2mint

Just checked, no HSA, only HCSA with max carry-over of $500. So no go. Thanks for the info anyways, Anonymous865.

OMG! I'm too healthy to take advantage of an FSA, but I had no idea you can do the above with the HSA. Thank you for this info! (Our benefits presentation truly sucks ***!) In 2017, I only contributed to my employer's matched amount: invested in 100% Large-cap index, with gains of 19% so far. My Plan: -In 2018 Jan, open and max out a Roth IRA, investing with Vanguard in 100% Mid-cap index. -In 2018 Jan, look into HSA and if it's a go, then max out and invest 100% in Vanguard's Total Market index. yep, I'm all in low fees index's: I have 15-25 year outlook, and besides, I make most of my income through...work...I invest to beat inflation, really.

A quick reality orientation from Nursing Fundamentals (Kozier): "The nurse employed by a hospital functions within an employer–employee relationship in which the nurse represents and acts for the hospital and therefore must function within the policies of the employing agency. This type of legal relation- ship creates the ancient legal doctrine known as respondeat superior ("let the master answer"). In other words, the master (employer) assumes responsibility for the conduct of the ser- vant (employee) and can also be held responsible for malprac- tice by the employee. By virtue of the employee role, therefore, the nurse's conduct is the hospital's responsibility. This doctrine does not imply that the nurse cannot be held liable as an individual. Nor does it imply that the doctrine will prevail if the employee's actions are extraordinarily inappro- priate, that is, beyond those expected or foreseen by the em- ployer. For example, if the nurse hits a client in the face, the employer could disclaim responsibility because this behavior is beyond the bounds of expected behavior. Criminal acts, such as assisting with criminal abortions or taking tranquilizers from a client's supply for personal use, would also be consid- ered extraordinarily inappropriate behavior. Nurses can be held liable for failure to act as well. For example, a nurse who sees another nurse consistently performing in an incompetent manner and fails to do anything to protect the client may be considered negligent. .... Several legal doctrines or principles are related to negli- gence. One such doctrine is respondeat superior. A lawsuit for a negligent act performed by a nurse will also name the nurse's employer. In addition, employers may be held liable for negli- gence if they fail to provide adequate human and material resources for nursing care, fail to properly educate nurses on the use of new equipment or procedures, or fail to orient nurses to the facility." I'm in the ER; I don't deviate from policies&procedures; I don't have a malpractice insurance.

OP, in the hospital setting, you're basically the nursing IT: these nurses teach and trouble-shoot the charting system, so you need to have an efficient and effective communication skills, along with basic computer skills--you're an IT in the software side, not hardware side (so IT skills may not be a deal breaker for hiring consideration if you're already an employee).

Yes, indeed, you should have. Now, you're in the clear: Resident gave a VO, the Attending agreed--with RT as a witness. Word to the wise: When you are in the right, be calm, be composed, be a BOSS: e.g., "The resident handed me a primed propofol and gave a verbal order for 30mikes, and the attending eventually agreed. I have plenty of witnesses." (a male nurse, btw, and a practitioner of Occam's razor).

OP, wow, hearing this, I'm so glad with our RSI policy: (Level 1 trauma center) the Attending, Resident, RT, Pharm--they draw our IVP meds; minimum two RN's. But usually 3-4 total nurses. RECAPS: 1. The resident handed you a primed propofol and a VO of 30mikes 2. Pt intubated 3. You proposed lower dose of propofol+Fent, Attending overrode you with Versed+Fent 4. "The attending requests [RT] to stop suctioning so we can...get an accurate [bP] reading before we start the propofol...and I have propofol [primed] and a verbal order from the resident and a discussion with the attending about changing sedation gtts and it's obviously not in the best interest to leave the pt [to] put in an order for a titration gtt that I didn't even get details for or wait for the doc to do it and then call pharmacy [to] validate it...." 5. ... so b/p is 125/88, sp02 is 86%, attending sees the b/p and walks out. The understanding is that this is an adequate [bP] to start propofol, so I start propofol at 10mikes instead of 30; I followed pharm protocol... 6. "the director is there waiting: 'did you hang propofol without an order?' 2 docs say you did" Now, my take: A) You have enough evidence to prove that the resident was lying. B) You're in a tough spot: Patient Safety (~sedation ramifications) VS. Med w/o Orders C) The heart of the matter: Was the Attending onboard with you on starting propofol? Point #3 nullified Resident's VO. Point #4 still no clear indications of approval; some indications of lack of details Point #5 running propofol on assumption D) Separate the two issues: 1-Resident lied, 2-You hung a med without an order Lastly, thank you for posting this, I myself have been taking things for granted, this story serves to emphasize the importance of 'read back' or 'communication loop'.

CA MS: 1:5 (my charge closed the unit down once, i.e. no admits since all nurses were max'ed out at 5 Pts). Tele: 1:4 Observation: 1:4 ER: 1:3 to 1:4 Well Bob, this is how triage works in my Level 1 Trauma center teaching hospital: Triage Rm 1: one CNA to take VS and four booths with 4 RNs Job functions: look at VS, chart CC (e.g., "cp for 1 day"), assigns acuity; then send Pts to room, fastrack, or back to lobby. So even if you see 60 Pts in a 12Hr shift, it is still not that bad (job requirement: min 2 yr exp). Triage Rm 2: two booths with 2 RNs Job functions: call overhead for Pts in the lobby (those seen by Room 1) to come in to take VS Q2H, then send Pts to room, fastrack, or back to lobby. When not taking VS, they are doing across-the-room assessments (for the non-ER nurses, it's basically your general survey). Armed with this info, that "20-40 patients" count no longer seems that impressive now, do they?

OP, seems like you already know the flow of the ED, and as for charting, we have check boxes for the "ABCD", then free-text box for CC/HX/etc. What you really want to know is the CC and their associated symptoms: I'll give you the two common ones: CC: CP 1. PQRST 2. Associated sx: SOB, dizziness, N/V, diaphoresis, cough, fever, chills CC: Abd Pain 1. PQRST 2. Associated sx: N/V/D/C, GI bleeding, Fever/chills, Etoh use, dysuria, hematuria, LMP If you're still in orientation, why not just ask your preceptor? (e.g., "Hey, for abd pain, I asked these and these, what else am I'm missing? or something equivalent). Good luck.

It is a sad day in the nursing world that so many nurses failed to see the humor in this article: creativity in the title, silly claims countered by solid claims, and the ending paragraph is the author's last ditch effort to say "don't take me seriously here, I am having a blast writing this article." The first part of the title of the article comes from the last 3rd of the article; the second part of the title comes from the first 3rd of the article. ....crickets....crickets....crickets.... Okay...how about this: The author made a silly claim of a male SN being teased by female classmates, but the author also provided a counter claim: "Nursing...may require levels of education or training that can be daunting for those men who were less successful in school...." The theme goes on: A lot of families prefer females,” then the author provided a counter example: There hasn't been a patient who had me who ever requested going back to a female....” Still don't get the humor?...just read the 1st and last paragraphs: "It seems like an easy fix. Traditionally male factory work is drying up. The fastest-growing jobs in the American economy are those that are often held by women. Why not get men to do them?" Pink-collar jobs are crap jobs for anyone,” said Joan C. Williams, professor at the University of California Hastings College of the Law. We need to reinvent pink-collar jobs so men will take them and won't be unhappy...."

I was hired for the ED, boarded in MS for about 9 months, been an ER nurse for a while. Level 1 Trauma center, Teaching Hospital, we have Psych ED, Fasttrack, Main ER, Trauma bay, Peds ER, and Obs. So I'll give you a sample of my report and some insight: Name. Age. Gender. Allergy status. CC and duration. Pertinent medical Hx. What we did for the Pt, what's currently infusing, last pain meds. Abnormal labs/diagnostic. IV site. Reason for admission. *if on a bipap/cpap, I'll just ask "What settings would you like to know?" Rationals from a former MS nurse: 1. Flushot/PNA vac: this is part of MS nurse admission process, so that nurse was just being lazy. Conclusion: illegitimate question. 2. Last BM: also part of MS nurse admission process, but this one is ALSO used to determine if the Pt is incontinent or independent. Yep, taking care of bed-bound Pts eats up extra time. Conclusion: a legitimate question from the perspective of time management. Also, last meals/BM is part of your SAMPLE Hx. 3. Last VS: since all my Pts are on monitors, spouting out VS takes less than 5 sec. 4. Medicine Team: I always see the admitting Team on my track, but ward nurses may not see this info for another 15-30 minutes. TIPS: #1: End report with: Pt is independent/ambulatory #2: Lift the other units up by being diplomatic and encouraging, e.g. Whoa, this Pt has a nasty left hook, be careful. You can handle it; I believe in YOU.

We're ER nurses; we know what we do. These three steps are just a down&dirty snapshot of what goes on in the ER for non-ER nurses. Based on your selective quotation of me, I agree with your objection. Based on my full quotation of me, I disagree with your objection. Here's why: your objection is that I am omitting the critical thinking aspects of our job. Look again at the full quotation, those subtle and somewhat sexy two words "as warranted" encode said critical thinking skills. E.g. This Pt is very tachycardic, let's give some meds to control the HR. Appropriate? Yes. Warranted? Let's see: the Pt is also very hypotensive. So, no, it's not warranted.

My level 1 trauma training hospital pays CC bonus, we ER nurses did not get CC bonus pay, so we know that we are not CC nurses. But we argued for and finally got ER bonus pay just a few years ago. My ED comprises Psych ED nurses, Observation nurses, Clinic nurses, Flight nurses, ER nurses, Trauma nurses, and MICN's. The last three are 'ER' nurses; all seven are 'ED' nurses.

We are not Critical Care nurses. OP, take your typical sepsis alert patients for example: you draw labs and blood culture and start Abx infusions, then admit the patient. Same with your RSI patients: after intubation and starting drips, you admit the patient. Same with copd/chf exacerbation, Stroke, etc. As ER nurses, we stabilize/start initial TX, then dispo. This is how my ED works: Level 1 Trauma center: a main ER, a fastrack, and a Trauma bay I will speak for the main ER 1. Pts come in, we put them on the monitor, draw labs, send them to diagnostics. 2. Run IVF and/or medicate for pain, give appropriate meds in the meantime, as warranted. 3. Labs/diagnostic results will dictate further interventions and appropriate dispo (d/c, admit, or transfer to observation) Steps 1-3 happen in an avg of 90 minutes. As ER nurses, we receive 'Emergency Nursing' training, which entails BLS/ACLS stuffs: Primary survey (ABCDE) and Secondary survey (H&P). After a year or so, ER nurses will receive additional training in Trauma to work in Trauma bay. I'm an ER nurse, I don't do Q2H repositioning or strict I&O (or even I&O for that matter), therefore I'm not a critical care nurse....I kid, I kid...but lots of truth to it, though.

Awesome article! Thanks! I love the way you mention the fine prints regarding how insurance works, and thanks for bringing up the term 'respondeat superior'--we touched briefly on it in 1st semester. This article should have more than 3 pages of comments, but d/t your fact-based communication style, it is expected, as this type of communication style precludes anecdotal comments. According to the National Practitioner Data Bank, nurses account for about 2.5% of all medical malpractice payments (as of 2015). Googling further, these malpractices revolve around these three areas: medication errors, communication errors, and failure to monitor and assess --> the top 3 'skills' nursing instructors heavily focus on (recall: 3 checks; repeat back; re-assess). I'm still in my first year and I don't carry a malpractice insurance; reading other related threads, I think I might have the skills to sell insurance for kicks&giggles...

Here's one from a non-ACNP: "Mar 10, '16 by emsguy, BSN, EMT-I I am an RN with a BSN currently in my second semester as an FNP student. As a Family Nurse Practitioner we are trained as primary care providers and sometimes generalist. So our education is geared towards managing this population in the outpatient setting, treating chronic conditions and referring or consulting with another provider.... .... The point is an FNP curriculum is designed to create an outpatient novice primary care provider, not an intensivist, hospitalist, or emergency department provider."