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JKL33

Content by JKL33

  1. JKL33

    Ghosts of the ER (Clerks)

    Excellent!! If you get a couple of good shifts in like this you will at least have some experimental data to present to your manager. And we'll all just hope your nursing colleagues shape up. You're already working on those inroads, though! Solid work. Sending good vibes that you don't get any nastygrams for your efforts.
  2. JKL33

    Bad CPR techniques- do you say something?

    Yes, you do. It works best when everyone understands and agrees that they will stay focused and accept feedback without feeling criticized or insulted. Use of feedback devices helps a lot; then the one who speaks up is simply reporting the feedback and encouraging, and there's less chance it comes off as a personal criticism. *** LUCAS is a mechanical compression device. https://www.lucas-cpr.com/
  3. JKL33

    Ghosts of the ER (Clerks)

    You know, here's a suggestion for them: If they want their 10-minute thing, FINE, yes you should take less than 10 minutes in the room, for sure. In doing so, you will easily see 6 pph. The part that's wrong is the "you have 10 minutes to get in there." As soon as the provider leaves the room/orders are entered that is the busiest time in that room barring initial settling of the patient and any emergencies that might arise. Those 10-20 minutes when the provider is in the room and then subsequently leaves is when the nurses are going to be hopping to initiate and/or complete all the initial orders. They are setting you up for the exact hostilities that are arising by sending you in there on a mission the minute the nurses are trying to implement orders. I will never understand why "this" (what you are going through) is more preferable than just getting rid of individual lazy employees or those who can't/won't perform the role adequately.
  4. JKL33

    Ghosts of the ER (Clerks)

    Source: https://ekasper.chfs.ky.gov/FAQ/FAQ.htm#q2. So I'm curious now. Do you sign up under your own name or under some qualification that the hospital has?
  5. JKL33

    Ghosts of the ER (Clerks)

    No, I got you. That's exactly how it works in a lot of places; I'm familiar. I'm just saying that EMTALA basically does allow you to go in at that juncture unless you would be delaying or obstructing emergent care.
  6. JKL33

    Ghosts of the ER (Clerks)

    And, for nearly all intents and purposes, it is completely unnecessary. You can also use the word "arbitrary." How did they come up with that number, you know? No patient has a 10 minute visit, whether they should or not so the actual truth is that you have more time than that to get in there without missing patients. There is just so much going on at your place @Cody1991. Sorry about that. Another head-scratcher is why they have you running KASPER on everyone. They should be focused on only giving out essential and reasonable controlled-substances, which would mean that MOST patients will have no need to have KASPER checked. Secondly, I would look into this KASPER thing a bit more as far as registration staff is concerned. As far as I know (and someone please chime in if it is different elsewhere), hospitals are not authorized to run these types of reports. Specifically, pharmacists and several different types of practitioners/prescribers are authorized, and pharmacists and practitioners may directly delegate each occurrence of this task directly to an employee of theirs who is under their direction. I am quite skeptical about whether a general hospital employee meets this qualification. Where I work nurses don't even get involved in obtaining such reports (and yes, this will vary state to state and workplace to workplace somewhat).
  7. JKL33

    Ghosts of the ER (Clerks)

    That is true; the main thing that is a clear violation of EMTALA is delaying the MSE (medical screening exam; the part where the doctor sees the patient to determine the presence and nature of any emergency medical condition) in order to check insurance statuses and collect payments and the like. This leaves a lot of leeway for things to happen exactly as they are happening at your place. However, many places acknowledge the aspect of not wanting the appearance of delaying and interrupting active treatment in order to do those tasks. Realistically, it doesn't make sense to say that yes, we have screened this patient and we have decided we need to provide some kind of treatment to them, but then to have some section of our staff rush in and start up with all these business items just as we have decided we need to treat the patient. (I'm not saying you're going to talk sense into anyone, but it still doesn't really make sense).
  8. JKL33

    Ghosts of the ER (Clerks)

    I think their place sounds like chaos. It truly sounds like a place where they are perfectly happy pitting people against each other. I have never heard of registration being timed with regard to how fast they collect payment. Not letting people escape without collecting payment information-yes. But not racing to collect the payment and being judged upon that. I believe it's someone's true experience though (nothing like this shocks me one bit) and I feel sorry for the OP. They're giving their patients a real show. ETA: Although--you kind of raise another idea: The OP should make very sure that his/her understanding of what is expected is accurate (that should always be step 1). But I absolutely believe him/her when they say they are being timed on some aspect of getting in there; that doesn't surprise me one single little bit. So toxic.
  9. JKL33

    Ghosts of the ER (Clerks)

    Yeah, I'm familiar with variations of the quick reg process which doesn't include the payment part of it at all. Quick reg is one thing; it takes like 30 seconds.
  10. JKL33

    Ghosts of the ER (Clerks)

    Welcome, I'm glad you posted and I have a few thoughts for you. I started to read this paragraph and thought, meh--who cares, it sounds like they get along good together. But reading on, it just kind of sounds like they were raised by wolves maybe. They sound downright uncivilized. But then...there are more problems with your scenario I'm sorry to say. This is somewhat my personal opinion, but it's a lot of people's opinion at least where I am (supported by employer, even!): I don't think it's one bit appropriate for the employer to have registration/billing clerks initiating or dealing with their payment processes at some of the times you are talking about; not at all. Yes, the following kind of thing is a problem: ...and the problem is that your employer should not be asking you to be in that room doing that when the patient's treatment is just beginning to be initiated. I am surprised if your place has cash/cards changing hands when IVs are just getting started or the patients are in the timeframe of receiving their initial treatments. The patient's treatment takes priority over everything else generally speaking. You are correct. Many employers have decided the best way for these two groups to work together is to develop a system where registration staff can be alerted to appropriate times to be in the room. At some big systems, registration staff is to follow this process and if they still happen to find themselves in a patient room when elements of treatment need to take place, they are to immediately excuse themselves and return later. I'm often the one telling reg. staff "no--go ahead and finish what you are doing, it looks like you're almost done." They, for their part will either say, "yep, I'll just be a few more seconds" or "eh, we're just getting started here, I'm happy to come back later." We DO have to work together, and we absolutely should be being polite to one another and considerate of each other's roles, but this whole project revolves around the fact that the patient is there for the evaluation and treatment. This isn't a matter of your job being less important or anyone being equal or unequal. She is [words that would get censored]. That is definitely mean girl. Most everything you've written about them is bona fide mean girl. PART of the problem is that your own employer has you at each others' throats and that's nothing new AT ALL. I will come back to this, but one more important thought, first. **The reason that many big places have developed such specific registration processes is because of a federal law referred to as EMTALA (Emergency Medical Treatment and Labor Act). I'm not sure how familiar you are with it (don't mean to insult your intelligence here), but it's a big enough deal that employers don't want even the appearance of violating it in any way. One of the major provisions of EMTALA is "examination and treatment cannot be delayed to inquire about methods of payment or insurance coverage." This doesn't mean that registration/billing activities can never happen until treatment is complete, but it does mean that no one wants to give the appearance of delaying the treatment part of the patient's visit for anything related to payment. So hospitals generally develop specific processes about specifically when (during the patient's visit) registration staff will complete their duties. All the hospitals with which I'm familiar aren't taking any chances with interpretation, and have decided this means that at no time will the activities of their registration/billing departments delay the medical/nursing care of the patient in any way. They want it to be very clear to everyone (the other staff, the patient and the family) that collecting your money is not taking priority over this IV that you need, this medicine that you need or this test that you need. For all these reasons, which I sincerely hope you understand are not about me or you, you simply should not be being asked to collect money and all of that while the medical/nursing staff is engaged in episodes of active patient care/treatment. If you really like the job, here's what I would do. I would read and research the related issues so you know you're sure of what you're talking about. Then I would go to your manager and offer to help spearhead a more coordinated effort that allows you and the nursing/medical staff to all do your jobs with fewer instances of getting in each others' ways and one that, to the extent possible, does not interrupt care in order to collect payment. It's too bad the nurses don't have the maturity to come up with a process improvement plan related to this. The other thing I would consider with regard to these nurses specifically is letting things cool down a little and then start trying to make some inroads. Go to the charge nurse and say you aren't happy with the registration process because it seems weird to be exchanging money while they are trying to take care of the patient (which it is weird--to almost everyone; the direct care staff, the patients and the families....hospitals get plenty of complaints about this kind of thing if they aren't careful). Let the nurses know that your manager has put a lot of pressure on you and no one has really explained anyone else's role or perspective so that you can try to work together. Tell her that you're tired of getting in their way and generally having the problem you're having. Say it kindly (which honestly is more than they deserve, but keep your goal in mind!!). This is a problem with your hospital basically pitting roles against each other (I mean, who isn't going to hip check people out of the way when your VALUE as an employee is being judged by something so stupid as how fast you do something)? I'm being a little silly here just to lighten the mood, but it SUCKS, it downright sucks the way each of us--you, me, and the doctor--are being judged these days. Our **ONLY** hope is to try to rise above and work together despite such a degrading and unpleasant situation. Sorry for the book but I hope it helps in some way. Let me know what you think or any questions...
  11. JKL33

    Putting in orders without an order.

    The situation (of nurses and what they do with orders) sounds like a bit of a mess. I'm not sure why they would critique you for following the procedure your employer has in place (with the form, etc.) but then also why not immediately inform the physician that the whole propofol plan isn't working out too well or...when s/he first ordered you to shut it off clarify what their plan is for increased agitation? Then you wouldn't need to bother with the form at all.
  12. I do suggest getting over that pronto along with most other forms of nurse-guilt, which should just cease to exist. Start putting out lots of apps and resign from this job after you've secured a different one, as advised above. Good luck!
  13. JKL33

    Lazy patient

    I missed this. No flaming necessary, you are simply wrong according to the principles of patient assessment and the idea of interacting with them therapeutically as nurses. Is definitely not therapeutic to do everything for a capable patient, and especially wrong to believe that doing so is related to some therapeutic iteration of compassion. Your comment is so intriguing. Can you explain yourself more/differently? I sincerely cannot imagine why you would believe what you have written; why you would have a negative view of empowering people.
  14. I've seen my share of low hgb, I just don't know how often I've seen it without any inkling of something being amiss before seeing the lab result.
  15. JKL33

    I feel unsafe and unsupported

    WHAT. You need to go to HR and tell them you are being harassed and that you have already addressed this with both the person in question and your manager with no changes and no plan and you are expecting the problem to be actually addressed pronto. Is there more to this? What the world. I believe you, I just can't imagine why a manager is dumb enough to actually handle this that way.
  16. My tip would be to phrase everything as positively as possible and to avoid the temptation to convey the problem by rattling off or listing all the grievances. Remember the other side of it (keep it in the back of your mind): Distasteful as these grievances may be, they get off the ground because of other problems. The nurses who aren't treating others well are quite likely to not have been being treated well themselves. I'm not excusing them, I'm just saying it all isn't as simple as it seems. I say your presentation should be a picture of what the future could/should look like as far as this topic is concerned. What do we want to strive for in welcoming others to our unit, etc., etc. ETA: In other words, if the home-unit nurses have been feeling burdened, worn out and overworked, the worst possible thing is to inadvertently imply that every bad experience float nurses have had is because of them. In reality it just isn't. If you want to make progress EVERYBODY probably needs to be empowered and built up.
  17. JKL33

    Would this be considered abandonment?

    Your take is how I read it. That's the context in which the document is being offered. I was just asking because it seemed like it was implying in another post that the document means you don't have to stay no matter what. This makes more sense. Thx
  18. JKL33

    What do you eat during your shifts?

    Is it possible that if you can afford cafeteria food you could afford meal prep or bringing snacks from home? I can't eat anything other than snacks and very light meal at work. Almonds, small greek yogurt parfait, small/medium salad, cheese/crackers, fresh fruit, fresh fruit, more fresh fruit, cottage cheese, fresh veggies w/ hummus, bean/rice combo + whatever you might want to add in, quinoa/brown rice+add ins, homemade soup (easy), 1/2 PB&J (or fruit spread) or apple/celery & PB, hard-boiled egg, veggie wrap (or whatever you want in a wrap), various trail mix or energy bites, bean/cheese quesadilla (using regular taco size tortillas, not huge), etc. If you commit to learning to make a few different meals, your options are even more increased since then you can take small portions of leftovers to work, too. Check out recipes for weeknight dinners, these tend to be quicker and easier to prepare in general.
  19. JKL33

    Assualted by psych patient

    It actually is pretty simple if you start with the issue of the occurrence itself (the fact that it happened) instead of worrying about the whys. The whys only need to be worried about to the extent that examining them might lead to solutions/interventions. The whys do not need to be worried about for the purposes of deciding whether occurrences are okay or "part of the job." The idea that a professional who is there to attend to someone's healing should be punched in the head and knocked out in the course of duty is unacceptable regardless of any contributing factors or extenuating circumstances. Note that I didn't say the patient shouldn't be handled as therapeutically as possible or that they should be judged for their circumstances; it's just that when talking about people being punched in the head and knocked out or shot, stabbed, bitten, thrown around, etc, there is no circumstance that makes such things okay. Going forward we must start from the position that, at baseline, a care provider being punched in the head and knocked out while caring for others is, independently of everything else, 100% unacceptable. Whatever the solutions are, they need to flow from that idea and from thinking about it that way rather than acting as if various circumstances might excuse the problem at hand or make it so complicated that a solution is too difficult. The phrasing is important. Note that I didn't say "a patient who...[punches, kicks, etc] is 100% unacceptable" or even that "punching someone is 100% unacceptable." I said being punched [kicked, knocked out, stabbed, bitten....] is 100% unacceptable. An occurrence of battery is not acceptable. Once that idea is accepted, then it is useful to move on to the whys in order to enact appropriate precautions and prevention (which will not happen without increased man/womanpower). But the whole reason we have been putting up with this for so long is because some people want to start and stop right there...with the whys. Don't worry about judging patients' motivations or situations. Just deal with the fact: It is not okay. It is going to stop. I say we advocate only that battery upon healthcare workers should be officially addressed as a "never event." This is totally possible, just like we can go to great lengths to prevent patient falls despite the overwhelming array and combinations of circumstances that may contribute to falls.
  20. JKL33

    Would this be considered abandonment?

    That's a nice/interesting document; I appreciate that they have stepped up and called out bad behavior. But in their statements they do not (in black and white) essentially change the definition of patient abandonment. That is to say, they are kind of on a roll and then all of a sudden stop short of saying that walking away from patients at the end of the shift (when one is being told there is no replacement) is not patient abandonment. I suspect that's because it still is. (?) They say: They outline the impetus for their statement at the beginning of the statement: Employers using mandatory OT or mandatory extended shifts as their first-line staffing plan and then when staff balk telling them that they will be reported to the BON for "patient abandonment" if they don't agree to the extended hours. So, from my reading they seem to be addressing the inappropriate use of mandatory overtime and the inappropriate threats that go along with it more than they are addressing actually walking away from patients. The quoted statement above, in context, basically says if you are advised that you will need to work 16* instead of 8*, you can inform your employer that you will not be doing that (and that they need to find someone to come in instead of using you as the staffing plan) and they can't fire back that you will stay or be reported for patient abandonment. Great/wonderful. But that ^ scenario is not the same as: "Welp, no one is here and I'm leaving." Even if it does say what I'm pretty sure it isn't saying (that you freely walk out of an LTC full of patients leaving literally no nurse) there's no way I would do it. I would inform them that I was calling the Ombudsman (or whomever you all call for pt rights violations), the state and whatever emergency resources were available, even 911--and then I would do those things/raise absolute h*ll before I would just walk away from all the patients. I can't believe the document is actually allowing that. What say you all?
  21. JKL33

    Feeling defeated as a bedside nurse

    Not okay. No you didn't. Whoever has messed that place up such that someone off orientation for several months is the most experienced one on the floor and is charge nurse by default is who is responsible for this. It's that simple. Nurses have to stop feeling guilty, ashamed, responsible, blah, blah, blah, for other people's *** choices. I will admit, it makes me both sad and irritated to hear you talking this way.
  22. JKL33

    Advice on new job location

    I would consider rotating shifts a deal-breaker, and not because they are completely unable to be survived for a short/defined time in one's life, but because I believe there is an inherent disregard involved in offering this shift situation to professional nurses most of the time. When I see them posted I usually think to myself that someone in that organization said to themselves, "Yeah, we know that these work patterns don't easily lend themselves to a healthy/happy existence for the long term, but, well....we don't care and this is what we are offering, take it or leave it." So, yeah. I would check out the other job if they offer it to you. Give proper professional notice and do everything necessary to leave on excellent terms. Your other option is to speak with your manager about a timeline for a regular shift schedule and say you are interested in working a straight shift schedule. Fair notice.
  23. JKL33

    Putting in orders without an order.

    Is the above related to concern about what will happen if you knew but didn't report or concern that their behavior will put your license in jeopardy, or moral obligation or ? Just curious.
  24. JKL33

    Lazy patient

    Context is important. Everything depends upon what is motivating the patient's behavior. If they expect that they are in a facility where nurses are employed to do this "for" them and that's their sole rationale for wanting it done, obviously that isn't okay. But there are a lot of other possibilities, such was what a previous poster mentioned: They may be actually worn out by the time you're on the scene and really could use some help. Don't assume, do find out their rationale/motivation. Go from there. Also, it's probably best to not think in terms of whether or not they are "lazy" or whether or not you have an "obligation" to help them. Instead, think in terms of what action of yours would facilitate that which is therapeutic. Is it therapeutic to do everything for someone who is capable of doing at least part of a task for themselves? Usually not. Is it therapeutic to demand that a patient do something when they have exhausted their energies and/or are not able to continue for some other legitimate reason that day? No, that isn't therapeutic either.
  25. JKL33

    Torn between job offers

    Great tips, just one comment about the childcare: There's a decent chance that in a professional role like this it will be an expectation that one have the same level of attention to work (and not one's children) that one would have if coming to the office for work. IOW, if you would have to pay for childcare to come to the office, you will still need to pay for childcare when working in your at-home office. Some companies are pretty serious about it; I can't say that I blame them. The people I know who hire for roles allowing at-home work don't hire anyone who states they're interested in the job in order to "stay home with my kids;" it's an immediate disqualifier. Obtaining/maintaining proper childcare arrangements is part of the contracts. There might be other/lesser ways that not having an out-of-home office job saves a little on childcare, but I'm mentioning the above b/c the OP shouldn't plan on tens of thousands saved and make a decision based on that only to be very disappointed. At the least, it's something to be discussed specifically.
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