AMV

BTW, at my facility, this is done through the Risk Manager.

Device failures (such as the AICD) should be reported to the FDA. The hospital is required to report these. The FDA keeps statistics on this for possible device recalls.

Yes, I am a little worried about the OPPS as we have no idea what the volume will be and it looks like I will be abstracting those as well. At this time, the corporation that owns our facility does not allow sampling, even though our numbers would allow it. For example, SCIP has 500 to 600 per quarter.

PDSA is Plan - Do - Study - Act and is a method of rapid cycle improvement. Check out info from IHI http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/testingchanges.htm for more information.

For any of you out there who abstract from the paper chart, how much time do you average per chart? We are a 300 bed facility and do 100% of SCIP, AMI, PN, CAC and HF. It seems that with the continual addition of measures to each of the measure sets - especially SCIP, abstraction is becoming increasingly time-consuming - leaving less time for process improvement. We abstract from a paper chart, rather than electronic and gather data on all measures for each of the measure sets - not only APU indicators.

I am in an MBA - Healthcare Emphasis program and my CNO is trying to convince me to switch to MS nursing. I started with an ADN and went into an RN to MS bridge program where some master's level nursing classes are taken instead of BS - such as nursing research. After I completed my BS nursing, I found out that classes the next semesters (all completely master's-level from that point on) had time-requirements that were not compatible with my M-F 8 to 5 schedule - in fact I was told that they don't recommend that students work full-time. How realistic is that? The university that I am at had just opened up the Healthcare Emphasis MBA program and I have now completed one semester (9 credit hours) of this. The classes are Saturdays 9 to 5 with a great deal of online work, and of course every class has group work in which we all meet after work to work on projects. It is very hard! I am learning so much about business that is very applicable to all industries, including healthcare. I am concerned that my CNO thinks this is a bad move - in fact, they refuse to provide tuition reimburesment to me now. It seems that more programs are offering dual MSN/MBA degrees and more nurses are pursuing MBA or dual. I don't think that I can go for the dual that is 60 some credit hours - this last 36 is for the MBA is enough! It has been very hard on my family in obtaining the core classes for the BS nursing as well as the BS bridge program itself - I have been in school for the last 5 plus years. Has anyone else faced a similar dilemma? My co-workers say to stick to my guns - some who have their MSN's state they wish they had gone for an MBA. One of these who is a nurse-attorney loves to say "how many times can you get a nursing degree?" I guess that hard part is the fact that the CNO whom I really respect and admire does not support this.

If you are open to relocating, these exist all over the country. The University that I attend also offers one... I will post the link here http://www.twu.edu/nursing/programs/rn_ms/index.htm Good luck!

I have to admit, this is one of the biggest things that bothers me! I am 40 now, I am in an RN to MS program for FNP. I work full-time and go to school "almost" full-time. At the rate I am going, I will be 43 or 44 by the time that I finish. Lately, I have really begun to wonder if it is worth it?? My last pay check for the end of 2005 showed that I made a little over 70K ( I work in a cardiac cath lab - so just a little bit of a diff for that). This is really tough and I feel that I have so much on my plate - and tough for my husband and children too! Anyone else ever feel this way while going through the program?

I am in such a program at TWU - Texas Woman's University. Here is the link for the RN (ADN) to MS program, which includes the NP programs. http://www.twu.edu/nursing/programs/rn_ms/index.htm

What did you do in the event that one called in sick and a replacement couldn't be found? Did you use a nurse from the unit or did they just use one tech?

Actually, our monitor or tele techs are trained in a two day basic EKG class and then go back for another one day advanced class that focuses on blocks, lethal rhythms, etc. Usually these people have a background as EMT / paramedic or have done this kind of work before. If we have a CNA who is in nursing school - or student nurse, they can take the class as well. They have a test they must pass with a 90% and cannot miss any lethal rhythms. They do a great job! Our IMCU has 21 beds monitored by remote telemetry (not bedside monitors in the ICU - they do not have a tele tech and we do not watch their patients). We also monitor patients on Med/Surg who need telemetry monitoring. My question was, once you get to a certain number of patients, at what point, is a second monitor tech necessary? I am trying to find out if there are any "standards" out there?

I have a question for those of you out there who work on a Tele, PCU or IMCU unit that uses remote telemetry monitoring. I am trying to find out what your facility standards are for the telemetry tech as far as what is the max. # of patients that they can monitor before a second tech must be added? Are there any "standards" out there that your facility goes by?

Any of you out there who work on a Tele, PCU or IMCU unit that uses remote telemetry monitoring... I am trying to find out what your facility standards are for the telemetry tech as far as what is the max. # of patients that they can monitor before a second tech must be added? Are there any "standards" out there that your facility goes by? Thanks!

Gosh... I am so sorry about your job. I am surprised though because I just went to their site last night and based on some of the threads that I had read here, the job they had posted sounded like the disease management. I am also disappointed because I would love to get in to this area... I found this thread while looking into the case management section. As unit coordinator, at times we "assist" case management (although I don't know a tiny fraction of what they have to do in order to do their job!) - but I have been very interested in case management.... I guess I am thinking (just thinking!) about a change because I am truly tired of being expected to come in and staff my unit 24/7 when need be... and lately, it has been a lot!! My family is about ready to disown me! It is true for nursing though - any job - we are all replaceable and they will work you to death if they need to! It doesn't matter if you are staff or management.

I see the posts from March from a couple of you that are training for or just going in to telenursing in the disease management field. Are you still liking it? I am looking in to this field - currently working as a Coordinator for a step down unit and tired of being on call 24/7. I have a lot of experience in cardiac as well as DM and the one-on-one patient contact sounds interesting... I would love some feedback! Thanks!!

Our hospital did the same thing. Hospital Week this week, but no mention of Nurses Week last week. Nothing. I know you all think they are just "token" thank you's, but imagine NO acknowledgment - NOTHING!

Our ratio is 4:1 on our step-down (Intermediate Care). Our nurses take Reopro and Integrilin drips with post stent placements as well as low dose Dopamine, Cardizem, Nitro drips. They pull sheaths and 10 of our beds have bedside monitoring for art lines and CVP. If this is going to be a transition for your nurses, as with any new skill, extensive education and competency check off's should preceed patient care.

I have been in management for a little over a year and am finding the posts in this thread very helpful. I have to admit, I am beginning to wonder what I have gotten myself in to?! I love this role - but the divisiveness between staff and administration and all of the gossip that goes with it is becoming exhausting! It doesn't matter that I just worked two twelve hour shifts over the weekend to make up for sick calls (3 RN sick calls on ONE shift alone), it doesn't matter that I hear from the staff how tired I seem to look, it doesn't seem to matter that they see me here long hours every day - during the week and sometimes on weekends. It doesn't matter that I haven't called in sick once since I have had this position. I could go on and on. What does seem to matter is that is if anyone has a bad day (which means busy day with patients and staffing), it is managements fault. Even though I have my doubts ... I have to say, that I have never found another position so challenging, rewarding and motivating. It has been one of the reasons that I have gone back to school to get my MSN. Even though sometimes I want to run out of the place and never come back - it hasn't "licked" me yet and I hope that I can turn this challenge around. I am hoping that I am going to gleen information from some of the posts here that will help me to improve things on my unit. One of the most amazing things I am finding is the amount of gossip and "meanness" that I hear about. I guess as staff nurse, I would come in, do my job, go home and didn't "notice" it as much. It just amazes me in the things that I hear about different situations that seem to get more embelished as they go round the rumor mill. I think overall, my unit does have a good group of people - so my goal is to try to build up the positives and try to work on the negatives. Are there any of you who manage a group of people where there is mutual respect between staff and management? Where management and staff sees each other in roles that are different, yet vital to the work of the unit? Is there anyone that has done something that they found was successful to bring this change about? I would love to hear about it!

I have a new position in the hospital that I have been at for a year - having recently been promoted to coordinator for my unit. By the way, I have been an RN for 14 years. I love this position and the people I work with. I have one dilemma though... I have been at this position for a month now and I have been jumping in to help out when ever it is needed - our unit is typically very busy and we often have many admits/discharges - especially toward the end of the shift - from 3P on. I had been staying late to help and am finding that since I arrive at 7 45 a.m. I am putting in quite a lot of overtime. And it's not because we are short staffed - just our typical busy unit. Today the charge nurse got a bit bent out of shape when at 6 15 pm, I was leaving. The charge nurses take up to three patients (the ideal is zero) and he did not have any, but was getting a patient at the end of the shift - who was a transfer and all he had to do was get them settled in - vitals, assessment but no admit since it was a transfer. We were adequately staffed and there was no reason for me to stay. I explained this, but he did not like my explaination... I know that many feel that when one makes that transition into management, they forget what being a staff nurse is all about. The truth is - no - at least I haven't, but now I see how BUSY it is in a management position. There is a lot to do - most of which many who haven't been in that role have no idea of. There is a lot of responsibility and a lot of work involved with BOTH roles. I have heard so many times from other nurses that those in management have forgotten what it is like to be a staff nurse, but I doubt that many of those same people have a clue as to what management is all about... I am putting in 9 and 10 hour days 5 days a week. I can see going in to this that if I don't have some sort of balance - I will have NO life!! What advice do those of you who have been doing this for awhile have?

We have one drug seeking "frequent flyer" who insists that she doesn't have any viens left (she does!) and should have a central line or mediport placed!! LOL!! Nothing wrong with her... she is in her 30's. We have several that do this - and we aren't an inner city hospital, but way out in suburbia. All they have to do is come in complaining of chest pain and - voila - chest pain (cardiac) orders include good ol' morphine... they get a night stay in PCU until - once again - until cardiac enzymes come back negative x3, etc. and they've ruled out the MI. Amazingly they have this chest pain which seems to reoccour every 4 hours (although the orders WOULD allow it every 5 minutes!) and this pain magically disappears as soon as it is time to go home. All at the expense of the hospital, since they don't have insurance.

Thank you all for the great information.... I followed one of those links to http://www.calnurse.org/finalrat/finratrn7103.pdf and I printed out much of the information given and will take it to work. Our PCU (Progressive Care Unit) or "Telemetry" unit's tele tech also has the function of acting as unit secretary. Needless to say this is very unsafe and much gets missed. We have many cardiologists who have voiced their dissatisfaction with this set up. I notice that the link I listed above specifically mentions the monitoring person doing ONLY monitoring. What a concept!! Wish I knew what to do to get a law like this in Texas. I LOVE being a nurse, but HATE the staffing. Thanks again! Anne

Thank you all for the great information.... I followed one of those links to http://www.calnurse.org/finalrat/finratrn7103.pdf and I printed out much of the information given and will take it to work. Our PCU (Progressive Care Unit) or "Telemetry" unit's tele tech also has the function of acting as unit secretary. Needless to say this is very unsafe and much gets missed. We have many cardiologists who have voiced their dissatisfaction with this set up. I notice that the link I listed above specifically mentions the monitoring person doing ONLY monitoring. What a concept!! Wish I knew what to do to get a law like this in Texas. I LOVE being a nurse, but HATE the staffing. Thanks again! Anne

Are there staffing ratio's that will be set in California (when the new ratio requirements take effect) for step down, telemetry or PCU area's specifically. I know there are for critical care and med surg... Our CNO recently used this as an excuse to staff our PCU with 6 patients per nurse, stating that is what California will be using as a ratio. My understanding is though that that is for Med/Surg. How can they include PCU in that? I live in Texas by the way, and apparently, where I work is looking at that - what will happen in California. We have gone from 4:1, now to 5 and it seems like they are trying for 6! Way too many patients... 5 is crazy enough with the high acuity these patients have. I don't know much about the new law that will go in effect in California and hope my question isn't way off! Thanks!! Anne

Wow TreceRN - what hospital in So. Washington state is that? Benefits and good staffing as well as respect that the nurses are given by administration and doctors are very important to me. How does that rate of pay compare with the cost of living there? Thank you all for the good information. I will try to find the web site you mentioned!

Those of you out there who feel like you work in a hospital where the staffing is really good (and consistent), as well as pay, benefits and scheduling, please share. What is the name of the hospital/City? There is a good chance that we may be moving due to hubbies job situation and we are keeping all options and possibilities open. :)