catbox9

I work at what is essentially a government run prison in a reasonably small town. This facility is by far the largest employer in the city in which I live. For the purposes of this discussion, let's call this my primary employer. I also work part time as a primary care provider at a clinic which one could argue is a rural clinic. My clinic accepts essentially all patients and is a FQHC. I don't work here often so I don't really consider this my major employer or a significant source of my personal income. Last week my employer informed me that they spoke with "the legal department" and effective immediately I would no longer be able to treat any current employees at my clinic for any condition whatsoever. They didn't give me this in writing but state that they will do so "soon". I am wondering if this is at all legal. While I understand that there's an ethical gray area treating coworkers, the vast majority of the people who work at my facility are complete strangers to me. It is a 24 hour facility and I have never seen most of them (there are something like 2500) let alone met them. Second of all, I do not routinely ask patients at my clinic where they work. Finally, this seems like a major breach of HIPAA because my employer would have no way of knowing who I see and treat at my clinic because we do not send them a list (obviously). I can understand how they could argue there is some sort of conflict of interest in me doing this because I can write work notes and such, but I don't think there is really justification for that either. To further prove my point, there is a psych NP where I work who happens to have a side job as the psych comp provider for our facility. If that isn't a conflict of interest, I don't see how what I'm doing is. Any thoughts?

Perhaps this is a better question. Pretend for a moment I was working full-time as an NP in a primary care office but wanted to someday work in a different setting (whether it be urgent care, dermatology, orthopedics, or wherever) but was told I lacked the experience in that specialty. How would I go about getting that experience?

That's all essentially true. While you might be right, I still feel that doing 1 day a week, while certainly not traditional or ideal is still better than doing nothing or working at my current facility. If I worked that job full-time I would certainly gain traditional experience so isn't working 1/5 time allowing me to get the same experience...just at 1/5 the rate? Absolutely, yes. I've been there 10 years and can retire at age 55 so whether or not I like this job, there is no way I can leave this facility. Yes, but not if it means sacrificing my other job. In a perfect world I would someday be working as an NP at my current facility 4 days a week (10 hours/day) and then working at an urgent care as an NP somewhere 1 day a week. I am trying to find a way to do that without leaving my current job full-time job. If that is, in fact, impossible then I will eventually take the full-time NP position with my current employer. I am willing to make some changes, but not leave my current job. I am willing to work for free if need be at an urgent care or wherever in order to learn how to function in an urgent care. I'm also not particularly in a hurry....if it takes me 10 years to get to where I want to be then fine. I know that urgent cares will hire people on a part-time basis (i.e. 1 day a week) so I'm just hoping that someday I can find a way to be in that position.

The problem with NP training, at least for me, is they focus way too much on things that don't matter (nursing theory, etc.) and don't have enough clinical component. Even though I went to an on-campus, traditional school, all of our clinical hours were self-scheduled with no oversight by the school. I also think that doing a thesis or project is a huge waste of time. While I know more about treating recurrent skin and soft tissue infections than perhaps even the MDs I work with, this isn't a very useful skill in primary care as skin and soft tissue infections aren't that common outside of an urgent care or ER. While I think seasoned NPs can do a phenomenal job, I think new grads are really put in a terrible position and can mismanage even the simplest of diagnoses. One of my first real patients as an actual NP was a teenager who came in with acne so I gave some Clindamycin gel as it seemed warranted but only after the patient left did I learn that I needed to have him take benzyl peroxide, too. While acne should be an incredibly simple condition to treat, my clinical site for NP school was very medicare heavy and as such I didn't treat a lot of acne in school.

I haven't done it although I think it's reasonably common practice. I'm newly-licensed so I'm a little more hesitant. My mom keeps asking me for an Rx of anything just so she can have a "real" Rx on a "real" Rx pad from me as a souvenir. I think for Xmas I'll write her Haldol PRN but put an expiration date of 12/24 so that she can't somehow turn it in by accident. We both worked in a psych hospital so it would be kind of a funny joke. The bigger issue I'm running into is what to do when people I know show up as actual patients in my clinic. Seems kind of unrealistic to deny them a refill of something that they've been getting from my clinic (primary care) for a while. I live in a small town with very few offices so a lot of my friends want to start going to my clinic since they need a primary and the choices are few and far between here.

While you're essentially correct, I wouldn't say I'll never advance at all. Even though I don't work full-time, I still see some pretty complex internal medicine patients and do get to do a lot of decision making with the MDs guidance. I feel like I've learned a fair amount since I started. Of course, if I was doing it full-time, I would be learning a lot more. As for why I decided to become an NP...I really don't have a good reason. I've always thought my RN job was meaningless (I work at a psych forensic state hospital) so I wanted to do something meaningful. I like my RN job because of the lifestyle it gives me, but I want to do something that matters. No hospital would hire me per diem as I have zero experience so I went the NP route because there is a huge lack of primary care providers in this area and even though I'm still not very marketable, I knew that I would at least be able to do something. I probably didn't describe that job very well. Technically you're doing H&Ps all day, but you don't really take a history or do much of a physical. You essentially look at the patient's record from their prior facility (prison) and re-order what they're already on whether or not it makes sense or is good medicine (if they're on atenolol and nothing else for HTN, just leave it). That job will teach me absolutely nothing and I will forever be non-marketable to any other employer if I do that and nothing else. Other than the fact that a medical assistant isn't legally allowed to write orders, you could quickly teach an MA to do the exact same job because it's so easy. The only reason the job exists is because somebody needs to write the initial orders for the patients and the NPs are far cheaper than the physicians...plus there's a huge lack of physicians at my facility. The job is basically a career-ender once you take it as you're forever non-marketable once you work there and everyone around here knows it.

Unfortunately, that won't work because I currently don't work on Fridays at my RN job but if I promote I would work on Fridays which is the day the family practice office wants me to work because the Dr. likes to leave early on Fridays and is hoping to eventually not work at all on Fridays.

I'm facing a bit of a dilemma. I'm a new FNP grad (May of this year) and ended up with a job at the site I did my clinical rotation. For reasons that make sense to almost nobody, I refuse to quit my RN job (it pays very well, I get a pension, I have a flexible schedule) and want to instead work as an NP 1 day a week. My RN employer offered me a promotion to NP but because the NPs essentially do nothing but H&Ps and have to work 4 10 hour days for only slightly more money, I declined because I want more real experience. The problem I'm facing is that I don't think I actually want to work in the family practice office where I currently work. As I'm only there 1 day a week it is difficult to establish relationships with patients, and even the new patients end up following up with the MD (he and I are the only 2 providers at this office). When I see the doctor's patient's it's usually for more trivial manners as his patients are not generally receptive to me significantly altering their plan of care for chronic issues (which I can understand). I think my actual goal would be to work in an urgent care as they seem most likely to hire someone for 1 day a week and nobody really cares who they see at an urgent care. Unfortunately, I have very little knowledge of how to function outside a family practice office. My entire RN career has been at a forensic psychiatric hospital with very little "real nursing" and my NP school didn't force us to do rotations in specialties so 90% of my clinical experience was in an internal medicine office. As a result, I can't do many procedures well (if at all) and I can't read Xrays. I also have no experience treating people younger than teenagers as we don't accept them as patients at my office and my NP program counted anyone under 18 as pediatric. Is there any way I can go about getting experience somewhere else? While it sounds crazy, I don't even really care about getting paid but I think if I walked into a specialty office or urgent care offering to "volunteer" they'd think I'm crazy. Any thoughts?

Absolutely not. My present supervisor is a good one and probably values me, but my employer as a whole absolutely does not. If an employee does something wrong, my agency will do everything in its power to protect itself and punish the employee. I recently had a friend who was randomly assaulted by a patient and after 5 months learned he had a torn rotator cuff. His management has been doing everything in its power to try to deny that this is a work comp injury and insists it is somehow his fault.

Based on what I was told today, the main concern is whether I in fact assessed that the patient was unharmed in a timely manner. The patient required nearly continuous monitoring due to his underlying behavior/ mental status so I feel it is reasonable to say that I did (along with the other RN on duty). Given that this investigation is ongoing, I don't want to say specifically where I work, but your assumption is a good one. In my state psychiatric technicians are licensed and go to school for 12 months prior to licensure.

I wouldn't say it was as soon as I knew, but rather within an hour or so. I think the main complaint administration has is that because we did not complete the SOC that same shift, it is plausible that rather than assess the patient to make sure he was unharmed, we instead tried to plot a way to hide that this ever happened and then turned her in when we realized we couldn't. Since all documentation regarding the patient's physical status is charted as a late entry, this (wrong) assumption is slightly more plausible. No, the other RN is a close friend of mine. We have discussed at great lengths our versions of the story and they are essentially identical. We're both equally fearful of disciplinary action we may receive because one could argue we temporarily tried to hide this rather than report it. Yes, policy requires that the form be completed before going home. The SOC form was filed by my supervisor at about 1130, so it was not at the start of my shift but rather several hours into the shift after I spoke with the AM medication person regarding this incident. She had been suspicious that this may have taken place because she talked to the patient that was documented as having received the med and he denied receiving it. She also questioned why the med was documented as being given at the time listed as the patients are not on the unit at that time, but rather eating dinner in the dining room. In order for a patient to receive a PRN of Ativan during meal time, something serious would have had to take place requiring the patient to be brought back from the unit. Since this did not happen, it makes absolutely no sense that the patient would take Ativan during meal time. This is my concern. The people that will ultimately decide my fate are a social worker and a recreation therapist who just happen to make up upper management at my facility and supervise all nursing staff despite not being nursing staff themselves. While nothing is official, I was told that it is essentially guaranteed this person will be terminated (which is no easy feat at my hospital as permanent employees are nearly impossible to fire). The investigator I talked to said they are pursuing criminal charges against this person for illegally dispensing a controlled substance. One last interesting piece of this story is a stat urine drug screen was ordered about 36 hours after this event and it was negative for benzodiazepines.

While I keep telling myself this, this doesn't leave me feeling relieved. One major problem is my immediate supervisor that night (who did nothing) was just the acting shift lead that night and his license is lower than mine (he is a psychiatric technician). While I did assess the patient, a late entry assessment is significantly inferior to one that was documented at the proper time. Furthermore, while it seemed reasonable that the alleged medication did not harm the patient, I'm not qualified to make that judgement. My actual supervisor (who is also a psychiatric technician) says that my management is supportive of what my coworker and I did although we did not follow policy. She says the most likely discipline will be a letter of instruction that will be removed from our files in 6 months. She did mention that administration wondered why SOC341s weren't filed on us for patient neglect and it is possible that administration will override whatever disciplinary action my management elects to take. It is worth noting that I have been allowed to report to my workplace since this incident took place while the person that administered the medication is not allowed on hospital grounds.

I am in the middle of an absolutely horrible incident and would like some people's opinions. I work in a forensic, psychiatric hospital as an RN. The majority of my coworkers are psychiatric technicians (similar to LPN). Recently, we had a patient who was very disorganized, confused, and a significant falls risk. His condition had been deteriorating significantly since his antipsychotic medications were decreased due to an ECG abnormality earlier in the week and had not slept in several days. Shortly after the medication pass, the person administering medication stated to me that she hoped he would sleep because she "gave him a PRN of Ativan". I did not think that this patient had ativan ordered so I alerted the only other RN on duty of this and we looked at the MARS to investigate. The medication person came into the med room at told us that she had given him Ativan even though it was not ordered but that it was "okay" because "he doesn't have an Ativan allergy". She then said "I'm just going to say [another patient] took it". My coworker and I were shocked by this event and reported this to our shift lead who didn't seem to care and suggested that this occurs commonly. Just before the end of my shift the employee came up to me in front of numerous staff and angrily informed me that she was aware I was discussing this and if "the AM shift found out" she would know who to come after. The following morning I reported this to my supervisor and an SOC341 was filed. My concern is that per my hospital's policy, this should have been reported before the end of my shift and it was not. California law requires that this be reported within 24 hours (which it was). I realized that this took place at about 2130 and alerted my shift lead at about 2230. My shift ended at 2315 and I had to return to work at 0630 the following morning. A second concern is that while I assessed the patient that shift, I charted my assessment as a late entry because I had already stayed well beyond the end of my shift and I had to return so early. I was unable to get to charting because the patient's behavior was so unstable that he required multiple staff to be with him on a near-continuous basis. Anyone ever been in a remotely similar situation?

Thanks. Their website isn't too clear as to what exactly is required. My only concern with that program is it kind of gives the impression of a diploma mill more than a traditional university.

Hello. I'm about to graduate from my ADN program at a California Community College and would like to pursue a BSN. The main objective of my BSN is to obtain a Public Health Certificate in California. As part of the California Board of Registered Nursing's Public Health requirement, BSN graduates need to have 90 clinical hours in public health. I know that all of the CSU RN-BSN programs will give me the required clinical hours, but none of them are taking applications for Fall, 2013 and it appears that the earliest I could start most of them would be Fall, 2014. I have found plenty of NLNAC/CCNE approved online RN-BSN programs but have not yet found any with clinical components. Can anyone help me out? Also, if there is anyone out there that has a public health certificate in California but received their BSN out of state, I would be very interested in hearing how you did it.