rn_patrick

I don't think anyone is lazy. Like I said in my initial post I was asking am I overreacting for my more at risk patients to want vitals daily. Obviously the feeling here is "something small like vitals" is not that big a deal. Corporate SNF or LTC are the worst for wage and hour abuses. Report them and they will find all your mistakes and send them to the board. The nurses here get out on time usually, and this place is exceptionally well staffed. I suggested the class and it died in someone's mailbox. I think you have the right feeling about how that was received. I spoke to the Medical Director is trying to get the P&P changed. Their concern is that at 1x a week means if missed it will be possibly 7 days before they are taken again.

I have been doing #1 with specific nurses and techs. Which has increased compliance on my high risk patients. Which is really all I wanted. Since writing this, I did go to RN management and ask "Do we really need to do this every day." I have been told this is something I am working on. Currently facility policy is daily in the AM. I can't override that. I have been doing that at times, for the high risk patients. The other side of this is I work with a team of MD's. I have the same role as one of the MD's. They don't do any direct patient care at all. Many times as an APN/NP you have to be careful how much "Nursing" you do or depending on the culture it can cause some culture issues and disrespect from the MD's.

"Thanks for taking the lead on this..." I'm going to go back to him and ask if he just wants me to drop this or to work this up. I asked the question since I may be pursuing something that nobody really cares about.

That one person with the A1C of 11-12 is on Lantus. I'd be fine with her getting VS daily. I can't find a set of solid guidelines "This is how often you do vitals..." I'd be happy with Admission, 3x days after admission, then once a week, UNLESS on Anti-Hypertensives, good medical reason, starting a new medication, or Medical or Nursing judgement. Writing my own seems too risky. I'd like to see refusals documented. Which they are not doing. I'd like to see responses to PRN's documented as well. The Medical NP has mostly correctional experience, where I guess the standard of care is lower. He knows his stuff and he's been supportive which is good.

I'd like a source on that. Especially when I read that failure to assess and failure to report a change of status is one of the leading reasons RN's get sued. Overall I agree with you about the vitals not being indicated daily. That is what their facility P&P states. Or I would cut it back for most of them to 1x a week. I'm making that case but nothing seems to be happening.

Do you have malpractice insurance? If so contact them. I know with NSO part of the policy covers board representation. If you Google dealing with a claim from the BON everyone suggests NOT going it alone.

I've tried that. I was more thinking as a staff nurse I would not disregard orders or at least document why I could not obtain the vitals. Maybe all RN's don't feel that way?

I can usually get the patient to do the vitals for me. We also have a new RN who is more motivated and is able to get them also. I very much as a former staff nurse at a different facility appreciate the patient is too agitated to do vitals. The issue is the patient had no vitals for weeks or months and the order is daily or TID and it seems people are like "Meh" so what?

It's been a while but everywhere I have worked you waste it in the sink. The real risk is contaminating the whole bottle with something and not catching it.

There are really strong anti-kickback rules for reasons like this. I used to service as a Psych NP several group homes owned by one Woman. Suddenly I lost many of my patients because they were all going to a new program. Turns out the owner of the group homes partnered/co-owned that program.

Hello. I'm an APN/NP working at a Psych Hospital as the psych attending. Let me tell you what's happening and can you tell me if I am overreacting? I wanted to edit this down so it's not quite obvious if someone else from that facility is reading this who I am, and where I work. Patient's are ordered vital signs once a day as per P&P. Most of my patient's are "Chronic Stable" I don't actually think they need the vitals done daily for most of them. This is the P&P right now. We were getting low numbers and then it turned out the CNA/Techs were doing them with the patient in bed early in the AM. We have a few that refuse, so when I inherited one or two of them we had no vitals for 2 months. Yes 2 months. I've been working on that. I also have one or two delicate patients, one with uncontrolled DM2 (A1c 11-12) and three HTN medications, and another on very heavy psych meds that the vital signs were not being done consistently. Ordered daily and then 2-3 times a week being done, and the other patient three times a day and being done usually every 2 days or so. They are both challenging patients, but usually can be convinced with coffee or some attention. I've gone to the DON about this but it's still not being done. I've been coming at it from a Nursing Liability standpoint but I feel all I am doing now is annoying the staff Nurses. DO I sound like I am overreacting?

I think hospitals pay the best. Like that rate posted above.

Which is part of their model. Start people and have them move on in a year. Get more. Repeat. My patients are on their 4th provider in a row.

Im doing community mental health again. You commented on another post a while back. Maybe you work in a hospital so the facilities can pay more. Maybe you are a rockstar? I like a slower pace since i can get overwhelmed at times. The numbers you quote don't seem typical. Or maybe im a schmuck. I have some issues with the practice model that was not discussed going in. No clinical support and im floating in four programs. I have an email into the recruiter and want to talk to her today. I'd like to quit. They hired me for a leave coverage for 6 months. Like we said in previous posts I'm semi retired at this point. I needed somewhere to over winter. Breaking a contract is going to get me blacklisted. I've lost my ambition. 10 years ago I'd be all for an intense position with paid ot. The local clinic also gets contract people from a local medical school also so I'll be also on their black list. I still think the op should calculate the cost of getting to write off grad school as a business expense as a 1099 for the years she is in school, and max I401k if they can. Might come out cheaper than the employee side of things. Thanks for the advice.

1. Are they covering anything? Group Malpractice or letting you buy into their Health Insurance (The second one if you are older is the big one). 2. 130 is really up there for psych. I'm locums and my package comes to about 85/hr. (Or I failed my negotiations miserably) 2. Depending on where you are in your career especially if you think this is going to be a shorter stay with both school being deductible as a business expense and maxing out a I401K both the employee side of 19K or more if you are over 50 and then about 20% of the profit.