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mamain

mamain

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mamain's Latest Activity

  1. So I’m am super excited! I’ve been a nurse for 8 years. In the healthcare field for almost 20!! I’ve been kinda trying to find my calling all this time. Always wanted to try peds but was always nervous about the idea. I’ve spent the last several years in dialysis (acute and chronic) but took the jump into private duty peds and now just accepted a job in the hospital environment in peds. Anyway its a huge jump, I’m excited because I’m pretty sure this IT for me! I’m hoping to honestly retire at this hospital working in pediatrics (in 30ish years ). Anyway, I need help to get up to speed super quick! Please share any must have apps, books, references, refresher courses, tips, experiences must see YouTube videos. Anything that can help me get up to speed as quickly as possible. I will be give an 8 week orientation due to my inexperienced. But I don’t start for 3 weeks so this is an excellent opportunity to really dig in and study.
  2. mamain

    Breaking a 2 year contract

    Can you ask HR about what kind of repayment options you may have?
  3. mamain

    Frustrated

    You are in a rural position and the clinic sounds maybe like a new clinic if you all are only MWF. In addition, its very common to start an RN in a pod for at least 6 months to get the basics prior to letting them charge. What you are describing is very typical. I am in a new, rural community myself and a manager. I bring all new people on with the understanding that to get full time hours they will have to drive the distance to other facilities. That is at least until we grow past MWF only.
  4. mamain

    Dialysis Nurse to stepdown

    Me!!! I just posted about this. I want to.... but not sure where to turn. I really need some hands on skills training to jump out of dialysis.
  5. mamain

    Jumping Out of a Specialty

    I've been an RN since 2011. Prior to that a medical lab tech for 5+ years. I've been in the same specialty almost since the beginning other than a fairly short stent in Med-Surg. I am a dialysis RN and have moved from acute dialysis nurse, to chronic dialysis nurse and now into management. However, I've been burnt out with dialysis for a really long time. I stay because I'm good at it, to be frank. I have considered on several occasions jumping into home health or private duty, mostly because I feel as though I have lost my nursing skills. Additionally, I'm in a masters program for nurse educator and feel that in order to teach, I'm not well served in such a specialty field unless I plan to teach in this field. I am really worried about jumping into something and being way over my head and that creating a liability for the patient, myself and my employer. But I also know that I'm not learning anything new by staying where I am at. Any suggestion on my next step? I am thinking of making a move after the beginning of the new year. I have a little over a year left of my master program. Thanks for any help.
  6. I started the endorsement process for indiana 6 weeks ago. Three weeks ago I submitted finger prints after receiving an email stating the board of nursing had my application. The email said it may take several weeks after fingerprinting and to not contact them regarding status updates, but that is SO hard to do!!! I'm ready to start that job hunt, but don't want to start without knowing when I will have a license. Can anyone empathize... Sorry had to vent! This is taking too long!!!!
  7. I took a job last August at a local hospital that offered a residency program and the fee for leaving after the program is 10000. However, If I stay for 2 years they would wave this fee. I have decided to leave after the program and am being faced with having to pay this whole fee up front. They will not take payments. I feel that this contract lures in graduate nurses that are these days hard pressed to find work and then it is used to keep them unhappily in a job that severely overworks them. With no way to escape I have been left with severe anxiety. Is there any thing I can do. I am in a non-union state.
  8. mamain

    A Paradigm Shift in Nursing Practice

    Don't know what happened to spacing when I posted this. I tried to clean it up. Hopefully, that doesn't distract from what is actually being said, as I feel that it is a worth while conversation.
  9. CONGRATULATIONS, YOU'RE JUST A NURSE JUST a nurse. I am JUST a nurse. No big deal, had I been more adventurous maybe I would have gone to medical school. These thoughts are the thoughts of many, including myself, which I have over heard for years, even prior to nursing school. It's actually sad when you think about it. Nursing recognized as a profession has gained it awareness in our current culture somewhat piggybacking off the Women's Right movement. Even though many nurses are now male, the stigma associated with nursing has its roots attached to a time when women, whom comprised nursing, were thought of as hysterical, at worst, and not equal to a man, at best. Doctors by contrast, predominantly male, has commanded respect and paid well for that respect for years. THE WORLD AS WE NOW KNOW IT The world of nursing as we currently know it is complicated by supposed "Staff shortages", high nursing to patient ratios, lack of documentation for nursing interventions, problems with compliance to "Core Measures" or other Joint Commission regulations, deficits in inventory charging, poor attitude, and lack of ambition in many situations. This in turn creates extremely high turnover, million dollars in lawsuits, millions of dollars on Core Measure fall outs, and loss of thousands of dollars in inventory, difficulty for managers to make safe staffing assignments. To combat many of these problems the nursing world has sought legislation to control nursing ratios at the detriment of no longer having nurses aids which help feed, bath, change bedding, toilet, and other similar tasks that take much time and attention. Their supposed rectification of the situation leads to more work for the nurses and a cut in positions for other healthcare members. A POSSIBLE ANSWER In a perfect world, which valued nursing similar to other types of therapists or physicians we would be able to bill patients for our services. This thought is nothing new and there are several reasons many have decided that right now this is not the answer. So what is the answer? To me it's exquisitely simple. It is common knowledge that a floor nurse is paid out of the room expense for the patient. But when considering the average room is at least $3000 and many times much higher and then multiplied by the five to eight patients the typical nurse must take care of its easy to see that $20- $30 dollars an hour is not much in the scheme of things. However, taking from a rare specialty in nursing which pays a base hourly rate plus one hundred dollars per patient a day I ask myself why isn't this extended to the rest of profession? If a nurse was paid based on acuity and that acuity was calculated by the end of the shift per patient based on documentation into a computer system with an algorithm (which already exists) then the nurse would be motivated to properly document, become more efficient, give the nurse the ability to control how many patients they wanted with the incentive to accept more patients per shift. In theory, this would increase positive outcomes for the patient, diminish lawsuits and fall outs over Core Measures, and increase compliance with Joint Commission standards. AN EXAMPLE Based on acuity a typical day might consist of a patient that is waiting for discharge at some point that day, has nothing really wrong with them and only needs some basic nursing care. For this patient the nurse might get paid $80 per shift, but since the patient leaves a little past the middle of the shift the nurse would likely be paid $50. The nurse then admits a patient whom is more acute. The patient is a direct admit patient and requires and IV to be started, a urinary catheter to be placed. The nurse is spending two hours getting this patient admitted, stabilized, calling doctors, making sure the patient is ready to go to various departments for diagnostic testing and based on all the nursing interventions this patient is fairly acute. For a whole shift with this acuity the pay to the nurse would be possibly $120, but since this patient came toward the end of the shift maybe the nurse is paid $60 considering the amount of time and interventions that this patient required. The rest of this nurse's patients consist of a patient with several wounds that need to be addressed, another patient with tracheostomy requiring hourly suctioning and tracheostomy cleaning. Another patient has a feeding tube and is trying to get out of bed frequently, but has dementia and is unable to walk. Another couple of patients are requiring blood transfusion and yet another patient is relatively stable, but not ready for discharge. Each of these patients would be a different acuity based on the algorithm the nurse would be reimbursed differently for each patient, depending on her documentation. Let's say this nurse on average makes around$100-$150 per patient for 12 hours, but this determination is based on 24 hour equivalents. For those nurses working in a procedural type arena, the pay reimbursement would be even simpler. The nurse would be paid based on a percentage of the cost for the procedure. I am not well versed in this type of nursing, so I wouldn't be able to extrapolate the price for different procedures, though that could also be taken into consideration. ADVOCATING FOR THE PROFESSION This type of pay reimbursement would give the power to the nurse to direct their own practice. A new nurse may only want to take 3- 5 patients that particular day, while a 20 year veteran might be able to handle 8 or 10 safely and efficiently. However, it would be the nurse's call based on where they felt comfortable and their pay would reflect this desire. The theory advocating for nursing control of practice would also not negatively penalize the nurse for taking more patients as the currently system does. If I get paid 'X' dollars an hour for the shift and it doesn't matter if I have three patients or ten, of course, I will opt for the latter. However, if I was going to get paid significantly more to take either a sicker patient or more stable patients I would be more enthusiastic about this assignment. IT'S NOT ABOUT THE MONEY The first critique to this work will be that this type of philosophy is money oriented. I bet the first person to even say this will be a nurse. As nurses we can sometime perpetuate the cycle of professional disregard. And while thinking I would love to live in a land where the most important thing was taking care of my patients and making sure they had the best hospital experience possible and my direct contribution mean they got better faster. Unfortunately, this current system does not cultivate this type of thinking and simply irradiates this type of idealism, disregarding it as a naive view point of a not-so-seasoned nurse. As much as each nurse may have come into this profession thinking they would make a world of change, reality is they are not given the tools needed for success. Nurses are currently given all the responsibility and none of the resources to give "nursing book" quality of care. Think of it this way, a physician get to say how many patients they will take and how much they will charge. Society accepts this, may grumble a little, but still puts up with this situation. This theory would put the power back on the nurse to decide how much he/she is able to safely take on for one shift. This theory is in no doubt a paradigm shift and it acknowledges that resistance will be met by hospital that does not want to lose profits. It is not asking that the patient pays more inherently. And to this end, when people will say it cannot be done because of the price to be paid, I would say, then why isn't this an obstacle for other professions that may only see the patient for a few minutes each day. ~ Written by Melissa Main, RN 2012 Feel free to share and comment. My ideas are fluid not set in stone.
  10. When you apply for another license are you giving up your original compact license for say a california or washington license or do you get to keep both? Also is there any additional testing or education required to tranfer to these states?
  11. mamain

    Spinach/Vitamin K.

    I just had this question!!! So glad to find it was already asked. I just started adding raw fruit and veggie juice about three times a day to my diet. One of my main ingredients is spinach and other big Vit K contributors. I was running on the treadmill last night when all of a sudden I got a small but very painful blood clot in my finger tip. I too am on birth control and then started to freak out, took an aspirin and today I am eating lots of fish. I am not too worried about it as today the blood clot looks more like bruise and is not red, hot, swollen, and painful like it was. I am not sure if its the birth control or my new diet or the combination of the two I need to change. I just graduated from nursing school and have not started working yet so I do not have insurance so I am trying to deal with this on my own for now. If something else happens though I will surely go get a medical opinion on the matter.
  12. Feeling you pain here in Texas
  13. mamain

    Autism and the Nurse Practitioner

    I realize this post is over a year old. I just wanted to add that I too am looking at PNP possibly to work with Autism. I also wanted to second the opinion on the vaccination issue, that many people are very uneducated as to the discussion of alternative vaccination schedules. In personal experience, my oldest son has Autism, classic, moderate to severe with aggressive behavioral problems requiring medicinal management. So when my youngest son was born, I had read many different theories regarding the autism spectrum and had decided on following an alternative vaccination schedule. I obtained affidavits from the state in which I live, exempting my children from being required for vaccination and came to an agreement with my son's pediatrician regarding this schedule. We were able to space out his vaccinations fairly effectively for about two years. However, at my son's last visit the nurse practitioner, whom we do not usually see, forced my husband to consent to 5 vaccinations to include MMR at one time. When he explained about the affidavit and previous agreement with the head pediatrician she said that it was her call, because it was her license and that if my husband were to leave the office without having all 5 vaccinations, she would report him for child neglect. Long story short, my husband, with out being able to talk to me first, folded under the pressure of be threaten and my beautiful son was vaccinated. Hopefully, nothing will become of it and hopefully my worst nightmare will not come true. It is issues like this that make we want to work in this field. To hopefully raise awareness to these types of issues. And for anyone else reading, please, even if you do not believe vaccinations have anything at all to do with Autism, respect the wishes of the family. Be culturally sensitive.
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