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Hello, TVCCRN No matter what the technology is today. It takes one patient to have a complication that may cost his or her life. Then the policies will change to prevent any type of mishap again. Therefore, caution is always on the side of the nurse and assumption is on the side of those who wants to rush the patient out.

Hello, Kmach http://www.microsoft.com/technet/itsolutions/cits/iwp/cda/hl7cda02.mspx scroll down the page and you will see a description of a SOAP. http://www.nso.com/newsletters/advisor/2004_fall/documentation.php SOOOAAP in the above link. http://www.marshall.edu/commdis/formsetc/soap-notes.doc I hope these links will help you. Buttons

Hello, Mathew It is funny you said "Maybe it is a "guy" thing, but I didn't know what area I wanted to work within so the PA model fit me." I have heard that phrase by PAs (some) who are males. Not sure the correct meaning. Is the correct meaning if the males perfer an occupation that allows for flexability and variety than one that does not provide those elements? Help me out here. I believe that times are changing for NPs to obtain more of a flexabiity and variety as well. The thing that bothers me most is the NPs must return to school to learn about another area to practice in and to recieve more initials behind their name. Oh, there are several physicians will accept you as you are package and train you into the position. I cannot wait till I locate them...just joking. Back in the past, FNPs were floating around and not enough jobs for them in that specific area. Now, the spaces are available due to the medical school students, residencies, interns are not allow to work over a certain amount of hours during the week. The doors are open for NPs and the surplus of FNPs from the past to apply. It was tough for the FNPs and now it is competive as well for a spot with the FNPs from the past, today and PAs. I know several NPs that work in pain clinics, ers, family practice, cardiac, psyche, holistic, cardiothoracic, public health, long term care facilities, assisted living, corporations, generalist (pennslyvania hospital on walnut), wills eye, and etc. So the field is opening up and giving better days, hours and hopefully better pay scale. I do not believe that NPs should be under the Board of nursing in their states. If medical hires you than you are under medical and given the appropriate benefits as PA. The BON should not have any say about your salary period and training as well....it is medical's problem. I cannot stand that at all. Therefore, as time comes and goes, the opporturnities will be there for NPs as well. Buttons

Hello, I would like to know what is important to you? I believe you have to go where your heart is as one person said in their post. There are numerous of reasons why people select a choice. I do not believe it is motivated by money 90% of the time at all. I believe people inquire about the finance of the careers to meet the bills and to have money for retirement. I believe you need to know what is going to work for you in the future a nurse or a pa. You have to know what can you give into the career and what you can receive from the career as well. I believe medicine is a career that will demand a lot work, devotion, time, compassion (depending on the job title), giving and respect. As my one friend told me, " I choose to be a CardiologynPhysician because this is my number one devotion in life. Everything is second in my life and third and etc. Whoever I am going to be in a relationship will have to understand my long hours and devotion. I will be making great money, however, take the hours I will be spending and the money I earn will be less than the money offer to me. I do not care if I die single as long I am doing my job as a cardiac physician." She is a very good cardiology physician and she is working at the hospital of her selection. Not everyone is like her and you may feel it is going over the top. Well, she has the characteristics and mental attitutide to be the best cardiologist. Therefore, she is working each day to become better than yesterday. You have to find what is best for you and your personality. You need to decide how you would like to see your future? and what you want out of your career? Do you want the family, house, and the dog "spot"? or Do you want to be a workoholic? or both? You need to be able to balance life, career, education and relationships no matter what you choose. It is all about you and no one else...unless you are marry than it is about the family and you. I have heard so many reasons why people chose nursing from I want to give back to someone for the care I received during my illness, I need to get out of a bad relationship and this will help my family and myself to stand on our feet, and from the money. Regardless of the reason/s, it is a career and it will remove you from a past of negative to the present of positive as long as you respect it. As long you can be devote to your choice and attend school without an unbalance in your life...go for it. Just make sure you do what is asked by the instructors, study every night and day, be prepare for classes and tests, give your best during clinicals, do not act like a know-it-all or a rebal and never quit ...then you will become whatever you choose as a career. By the way, a patient does not care what your grades were in the courses, they want to see the RN or the PA-C, MSN behind your name that is tailor onto your jacket. Patients want someone that care about them, illness, treatments and be respectful to them. Therefore, your choice is on you and how you want to proceed in life, no one else will walk into your shoes and it will be your learning experience in life. Have a great weekend and Go steelers.

To get the student to think and to research the literature/internet. It is a great assignment for her. She will do well with the assignment. Buttons

Hello, Well, global nursing a very important issue these days. I do not want to spoil or ruin your opporturnity of finding the answers. I can give you a huge hint ....look at the nursing shortage in the USA and what is being done to meet the demand. In addition, here is a link to one of my favorite search engine..... http://www.answers.com Have you search the internet and the library? Good Luck. Buttons

Hello, All Krissy, do not lower yourself to this woman. Obviously, she has a personality of an angry bull. She just is expressing herself and using projection mechanism on you. She is upset because the times have now change and she was not given the opportunities as they are given out today. Her gripe is with the nursing board. Use psychology on her. I would say please express your concerns and I understand you are feeling angry of the rules and changes in the nursing career. Tell us how would you resolve this issue? Do you feel threaten of the new changes in nursing? Is change hard for you to accept? How can I help you? or How can we help you through this difficult time? I would not belittle her in my responses to her or argue with her. I would put on my psyche sweat suit and hit the timer. I would not get swallow into her issues or concerns. I would address her with caution and speak clearly to her. In addition, I would take her negativity and use it as my energy to do well in my classes and think positive each day. Therefore, you know that you cannot feed into her negativity because it will hinder your goals as a student and to be a psyche np. Buttons

Hello, Everyone I would not place a female into a room with a male unless it was her husband or family member. I would tell the female of the policy prior of her in the room with a male. She would have the choice of acceptancing of the room assignment or rejecting the room assignment. Also, I would tell a male as well of the policy and etc. I have a problem with the cohabitate in a hospital. I believe there will be some negative reactions and incidences with this procedure. For example, a young male and female in the same room, the female ends up pregnant and the parents would want to sue. Hmm, Nah, cannot picture and I would not accepted the responsibility for any incident that may occur by placing a male and female in the same room. Nah, I would not take part in this procedure without CYA. I would have everyone sign paper/s giving consent, understanding the policy, Clear from any mind alterating medication, policy (sign off) and to report any incidents as soon as possilbe. No way I will be sitting a court room because a hospital policy by someone who thought about the ideal and greedy for money. Nah, no way. buttons

Hello, Rayrae & Everyone Rayrae, You did the correct steps. You always assess the situation prior to administrator a pain medication. I worked at a private facility for the mental, physical, and emotional handicapped individuals in the state of PA. Also, I am a bevhavior modification specialist and a crisis manager at the facility. I had learned how to communicate with the nonverbal individuals by learning sign language and the usage of a communication board as well. In addition, the parent, caretaker or an individual who works with the patient know the patient like the back of their hand. Always try to utilize those individuals in your assessment. I do not know if every hospital have communication boards and sign language interpreters for individuals who are hearing impair and nonverbal individuals. I am not sure if nurses know how to communicate with nonverbals and hearing impair individuals. The hospital should provide those items and give short sign languages classes to all medical personal. This would enhance the knowledge and working skills with the nonverbal. Therefore, the hospital would be able to prevent any miscommunication, misinterpreting and wrongful diagnosis/treatment to these individuals. It is not hard to show a nonverbal pain scale and allow them to point at a face that represent their pain. If you do not have one then draw one. It is not hard, to take your middle finger downward and the others upward, point to areas of the body and make a face of pain and watch the patient nod "yes" or make sound when you point at the part of the body. In addition, making a comunication board is very easy to produce. In conclusion, I feel that each nurse and medical peronnel should learn sign language because the value if priceless. Also, you will be able to speak with trach as well. The hospital should consider of having an interpreter on board for these patients. Therefore, the hospitals are not providing the services and deny them a way to communicate to others. Yes, I am a patient adovacator for all patients and especially for those types of patients. I have seen a lot of misdiagnosis by the medical personnel. For example, A patient came in confused and combative. Patient was in a lot of pain from broken ribs, face contusions, and stomach lacerations. They sedated the patient and intubated for a week. He went to surgery, treatment applied and care. He continue to way his hands around and the nurse thought the patient was psychotic and called the dr. The dr. gave an order of Haldol. Well, you know the patient was really out of it. The nurse was happy and the psyche eval will be given later. In addition, they tied the hands of the indivuals to the bed. The next day, I walked in the room and I was wondering wwhat was going on. I read the chart and asked the nurse. She told me I could have the patient because he was a behavioral patient by waving his hands. I went back in the room and released one hand and then the other. He was signing that his leg was hurting bad. I told the nurse he is deaf and his hands waving was his signing. She was OMG and called the DR. He came up and they asked me how did i know? I told I know sign language. Therefore, was the patient mistreated?, Was the medical personnel neglectful? How would you had handle the situation? Would you learn sign and the use of the communication board? The outcome the patient was treated appropriate and the hospital made a quiet deal alleged by the lawyer who represented the patient. We all assume that we will have walkies and talkies all and nothing else. Well, it is not true, hearing impairs and handicapped individuals are not coming to health care facilities. Buttons

Hello, Thank you for the clarification of their roles. I figure the medical assistants are coast effective compare to a LPN and RN. It is strange the tilte of nurse for medical assistants. Thank You, Buttons

Hello, All I am not sure it this a joke or not.:chuckle We were speaking to a medical assistant from Texas and they are called "Nurses". In addition, they give shots, pass out medications and do vitals. Therefore, medical assistants are called "nurses" in Texas. I never heard medical assistants called "nurses". I thought they could work in the office, do vitals and place the patients in the room. I never knew medical assistants could replace nurses. Would someone please clarified with me about this controverisal issues? Thank you, Buttons

Hello, All I would like to know what does a CNS do in the acute and non- acute settings? Are CNS independant like a NP and PA? Are CNS a brdige between the NPs and PAs? What are their responsibilities? Will CNS take jobs from the NPs and PAs? What is the CNS education level? Most important of all, can they work independant to a physician and a NP? Thank you, for your assistance and helping me to understand their job role and functions as a CNS. Buttons:)

Hello, all If the ultrasound shows a dvt in the leg. It depends on the philosophy of the physician and if he decides to place you on herparin IV or not. One physician may say we do not treat the small dvts in the legs and another might say he will treat it. If you are taking birth controls discontinue them as soon as possible and inform your physician you were on them. That is a very important piece of the puzzle. Do not be scare at all the ultrasound is wil show your arteries in a red color and veins in blue color. You can actually watch the test. Sometimes they will explain things to you and if they do not ask them too. Depending what they find and the physician you may be on heparin and wean off to coumadin. Then a blood test is require for the PTT level while you on heparin...remember the test is PTT is for heparin and they will want you at a specific level. They will determine when to wean you off heparin and give you coumadin for a certain time. You will have to go to the lab for a pt to check your level and your INR. There is a range the doctor would like for you to be in...the PT is four coumadin and it is how many seconds your blood clot and the INR level will keep you above the 2.0 level for theraupetic range to keep your blood thin. You do not want to to be below 2.0 because that is normal. You want to to be thin to prevent any clots to form. Now do not jump the gun till you have all the facts first and ask questions about the dvt, the location, how come no chest xrays? and etc. Remember you cannot have a large amount of Vitamin k because it is the antidotic to coumadin. Therefore, if you have salad be consist and not too much dark green and leafy veggies. This is premature till you receive the ultra sound and the doctor tells you the findings. Just take one step at a time and do now worry about work. Work will survive believe me. So relax and go to your ultrasound. Emm, Thecommuter your physician si not true about the age thing. I received my first dvt at the age of 27. Therefore, you need a physician that will listen to you and take actions. You might want to think about it and want to be heard. Have a great day, Buttons

Hello, Yes, 99 is the cleanest patient and she loved her bed bath. The water was change several of times and I had two basins (one for bathing and one for rinse). Nurs should be able to take credit for her foleys and 99 did you tell her the wrong procedure? Have a great day and evening, Buttons

Hello, As we know the expense for the equipment for patients are little to none. Well, as we went through school we were taught if a piece of equipment falls on the floor or becomes dirty, throw it away and get another one. Do you wonder who will be charge for careless mistakes of equipment? Well, a nursing student used five foleys for the procedure of placing a foley. Now, would you think the student should had study or practice on the manaquin a little more? Do you remember if you had any mishaps in nursing school you would love to share with everyone? I went through fifty disposal wash cloths cause the person was not clean and I was afraid of receiving a failing mark for bed bath. Ok, please contribute to the post of the mishaps in nurisng school. Thank you, Buttons