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myoglobin

myoglobin ASN, BSN, MSN

ICU, trauma, neuro
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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

"When the mob and the press and the whole world tell you to move, your job is to plant yourself like a tree by the river of truth, and tell the whole world "No you Move"...

myoglobin's Latest Activity

  1. myoglobin

    Is it an ethical violation to quit a job before you start?

    Well I’m certainly not a troll and like all of God’s creation certainly broken. All I can say is that I graduated at the top of my class. Never, paid a bill late in the last decade (yes that is about to change and my credit score is poor due to credit utilization). Never slept with another person besides my SO. Never drank alcohol or did drugs or was arrested Or even had a speeding ticket . Held a tough ICU job that saw about 90 percent turnover. Maybe, it’s just that everyone else hear is perfect. I have always tried to support others on this forum even when I disagreed with their perspective ( and will continue to do so). If I am unfit to help others as a prescribing professional then I dare say that the mental health shortage is even more dire than commonly understood. There is a reason that they say “nurses eat their own” and if these responses represent a consensus opinion then that spirit is in no short supply here. Heck, I’ve just seen a string of applicants struggling with challenges ranging from heroine abuse to molestation (a job I don’t even expect to be paid for) and managed to be far more optimistic and encouraging to my clients than some on this venue. I’m not sure why Fullglass and others started calling me bonkers only at the point that I mentioned that I also had an RN job offer ( as another option) and that I had extensively read Dave Ramsey’s work (in fact I gave one of his books Total Money Makeover to my SO in the mid 1990’s), But pointed out legitimate challenges that I faced in implementing his advice.
  2. myoglobin

    Is it an ethical violation to quit a job before you start?

    Why would the information in the above statement cause you to arrive at that conclusion when the proceeding information did not? To me having multiple jobs lined up is perhaps one of the most financially sensible things that I’ve done. All to often a solid job offer or “sure thing” evaporates in the realities of the business world. In any case my priority is my finances rather than my mental or physical fitness. Indeed, I would argue that anyone who wasn’t severely stressed by my circumstances wouldn’t be in touch with reality. I will strive to maintain my daily workouts, SAM-e, IF, and Saint John’s wort, and omega 3’s as best I can afford.
  3. myoglobin

    Is it an ethical violation to quit a job before you start?

    The 4th job would replace the other two it would thus be my second job. I thought that since I was moving across the United States with no friends, family or credit that I at least should have several job opportunities lined up. One reason that I chose Seattle is because of the relative high demand for PMHNP’s, along with RN’s, public transport, and abundant affordable housing (at least when it comes to Airbnb). I also felt that it was possible that the Mindful 10k bonus wouldn’t happen (which I was correct about) and that the Pontum job wouldn’t therefore work. Also Lightheart told me that they couldn’t even start on my insurance paneling until Mindful had first paneled me with their companies. It turns out that they already have me booked with at least 5-10 clients willing to pay cash and their only other prescribing clinician isn’t taking any more clients. I was kind of subscribing to the “in the land of the blind the one eyed hermit can be king” philosophy or at least sufficiently successful to gain experience and pay down debt. Also someone mentioned Dave Ramsey. I’ve probably read and listened to him enough that I could teach one of his courses. However, the fact that my SO (of about 25 years) and I maintain separate finances and have fundamentally different long term goals creates unique challenges to implementing his approach (starting with the fact I won’t work as an NP or RN in Florida and she won’t live anywhere except for Florida since our 19 year old son just started college there).
  4. myoglobin

    Is it an ethical violation to quit a job before you start?

    I worry about being able to do well on the exams as well which is why I tried to quit the job over a week ago. It would have been one thing to have done the exams when I was only working three 10’s with Mindful (thanks to the bonus money), but quite another with the additional two days with Lightheart. One would think that Pontum would care as well since they have been doing this for almost a decade for the state of Washington and have many, many providers doing these all over the state. At least the disability clients can count on getting the most favorable interpretation of their symptoms that is possible based upon the facts. In general I believe that if someone is sufficiently desperate to apply for disability that they probably deserve it. As for the residents they have often told me that they are scheduled for six 12’s per week with additional call responsibilities and with other coursework are often well over 100 hours per week (this is through UCF) in Florida. Also not to complicate matters further, but I also have a psych RN offer at a place called Wellfound for $57.00 per hour prn working Friday and Sat. in patient from 7pm to 7am (probably less than the 70 percent of insurance that Lightheart they said most of their NP’s earn well over 100.00 per hour once credentialed, would pay and there would be no 3 k advance, and obviously I would have to run afoul of Pontum since Wellfound would need me in two weeks. Still $57 is much more than the 42.00 that I was earning as an ICU RN in Florida)
  5. myoglobin

    Is it an ethical violation to quit a job before you start?

    Very simply I was rather shocked when Pontum threatened my license on an ethical basis for wanting to pull out of the disability exams. Shocked to the point where I basically told them “I disagree, but maybe I’m wrong and cannot afford to be wrong so you win I will do my best to do the exams as you request”. However, it continued (continues) to eat at me which is why I posted here. Thus, I thought someone might have experienced a similar scenario that would perhaps shed light upon my situation. If the overwhelming opinion was “there is no way the BON would pull your license for not doing the exams” well then I might tell Pontum “sorry no I will do this week and no more as I need to focus on my main jobs”. I might still worry about a breech of contract lawsuit and what implications it might have for my liability insurance rates. But I would worry less. As to whether anyone thinks I “have what it takes” to provide adequate care that is a different matter ( and not a question that I asked for an opinion upon). I have met the requirements for the states of Washington, Florida, Colorado, and Arizona and will do my upmost to provide the best evidence based care of which I am capable. I don’t really care about empathy, sympathy or friendship just perspectives that may improve my ability to make the best decision with Pontum given the less than optimal facts and circumstances. At this point I haven’t walked away from anything. In fact I’m four hours away from Seattle staying in a cheap Airbnb (but with nice cats) and planning on getting up at 0500 to do Pontum’s exams which I will somehow find about 12 hours or more to write up this week and or end up turning in late and at a standard that is less than optimal.
  6. myoglobin

    Is it an ethical violation to quit a job before you start?

    I have been a member here for almost ten years and my posts while not perfect stand for themselves. Yes, I am a new NP, but I've been an ICU RN for over a decade. Also, I think I've been clear, I owe alot of money between credit cards and school loans so yes earning a sufficient income is important. I don't think that wanting to pay that down (or at least be able to pay it plus send my SO the money that she came to rely upon when I was working as an RN) is greed it is rather a matter of trying to meet my responsibilities and be in a position financially to meet the ongoing need of my family (and my clients). I'm not sure why you are so against 1099. the last ten years of my nursing career as an RN have essentially been 1099 (W-2 non-benefitted). Keep in mind that I only want to work ONE part time job. Pontum threatened my license for trying to cancel what would be the SECOND part time job (three jobs total). I would also point out that virtually every resident (dozens to hundreds ?) that I worked with at Osceola Regional over the last five years (since we became a teaching facility) was working almost (or in some cases more with outside employment) 100 hours per week. Having said that my full time job with Mindful and my Part time job(s) with LightHeart would total about 50 hours per week. The additional shifts with Pontum are a challenge (note the disability exams are at least computerized and the records review perfunctory mostly a matter of listing the records you reviewed, the dates, and authors and they are all online and attached to the fill in the blank computer files that I complete for the exam). My point is that I moved not only to make money for bills, but also because it is something of an "immersion" experience. No TV, no friends, no family, I already practice IF only eating in a 4 hour window and I am done with school for now so my ability to dedicate a great deal of time towards work isn't overstated. I'm sure that I will make mistakes with my clients (just last week for example I wrote for Trazodone and didn't realize that it didn't come in 25mg tabs only 50 mg meaning the script had to be modified but at least she was started on CBT-I which is available at Mindful, and Trazadone rather than the Ambien with no therapy which was the norm where I did clinical in school), but I will learn from these mistakes and improve. Also, consider that in the case of many of my clients they have been waiting for ANYONE who can prescribe anything for in some cases over a year. Perhaps, my best efforts will be "worse than nothing", but that is not probable. Also, keep in mind that I have worked through thousands of cases with my SO and will discuss most cases with her individually on a nightly basis (in general terms with privacy protected). Several of the people that I graduated with in 2019 who work in non IP states tell me that they maybe get to talk to their collaborating physician "once" per month if they are fortunate and then it is more about administrative than clinical matters. Also, LightHeart has a DNP in the office next to me and mandatory biweekly clinical meetings. The point being that there are abundant opportunities to improve my practice. Perhaps not completely ideal, but still better than what many have/had (including again my SO who no one but me to consult with when she was new).
  7. myoglobin

    Is it an ethical violation to quit a job before you start?

    I appreciate your perspective but would encourage you to consider that there are multiple perspectives as well that may be valid. I would ask that you consider that there are multiple paths to ultimately becoming a reasonable provider. For example I explained how my SO has been a PMHNP since 2016 and started in telepsych with essentially no support. I would argue that she provides top notch care considering the resources she has to use (her clients are mainly Medicaid in Arizona, most with substance abuse issues, and no access to counseling). Also as I previously explained the New York job didn't make an offer for almost two months after I interviewed. They didn't like the fact that I would be moving without my family. By then I was far along the process for the Seattle job. There was also the fact that my SO said that if I took the New York job I could essentially forget her even coming to see me once per month from Oct to May as she doesn't like the cold. Of course being a good NP is more than about following algorithms and I'm sure there are excellent MD's who understand that. However, many of the ones that I worked with at least in central Florida were forced to see a "mob" of patients in 15 minute intervals for medication management who were often on multiple benzo's, often combined with opioid medications, muscle relaxants, antipsychotics,, and other medications. At my clinical site patients had to often wait two hours to be seen and we literally had to put them by the elevators because our office was so full. My preceptor didn't take a lunch, and usually worked at least one to two hours after close (and the patients still backed up). If your experience has been better then I'm grateful for that. However, it is difficult to imagine the mental health challenges in the Kissimmee Florida area without being here. Having said that I was mainly asking for help with a specific situation with Pontum (could they legitimately hold my license to task for not starting a job). I did read the contract and there was absolutely nothing about notification terms for quitting. The advice that you gave concerning my other jobs while appreciated was non responsive to my main concern. I really like Mindful and they are one of the leading mental health care providers in the greater Seattle area. I also really like LightHeart (the job I hope to work on Friday and Saturday's). True, the bonus issue is unfortunate, and something of a red flag, but to me it doesn't overcome all of the many other positives (great pay, ability to control who I see and for how long, nice working environment, good office support). Again, to me your response would be like a came to the doctor to ask about a sinus infection and instead you're telling me I need to move to Arizona to live out my final days with TB. If I didn't have the "Pontum" issue having Sunday's and Wednesday off to focus on "lagging/learning" issues from my other jobs would be mostly sufficient. Especially, since I have literally nothing else to do here (in Seattle) besides work, and exercise. I don't mind putting in 100 plus weeks toward my job(s).
  8. myoglobin

    HR wants meeting or report me to BON

    Also in the future it may help to have a strict policy of always having waste witnessed before giving a med. Personally, it wouldn’t matter if my dying mother were screaming in pain the waste gets witnessed before the med leaves the Pixus area. Also getting a serum and hair drug test now may be worthwhile to demonstrate you were not using if your attorney agrees.
  9. myoglobin

    Is it an ethical violation to quit a job before you start?

    The job that I want to keep originally offered the bonus when I talked to the owner, but withdrew the offer at the time of the contract signing. It is still a great company and a good deal it’s just that my “cash flow” and part time job strategy has to reflect the shortfall. Meaning that I need to earn more than what the disability exams would pay.
  10. myoglobin

    Is it an ethical violation to quit a job before you start?

    Those are really good resources. Sincere thanks.
  11. myoglobin

    HR wants meeting or report me to BON

    So all of you out there who are always saying "I don't need a union". How do you feel about that sentiment in light of situationslike this? In a union facility not only would her representative have been present, but the hospital would have the burden of showing that they "terminated" other nurses who made the same errors (requiring lengthy and tedious record examinations), which they probably didn't. It is too bad that you could not have taken an attorney and served them with paperwork for defamation and libel. These corporate cowards make me sick. They overload nurses with impossible workloads, outdated equipment, and inadequate systems and then not only do they "throw them under the bus" when the inevitable errors occur they want to turn their system error into a criminal offense on the part of the nurse. There is no grave to shallow for these jerks.
  12. myoglobin

    Is it an ethical violation to quit a job before you start?

    Except that the company indicated that if I did not complete the shifts I signed up for that they would not only sue for breech of contract but also file ethical complaints with the BON against my license. So at least from their perspective it is an ethical issue.
  13. myoglobin

    Is it an ethical violation to quit a job before you start?

    It hurt when she said that "I didn't care about her". I guess because I do, but restarting her on something that even she acknowledged had "helped mess her up" would make me part of the problem (especially after she had been off the drug for three months).
  14. myoglobin

    Is it an ethical violation to quit a job before you start?

    I did talk to several of their NP's earning well over 200K who told me they were "full" within 90 days of employment (on their schedule). Most of the practices in the Washington area either pay around (70%) and charge fees or are "community health" and pay more like 130K. Most are owned by Psychologists or counselors (rather than MD's) and have something like 10 counselors for every prescriber (unlike Florida where there are typically many more prescribers than counselors making it often difficult or impossible to find effective counseling for clients). I am not complaining about my primary job or their contract. I believe I have a good opportunity to make a go of it (and it would have been even better with the rock solid paycheck as a Psych RN working Fri/Sat nights which doesn't seem possible with the disability exams on Sundays). I also pretty much gave up my credit rating (I will go at least 60 days late on my credit cards and possibly even my 26 year relationship for this opportunity especially if I fail). This was a high risk reward endeavor I knew that going in it's just that this complication (Pontum) creates additional challenges.
  15. myoglobin

    Is it an ethical violation to quit a job before you start?

    Good advice but: a. I am in a contract with Mindful Therapy. If I terminate the contract I owe them $1000 plus $600 per month for every month left on the contract (12 months) and I forfeit the fees that I have paid to them (about $1000.00). Also they would probably consider me ethically bound to give notice to the clients that I am seeing there (I saw five yesterday as new intakes). Also, they consider three ten hour days (in my case Monday, Tuesday, and Wed) as full time. Also, they are rapidly filling my schedule and may do so even faster once more insurances become "paneled". b. On Friday/Saturday (since I cannot work the RN/Psych position since I have to do the Sunday disability exams) I will probably go with a second company as a Psych NP (in Redmon) since they have promised a $3,000 advance, pay 70%, and don't charge any fees (and they have already booked me six new intakes for this Saturday). Of course Pontum health is requiring me to do the disability exams on Sunday's under pain of a lawsuit and allegation against my ARNP/RN license in Washington (I am poor, so they would win by default given that I cannot afford representation other than through my liability insurance, and in any case that is a battle I do not wish to fight). c. I am "renting a room" for about $1,200 per month in the Seattle area. There are many options (albeit Spartan) on Airbnb in the $900 to $1200.00 price range). My significant other has made it clear that she will not be helping with money so if I fail I will literally be sleeping in my mini van and showering at Anytime Fitness (provided I can continue to pay their $30.00 per month fee).
  16. myoglobin

    Is it an ethical violation to quit a job before you start?

    When my current Seattle job called last December (I had already tentatively accepted a 100/hr job in Flagstaff Arizona that would have let me work 45 hours per week at a place called Phoenix mental health (they are a great company if anyone is looking for a PMHNP job and it is a nice place to like if you life the out-doors). Anyway, my current "Monday, Tuesday, Thur" gig seduced me with their insurance reimbursement rates (about $150.00 for 30 minute med management) and their 70% split (less about $600 in monthly fees), oh and the 10 K bonus (which their attorney's later told them would violate the 1099 relationship in Washington). I didn't realize that the credentialing process would take so long, and they had planned to have me credentialed when I started today (I'm still cash only until March 01 and then I should gradually pick up insurance companies over the next several months). The whole selling point of their "being the biggest company in the Seattle market" and having 1000's of referrals per month was seductive (Oh and the fact that most of their NP's were earning 175-250K per year working four days per week). Anyway, it may have been a poor decision. As for the New York gig they flew me up in early Nov and didn't make an offer until early Jan, By then I had already paid for a Washington State DEA and many other fees in the licensing process. As it is I'm licensed in Florida Colorado, Arizona and Washington. I need to work, work, work rather than obtain more licenses. As for California it would probably take me a solid six months to get through the RN, NP, furnishing, DEA process and I would probably be living in homeless shelters by then (as for the landlord I'm strictly living in AirBnb extra rooms for about 1K per month, there is no such thing as mercy or late rent with AirBnb).
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