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Urgent Care, Oncology

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DowntheRiver has 7 years experience and specializes in Urgent Care, Oncology.

The Perpetual Student - MSN Ed. Candidate 2021

“All of us take pride and pleasure in the fact that we are unique, but I'm afraid that when all is said and done the police are right: it all comes down to fingerprints.” 
― David Sedaris

DowntheRiver's Latest Activity

  1. Do not tell your employer. This is what happens: You do your drug screen. It gets sent out. You test positive for amphetamines. The organization's MRO (Medical Review Officer) calls you and tells you it was positive. You tell that person you have a legal RX for the amphetamine. They will ask for the prescriber's name and phone number, a copy of the RX bottle, and/or the pharmacy info for where it was filled. The MRO then verifies the RX. If it is legit, that positive is turned into a negative. If it is an instant cup, Occupational Health will find out, but again that positive will turn into a negative as they will send it out and the MRO will follow the same procedure. Occ Health cannot say anything to your manager/HR unless it is a confirmed positive.
  2. DowntheRiver

    I made a mistake!

    We just finished the Peacock series Dr. Death yesterday based on a true story. The documentary about this guy is coming out soon, and there is a good podcast about him. Chris Duntsch. Anytime you're feeling silly about an honest mistake, think about this man. He purposely operated on 40 patients, injuring 31 and killing 2. He either knew his skills were subpar or he harmed them on purpose; either way, he still went through with it every time. He was convicted of elder abuse (one of his patients was over 65) and is now spending 30 years in jail. There are people out there that truly mean to harm someone. What you did was a minor mistake, no harm was done, and maybe some patients waited a bit longer because of it. Don't beat yourself up. Every nurse has made a mistake, some minor and/or major. They're lying if they say they haven't. You realize it, learn from it, and move on.
  3. DowntheRiver

    Nurses, invent what you want.

    I work in Oncology and have been a cancer patient myself so I know firsthand how awful saline flushes taste when you're nauseous. I mean, this applies to non-cancer patients as well, but for some reason it was just worsened when I had cancer. It doesn't bother me as much now. So, finding away for saline flushes to have no after taste. I've been told it is a combination of several things: - The plastic leeches chemicals into the saline which causes the unpleasant taste - The fact that it goes past the olfactory nerve so you are smelling it and not tasting it -Microscopic molecules in the saline flush I do tell patients to suck on mints or hard candies but patients who are NPO can't do that so we still have patients who experience it. Is this issue life ending? No. But some people get real cranky about it and I wish I could do something about it permanently.
  4. DowntheRiver

    Getting Fired

    Since you live in Florida, I'd suggest the Health Department for you. Monday through Friday 8-4:30 with excellent benefits - I paid $50/month for just me with a $500 deductible with great coverage. It really is easy work and you get holidays off. The only down side is you have to manage medical shelters whenever a natural disaster comes through but you get credit in the form of PTO for AND they do actually let you take it. The pay depends the area of Florida you live in. If that doesn't sound great, I'd suggest your local FQHC. Again Monday through Friday business hours and no holidays. Pay is OK. If that doesn't sound great, I'd suggest corrections. I don't know much about it but it would be worth looking into.
  5. I don't see it going away here in Florida anytime soon. Only 42% vaccination rate in my county but 99% of people are not wearing anywhere we go. That 1% is usually me and my husband or family, and we wear them despite being fully vaccinated. I'm 33 weeks pregnant and high risk.
  6. DowntheRiver

    Things I wish my patients understood

    I also cannot control the cable package the hospital subscribes to. I'm sorry we don't have HBO, DVR, etc. and that you're going to miss your show. But it's not my problem and is not even on my priority list. When I worked outpatient, I also could no control the TV channel in the waiting area. The rule was it had to be politically and gender neutral so we were only allowed three stations - Food Network, HGTV, or the Weather Channel. No, I cannot turn on Fox News.
  7. I've been in this situation. Not narcs, but the manager making stuff up. Get out. You'll be happier in the long run.
  8. DowntheRiver

    9-5 (or 8-5) shifts as a new grad possible?

    I was thinking about this, too. As student nurses, we had to be there by 6:30 AM and ready to hit the floor at 6:45 AM for report with our paired nurse. For me, that meant being up at 5:15 and out the door by 6:00 without kids. We had to look presentable, too; if you looked sloppy or disheveled you were sent home with an absence. This was 2012-2013, so not too long ago. All schools are different and some are more or less strict than others, however keep in mind most have a one or two day absence policy where you fail if you miss those days. It's because the state requires a certain number of clinical clock hours for you to graduate. Some schools will allow make-ups with health notes but lacking childcare or sick child is not one of them. I'm not trying to be mean, just trying to let you know what I've seen in my experience while you have time to form a more concrete plan.
  9. DowntheRiver

    Achieve Test Prep for CNA to RN

    You have to be very dedicated and studious to pass CLEP exams. I took both US History I & II and only managed a passing score on one. It's funny, where I took the US History I exam at USF a 55 was needed to pass; UTA required a 60 and I made a 58. So be well-versed at what scores each individual school requires because they're not all the same. I spent my free time reading and re-reading the CLEP books for the test and it covered a wide range of topics, but 25% of what was on the test was not covered in the book and I had to rely on my knowledge from high school. If I were in your wife's situation, I would start the LPN program. It's one year and she can study independently for CLEP exams or start studying once she becomes a LPN. Then do the LPN to RN bridge program. Around here, there is no wait for LPN programs but long waits for RN programs.
  10. DowntheRiver

    Getting Flack For Not Getting Covid Vaccine

    None of my five nurse and one pharmacist coworkers got the vaccine. They pulled their masks down and off quite frequently during shift. They do not practice social distancing in their free time. One actually took a trip, brought back COVID, and have an event where 15 people got sick. Came to work for 3 days before getting the positive. We work in an Oncology setting with immunocompromised and elderly patients. We'd have 16-20 patients in infusion at any time. I found it incredibly selfish, to be honest. I'm a little sour because I became pregnant and my co-workers knew this. I'm a cancer survivor and have an autoimmune disorder. So, I can sit here and say woe is me, but what about the 16-20 different patients that were treated each day that are already fighting for their lives? When did we stop caring about others and what effect our actions will have on them? I ended up quitting my job. Too risky. Now they're short. I did get vaccinated at 13+4 with the Pfizer. Not looking forward to March 4th but at least then I hope to have some freedom to go to the grocery store other than at 7 AM or 9 PM. OK. End rant. Feel slightly better having gotten it out.
  11. DowntheRiver

    Late for Practicum

    I need more info: - Have you been late before, or was this the first time? - Have you previously clashed or had an issue with this preceptor or clinical site?
  12. DowntheRiver

    I'm Overly Stressed Now

    As other, more wiser nurses have said here before - research your state's BON for why nurses lost their license. Not having an aid go to the hospital with your mother where there are competent staff to care for her is not going to be one of them. Even if she makes the complaint and the board investigates, you did the right thing by sending her to the ER! The board is looking for incompetence. The only thing you have to worry about is possibly losing your job. If they're making such a big deal about it then I don't think you want to work there. I'd start putting your feelers out to see what else is out there now. There are TONS of vaccine nurse jobs open nationwide that pay well, even if they are temporary.
  13. DowntheRiver

    Taped by a patient

    I live in Florida and had a patient's daughter tape our phone conversation without my consent. It wasn't a big deal what I goofed on, I gave a Wednesday date instead of a Thursday date for treatment supposedly. I only found out when I called to see why the patient missed treatment and she said "oh, I went back and listened to the convo because I record everything, you said Thursday not Wednesday." My documentation in the computer said Wednesday, though. I do recall us going back and forth on dates, so it could have been my bad. At that point I just informed her it was illegal in the state of Florida to record someone without both their consent. I sent her to the manager. Apparently the patient's daughter had a habit of recording things without anyone's consent so from there on out she was only allowed to speak to the manager. But, management did back me up.
  14. I stopped feeling guilty calling out when employers refused to properly staff. Before I left my job, I was burnt out. We all were. 3 of us quit in the same week. At my last job (outpatient infusion), we were supposed to be 10 patients to 1 nurse. We were so short that we were typically averaging 15 patients to 1 nurse. This had been going on for six months with no end in sight. Keep in mind, we're handling and administering hazardous drugs. The group decided that their smaller outpatient facilities (where I worked) were not as important as their larger cancer centers to be staffed, and they would routinely get the PRNs. We had so many qualified people apply but they wanted everyone to work FT 5 days/week. If they had just considered 4 days/week or hiring two PT people we would have been adequately staffed. People were regularly calling out from being burnt out so it made us short. Some people took advantage of the COVID job protections and called out for 2 weeks "pending test results."
  15. DowntheRiver

    Nursing Products We'd Like To See

    You should get a Tile and put it on your stethoscope. It doesn't shock the person, but it will make a noise when you call for it and it's a GPS tracker. https://www.thetileapp.com/en-us/how-it-works
  16. DowntheRiver


    When you say only 2 RNs off at most, is that per clinic or for all total 10 clinics? I worked for a similar type set up here in Florida up until early this month. Outpatient Oncology practice with 100+ clinics state wide. The staffing was good at the cancer centers but the more rural clinics like mine was awful. They always staffed the cancer centers before staffing us. Our ratio was supposed to be 10 patients to one nurse but I was often at 15 patients to one nurse. There was recently a mass exodus at my office, including myself, because the company would not hire PRN workers for our site. Three nurses quit within a week. The nurse manager also kept the scheduled number of patients the same instead of trying to reschedule them. Do you have PRN staff to support vacations? Do your PRN workers have a mandatory number of days they have to work, I.e. 8 hours every 2 months?