Neats

I am not only a nurse but have had a career as an Administrator too. This is my soap box about LTC; 1. We can all continue to voice our frustration about LTC, this is what we have been doing for decades. Now for solutions 1. Contact your nursing, medical and state health department. Contact your local senator and contact CMS for and to demand changes in staffing, and in payment for services--demand DRG codes for specific tasks like full assist with dressing, need assistance with ambulating, full assistance with eating/bathing...tasks based on ADL's. 2. Take your time when you are with a resident. Be safe. If you cannot get it done then let the next shift do it, just be sure you are doing your fair share. We cannot do it all. 3. Document what you do and time it took. This also keeps you safe. 4. Go to your nursing board, and any other meeting you can to talk about your concerns, be brief and make your point. The LTC situation will not change until we get Diagnostic Related Group (DRG) codes based on reimbursement from CMS and insurance companies. Nothing will change until we get staffing ratios based on acuity at a local/federal level. If as a collective and based on evidenced based practices we come up with specific tasks that should be reimbursed each time perform that task present this to your senator at least 4 times a year. Lastly remember the profit margin for LTC is slim less than 5 percent. Many times, just breaking even is appreciated.

I am a case manager with the VA. I do the same for veterans as I would my own civilian patients. Within the VA the big focus is 30 day readmissions.

Ugh.... as a case manager I have never had to "enroll" new customers. I would have left a long time ago. To answer your thoughts about public health and getting into the administration side of nursing..... I would look for state opportunities, federal opportunities. If you are in school I would look for fellowships that you can get into as a senior or new grad. Go to your local VA visit their web site.

I know this is 8 weeks late but here goes...... Although those questions are valid, I am not sure why they were asked in a interview forum unless it was a follow up interview. We use Interqual and Milliman criteria. This criteria is reviewed against what the provider sends in. Now this sounds simple but there is more to it than just this. If you ever get another chance to interview I would be knowledgeable about what Interqual and Milliman is, about basic chronic care foundations and about basic surgical steps form initial to end as far as patient flow. It helps to just know what an OASIS is, what specialty medication are, and what insurance can do for you. Good Luck I will write up a brief overview of health insurance is on a different thread.

I have a masters in health care administration, and computer information management

Healthcare employees who get "walked off" in corrections deviate from safety rules/policies. Some of those rule breaking rules result in a felony and you your self can go to jail/prison. If you are a person with boundaries that change or a person who will go out of your way for a patient then corrections is not for you, for in corrections you need to be black and white when it comes to communication and following the rules and have an attitude of this is the way it is. This is to protect you, me and all staff, it also teaches inmates a new concept to follow rules so in the future they can perhaps go back into society safely.

After reading your concerns I as a manager most of my career I would not feel you lack of med/surg experience would hold you back. Yes Utilization Review/Case Management would serve you well. In these roles you come across alot of things you need to google, saying I never heard of that before. You can work a case of ovarian cancer, finish that and go onto a MVA with multiple fractures to gastroparesis. I suggest you really research and then when you find what you want go for it.

Community health nurse

From what I know of the new designation it is like a case manager but focus is on the affordable care act (also know as metallic plans/Obama Care), you work to keep costs down and usually in a designated team.

Late to this thread but thought I would reply. In 2004 there were 66 emotional support dog complaints of which 57 were found to be related to "other disabilities" meaning they could not show proof of disability in the end. In 2011 there was 466 complaints of which 411 of these could not show proof. Source NBC Chicago. I have sat by a bird on a flight one time, that bird was wearing a diaper. The bird slept and was vocal at times. The person was nice and kept the bird away from me. On another flight I sat by a yapppy dog who would not shut up, many other flyers complained and the dog owner offered many apologies. If it was a pit bull I would not take care of my patient until the dogs were removed.

Sorry this is late did you pass?

I like ANEMONE it means wind. Ava works too I like it!!!

No need to get upset, Just tell your boss I did my job AND even allow collaboration with this nurse as she picked her patient whom she complained about, not my monkey not my circus, you need to speak with her about her attitude, she needs to make things pleasant and herself approachable. Nothing more to say. Then walk out.

I took my test this morning.....I passed!!! Yes I agree I used the books, took a workshop and after taking the test was surprised I could have just completed the practice tests. I do think by the time we take this test we are already well versed in the knowledge we should have though. Thank you for your reply.

PC...get real. This song I agree with what others wrote it is an innocent song nothing more. I love watching James Bond this time of year the old ones (I am sure these will be a topic too to get rid of). Oh my what next are they going to be verboten (not allowed)? Too offensive? Same with Red Nose Reindeer...to sexist? We are losing reality here people. You cannot please all, heck I am afraid to just say hello and smile at someone walking down the street anymore just because I may get sued for being me. My spouse tells me it is people want their 15 mins fame. When you click on these articles it is money in their pocket so to speak each time a person reads the truth or untruth that person gets moneys, same with like buttons. I do not believe what I see or read in the print any more. Life is just a show and everywhere I go I am part of the audience watching things unfold staged or not. My spouse says there are people out there who write untruthful articles just to get paid. We are suppose to write the truth for historical value, 50 years from now no one will know the truth if it bit them in the bottom...just like now.

In the prison system we teach the offenders any where there is fat deposits. I had a guy whose knees were fat...yes he injected there says it was better than the back of his arms and tummy. Had another man who liked to inject in his neck area...yuk, tried multiple times to stop him but he always injected into the fatty tissue he was morbid obese (450 pounds) I think anywhere would have been fine.

I think mid level management is the worst job to have in todays environment and here is why I was an Executive Director (Nursing Home Administrator) the average salary is about 150,000 annually I worked my tail off and there was one time I calculated I made 39 dollars an hour over a 12 week time period because I was always in the facility cleaning up things that needed to be done. This was my job and this was when I went to troubled facilities to help our organization. I did this continually for about 5 years until I realized I was not making that much, that with all the time spent I was making about half that. Although it did teach me to be a great administrator it also taught me not to be "married" to my job and the time spent in it. I started to delegated all the things I learned over the years to mid level management and continue to do this with my co-workers. In the military they have 3 kinds of workers/designations 1. Officers who are like the executive director responsible for everything, focus is on the paper trails/audits/reports, policies, procedures, daily operations it is your name on the line so of course you want to look good and you expect good performance out of all those you are responsible for. I get the credit if we are good and the bonus or I get the wrath of corporate if we fail. 2. Enlisted- these are the ones who really do all the hard work, get in the trenches, direct care much like a floor nurse. With enlisted experience you get promoted to supervisor and maybe mid level management where it is expected that you get those reports, scheduling, annual review ready for my review at an executive level. You get heck from the top and from the bottom, and not much pay. If the executive fails you get a new executive, if the executive succeeds then you get a pizza party. 3. Warrant Officers- These people are a special designation. They have the subject matter expertise, are not responsible for really anyone person, the go to person for any issues/fires where they tell you what you can and cannot do and the Officer/enlisted can run with it or not...this position is much like a House Nursing Supervisor and this position is great to be in as long as you are an expert at what you do. You will find this person on some sort of QA board again with no "hands on" feed back/report responsibility/any tasking, they are there for their input. Being a house supervisor would to me be the perfect position if I am subject matter expert, if I had common sense and good at what I do. My spouse who is CIO of a small computer firm will not manage anyone at any time, he acts like the Warrant Officer at all times. He has a manager who does all the "managerial work" for him and only signs off on annual eval and big picture documentation that have been developed by his guidance (he just checks in once in a while to see the development/project/improvement is going good). Staff go to him for specific question the supervisor cannot answer, management goess to him for his expertise when it comes to decision making. House supervisors to me are like managers, they have the expertise and the "influence" move the company in the direction it needs to go...this is what leadership is about.

You said they had a trial so the dietician and MD should know what that trial revealed. Stand your ground because if something is amiss it will surely fall on you. I would not set my own trial unless I had orders from the MD to titrate until the agreed amount is over 14 hours. Then I would speak to my supervisor and let my supervisor know I will need to be going back into the home several times throughout the next 28 hours to determine this patient need for nutritional support from the titration. Make sure you document well so the reimbursement can be made using time increments of 15 mins.

I would get clarification of BP for 90 patients daily. If so I break it down into manageable can you do 30 each shift or say 45 each shift and do you have an aid to assist? This clearly is puzzling and really a patient concern because those darn BP machines hurt, why would you allow a patient to be subjected to this on a daily basis and cause pain? If I was a patient there and you approached me daily I would tell you to buzz off.

really sound advice form other seasoned correctional nurses. When I was in corrections I never really had any issues about providing care until I came to the state where I was a contract worker. You are there for no frills medical nursing care. Do not go out of your way, do not deviate from the rules not even if it seems like a common sense dictates .. The only time I do different is say when a medical emergency arises like diabetic, if a diabetic inmate comes in shaking, a little confused I give what is in the med cart, if I am out in general population and it is a medical emergency I take whatever I can get from security one time the officer had an unopened bottle of coke, I gave the known offender sips of this and slowly he began to stop shaking I brought him to medical. He did come back and thanked me for saving his life asked me if I could give him bottles of coke to prevent his "diabetes", I told him nice try but no. He just laughed. He really was hypoglycemic and we were a long way from medical. It was one of those decisions you question but keep coming back yes I would do the same over again. Just be the best nurse you can be, do not do any favors, do not hold hands/wear your heart on your sleeve and you will do fine. It is OK to say no and you do not have to worry about a star rating.

The end of this week I am taking the CM test for the first time. I have been studying but my tummy is upset. I am told as long as you study and take the practice test you should be OK, what have been your experience taking this exam for the first time?

I have sent nurses to other floors at various times during the shift as long as they have the skills for that floor. Are they mad at me yes but I have no choice in the matter, nursing must be covered. I have been assigned to other floors as well, I have no heartburn about it, I let my patients know another nurse Ms XYZ will be coming by as I am needed on another floor, I get report in the new floor and start over as if I was just coming on shift and if I do not get things done the next nurse can pick up where I left off. Just my feeling about it.

There is a great article that is a good short read from the BBC Why do people swear? - BBC News "The emotional release from swearing has been measured in a variety of ways. It turns out that swearing helps mitigate pain. It is easier to keep an arm in ice-cold-water for longer if you are simultaneously effing and blinding. And those who speak more than one language, report that swearing in their first language is more satisfying, carrying, as it does, a bigger emotional punch. Catharsis aside, swearing can boast other benefits. The claim has been made that swearing is bonding: a few blue words, uttered in a good-natured way, indicates and encourages intimacy. A very recent study suggests that people who swear are perceived as more trustworthy than those who are less potty-mouthed." The only time swearing has really bothered me is coming form my kids mouth (they are military) they can swear but alas so can I and my husband because we all are military. I did not learn this form the military but it is more accepted so maybe we use it more.

Oh hugs to you. First off what you did for that patient was above and beyond duty. I would have gotten a sitter (maybe not available where you are), I would have talked to the provider about this patient emotional outburst and perhaps gotten something to relax him. It is over and done with . You sound like you have PTSD from this experience. It is real and you need to get assistance with this. I would file a workman comp so you can get counseling, no harm in that. Sorry you could not count on your supervisors assistance, it sounds like the unit is not cohesive. Good luck with your next job. You know what we do after the code has been completed, we talk about it, we come up with all sorts of scenarios we should of, could of done. This is helpful in that you are better mentally prepared next time. I would practice this with co-workers you trust just to get a peer to listen.

"To make a long story short... BOOM! I failed my 2nd LPN to RN bridge course by 1%. I'm devastated, pissed, blah blah blah. Next day, I called my school and asked whats next? I was given two options: restart where I left off or start from the beginning (mind you if I pass this course I go to third semester). I absolutely suck at critical thinking and made that known; since this is an accelerated program they do not teach you (you read the assigned pages and take the test). My instructor tried to help a little but told me to get a tutor (too late). There's another school that would allow me to start 2nd semester as a traditional student that I might try even though its way more expensive. Do you believe that critical thinking skills can be developed? I hear some people say either you have it or you don't... and I don't right now but I'm trying" Well I see you have some critical thinking skills 1. Tutor but too late. You know enough to get help form instructor and tutor those are critical thinking skills. 2. School options and importance of where to start in this process as a student, again critical thinking skills. You seem to be placing a lot of cadence on critical thinking skills. They are not important and with time you will develop them even more as you gain experience. I think you looking at the glass half empty when you should look at it half full or get another glass that suits your needs. If you want to be a nurse, a good nurse you have to think common sense, if I make this decision then these could be some results of my decision...scenario based. It takes practice give yourself some grace.