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.

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.

It's pretty common to see duoneb scheduled and then just plain albuterol prn. You generally wouldn't give them at the same time, but would be reasonable to give the duoneb as scheduled and then follow it up with plain albuterol if the duoneb wasn't enough. Canoehead -- it says "My pt pulmonologist" so I don't think the poster is asking about a personal med. Easy to miss that "pt" though.

Where does it hurt? Near the port site itself or near the exit site (SVC), or somewhere along the path of the port tubing? If anything around the port itself is painful, it indicates that the septum is leaking at least a little bit. Did the dye test confirm that there was zero extravisation, or did it just confirm that the tip is in the SVC (or IVC for a lower body port)? Or is it possible that the needle you are using to access it isn't long enough and you are getting partial leakage into the subq tissues surrounding the port? Does the needle definitely hit the back plate of the port when you access it? Infection is a possibility, but less likely since it only hurts when in use.

I've worked at both small community hospitals and large teaching hospitals. While a big part of the nurse's job in a big teaching hospital is definitely keeping the resident from harming/killing the patient, you still have a bunch of residents around that can give you orders whenever you want/need them. You might have to explicitly spell out what it is that they need to order, but they are there. In smaller hospitals, you don't always have a physician around, though that is changing a bit with the hospitalist services. Learning when to call the doctor after hours becomes a skill in itself. You have to decide if it can/should wait until morning. One hospital I worked at (many years ago) you had to call the nursing supervisor at night and run it past her before you could call the physician because they collectively complained so much about inappropriate pages. And it isn't just about upsetting the physician/getting screamed at for calling. It's about having a good/great working relationship with them. You need those physicians to trust your judgement/assessment and react when you call about something important. If you are someone who has no problem with picking up the phone and paging the physician at all hours about every little thing, then you are going to find out that you don't get your pages returned promptly and that they don't always actually listen to you when are talking to them -- they often are half asleep afterall. If I was a hiring manager at a small community hospital that didn't have 24hr in house physician or midlevel coverage and I was interviewing someone who came from a large teaching hospital, you better believe it is something we'd discuss in the interview as it can be a HUGE adjustment for some nurses. Some adapt well but others really struggle.

I think coming from a big name hospital *can* make you stand out, but it is just one piece of data about you. If the applicant pool is crowded, it might get you an interview but it won't get you the job. (And most places throughout the country, the applicant pool for most jobs isn't that crowded). Overall, though, it is about the experience you gained at that big name hospital. For example, say you've been a bedside nurse at St. Jude for five years, but are moving across country. You apply at a peds oncology floor. Of course having worked at St. Jude is going to stand out and tip the scales in your favor. To a hiring manager, you have great experience in taking care of kids, giving chemo, taking care of central lines, following research protocols. But -- it is because you actually have great experience in those things. You'd probably still get the interview with that experience even if the hospital wasn't St. Jude. It just makes you stand out. Take the job with the better benefits.

I was a unit secretary at the tail end of the Days of the Kardex, and it was our responsibility to update it when we took off orders. It was the nurse's responsibility to make sure we wrote the order on the Kardex (and/or the paper MAR) correctly. I believe that was pretty standard. If the unit is still using a Kardex, shouldn't that process still be used?

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.

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.

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.

Do you have the ability to terminate his employment? If not you need to talk with whoever does, because I don't think this is going to work out. I think you're going to have to have another meeting with him. Lay out your expectations for behavior. Be clear. Do not soften the information. No more "suggestions" (suggestions are optional). He needs to do the new tasks (he might have time for this if he'd stop auditing his coworker). He needs to stop monitoring his coworker's work. While he might still need to monitor the PCTs' work, he needs to limit what he is monitoring -- only what impacts him. Turn some of your suggestions into instructions. Call him out on his defensiveness. If you are able (meaning that if you have firing authority or the backing of whomever does), be explicitly clear that if his behavior does not change, he will be terminated. Lay out expectations of how long he has to make changes: As of now, I need you to stop monitoring your coworker's work.As of X, I need you to start doing Y (a task he says he can't complete).As of Z, I need you to start doing A (another task)When it comes to monitoring the work of the PCTs, my expectations are that you will ______and so onStart the disciplinary process/get a PIP going if your company has them. Loop HR in on this if needed. Good luck.