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Spartacvs BSN

Med/Surg - PCU - PeriOp - CDA/Obs

Staff RN for a non-profit in upstate NY

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Spartacvs has 9 years experience as a BSN and specializes in Med/Surg - PCU - PeriOp - CDA/Obs.

Spartacvs's Latest Activity

  1. Spartacvs

    Mask refusal

    Yepp, I know its easy to say. However, if they are willing to compromise your health in this matter, you'd be better off cutting your losses before they do something else that will.
  2. Spartacvs

    Nothing changes as long as you obey

    The two sides are diametrically opposed. - The worker wants to do the least amount of work for the most amount of money. - The owner wants you to do the most amount of work for the least amount of money. The worker has an alturistic motivation to do good and help their neighbor (sort of). The owners motivation is profits, to make the most amount of money. This comes on the backs of the worker. And so a union is formed How do we collaborate? We don't. We bargain through intimidation. This goes for the worker and the owner alike. If not for a union the intimidation is one sided in favor of the owner. As to the OP about 'Nothing Changes As Long As You Obey'... this is true for union and non-union alike. The owner has the upper hand and the union is complicit in many respects to the owners needs. Im Spartacvs
  3. Spartacvs

    Mask refusal

    It's very simple... No Mask... No Treatment Don't work for an organization that doesn't follow this principle. Let your boots speak. Im Spartacvs!
  4. Spartacvs

    Staffing Ratios - New York

    Thanks for your reply. What are the ratios at NYU? What are the ratios at Monte? Thanks, Matt
  5. Spartacvs

    Feeling VERY Incompetent

    Welcome to Nursing KY... Don't take this the wrong way... You are incompetent!!! However... we all started out that way. :) School gave you a very rudementery idea of nursing. It set you up to be a sponge... jam all this knowledge into our brains, absorb most of it, and be able to function. (just like a sponge) Reality is different than school and you will learn so much once you are on the job. There are going to be so many people that are going to help you become competent. Over time you will be competent. Embrace the sponge!!! lol -Matt-
  6. Spartacvs

    Staffing Ratios - New York

    Thanks for you reply... It's been made clear that improving ratios improves patient outcomes. Mandatory ratios are a starting point, a ceiling not to be exceeded. If it were up to administrators they would have less nurses taking on more patients. They are constantly pushing on nursing staff to take on more to control costs, do more with less. Acuity should be the main consideration in giving patient assignments but is 'never' followed. The hospital is a factory/hotel, when a bed opens up it gets filled, 100% capacity is the goal and leaves no room unoccupied. The question is how can organizations afford the extra staff? It's starts by separating the nurse from the room charge as I have discussed in a previous post. This will enable us to give evidence to the care that's provided and eventually get paid for it. Medicare & Medicaid do not provide adequate reimbursements and need to be changed to cover the increased acuity of the population served. Organizations need to do a better job of capturing the costs that are incurred by patients. Every flush, every IV stick, every dressing change, every linen change... the list goes on. It costs less for someone to stay at a 5-star hotel than in a hospital and you get better service. If you don't like your room in a hotel the hotel doesn't charge you less do they? So then why should the hospital get paid less when they receive a negative survey? The idea here is to generate thoughts and ideas for our profession to start driving the bus. We have the numbers as a profession yet we are not utilizing this leverage with our legislators. -Matt-
  7. Spartacvs

    Being Bold

    Good Morning, The incoming administration has been quite vocal on repealing the Affordable Care Act (Obamacare) and I am sure administrations are worried about those changes and how it will effect their bottom lines. With that in mind I asked how can we get more for what we do and came across this article entitled "Testing an inpatient nursing intensity billing model" that outlines changing the billing system. They call it nursing intensity but it looks to me that its just another way of saying acuity. Testing an inpatient nursing intensity billing model. - PubMed - NCBI Some key points... "If nursing care represents an independent treatment effect and is one of the largest resources expended by hospitals, then nursing hours and costs (nursing intensity) should be isolated and introduced as a separate variable..." "... Nursing care was undervalued by 32% using fixed per diem rates compared to actual nursing time and costs. For example, the cardiac step down unit had 44% of the intermediate care charges, but the actual mean nursing intensity and mean direct costs per patient for the unit was lower than several other units that were billed at the lower routine care rate." The article concludes "... automatic data capture and direct linkage of nursing intensity and costs to the billing and discharge records may present a viable solution to improving payment accuracy, providing additional clinically meaningful data to examine trends and compare patient care..." In these changing times we need to find better ways to get paid for what we do. Bold ideas... Regards, -Matt-
  8. Spartacvs

    Staffing Ratios - New York

    Good Morning, I would like to bring your attention to the New York State Assembly Bill A08580 "Safe Staffing for Quality Care Act". It proposes a ratio of 1:3 for Step-Down & Telemetry. It does not differentiate between night & day staffing ratios. This bill was passed by the New York State Assembly June 14 2016. You can read the full bill here: New York State Assembly | Bill Search and Legislative Information The bill has been moved to the New York State Senate for input. It's unfortunate since the original justification for changing the ratios was recognized in 2003 by the Institute of Medicines report "Keeping Patients Safe: Transforming the Work Environment of Nurses " that we still don't have appropriate ratios that are supported by evidence based practice.
  9. Spartacvs

    help with steps/routine

    Hi There, As you have found out he OR is very task oriented. Everyone has a way to do things, good and bad. Like nursing school, just do it the way they do it. When you are on your own you will take the good and bad and make it your own. First things first... What kind of case are you setting up for? You and your scrub tech should be doing things at the same time. You also need to be there to tie them up. Scrub tech is setting up their sterile field. You are not responsible for the sterile field, only that no one breaks it. They have a list of things that they have to get for the case. This should include gloves, blades, gowns... and things as part of there set up. You may help by opening things for them, but for the most part they will do the set up. You don't have to know what they do, that's their job and don't do it for them. Look at what they are opening. This will clue you in on what you need to set up. Talk about the case with the scrub tech while you are setting up. This will help both of you make sure you've got everything. You live and die by your scrub tech. If they are good you wont need to support them. If they are bad you are going to be VERY busy during the case :) You will never go wrong with Head to Toe, Top to Bottom. Head Anesthesia is at the head. They are responsible for the machine but I will set it up before they get in by hooking things up. Every Case!!! O2, Suction, EKG leads, Fluid warmer Middle Set up your tower - Top to bottom Power up equipment and make sure its working. Irrigation - Bovie - Insulflation - Camera - Light-source (All depends on the case) - Monitors Arm boards - Safety Belts - Pillows - Padding Toes SCD (Venadynes) That should take you all of 5 minutes. You can count if the tech is ready but most of the time they wont be. Don't worry... you will have time to count and your tech knows that it has to be done and will let you know when they are ready. Don't be pushy... your tech is your team mate... remember what I said... "You live and die by your scrub tech" Now you can really look up the patient. Look at what you set up, make sure you've got what you need for the case. What meds do you need? That depends on the case but your case card should have them written down so go and grab them now. In general its a very short list of two or three items. Don't open anything. MD's are notorious for changing things up. If you grabbed the wrong item you can return it. You don't have to give them to the field now but have them in the room. Don't stress... your scrub tech will ask you for the meds when they need them. Anesthesia should have come into the room at some point during your set up and you can have a quick conversation about the case and the patient and anything that they need. Before you leave the room ask if everyone is ready for the patient. The problem with being precepted is that their are two of you doing the tasks and you will never get a routine down until you are on your own. Their is so much to do that it just makes it easier with two of you doing it. Take it all in. You will be stressed and their is nothing you can do about it except embrace it. You will forget something. You will have to go under a drape to hook up a bovie pad. You will have to run and get something. Even the most experienced nurse forgets something because they get distracted. Its okay... Breath... You will get through it... I promise
  10. Spartacvs

    Residency or on the job training?

    The point that I was trying to make was that you can't even begin to think about scrub/circulate/residency without your RN license (formal education) BSN. One step at a time.Once you have the license then you can see what options will be made available to you, and there are many. You will become more 'marketable' with experience. Your experience will help you gain entry into a residency program or other areas of nursing that might appeal to you. There are many. Without a formal certification (CNOR) your residency may not be worth much in another organization who will be looking for the certification and perhaps even the AORN periOp 101 course completion. It would be a waste of resources to take a new nurse with no experience into a program. I am curious though... What prompted you to attain a masters in sports medicine? I presume you spent 6 years in attaining the degree, why throw it away by going back to school to get another bachelors (BSN)? Would your education lend itself to your pursuing a doctorate in physical therapy? -Matt-
  11. Spartacvs

    Residency or on the job training?

    HTCC... You don't even have an RN license yet. With your masters you could probably get into an accelerated program and be done within a year. Then it's another couple of years for an NP. However you will have no clinical experience. The education is useless without clinical knowledge. You have to walk the walk and talk the talk. If you go the RN route, I would get some floor experience first and then decide on a specialty. There are so many options as an RN but you have to have experience on the floor in order to build your knowledge base and advance. Lots of options.... TONS!!!! but you have to have experience. Also, any organization worth its weight will have a reimbursement program that will pay for you to get your NP. Why pay for it if someone else will. As far as the OR... They really don't use NP's within the OR setting. You might do education, or managing as an NP but not working as a scrub or circulator. And, as you have pointed out many organizations use scrub techs and are not training RN's for that role. While an organization may train you to scrub in, that alone does not make you a first assistant and I would imagine that it might be out of your scope of practice and open you up to some liability. You would need to pass the CRNFA exam in order to get a job anywhere else in any case. For the most part, in order for you to be hired as an OR RN many organizations are requiring the completion of the PeriOp 101 course through AORN. In order to sit for the CNOR test you have to have 2000 clinical hours as an OR nurse. Thats about full time 5 days a week 40 hours a week for 2 years. -Matt-
  12. Spartacvs

    What is your nurse-patient ratio?

    Morning... I'm on a Med/Surg unit in Orange County NY 6:1 on days covering 2 pt's of an LPN 8:1 nights
  13. Spartacvs

    Another 40-something Newbie - just joined

    Hey There, I'm 45, spent the last 2 years on pre-req's. Aced them all. I was just accepted into a local program. I have a wife, a full time job & 3 teenage kids. Don't talk to me until it's over :-) It's hard work but if you want it bad enough you CAN do it!!! Spart