SpEdtacular

I looked into WGU but chose Excelsior (MSN in informatics) which I found to be excellent. I was told WGU gave grades of pass/fail, so I asked an admissions advisor about how that would work with GPA/transferring credits. They told me something like pass would equal 3.0 (B) which seemed like it would be a disadvantage on the off chance I wanted to pursue a doctoral degree. My understanding was that the program is mostly writing independent research papers and not really traditional classes. That being said I have known several nurses who got their MSN through WGU, and they are gainfully employed and perfectly satisfied with their degree. When I inquired, WGU had the advantage of flat tuition and flexible schedules, so the program could be done quickly and inexpensively. Not sure if that's still the case though. I have heard Capella has a reputation for being a predatory diploma mill, but I to be fair I don't personally know anyone who completed a degree there.

As an EHR analyst by trade, I will add that it is always preferable to show someone how to do something logged in as that person. Epic allows tons of customization and different types of users have different workspaces. If I show you how to do something logged in as me, it may not translate. I need to see what you are seeing in order to help you properly.

JKL33 is correct. As someone who does EHR build, I can tell you your full name is all over the place. If you use Epic and assign yourself to the treatment team, they can see that. It shows in MyChart and often appears on the after visit summary, so not writing/hiding notes to hide your last name is misguided. Reasons available for hiding notes will vary depending on the organization. The reason you gave above is one example. Another might be surgical or anesthesia notes so the patient doesn't see them before speaking with the doctor after a procedure. I am pretty sure all notes have to be released to the patient eventually for regulatory reasons, so hiding notes just delays this. If it's a note's contents you don't want the patient or family to see, then I would say don't write a note. If you are truly afraid a patient is dangerous or they have been violent towards staff, many organizations have a process for flagging that person's chart to alert other caregivers. If you are trying to record information to alert other caregivers, there are some types of documentation that are not patient facing (FYI flags) and that do not get saved to the chart (Sticky notes and in most cases ED trackboard comments and Hand Off activity notes) when the encounter is closed. My expertise is in Epic and build can vary greatly between organizations, but if you are at an Epic organization, one of the aforementioned features is probably available.

Think of it like a driver's license. I live in NC, but I can drive in all 50 states with my NC driver's license. If I move to another state, I need to give up my NC driver's license and get a new one from my new state of residence. My NC driver's license becomes invalid, but I can still drive in NC using my new state's driver's license.

I got my Master's at Excelsior college and I really enjoyed the program. I was able to find a preceptor and do my Capstone project with the organization I was working for at the time. I got a job as an Epic ASAP analyst about 5 months after I graduated with no informatics experience, however, I was experienced in emergency nursing which is the area I was going to be responsible for. I absolutely love what I do and have no regrets. There are jobs out there, and some are willing to train people, but finding one may take time.

Don't you have to have a cosigner when you waste?

I agree. The best degree depends on what you want to do and job titles can be tricky. My official title is Systems Analyst-RN. I build and maintain the workflows for the ED portion of our hospital's EHR. I absolutely LOVE what I do, but many people would find what I do tedious, boring, and difficult. I didn't want to do bedside nursing anymore, so now instead of taking care of patients, I take care of my end users by giving them tools that makes their jobs easier.

I want to say there's like a 256 character limit for free text fields. I am not sure what it is for flowsheet comments. Character limits are universal so I don't know how other people would be able to leave longer comments than you (unless I am not reading that right). I would recommend using a note for longer comments. Flowsheet comments aren't displayed in a lot of reports, so they can be easy for others to miss. With a note, you also have the option to use SmartTools. Are you charting in flowsheets or another activity?

I assisted the chief nursing informatics officer with a big upgrade my organization was doing. I analyzed and presented survey data collected from end users before and after the upgrade for my Capstone presentation, but I wanted to learn and get experience, so I offered to help with whatever. I also ended up creating a presentation on hospital acquired malnutrition to support a new decision support workflow for nurse driven diet orders that was part of the upgrade, and I was asked to do a blog post on informatics for the hospital's social media.

We'll you guys are certainly working hard to be #1 in Covid-19. Texas and NJ will graciously concede and let you guys have the title of Corona Capital of the US ?

As someone from New Jersey, I must point out that NYC is not located in NJ.

The OP's "double dosing" is just a symptom of a bad system and stems from multiple issues. Here's what comes to mind for me: Benzodiazepines are not the best treatment for insomnia and if used regularly they can cause rebound insomnia and make the patient dependent on the medication in order to fall asleep. Now granted sleeping in a hospital is way different than sleeping at home so some extra help might be needed, but many of the folks in the hospital that need benzos for sleep were already taking them for sleep when they got there. Technically, the patient saying the doctor prescribed 1mg of Xanax is true and there's a good chance the OP isn't the first (or last) person who did this. The doctor wrote the duplicative orders for Xanax which were then reviewed by a pharmacist before being profiled on the patient's MAR. Ideally this should have been caught by the doctor or pharmacist and one of the orders should have been canceled. The hospital should have a policy regarding duplicative orders and educate nurses on how to address them. It's not clear if that's the case here, but orders like the ones referenced by the OP and orders where there are multiple meds prescribed with the same or similar indications get a lot of well meaning nurses in trouble. For example, there's an order for 2mg of morphine for PAIN and 4mg of morphine for CHEST PAIN greater than 5/10. The nurse decides to give the 4mg of morphine because while the chest pain is only 2/10 the patient's leg pain is 10/10. It seems okay on the surface, but it could get a nurse in big trouble. Or maybe a patient has orders for both Tylenol and Motrin for pain and fever q4 hours. How should you give them? How do you know which you should you try first? Do you give both at the same time or rotate between them every 4 hours? What if Tylenol is for both pain and fever but Motrin is only for pain? If I give Tylenol for fever and shorlty after taking it, the patient wants something for pain, can I give Motrin or do I have to wait since the Tylenol has pain as an indication too? Having a clear policy about these types of orders can prevent this confusion and nurses who are aware of the issue are less likely to second guess themselves when deciding whether or not to give a med and/or get clarification from the provider. When the OP scanned the medications, the EHR should have warned her that it was too soon to give the additional Xanax (it may or may not have done this). Unfortunately, technology bias can lead to an overreliance on the computer to catch mistakes and some nurses (and doctors and pharmacists) assume all is well if the EHR "lets" them do something. Reporting this as a med error or near miss is appropriate, but I sincerely hope the OP isn't being punished for her actions. That helps no one and negatively impacts safety.

I did an RN to MSN in Informatics through Excelsior College and was very happy with my degree program. I'm not sure why you think you'd be "stuck" and unable to work in other disciplines because you specialized in informatics. Most MSN programs have the same core curriculum and then additional courses for whatever you are specializing in. If you decided you really wanted to do NP school and got accepted into a program, you'd already have a master's degree and would just need to take the NP specific courses and do clinicals. The same is true for becoming a nurse educator or clinical nurse specialist. As far as employment is concerned, it depends on a lot of factors like your background, your experience, the job market, and the type of job you want to do. When I graduated, I had worked as an acute care nurse in ED/ICU for 6 years, but the only informatics experience I had was my Capstone and using an EHR as a nurse. When it came down to it, my knowledge of ED workflows was as much a factor in me getting hired as my degree. Some of my coworkers did get a foot in the door by becoming super users and/or trainers, so if you have the opportunity, it's worth looking into. Saying that being an NP and being an informatics nurse are different is an understatement. First and foremost, I'd think about whether or not you want to provide direct patient care. If you love being at the bedside and spending time with patients, informatics nursing may not be the career path you want to take. If you like working with end-users, collecting and analyzing data, and designing and building workflows you'll love informatics.

The one thing I have discovered about metabolism and nutrition/food science is that we know almost nothing. Increasing your intake of foods like fruits and vegetables, practicing moderation, and avoiding highly processed foods is probably a good rule of thumb, but science doesn't really understand why people react differently to the same foods. Why can some people eat a lot and stay skinny? The amount of calories in food is basically based on how it burns (like literally burns) but the last time I checked my tum tum wasn't a furnace, so does the way we count calories even make sense? Then there's the whole microbiome factor...

I think Med/Surg nurses are amazing people because I could not put up with what they deal with on a daily basis. They have to care for half a dozen or more able-bodied yet inexplicably needy patients who won't do what they are supposed to (e.g. ambulate, incentive spirometer, drink golytely for a GI procedure) and then they get b*tched out by **hole surgeons because the patients flat out refused to do xyz. They are entitled to some grumpiness.