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  1. kmrmom42

    Customer Service...........yay or nay?

    Wow, this thread has been very interesting to me. I am a nurse who, fortunately or unfortunately, gets to see both sides of things, the clinical and the administrative. I have worked at the bedside for many years and still can and do in a pinch. Currently I am a unit-based educator and, as such, I am privy to the administrative processes that go into keeping the hospital operational. The most important staff in ANY hospital are its medical and nursing staff. Administration knows that they are to be protected almost at all costs. An administrator can take on the job of two or three other administrators to their detriment but nurses cannot be asked to do the same without huge costs to the operation. Most hospitals in my current area have had to make cuts to save costs, not only due to the current economy but also due to the regulatory environment we are currently functioning in. I am sure that most of you know that hospitals do not get paid for the treatment of a UTI, skin wound, pneumonia and other conditions if they are acquired during the hospital stay. DRGs have made it necessary to try to get patients out of the hospital as quickly as possible because there comes a point in a patient's stay when their care is no longer paid for AT ALL because there is a set number of days they are expected to stay r/t those DRGs. In response to this need to cut costs in order to be able to pay the salaries of the medical and nursing staff administration in almost all of our area hospitals has taken huge hits. I currently work for two organizations involving three hospitals. Both organizations have cut salaried staff from 40 hours to either 37.5 or 36 hours per week. In addition, there was not only no decrease in the expectation for work produced but, in fact, many administrators have been let go and their jobs incorporated into the now decreased paid hours of the ones who remain. Directors and managers are now responsible for two or three service areas....an almost impossible task. As a result there have been NO lay offs or salary cuts for the medical and nursing staff and that is okay with those of us who do not provide the day to day care of the patients, we KNOW that is the priority and we work without pay to make sure that you can do your job. I agree that there are a lot of requests that come from administration that seem silly- scripting, increasing customer survey scores etc. but they come from an effort to increase revenues so that they can keep their nurses. Hospitals are starting to look at successful businesses for solutions to our issues. What is it that they do that makes their "customers" happy? Like it or not we do have customers. Patients, non-hospital employed physicians, outside vendors etc. These are all people who can take their business elsewhere. Hospitals do have to make money in order to pay salaries and the largest hit they take is nursing salaries, appropriately so. Hospitals are now required to post their pt. satisfaction scores as well as their rates on those "acquired in the hospital" infections so that patients can choose where they want to go for their care (and yes, many people do have options). So, in this current environment what you may not see is all the effort that is going into trying to increase outpatient services and other service lines that actually bring in money as opposed to inpatient care where we often lose money. That leaves administration in the difficult position of having little time to do anything but try to come up with quick fixes for inpatient issues. As nurses we have a lot more power than we recognize. If a group of you who truly care about what happens on your units took some time to get together and try to come up with some real solutions to your issues that you can present to administration I can't help but think they would at least listen if not respond. The hard thing for an administrator is when people come with complaints but don't offer solutions expecting that overwhelmed administrator to come up with the solution themselves. I am not an administrator per se but I am one of those people who has had hours cut, more expectations piled on and people come to me with issues expecting me to solve them. I love it when someone comes to me with workable solutions, I stand on my head to try to help make those solutions happen! Now I think I can predict what the reaction will be to my comment above...."how can we take time to get together to come up with solutions, we are already swamped". The truth is we are ALL swamped, just in different ways and if we are ever to get out of that situation we need to solve our own problems and not just complain. I know that many of you are trying to do just that, we just need MORE of you to help us get out of this rut. There is power in numbers. Unfortunately money is needed for many of the solutions but we just need to keep that in mind as we propose those solutions. What will solve our problems that will be cost-effective, allow us to provide the best evidence-based care and make our patients happy at the same time? We need to put our thinking caps on and provide solutions to administration that will truly work for nurses and patients alike. Sorry for the soap box, being in the middle is a tough place to be, I value the points that both sides are trying to make, we just need to all get together and find some common ground. (And yes, sometimes I DO wear rose-colored glasses) Thanks for listening!!
  2. kmrmom42

    NP discusses MJ on national TV ????

    I read through the posts until I found one that at least somewhat mirrored my initial reaction. I agree that her behavior is making us all look bad. Nurses were once thought to be the most trusted of professionals. What will the public think about trusting us in the future after this violation of a dead man's privacy. If there is any information that the public needs to know about drugs being involved in MJs death it should come from the legal system and not from a shameless publicity seeker.
  3. kmrmom42

    Multiple Sclerosis

    Check out this article on WebMD: http://www.webmd.com/multiple-sclerosis/news/20040913/hepatitis-b-vaccine-may-be-linked-to-ms After reading the whole article it seems that the last sentence says it all- "This has certainly been on our radar screen, and we need to continue to look at it," he says. "But the preponderance of evidence suggests no association." In my personal opinion, statistically I would be more afraid of contracting hepatitis B than developing MS. (And I have MS) Good luck with your decision.
  4. If pain was the goal then sterile WATER would have hurt a LOT more!! LOL
  5. kmrmom42

    Multiple Sclerosis

    pegsuern, I am an L&D nurse, currently OB clinical educator, with MS since 1996. I live in CT and I am 52...so it sounds like we have a lot in common. If you want to you can email me . I only go on this board once in a while. Karen
  6. kmrmom42

    Multiple Sclerosis

    Hi Patti, I would think that with your experience with teaching and your enthusiasm for the job that SOME school would be willing to help pay for your education? I wouldn't bother with the RN-BSN either, I would go straight for the RN-MSN. It only takes a couple of additional courses and is well worth the effort. That is what I did, got my degree about 5 years ago and now I am an OB Clinical Educator working between two hospitals in the same system and very happy. BTW I was also diagnosed with R-R MS in '96 and I am 52 and on Copaxone.
  7. kmrmom42

    have you delivered a baby on the ob unit you work on?

    I had already had my children when I became an OB nurse. I did have my first when my nursing school classmates were on their OB rotation though. I had a cesarean because she was a 9lb 14 oz double footling breech. I had my classmates taking care of me post-op, some even gave me their first injections! The first time I stood up after delivery I had two classmates helping me and I gushed blood all over the floor....sooo embarrassing. When I had a spontaneous pneumothorax I was admitted to a med-surg unit in a hospital where I knew very few people. Not a good experience. However, when I had to be admitted post lap choly and during an exacerbation of my MS both times I asked to be admitted to the OB unit that I worked on. Like you I wanted to be with the people that I knew and trusted. And I was right, they took great care of me. Of course, you have to be comfortable with the idea of your co-workers knowing your whole medical history etc. but that didn't bother me.
  8. kmrmom42

    Ugh! Delivered Baby On My Own The Other Day...

    OOH How I wish THIS were true!! I worked once with a doc who was having trouble with his vision but didn't want to admit it. He would putz around with the paperwork long enough that the nurse ended up delivering the baby. He would say "Gotta get this paperwork done, it is important you know" and then after the baby was out he would say..."Well you might as well go ahead and deliver the placenta too!" He would even expect the nurse to check the perineum to tell HIM whether she needed a repair or not. (As he did the repair he would get so close to the perineum to see what he was doing that I would worry that he was going to stitch his tie to her bottom!) As the educator on the unit I worked with the manager to get this practice to stop because it was a risk issue. However, I sure would have loved to have been paid extra for every baby I did have to deliver myself. I could tell you some stories! One was a delivery of a double footling pre-term breech where the pedi made it in time but not the OB who lived further away. The pedi just stood there wringing his hands, looked at me and said "Karen, just hand me the kid when you are finished delivering it!" And that is what I did. OB got there in time for the placenta. Baby and Mom did just fine by the way. I really do love OB. It is never boring! :loveya:
  9. kmrmom42

    new in staff development

    Usually I go to the OB section of this website because that is my specialty. However, I have been in Staff Development for the past 5 years so I decided to check this section out. At first I was surprised to see so few posts here...people ask questions and they only get one or two answers. But then I thought about it....Staff Educators have SO much on our plates that who the heck has the time for posting on discussion boards!! Reading through this thread I can see that my instincts are correct. How the heck do we all do what we do in the 40 hours we are paid to do it in?! LOL That said, I love being a clinical educator and wouldn't dream of changing.
  10. kmrmom42

    The Male Dr Nurse

    I am curious as to where this was that you were asked to wear a mask and cap to do a vaginal exam? You don't even REALLY need sterile gloves (what is sterile about a vagina?) but we usually do use them in case the Mom might be ruptured. I also hope that your instructor didn't REALLY say that a G4P3 who was 6 cm dilated would be "giving birth for the next 24 to 48 hours". Even if that was a typo and you meant giving birth IN the next 24 to 48 hours, that would still be a ridiculous thing to say. Either your memory is flawed or your story is.
  11. kmrmom42

    A Guy Explains Birth to a Pregnant Woman

    With passion like this I hope you consider perinatal nursing after you graduate. We need nurses like you who feel so deeply about the privilege of attending a family during these life changing moments. People who remember that it is not about us but it is ALL about them. There is an amazing guy on the Perinatal Nurse Listserve (PNATALRN) who started as an L&D nurse, is now a midwife and a lactation consultant and has about 6 or 7 (I forget the exact number) children of his own. Just reading his posts I know that he has made a difference in the lives of the families he has touched. You sound like you could do that too. Don't let anyone discourage you or cause you to lose that passion!!
  12. kmrmom42

    Why Does Everyone Hate Florida So Much??

    It is funny you say that. My first year in Florida there were four major hurricanes in a row. When the first one was starting to come into our area I was scheduled to work. As I was walking down the hall toward the nurses station I saw everyone's jaw start to drop. "What the heck are YOU doing here?" I said "I am scheduled to work" They were flabbergasted. It took me quite a while to understand that you don't go to work during a hurricane. The people who are there when it hits stay and the people who stay home come in afterward to let the ones who stayed go home. Having driven through the most horrific of weather and driving conditions to get to work since I was 16 years old I did not understand that nurses were not expected to do that in FL! :chuckle
  13. kmrmom42

    Why Does Everyone Hate Florida So Much??

    Put me in the category of people who like living in Florida. I only moved back to the Northeast after my kids had babies that I would have missed too much being so far away. I had an awesome job, wonderful friends, a beautiful home (that I could not have afforded up here) and SUNSHINE, BEACHES and MORE SUNSHINE!! I would still be living there if I could have talked my kids into moving there!
  14. kmrmom42

    Multiple Sclerosis

    If you are able to manage a schedule like that even during an exacerbation of MS then you are probably going to do just fine! There are many of us who live good, active, full lives with this disease. Get yourself on one of the meds like Betaseron, Copaxone of Avonex (do some research tohelp you decide) and take it religiously. That way you will be doing all you can to minimize the chance of another exacerbation occuring. If you do have fatigue I have found relief with Adderall. I tried several other meds first but this one is the best. I have had MS since 1996 and I am still doing quite well, knock on my wooden head!! I have mild ataxia in my right leg, annoying residual issues in my right eye after a bout of optic neurtiis and fatigue. I take Copaxone every day, Adderall for my fatigue and I have slowed down a bit by becoming a Clinical Educator, no more 12 hour shifts for me! Best wishes to you, keep your spirits up, there may be very few changes to your current lifestyle as a result of this DX.
  15. kmrmom42

    Multiple Sclerosis

    How is everybody? I have moved from Florida back to CT because I now have two new grandbabies! Problem is the stress of a new job, uncertain living situation etc. is making living with MS a bit more challenging lately. I am sure once things settle down things will get better but for now I just have to hold one of my beautiful grandsons to feel stronger! I was just wondering how the others on this board with MS are doing?