trudlebug

If you want to look at the Military option: They will pay tuition/student loans for physicians, nurses, and other healthcare jobs. I don't know the service obligations, but many people do this. I know they did have a program where you enlisted as ROTC with a College/University and they paid for schooling, then you entered the service, but I don't know if that is still an option. The military can be a great starting point for a lot of people, and there are a lot of benefits during and after service. But also a lot of hard work, being away from home and the possibility of being deployed to a war zone. If you are able to get into one of these programs - you can get your degree AND experience that will probably open doors to a lot of opportunities once you get out. Whatever program is available, make sure if your recruiter says that you have something as a benefit - GET IT IN WRITING! Also make sure all the details about what happens if you don't complete the service obligation. Sounds like you are good at doing research, so you should be fine. But recruiters are just sales-people, don't let them double talk you! (My husband spent 3 years as an enlisted recruiter, he tried to be honest and helpful, but he HATED it, because it was all about the numbers.) I am stressing this because when I joined (enlisted - not a healthcare field), I didn't follow up on all the details and lost some benefits. I'm not saying it was a bad choice, I was the one who didn't read the fine print. However, my husband did remain in the service, and I was able to get my nursing degree and then work at the military hospital. He recently retired after 25 years. Then he decided to go to nursing school :) You have a lot of options - and I wish you the best of luck! PS another small bonus - not as much "toileting" for patients at military hospitals. Most patients are generally healthy soldiers and family members with injuries or short term illnesses. Generally not the type who need much of "that" kind of help. If you go into nursing, there will be SOME - but it's really not a big part of the overall job. Actually the worst is suctioning trachs -

I work in Utilization Review on the insurance plan side. I have seen bills over one million dollars for many NICU babies. I think the highest one was almost 6 million. Frequently I see bills that are well over $100,000. My company figures the "average" hospital stay at over $5,000 a day. I did not see the math they used to come up with that number, but they use it to sell their service, so it must have some basis that can be quantified. I am not sure how the affordable care act plans work, but many commercial insurance companies as well as private, self-funded plans have deductibles and co-pays. These rates can vary between "in network" and "out of network" providers. There are many other ways they can figure out the payments - it can be very confusing.

An Open Letter for Patients in America's Healthcare System With the Affordable Care Act causing so many changes and questions in healthcare, more people are asking questions about what it means to them. Many people do not know how insurance plans decide how to pay for medical care. I would like to give you a brief overview of how the process works, so you can use that knowledge for future decisions you may need to make regarding your healthcare coverage. The first thing to know is the insurance plan can decide what they will or will not cover. If it is not a covered benefit, they will not pay. This is where the Affordable Care Act is causing changes in insurance plans. There are some things they are no longer allowed to omit. If the costs for these benefits are higher than the company feels they can pay, they may decide not to provide insurance coverage for their employees. These are the people who will need to go through the health care exchanges that have been discussed in the news. Generally speaking, the process works like this: Hospitals have nurses or social work/case managers (often known as the Utilization Management or Review Department) who review the medical information and send it to the insurance company. Doctors often employ someone that specializes in billing, coding and making insurance claims. Insurance companies have nurses who review the claims, and if it is for a covered benefit, and they meet criteria*, the claims are approved. If they do not meet criteria, or are questionable in some way, those cases are then reviewed by a physician who decides whether or not the claim is appropriate. If it is not a covered benefit, the insurance plan will not pay. I am a nurse reviewer at an insurance provider. I previously worked in Medicare/Medicaid. Now I am working for a third party review company for businesses that do not purchase one of the big-name insurances, but fund their own insurance for their employees (self-funded insurance plans). I have experience in multiple types of plans, and have reviewed thousands of hospital cases. Most of these insurance company nurses and doctors are looking out for the patient's best interest. I have fought with hospitals to track down information, or even just to get them to send information so we can review and approve cases. I have searched for providers and facilities that are in network, and arranged for special contracts with those that are not, in order to save the patients money. I have even argued with the "business" people at our company to get claims paid. I would say we approve most claims without any problem. Claims are often denied due to lack of information or improper coding that does not match the diagnosis or procedure. When these are corrected, payment is made. It is rare to get a denial when we receive all the proper information. One of the biggest problems I have run into is the hospital often does not send the correct information, and sometimes does not send ANY information to the insurance company. Also, many insurance companies have contracts with "in-network" providers that prevent extra charges being passed on to the patient. Look at your individual plan coverage to know what your co-pay and deductible payments are, and be sure you do not pay more than you need to. I worked in many different hospitals before becoming an insurance review nurse. I have seen the process from both sides. People have to be an active participant in their care for themselves and their loved ones. My recommendation is "Be a good consumer and a partner in your healthcare". - ask questions and read the details of your insurance plan. Talk to your doctor and insurance company and find out what is covered before any elective procedures. And do not pay any bills that seem "wrong" without calling your insurance provider or doctor first. They can review the claims, deductibles and so on for you to make sure you are not getting over-billed. My suggestion to anyone who is told by a doctor or hospital "your insurance company denied this" - Call the insurance company and find out why! It could be that they never received the request. It could be a clerical error - a mistake in a diagnosis or procedure code will stop a claim payment. Maybe the fax just did not go through. Maybe the nurse reviewer spent days chasing down information, and did not get a response from the hospital. Maybe the insurance company really is one of *those* companies that tries to deny everything. Maybe the planets were aligned in just the right (or wrong) way and all of the above happened. If you do not want to call the insurance company, ask your doctor, the office staff or billing office where you were seen, but ask someone. I cannot tell you what all insurance companies or hospitals do. But I have spoken with many people involved in both patient care and claims. Most of these individuals want what is best for their patients - those on "both sides". And remember, it is easy to blame the nameless, faceless insurance company. But the companies employ people, and people are human. We have families, friends, ideals, ethics, and beliefs. We care, we love, we learn and we make mistakes. So get involved and ask questions whenever you can. Take control of your healthcare. Try to use your insurance company as part of your healthcare team, not as the opposition**. I have a name, and a face. And I do care. "Trudlebug, RN" nurse reviewer for a great insurance company. *review criteria - should be evidence based and peer-reviewed standards of care. The hospitals can also use the criteria to assist them in planning care. (**Unless your insurance company really is one of *those* companies - then educate yourself and take them on! But again - take control of your healthcare!)

Hi fellow OU grads of 2013! I see no more red on my DARS either :) We did it!

CIWA - What does CIWA stand for? Acronyms and abbreviations by ...acronyms.thefreedictionary.com/CIWA Acronym, Definition. CIWA, Clinical Institute Withdrawal Assessment.

I left the ED just over a year ago and am now working as a home hospice case manager for the same reasons you listed in your post (OP). I got tired of doing "everything" for those who you know were dying. It seemed like torture sometimes. And as a bonus, the patients and families appreciate the hospice staff :) (well most of the time:cool:) I do sometimes miss the rush of the ED, but not often...and my back has appreciated the rest, too. Good luck with whatever you decide

Is this a RN/case management position, or possibly a "float nurse" type of position? We have both, and as far as case management, well the schedule is not usually quite that flexible. But we have a few full time "team nurses" that do not carry a caseload, and some part time/contingent "float" nurses. They assist with coverage when case managers are not available, such as vacation or for education. It's really nice when they are available for extra visits during the week, like when one case becomes very demanding, they can see the "routine" patients as well, just to help out. I would find out more details, because not all hospice nurses are case managers. Also, FYI, my company would frown on waiting until the evening to chart, because we are expected to have our charting done and computers synchronized so the evening/night staff will know if any changes were made during the day. Make sure the HR person is giving you all the details. Also, find out what kind of orientation you will get. Big difference between hospital and home nursing. (been doing it about a year, and still feel very wet behind the ears, but loving it - most of the patients and their families appreciate the hospice nurse, and often say thank you. I found very little of that in hospital nursing.)

I was a vet tech - started in the kennels and worked all positions, ending up as a full time surgical tech. I loved it, but as a PP said, the cost of living made me look elsewhere. (also, I had a tendancy to bring my work home, which began to crowd the house a bit, and stretch my husband's patience:rolleyes: ) I have found a nursing job that I enjoy, but I still miss the four legged patients. (Once I took an on-line personality type quiz to find your "super power" Mine was animal communication. :) )

OMG - I think I heard them at work today (out moaning each other :roll) I don't often laugh out loud when I'm watching these alone, but this one got me!

Isn't that a way of reorienting the patient? Albeit, only the immediate "now" is being addressed. That is probably all an end stage dementia patient can handle anyway. But it still can be a form of reorienting, without the terrible detail that he is dead. Just a thought...

good advice, worth repeating

Yes (see my other post)

was this for a psych class? if so, then they definitely would want you to try to re-orient the patient (sorry, client:icon_roll). in the world of nursing school, the only possible answer is d, but in the real world, both a and d are "wrong", because eventually it becomes impossible to re-orient some patients to reality. btw, all who answered a, re-read answer d. the question asks for what would not be included, and d states that you would avoid humor...is that what you meant? remember, look for those key words in your answers that will key you to an answer. also watch for the distractions in the questions...example "challenge" does not only mean to confront, but to "test one's abilities or resources in a demanding but stimulating undertaking."* how do think those people get a's remember everything? they don't, they just know how to read the questions. (took me a while to learn it, too, but once i did, my grades improved from high c's to low a's...2 letter grades!) nursing isn't just knowing the facts, but being able to interpret and use them, that is why the questions are worded the way they are. (nursing is like texas, it's a whole 'nother country :) ) *thefreedictionary.com

Quick update, finally got the MRI done last week, but won't get the official results until Monday. Still not allowed to go back to work, clinic still won't tell me if I can start to exercise or not. After quitting smoking, the weight is creeping up a bit, and I am sooo depressed about that Plus my daughter's b-day is tomorrow, and christmas next week....My diet just doesn't stand a chance. Thanks for "listening" Sharon

Got my MRI today, now I just have to wait for the results...hopefully by Tuesday I should have some more information. I haven't even gone in or called work this week, decided to get some Christmas prep done instead. Thanks for all the support, Sharon Ex-smoker for 14 days. 267 cigarettes not smoked, $60.08 saved Bought myself a small MP3 player so when I can start exercising and/or physical therapy I'll be ready! :pumpiron:

Yang - Congrats on the GN!!!! thanks for the encouragement Sharon :)

:hgu:Hugs and best wishes. I know how hard it is to wait for an answer, like the others have said, get to a neurologist, get a second opinion or whatever it takes to get an answer STAT! Hang in there, Sharon :hngon:

We have one too. In our ER it is right outside the patient bathroom, in the hallway. We don't have a cover over ours, though. Guess where the drunks usually go....and the looks from the LOLs walking by to use the REAL restroom .

Thanks for the support. I am one of the worst at getting mad and fighting for others, but not myself....plus my husband is one to not make waves about anything. He says just get better and don't worry about it. You all have given me something to think about, thanks again. Sharon PS: One good thing about all this, since I felt so crappy, I did manage to quit smoking cold turkey (thanksgiving night - turkey day;) ) so I am now an Ex-smoker for 12 days, 6 hours and 35 minutes. 220 cigarettes not smoked, $49.50 saved. :hngon:

Thanks for the ideas. I just need a release note saying I can come back to work, and the PA won't write it or do any other treatement until the MRI is done, since the MRI isn't done, I don't get the note, so I can't even go back to work as light duty.....(that circular problem is driving me nuts. :thnkg:) Hopefully only another week or so of sitting around. (Well, I think I am going to send my daughter to the store and get stuff to make cookies, at least I can take some of those in to my co-workers to tide them over for a while :cookies: ) Thanks again, Sharon

Thanks for the advice. I haven't really had any problem with the worker's comp insurance company, they have been helpful so far and approved the MRI. It is just that the HR dept had some trouble getting the paperwork together as this happened on a weekend and employee health wasn't open....bureaucracy at its' best :). Then the holiday came around and again all the offices were closed. So it's not like they are refusing to do the diagnostics, it is just the process is frustrating. Also, the staff and management in my department have been absolutely wonderful during this whole thing. So anyway, thanks again for the advice, my MRI is scheduled next Friday, hoping that I'll be able to start some physical therapy or something soon. (I just want to DO something, sitting around waiting just gets me worrying and :thnkg:too much.) Plus the office staff at the clinic where I am being seen do not seem to be held to the same standards as I am used to (if I were their boss, they would be taking some customer service or communications classes ASAP, because they just kept arguing with me about whether or not the WC insurance was notified and I had the letter and claim number in my hand and gave them a copy!) I guess they don't have to impress the Gallup people like we do :) my original post was so long, I left this part out....sorry. BTW - Yang, I am not in Dallas, and my Staff is actually being very helpful and supportive, it is just the waiting that has been driving me crazy and I needed to vent. Sorry I didn't give all the info, I really was just venting to stop worrying so much....

I don't usually start threads, just lurk and reply once and a while, but I have been going stir crazy sitting here and worrying....so anyway, I was attempting to keep an adult patient with severe handicaps safe in the bed while at our ED. (Kept moving/getting head/feet caught in siderails and so on) This patient was very strong and unaware of the dangers of being so active on our lovely ED stretchers. So I asked for help (multiple times) and even hollered across the ED at the charge nurse to come in and give me a hand/check on my other patients and ask the doc to come in and assess pt/possibly move pt (or gasp, maybe even d/c home as tx. was completed....pt had already pulled IV out) Doc refused to even come into room, and wouldn't allow the EMT-B student to come in and help (another gripe, why did he NEED this student with him, he never does that on other days). We were (of course) short staffed, so my charge nurse took care of my other patients and asked the doc for an order for restraints, which the doc said no...(I never asked for the order myself, as I was afraid the pt. would get them caught and provide more chance for an injury, but the doctor didn't even come in to talk to me or assess the situation, and my charge nurse told me he informed the doc of the acrobatics my patient was doing) SO this continued constantly for about 30-45 minutes (me "catching" 80-100# patient who repeatedly launched around the bed, twisting all the cords/iv tubing etc. and then getting on hands and knees and throwing self back toward the floor.) I was trying to calm pt down, singing and hugging and trying to distract the patient to get some relaxation (for us both) And I was grabbing people for help, but they would leave as soon as the pt. was lying down, not sticking around for the repeated "rodeos". When the doctor finally came in, the patient was literally in my arms, head towards the foot of the bed. Rather than helping me get the pt. back in bed, doc moved the pillow to the foot end and waited for me to lie the pt. down. (like I hadn't tried THAT 197 times already:banghead:) Then he asked me what I thought we should give the pt to help with the agitation. (BTW So anyway, if you are STILL reading.....I was rather peeved at that point and reminded him that prescribing medications was out of my scope of practice (probably shouldn't have done that, but I was not a happy camper at that time.) So the doc leaves (takes the EMT student with him AGAIN) and then the charge nurse comes in a few minutes later. At that point, the pt. again launches out of bed and toward my head/shoulder and made contact with my chest/left shoulder area and I felt a sharp pain down my right leg, put the pt down and told my charge that I was "outta here" and limped out of the room. Anyway, to make a long story longer...I have been out of work since Nov. 16th, trying to get everything straight with a physician's office and worker's comp just to get an MRI of my back/neck..... generally sore with sharp pains and can't walk/stand for very long without feeling weak in my legs and getting kinda worried that it has not improved. Since my primary care provider is at a military army clinic (hubby is active duty) I cannot go see them because they don't handle worker's comp insurance. So the PA at this other dr's office just keeps writing prescriptions for Lortab and Valium and telling me there is nothing else he can do until the MRI is done:o. (I'm wondering when they'll start calling me a seeker...even though I told him I am not taking the meds as often or as much as prescribed because they are too strong for me, I am only taking half tabs 2 or 3 times a day of the lortab for breakthrough from motrin) But the good news is I got to spend Thanksgiving weekend at home with my hubby and daughter, and maybe even Christmas at the rate everything is going. Thanks for letting me vent, (if anyone actually read this far:chuckle) sorry it got so long.... Sharon

Hellllloooo, Yes, LPN/LVNs are nurses! And just like any job/profession/group there are good ones, bad ones and mediocre ones. Perhaps more instruction is given in the RN program versus the LPN program on therapeutic communication, but from my personal experience, it is not something that can just be taught, it needs to be practiced. (btw....in my experience, many of my instructors knew the "steps" of communication, but were not masters of it . Therapeutic communication means you actually listen to the other person, then formulate your response based on what they say. some of my instructors forgot to listen:nono:) That being said, there is a lot of other theory and information taught in RN programs that is very different than what most LPN programs are able to teach. Study hard, take it one day at a time and you will do fine.

this is where education comes in. explain to them why and the consequences of not allowing tx. then if they still say no, make sure to document it! :typing but i agree, forcing an alert and oriented patient is just asking for trouble later.

Great Site!!!! Loved the ER Blitz! (caution, the singer is tone deaf! but it kinda works in this case:loveya:)