months!!! Can you give me an idea of what I should expect out of a preceptor?

How should I go about this without stepping on her toes? She has ALOT of pull around there and I was hopeful to work in this department when I graduate.

Hi everyone, I am in my last semester of nursing school currently doing my preceptorship the emergency room which I was REALLY excited about starting. My first couple days with my preceptor have been really disappointing and I am trying to make the best of the situation but could use some advice. I am a fast learner and a hard worker and am passionate and positive about nursing. My preceptor has been working in the ED for about 15 years and while she is very knowledgeable and a great technical nurse she is less than enthusiastic about her patients or teaching me. The first day she had something negative to say about each and every patient we cared for and instead of taking the time to talk to me about what she was doing she said just to watch her and ignored me most of the day. Now I am not a very sensitive person and I thought that maybe this was not to overwhelm me, but the second day got worse. She doesn't communicate with me at all, she disappeared for an hour and half first thing in the morning and I finally tracked her down in another area. She had taken over for another nurse and stayed there while her collegues were left to care for her patients and I had no idea where she was. She ignores direct questions I ask her about tasks necessary for care of our patients, and instead of taking the time to explain procedures to me she does them. I have asked her multiple times if I can do any one of the many tasks we have and she brushes me off. I understand that working in a busy ED that we need to move fast but she has not even taken the time to explain their charting system and it is my first time in this hospital. She gossips constantly about the patients and her co-workers and is out drinking many nights of the week (a fact which she is proud of). I am getting more guidance and experience with other nurses than with her and I have the sneaking suspicion that she is only doing this because it gives her extra money. I am really sad about this because I LOVE nursing and I want to keep a positive attitude about my profession and about our patients. I don't expect her to give me 100% of her time and attention, but 10% would be nice. I would love some advice on how to change this rocky start because I want to learn!!

Thank you so much for your thoughts. I think it is something we have to learn as nursing students that every patient will present differently and we can't know what is going on based soley on the monitor. This is why I have so much trouble with this question because there are too many what ifs.... I would at least like to know what the diagnosis of the patient is. The only clear cut answer for me is V fib since you have raised so many good points about sinus brady over a fib. I guess I will just have to hear her out next week on her reasoning, and she may decide the question was too vague. I really appreciate your insight, it always helps to hear a more experienced point of view.

I have had the same problem because there is not enough info. Can you tell me why you chose sinus brady over A fib? I thought with the risk of emboli that this would be a priority... I would love to know your reasoning. We are not suppossed to pick the most serious, we have to chose the order in which we would attend to the patients based on the rhythyms alone. My teacher is notorious for giving us questions that are very subjective...Based on the rhythms alone I have ranked them as 1 V fib, 2 A fib, 3 sinus brady, 4 sinus tachy (there is more treatment for sinus brady than sinus tachy and with the risk of emboli I chose A fib over sinus brady) I know there is room for debate here and I am assuming it is a new onset of A fib and not a controlled, or medically managed, case. Thanks for your help!!!!

Thank you so much for your input!!! I was thinking the same thing because there is more that can be done to treat sinus brady, and pts in the hospital are under stress which can cause sinus tach without pathological causes. Does anyone have other thoughts, agree or disagree??

Hi, I am new to this site and have encountered a question that I can't seem to find a definitive answer to. I am a second year nursing student and have been asked to prioritize care of four patients with abnormal cardiac rhythms. We have not been given any information about the diagnosis, if the pt is symptomatic, or anything additional besides these four criteria. Ventricular fibrillation (1) A-fib (2) sinus brady (?) sinus tachy (?) The first two are obvious to me, but with such little information it is difficult for me to make an assessment on which of these two rhythms requires my attention first. Any suggestions would be greatly appreciated. Thanks!!!

We haven't been told whether or not they are symptomatic, would you still assess this over A fib?

Hi, I am new to this site and have encountered a question that I can't seem to find a definitive answer to. I am a second year nursing student and have been asked to prioritize care of four patients with abnormal cardiac rhythms. We have not been given any information about the diagnosis, symptoms, or anything additional besides these four criteria. Ventricular fibrillation (1) A-fib (2) sinus brady (?) sinus tachy (?) The first two are obvious to me, but with such little information it is difficult for me to make an assessment on which of these two rhythms requires my attention first. Any suggestions would be greatly appreciated. Thanks!!!