pkapple

I am a per diem ER nurse, having trouble with Meditech. Would anyone know of or be willing to share a simple step by step walk thru of a patient in ER??? No problem with pt care, just the documentation keys and entries. Thanks

Opti.. The best way for you to figure this is simply to eliminate the % amount of NY state tax. Your example would not hold true, ie claim married 5 or claim single 0, however both state and federal are % values, not flat percent, but based on tax brackets.....gets confusing, huh. You can go to a web page to figure this out. Try one to calculate nanny tax or some such search. I am pretty sure NY state tax will not offset an $8 an hour pay dif.

Ok folks, from the ops profile -education is as an lpn/lvn. It does not say what state she is in, but many states only allow lpn iv cert after taking a class. Here in FL it is required that an lpn take a 30 hour course and get supervised sign offs, even then it is still up to facility policy how and when an lpn does iv starts/meds. Don't ever feel stupid gradnurse. You will only learn by watching, listening and doing. Check with your facility policy and if lpns need a class-ask your NM about taking one.

twist, clip, pin, headband,pony..anything that keeps it from hanging over pts or in unamed yuck. Hard to start an IV with long or half bangs across your visual field, too. Your school will have a strict clinical policy re: hair, nails, and jewelry.

I did a stint in Home Health as a newcomer to a small town...everyone asked how I liked living in the ole Taylor place, if my son enjoyed Mrs Denman's 3rd grade class, etc, etc....apparently very few people moved there!!!!! I now live in a small town (work ER, DH is PA-c) everywhere we go some one says how nice our house,lawn,garden is looking... it's just part of small town life. DH always smiles and shows interest then tells them to make an appt on monday If you were in Law Enforcement, they'd ask about legal matters!!! Just let them know up front who to call after hours for questions and explain ever so nicely that you are not allowed to give advise or "help out" when off duty. Who knows you may meet a lovely new neighbor and really enjoy the relationship!!!

Visitors are a problem here in the panhandle, too. But the ones that drive me batty are the locals who show up at 3am and smile sweetly...you have my records here. UHHH no I don't, and even if I could find your last visit(we don't have med rec or even a sec at night) it would most likely not be current, esp since you seem to come here often, so sorry your doc isn't open at 3am. How crass of him, he should know you would never go see him until your ear/bugbite was at least 4 days old and you couldn't sleep!!!! I am advising every patient Isee to fill out and carry a med list and allergy list...hx would be nice, but at least we get an idea from the meds.

I always "dress up" for an interview, well except telephone interviews-lol. I have been a nurse for over 20 years and have gotten all but 2 jobs I interviewed for. I almost always wear nice slacks/skirt and a jacket. Really make sure you wear nice shoes-male or female. A tie would be important for a management/supervisor level, staff nurse maybe not so much. But I agree you really can't overdress as long as its professional attire. The worst attire is no socks!!!!! Oh get a manicure-guy style-not fru-fru it really amkes a good impression in nursing or any other field to have impeccable hygeine!!! good luck

Oh dear..seems I remember we as nurses have to be very careful not to make a 500 pound pt feel "bad" when we about kill ourselves turning them. And didn't they make obesity a disability.....oooh the lawsuits will be so much fun, and since HTN is more prevalent in young men of black/african descent maybe Al Sharpton could help out!!!! This is getting out of hand, yes smoking is preventable, but like the sunburn when you were 10, the smoke and pollution yuo inhaled from birth won't go away!

Best of my recollection...HHA can't see pt on day of discharge-not billable, we always saw pt next day to do intake/admit. HHA can see and eval pt prior to discharge so to have everything in place. No patient should ever be discharged without instructions, and a pt is not transferred to HHA, they are discharged and HHA is providing some services to them, pt/family will need to give meds, transfer to toilet..whatever it takes. Nurse can set up med box and perhaps they qualify for an aide to bathe a couple times a week, but incontinence etc falls to the family caregiver--Hospice can provide some heavier care, but 24/7 care is self pay or back to the LTC. Your charting was litigation fuel or at the least State survey ammo. Perhaps something along the lines of ..Pt returned for clarification of home regime, meds,wound care. Husband present, instructed and return demo given with good understanding verbalized. In a separate narrative or even a variance report I would of listed the rest of it. And verify when HHA will see a patient before thay are discharged so the family will not be frantic or confused. You should not have been fired for this, you should have been counselled unless your charting has been questioned before. You could fight this, I am sure you have a mediation/greivance process in place at your facility, do not ask for your job back, instead ask to have your dismissal listed as voluntary and 2-4 weeks pay, since you should have been warned or placed on probation and that would have been 30 days. You don't need a lawyer for that, but if they are not providing you with some satisfaction by all means call one, and let them know that is your plan. Good Luck When applying for the new job, personal differences is acceptable as a reason. Don't give any administrative people as ref, and ask your charge nurse or house supervisor if they will give you a personal ref.

Ideally a float would be lateral or previously experienced, then maybe the ER nurse-but ER can't give up a nurse, they are usually short anyway. A tele nurse should have basic knowledge of critical patients, since many tele patients were in icu just 5 seconds before they became a tele pt. Any ICU that was so short they needed a float nurse-really needs that nurse, and tele is probably the best choice for safe care. I am certain the assignment would be the most stable, or least likely to crump patients

You were right to transfer. You felt unsafe in that position, and are now out of it. Good luck with your neww position.

Never got time and a half for coming in, we did get on call or standby pay and then regular pay if we came in to work.This usually occurred due to low census--but we usually had a list of nurses wanting the time off! The exception s were the traditional on call type jobs, nights/weekends in the OR or PACU. Then it was a whole preset pay scale--callback pay, certain number of hours minimum, extra time off if worked all night etc.

Julia, Sounds like you have more issues here than just a schedule change. You obviously do not like your job-the charge nurse being your biggest concern. the best way to deal with that-if is not just personality problems-is to document everything. IE very busy shift, requested charge to assist with med pass while soothing/cleansing agitated and confused pt for the 3rd time in an hour; charge talking on phone, doing crossword puzzle at desk aides and myself extremely busy and pt care affected, etc etc. Remeber you can complain and report all you want, but you need to keep a record, maybe turn it in weekly if there are that many concerns. As for your schedule change, we all like our scheduled rotations to stay the same, but, unless you have a written contract that says Julia will work the set A rotation on day shift with alternating holiday coverage affecting schedule changes or something similar, you're basically at the manager/schedulers mercy. Most rotations were created to make the schedulers job easier, she only needs to fill vacation requests and arrange to cover illnesses. Technically you were hired for a fulltime slot, I am sure somewhere it says what your shift difs are, it may state you will alternate weekends, at any rate you could be scheduled with any combination of days/nights/weekends etc and still earn your fulltime status hours! All that said pick your battle--is it the charge nurse or the rotaion change that bothers you most, address your priority with the manager. Good Luck

It all depends on the hospital. Call or stop by some in your area and ask the HR or ER manager

The cheaper coa used to be true, but it keeps getting repeated ad nauseum and keeps the wages low! Don't know any bank that reduces your car payment, credit cards or mortgage rate cause you're in sunnyFL!! And speaking of mortgages.....houses are not cheap here, apartments are getting outrageous and insurance is going thru the roof, if you can get it! And hey--CA and TX have some beaches and golf courses, too, oh and wages are well um quite a bit higher.

Traveled for years before TaxAdvantage was being given. In order to claim the perdiem expense --you must not be reimbursed(lol) and need to accrue actual expenses or utilize the accepted perdiem rates(see IRs webpage fro links) SOOOO the 99 bucks a day is acceptable rate for the area and is allowable--but you can not claim any deduction since thay are giving it to you. Kinda like having your insurance and 401k taken in pre-tax dollars instead of figuring it all out with the annual 1040 junk. You must be at least 50 miles from home to qualify--local agency/travel does not qualify, so all earnings are legally taxable. Now the get around it sometimes works if you stay with a friend or relative for free and get the housing allowance, but is actually the most legal if you use the money for housing. The meal portion is an allowance that is easier to take pretax cause otherwise you have to keep every receipt for every meal and then only 50% will be used at tax time on your itemized deductions or business expenses. Think of all the allowance as your expense account, do not add it in to your hourly wage!! if you are getting 14.00 its 14.00! you still have a car payment etc. and should be maintaining a home elsewhere. All that being said, I loved traveling and did make good money, now tho it seems the pay is nearly the same as staff wages-sure you get the apartment so its cheaper cost of living, but used to be a traveler got the housing and still made 10 bucks more than staff!!!! Why do you think they resented travel nurses(wink) Been on both sides!

My hospital has finally gotten all of our LPN's fully med certified. Now they are getting approval/policy for IV push meds. So far all the bigwigs are looking to approve are : Lasix, Phenergan, Benedryl, Solu-medrol, and maybe Toradol. What drugs can you all push? and what hospital or part of the state are you in? Abx and piggybacks are approved pretty much across the board, but we need to improve the push meds selection, so need your input. Thanks

my DH had similar op but C5-6 only on June 3 and was cleared for full duty on NOv 12. This was several years ago, he took Vioxx as needed esp after a long trying day, but had no restrictions. Has your doctor not cleared you to go back to work? Do you have a lawsuit pending for disability charges against the other driver or insurance company? If not I do not see a problem here.

don't feel bad over getting that shift if it is something you want. The other staff members may be upset, and rightfully so if they are waiting for a dayshift job. However no one should blame you for taking the shift. I have been on both sides of this and currently am really p--d off over yet another day shift going to a new hire....but it is not her fault, management is just completely inept and the er docs wont work with the new inexperienced staff at night---only one RN---catch-22 I guess... Any way if some one is less than friendly towards you, just be even nicer to them and remember it was not your decision Good Luck with the state

I live on both sides of this. I work nights in the ER, my DH is aPA-C and last night(my night off!) got 6, yes 6 phone calls from the same nurse. He only had 2 patients in the hospital! Does he get nasty? NO Did he give this nurse q1h VS/neuro checks with parameters at 0030-you betcha! Pt (70) roams the halls all night, not really a fall risk or a wanderer, just anold night worker who still sleeps days.--The other pt and 2 calls at 8pm and 0530 were appropriate and warranted orders for meds/labs. Oh, this nurse really wants all her patients asleep by 2200, guess they all need sleepers, and repeat sleepers, well maybe something stronger--you get the idea!! LOL

slightly off topic, but, an LPN is your ADON? What state are you in? My sister in FL was temporarily placed in this position and AHCA fined the facility! An LPN can not supervise RN's in FL. on topic, I agree and see it all the time. Day shift missed items, NOC's must fix it and visa versa. The MAR's etc must be corrected, updated and completed before you leave. Point out to ADON errors that occur, but you are responsible to leave correct orders etc for the next shift.

Mommy2-there are probably a kazillion jobs that would fit the bill! Have you looked into your county health dept, planned parenthood type places, ob docs offices-most of these pay a bit less, but benefits could be better. How about management or education department right in your current hospital-might require a higher degree, but usually M-F jobs. Employee health, school nursing, some exclusive private care for a rich lady going to europe---oh not that one, lol! Seriously, look into jobs you are qualified for or can easily work into, if the M-F shift is what you need, look for oppurtunities all around your community. If a more advanced level of practice is what you are after, go for it...just remeber a lot of midlevels do take call, especially in OB field. My DH is now a PA-c, he loves it, but in this small town, he is on call virtually 24/7, and makes hospital rounds after work and on weekends! Good Luck--you will find the perfect spot for yourself, give it some thought and try on some new jobs.

starting as a CNA could really help you decide! After all they get pure patient care, if you find you don't like bathing, ambulating, answering call lights and all the other "dirty" aspects of nursing care...well as a nurse you do all that and the more advanced meds, treatments, planning, and the ever popular paperwork. you will build on your knowledge as go thru school and the more you see and learn the better start you will have as a nurse. If you get part way or even fully thru the program and decide nursing is not for you, so be it. Remeber, there are so many levels and opportunities for nurses that I am sure you will find a niche. Good Luck

When I have a pt complaining about d/c, I can usually just smile sympathetically and get them out. Now if they are really obnoxious or insistant, I get the doc to go talk with them-that way if they have a question or concern he can adress it and/or tell them that's all ya get buddy-go home. I also document that doc adressed concerns in nurses note and hopefully it was reflected in doc notes. As for the phenergan cost basis: we charge for the drug, so no matter how its given there is a drug charge, needles, syringes and saline are not charged out. I really cant see saline dilutant and a flush costing much.The least invasive route for a pt with an iv is iv push, we always put an iv in if we draw blood-so a better argument is the vesicant effects not cost this time around.

Thanks David--I think the E&M codes are the provider codes, right? Well our docs bill their own fees. We have to charge the er part of the visit.It doesn't matter if a lac is 2cm or 6 cm, it matters how many resources are used. Like a suture, tetorifice and dressing with suture teaching, no xr, no lab would be a level2 on our old ER chg I just need guidelines to be correctly charging and consistently charging from one shift/nurse to another.