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ICU, LTACH, Internal Medicine
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KatieMI has 6 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

I have been through the Hell and came back out singing.

KatieMI's Latest Activity

  1. KatieMI

    NP in Nursing Home/SNF

    I covered plenty of SNFs, ALFs, independent care facilities, etc. Doing that was one of the reasons for me to leave this job. It is just not my cup of tea. The wast majority of the facilities are not fit for caring for patients with level of acuity they are sent from the hospital. Facilities are operating under policies/schmolisies which are definitely products of someone's deeply disturbed mind. Spontaneously increase a dose x2 times because "as per policy we cannot give half pills, only whole ones" - easy thing. Substitute one pill for another without telling provider as per "pharmacy request" - even easier (the med in question was immunosupressant for transplant scheme, mind you). Yes, autonomy (sometimes), and flexible hours (again, sometimes), but tons of paperwork, calls any time of the day and night for the silly "concerns" like mosquito flying around the patient ("but his roommate has hepC, can we order some blood test or something???"), endless notes for 20+ patients seen in a day, forced to "double prescribe" narks because "we always need TWO scripts" and heck with the fact that double scripting is illegal and endangers YOUR license, politics worse than in hospital, treating payients as "clients" and families as "guests", the said families pretty much run the place, etc., etc. Maybe someone would like it. Not me, for any money.
  2. KatieMI


    It is just not your cup of tea at this point or at all. It happens. They likely do not set you for a failure. They just have to place an NP student for an assignment and have little to no idea what to do with him or her otherwise, so they placed you in the first hole that opened. And you're not comfortable there, which is kind of normal human feeling. Most NP and, indeed, medical schools are operating this way. Medical students and residents have little to no control over their rotations. They are required X hours of surgery - so be it, nobody cares if it happens to be Plastics or Transplants while you'ge going to be a GP and have zero interest in either and would be better prepared doing Ambulatory instead. Meet with whoever has the power over how things are run there and directly ask for reassignment ASAP. Glue into as many arguments as you can pull out. You're DNP student, therefore you probably already have a big research project, its goals are not aligned with inpatient, it is not your future role, you wanna be more productive/better prepared, you won't be able to practice inpatient as FNP (if it is the case in your state or your institution), etc. Any big institution has an outpatient department. If they cannot fix something for you there, ask for Urgent care or, at the worst end, ER because that's where you'll send your patients when you have no freaking idea of what is going on with them
  3. Ok, ladies and gentlemen 1) after speaking with two program directors, I was told to sleep tight assured that no local program will welcome this student regardless of circumstances, and the programs they cooperate with, as well as local for-profits and, the main point, background checking companies they all work with will be "informed" and keep an eye on the potential candidate. 2) the medical bills will be paid. So, my Christmas gift will be something else but that belt-worn mini oxygen concentrator. I'll probably buy Chanel waist bag for it instead. Or YSL 3). there is no way in the American legal system to name or make it "murder" or attempt on one. There was clearly no intention to kill, no understanding of possible sequela (even if my words "if I touch, smell or taste any of it, I can really just fall down and die within 5 minutes" were actually heard, which I doubt), no expectation of a bloody show "field CPR with crash RSI though advanced upper airway edema, Vfib ACLS protocol". What was there - a bratty, fantastically immature even for her age girl who hardly ever heard the word "no" and is used to get everything she wants her way, any way and no questions asked. Without any proven benefits for her (save for that essay, which clearly came months later) it will be at the best assault/grievous body harm charge. Which, nevertheless, will effectively kill not only dream of nursing but all other dreams of a young person, as being a felony it pretty much closes ways into most of professional occupations. Even of a worker of an animal shelter (if she loves animals soooooo much)... The nursing dream will have to go. The other dreams will, hopefully, live - after lessons learned hard way. Hopefully. Hopefully, there will be no one more dangerous CENA, nurse or doctor. Maybe, she will grew up into a good vet, for one instance. This is not the first time I see people who do not know what "allergy" means or "do not believe" in it. One time patient's family demanded me eating a piece of candy at the nursing station when I politely said "no, thanks" in the room because "they just always wanted to know if all this business is really the truth or what". They "figured" that, since I was in hospital and in ICU, nothing bad can happen even if by any chance i was not lying, and felt that, since they are "paying clients", their wish should be granted, they were just curious, after all. I was banned from the room that very second, and, since I was the only one at the shift familiar with the particular condition, I have to "consult" by yelling through the door This is middle school pack mental level some people never overgrow. Thank you very much, everyone, for support and kind words! I will survive it one more time
  4. KatieMI

    A friend bought her degree from the Philippines.

    Officially and by current license, NP.
  5. Here is the story: About three months ago, our family hold a big celebration gathering in our house. One of the invited guests asked to bring with him his daughter who is a senior in the same high school as my daughter. By him, his daughter was sleeping and breathing nursing at all times and wanted to speak with me. Ok? - sure, of course. Three days before the party, the daughter called me and requested that, since she is a vegan and "abhorred" by anything which can be even remotely related to "disrespect of life", all food must be strictly vegan for everyone. I pretty much signed it off and asked her to bring whatever she would enjoy except for mushrooms, nuts and chocolate, to which I am so allergic that anything of that kind is banned from my house, period. She argued for a while about "organic and GMO-free food cannot cause allergy" and some pseudo-scientific stuff she read somewhere on Internet, but we kind of settled down at the above. I thought she understood what it was all about as I told her everything in very plain and unequivocal terms. At the day of the party, everything began cool and the girl was chatting with me to no end about her love to nursing, making change, etc., that she volunteered everywhere, got her science grades on top, the stuff. She told me where she wanted to apply - in two local community colleges ADN programs, both of them highly ranked and graduating excellent nurses. Asked for a letter, I said ok, will write you one, huney. Everything went smooth till I asked her to help me to bring dessert. She wanted to cut the cake and serve it individually, I agreed and she brought pieces to the table. The cake I baked myself. I started to eat... next thing I know, I was in ICU hooked to the vent, with two chest tubes, and it was over 3 days later. I went into anaphylaxy right then and there, had a full arrest. The girl, who, of course, never saw what a "code" really was with its inherent violence, was so terrified that she started to cry hysterically and admitted to paramedics that she added powdered mix of nuts and dried mushrooms to my slice of cake in order to prove that "organic" stuff was safe. She and her dad pretty much run away right after. Spent 2 weeks in hospital, 3 months after still needing oxygen at times, still in pain from multiple ribs fractures, all the shabang plus, of course, large bills to pay and a new job I signed on right before it all happened is getting nearer. The girl or her dad did not call even once. Quick ahead, a few days ago the high school my daughter and the girl in question both attend, made a show of the best college admission essays class 2020. They do it every year. My daughter spotted the essay written by that girl. She described in great colors how she "by a touch of luck" was exposed to a "real life-saving situation" in the form of CPR in the field, how she "found the name of the injured person" and helped all along (outright lie), how it influenced her wish to save humankind and fueled her dream to became a nurse which she first experienced right after she got out of diapers, and so forth. It was excellently written with large number of details. By these details, I know she meant my code. I have a copy of the essay and, by other details and her previous talk, I know where she applied. Now, I am torn. On the one hand, she is just a silly idealist teenager, as we all were at some point. Life will teach her stuff, and soon enough, as it taught us all. On the other side, I cannot live with the idea that someone so careless regarding others' lives and so convinced in her personal world being the only one truthful and real should be allowed near sick, dependent and helpless. What if she realizes that the flu vaccine is made from innocent, intelligent chicken embrios and starts to inject patients with saline instead of vaccine so not to compromise her vegan worldview? What if she again feeds or injects another person with a known allergen? I know both program directors of two places she can potentially apply to in person; if I call, her nursing dreams will have to wait at least for a while. I had my dreams killed by others more than once. I hate to do it with another human being. But the girl already proved herself to be unsafe for others.
  6. KatieMI

    A friend bought her degree from the Philippines.

    Well... Many years ago one "watchful" and "responsible" lady just like you reported me to Michigan BON. Her point was that she was struggling soooooo much through pharma and patho in BSN program and I was not "even" required to take those classes and yet "somehow allowed" to progress through the program and she "just got concerned" and requested investigation of myself and of the whole place. She had no idea who I was, that I did years of both subjects + USMLE, and that the program took my past education into account. She also did not know what "libel" was, that it was a misdemeanor in Michigan, and that she would have a little box to check on her license application stating if she was ever involved, prosecuted, convinced... etc. She was so naive that she did not get a lawyer before writing her little dirty letter. Long story short, the lady never finished the program. As a matter of fact, she will never work as a licensed professional in healthcare, education, jurisprudence, etc. due to being labeled as a person of "poor moral standing". You may have no idea about one's life past and present even when you two share house, food and bed for years. Your friend very well might be a foreign grad taking various pre-NCLEX online classes and working as a caregiver in the meantime. She applied to BON in one state and for license in another, just like every third or fourth other NCLEX applicant does. If BON finds something shady or unclear in her file, they will deal with it. If she is just a lawful non-traditional applicant, she will have all rights to sue you for libel and all chances to win the case. She will have all 4 components cut and served on a silver plate. Never underestimate the perceived level of knowledge of an immigrant. Being it nursing, legal or any other area - never. Many immigrants pass not only NCLEX, but USMLE 1, 2 and 3 with flying colors and minimal prep, because in the shell they are very superficial and require minimal baseline knowledge. And going through immigration hoops makes an average immigrant better versed in the US legal system than an average born and raised American.
  7. KatieMI

    Return to NP Practice

    Godsgirl 73, you will do a lot of favor if you continue to update this message as things go on, and if you make another one in the World/Canada part of this forum, with noting a province (no other details) Really, one day someone may send tons of positive vibes your way. You're the first one and making a precedent. We hope you will succeed and show the way to another nurse facing the same hoops to jump through. This is what this forum exists for, after all. Good luck and many blessings to you!
  8. KatieMI

    Return to NP Practice

    Godsgirl73, The fact that they want you to write down your own "plan" can mean only one thing: in clear English, they just got no idea in the world what to do with you. Therefore, your job gets to be quite simple: impress them BIG DEAL. Your past experience clearly counts for nothing (otherwise, they would know at least in general what to require from you). So, your powers lie right now and here. Propose the same number of hours you did in school in every area. Volunteer as an RN - hours won't count, but your earnest efforts hopefully will. If you get a chance to join some kind of professional society, do it. If you can visit a conference, do it too. If you can snatch a course in addition to what you proposed, include it. Here in States even smaller hospitals regularly hold meetings where specialists duscuss various clinical questions. NPs, even when not officially invited, are allowed to participate. If there is something similar in a hospital near you, go there and make friends. A letter or two written by NPs or MDs would be a good supplement for your "package". The more filled and creative your package would look, the better. Show your efforts and willingness to work your tail off for that license, and, hopefully, they will believe you. If it seems simpler thing to do and possible at all, consider post-masters certificate. P.S. I am surprised regarding number of hours required. In my school, it was something close to 200 hours for at least 3 areas out of four, and most students did twice more without making too much noise about it. I am considering post-masters in acute care, and most schools wants anywhere from 500 hours and up from students who already employed as NPs in acute.
  9. KatieMI

    Return to NP Practice

    1). Start to get CME (or whatever it is named in Canada) like crazy. Choose reputable sources and the courses which correspond with what you see as your future area of occupation. 2). If such things exist in Canada, do refresher courses in patho, pharm and therapeutics/management. Preferably with clinicals. Try your former school - they might be easier to speak with, although the end result will likely be expensive. 3). Volunteer, volunteer, volunteer. I do not know if it is an option in Canada, in States you can find a formal "RN" position in a private practice office for a small money and go with an NP on home rounds, doing his/her notes, helping in SNFs, etc. Sign up for every health fair and such event you can reach. Go to summer camps as RN. 4). Find a practicing NP with license in good standing in the area of your interest and try to become an apprentice of a sort. Like a preceptorship. You might have to pay for it (in States there are services catering to just that kind of situations, and they charge $$$$) and do the dog's job writing 30+ notes in a day, doing billing, calls, all other paperwork, etc. 5). Network, network, network. Join professional society, go to conferences. 6). Document all the above as if your life depends on it. Just my 2 cents. I am sorry you find yourself in this situation.
  10. KatieMI

    FNP job outlook in Michigan

    There are tons of jobs but not so many of really good ones. Those which hit the market are filled quickly. Do not get confused by the time these jobs stay in "open" status. I recently signed for one in Sparrow - those three position are still technically "open" but all three were opened in September and interviewed, revised and filled in 6 weeks, they still listed as "open" as HR process is not completed. Places like private practices, outpatient clinics, urgent care, hospice, Visiting Doctors, walk-ins, various locums and Sound physicians are hiring all the time and pay in rural North can be quite high (I passed a begging offer for >$140000 for essentially 28 h/week, PTO 8 weeks off, no call "primary care" coverage for an office in one of the most drug-infected communities in Lower Peninsula, just knew that it was a politically correct wording for a certified, licensed and Master's prepared drug dealer) but most of these go under "just a job" category unless someone really likes that kind of business. In Tri-City area where I am there is a good dozen of openings for above type of jobs which go unfilled for the last year or two. For a really good kicks one has to have experience, good school (in most places I know of, diploma mills grades are not welcome as there are plenty of grads from UofM and other reputable places) and connections. One thing that may help: most of mid-size to large hospitals do not let "their" positions to go into aggregators' boards like Google or PracticeLink. If you search under "carees" on hospital site, you can find more openings. And, yes, Michigan is so restrictive that I know people working 7/7 in Ohio in order to not being pushed into "scope of practice" issue for every breath, despite of pay cut.
  11. KatieMI

    Strange prescribing practices

    Well, in order to make it in 99213, theoretically, one Dx of "chronic pain" is enough, but one still need to document at least a short physical. If the provider feels that documenting all other stuff and acting accordingly (i.e. prescribing BP meds and such) is "looking better", it is his right. It is not illegal as long as cases are not billed higher without good and documented reasons. I always use those "pain pills visits" for med refills, education, etc. People love it as they feel that they are "cared about", I love it because it helps to keep things under control and avoid accidental prescribing of 3 PPIs and 5 laxatives, labs falling through cracks, etc.
  12. KatieMI

    Elevated H/H, very low Folic Acid/B12

    https://www.hindawi.com/journals/bmri/2013/205467/ Part 7. Copper deficiency and MGUS-like changes in bone marrow, can lead to high Hb till the iron stores run low.
  13. KatieMI

    Elevated H/H, very low Folic Acid/B12

    Relatively common, only one type of it. Polycytemia vera or MGUS going into this direction with prevalence 22-24/100000 (well, there are a few more, but they are closer to dinosaurs than to zebras). Overall, this is a possibility rare enough to worry about at the first stage of DDx. All very common "horses" (smoking, dehydration, etc) should be reliably excluded before specialty referral.
  14. KatieMI

    NP vs MA vs MD power struggle

    I see amazing number of job advertisements for urgent care and the like settings which openly state that the NP candidate they seek will be treated as "all tasks' maid". Rooming, taking vitas, venipuncture, all other tasks as assigned, then provider's job, then calling on scripts, case management, insurance business, etc., etc. What is interesting, most of them want NP, not PA. I wonder why - probably, because PAs will not put up with it. And I do not even mention this example of greed level 80.01: https://www.practicelink.com/jobs/676574/physician/hospitalist/Michigan/Rural Physicians Group MI (7 on/7 off round the clock - yes, 168 hours in a row, no interruption, no chance to leave, not seeing your family, eating cafeteria junk for your own $$, responsible for anything and everything - for LESS than local standard salary. New grads, please pay attention). They were looking for an MD for over a year, found no fools, now fishing for PA or NP to do two people's job for one salary.
  15. KatieMI

    NP vs MA vs MD power struggle

    It is bizarre but indeed quite common. In my experience, hiring "to help with the influx of patients" can mean literally whatever. If office personnel has no knowledge of what "NP" means and only hear the "Nurse" part, they very well can think that the person is "still just a nurse", with functions assigned accordingly. Random "helping here and there" just out of wish to be "friendly and helpful" only increases confusion. I would advise a meeting with practice owner/office manager and getting the job functions/expectations in written and in details. Explaining what you can do (prescribing, etc) can help. Then just act accordingly with no exclusions and without caving for "they told me that you'll do it for me".
  16. KatieMI

    Elevated H/H, very low Folic Acid/B12

    That would be either CKD at least IV (in which case he likely wouldn't go bariatric and wouldn't be so high) or use for doping in sports (in which case bariatric also unlikely). Too much a zebra to even considering as a possibility.