chordringer

What is said, is not what's being practiced. We already have 3 patients who have received these notices and their medications, which we already were not covering, were being denied coverage through Medicare part D. The verbiage in these notices point the finger at the hospices, but that doesn't jive. Families are getting very upset and may decide to revoke altogether.

So the buzz is around the office today about new Medicare Part D changes that are going to majorly and adversely affect patients and their families, and also be the death knell for hospices throughout the country. See the following link for the actual final determination and new rules that are supposed to be effective May 1, 2014: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/Part-D-Payment-Hospice-Final-2014-Guidance.pdf The Readers' Digest version of this new policy is that patients, once enrolled onto hospice services, will only be covered for medications directly related to the palliation and symptom management of their illness. In example, Sally Jones is admitted to hospice with a Dx: Cervical Cancer. Medicare will now only cover medications directly related to this illness (e.g. Analgesics, Anti-Emetics, Laxatives/Stool Softeners, Anti-Anxiety). But if Sally Jones also suffers from COPD and is also s/p CABG, medications related to those diagnoses will no longer be covered under Medicare Part D and will become the liability of the patient or the hospice provider if they so choose to cover the medications. So what this means is that hospice patients facing terminal illness for one problem may very well become at greater risk secondary to other comorbidities than their primary diagnosis. Additionally, this will add financial stressors to families already dealing with terminal illness. Coupled with the cuts already hitting hospice providers last year, this is surely going to sink some hospices altogether. And we'e already seeing patients getting their rejection notices for medications two months ahead of this change being implemented. I'm curious to know thoughts on this. Is this buzzing within your own work culture? Better freshen up those resumes, ladies and gents, because this could be a game changer. Chordinger

Hey everyone, I work in a SICU at a mid-level 400-500-bed hospital in an urban area. Our hospital is a teaching hospital and has the 12-bed SICU I work in, a 12-bed MICU, and a 10-bed CVICU/Step-down Overflow. Since late March, our unit has experienced persistent low census of SICU patients. It's gotten so bad that our unit has actually been closed four times in the last 3 months. The patients that we do get aren't very sick and usually transfer out in a day or two. We've actually taken quite a number of stepdown patients just so we can stay open. While all of this has been going on, my colleagues and I have been persistently floated far and wide, low-censused, and put on standby. This has resulted in several of us having to deplete our PTO bank just to subsidize a full paycheck. Administration says we're just in a slow period, but some of the nurses that have been around for 10+ years say that we have never had a time period in which the SICU has closed more than once and even then it would be closed only for a day, not a week at a time like we've had recently. I attribute this problem to less and less surgeons doing surgeries at our facility. Our entity is the oldest in our healthcare system and I think a lot of the docs are opting to take their cases to the newer facilities in the system located more in the suburban areas. Some of the more tenured nurses on our unit have said that we used to have nearly 10-12 docs doing surgeries every week... and they were from a variety of specialties. These days all we get are the occasional fem-pop, carotid, and colon resections. I was curious to know if anyone else has dealt with this and whether this might be foreshadowing of things to come down the line. What is the best way to approach the employer with concerns about this. I like my job, but I worry about the sustainability of this if it continues.

I remember my first patient death and I know what you mean with feeling bad and constantly wondering and thinking if there was something that could have been done to bring a better worldly transition. But in the end, I think it is important to realize that medicine --while doing some miraculous things for people -- is ultimately limited in what it can do to prevent human demise. Our jobs, at least when the time comes, is just to help the patient and the family prepare for the inevitable and let God handle the when and the why. Working in the ICU, I see death much more frequently and the kinds of death I see are often worse than what is seen on a typical medical floor. It requires a little bit of resolve because with each death, I think we see in ourselves our own vulnerability and our own finiteness. We will all be there ourselves one day. I hope that when its my time that my family will be there to wish me a fond bon voyage.

Having taken the Organic Chem at UNE, I would strongly, STRONGLY recommend having a strong foundation in gen chem before taking the class. The lectures are along the lines of frontier classroom teaching and do not add much at all to their textbook (which is dense for the self-learner). I withdrew from the class and never completed because of the diffficulty. I'm a capable self-learner but that class was just not coming together in a way that made sense. I would not recommend organic chem from UNE.

Wear really good deodorant and act as though you are itching your nose as you bring it towards your arm pit to inhale the burst of freshness there. It is a modest way of getting a break in when the environment is polluted with awful smells.

Realllly... who gives a toot?

$37,000 for an RN degree? That's a crock. I hope that's a BSN and not just a ADN. Still costly if you ask me.

Having been in your shoes once, I can tell you that the drive might be more worthwhile. Here's a couple things to consider: Cons of Smaller Hospitals ============================================ - Smaller hospitals have far less in the way of educational resources for you. - Acuity will be less than in larger units - It can be far more difficult adjusting to higher acuity after working in a smaller, low acuity unit Benefits of Smaller Unit =========================================== - You will occasionally see patients with higher acuity - More often than not, smaller hospitals will see a broader spectrum of patient problems than you might see in a larger, more-specialized unit (i.e. Larger hospitals will have separate ICUs... MICU, SICU, TICU, CVICU, etc.... whereas smaller units might have both MICU and SICU patients.) Honestly, If I were you... I'd go for broke with the bigger hospital. You're going to see the things you will need to see on a much more regular basis... and usually just working for one of the "big guns" for a short amount of time will make you look golden to rural hospitals that have a harder time recruiting experienced ICU nurses. Good luck to you! Jason, RN

Sorry to learn that you didn't get the position. Keep your head up. If you have no experience as a Tech, it might be better for you to get your first experience on a medical floor or somewhere other than an ER. Those kinds of settings are a little more routine/controlled and would be a better learning environment for you. I would contact SSM again and see if there are opportunities elsewhere. I can tell you that at St. Mary's, the ED is experiencing some changes throughout down there and it would be difficult to put someone with little experience into that kind of situation. All the best, Jason, RN St. Mary's Health Center

I am a FUTURES alumnus, so to speak. I was an LPN prior to the program and actually was licensed as an RN before I had my first day. It's a fairly well-rounded program. They will teach you the ins and outs of the EPIC Electronic Charting, give you a review of several clinical things you should have learned in school, and provide you with 24 hours of telemetry knowledge (how to read strips, etc.). This is integrated with practical experience working on an assigned unit with a clinical coach to actually follow along with a staff nurse to handle patients. Each week is a hybrid of shiftwork on a unit and classroom work. During the last several weeks of the program, you will work with your clinical educator and recruiter to be placed in a unit of your liking (not always your initial or #1 choice... but you CAN transfer to something else within 6 months if you don't like the end result). I think it's a very nice way to orientate and integrate new hire nurses into the system. Cheers, Jason, RN St. Mary's ICU Stepdown

I've finally had the chance to get back and read through everyone's ideas and comments. I really appreciate the feedback, some truly great and real issues being tossed around.

You know what, I hear far too many people saying that you need Med/Surg experience before going to the unit and I have to say that I disagree. I think working in a Step-Down unit or something that will give you higher acuity of patient, along with some telemetry and limited drips experience, would be a good starter for someone more motivated. Also, the hybrid nature of that kind of unit will give you a feel of Med/Surg in a less intense fashion. It's up to your desires. Know your pathophysiology. That's the best advice I can offer. Cheers, Jason, RN

Hello everyone - I am interested in getting some feedback on a problem we incur rather routinely at our hospital: ED admissions right at shift change. I currently work on a Surgical ICU Stepdown unit and our patients aren't always the most stable bunch. Oftentimes, a patient report called to us from the ED will be from a task nurse or someone who has not had a chance to thoroughly assess the patient. They are instructed by their charge nurse to call report. Usually the only information given is what we can view from the EMR ourselves (lab values, time of ED admission, etc.), but nothing that would resemble a full head to toe assessment. This is complicated by the fact that the patient is usually dumped on us within the 20 minute window surrounding our shift change (when nurses are typically in report at their other patient's bedside). We do not have techs on our floor and usually have a 3:1 Nurse to patient ratio (which is more than enough given how complex they usually are). The concern that many of us have is not so much the admission itself, but the manner in which we may not have a full idea about what the incoming patient might have in terms of acuity, and how we are not able to effectively tend to our other two patients during the immediate time of admission. There have been too many instances where an admission might require one to two nurses working on that admission due to the emergent necessity of interventions, and the other two patients (who possibly might have just as much acuity) are sort of left hanging. Does anyone else have problems that are similar? And if so, how has the situation been addressed at your hospital? We have obvious ideas on how to improve this problem and make it easier for everyone involved, but it's not as easy to get addressed as it would seem. So, I'm trying to research and see if there are similar issues out there and to get input. Any and all comments welcome! Thanks, Jason, RN St. Louis, MO

Hey bud, First congrats on doing what you're doing. Second, worry less about others and focus on yourself and your situation. The world is not fair and sometimes that means we experience it firsthand. Keep your chin up and work on your own credentials. You'll pull through. I know I did. Cheers, Jason, RN St. Louis