Susie2310

I was going to say something similar. I think that, in addition to the above, you are expecting too much of your co-workers to expect them to just jump in, read orders, and start doing them without first asking you (and you said they do ask you if they can help you). I don't know RN scope of practice in Texas, and I don't know RN scope of practice in the specific setting you work in - I think these are things to be aware of along with your facility's policy if you are the nurse who is given a patient assignment and various co-workers (you don't specify the types of licenses or credentials that the co-workers who are offering to help you hold) come up to you to offer to help you.

I am correcting the above bolded to say an acute medical problem instead.

My understanding is that the litigation has occurred due to various facilities' interpretation of the standard of care required in the emergency dept. setting. As I understand it, the outcome of those cases affects what is defined to be the appropriate standard of care in the emergency dept. Also, as far as I know, the threshold for inpatient admission for Medicare is that the patient requires medical/nursing care for an acute illness that cannot be treated at home and for which the patient is likely to deteriorate/would be expected to deteriorate if they are not admitted as an inpatient.

As far as I know, the above is incorrect. My understanding is the following: Prior legal cases have brought up the definition of stabilizing care, and this includes the definition of emergency care. My understanding is that the general view, based on prior legal cases, is that if a patient's medical problems are such that deterioration would be expected/likely if they were discharged home from the emergency room, then the patient should be admitted for inpatient care, and a duty of care exists in this regard. In the above situation, the stabilization of the patient concludes when the patient is admitted as an inpatient. The exception is that if the emergency room is unable to provide the type of stabilizing care necessary, they must then transfer the patient to a facility where they can receive the necessary stabilizing care.

Not all members of the public are able to easily and quickly differentiate between various doctoral degrees held by the person treating them or by the person from whom may receive care. Leaving aside the debate about which doctoral degrees merit informing the public that the health care provider holds the degree, and leaving aside the debate as to whether an online doctorate should be considered equivalent of a bricks and mortar doctorate, and the debate as to whether some doctoral degrees are really significant enough to merit informing the public that the provider holds them, is the question of why exactly the public needs to be informed that their health care provider holds an doctoral degree (apart from the need to inform patients who are seeking care from a provider who holds a certain license eg. M.D., D.O. O.D., etc. that the provider does indeed hold the license that permits them to provide the specific professional health care that the patient is seeking). I think it's fine and good that people further their education and obtain doctorates in whatever they find useful and satisfying to them, and I think people who have obtained a doctorate that is not a specific requirement of their professional licensure, should be able, if they choose, to display their credentials in settings where they don't have direct patient contact (I have modified my position from my earlier post), but I think it adds more confusion for patients at the point of care when they are faced with determining what provider X's letters after his/her name means as patients are then in the position of wondering why provider X who is not an M.D., D.O., O.D., D.P.T. or another doctoral holder whose degree is a specific requirement of their license but whose doctoral degree primarily represents further education that may be very worthy in it's own right but is not a requirement of their professional licensure, felt the need to communicate to their patients that they hold a doctorate. I think this can add anxiety to a patient's visit to a provider as patients can find themself pondering what professional deference the provider may expect or wish the patient to show them, or pondering how to behave with said provider. I think we need to make things as easy for patients as possible. A visit to a provider shouldn't be an ego parade for the provider.

I have to disagree with those who believe the behavior (filming) necessarily has hostile elements. Of course, peoples' intentions vary, but as some posters here have mentioned, some people choose to film/record procedures for educational purposes which can be helpful when the patient is discharged and they, the family members are now providing care for the patient at home. Some posters who have indicated confidence in their abilities have stated that they don't have a problem with being filmed when they are performing a procedure. I think it's important for everyone's sake that laws and facility policies in regard to filming are clearly stated so that patients/family members know what is expected of them. I think it's courteous and reasonable to ask permission to film, and that health care workers should have the right of refusal. I don't think we need to ascribe negative intentions to all patients/family members when patients or family members ask if they can film. I think communication is important; understanding the reason the patient/family member wishes to do this is important.

I think there's an area of strong resistance to any public admission that in the health care industry licensed health care workers can practice negligently or worse. Loss of public confidence has significant ramifications.

I think this is a good move towards protecting patient safety and patients' rights.

If not much is actually known about this situation, there's no end to how much anyone can speculate about what happened, what the working conditions were, etc. I'm not sure it's really useful to speculate at this point. If your concern is that charges have been brought against nurses again and that you don't believe nurses should face charges, period, I think that nurses and other licensed healthcare workers are going to have to come to terms with the fact that they too can face charges.

I'm wondering how they managed to gain access to your documentation to be able to alter your note.

I find the above quite reasonable. Patients should be able to know up front, at the point of contact/utilization of a nurse practitioner's services what type of license/certification the Nurse Practitioner holds. Patients should know that the person providing their care is not an MD or a DO. This doesn't in any way minimize the nurse practitioner's accomplishment in obtaining a doctorate and it means they can use the title Dr., but they must distinguish their credentials from that of a Doctor of Medicine or a Doctor of Osteopathy to the general public and to their patients.

I think it's more than just that some people don't know the difference, although I think this could be part of the problem. I think that some people are quite comfortable with negligent actions being attributed to "mistakes." It's very convenient and desirable to not be held accountable for one's negligent actions. As I see it, putting the spotlight on individuals who practice negligently runs the risk of incurring more widespread practitioner scrutiny, and people are afraid of this and opposed to this as they fear both personal and professional loss for themselves, and also fear not being able to make as much money; e.g., the money train being slowed down. I find it shocking that some people apparently want negligent actions in providing care to be routinely blanketed under a smokescreen of "mistakes" and "systems problems" in situations where they are evidently not these categories of actions.

My understanding is that some facilities have been receiving funding from State allocated Covid funds which have been paying for travel nurses to supplement the staffing . I don't know if this is still happening currently.

Good article. I know people who credit AA with saving their lives and I have witnessed their transformation and return to health and to maintaining satisfying family relationships and being able to be employed at the level they desire - completely turning their life around so that they are enjoying their life again in a healthy and positive way.

I find it hard to believe that most people would find the type of lenience you are saying nurses/health care workers should expect and receive as a matter of course, regardless of negligent actions, acceptable in any other licensed profession. Let's apply your arguments to other industries; any industry. A licensed "you name it" professional performs criminally/grossly negligent work, taking a number of shortcuts, using inappropriate materials/taking decisions that are below the industry standard, and members of the public are killed/harmed as a result. I think most of us would expect a proper enquiry into what happened and into the licensed "you name it's" professional actions; we would expect that they would be held legally accountable for breaching the standards of their profession with harm (death) resulting to members of the public. I don't believe most of us would feel sympathetic to a licensed "you name it's" pleas that they had no intent to cause harm, or that the "you name it" industry is a profession where dangerous, negligent actions and errors take place regularly, and that public safety can only happen if licensed "you name it" professionals feel safe enough to informally report their errors, and that prosecuting licensed negligent "you name it" professionals who harm or kill members of the public is a grave setback to "you name it" safety and to the safety of the general public. I don't think most of us would care about hearing that "in order to make the "you name it" industry safer, which all of us want, and which is so badly needed, criminal charges should not be brought against licensed "you name it" professionals who, with no harmful intent, negligently harm or kill members of the public, because then licensed "you name it" professionals won't report their errors and the "you name it" industry will just become even more unsafe, and we all know how unsafe the "you name it" industry is for the public already." I think most of us would say that a proper investigation into what happened is absolutely necessary, and that if a proper investigation shows that criminally/grossly negligent actions by licensed professional/s have taken place that caused/resulted in the death of the members of the public, that criminal charges should be appropriately made in order to protect the public.