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JKL33

Posts by JKL33

  1. I can understand why you want to try to make up the difference, but suspect they will quickly decide to post the position if you don't give them a reasonable wage suggestion. You need to find out what other office/clinic nurses in your area are making and use that as your guide.

  2. In my area you would be extremely lucky to simply just not have your base pay (hourly rate) go down when making this kind of move. I hope I'm wrong but in my area the "good deal" would consist of sacrificing the differentials, the holiday and charge pay, etc., in order to gain the benefit of the clinic work-week and the office-level intensity/acuity...and hoping against hope that you don't also take a huge hit in the hourly wage department. Offices/clinics around here do not compete well with hospital base wages.

    That's the trade-off I'm familiar with: Lose pay differentials, gain a desirable work-week in an office setting...and usually people are sacrificing their hourly rate somewhat for this kind of change, too.

  3. Does getting sick refer to active v/d, etc.? How did you make it home?

    This seems like an awfully harsh reaction on their part. I'm sorry for asking but is there more to the story? Are they suggesting this was contrived or what? I've never seen or known of a coworker being treated this way over being actively physically ill at work, even if they have given reports that are very brief or not up to usual expectations.

  4. 13 hours ago, TeeRN said:

    At this time, we are being told we are not admitting any respiratory patients as well as non urgent OR cases (including asthma and PNM).

     

    12 hours ago, Rose_Queen said:

    How exactly is your hospital getting away with not admitting respiratory patients? Couldn't that potentially be an EMTALA violation if these folks are coming in through the ER?

    I don't think the OP's facility has explained the details of their statement that they aren't admitting any respiratory patients; it does not mean that unstable patients can be just turned away, so-to-speak. Facilities are allowed to screen patients elsewhere at this time. If "respiratory patients" are not being admitted at a particular facility that would be possible if the patients did not strictly require admission and/or if their admission were being coordinated elsewhere under a facility's disaster response plan.

    A declaration of national emergency has been made and an 1135 Waiver has been issued.

    https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx

     

  5. I would begin by filling out a second incident report related to the alteration of your documentation. When you do that I'd contact your supervisor to discuss the matter. "I'm filling out a second incident report and I'm pretty disturbed that my entry has been altered. That is not okay."

    I'll refrain from an opinion about reporting for now; ideally if there is a concern about controlled substance discrepancy this is investigated by the employer and appropriate actions taken. If your goal is to protect yourself, I'm not sure that reporting her through outside channels protects you any more than reporting through your internal processes (neither of which protect you very much in this kind of situation).

    Hope it gets sorted out.

  6. 4 hours ago, daniela095 said:

    Should I settle for a night position and hope to switch to day shift ASAP?

    This is just straightforward, not snark:

    No you should not do that. If you want to take such a position, you should accept it fully believing, understanding, and accepting  that the night shift stuff is going to be indefinite. You will compromise your own happiness in knowing the facts but "settling" and then banking on a fast switch, KWIM? 🙂

     

  7. It's great that you are thinking through this.

    3 hours ago, fourO said:

    I do not like the mentality of being subservient and being silent as a response to aggression from residents because I'm there to help their asses, not kiss them. But then what good does arguing do?

    The crux of everything is right ^ here.

    There are many ways to look at the matter; many people choose the first part of your sentence (there to help not kiss) and some people resign themselves to the latter part of your sentence (what good does arguing do).

    There is an in-between, plus many nuances.

    A train of thought that has been helpful for me is not to think of it either of the two aforementioned ways. I try not to "reply in kind" (act like someone else is acting) when I don't care for the way they are acting. Why would I want to act just like they are when I know I don't like their way?

    I prefer to think of being a rational, calming force, rather than thinking of myself as "tolerating disrespect." Taking the high road rather than ever fanning flames. Some of these things are indeed how one chooses to look at it.

    One way or another, give some thought to what is more likely to preserve wholeness and keep you feeling that you have done right/good. We can't control what others do/say, but we can listen carefully and then respond in a way that doesn't leave us feeling bad about both what they did and what we did in return. 👍🏽

     

  8. 21 hours ago, okurilen said:

    My true concern is that I will not have as many opportunities for growth during night shifts. Yes, there are things that you are doing at night time, but it is nothing compared to what day shifts are like.

    You will have p.l.e.n.t.y.  of opportunities for learning and personal/professional growth on the night shift.

    I'm not going to get into the classic "battle of the shifts;" suffice it to say there are plenty of things to learn on all shifts and they all have their own perks and challenges.

    Part of your experience has to do with what you choose to make of it.

  9. 1 hour ago, namaste111 said:

    I got a call half way to the interview and I got a call saying that they had to cancel the interview because of the coronavirus. They said they still want to interview me and the position will remain open. Ugh! 

    Some places are going to video interviewing as resources allow, for positions they need to fill. Will hope something like this might become an option for you/them in the near future.

  10. On 3/13/2020 at 1:21 PM, YouCanCallMeFrank said:

    However, any students who've recently traveled internationally or any students who've experienced any recent illness or who are currently ill, are not allowed to attend clinical until cleared to do so by the department chair following clearance in writing from their PCP.  

    That is a very irresponsible way for them to go about this.

    If the SoN can't follow public health guidelines they shouldn't be trusted to run a program. Anyone who has a concern should be advised to follow the damn guidelines. Call the hotlines states are setting up for risk evaluation and guidance PRN. Start using logic and available tools instead of scrambling to pass the buck.

    It isn't even fair to ask a licensed professional  to "clear" someone in these scenarios, but it's also illogical -- are they supposed to somehow be able to verify that someone has observed a recommended self-quarantine, for example? 

    Lastly and most importantly, requirement of these useless notes is a very irresponsible stressor on the healthcare system.

  11. Edited by JKL33

    When numerous people decide they need something during the same time frame, this is what's going to happen hysteria or not.

    Empty shelves where the hand sanitizer, antibacterial wipes and facial tissues are stocked are also seen in my area during the week or two leading up to back-to-school. Every year. And don't try to do in-person shopping in the days leading up to the start of the new school year or you'll have to buy the super-expensive brand pencils and paper that no one else wanted, if you can get those--and if you can put up with the crowds.

    Actual hysteria and accusations of hysteria are both unhelpful in the end. It just makes everyone way too worried about everyone else's actions and motivations.

    I say this with due respect towards all who have replied.

  12.  Susie2310, the main reason I ever engage you is out of curiosity and some desire that you would participate in good faith to possibly consider of other points of view.

    I made a second, even more careful attempt to review your original post. [I see you are now bowing out, but here it is anyway]:

     

    Quote

    I don't think the best way to begin a relationship that for the patient is based on trust between them and the physician, is to vet the patient/prospective patient for possible signs/characteristics that they may be a risk to the physician's financial or professional livelihood. 

    On 3/12/2020 at 12:43 PM, Susie2310 said:
    Quote

    I said that in my OPINION the practice of vetting patients in this way ( the way the OP described) is not ethical; I did not comment on the practice's right to do this or on the legalities of doing this

    1. In the first quote, you specify that, for the patient, the relationship is based on trust between them and the physician. In your opinion, does bi-directional trust come into play here, or is it only about whether the patient can trust the physician?

    2. In the first quote, you state [the practice] isn't the best way [for the physician/provider] to begin a relationship based on [trust--from the patient's perspective]. In the second quote you add that you believe it is unethical. In your opinion, are there any ethical means by which a provider may attempt to ascertain the likelihood that a given prospective patient will engage in the relationship in good faith?

    3. In the first quote, you state [the practice] isn't the best way to begin [a relationship based on trust]. What is the best way?

     

    Quote

    Employing methodology to assist the physician in determining whether the patient will be a "good patient who will not be a financial/professional risk to the physician's practice regardless of the patient's particular situation, individual circumstances, or personal experiences," with the intention of gleaning psychological information about the patient, is not ethical in my opinion.  

    4. I feel that "intention of gaining psychological information" is an inappropriately broad (and thus disingenuous) way to characterize the action.

     

    Quote

    As far as a patient suing a physician, for malpractice claims in my state there is a specific, very short time window of not more than a few years if I recall correctly in which a claim can be brought.  Considering that it may not even be possible to determine the full extent of a patient's injuries within that time, and considering that patients that are harmed, including their family members, may be expending all their resources - emotional, and financial - on trying to assist the patient to recover, and have no time, energy, or money to spend on initiating a lawsuit, the legal system in regard to bringing suit against a physician favors the physician not the patient.

    5. I'm not clear how you are you linking [the practice described in the OP] with your assertion that "the legal system with regard to bringing a suit against a physician favors the physician not the patient"? Does the ease or difficulty of bringing a malpractice lawsuit have something to do with whether or not the OP-described practice is ethical or not? Or were those two portions of your original comments unrelated?

     

    Quote

    With electronic health records today, large amounts of patient data exist, and there is the ever present potential for patient data to be used in ways the patient never consented to nor would choose to consent to.

    6. This is a concern, I agree. I guess I just put it into a different context for myself personally: There are health data-collection related issues that concern me infinitely more than the thought of an individual small-time physician/provider who basically just wants to try to guess whether or not s/he and I will be able to get along and have a productive physician-patient relationship (which is what I think most of such screening is really about).

     

  13. 1 hour ago, Susie2310 said:

    Again, I haven't advocated that people (patients and family members) should be able to operate without concerning themselves with the consequences of their actions.  

    You can't just put "patients and family members" in parentheses like that, though. People are the general public who are the prospective patients of a particular provider. Patients are, well, already patients (of a particular provider).

    Patients (those to whom a legal duty is already owed) and their family members are not what this topic is about. It is about whether individual people who have no legal duty to one another should both be able to evaluate whether they want to enter into a legal relationship.

    I am not trying to misunderstand your position. To the best of my reading/understanding, you are advocating that if one of these individual people is a healthcare provider, that person (provider) either does not or should not have the right to evaluate the prospective situation in order to help them decide whether they want to enter into a legal relationship.

    If that ^ is what you believe, then you de facto believe that certain people (prospective patients) who appear to engage in illegal, abusive or very disruptive health-care related activities and behaviors should not be subject to this particular natural consequence of their actions [where the natural consequence is that an individual may not wish to enter into a legal relationship with them some time in the future]. 

    I agree with you that where such legal (patient-provider) relationships are already established it is both right and fair to have regulations about how the relationship may be terminated (by the provider). But again, right now we are talking about whether providers should have any rights regarding the decision to enter into said legal relationships in the first place.

  14. Edited by JKL33

    44 minutes ago, NICU Guy said:

    I think that their intention is several years after you are working there. The company decides changes policies that you need to work XX hours/wk for benefits, percentage the company matches your 401K, switches medical insurance companies. They don't want you coming to them and say "It says in my letter when I was hired that the company will match 4% of my 401K and now they changed it to 3%. You can't do that, I have it in writing". 

    Which is a perfectly reasonable thing for a person to say when someone effectively reneges on their portion of an agreement. 

  15. On 3/11/2020 at 5:21 PM, capybara123 said:

    Should I tell my manager that I did follow the wound care nurse and apologize for not telling her in the case that she does find out ? 

    Yes.

    If manager knowledge and approval were considered necessary at your place (whether for reasons of practicality or collegiality) I would think the professional practice team would see to it that manager involvement was a part of the process of approving such experiences.

    Irrelevant, though; now Ms. Educator is the problem. Classic pot-stirrer. She doesn't have anything to do with this situation, but she has made it clear that she wants to be in the middle of it anyway.

    So yes, ask for a few minutes of your manager's time and say that you aren't going anywhere any time soon, you love your job, etc., but you have an interest in wound care and took some steps to learn more about it. Because you aren't planning any immediate changes it didn't occur to you do extra notifications or seek additional permissions, but that you regret and are sorry if having gone about it that way was not the proper collegial thing to do. Etc.

    This seems like kind of small potatoes; hopefully you can smooth it over without too much difficulty.

  16. 23 hours ago, Susie2310 said:

    I don't think the best way to begin a relationship that for the patient is based on trust between them and the physician, is to vet the patient/prospective patient for possible signs/characteristics that they may be a risk to the physician's financial or professional livelihood.

     

    Most of us (nurses) are employees so our actions of personal discretion take a different form than what might be expected from an independent/self-employed physician (my comment uses them as the example because none of the employee physicians I know are allowed to routinely screen out potential patients anyway). We--health care workers employed by others--instead attempt to uncover red flags by vetting employers, scrutinizing job descriptions, observing the behavior/manner of hiring mangers, judging the working conditions and evaluating the pros/cons of the offer in order to make a decision about the kind of work we do or don't accept, as opposed to attempting to evaluate the pros/cons of entering into individual legal relationships with a particular patient.

    And yet at the end of the day the underlying motivation is quite the same: If possible, people generally prefer to support ourselves/put food on our tables in ways that are less likely to unnecessarily increase our professional, financial and emotional stress beyond the usual levels of risks and stressors. We also don't willingly prefer to sign up for work we don't reasonably believe we can do (regardless of the reason we don't believe we can do it).

    Nearly all people in general tend to attempt to control whatever additional risk and stress they can, with their own and their families' best interests shamelessly in mind, when it comes to providing for their existence. This is most certainly not behavior limited to (some) physicians.

     

    15 hours ago, Susie2310 said:

    The majority of patients are reasonable in their expectations of health care providers and behave reasonably given the frequent stressors that are experienced in the process of receiving care.  

     

    Agree in general. That's a good deal of the reason why the majority of people don't have to worry about this issue to whatever extent it exists.

     

    2 hours ago, Susie2310 said:

     I understand many of us would like to have a world where actions have no consequences.

     

    No. That is not true. But with regard to the topic at hand, your position is the one advocating that people should be able to operate without needing to concern themselves with the natural consequences of their actions.

  17. Edited by JKL33

    1 hour ago, Kooky Korky said:

    I don't think you should be quite this militant.

    I understand what you're saying and accept your opinion. I would soften up the edges a little.

     

    On 3/9/2020 at 9:30 AM, JKL33 said:

    "I was informed you had some concerns about my care of my patient yesterday which you shared with others. What are your concerns?"

    I will amend this to the following: "I was informed that yesterday you were sharing some concerns about my care of my patient. If that is true, I'm asking that you would also share them with me."

    Use non-threatening non-verbals/para-verbals.

    I just find tip-toeing very problematic in and of itself. It causes nearly as much trouble as outright rudeness does, it only seems better because the kind of trouble it causes is insidious.

    Straightforward is not synonymous with curt and not the opposite of kind. I mostly wrote the way I did because the OP sounded to me like someone who needs to resist being tossed this way and that by the very same wind currents responsible for the swirling gossip.

  18. Edited by JKL33

    20 hours ago, Smsanch2 said:

    We haven’t talked to each other since a few weeks ago when she told me she was panicked and would rather stay in and avoid being “in public places”. I told her afterwards that she shouldn’t live in fear or be panicked and to continue protecting herself/family normally by washing hands thoroughly etc. and that she shouldn’t be limited to living like a Hermit by this. I think that triggered her.  We haven’t talked since. 

     

    I don't think any of us should be taking either extreme with regard to the present/looming issues and I think we should be very conscientious in how we speak to others about it, especially lay people/general public.

    The people who say we're all gonna die and the people who essentially claim it's nothing are wrong. 

    Believing that you have "triggered" someone is an attitude that probably has something to do with this, as "triggered" itself is becoming a loaded word when leveled at others.

    She neither wants nor needs your disapproval. Period. If you don't like that, then concern yourself with how you speak to people.

    From a realistic perspective yes, everyone should wash their hands and observe improved hygiene procedures to help limit (not eliminate) risk. But telling people, "Pff, yeah, don't be crazy just wash your hands" isn't the whole story. And any thinking person knows it isn't, so then you're just insulting them and pretty much mocking their concerns--in the very midst of official uncertainty, I might add.

    [I think this is a big deal whether we're talking about COVID 19 or immunizations or lot of other things where fear is in the mix, especially when there is a shred of rational thought to the fear. We never do anyone favors by 1:1 counseling or advice that leaves room for lay people to know they are being mocked and disregarded. If you do that, it's over.]

    JM $0.99

     

  19. Does she know that you don't wish to apply for a job in that unit? If so then this is simply a very low-priority issue for her. In a perfect world it would still be medium/high priority r/t the idea of trying to keep talent in the system, but putting it into perspective alongside the innumerable other demands upon managers...just like with endless tasks that are assigned to staff nurses, at some point something gets pushed down the list of priorities. Sometimes the items that get pushed down are things we ourselves feel shouldn't be low priority but there is a limit to what we can do (and an even bigger limit to what we can do well.)

    Kind of harsh reality: It's also possible that they simply aren't concerned about you looking elsewhere, and for one of a dozen possible reasons are not motivated to try to keep you in the system.

    Not a lot of explanation is needed at this point, you kind of have your answer. Start putting out apps pronto.

    Best of  luck ~

  20. Edited by JKL33

    4 hours ago, OneRN50 said:

    The doctor normally would send remainder of pills and had asked that morning what he had left I told her and she never called back to say she wanted less sent and did not bring us the chart....I felt like I did everything I could to resolve the situation.    The PO did find him and he did bring back the extra

    I take full accountability for my actions...I feel so guilty like if I dont tell on myself I'm not being honest

    This is an opportunity also to advocate that your facility's procedure be cleaned up a little bit. A patient should not be leaving with remainders of prescribed controlled substances when there is no (confirmed/verified) order for them to do so. You should see the order and follow an established procedure which takes into account your state's regulations related to dispensing medications. If you don't have an established policy/procedure related to this, you should. Then make sure you check the order and treat it like any other occasion of administering medication (5Rs, etc.).

    You don't need to be wracked with guilt. That's why @JadedCPN wrote the answer that way; s/he isn't mocking you at all. You learned something here and so just move on. But do so remembering to uphold the spirit of the rules you know, and apply them appropriately as situations arise. Next time don't panic and make a situation worse by trying to handle it your own way. 👍🏽

    PS- maybe this incident will also sharpen your eye for things/procedures in which what you're doing ("the way we do it here") is not really the way it should be done and bases aren't being covered.

    All is well ~

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