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.

NJ publishes the BON actions against Nurses. Many of them are for not doing the CEU's as required because "Nobody ever gets audited..." Well people do get caught and have not done any of them. Then don't buy one of those 30 CEU online classes and get them done ASAP when requested. Or they lie and state that "Oh I lost them. All of them." You were off by .2 hours. Take one more hour, copy them, put a letter going "I miscounted by 0.2 hours but you can see all the hours were done in a timely fashion." I did one extra hour, and next renewal I will do better with my math." You are not what they are looking for.

What about providing medication past the 30 day window if they cannot get services? In my area Psych Prescriber appointments can be 2-3 months from initial intake with social work.

Everywhere I have worked the facility has done extensive due diligence in checking that I actually have the licenses and background I say I do. Copies of diplomas, licenses, verification with the State and so forth. These have all been for Hospitals, a few agencies, and one corporate nursing home. I'm wondering if the OP works for a big organization or maybe a little single owner nursing home. I did some consulting for one a couple years ago. Always behind on their various regulatory paperwork, and eventually they shut down. It's possible someone could slip through the cracks. I'd also wonder if anyone knew they were a nursing student? Everywhere I have worked before I was an RN and then after you knew who the RN students were because they talked about clinical, or they were studying on break, or they were asking the RN's about test questions. We all have been there on this board. If they have the social skills to softly ask those "So where did you go..." then that can be an approach. I don't. Plus if the person is truly lying then you have put them on guard and again they could feud against you. I will also mention it can take a while for the board to update the online registry in some states. I'll echo what several people here have said. If this person makes the accusation and they are wrong, that person is going to have a feud on their hands. If management is the "Mind your own business and don't rock the boat..." then it can be against you. Again hoping management is vigilant.

Exactly. Outstanding warrants might come up on a facility background check, or a landlord background check. Plus if you get pulled over for anything the officer has to bring you in for an outstanding warrant. Even possibly going through a border, or similar it might come up.

Thanks Mary Jean.

Was wondering do hospitals use more travel RN/NP after something like the Hurricane right now in effected areas? Not trying to be an opportunist, but I am a traveler who can work, but has been on vacation for a bit and it may be a way to help.

The agency you applied to may never work with you again.

I'm not the person who asked the question. I wanted to make that follow up statement if they choose to elaborate if possibly there is profiling. Due to expense I can't see the company paying to test everyone, every month. I'm hoping the person who asked the question responds to the frequency for other employees and if there is any racial or other profiling going on.

It's not in the OP's question. Like you said if it's policy you have to do the UDS. I just wonder if part of their frustration is it's not really random. You would hope HR would have something to back up that it is random or that they are not targeting based on appearance or worse a protected class.

I am curious, are you the only one being tested every month? It's "random" but we just only test certain people every month?