JnJTyson

My standard call-in "Hi this is Julia calling from Dr. so-and-so's office, our number is ###-####. Calling in an RX for Joe Shmoe DOB ##/##/####. Prescription for Lipitor 20mg 1 by mouth every day quantity 3 months with 3 refills." Our doc gives yearlys...its a bit trickier to call in insulins...My doc is an Endocrinologist. He's got these people on some pretty wacky regimines, so it gets hard to call em in sometimes!

Hi everyone...just kinda wanted to get your opinions on this....I work for an Endocrinology practice....just got our samples of the new rapid acting insulin Apidra...put out by Aventis...same people who make Lantus... Does anyone else see a HUGE med error waiting to happen here? Lantus is made in a 10ml vial, just like all insulins, but they made the vial taller and skinney-er than regular insulins because Lantus is clear...all other long-acting insulins are cloudy....so to avoid med errors, they put it in different bottles.... The new rapid acting Apidra (I guess its down to 5 min action rather than 15-30 with Novolog and such...) but they put it in the EXACT same vial as Lantus! The only difference is the label...Lantus is purple lettering, Apidra has black lettering. We take care of so many brittle diabetics at the office..so many on TID regular injections premeals with Lantus at night....Once we get the OK to start prescribing it, I fear I'll get that call that says "I took my 34U before lunch, and now my BS is 400!" It happens all the time now with patients who don't pay attention to the bottle differences as they are now! What do you think? Should they put the new Apidra insulin in the regular vials the rest of em are in? We already griped about it to our drug rep..lol Jules

Its going pretty great. The patient came back for her first visit after the start date. She's doing pretty good. She still wants to call me when she has to do the averages of her blood sugars so she can titrate the insulin dose....but other than that, she's getting everything about the study just fine. I thought it was pretty funny, the doc went in to say hi and check how her blood sugars were..and he told her to increase her evening insulin dose. When I came back in, I read the progress note, and had to tell her to leave it as it is because with the study rules, you titrate the dose every three days!! I tried not to make it sound like the doc didnt know what he was doing...but the pt said "so, I should just listen to you when it comes to the study huh?" We have a few other pts on our list of possible study canidates. Can't wait! What type of studies do you do? This is my first, and its an open label study.so its a drug already on the market, and the pt knows what they are taking. no placebos. Are you guys doing studies of meds not on the market yet? I can't imagine how much paperwork is involved with those!! Oye! Jules

I've never been a big fan of "you can wear anything you want...as long as its we tell you what color it is and how to wear it" I figure, as long as its professional, and you look decent....who cares. You can always tell when its laundry day at my house, I show up wearing my Nemo shirt, or my Strawberry Shortcake shirt. I have a 2nd job as a visit nurse for a pediatric home care company..so I have a small supply of kid friendly shirts. But most of my older patients LOVE my I Love Lucy shirt!! I'm totally a scrub sl*t. If I had enough money, I'd have the largest scrub selection in the world!! =0) Jules

I've been on the guard all this time for a pt that met the inclusion criteria! The biggies were: pts were never on insulin (greater than 1 week) and their a1C being >8.0 We finally randomized a patient on Friday!! I never knew there would be so much paperwork!! Its just me and the Doc doing the study..so you do the math to figure out the quantity of my work..lol Finally...once I had given up my hunt..(they were all canidates except for one reason: heart failure, A1c was too low, they were already started on insulin......) FINALLY!!! We have randomized a patient!! She got the intensive dietary management arm which I was hoping for....I'm so excited! I don't care about the 5 extra phone calls to her I've made this week...she's a great lady, and will benifit well from the study! Do you guys get excited like that? =0) or will I soon learn that all this needs to be taken with a grain of salt? Jules P.S. We are doing an open label study on the effects of a mixed insulin on a standardized titration dose vs. the effects of the insulin named above doses along with standard (1 call only) dietary counceling or intensive (3 calls during the 12 weeks study) dietary counceling.

I love NPs. I'm an LPN right now, in distance school for RN. I'm hoping to become an RN/CDE. But I do know from paying attention down here in Florida, that NPs are in high demand. Most MD offices are so overbooked with pts they see frequently, and those who just came to the area and need care now. The practice I currently work for now is an Endocrinology specialty. We put out an add in the newspaper for either a NP or a PA. We only got 1 reply. As it stands, if our one applicant started tomorrow, he'd have at least 15 pts per day to start..We figured that based on our waiting list and the number of pts we've turned down. Wt list is over 150 pts long, we've turned down at least 50 new diabetics due to no room in schedule (booked out to August now). Plus all the general appts that pts want to be seen for at our office. So, depending on the area, NPs are a GREAT asset! I rarely see my doc. His office has 2 NPs. One I won't see anymore due to an unfortunate ICD-9 coding error, but the other one is amazing. I see no real need right now to see an MD when she can do everything I need. Just a little side note...watch those ICD-9 codes! The one NP who I won't see anymore coded me as having a metastatic neoplasm of the lower lung. So, the insurance sent me a letter asking for my pulmonary history as well as oncology history...I almost died! Turns out....no lung cancer with mets....just a general checkup! =0)

hehe..I work for a doc with TERRIBLE handwriting! I've gotten use to it, so I'm able to read it....but no one else can. Especially when we fax prescriptions and whatnot... I've gotten into the habit of just re-writing it when we have to fax. If he writes a prescription for a total body radioactive iodine scan (he's an endocrinologist)...he writes it all out on a prescription, I tape it to a blank sheet of paper and write: the pts name, dob, contact numbers and then "please contact pt to schedule a whole body radioactive iodine scan to r/o thyroid ca mets. DX code XXX.X...its already on the RX...but it just saves time. Takes a bit of extra time..but frankly, when the hospital calls me 2 days later and I have to pull the chart and read it back to them, it actually takes more time!! Good luck with the other docs!! =0)

Hi everyone! Just thought I see what everyone else is wearing! (been scrub shopping..down 50 pounds...WOOHOO!!) :balloons: Does your office require a uniform? I've worked for a few different offices (as a nurse, a secretary, medical records, and transcription....couldn't make up my mind until I becacme a nurse..lol) I've had to wear any scrubs I want as long as they are solid, I worked for a multi-physician group where the office staff wore one color, and each MDs nurses wore a color (Dr. A's nurses wore blue, Dr. B's nurses wore pink and so on) and now I'm the nurse at a very small office and we can wear anything we want. Since I just dropped some weight, and am quite uneven (my darn belly and butt won't budge!!) so I've been looking quite...baggy lately. I've recently been wearing embroidered t-shirts (with the stick nurse, and LPN and such) and pants....the pts seem to love it. its quite comfy too! What do you guys wear? =0)

Oh no...no offence taken! I know some of these shots burn and hurt like the living daylights!!! Like I said, this just may be the emotions running wild! LOL I decided the technique the nurse used....dart throwing stance..it was REALLY an odd stance! But he is feeling better! So, I just told my hubby the next time he needs an abx shot to have the MD write an rx and I'll give it to him. =0) So if it REALLY hurts him, he can blame me...lol Jules

OK, I don't know, maybe because it happend to my husband, I'm blowing things WAY out of wack. And we all know what emotions can do to our view of what happens. So! here's the background... My husband woke up with sharp right-sided abd pain. I did my little assessment and told him to go to the doc. My head is screaming appendicitis, but I wouldn't tell him that. He didn't have rebound tenderness, but he did have pain on the right when I pushed on the left...you know...all that good stuff. So he went to the doc, and they sent him for an CT with oral and IV contrast.... poor guy said he felt like he was in the microwave when they pushed the dye Anyhow, on the plus side, they decided that he didn't have appendicitis! WOOPIEE! The doc orders a Rocephin IM inj, leaves and sends the nurse in. OK. My husband weighs about 120 pounds soaking wet and is 5'10! So, very little fat, VERY little-but cute-tush. I joked around with him about getting harpooned in the butt...boy did I feel dumb...he got harpooned in the butt!!! She used the longest needle I think she could find, and just shoved that needle into him so hard, I was waiting for the needle to come out the other side and start spraying Rocephin all over me. He didn't want to sit down in the car because he was hurting so much. :angryfire OK, so...VERY thin guy, not much fat in the heiney department needs an IM inj. Heres what I would have done....5/8 inch needle, skip the v. glute. go for the d. glute. His inj site was...well..on the butt...but kinda in the middle (thank goodness she didn't hit the nerve!) Do they not teach that needles are REALLY sharp and coated to slide in easily? You need some force....but jeez! She took the 1 hand approach (the other was kinda in that off to the side stabalize the aim pose) and just jammed it right in. I usually hear "that wasn't TOO bad" when I do injs. So..am I over emotional, or was that nurse WAY to rough with the inj? Thanks for letting me vent... Jules

My mother has FM. She is TERRIFIED of having to take narcotics all the time. She's to the point of just dealing with the flare-ups rather than try a new med. She's pretty much allergic to everything anyhow..makes her itch. She tried Ambien-made her dopy, she tried Percocet/Vicoden/Darvocet-dopey and scratchy (itchy too...) Not too sure of my moms depression status...as much as I know..she's ok in that region. But I do see a HUGE connection with FM and thyroid disorders. I work for an endocrinology practice, a large number of women pts with hypothyroid tend to have the dx of FM somewhere in their chart. My mom has had hypothyroid since she was 12. She's on an Armour-Thyroid dose that I never knew was made because its so large!! The only thing I don't really get is the FM "bumps" what are they? where do they come from? Are they little muscle fiber clumps that cause pain?

My husband works for a small fine-furniture business (owned by my parents). No particular job title..he runs all the machines to manufacture the furniture and makes the programs for the machines..I think its AutoCAD.... I get so confused when he talks to me about melamine..I guess its like how he feels when I go into it about insulin pumps and secretegogues *sp? =0)

This is my firsrt research project that he's done since I've started working there. The company sent me this huge binder with all the paperwork and such in it....plus all the boxes with the stuff for the pts who do the study. It was VERY overwhelming to find all the right places to put the stuff...I've never seen a filing system like this one..it had sub tabs! There were sections for the pharm company (and sub tabs for communication, forms....) a section for the study name group (and sub tabs) and a tab for the company thats running the study (and even MORE sub tabs) The study is pretty neat, but we are still having a heck of a time getting qualified pts. The pts must be insulin naieve (sp?), A1c over 8.0 and so on and so forth. Most of our pts are either already on insulin, have a disqualifying heart problem, or the a1c isn't high enough. We had one lady that was PERFECT for the study, but she didn't want to test her BS 8 times on the day before each appt (which are about monthly) and that was the ONLY reason she declined signing up. ARG! She ended up on the same insulin as the study used! Well, I guess I'll have to come back to this thread more often! Jules

I graduated from LPN school in May. I took the NCLEX in July, but didn't do anything with it until late August (got married...not a good interview when I tell them I need time off before I'm even hired) I knew from the start that I'd hate LTC work. My favorite clinical round during school was Oncology. I loved it...made me feel so good knowing I made someones day a little brighter just by being kind. Most people though Oncology was "depressing". I knew I wanted to to oncology a few weeks after I left that floor. I was waiting on an elevator to go to lunch one day at clinicals. An older woman came out of the elevator, she looked at me and said "you were the girl that took care of my husband a few weeks ago weren't you?" She went on to tell me that he passed away last week, and that she (and he) really appreciated all the kindness and compassion I showed him. Ding! thats my calling. Well, now I work for a small endocrinology private practice. LOVE IT! I'm trained to teach pts how to use insulin pumps, I'm doing a smidge of research, and am also working on my RN at home. Is oncology still my "dream"? possibly. In our state (FL) LPNs can hang chemo. In the hospitals here, LPNs cannot hang chemo. But now I'm looking at what I can do with diabetes care as an RN (CDE and such), not just that I need an RN to hang chemo in my city. I may not go back into a hospital for a job..who knows! Just let your heart guide you! Take any opportunity you can get, always look for new/more knowledge, and you will find something great! Amazing how its so hard to find what you WANT to do...but always know immediately what you DONT want to do. Me? never ever ever ever LTC or OB.

Hi there! Quick question (or maybe 2-3) I just wanted to see mainly what type of research nursing this thread is about. I work for a small Endocrinology private practice. We are doing a study through a pharm company on one of their drugs already on the market (Novo-Nordisk) Its a basic study about the effects of the pharm companies insulin mix in relation to dietary therapy. The enrollment requirements are SO strict. Is this the type of stuff you guys do, or am I missing a whole area of nursing entirely? My job (research coordinator..according to the company) is pretty much everything..I go through all the check lists, do the tests, educate the pt, and so on. The doc...well, once I'm done with my stuff, he comes into the room, says hi, and signs the forms. So..I guess thats my question...what all do you guys do in nursing research? =0) Jules

Hi! Glad to hear you are doing so well with school!! If you go to a bookstore, they have a ton of books about pharmacology. Boarders seems to have a bigger selection of text books than B and N....One of those books may help. Once you get the jist of the math...you won't believe how easy it is. It will become second nature. I even found out that I knew how to solve problems from high school because its the same formula....last but not least...practice!! if you ask your teacher, they may have some extra worksheets laying around that they could copy for you...mine did! =0) I was terrified too..but it turned out ok! Goodluck! Jules

I wish I could remember the whole song...last year during our last few days of LPN school, we came up with the 12 days of christmas...nurses style....I only seem to remember "5 Full bedpans" I'm sure we could all make a new one..LOL Jules

They probably won't ever get rid of those boxes...We are beginning a study right now for Novolog 70/30...and part of the rules state that we have to keep the records for a min of 15 years. Since the drug is already on the market, has been tested before...its not as extensive as the original testing they have to do....so who knows...that stuff may need to be kept forever!! Maybe the FDA website might have some info on the original company to apply to get Lithium on the market (it was used before the FDA was started..I think) might get you something! =0) Jules

My doc is VERY good with the reps...they love him...so we tend to be kept VERY well stocked. Besides lack of money...he gives samples for people trying new meds, or for starting meds like Synthroid...where the dose has to be slowly moved up or down depending on lab values and things. Why make a pt fill a 90 day rx for a pill he may hate 3 weeks after he starts it? And who would want to fill two weeks worth of Synthroid in 4 different doses? I think its great that the pharm companies do the advertising in the form of samples...its even helped me a time or two in the past when I was uninsured! A few years ago I got pneumonia...no insurance...a probably $1.50 in my pocket. After the x-rays, abx shots and so on and so forth....My bill was HUGE. They let me do payments, and the doc that took care of me, gave me inhailers, abx, cough syrup...all samples. They lasted me until I was better....I sent the guy a card!!

Hello everyone. I work in a Endocrinology private practice. Right now, we are a VERY small office (the doc, me and the receptionist) We have about 3000 total pts. We have a pretty decent sample closet...figuring how much stuff is effected by Diabetes. The reps love my doc, and we are kept pretty well stocked. We had to change from the mini insulin fridge to a much larger one because we ran out of room. All the reps keep bringing in TONS of insulin..pens, vials, refills..you name it. Do you have pts that abuse the samples? My doc believes that samples can help improve compliance. When a pt comes in for an appt, they usually walk out with at least a months supply of their meds (if we have the samples). He figures, if he can give them 3-6 months of free meds per year (they have to come for a visit usually every 3 months) that can save them a TON of money. Our doc does not chart his sample giving at an appt. But I chart whenever a pt comes in for more samples, what I gave and how much. I get a kick out of the ones that come in on Friday afternoon at 4:55 and scream. "I ran out of this and I just sent the RX he gave me last month to the mail oder company yesterday! Can I get 2 more months?" repeat every 3 months...I know we get the samples for free...but how much is too much? What do y'all think? How about the demographics of those people? We have a mix of people who don't WANT to spend the money of meds, and people who just plain CAN'T! Do you have policies about samples?

This one is a set of Billboards in Ft. Lauderdale, FL.... On US 1 coming out of the airport, there is a big "Welcome to Ft. Lauderdale" sign. The next billboard right behind it is a naked man covered only with post-it notes in the "naughty places"...its an add for a local gay bar. Welcome to Ft.Lauderdale...come see naked men!!! =0)

What do you mean the shortage is debatable?? Here in Florida, we have 4-5 hour wait times for a flu shot at the grocery store..every time I call in an RX to a pharm, there is an announcement about canceling this years shots...and we are still fussing with Adventis and our ordering company about getting shots...its awful!!! Jules

Shotzie...what type of office do you work at with that kind of pt load?? Yowza!! I work for an Endocrinologist. 1 doctor, 1 nurse, and a receptionist. So its a VERY small office. And being a specialist practice, we don't have a HUGE demand for flu shots. We get hit hard after the GPs run out of flu shots and the pt waited too long. We have ordered 20 vials..and I think each vial does 10 shots..is that right? My MD is great.he's letting my family come in and get theirs for free...but I have to make a little file for non-pt shots that I do so we have the right documentation and forms signed! Can't wait for them to get here..I want mine too.... BTW...who do you order your flu shots through? and how much are they per vial? Jules

Is your office paperless?? If so, what program do you use? Our office is totally not paperless. Our MD does transcription of the first appointment on computer, and the rest of the appts are on paper. We then use a totally seperate program for billing/scheduling since they use an independant contractor for billing. Its terrible!! We are in the process of adding new doctors, and making the group grow...any suggestions for programs or anything like that? I went and had my wisdom teeth pulled the other day, and the dentist was TOTALLY paperless, they walked around with little tablet pcs, when I initialed the informed consent, I did it on the little tablet so it went right into the computer. It was so cool! =0) How's it done in your office?

I work for a 1 MD practice. A grand total of 4 people work here. So the RXs always cross my desk.....along with a lotta other crap..lol but as far as the print-out goes, I just copy it, and stick it in the chart. I document the heck out of pretty much everything. We have a page in front of the chart that is for all communication, if they request a refill, I call it in, chart it that I did it and who I talked to at the pharmacy. That way when they call back and say I didn't do something, I can tell them exactly what I did, and tell them to go to the OTHER pharmacy they go to..lol Its probably much different working for a multi physician group, or an MD that is in and out of rooms like lightning. My doc takes 1 hour for a new diabetic pt...its pretty cool.