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Posts by JKL33

  1. I do not agree with a couple of elements on the school's part (at all), but since my disagreements are unlikely to be helpful here I'll just say good luck to you in the future. Not everyone blatantly plagiarizes something but most people's integrity isn't quite what we/they make it out to be. You learned a lesson about doing what you can to be a person of integrity. Don't let this terrible disappointment make you second guess it.

  2. 18 minutes ago, Brittany RN said:

    Filling rooms, stocking, cleaning, transporting, vitals, blood, tests, physician orders, ekgs, blood sugars, medications... etc. idk if this is the norm in an ER or not.

    It may be the norm. It may also be why many people feel the same exact way you do about it and are thinking similar thoughts about the meaning of life.

  3. 5 hours ago, Rose_Queen said:

    Regardless, anyone can make a report for any reason- including vile and vindictive employers. Doesn’t necessarily mean anything will come of it, but it can sure as heck be a big headache. 

    I think I see what you're saying, but that's no good reason to stay in such an unsafe environment. Then, instead of a vindictive type report, one would be at risk for an actual report involving something serious like negligence.

  4. 14 minutes ago, Rose_Queen said:

    Some states require reporting of termination.

    Yes. Resignation is not termination. Some resignations have to be reported, too, but that generally refers to resignations in lieu of termination for something that would violate a NPA/board regulations. If you try to resign in order to avoid being justly terminated and subsequently reported, yes in some states it is mandated to report that resignation as well.

    I'm not getting how any of that is related to this situation, where the poster is being advised to resign ASAP (but not to do it at a juncture that leaves any patient without nursing care). ?

  5. 10 minutes ago, Daisy4RN said:

    Because of your current situation it might be easier on you to just go back to the current facility than to move and find a new job (seems like that would just add even more stress to the situation). 

    Same thought. OP, have you been told that you cannot return to your previous/current position? Or is the work (or the hours) such that you don't think you can do it? You know about that better than any of us, but there is something to be said for a job that you at least know, as opposed to assuming that it is going to be easier to start a new job (after the time, stress and uncertainty of the process of obtaining one).

    Can you reach out to resources in your community for help in some of the other matters? Community organizations, services for women/children, etc.?  Even if you're not sure how you would use the services, they are likely to have information that might help you. Hospice organizations or other communities that facilitate grief support may have ideas for you or services you find helpful. Religious organizations are not everyone's cup of tea but a number of them at least seem keen to try to assist people with practical needs in your situation? It seems you do need to do some kind of networking one way or the other, difficult as it may be.

    Do you have a lawyer or anyone who has helped you through the legal/technical processes involved in losing a spouse? Social security, etc.? I don't know the details of these things except to say I hope you have received advice about them and are utilizing whatever resources may be available to you.

    I'm very sorry you are going through this.


  6. 6 hours ago, PollywogNP said:

    Why do you have to wait until the doctor has  seen them ? (“Moves from waiting to be seen to treatment in progress”) before you can see them to complete the registration???

    What is to be gained ?  In a busy ER patients could wait quite a while before the doc/pa/np sees a patient and writes treatment orders.

    The Lobby wait time can be hours long ( recently waited 2 hours), another  opportunity to finish the registration?

    Technically you don't have to. The law only says that the screening for an emergency medical condition or the care required to stabilize an emergency condition may not be delayed in order to inquire about the patient's finances/insurance, and we all know that if there is a delay in screening it is likely due to patient volume vs. resources, and more efficient or less efficient processes.

    The problem is having to prove the why beyond a shadow of a doubt after an allegation has been made. No one wants to be investigated for an EMTALA violation or, as I said earlier, give even the appearance that someone's screening or care was delayed in order to inquire about their payment method.

  7. 4 hours ago, DribbleKing97 said:

    My friend said if its a family member/patient you should remind them who's the Nurse,

    That is poor advice.

    What you should do is start working on the mindset that your security (self esteem), your goodness, your caring, your competence, etc., etc., does not depend upon what people say to you or about you, particularly when they are not in a position to objectively judge such things.

    Don't argue with patients/families and don't chastise them. That is neither productive nor therapeutic.


    4 hours ago, DribbleKing97 said:

    I think there are other ways like apologizing.

    For what do you plan to apologize?

    Just hang in there and listen carefully so that you can learn what sort of a problem or perception they are having and then go from there. Generally we are not able to do that very well if we become defensive.

  8. Edited by JKL33

    16 minutes ago, egg122 NP said:

    You can be EMTALA compliant and have the clerk collect information in the room once the case has been screened and deemed not emergent.

    Yes, but now you're getting into weeds that are simply not going to be parsed out each time registration visits a patient room.

    Is registration making an attempt to know whether the patient 1) has been screened and cleared 2) whether an EMC has been found to exist or 3) whether the testing has been ordered to rule out an EMC or 4) the treatment has been ordered to treat an EMC? No. They do not know these things and #2, 3, and 4 are all situations where EMTALA obligations are not yet satisfied.

    They operate from one basic process and therefore it needs to cover all scenarios. Patients to whom the hospital technically no longer has an EMTALA obligation could be asked for payment/co-payment  before any further care is rendered and they can even altogether be referred elsewhere. But all of that gets into very dicey territory and so it is just not the way things are.


  9. Edited by JKL33

    Yes. That's what the whole discussion has been about.

    It seems we agree on all of that. I only disagree with your assertion along the lines that we're all equal and so clinical staff should wait their just as much as anybody in this scenario. I don't think they should and the law agrees with me, but that doesn't condone rudeness on the parts of these RNs. My comments to you are only to point out that there are some pretty official reasons why decent places try very hard to incorporate reg/billing in a way that doesn't approach interference with medical/nursing care.

    I make no excuses for these RNs. As I said, they are official mean girl.

    I also believe that there is no excuse for these RNs' behavior, but at the same time this toxic process (and many others like it in EDs around the country) is ultimately to blame. It's much easier for me to try to see my coworkers' POVs and try to work together with them,  than it is to try to defend anything as asinine as telling registration personnel to run into the room the instant it's time for nursing interventions to get underway. That is not fair to anyone involved, not the OP, the nurses, or the patient.

  10. 8 minutes ago, egg122 NP said:

    And unless it is an true emergency (which will happen more often than in other settings given it is the ER), the medical and nursing staff can wait for you to finish your transaction with the patient before busting in like that.

    You are not correct. If the basic EMTALA obligations have not been satisfied, then payment operations may not delay the provision of screening or the care required to complete the screening or stabilization.

    Secondly, beyond EMTALA, all clinical staff are being timed on everything and being judged by such speed without regard to patient acuity, and not just by our employers' policies or harebrained initiatives as in the OP situation: ED throughput is a CMS quality measure. That does mean that the actual care and treatment of the patient is being used to officially judge quality of care. There's nothing about making sure to collect $50 in those quality measures. Granted, those procedures are  important, but for different reasons. Therefore, different approaches for satisfactory performance of those duties are needed.

    Lastly, if you were the patient which would you prefer:

    1. Nurse or provider is extremely rude to clerical personnel who are interacting with you and tells them to leave.

    2. Nurse or provider stands in corner while you are uncomfortable and/or anxious, delaying the resumption of care provision until you are done providing your payment information and fumbling around for your various cards.

    3. Nurse or provider (the people you came to the ED to see) pop their head in and see that you are engaged with billing procedures and say they will come back later, which is likely going to be 10-20 minutes from now.

    4. Your actual care is prioritized and the business end of things is taken care of efficiently without interrupting or delaying any other aspect of your hands-on care.

    You would not appreciate #1, 2 or 3 as a patient. You would appreciate #4.

  11. 3 hours ago, jeastridge said:

    You will probably agree, that most of us have some room for improvement at some point.

    Of course.

    And nursing in general is a profession in which one will have the opportunity to experience both personal and professional growth related to our interpersonal interactions and relationships with others.

    It is good to think before we speak (in real time) and in general to think about the types of things we tend to say in order to learn better ways to respond therapeutically to patients.

    In my original nursing program therapeutic communication techniques were taught as part of the psychiatric nursing curriculum. Although the techniques are useful for helping patients requiring care for psychiatric and mental health concerns, I always wondered why the information was presented as if those situations were its sole (or main) use. The specific techniques are applicable to many different situations including most nursing situations and even some other professional, collegial, and personal situations. 

    Here's a scenario: A coworker had ongoing nausea and overall felt nasty during a pregnancy and didn't have much excitement for the situation (being what it was). When the pregnancy suddenly ended in a 2nd trimester fetal demise, another coworker tried to provide comfort by saying, "Well, you weren't really very happy about it anyway" as if to say the outcome was some kind of relief or blessing in disguise (maybe it was and maybe it wasn't, but that's for the person themselves to decide, not for someone else to suggest).

    That's the kind of thing we should be thinking about.

    We are wise to start with not assuming what others are feeling and go from there. Even if we start with that one little thing (acknowledging that people feel various ways about things and we can't assume how they feel), that will tend to lead us to make more careful choices with words.

  12. On 2/11/2020 at 7:25 PM, Premed2hard said:

    Any premeds that aren't doing epically well considering the same? 

    I don't know but theoretically it's possible since nursing is an...interesting...body of knowledge and educational process. That is to say it has some quirks beyond just being able to process and regurgitate factual information.


    On 2/11/2020 at 7:25 PM, Premed2hard said:

    Well, it is evident now that I will not have the grades to be accepted to MD, DO, or PA school not that I was ever against nursing (my mom and sister are RN's) I always wanted more science, more why, more understanding or so I thought (Reality was humbling).


    My advice is to think long and hard and investigate every single possible option from where you sit right now.


  13. 14 hours ago, jeastridge said:

    “Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I’m contributing, but not so much that I’m letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered “mom-guilt” I already put on myself.


    She did not imply that. She said something about her own feelings as they related to her own life choices. It probably didn't need to be said--although it sure sounds like a response to the type of question that didn't need to be asked, either.


    15 hours ago, jeastridge said:

    During my discussion with the bedside nurse, she said, ‘You’ll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, ‘I don’t need to hear that right now. I need words of comfort.’ Honestly, I don’t know if she even registered what I said.”


    Not entirely helpful for a lot of people, true. It isn't particularly heartless though. Hard to identify with the concern since I wouldn't be looking for comfort from strangers for the most part.


    15 hours ago, jeastridge said:

    Sometimes simply being present, prompt and professional is our best response—no particular words needed.


    Best/safest choice. ^


  14. 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.

  15. 3 hours ago, Peditra said:

    Now if you do see any bad techniques, do you ever say anything about it? I've never done it, but I know I've thought it.

    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.


  16. Edited by JKL33

    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.

  17. Edited by JKL33



    Who may request a KASPER report?

    A practitioner or pharmacist, or employee of the practitioner’s or pharmacist’s practice acting under the specific direction of the practitioner or pharmacist, for medical or pharmaceutical treatment of a current or prospective patient; Kentucky Commonwealth’s attorneys and assistant Commonwealth’s attorney’s; Kentucky county attorneys and assistant county attorneys; a law enforcement officer with an active investigation; a licensure board for a licensee; Medicaid for a Medicaid member or provider; a grand jury by subpoena; a medical examiner engaged in a death investigation; and a judge, probation or parole officer administering a drug diversion or probation program.

    Top of Page


    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?

  18. 3 minutes ago, Cody1991 said:

    Our doctors select patients charts electronically which moves them into “treatment in progress” from "waiting to be seen/triage" after they meet them and sign onto their chart.

    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.

  19. 2 minutes ago, Cody1991 said:

    The 10-minute thing is sort of producing a toxic work environment.

    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).

  20. 8 minutes ago, Cody1991 said:

    Something like, "If a doctor has introduced themselves to the patient and their status moves to treatment in progress, it's fair game."

    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).


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