mojitos2go

Congrats on passing your boards! You must be beyond excited. I left ICU to work on the reimbursement side for the ED so I could work from home. I am impressed with the NPs' documentation. I rarely have to return a chart for a signature, query a NP regarding a procedure or down code a visit level due to lack of elements in the history or exam. When ICD-10 is implemented next year, detailed documentation will be needed for the diagnosis codes to capture specificity, site and laterality/bi-laterality. I'm convinced the NPs will document better than the residents, fellows and attending EDPs. Currently, I am contracted with 2 children's hospitals that are teaching facilities. The NP privileges include ordering ancillary studies, nebs, IVFs and IV meds, suture/staple removal, pelvic exams, superficial lac repairs, cerumen removal, ear and nose foreign body removal, simple sprains, fracture and dislocation care (nursemaid elbows are very common) and I&Ds of skin abscesses. There are many visits for rashes, fevers, N/V/D, otitis media, asthma exacerbation and sore throats. The residents snag the patients requiring LPs, G-tube replacements, sexual assault exams, trauma and seizure treatment, fracture reductions and procedures requiring conscious sedation. Good luck!

Check out the state of Florida. There are plenty of misadventures reported. This is a sad case: HospitalInspections.org | Report Detail

Good grief, a pimple-popping CRNA: HospitalInspections.org | Report Detail

I see a lot money left on the table due to hydration and therapeutic infusion stop times not documented. Do you think staffing budgets would increase if more reimbursement occurred or would that money be diverted to other expenditures in the ED? UnionRN2: Is anyone assigned to check the MARs for infusion times? Some NMs are very proactive with this.

Measure 28 for PQRS (Physician Quality Reporting System) - Aspirin at arrival for AMI. Incentive payments peaked at 2% in 2009 and 2010 but dropped to 1% for 2011 and 0.5% for years 2012-2014. Beginning in 2015 there will be a penalty when the measure is not met. The measure is met if the aspirin was taken at home within 24 hours, was given en route by EMS, was refused or has an allergy. These variances need to be documented in order for the provider to meet the core measure. Other ED measures include: EKG in adults 40 years and over for non-traumatic CP, EKG in adults 60 years and older with syncope and those with CAP need VS, O2 saturation and mental status assessment documentation with empiric antibiotic treatment.

I took off for 6 months a couple of times over the years when my husband went to sea during his Navy days. The time flew by. There were some equipment and P&P changes, but after a few busy 12 hour shifts, I got into the groove again. I use Nurse.com and get the Medscape Nursing newsletter via email. Congrats on your decision and enjoy!

You must feel like you are in a nightmare that won't end. I am sorry for your pain and the management team's soul-less behavior. How do these folks sleep at night or even get into nursing? The PTB want to run healthcare systems like businesses but offer no personal improvement program? Shame on them. Your situation reinforces my stance on keeping work separate from my personal life. This type of scenario seems to be occurring more and more within our disintegrating profession. I witnessed half of my co-workers high-tail it out the ICU when a new director was hired to clean house. Others were blind sided, fired and too humiliated to fight back. It took 4 years for said director to get to me. Long story short, I refused to resign or go to another unit, applied for unemployment and like eriksoln had a telephonic court hearing. I was on vacation on an island in the Gulf of Mexico and didn't even know if I could get cell service during the hearing. The director, HR rep and 4 other ICU nurses were on the line. You would have thought the hospital was defending a federal murder case. It was difficult not to laugh, knowing how reheorificed 5 out of the 6 of them sounded, I was on vacay and they were not! The hearing officer chastised them for their personal opinions and repeating the same thing. The 4th nurse, a seasoned ICU nurse, would have nothing to do with their script. The ruling was in my favor. Did the firing affect future employment in the middle of a recession? Nope. In fact, the HR director at the new employer had worked at my former workplace and was familiar with the M.O. Oh, and the darling director: she is supporting her out-of-work boyfriend, her kids have nothing to do with her and her house is worth 100K less than what she paid for it. Karma is a wonderful thing. When one door closes another door opens but that hallway in between seems mighty dark. OP, do something really nice for yourself because you are worth it. Take care and keep us posted.

Good Lord! The nurse seemed rather callous telling you, a nurse, that you have a mass without an explanation from the provider. Aye, yaye, yaye. Don't we tend to think of the worse case scenario when it comes to our own symptoms? Is this business as usual in this particular ED? The Director of the ED should be made aware of this. This was a high level ED visit for which the ED physician will be reimbursed if he documented appropriately. Certainly he could have spent a few extra minutes with you. He dropped the ball. I hope you are feeling better. Keep us posted.

In addition to safe staffing ratios, I propose: every member of administration (CNO, CFO, COO, CEO, UFO...) will don scrubs and running shoes to shadow a nurse for an entire 12.5 hour shift every six months. Breaks will not be guaranteed. One night shift and one holiday are required annually and will be assigned by a vote of the staff. :) Chin Up, keep us posted, please!

Aww, Poi Dog, I love pay-it-forward stories. Random acts of kindness are the best!

Well, there is your out, "After completion of the internship..." Run! :)

Union Busting 101. Administration loves to divide and conquer. The public is clueless unless they have a family member or friend in the biz. Thanks for the reply, Catch22.

When I had my daughter, the staff knew I was a nurse from the facesheet info. The poor young nurse was so nervous while starting an IV, I told her, "I don't know nothin' 'bout birthin' no babies!" She did a superb job of inserting an 18 gauge needle into this sunburned and dehydrated patient.

"Mom is a nurse and she stays the night," was probably the first part of the shift report. Many moons ago, I walked into my then 6 yo's room; she screamed at a nurse using only a kelly clamp during a dressing change of an open wound, "Get those scissors outta there!" I calmly suggested sterile gloves, too. There were a few misadventures during the kiddo's 6 day stay and it didn't seem to matter that I was a nurse. Very scary.

Chin Up, do you have any idea how the community feels about the nurse's fight at Tuft's? Are folks supportive? There seems to be a lot of nurse-bashing in the Comments section of the Boston Herald site. Do these malcontents represent the masses? The 114K nurses' salaries ruffled some feathers.