CaptKris

The problem is the lack of direct feedback to upper management. No one says no to the CNO. They may say, "That will be difficult", but not "no that's dumb" because it is career suicide. It's like a group of people all standing around smelling their own farts and telling everyone they don't stink because they drive a prius. It all starts with ANM's. They want a non threatening never written up goodie two shoes that has been on the unit for years. Demonstrates great nursing, accepts all new policy changes with no flack, leadership skills were "learned" in corporate leadership inservices. They take those and cull the popular ones into NM's and it can become very cliquish to those outside and insulates them into the management world. If they do it right like keep a rotating musical chairs setup of directors so that every few years they maintain some fresh blood. Poof they will distill "proper leadership" that's accountable for numbers and not how they get them. This may not be a popular opinion but it's been what I've observed at multiple hospital systems in a non union setting. The new trend is to get rid of ANM's. Just have an experienced "charge" that takes 3-4 patients. Turf the ANM responsibilities to nurse managers and provide no direct path for advancement and hire compliant outside leadership from other hospitals.

I'm looking for some information/clarification to how these quality measures are reported. Specifically journal articles or places to research. Here's the situation. My background is in hospice services and we work with a variety of patients through out the hospital. One of the case managers I was working with was stating, she was hoping that bringing hospice on board would negate the negative report if a patient were to pass before POD 30. So currently many times, a patient will undergo a CABG and just not recover. Enough that their status is tenuous but the surgeons will recommend an aggressive course of treatment until they get to POD 30 and then allow comfort measures. The issue is that there are many patient's that need hospice services in this thirty day window but surgeons will not consult us to assist because it will reflect bad on their numbers. How can we get these patients hospice services without it reflecting bad on their numbers? currently we have inpatient units to where the patients can discharge to or contracts with the hospital to where the patient can be placed in a contract bed which is where the patient is "discharged", a new FIN and encounter is created and patient is readmitted with billing going to our hospice company. Will either of these negate the reporting numbers? Sorry if this is not quality terminology as I'm not in quality. Will try and clarify anything if you have question.

I work at a big hospice in floria. Our's is divided up among different divisions such as LTC, Home, Hospital. We staff every hospital in the area and on a good day I do one admit and 2 info visits. Hospice is like med-surg in reverse but you've got to focus on what's going to be their demise. You'll learn great catch all admitting dx's. Late effect CVA. Cerebral Atherosclerosis. etc. You'll start looking in the medical history for something you can use and what's pressing them. There's a lot of "kittens and rainbows" and hand holding. Being productive in hospice doesn't mean you have to be curt and not sensitive but you can't let the family get sidetracked off on that funny story with the brother at the family reunion a year ago. It has been my experience that a lot of home team nurses love to hear the stories and see the travel pictures and hospital team nurses are about clinical nature.

it's a lot of meds. My employer reimburses for the test if you pass and gives you a small bonus but it costs about $350 for the test and you get $500 - taxes bonus. To me it seems like a wash. The only people that take it and pass it are those that want management. I hope it helps you. It's a lot of work for not a lot of reward in many places.

Sorry but the above is the exact reason why EHR is complex and cumbersome. Both posters above are defending the systems complexity by saying that it needs to be complex to achieve its goal. "Why can't you understand me, I'm a people person"- Office Space. Even one goes so far as to say that EHR is just for the patient and not for the people that use it. EHR isn't iTunes. Yes because EHR systems invite complexity to sit down at every table and every form in the software. You end up with the most frustrating user experience and worse data. Sorry but iTunes right now can tell me everything about every song out of 9572 songs currently in my library. It tells me at least 44 data fields about each song and I can pull up anything in live search instantly. That's just dealing with the basic music, not including, apps, photos, streaming, billing, store, syncing, suggesting, licensing, renting, movies, TV shows, audio books, podcasts etc etc. iTunes is way more complex than any EMR system, it just presents a user interface that is simple and intuitive. That statement above shows a lack of understanding in the software development cycle. It was designed by people that do not value complexity and understand that simplicity is by far a much more important goal. One button is better than 3. An extra ebola form tacked on the front of some admissions questionnaire that buries a new check box in the middle of a field of 100+ data points isn't the ER physicians fault. It's the EHR staff that designed such a crappy system where they took an important piece of data and hid it in a field of non-relevant data. Sure it's going to fall back on him but EHR is so proud of their ten thousand data points per patient visit that they don't help clinicians see what is relevant. Data Visualization is a concept that is poorly implemented in most EHRs. The software just presents numbers, letters, checkboxes and poorly at that. EHR is not designed with a user experience in mind, or even a patient experience. It's designed around compliance and implemented by people that don't value simplicity. Do you think a focus group came up with an iPhone? or iTunes? you think they said.. you know what we want.. is a phone with one button that will do everything.. oh and apps.. yeah come up with an app store as well.. no. Apple thought of it. they came up with potentially creative ideas and new processes to enhance the user experience while not breaking it in the process. Instead hospital informatics departments are setup backwards. They rely on user suggestions, focus groups, committees, legal council and new legislation to make changes. They attempt to create something to satisfies all disciplines and ends up a watered down product that does nothing exceptionally well. In fact if there is one thing that does work exceptionally well, they will be sure to break it. Informatics has to get proactive and anticipate the users needs. They have to come up with a compelling interface that addresses the patients need to not feel like a piece of fruit in a walmart check out line and the nurses need to care for the patient and not spend all day documenting. No one is suggesting removing the human element, but they're suggesting letting the element work more efficiently. Let the user experience be so good that the effort to accomplish productive work isn't spent trying to get the item to do productive work. That user experience is tailored by the hospital.

I'm ready to be done....

and with this stroke of a pen, doctors and nurses will appear and fix decades worth of bad management and hiring practices.

Ever have a patient start flooding the sinks in the ED because dilaudid is not prescribed... other great responses I'm not an alcoholic but someone has been spiking my gatorade with vodka I don't know where that 1.75L bottle of vodka came from but I didn't drink it Nahh man I'm just seeing if toilet paper is really flammable. Don't you have IV xanax? If my roommate can melt it down and shoot it up then you think some drug company would make it. This hospital morphine is crap, my street morphine is way better and push it faster or I don't get the rush. I could do this all night...

Well that was over quickly... really not much to it.. if you didn't get an A or B in that class.. you probably didn't try.. the quizzes were based on the text right before the quiz.. the papers, although thorough, were simple and straight forward.. I'd rate this class almost cream puff.

I use K-Swiss Tubes.... and not because they made the most awesome commercial for it... but it does help to be the MFCEO of the nursing floor...

Here's how it works. You're going to go through this critique of her preselected paper. Each week. At the end. You are going to redo every question every group member did with every ounce of instructor feedback incorporated on a research article your group selected. In APA glory. If you don't want this paper to be crap. Do all the work on the front end so you won't be trying to figure everything out at the end with a wing and a prayer. DO NOT GET BEHIND. Don't put stuff off till last day. Everything takes 2-3x longer than you think. Finally. The OOH's will answer everything. They are required listening for the class. If your group mates can't figure it out from the rubric, the OOH's, and the examples; they aren't trying. There wasn't much that was unclear.

I worked a couple of months of night shift and I'll work some occasional shifts but I knew night shift wasn't for me when my 3 year old would see me getting dressed in scrubs and get frustrated while saying "you goto work now daddy". Night shift honestly doesn't have enough differential for the stress it causes on family life. If you live by yourself and have friends you party with, then it could be for you. It's hard on young kids though. Mine hated that I couldn't always tuck him in.

What I find bizarre is that a Nurse must go before a health committee full of people who do not live on the front lines nor have direct involvement to air staffing issues. At our hospital, we have a CNO advisory council that meets bi-monthly where everyone from OR, ED, MedSurg, Ortho etc all come together to work on staffing, process improvement, and interdepartmental communication. Our staffing took a hit but we're climbing out of that hole and it took 3 months to do it but everyone was aware of the tasks at hand.

Anyone in this class? I'm getting that excited feeling as I run out of classes to take. Any one with experience want to give me tips for what to expect? Weeks that will kill me? Looking like a lot of fun according to the syllabus.

nursing research was a crap storm masked as a chinese fire drill. We got a B in it. I walked out of that final paper grade going ZOMG.. I can't believe we pulled that off. on day 1. our group all exchanged email and cell numbers and started a group text. That is what kept everyone accountable and on task. I can not think of any way easier to communicate with 6 people in different time zones. And yes. Everyone does more than they want to. Some people chip in a little. Some chip in a ton. You can't cry about who is doing what, you've just got to finish. To some people it's wine.. I personally go for purple gatorade and vodka... it's personal preference.. whatever is your rage fuel. Just remember. Every little assignment must be done with 100% effort. Or else when you do the final paper, you're going to realize why you should have done it right the first time.

I'm 6'8" and the aviators fit me great... I get them custom length and custom pants..

Yeah begin to rotate your sleep schedule the night before... and if you've got kids/fam, you'll need to rotate it back. So if I were you, clump your schedule into 3 in a row.

I wear my carharrt camo jacket hunting. It's the best thing out there. So warm and after 4 seasons still looks new. I'm definitely down on their scrubs.

This is the difference between the legal terms of "internship". An intern is not actually supposed to complete any work solo. Much like a student. It would be a violation of labor laws if an intern took a patient solo for a shift. So the employee is either being trained, being hired for an internship, or just hired. Pick one. The 10k clawback is a very legally grey area and I suspect it would not pass muster in court.

As someone who likes to see how the unions work in a public environment, I find it hard to believe that, if unions wish to keep prospering, they expect workers to vote for them then wait years for the benefits. In the information age, nothing takes years to accomplish especially if it's been done before. This isn't NASA trying to land a geo metro on the mars, this is an employment contract for staff. One could argue that if any dues were paid during this process they were paid under fraudulent terms and as a measure of good faith from the NNOC should be returned in full as it seems nothing was accomplished by the union on the behalf of the worker, even something as simple as a basic employment contract. I'm sure the union had alot of motion going on but at the end of the day, what is accomplished is what counts. In the end, better luck next time for the Pro-Unioners. The only thing worse than being defeated in a vote, is winning the vote and then getting nothing done over 700 days.

When searching to get into the informatics field of nursing, I see alot of people go through the EMR trainer specialist/tech support position. Finding what is a proper pay for that position is much harder. I get numbers all over the place when searching and then trying to index it based on location makes the numbers almost useless. So my local hospital in florida has an EMR position open that I'm considering. The job is a salaried position that will be providing tech support for healthcare staff, designing training materials for the upcoming EMR roll out, implementing them, and evaluating their effectiveness. Working with staff to design screens and user interface items for upcoming EMR roll out. Consult with IT and work as a liaison. So, what does one get paid for this? They require an RN for it. No IT's with health care experience, must have license. No mention of HIT-Pro being required x months of hire. Also they plan on rolling out in January, is 5 months a suicide mission time wise to design the materials and instruct the staff.

Yeah I'm 6'8" 300+ line backer size. Patients have never been scared even on my OB rotation in school, and my obese patients like it. No 5'3" girl is going to scoot their oversized rear off the bed onto a bedside commode.

Do you feel that the hospital was better off with the union? Short of the whole "rah rah" promotion aspect, did they actually improve working conditions at all? Were better managers hired and the staff better trained? Were patient ratios better or the same? Do you feel you received good value for your union dues?

"disregard women. acquire currency." that will be the best advice ever given in this thread. you're there for studies, not random hookups. the instance you take your eye off the prize and start looking at someone else's prize is when you get sunk. do not go into the friend zone. when she starts crying about how her bf cheated on her, don't be all comforting and supportive hoping that will get you rebound love. be like "i'm pretty sure he probably had a good reason for cheating on you". she'll want to kick your ass but only for a day or so. it shows no matter how nice you are to each other, you're not that shoulder to cry on. keeps your area drama free.

A real manager will recognize "chronic lateness" with a different name. Time theif. A time thief knows that at 7:07 and 30 seconds, the clocking in system will report her back at "on time 7:00" 1 second after that it clocks her in at 7:15. You can spot time thiefs because they'll clock in at the swipe terminal in the lobby instead of the one on their floor. Usually they're the last to arrive and the first to leave. Always take breaks and work those breaks into longer than they should. If I need to be on the floor at 6:50 to get report, I'll be there at 6:40. Clock in, copy my cardexs, make my notes, draw my scheduler and be ready for when the first nurse is ready to give report. If I can be out of report by 7:10. I can usually have all 9 o'clock meds and am assessments done and charted by 9. Makes the day go by so much easier if you never get behind. "The biggest room in the world, is the room for self improvement" - Old Sage