CritterLover

Does anyone here have any experience using VersaSuite or Azalea Health as their EHR in a facility -- LTAC or other hospital? The facility I work at has been looking for a new EHR and these are two we are considering. Azalea Health has a lot of great reviews for use in a clinic/office setting, but not much regarding inpatient use. VersaSuite has doesn't have many reviews at all. I'd love to hear opinions on either of these programs.

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.

What do you *like* about nursing? That will help some. I've definitely felt the way you do ... and I was an ER nurse too. I tell people all the time that the ER sucked the compassion right out of me. Which may or may not be the case for you ... but I feel you. I can tell you that I'd absolutely hate both pharmaceutical sales (I'm too much of an introvert) and U R (I hate doing chart reviews). I think I'd be good as a scrub and/or circulating nurse but until recently I didn't live close enough to a hospital to take call so I never explored that option. I've worked with research nurses, the amount of patient contact they had depended on the study but overall wasn't the majority of the day -- they had plenty of office time where they got a break from patients. And the CRAs that came to monitor their/our work didn't have any patient contact at all. I currently do a mix of informatics and bedside in peds, and it is a nice mix for me. I like my pediatric patients (parents ... not always so much) and I really enjoy the informatics part of my job -- which in itself has zero patient contact. Informatics requires a lot of problem solving and hand holding. You send out emails telling people things are going to change. You post signs telling people things are going to change. You make announcements at shift change that things are going to change .... and then when things change people flag you down to ask why they weren't told that things were going to change. Kind of like your patients who won't get off the phone.

A lot of nurses overchart. It is not limited in any way to new grads. Charting according to orders/policy is in no way overcharting. I promise that if regulators see that only a few nurses are charting the required assessments they are certainly going to wonder why that is, but if no one is charting the required assessments they are STILL going to want to know why that is. They look at your policies and know what should be there. I consider overcharting to be charting your assessment in the flowchart via check boxes, etc and then writing a narrative note summarizing what you just charted in the flowchart. Narrative notes are for covering things that can't be charted in the flowchart (we can't make a checkbox for every possibility). I usually find it is older nurses who learned "you must write a note every 2 hours" (and the new grads they precept ? ) who tend to overchart.

RA placement can potentially cause atrial ectopy in sensitive patients but it isn't very common. In infants (<1year) it can erode the lining of the RA. Many radiologists prefer RA placement as they tend to clot less. Not all facilities Xray PICCs for placement anymore. There are a few different types of non-Xray technology that can confirm placement at bedside, so don't always expect to see an Xray report.

Not a big deal at all. RA placement isn't widely accepted yet, but is becoming so (as long as the patient is over 1 year old). Many radiologists I've worked with deliberately place their lines in the RA. Without looking it up I think INS still says tip should be lower 1/3 of SVC to cavoatrial junction (so above the RA) while AVA and SIR consider RA placement to be acceptable.

New grads: 1 year New to the facility (or unit/area) but not a new grad: 6 months

What part of the country are you in, and what is the job market like? Have you tried looking at one of the major job boards (such as indeed) and searching for corporate type nursing jobs? A lot of the big insurance companies post jobs there. The big benefit there is that many large insurance companies don't care where you live and you can often (though not always) telecommute, so even if the job market is tight in your area you can still often find something. Make sure you check them out on glassdoor though. Clinical liaison might also interest you -- that is the nurse from the LTC/Rehab facility that goes to hospitals to evaluate patients for suitability for admission to that particular LTC/LTAC/Rehab. Staff development might also be a option. Or maybe look for positions with device manufacturers if you don't mind a lot of travel. Some addiction/recovery centers use RNs to dose subutex/methodone/etc. I had always thought they used medication techs for that but I worked with a nurse who left to go do that so at least some places hire RNs. I think she was doing some counseling as well though. If your IV skills are decent and you don't mind some direct patient care I'd encourage you to check out infusion centers. If I lost my FT job and couldn't convert my casual job to FT, an infusion center would be my first choice. Depending on what you are burnt out on, the OR or a procedural area might not be a bad fit either. Good luck -- I hope you find something that you enjoy ? .

You're going to have to go by your facility policy here. There are several things that are compatible with TPN. As was stated earlier in the thread, the policy at most facilities is to run only TPN and lipids through the same lumen. At my casual job (adult hospital), we keep that lumen dedicated to TPN and TPN only; even if the TPN is cycled you don't run anything but TPN through that lumen. Not running other medications/fluids with TPN is a very very common policy/practice, but it is not the universal truth. In my full time job (pediatrics) we often run other things through the line with TPN. This is because multi lumen central lines are less common in peds. If the med is compatible with the TPN then great, we long line it all together. If they aren't compatible, we flush and pause the TPN, run the med, the flush and restart the TPN. Hearing that is probably giving most adult nurses an anxiety attack, but it is a generally accepted practice. I've also had TPN infusing in an adult home health patient who only had a single port, and he was started on a PCA that was compatible with the TPN, so it all went together through the same port (tpn, lipids, pain med -- I think it was dilaudid -- and NS for the pca). Again though, you have to follow your policy. Any time I've run other meds with TPN, facility policy has allowed it (and the providers have been on board with it as well). Something to keep in mind, though, is that compatibility can be concentration dependent and just because you can mix 20meq kcl into the bag of TPN does not necessarily mean that you can long line k riders into the y port on TPN (I actually think you can do that, but compatibility at one more dilute concentration does not confer compatibility at a stronger concentration).

Out of curiosity, did anyone get a reason from the PACU nurse as to why she wasn't doing it? When I was a house supervisor I took a lot of weekend call for PACU where I worked in order to maintain my hands-on skills, and it can get busy; those nurses can be stretched pretty thin. Often they're doing pre op as well as PACU, assisting with blocks and the like, and transportation isn't always available either. If that was the case and I was the OR director I'd be pretty irritated too. However, if it was just an unwillingness to put the wound vac on, that is totally different. In that case if I was the OR director I'd be upset that the PACU nurse wanted me to pay someone on call pay + overtime to sit there for two hours and then apply a wound vac. Regardless of the reason for the PACU nurse's refusal, the response from the OR director/hospital management is insane. I'd be job hunting.

I really like PACU, it isn't something I've done a lot of but have picked up shifts here and there over the course of my career. I was talking about possibly transferring there full time once, and an ICU nurse I knew outside of work asked me why I would want to do that to myself and told me that PACU is where ICU nurses go to die.

They might do evenings to accommodate parents' work schedules but overnight would be a little unusual in the OP world.

Well an overnight position at an infusion center is odd. Are they still outpatients? Or is this an inpatient unit that deals with infusions? Either way it should be fine as long as you aren't working alone.

As long as you won't be working alone I think it would be OK. Pediatric infusion centers see kids with a lot of interesting conditions/diseases. If peds is where you want to be, it should be an OK start. Not quite the well rounded experience you'd get in an all peds unit or hospital, but you'll get a lot of experience with central lines/ports, and some very expensive and uncommon drugs. What is your ultimate goal? Basic peds? PICU? NICU? Peds ER? You might decide you love it there; infusion centers tend to be popular places to work -- usually no nights or holidays though there is often (but not always) a weekend rotation. If/when you decide to move on from there, I'd think you'd have a relatively easy time getting a job elsewhere in peds unless your market is really saturated in peds nurses. You won't have the time management or assessment skills that you'll need, but you'll have great central line skills and good experience with some of the less common conditions that exist in the pediatric world.

One of your questions was about putting this on your resume or not, and you've gotten a few responses that mention both resume and applications. Leave it off your resume. Put in on any application. The are not the same. A resume is a marketing document and should paint you in your best light for the job you are applying to. It does not need to be an exhaustive list of all jobs you've had. An application, on the other hand, needs to comply with whatever expectations the potential employer sets out. So, if they ask for all jobs you've ever had, you need to list every job you've ever had. Some only ask for related work, some only ask for the last X years of work (most common). Most applications are going to have you sign a statement that the information is true and complete. If they find out you lied on an application, they will often fire you for it.