welnet66

Thanks everyone. I agree with the Q4 hours after medical clearance...it just makes sense. I still can't find what medicare/medicaid requires. I will propose the q4 and appreciate all your help!!

Hi Everyone, My director has asked that I rewrite our Seclusion policy for our ED. The reason is when a psych pt. comes in and is either an involuntary commit or becomes one while in our care, we continue assessing their vital signs as often as the other acute patients in the ED....which is every hour unless more frequent vitals are needed. The issue is, we are a critical access facility with no psychiatric beds nor a psychiatrist. We clear the patient medically and transfer them to a psychiatric facility. The psych facilities are always too full, have too high an acuity ect ect. so we end up housing the patient in the ED for days. Why take an hourly vital sign on a medically cleared psych patient waiting for a bed in another facility? Well, my director wants our vital sign frequency the same as what's required by CMS. CMS has requirements for many things we do in hospitals, how often to take vitals on a stable, medically cleared ED psych patient isn't on the list. What does your ED do? How often do you assess vitals on a medically cleared psych patient? Do you determine an acute phase for the first few hours till all the lab tests come back and then change them to an observation phase??? Do you assess vitals just as often as a chest pain? If there is a CMS requirement for vital sign frequency on ED psych patients or for any ED patients...does anyone know where I can find this info?? Thanks!!

1. Dad's were not in the delivery room during delivery 2. Most Mothers delivered under some form of anesthesia and babies via forceps 3. Everyone got their perineum shaved 4. Some Mothers were given a triple H to induce labor (a high, hot and until they holler enema) I'm sure there's more.......

She sent the patient to x-ray before you saw him because she feels your assessment would be irrelevant anyway.

Calling out sick is a tough issue for nursing. First, you're sick and shouldn't be around patients. Second, you're very likely not going to be replaced, leaving your coworkers to sweat it out that day. Here's a few tips for you and anyone else out there compelled to pick up the phone... 1. Make sure you are the one calling in, not your spouse/partner. 2. Never ever tell your employer/supervisor/charge nurse what is wrong with you. You are sick and that's it. If asked, it is none of their business. Ever hear of HIPPA? 3. Don't make it a habit. If you think for one second that your sick calls are not kept track of, you will be in for a rude awakening. 4. Really, don't make it a habit. Your coworkers will appreciate it.

Seems that these docs are using religion as an excuse for indifference toward human suffering.

There are really two issues to think about concerning this problem. These doctors are not thinking about the consequences of abortion not being safe and accessible and because it's a simple and "lowly" procedure, why not dump the responsibility on nurses. A similar issue is popping up here in NC with the death penalty. Doctors are refusing to push the syringe and now the state is considering allowing nurses to do it. Are we going to be forced to change our caduceus to a scythe?

Yes, RN4NICU..I agree. Please everyone, be careful what you say, how you say it and check your spelling!

I graduated from St. Vincent's School of Nursing in 1986. That diploma program along with all diploma programs required university prerequisites just like ADN and BSN programs. I'm not sure what's happening with diploma schools now but then they were all affiliated with a university.

This Sunday's Parade Magazine featured their annual report "What People Earn." Always very interesting but...if you look on page 4, there is a colorful box listing jobs that do not require a college degree. Here's the list: Sales Representatives, Translators, Dental Hygienists, Registered Nurses, Insurance Adjusters, Transportation Workers, Athletic Trainers, Auto Technicians, and Legal Secretaries. Shocking to say the least. I hope I won't be the only one writing to this magazine to correct this terrible misconception.:angryfire

The scary thing about this post is that it is not an isolated incident. A lot of people who are not RN's or LPN's claim to be nurses.

The most common diseases I've seen nurses suffer from over the years are back injury and depression. Cardiovascular disease is hereditary and/or lifestyle, and not necessarily caused by stress. Otherwise, we'd have all had strokes or MI's within the first year!

Hi Homeschoolmom, I graduated from nursing school 20 years ago, did very well in clinical and got good grades in class. But...the one thing I will never forget is the daily bullying, public humiliation and intimidation my classmates and I put up with by nursing instructors. Some even dared to complain to the school, to no avail. After graduation, I spoke to many coworkers about their nursing school experiences. It was the same everywhere. If I had to go back and do it all over again, I wouldn't. I don't know where this culture came from and it is obviously still accepted. Like most of the responses to your message, your daughters have little power to change the situation. However, personal insults and/or threats should be brought to the attention of the school. As I mentioned above, the school will probably do nothing about it but if your daughters had a credible witness, like a staff RN for example, they just might have a fighting chance.

Real soap!!

You're right MVH119. Why stay in a line of work that makes you unhappy..life is too short. Good for you..you made a decision many unhappy nurses are afraid to make. All the best.

I cannot believe some of the responses to this thread. Does anyone not see the real problem here? This instructor is using her authority to harass this person. This behavior is bullying and all too often condoned in this profession. This instructor is using the issue of smoking as an excuse and she should be reported immediately. As a non-smoker and a nurse, I have smelled worse things than cigarette smoke and so have all of you. Second hand smoke has been proven harmful but the actual odor of it has not. This student needs your advice and help dealing with this insecure, unprofessional bully, not a lecture on the harmful effects of tobacco.

It's called passive aggression, is completely nonproductive and a prime example of poor communication. In every facility I have worked, an incident report was made in the event a patient, visitor or employee was affected. Med errors go on a different form. I have yet to meet anyone who goes into work with the intent to make a mistake. Research has shown that errors that occur in the workplace, any workplace, are very likely system errors. In order to correct system errors, there must be a plan in place to eliminate blame, find the source of the problem and solve it. So, if a co-worker has made an error it should be investigated that an error actually occurred; they should be told in a private location in a professional manner so it doesn't happen again and the system should be changed so no one else makes the same mistake. "Write-ups" mean nothing and accomplish nothing.

I felt the same way when I left my first job. It's up to you but I wouldn't take a Per Diem position. You only have a few days orientation and if you're in a new facility with different protocols and systems, it's too stressful. Take the time now to interview for your next position and I mean really interview. Meet the nurse manager, go to the unit and meet the other nurses, get a feel for the place. Don't settle on a job offer unless you know that's where you want to be. Hospitals are pretty much the same no matter where you go...so no worries, you'll do well and good luck!

I have two friends who work for two different health information system companies. They are not nurses but some of their co-workers are. They will tell you first hand that nurses in informatics make on average over 50% less than nurses who work exclusively for health information system companies. These companies will provide training and do not require a masters degree. Kinda makes you wonder.....

I've done it all....ICU, Med/Surg, ER and L&D. As a nurse, you run no matter where you work and who ever assumes L&D is a cushy specialty has never worked there.

It's funny you should mention this rarely acknowledged fact. I noticed it when I first started nursing school back in the 80's and it hasn't changed. I could tell you some interesting stories...what are your theories?

Sounds like your Mother needs to see a different GYN since the one she has now is not addressing her problem. As far as ability to pay, that is never a concern or consideration in the emergency department.

Sounds to me like this Doctor should be reported. Not only did he insult you..which you will not be able to prove..he imposed his religious beliefs on you in front of a witness. That you can prove. Make some phone calls...today!!!

What specialty are you working in??

If MBT feels better...go with those. Look on the internet to compare prices. You may find a bargain. I wear Danskos..they are OK but feel like you're clopping around on a 2X4 for a few days and like any professional shoe..are over priced. Not worth it if you're going to suffer. Good luck keeping your feet happy!!