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katkonk BSN, RN

Occupational health, Corrections, PACU

Have been exclusively in Occ Health for the past five years, and at this point I don't forsee going back to any type of nursing other than Occ Health. Never say never...but..

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katkonk has 25 years experience as a BSN, RN and specializes in Occupational health, Corrections, PACU.

Love Occupational Health.  It is the only field of nursing where I didn't feel like I was just passing through.  I know I've saved a few lives along the way in Occ Health, and that always feels good.  Not like in acute care, where all that matters is "right now", but knowing that you are helping people both in the moment, the immediate future and for the rest of their lives.  Teach, teach and teach some more.

katkonk's Latest Activity

  1. katkonk

    Ethical Dilemma with Vaccine PPE?

    I worked on a huge government project in 2002, and at the end of it, the contractor I worked for did not want to ship all the left over items back to their corporate office to have to deal with (and did not want the expense of shipping from all the nationwide sites) and I was told, as manager of the medical site, to donate all the supplies to any FEDERAL entity that needed them. I could give them to the VA, to any Federal office or clinic, etc. But it had to be FEDERAL, not state or county. But, they explicitly told me that, and I would not do anything like that unless I had those specific instructions from someone in authority. And I would want it in email form for proof.
  2. katkonk

    Ethical Dilemma with Vaccine PPE?

    I absolutely agree that the GAO is likely the best place to start.
  3. I'll point out that there are really two primary types of environment in which to practice Occ Health Nursing. One is in industry, and it seems like you have already explored that. The other is in the hospital setting, in Employee Health. Those two environments have completely different foci. In the industrial setting, the type of work you will do will also depend on what type of industry you are in. You can be working in high tech, in heavy industry with large equipment or heavy product (think locomotives or large steel tubing for oil production), or corporate type of Occ Health Nursing, where your focus will be on treating/triaging primary care type complaints, facilitating lactation room use and scheduling the times employees can use it, and a LOT of health and wellness. They typically have you do emergency response, and typically there is not much of that, but it can be very important when it does. I am fortunate enough to have worked for 20 years in this specialty, and have worked in all the types of environemnts listed above. If you are lucky enough to get a good fit and love what you do in one type of company, and especially if it is with a premier company with very good benefits, then stick with it. If you are curious about the different types of practice, then certainly explore a bit. I chose variety, partly to facilitate time off for my personal life and some of the changes just happened (one company was merged and dissolved, for instance). Usually in industry MUCH of what you will do and decisions you will make about clinical care and what you try to provide onsite or whether you decide to send them for an evaluation, will have the element of OSHA recordability incorporated into your decision making. You need to know OSHA rules by memory and learn how much you can do to keep the treatment for injuries on site and what you can and cannot use that will affect the OSHA recordability. Some will say that this should not affect decision making, and but it does (to a certain degree). You must be a patient advocate, but at the same time, there can be HEAVY pressure by the company managers, directors and VP's to minimize outside treatment. And sometimes you have to draw the line and defend your decisions and advocate for the patient. This is where being confident in your assessment skills becomes very, very important. Know that this can also get you fired. (I had one company ask me if I would talk to the surgeon that had to repair a fracture, and was doing the surgery on a Friday morning, and ask the surgeon to release the employee to return to work for half the day on Friday (then he would be off for the weekend). They said they would allow the employee to just sit in the office at work after surgery. I said no, that the employee needed to go home and keep his leg ELEVATED to minimize swelling, and that he needed to go sleep off the anesthesia and rest to promote his recovery. That decision was not well received by the Director worked for, and he let me know it in no uncertain terms. I have been told point-blank that if we (my nurses and I) did not "play ball" with the company's wishes as far as "keeping things OSHA non-recordable, or avoiding lost time", that they would find someone who would. (And mind you, I am very, very good at playing that OSHA "dance", as I like to call it.) There is that very dark side to Occupational Health Nursing that OHN nurses don't like to talk about, and that is that companies often cheat (some cheat BIG and some simply bend the rules a bit) on OSHA rules and regulations. This is a great source of stress in many environments in certain industries, because as an OHN, you are party to their actions. You must figure out how to give prudent care, and advocate for BOTH your patient AND the company. I say both, because there is a world also full of malingerers out there, who want to abuse the worker's compensation system and get every dime and every hour of paid time off they can from a company when they have an injury. Or ALLEGE they have an injury. I have pursued surveillance for worker's compensation injuries which I felt were not legitimate, where undercover people follow employees around and video their activities at home or when they go somewhere in the car, etc. to collect proof that they are faking a disability. And most of the times I have been right. The others were inconclusive, because we never got anything on film. (For instance one employee said that his arm was causing so much pain that he had to wear a sling and couldn't even hold a paperweight -and therefore had to be off work and paid by worker's compensation- yet we had video of him loading bags of concrete into the back of his truck and then putting on his sling to attend a meeting with a work manager directly afterward.) So, while treating injuries and seeing employees for personal health problems may take up some of your time, the essence of your job is going to revolve around activities that are regulatory in nature. Regulatory, Regulatory, and more Regulatory is going to be your job. In chemical/oil/gas/some manufacturing, etc. it is going to center around hearing conservation programs and OSHA regs for hearing loss and testing, NIOSH regs regarding respirators, what kind, PFT's and fit testing, knowing your different filters and requirements, etc. So, just be prepared, there are volumes of information you will need to assimilate, if you choose the industry environ. If you like it, you will probably want to do nothing else but that for your entire career. If you don't like the rules and regs, then it might not be for you. Good luck in your path that you decide to go on.
  4. Did she begin to use laxatives after her jaw procedure, perhaps to counteract constipation due to opioid pain medications? Is there a history of long term use/abuse of laxatives at any time? Has a Fecal microbiota transplantation (FMT) treatment been attempted as part of her care? Has a sensitive gut diet been tried to see if symptoms are reduced, minimized, or eliminated? Has she had a psychiatric assessment?
  5. katkonk

    Occ Health Director

    I'm curious. Did you end up getting that job, and if so, what salary did you agree to?
  6. katkonk

    PACU Traveler?

    I worked for about 2.5 years doing PACU local agency stuff and one travel gig that I had planned to be 4 months, and it turned into 10 months. It depends on where you are, as to how busy you can stay via agency if you are doing local assignments. There were busy times and slower times, the main problem being last minute cancellations. One agency I worked for canceled me at the last minute all the time, after I had turned down work with other agencies. Grrrrrrr. So, I quit working for them. Traveling was a great experience over all. I went to Florida to travel, and the first hospital I had the pleasure of working in was fantastic. I was shocked that such a small city had such a top-notch anesthesia staff. They were as good as any at the 5 star hospitals where I live. Some of the best docs I have ever worked with. After they didn't need me any more (Florida "season" was over) after 7.5 months, I took a 3 month contract just down the road in another small city about 20 minutes away, so I was able to stay in the apartment I had rented for the first job. The second hospital I worked in was one of the worst hospital experiences that I have ever had. Their staffing was nuts, one of the surgeons there had serious RAGE problems, and I guess he brought them a lot of money, because they put up with it. He didn't care who you were...staff, director, nurse manager....he raged at everyone. Terrible. But it was a job, and I had a contract, so I fulfilled it. The other docs were okay, but the staffing was abysmal. You don't ever have to worry about being floated to other floors. Just be flexible. Be ready to stay over for add-on surgeries (we ALWAYS had lots of add-ons at the first hospital), and go home early if they had a slow day. But typically you got all your hours. I picked up a lot of call and overtime while I was there. When you get a PACU contract, I feel certain you can count on only working PACU or Pre-op. I didn't do Pre-op at all, only PACU. I hope this helps. Oh, and I contracted directly with the first hospital in Florida that I went to, no agency. Just a contract rate. I made a bit more money, but I had health insurance via COBRA that I paid, and so I didn't need that benefit. It was worth it to me. If you need the insurance benefit, then agency might be better. There is a huge amount of opportunity out there. If you have a certain specialty that you want experience in, you should choose your hospitals accordingly.
  7. katkonk

    ABOHN CSAT now $50 and two volumes?

    I would have to agree with you. Put the fifty dollars toward a good review course! I cannot even fathom paying that much for, as you said, a pdf. nope, nope, nope.
  8. katkonk

    ABOHN CSAT now $50 and two volumes?

    You say that you took a review course and it didn't help. I am a long time COHN-S, so my questions are just out of curiosity. Which review course did you take? If you have been working and have your CAOHC and NIOSH certifications and have experience with Respirator Fit testing, that will help immensely. I did not have those courses and only limited exposure to the knowledge base involved with those when I took the test. But I went to two review courses, and by far the best was the one given by Bonnie Roger's group out of North Carolina. If you are nervous about passing at all, I highly recommend the North Carolina group that is affiliated with Dr. Rogers. Good luck on the test!
  9. katkonk

    Random Drug Screens

    I just saw your post, as I haven't been on here for a long while. I completely disagree with Rbeck911. If you follow a strict chain of custody procedure with a COC form, with the urine sealed in the bag and the Lab COC copy in the proper place in the bag, and the seals over the top of the urine specimen container when you sealed the specimen with the employee's initials, then you are good. The employee is ALWAYS separated from the specimen once it is sealed! That is procedure. You do not have to send to an outside provider, who will then only send it out to a lab for confirmation. If you use an instant test, it is easiest to have the type that the urine remains in the same container, it offers a good seal against leaks, you seal/initial with the employee, put it in the bag, and send the whole thing off. If the seals across the top of the container are broken, the lab will not process it. The employee would have no case, as the protocol is foolproof if followed exactly. Only if there is an error in documentation or sealing would it be disputable. If you have an instant test, you can also always pour into a split specimen Labcorp or other lab tubes, and do the same seal, initial, etc. and send out as a split. I see no advantage at all to sending to an occ health provider that will only charge you more. And yes, the urine will keep overnight with no problems. I've done drug testing for quite a few years.
  10. katkonk

    Come on OHN's!!!

    I think you have to do whatever keeps the light burning in you. I love Occ Health nursing, but I have enjoyed meandering a bit during my nursing career the last few years. I always come back to Occ Health. It is my home and my comfort zone, and I (mostly) love it. I did Correctional work for a couple of years, and that was new, a change of pace, and definitely enlightening. I sharpened some skills that had been a bit rusty. Do you travel? If you do, how about Occ Health in a different setting, different place? And.....NOPE, wouldn't have done the deal they offered you either. I think I may be faced with that at the end of my current contract gig. Another year to go, and I'll deal with the decision then. Just trying to make the overtime now. Good luck with whatever you decide to do.
  11. katkonk

    Got a job offer as a Safety Technician at a cannery

    If you want to work lots of hours over the summer and make overtime to build up funds for school, that is great. Is 32 hours a week while in school too much?...I would say yes, most likely. When I was working on my Bachelor's degree, I worked 30 hours a week over half of the nursing school program. But I was very committed to making the best grades, and as nursing school went on, I found that was too much. I ended up splitting up one semester of school, and graduating one semester later. A good move on my part because I was exhausted. Every semester demands more and more study time and time for papers and projects and clinical hours. The safety technician job will give you an excellent background if you want to someday be an occupational health nurse. If they won't work with you during the semester on limiting the number of hours, you always have the option of quitting. Personally, I went to classes year round, taking some things in summer school to lighten the load during the regular semester. I also found out what books I would be needing during the next semester's classes and began reading them on the breaks between semesters, just to get a jump on things. It helped. Safety technicians, in whatever capacity, usually stay verrrry busy. I've never worked in a cannery, but I am guessing it is no different there. Good luck, and just leave plenty of time for study, reading and homework after clinical assignments.
  12. katkonk

    Dwindling faith in this profession

    Just an observation, here. No judgement. If you are feeling that you cannot care for your patients that depend on you, that would signal to me that you are simply "burned out". Caregiver burn out is real and documented. If you need a break, take one. Go to your EAP program and get some counseling. Take a couple of months away. And/or search for a new place to work. There are places out there that are rewarding to work, and different areas of nursing that you may not have explored. Or maybe after a short break, you won't feel the same way about the same place. People get afraid to change things up a bit. Sometimes a switch to another type of nursing is a leap of faith, but many good things come from leaps of faith. Rejuvenation can happen, or possibly a nostalgic longing for what you left, and perhaps realize that you really were happy there after all...you just needed a temporary change of scenery. GET OUT there and explore other avenues of nursing.
  13. katkonk

    UTA NURS 5327

    Just adding my two cents here. I had been in an Adult NP program at one time. I was a Summa Cum Laude 4.0 BSN grad from a major university nursing school in Texas. I took advanced patho - easy A. I love pathophys and it is logical, gotta love Biology. I took Advanced Health Promotion and education (or something like that, cannot remember the exact title of the course). A-again. It was tedious, but okay, and it was interesting and useful. I got to the Theory course and although I am very good with "theoretical" concepts and courses (I have 45 hours of psych and another 12 hours of Sociology from my BS days), I thought the Theory course and the demands, AND the instruction were ridiculous. While PA students go to school with the med students and get to do Gross Anatomy cadaver dissection and in-depth radiology courses with the baby-docs-to-be, NP programs whose goal is to churn out outstanding clinicians absolutely weight us down with their theory babble and research bullsh**. We are mired in it. Look how much effort and time and stress you have put forth...for what? To pass a theory course? I understand the need for academics to promote the profession, and for those who choose that route, that is fine. But if we want to become proficient clinicians and providers of care, we should stand up for ourselves and create a movement to get the NLN to change the curriculum to lessen the demand of these courses that drain our energy and time, and RE-Focus on the clinical care courses, the hard-core, nitty gritty diagnostics and A&P that we need to know. I was trying to work and go to NP school, and the Theory course simply made it unbearable. I was not going to stress myself out that much over that kind of course. If the NLN wants to say they need better NP graduates that are top notch providers of care, then they need to reassess how PA's get their training. Instead, the NLN has tried to pass the rule that now NP's must have a doctorate. WRONG path to the goal of better clinicians. I hope that when you get out, or as you go through, you will help start a movement to get rid of needless academic time on courses like this. I was too old to pursue a PA degree, so I am okay with just having my BSN. I would have been a very good NP, but in my mind, not worth the grief of getting through bull**** courses like theory and research. I've done enough in my undergrad time. I wish you all the best of luck in your programs. I hope for better for the future MS students.
  14. katkonk

    Online BSN degrees being accepted by hospitals?

    I believe that what you heard is false. I have never heard that. Whoever said that may have heard of a particular unaccredited school that was not accepted by some place, but it would be highly unlikely an employer would reject a fully accredited school's diploma.
  15. katkonk

    NURS 4510 Fall 14

    Congratulations !
  16. katkonk

    EHR in Occ Med?

    I see this post dates back to August, but I thought I would add my 2 cents anyway. I agree with Rbeck911. OHM is great, but I understand it is expensive to purchase. The only thing I didn't like about OHM when I used it, was that when you scanned in documents, you had to pull up each document to see what it was when you were looking in the file history. There didn't seem to be a way to label or have any kind of index under which the scanned documents could be filed, to shorten a search. Therefore, time consuming. One of the nicest EMR systems that I used in Occ Health was an SAP program in which they had custom built an EMR for the nurses to use, and they built it to interface with safety so that safety could only see safety information that they were entitled to see. The nurses notes and functions were restricted to only medical, so that took care of any HIPAA issues. It took a great deal of time for the IT specialists to "build" it, but it worked fine and was simply an outgrowth of the SAP system they already had use of. You might check and see if they have SAP. With a Medical Director that is not tech-savvy...ugh...that can be the worst. One of the most frustrating positions I had (back in 2000), was in a very busy Occ Health clinic where I was having to teach this new doctor (old doctor-new to this clinic) how to do the most basic of computer operations on his lap top. He had NEVER used one before....arrrrrghghghgh.... There are several other systems out there.... I HATE MEDGATE...the WORST of the worst. They must have a heck of a sales department because so many big businesses use it, but it is AWFUL. Redundant, cumbersome, not user friendly, complicated....BBBLLLLLEEEEECHCHCHCH! Good luck with your project. Just pick a user friendly one, and OHM is the most user friendly I have come across.