BostonFNP replied to traumaRUs's topic in Advanced
So you keep your patients on it?
This is my concern:
Shah, M., Avgil Tsadok, M., Jackevicius, C. A., Essebag, V., Eisenberg, M. J., Rahme, E., ... & Pilote, L. (2014). Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Circulation, 129(11), 1196-1203.
We are lucky if we can get cardiology to manage INR let alone nephrology!
Machines, at best, are only as good as their user input; this is why there are multiple fail-safes in place.
If you go to the Pyxis to pull out med A/patientA and the Pyxis gives you med B/patientB you don't just inject medB to patientA because you verify both the patient and the med prior to administering. Machines don't replace clinical judgement nor do they absolve HCPs from errors.
Nurses are the most vital of all the HCPs because they are the last line of defense. In many ways the buck stops with the nurse, not the prescriber or the attending. Nurses have a high-stakes and relatively thankless job of saving patients from prescriber/pharmacy errors.
Sadly in this case, the multiple errors lie squarely on the nurse.
Where is this quote from? Please cite your direct source to this as the advice of any major religion.
You can't because this was directly lifted from blog posts circulating the internet on how to write a religious exemption letter. It is not consistent with the teachings of any major religion.
Ironically it's origin was from a letter written by a mothe in the state of NY and it was deemed to not warrant an exemption under NY law.
The vast majority of this "blame" falls squarely on the nurse. If we want to blame the Pyxis for not knowing the nurse meant veRSED and not veCURONIUM...
There are so many breakdowns here for the nurse it really is hard to see any other blame.
So the next time when I order 100mg of Januvia and she enters Jan into the Pyxis and gives 100mg of Jantoven....
Lets say she did the right thing and: 1. pulled the correct med, or 2. didn't use an override, or 3. checked the medication before administering, or 4. checked the dose before administering it, or 5. re-evaluated the patient after administration. Any one of these might had saved a fatal error (all of them, not just one, is standard of care), which is exactly why this is gross negligence that resulted in a fatality.
But she didn't even administer Versed/midazolam, let alone do it safely. She overrode safety protocol and withdrew the incorrect medication, administered it in a entirely unsafe manner, which resulted in what was likely a horrific death.
That, and then administered it without checking it was the correct med. And then, killed the patient.
There are other systemic things we can learn from this, but at the end of the day, this was gross negligence any way you slice it. Unless there is more to the story than me know.
There is value in every experience and if the ICU is of clinical interest to you then now is a good time to get that experience. If you are looking towards a PC-NP track (and want to work in primary care not a specialty practice) the ICU experience may be a double-edged sword, as some of that experience may run counter-productive to your primary care practice. Med-surg is a great place to be as long as you remained challenged. It also offers you stability while you learn a new role.
The PA route is totally different and comes with it's own benefits and drawbacks. Remember that for PA school you'd need to quit your job while NP school you may be able to continue to work in some capacity.
I'm not a medical assistant but I employ five of them in my primary care clinic. Our full time medical assistants work Mon to Friday 8 hour days and have weekends and holidays off. They have benefits like heath insurance and a 401k match.
The pay is less than an LPN but it would be much easier to get a Monday through Friday clinic job as a MA. The cost/investment in education is also less than an LPN as well which may factor in to your decision at 40 years old.
My one word of caution would be: if you are stressed out as a pharmacy tech, you are also goign to be stressed out as a MA. It is intense work and is anxiety provoking.
1. There are no preservatives in single-dose formulations.
2. You don't seem to understand rudimentary principles of toxicity after 46.5 years.
3. Here are some other "neurotoxins" to avoid to be safe: food, water, air, and alcohol.
Simple example: You are working as an NP on 1/1/2019 and you have an active malpractice policy. Five years later, you are sued by a patient for malpractice from your visit that day. It is now the year 2024 and you don't have malpractice because you are doing something different.
Claims-made only covers you while your policy is active. You would not be covered for this lawsuit.
Occurrence covers anything that occurred while your policy was active regardless of when the suit is filed. You would be covered for this lawsuit.
Tail-coverage can be purchased at the end of a claims-made policy which would cover a lawsuit filed after your claims-made policy ended.
NSO or AANP both offer decent prices on coverage.
Remember there are different types of coverage and different limits you can choose. The most stark difference is between claims-made and occurrence policies.
You do want to check through the exclusions as well as you don't want to be paying for coverage that excludes you.
You can't appeal a decision that hasn't been made; hope it just works out for you without the hassle. If there is a rejection, get a lawyer.
I am far from a legal or BON expert but this is very curious, hope you post once you know more to let us know what happened. I have only heard of this when applicants have been dishonest on their licensing application.
Did you fill out a Certification of Professional Education Form?
I wonder if the BON is investigating your academic qualification, essentially verifying you attended and graduated from a valid nursing program. If you attended the closed school in 2008 you would be eligible to take the NCLEX-PN, then you could try to apply for a license with a board pass and fraudulent academic records. They would need to verify that your educational qualifications are legitimate, though I think that submission of transcripts occurs automatically in NY.