Kabin

Avoid Cerner. The company will initially lift your hopes and then disappoint daily thereafter. Lots of server crashes, miserably slow operating software, inability to resolve problems, and slow to develop new programs.

I'm not involved with admissions so take this with a grain of salt. Admit process needs to begin before the service starts. Whenever possible initial contact is made in the hospital, rehab center, etc. The trick is to not be in such a hurry that you...

Maybe it's the VA's Alternative Dispute Resolution? Not much you can do if the pt isn't hospice appropriate per FAST, PPS..

Hospice is getting more and more challenging these day. There's more layoffs, more employee turn over, and likely more cost-driven Medicare changes. I long for the good old days when Medicare was more worried about patient goals.

For those already holding CHPN status, there's another option. Complete ~24 continuing education credits per year plus extra requirements like presentations, community education. It might be less stressful than studying and taking the test.

And I should add several years back the law changed. You no longer can default on student loans. The banks legally can and will garnish wages for the rest of your life. Choose wisely.

The student loan rule of thumb is the total student loan amount should be less than one year's anticipated salary. Owing 3.5years is nuts! Don't forget you have to pay taxes and social security on income and the loan amount grows due to interest. Th...

It all depends on the reason for discharge. In general, the hospice team assesses and charts a pt's appropriateness for hospice. Different scales like PPS, MMSE, and FAST are used to measure decline. The pt's weight, intake and ability to swallow may...

The two non-profit health systems will merge by July 31. Reportedly, it will help them be more competitive. Hopefully it works out better than another large hospital chain entering the picture. Probably a few job losses from overlapping job positions...

Of course call depends heavily on how big your company is. Obviously, the main issue is smaller companies needing to cover 24/7 with minimal staff. But even then, there's not much savings with larger companies either as they look at efficiencies by s...

I have a rolling bag. Should I roll/carry the bag in and set it on a liner? Or is that only intended for carry in bags?

Plus, while you were away there's been big healthcare changes. Medicare has been reducing reimbursements. Hospitals have been losing patients, money, and downsizing staff.

We almost always let patients have treatments and office visits for non-terminal diagnosis related items. We don't d/c for ER visits or those rare hospital/clinic peritoneal taps for instance. It's a must to d/c upon hospital admission though. It's d...

Jargon for a GIP in patient care setting. Darn, there's no way to edit anything on this site. I agree. I think it doesn't quite warrant reimbursement for the next level of care.

How would you handle this c-diff case? A patient resides at an assisted living facility that's worried about other residents becoming infected from c-diff. The assisted living facility asks for a PCU transfer. Let's assume the patient didn't get c-...

For sure. Depending on the admission nurse, sometimes our company admits PPS 70 dementia patients. It never makes sense to me.

For those that have group homes in your territories. Do they provide an increased number of dementia and, in the past, debility terminal diagnoses? We're seeing caseloads with these diagnoses 3x the national average and they seem to be mainly from g...

Good point. Group home have different meanings. Group homes could be rehabilitation, mental health, etc. I was thinking more along the lines of smaller, mom and pop owned. converted home, assisted living residences.

Yes, for me those last few minutes can be crazy depending on the city fire and police dept personnel and policy. If the family calls 911, one city near me scrambles both the FD and police. Depending on the police officer there, sometimes there create...

Does your company consider the first 2 certification periods (6 months) to be a freebie? In other words, do patients stay on service for the full 6 months even when the team questions the pt's appropriateness?

True enough, but new projects become low priority when the budget hits the fan.

I've seen asystole as a terminal diagnosis and the patient was alive and on service. :)

That's good to hear. I'm in full agreement.

It might be good to keep your clinical experience fresh. In the not too distant future the electronic medical record boom will slow and there could be a bunch of excess NI folks playing musical chairs.

I've heard the AZ Board of Nursing is more harsh and less forgiving than the AZ Medical Board. It would be interesting to know how our board compares to other states.