darla80

You are not alone I am the only nurse in a BUSY Internal medicine practice fortunately I am very healthy and in the last six years have taken my vacation and only two sick days But I admit to some frustration that there is no back up My doc takes over for me ( sees less patients the days I am on vacation or as he is doing this week he is not seeing any pts the two days I am scheduled to be off I feel bad but realize it is his choice We do not have an offcie manger what happens in your office when the recpt is out? Does you office manager do her job? Is your office manager also the billing person? Do you like office nursing? I have done alot of different kinds of nursing and LOVE the autonomy I have in the office ..taking the good with the bad Hang in there ..stand up for yourself and enjoy the ride!! Joy and Smiles * Darla

There is a web site called Needymeds.com that has a variety of PAP ( patient assistance programs) The other difficulty I am having is helping the patients understand the myriad of forms and finding the time to explain it all to them. With the current nursing shortage .. who will be there when we are in our seventies and eighties with our cataracts and canes? Thanks for your reponse.. Buttons is a cute name !! Joy and Smiles * Darla

I could use some help!! what programs does your office most frequently refer patients to for medication assistance? I live in TN and we are in a medication and medical care crunch with the demise of some portions of TN care .( it is kind of like medicaid but rather than federal funding it was State funded) There have been a few handfuls of people coming to the office this week telling me they have not taken thier med as they can not afford it any longer since thier TN care was slashed. I have been handing out bags of meds but realize this can not continue and we have to look for ways to help them solve this dilemna Any advice from you guys is greatly appreeciated :) JOy and Smiles * Darla

Do you send sympathy cards to family members of patients who die? I work Internal medicine and this question has come up more than once in the last few months If both the person who passes away and the family member are patients of the practice I think it is appropriate to send a sympathy card to the remaining pt/family member What do you think and what does your practice advocate ? Does the physician sign the card? I am very interested in hearing about your offices. Thank you Joy and Smiles * Darla

My sister teaches refresher course for RNs Depending on the hospital you choose to work for you may be pleasantly surprised at the courses available to you. IN the meantime .. think of all the skills you are gaining at the clinc ..you are learning how to asses.. organize... chart... and your people skills are honed time and time again as you interact with each person Also you can learn alot about disease processes and medication management. recently a hospital nurse with very little medication experience made this huge med error..she wrote out instructions for the pt Digoxin 0.125 take four times daily ..after working in the clinic you would have had bells ringing seeing that dose of dig ( the pt came back to the hospital dig toxic) When you work in the hospital you will understand alot more about the patient b/c you shared some of thier lives in the clinic setting. Also your discharge instructions will be phenomonal as you know from experience the kind of thing pts need to hear to help them cope at home. I am glad you had a better week..wish you were working with me ..I would love to share my years of experience. keep soaring with the experienced ones and eventually you will be more comfortable solo Hang in there !! Joy and Smiles * Darla

nanaRN I am sorry you are having such a difficult experience.. I felt sad for you as I finished reading your post .. advice to the nursing student I agree with all the others .. One to three years in the hospital setting is what solidifies many if your nursing skills. So My advice is the same NanaRN.. is there a nurse in your clinic that can be your mentor? Are your previous medical experiences helpful to you in any way? There are so many wonderful things about a clinic job, it breaks my heart to read those words imprisioned in a clinic maybe it is b/c of your repay comitttment?? Working in a clinic affords so many opportunities to learn from the docs and the one on one with the patients is the highlight of my day I hope things get better for you.. wish I could offer you advice that would be helfpul Anytime you want advice or a listening ear..come here and share... we will all be glad to help you if we can Joy and Smiles * Darla

There are several determinig factors in choosing a clinic job and the skills you will need the size of the practice, the specialty, the availabilty of computers Electonic medical record etc Working in a specialist office Ie: neuro, endo, ENT, derm. Onc etc ..can be very challenging and you will use your medical skills. I work in IM .. and I love it as we take care of alot of pts with multiple organ problems and many geriatric pts, the elderly are some of my favorite patients..thier complexities and thier personalities. My office is small but very computer saavy .. computers in every room as well as the nurses station..I agree the computer classes would be most helpful My advice . find an area you love and enjoy the one on one interaction you get in an office setting Another plus to the office .... as you work side by side with a doc or docs ..you can learn alot about the practice of medicine I wish you Good Luck Joy and Smiles *Darla

Subcu injections I work in an Internal med practice and often give injections subcu IM etc However, we have Rheum pt ( rheumatologist is one hour drive for her ) and she is going to start Humira She broke her arm and wants to know if I will teach her family how to do subcu injections my Question teaching subcu to families... what would be the easiest site to teach Thank you or your input Joy and Smiles * Darla , maed but a rheum pt asked me if I could teach her amily nhow to adminsiter her HUmira she recently broke her arm and can not give her own ijectionWhat

the physician I work for is considering hiring an MA What is the pay rate for Medical assistants? What do you like about working in an office as a medical assistant? Joy and Smiles * Darla

what type opf practice is it? Have you wroked in an office previously? Do you like it? I helped my doc start his practice six years ago ,.. we have really grown and I usually Love it.. however I am still the only nurse and we need more help But the patients ..they make it all worthwhile Sounds cold in Vermont? Let us know how things go!! Joy and Smiles * Darla

How do you handle samples? Does the pt have to sign when picking up samples? Do you print out written instructions to give th pts with thier samples? Do you log out and chart samples in pt record? Thanks for you input Darla :)

we have two problems you just identified many of our patients have two or more pharmacies.. do your pts do that? they have their "mail in pharmacy" their local pharmacy, things they send ot the Canadian pharmacy and then we have some that use the Veterans hospital pharmacy..they see cardioliogy IM Uro etc .. not much continuity We have worked on the med list angle .. I have cards made up for them to put in thier wallets..my doc prints out a list etc then they go to another physician get a new med..do not put it on the list .. do not take the old meds off and they do NOT know why they take what they take .. do I sound a little frustrated ? Thanks for your input..I am still wearing my thinknig cap :) Joy and Smiles * darla

Interesting when I worked in the hospital nurses could get written up for med errors ..the pts go home and polypharmacy becomes russian roulette ************************* My office is on a campaign to prevent medication errors Patients are told to bring in ALLL medication bottles, to carrry an accurate list and I am tryng to help them identify what pills they take and why ..Of course this is time intensive. what stategies does your office use? and what are some of the most commen errors you see ? here are few of my recent findings true life..real time I had a pt tell me she was taking her ABX as directed and when I looked at the bottle ..it was Darvocet IM life Pt states I am taking my "diabetes pill".... patient brings in meds and she thinks her lanoxin is a diabetes medication IM life pt brings in all pill bottles.. he is taking 20mg Accupril and 40mg of Lisinopril and wonders why he is dizzy ..BP 94/52 he does not know or understand these two medications are blood pressure meds . he was given by two seperate physcians and filled at two seperate pharmcies IM life pt taking actos 45mg and avandia 8mg .. BS are bottoming out and he does not know they are the same diabetes meds . How can we help them? I wonder if there could be a more collaborative effort on the part of the pharmacist, physician office, and the pt? Looking forward to your ideas Darla

sounds like it was difficult but good for you hanging in and holding on to principles .... we have to look out for our patients and ourselves Carry on the flame and light the way!! Darla

Thank you, I started the process yesterday and hospice is going to evaluate her today. We had a pt once who rallied and was discharged from hospice and lived another year. People are absolutley amazing.. the nurses and the ones we take care of Have a Blessed day!! Darla

Thank you, I started the process yesterday and hospice is going to evaluate her today. We had a pt once who rallied and was discharged from hospice and lived another year. People are absolutley amazing.. the nurses and the ones we take care of Have Blessed day!! Darla

how did it go laura?? hold fast to your strengths ... Docs like this can be so glib ..they sometimes fluster us out of our issues.. Darla

First of all I am a proponent of Hospice and a firm believer in all that you do I believe you are all angels I am a nurse in an Internal medcine office and we often refer to hospice for palliative end of life care My current dilemna.. we have a 94 Y/O female .. FX hip in 09/04.. since her hip FX she is unable to walk, cannot stand up without support on both sides and is for the most part bed bound. She has DX of Parkinsons and is blind. She currently can not carrry out ADL due to general debility her parkinsons has been well controlled The physician I work with states that she will most likely not live another six months Tha family has been involved with Hospice a few years ago with an Aunt who had cancer the family would like hospice care Will the above listed DX be adequate for hospice eval? Please let me know ASAP thank you!! Darla

Ahhh how about that weekend.. they certainly make me feel better Has a little distance from Friday helped you to clarify what you want to say? of course it needs said and I wish you the best Does he have a habitual anger problem? Sounds like some counseling may be in order...... Let us know how things turn out and I certainly hope your coworkers reuturn!! Good Luck * darla

Lori we have also seen two cases of fllu in two people who had the flu shot.. on the optimistic side .it is the younger basically healthy ones coming down with flu at least they are less likely to die from influenza although they may at times feel like it ...... I am saying a prayer that I stay healthy the next few weeks and the BAD BUGS fly out !! joy and Smiles * Darla

I am in TN We are starting to see several cases of the flu in our offfice it is mostly people in thier 40-60 age range What about in your office? ' Darla

I am in a small practice and I too can wear whatever I lke I still wear scrubs B/C theyare so practical and comfy :) However I like scrubs with snaps or buttons down the front and some kind of detail in the back.... I can wear solids or designs..I tend to go with patterns/designs ..I am in an IM office so flowers and butterflies are a big hit with my patients Landau and Peaches are my favorite brands Congrats on the wt loss!! Joy and Smiles Darla

What is your experience with these meds? The doc I work for said the side effect profile for most of our patient population is not worth the risk of the med ( we have alot of pts with heart disease, COPD and Diabetes) what has been your experience? Darla

WE are supposed to get 100 doses this week Now we are tasked with determing the most 100 at risk patients . I work in an IM practice this will be challenge...age level of illness etc I am relieved we are getting a little Have any of you received your shipments? :)

I think I will tlak ot my Doc about this .. Are you in a large office? I am in a small IM office ..one doc . one nurse but we use the computer alot..computers in each exam rooms, nurses stations etc and terminals all over the office we do computer messaging..has also helpd my typing skills but I still make to many spelling errors Thanks for the info have a great Day!!