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."

And another term comes to mind: broad-brush. Spicy prawns (who am I alluding to? Hint: politics)

You are no doubt foremost among men; when you walk into a room and give a speech, men grow chest hair , women curl their toes , birds chirp :singing:and cloudy sky turns blue revealing a twinkling sun as if it's giving you a wink--scratch that--multiple winks ;) Now that you've spoken for the 7.7% NP's,...I digress.

From aanp [dot] org/all-about-nps/np-fact-sheet 220K+ NP's in the US 7.7% in Acute Care 1.7% in Neonatal (for argument's sake, let's exclude CRNA since they require ICU exp) Majority are in primary care (i.e. preventative medicine). Specifically for FNP's, I think 0-1 yr MS/ER experience is good enough--some nurses here "seem" to think that an MD would let a brand spanking new FNP run wild day one, as if a hospital would let a new grad RN run wild day one I personally will have about 9 months MS; 12 months ER; X months parttime ER while doing FNP program. (ER is something I always wanted to do--will I use my ER experience in my future FNP job? Possibly, but ER nursing is about stabilization, not prevention). RN is an entry-level position (that happens to pay very well here in California). Bottom line: roughly 90% of APN's do not work in hospital setting. New grad FNP managing DM/HTN vs New grad FNP with 5 yr RN exp managing DM/HTN...

OP, I'm in a teaching hospital, our policy is "no verbal orders unless in an emergency." I heard from our senior nurses that they fought hard for this, which is great as it protects the nurses. When I float to ER/Obs, our Residents/NPs/PAs are great about putting in orders immediately (as in less than 10 sec) when they're not with a patient at the moment.

OP, see how this ER nurse speaks? Big EGO with no disdain for the occasional humble pies. I'm the same way, a few weeks prior to getting off MS orientation, I was the go-to for hard IV sticks I am going to the ER training soon. I was hired for ED, but as a new grad, I along with some new hires had to board in MS until our basic skills are up to snuff. All of us are sure of ourselves. OP, are you known to: 1) Vocalize your opinions, but follow up with possible solutions? (i.e., Do you complain AND offer solutions to your complaints?) --> opinionated shows passion, which invariably shows leadership potential. 2) When **** hits the fan, are you at the scene? It could be something as simple as a Pt being rude to your co-worker/classmate, are you there just in case he/she needs help/backup? --> this shows teamwork 3) How big is your ego? --> Too big and you're a liability i.e. 'can't be taught'; too small and you're too timid. 4) Is that other C student more sociable than you? Lastly, OP, based on your responses so far, you cared way too much about what strangers think of you, not a good trait of ER nurse--simply "ain't nobody got time for that ****" ps Top student going to ICU is a correct placement.

Maybe you should have added something positive about me...” -I did, with this -Good observation and efforts on your part.” You observed that she started timidly, then you saw improvements by week 6. We all recognized you put efforts into teaching Alice. The rotation is not a set amount of weeks but based on hours so you keep saying week 6 or 7...” -You said hand-holding was the first 6 weeks”, so I hope you could see why assumed week 7” as solo time, as midterm eval time. You also say I've had 3 or 4 students before, also wrong.” -I'm sure I was referring to L&D students, as Alice is a student. Two yrs in L&D = six semesters: 1) T/F: Alice is your 3rd of 4th preceptee? Deduction: 2 yrs in L&D, likely started precepting in Yr #2.” Not sure why you consider me an inexperienced preceptor..” -You know that I assumed Alice as your 4th L&D preceptee. So what is your criteria for labeling a fellow L&D co-worker as an experienced L&D preceptor? I did have discussions with her along those lines...” -By your admission, they led to confrontations. The communication styles you were using with your early L&D preceptees were Effective. I am pointing out that those communication styles were Ineffective with Alice. Me pointing this out should not offend you. There's no one-size-fits-all communication style. Would I work with her based solely on your descriptions of her? I believe thoughtful thinkers do not make decision based on incomplete information.” -I can't really be anymore clearer than this. Well, thank you for keeping this back-and-forth civil and further clarifying your position. I hope I have contributed something positive in this discussion. Again, it's just an unfortunate event in which you were forced to take on a student in your last semester. I believe people questioning another person's leadership/communication skills IS a Good thing. A good leader in one unit may be not be that good in another unit.

Why are you replying to me with something that I did not say? Please copy and paste that specific quote of mine. (You don't have to; I prefer you not to; you got a free get-out-of-jail card ).

Thanks for replying and being adult about it—instant respect from me. I questioned your leadership skills based on the totality of what you said in your original post: did you get anything useful out of Alice? Your original post suggests no. (Leaders do not consider people's doubts about their leadership abilities as a negative). Regarding my deductions, I'll show you my process: 1) T/F: Alice is your 3rd of 4th preceptee? Deduction: 2 yrs in L&D, likely started precepting in Yr #2. Based on your latest post, I was right, you had a few easy, self-directed preceptees early on, then got a difficult one and did not seek advice until 4 days before failing her. 2) CC and L&D are essentially solo practice areas where you don't have to direct other nurses and NA's as often as in the ER or even in MS. Deduction: self-explanatory (in context of frequency of leadership/comm skills usage) 3) You never sat down with her to inform of her progress. (On your latest post you said you talked to her but led to confrontations instead.) Deduction: you mentioned about the charge has to find her which came across as in passing and not in a sit-down-post-conference manner (leaders are not passive-aggressive...) Let me script it for you: You: "Alice, let's have a talk. You've been here for X shifts, and I see you've made improvements, but at this rate, I believe you are failing this practicum. How do you think about that?" The difference? My script opens to clarifications/suggestions; if it led to confrontations, then I would stop it asap with relevant fact, such as, did you or did you not refuse to start the IV?” When it comes time for VS, you didn't take them”, etc. Would I work with her based solely on your descriptions of her? I believe thoughtful thinkers do not make decision based on incomplete information. Good qualities: Alice is by no means ignorant or incapable, in fact, she is quite capable.” She has observed all of this for the first half of her clinical with some guided participation and voiced confidence in each portion before she was asked to do it independently.” Poor qualities: She has a bad attitude and is lazy” (won't attempt IV's, not taking VS, making excuses, go hide to get out of things” It's too late now, but it would have been nice for you to start the above script x2 in wk 7 and wk 8, then email the instructor. Overall, this is an unfortunate case of a difficult preceptee being paired with an inexperienced preceptor (in regards to dealing with difficult preceptees). p.s. You did paint a cuddly picture of the first 6 weeks, then a train wreck started in week 7. Too little too late to right the train. p.s.s. You are making too big of a deal out of that IV opportunity being lost (and if her IV skills are that bad, not attempting is not as bad as you think)—other thoughtful posters already hinted this to you. (To put into perspective, I started 3 IV's during clinical; at the end of my MS orientation, I was the go-to for hard sticks

Mar 10: ...I've been a nurse for 6 yrs...BSN...MSN...also a CNM...4 yrs in CC...the past two in L&D...I've precepted several students...I was not planning on taking another student...as I finally am transitioning into full scope midwifery practice...So in January, this student, let's call her Alice, started with me.” -OP, given that Alice was likely your 3rd or 4th preceptee, I and a few other saw immediately to question your communication skills and leadership abilities. I'll elaborate as I go. "When Alice first started she seemed very unsure of herself...But I got my teach on...I felt like I was seeing improvement but I was always right there with her helping with her during the first 6 weeks of her rotation.” -Good observation and efforts on your part. When we had her midterm eval, Alice was told she was to take the primary role [VS, IVs, foleys, reposition, meds, H2T as we found out in Mar 14 post] and I was to back off...Unless safety is in jeopardy. And Alice is crashing and burning...She is lazy, refuses to do basic nursing tasks such as starting IVs, and will just go hide to get out of things.” -Communication/Leadership: Wk1 thru Wk 6 she was "improving"--what is less than "lazy"? Moving on...on day 1 solo, did you re-iterate the expectations of her? See next comment. We admit a patient. I go in to the room with Alice, she just stands there. I say "Ok, go ahead and get started." She says (in front of the patient mind you) "well, I haven't done many IVs so why don't I watch you one more time?" -On day 1 solo, you lose nothing by re-running through the process for her, as in, first lets do H2T assessment, then we start IVs, etc. especially when she voices her poor IV skills to you in front of the patient (imagine her embarrassment, that's why she said this 'Alice tried to blame me for not making her feel welcome and for "pushing her too hard."') Fast forward to when the patient is complete. Alice is nowhere to be found. I'm in pushing with her and the charge nurse has to find her.” -At this point, you were rightly frustrated, but how is it that she left the room without you knowing? That's a major disrespect which likely stems from lack of communication and leadership abilities...on your part. (Please refer to my first comment above). I've confronted her on it and she always makes excuses, and I've now emailed her faculty.” -You confronted her multiple times? Did you once sit down with her to discuss she might be on track of failing this portion of her program? She makes excuses because throughout this 7-week relationship, she simply doesn't respect you (it takes two to tango). ...she only has 3-4 shifts left with me and I'm getting really frustrated with her...of the behavior I've observed. I feel like she's skated by through her whole program somehow and now she's finally having to actually do it and she can't.” -Those who lack good communication skills do experience more stress in life in general. Your resentment of her ("she's skated") likely manifested in your speech and body language => instant or further disrespect of you. TL;DR: OP, you had "easy" first 2 or 3 preceptees, now you got a "harder" preceptee and d/t your lack of experience you did not know how to interact with her, ultimately leading to neither respecting either. I'm boarding in MS, going to ER training soon, so I'm big with communication skills and leadership abilities. No matter how you define leadership, the main focus of a leader is to get the most out of his/her people. And the first step is to get to know your people.

Wow!!! I can't believe how nice M/S nurses are, given how looked down upon they are! M/S nurses, you should be having a field day with this. OR nurses, if that list is what you call "assessment" , then here's my grading: From K-12 (again, I repeat, based on that list? OR: grade 3, by mentioning skin/respy bumps you up to a solid Grade 6 M/S: Sophomore ICU: Junior, d/t needing to be aware of the intricacies ER: Senior, they do this day in and day out, with a bunch of liars thrown in no less To OR nurses without non-OR nursing experience, when MS/ER/ICU nurses use the term 'assessment', we refer to "patient" assessment, not "paper" assessment . *I'm in M/S. I float to ER and Obs about 4-5 times a month.