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

Dear OP, Please quickly and kindly get over yourself. Now, let's have a real discussion because this is something us night nurses were chatting about one evening after one of our day shift nurses made the mistake of uttering similar words. Firstly, you should know better than to pile everyone into a stereotype as you did in your opening shot across the bow. I think day shift and night shift differ in the different KINDS of tasks and stress, but not necessarily mean one is better or worse than the other. On my unit, we do not have any techs/CNAs/(insert other equivalent here)... it's a pure nurse to patient relationship. The night shift is responsible for bathing 85-100 of our patients at night. If an IV is to expire, we start new ones. If a patient has a CT or XR, we have to take the patient to radiology. You mention working a stepdown unit, so do I. Don't be so naiive to believe that we only give 2100 medications. I would say that between drip titrations and piggybacks, I'm in a room admin. medication at least 3-6 times during my shift, which is fairly comparible to a dayshift. We stock and clean the unit because day shift purports to be too busy to actually clean up after themselves. I get that it's "hectic" but it can be that way on nights just the same. We don't get the luxury of having half of our patients in dialysis or in surgery or elsewhere for a nice length of time... we are with them all night long. Frankly, the majority of the nurses on days that complain about being so overwhelmed are those with poor time management and organizational skills. They show up mere minutes before their time to work and aren't really prepared for the assignment so they get blindsided right away. Show up earlier and really get all of the information you need before report that way report is just a confirmation or clarification process instead of the only means of getting information. You'll find your day runs a great deal more smoothly. Good luck with your mentality about night shift. And while you're thinking about all the extra money we make... think about this... 3 nights a week I don't get to have my wife cuddled up in bed with me, I have to often go without enough sleep due to family interruption, and my first and last days off in the week are usually a wash because I wind up having to get back into a different sleeping cycle. It's rather unhealthy. I choose to work nights because I feel I am able to deliver better care to my patients, not because I'm looking for an easy ride. Something else you might consider before slandering people. Cheers, Jason, RN St. Louis, MO

I graduated this past May as a GN, but also already had over a year of experience as an LPN. I applied to several health systems: BJC, SSM, and St. Anthony's. I had completed a lot of clinical hours at BJC and was an employee in a very busy ER at Parkland Health Center in Farmington, MO. I was not really thrilled about BJC because, like previously mentioned, there was a bit of an arrogance and something intangible that just made me uncomfortable. My experience with St. Anthony's included looking online to see their job postings that included "Graduate Nurses welcome" in them, only to get a response back from an HR representative saying that they were NOT going to hire GNs for the position, and that I should consider some of the other postings. Not knowing which ones were actually ones they were willing to accept GNs with, I asked where I should look. The individual was not helpful at all and basically told me to just apply for all that I was interested in and I would be contacted if that position was going to work or not. Needless to say, that ended my St. Anthony's job search. Like the previous respondant, I, too, was subsequently hired into the FUTURES Academy in August. The program is still in its infancy, but even still, it was very, very excellent. It is a hybrid of classroom and clinical time that builds upon clinical skills you may have touched on in school, but is now put into practical application. There wasn't a single person that did not make you feel welcome, and the environment is very nurturing. I am currently working for St. Mary's Health Center in Clayton, MO and couldn't be happier. I feel I am equipped with the support I need in my first year of experience. All the best, Jason, RN St. Mary's Health Center Surgical ICU Stepdown Unit

I will be graduating from MAC in a few days and agree with what the last person said, aside from the 'if you don't make the cut, you can do the PN program.' Being a student that went the PN-RN route, I have to say that I wouldn't have done it any other way. It takes the same amount of time to complete the RN, if you struggle with the second year of the RN program, you are still an LPN instead of losing ground and having to start over again. What's further is the articulation of Med-Surg nursing credit to the sophomore year if you complete the PN Med-Surg nursing class with a B or better. What this means is that you don't have to attend all of the lecture, your clinical experiences are abbreviated and you get the choice of working immediately in an ER or ICU setting in the fall section of Med-Surg, while the traditional RN students are completing their med-surg floor clinical classes. Additionally, I was able to work fulltime as an LPN while attending the last year of the program, gaining practical experience that makes me more marketable to employers than grad nurses with only clinical experiences on their resumes. In some cases, I was offered a higher starting salary than my traditional student counterparts for having the LPN experience. The program IS comprehensive, but this also attributes to substantial success in NCLEX pass rates. Employers in the area readily seek MAC grads because they know how rigourous the program truly is.

Erm, I would steer clear of the "Prison *****" mentality and approach as recommended by Bug. It can work sometimes... and othertimes it will just backfire in your face and make your situation ten times worse. Just sayin'

Hey there, Hang in there and don't worry about what others do. At this point, it's about getting into the program, and for what it's worth, that's something only YOU can control. Don't rely on other people for handouts and getting information. Take charge and make sure that you are on top of the game in every possible way and you will get in. Your fellow students, whether male or female, are in the same boat that you are in and once you're on the other side of the fence (you know... actually -IN- the program), there will be less of this, because at this point, the gals will start pushing for their own pecking order. Just stick clear of this and do what you are there to do. In school and beyond, this is the expectation from instructors and employers alike. To answer your question: Yes, being more outgoing is only going to help, but don't do that just to gain favor with these people. Do it because you will need to be outgoing in your profession. All the best in getting accepted into the program you desire. It's a great route! Chordringer

I wouldn't gratify their insulting mannerisms with even a second thought. These people will be with you for a short amount of time in your life, and while they can choose to be disrespectful and rude, you have the choice on how to respond to that.

You know, it's amazing to look back and see exactly how fast and furious one year can be in one's life, particularly when that year happens to involve the cycle of events that follow acceptance into a nursing program. My classmates and I are counting down the days until our pinning and rejoiced when this just a few days ago we fell below 100 days left in class. By far, this has been the most difficult thing I have ever done in my life, as I simulatenously work fulltime, juggle a turbulent family life - complete with a wife who has been having a tremendous amount of health problems, and go to school to have 3-5 tests per week on average. For me, this year has taught me an overwhelming amount of humility and in my darkest hours even brought me to a higher level of spiritual awareness I didn't know existed. I find it strange how all of this resulted from an application to nursing school. I'm thankful each and every day I did. To all of my fellow LPN/LVN students out there, I hope your experience has been rewarding. And if it doesn't seem like it now, just remember to look back a year from now and think about it again. Jason

I think these kind of people exist in every classroom known to man, woman, and beast. Brush it off and focus on what you can control. I was a straight A student before this semester, but I'm not going to be enjoying that this semester. Be proud of what you achieve and share in the successes of others in class. Remember: It's impossible to truly compare yourself to students who do not share your lifestyle and situation, so keep that in mind.

The program I attend is a full-time M-F 8am-3pm affair. It's tedious, but I feel like I am getting it. Thanks for your response. :)

I go to school in eastern Missouri.