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CritterLover BSN, RN

ER, ICU, Infusion, peds, informatics
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CritterLover has 22 years experience as a BSN, RN and specializes in ER, ICU, Infusion, peds, informatics.

CritterLover's Latest Activity

  1. I do work 2 different positions but the 2nd job (casual, different employer) is in infusion therapy. My FT job is split between bedside peds (12 hrs/wk), charge (12 hrs/wk) and informatics (16 hrs/wk) and I like it that way. I truly think that to do a really good job with informatics you either need to still work occasionally at the bedside or be very close to those who do. Even back when it wasn't part of my job structure (currently my job is set up to split my time this way) I worked at least 8 hrs/wk in the ER because that is the only way you understand what it is like to ... deal with the decisions that we in informatics make. If that makes sense. It makes me better at the informatics portion of my job. If I'm trying to decide how to structure something, I can sit down in the nursing station and take a quick informal poll of those who have to live with my decisions. Works well. I would say the same is true for charge vs. bedside -- it is super helpful if your charge nurses have to take an assignment at least once a week.
  2. CritterLover

    Terminated the third week into my orientation

    I disagree that the first day you were late should be held against you. You can plan on going in early, but between finding your way in a big hospital and a malfunctioning badge, a reasonable time cushion can disappear really quickly. I mean, you might plan for 30 min early the first day, but once you've got a handle on how traffic goes and all that 15 min should be sufficient. Until you have to walk around the hospital unexpectedly. Though a phone call would have been a good idea. Your BIG mistake was texting a classmate when you overslept. You should have notified whoever your main contact was -- preceptor, manager, charge, educator. I think the note is a nice idea as a way to maintain your professionalism and go out on a positive note. I wouldn't be certain that your chances of getting a job at this facility are shot. I'm pretty sure you were 10 min late one day and then overslept one day? That isn't THAT big of a deal for someone new. I've had more nursing jobs than I care to admit and I've only worked in one facility where that would even be a blip on the radar. I mean, from a management perspective I'd keep a close eye on you and monitor for other issues but things happen. If you're eligible for rehire there is always a chance. Some managers might be more forgiving than others. A lot depends on their personality and how hard it is to staff their unit. However, it will probably mean a less desirable/popular unit, so do keep that in mind.
  3. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    So it sounds like he is fed up with the way his patients are treated at the other clinic and so wants to open his own. That isn't such a bad thing. There are a lot of logistics involved in opening a surgical clinic. It will take him a while to figure it all out. I ... don't think this is such a horrible option. Necessarily. Check on what is going on with PACU. Check on anesthesia. Clarify who will be the author for the post op notes. You'll need ACLS, which I'm sure you don't have as a NICU nurse unless you had it before you became a NICU nurse. In other words, do your best to make sure he isn't cutting corners. From your last few posts though, he doesn't sound like someone who would put his patient's safety at risk. His talk about wanting to grow this practice with you sounds real, though a bit idealistic. Again, hiring a business manager is a good sign. I'd investigate more, though. Just because he is acting above-board with respect to medical ethics does not mean that he understands nursing responsibilities.
  4. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    Yeah, I'm in the minority in that I don't see this as the great dumpster fire that many see it as. I've ready everyone's responses too, and I do see where they are coming from. However, I think many are reacting from the "prefers new grads" part as that can be a huge red flag but can also be code for "don't want to pay for experience." Most nurses are also very very conditioned to what insurance companies require/expect, and those aren't necessarily the standards in a cash business. For example, an insurance company might require, as part of their reimbursement practices, that the post op visit be done by the surgeon or a midlevel. Keep in mind that in general surgical services are bundled -- insurance pays one fee for the surgery and typical post surgical care, so they can dictate who does the post op visit. In general, a 24 hr post op visit is pretty basic, but for a surgeon to let an RN do it but still be reimbursed for the full fee is insurance fraud (depending on what the agreement says). If you want to do outpatient, this might not be a horrible option. It *is* a risk though, and you'll need to weigh that. Honestly, though, the fact that he is board certified has alleviated 90% of my concerns. That is pretty huge - it isn't easy to become board certified in plastics. I would, however, draw the line at truly being the only RN in the building - at least on surgery days. There needs to be an RN in recovery, unless for some strange reason anesthesia stays while the patient is in recovery and monitors the patient. I guess that is possible? That would require that there be more than one person doing anesthesia. There also needs to be someone responsible for OR set up, etc. That is usually the scrub tech. It could become you in time, but that is a lot of training and not something to just jump into.
  5. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    So that makes a lot of this more palatable. He has a license to protect, too after all. Someone with those kinds of accomplishments isn't likely to risk it all. I'd still check Google reviews, yelp, glassdoor, etc. Google his name (hopefully it isn't common). Ask about shadowing, tell him you want to make sure that you are a good fit before you quit the job you have. Many plastic surgeons are looking for a certain image in their staff, for better or worse. It's another reason why they like "younger" nurses. They have an image they want to promote. Feels kind of icky but they do have a business to run.
  6. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    This is why it is really important to find out if he is board certified -- or at least eligible. Any physician can take a weekend course and call themselves a "trained" plastic surgeon. If that is the case -- then I would run far far away. If he's board certified or at least had a surgical residency/plastics fellowship and has worked as a plastic surgeon for a while and just needs a certain number of additional cases in order to be eligible to become board certified, then this sort of thing becomes less of a possibility.
  7. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    I don't know that any of us (other than the OP) can really get a vibe from this situation -- we weren't there. We don't know what question/comment/part of the conversation prompted that comment. It is pretty much being taken out of context -- which is not a knock against the OP at all. It just means that we weren't there and didn't exactly get a transcript of the conversation. I agree that it is possible that he wants someone who doesn't know any better as far as best practice, shortcuts he might be taking, that sort of thing. But we don't know that. Lets face it -- new grads are cheaper. By *a lot* if you compare their salary to that of an experienced OR nurse. Given that he agreed to give her the top of his range, which still did not match what she is making in the hospital as a new grad, money probably has a lot to do with wanting a less experienced nurse. He probably didn't want to say that. He probably thought what he said would sound better and reassure her. He very well might not have any idea how sketchy that sounds.
  8. CritterLover

    I just got hired in a plastic surgery clinic. Are these red flags?

    Writing his progress notes in itself isn't an issue for me as long as it is his assessment that he relays to you -- that is a lot like he's using you as a scribe which is very common. Writing progress notes based on your assessment that reflect that it is your assessment is OK. Writing progress notes based on your assessment that he signs as his assessment is not OK. Doing the next day post op visit is OK (but questionable) if he's available and upfront with his patients that they will be seeing you 24hrs post op. He has some leeway here since he probably isn't billing insurance. If you had more (and relevant) experience it would bother me less. Are you sure that you will be his scrub nurse? Usually there is a scrub tech for that. Some docs do use RNs but that isn't very common anymore. I'm not an OR nurse, but I wouldn't be comfortable with there only being me, him, and anesthesia in the OR -- there should be another licensed person who isn't sterile. Who is doing the anesthesia and who is in PACU recovering the patient? If it is a CRNA doing the anesthesia, are they supervised as require by your state (and that might be no supervision -- some states don't require it)? The insurance/401k stuff makes sense, though I'd nail him down on the timeline. The business partner thing I think is a plus -- most doctors are terrible at the business end of things. Hiring someone to focus on that for him indicates that he wants to grow a successful business and isn't just interested in Cash Now. Have you done any research on this? Google reviews, yelp, glass door, etc? Are his patients happy? Does he have any pending complaints/lawsuits? Is he board certified (in plastic surgery)? Consider asking if you can shadow for a day or at least a few hours at the other clinic. Is that other clinic run the same way? Will they all be moving to the new location once it is ready? The lack of insurance involvement (on the part of the patient) does mean that some of the practices that we consider to be standard don't necessarily apply. Insurance billing requirements dictate a lot of that. Plastic surgery is generally a cash business. If he does accept insurance at times, it is important to find out if he follows their requirements for those patients. Overall I would lean towards "pass," but if he has good reviews, his patients are happy, he has decent staffing, his overall staff is happy and you have a reassuring experience at the other clinic I think you could possibly make it work.
  9. CritterLover

    Inserting Indwelling Catheter with No Foley Kit

    I think she means the wrapping the gloves come in -- not the glove itself. I was taught to do that a long time ago -- open up the gloves, completely open up the paper they are wrapped in, flip one glove to the other side, and then dump my other supplies onto the packaging from the gloves. It isn't a waterproof sterile field, but if everything you are using is dry it works quite well. I think the kits aren't very cost effective in low use areas/facilities because so many supplies inside can expire, and once one thing expires it basically renders the whole thing useless. I mean you can open it up and salvage what you can, but most won't. OP, I've always treated straight caths as a sterile/dirty procedure -- one hand is sterile while the other is dirty. Before you put on your sterile gloves, carefully open the betadine package and prop it so that the ends are in the air. After you've set everything up and put on your sterile gloves, grab the betadine package with your "dirty" hand, pull the swabs out with your sterile hand. Lay the swabs on the sterile side of the plastic (waterproof) packaging from the gloves.
  10. I'm trying to gather some information on the various EMRs out there. My facility is unhappy with our current EMR and are looking to switch. I'm wondering what everyone else out there is using and what they like/hate about it. We're too small to use something like Cerner or Epic. We've looked at Cerner's small facility application, and it will not work for us. We are a small, specialized facility. Most of our patients are under 5 years old though we do have some adults. We are not a long term care facility, though it is possible that an EMR designed for LTC facilities would work for us if it can be customized for pediatrics. Our LOS generally ranges from weeks to months. We must have an electronic MAR with the ability to scan the armband/meds, flowcharts, forms, and some type of provider documentation with templates. We have to be able to customize our charting ourselves. I make small tweaks to our EMR on a regular basis and we can't move to a system where we have to request a change and then wait for someone else to implement it. We do not have an in-house lab, in-house radiology, an OR, an ER, or clinics.
  11. CritterLover

    Gustav Roll Call

    i'm well north of nola, but we are getting thousands of refugees. (we're along the evacuation path). so far, everything is going ok. my hospital has gotten a few patients, and so far has had the capacity to take care of them. all is going as planned, so far.
  12. pm sent, let me know if i can help!
  13. CritterLover

    Hurricane coming: evacuate or stay and work?

    hard to say, but i think i'd stay. i'm single/no kids, but i do have animals to worry about. if provisions were made for them, i'm pretty sure i'd stay. i work in one of the cities that they are evacuating people to, and live south of said city. on my way home from work this weekend, i drove south with several national guard caravans. i felt really drawn to what they are doing, and feel that if i could (financially), i would volunteer down there now. that level of "helping people" is what drew me to nursing in the first place -- as opposed to filling out "safety rounds" and "fall precautions" checklists. looking at the news right now, i'm hopeful that things are going to turn out ok and people will be able to return to their homes soon. (there are still people in my city that were displaced from katrina.) i really hope that when (because i don't htink its an "if") this happens again, i'll be in a place in my life where i can do more. we talked about this over the weekend at work (we admitted a handful of the refugees). my coworkers all think i'm nuts. maybe, but they all have kids. to me, it is different when you are single and childless. i know that other single/childless people feel differently, and that is fine for them; but i feel an intense urge to help. of course, it is easy for me to say that when i also say that i'm staying put because i don't have the financial resources to leave my job for a few weeks so i can help out.
  14. CritterLover

    Need advice BAD

    i worked as a cna/unit secretary while in nursing school, and i think that nursing students benefit greatly from doing the same. however, most (or at least many) nursing students don't work while in school. so i'm not sure why you think you won't be able to get a job if you don't work as a cna while in school. unless you live in an area that is highly competitive for new grads, i can't see a lack of a job causing you too many problems. if you really feel you need a health-related job, do consider working as a secretary/clerk. i swear i learned more working as a secretary/clerk than i did working as a cna. the cna experience was nice and helpful, but i learned so much more reading all of those orders and making all of those phone calls as a secretary.
  15. very true -- facilities can't pay foreign nurses less. however, not only do most us nurses not know this, many refuse to believe it. in addition, many believe that the availability of foreign nurses allow facilities to get away with overall lower wages and higher staffing ratios. does it? maybe. probably? i don't know. personally, i suspect that facilities would find other ways of cutting back on licensed staff, rather than improve conditions to the point where non-working nurses would come back to the bedside. uaps (unlicensed assistive personnel) are cheaper, easier (read cheaper) to replace, and can do many of the things licensed staff traditionally do, as long as the licensed staff does the assessments and charting. which is really unfortunate for those of us with nursing licenses -- we spend nanoseconds with the patient, yet "get" to complete mountains of paperwork (or pages of computer forms). however, i work in a hospital that would be in a dire condition if it wasn't for our foreign nurses (most from the philippines). for the most part, i think we are very welcoming. maybe not --maybe i'm very naive. but i haven't seen any prejudice first-hand. if anything, people seem to prefer working with the nurses from the philippines because (at my hospital) they are perceived as hard working. i'm not completely stupid; i'm sure some prejudice exists, but it hasn't yet occurred in front of me. you know, it is an unfortunate tradition in the usa for new immigrants to be mistreated by the immigrants of past generations. my irish-born relatives learned that first-hand in the early 1900s, as did their italian contemporaries. fortunately for them, they looked anglo enough that much of that was overcome by a change in their last name. kind of ironic, isn't it?
  16. CritterLover

    Please dont hate me for saying this...

    hmm... there isn't any denying that there are lazy nurses out there, and i don't want to make any excuses for them. i like to think though, that part of learning to prioritize is learning to ration your energy (mental and physical), in addition to learning to ration your time. i think this is really true in the er, when some patients really need your energy; yet others shouldn't even be there. when i read your comment about checking a patient's vitals and not going back into the room, i laughed to myself. i consider myself to be a pretty hard-working, kind, compassionate, skilled nurse (most days :) ). but i have to admit that i've been guilty of this. when i worked in the er, i was usually in triage. but on the days when i was in the back and took patients, it wasn't all that unusual that i would go in, check vs, do a quick assessment, and never see the patient again until i went in with discharge instructions. for a long time, this really bothered me. i went to the er from icu, and the thought of not at least eyeballing my patient every hour or so was disturbing. one day, it dawned on me: most patients that come to the er don't need more than a quick assessment, a set of vs, and their discharge paperwork. actually, many don't even need that much. the set of vs they get in triage, plus the set i got when i roomed them, plus the set i got when i discharged them, was pretty much overkill. most don't need to be in the er at all, let alone have their bp and hr checked three times. i can honestly say that i'm much better at spending some time with what i consider to be the "real" er patients -- you know, pts who are experiencing an actual emergency. obviously, if the patient needs meds or treatments, the nurse will be in the room more often. beyond that, they tend to be scared, and need to be reassured and updated. (and the patient doesn't have to be a major trauma or an ami to be a "real" er patient. just something that warrants an er visit). on the other hand, the patients that come in for their repeat utis, yeast infections, mosquito bites ... not only do they usually not really need reassurance, they don't want it, either. they are talking on the phone, or watching tv, or napping, and they want/expect to be left alone until it is time to be discharged. don't let your reaction deter you from trying er nursing. there really is a place in the er for nurses that want to spend a little time with their patients. you just have to accept that you won't be doing that with all -- or even most -- of your patients.