bestblondRN

I am interviewing this week for a Telephonic CM job that will transition to a home-based position. Would you be willing to share pros and cons of home telephonic CM? Thanks!

Hey Chris--best wishes in your new profession, and congratulations for taking the plunge into something different! I've been in this for 28 years and have seen the good, the bad, and the ugly also......Nursing has taken it's toll on me as well--just had a spinal fusion in February and now how a rotator cuff problem as well as a labral tear in my hip, not to mention the stress-related stuff in dealing with patients day in and day out. I think I've lasted longer than many, but it's no longer a game of endurance for me--I need to segue into another profession that utilizes my knowledge and skills, but doesn't tax me the way nursing has, both physically and emotionally. I'm still trying to figure out what that profession is :smackingf , but figure it will come to me at some point......there is no utopia, but there's gotta be something easier! Anyhow, good luck to you in your next endeavor!

I work for a large, incorporated group practice with a number of specialties and each office does their own thing when it comes to care models. There are practices in which the RNs are used only for phone triage, paperwork and refills and the MAs have the clinical responsibilities (rooming patients, VS, chief complaint, meds, etc. I have worked in Neurology and Neurosurgery, both of which have RNs working for 2-3 physicians, NPs working with one physician, and no MA or only one for an entire practice of 20 MDs. Obviously, this is the other end of the spectrum--we clean and stock our own rooms, perform phone triage, run our clinics (4 days per week), set up surgeries, exams/testing and perform other coordination of care duties, fill out all LOA and disability paperwork, make appointments at times, and see patients in Nurse Visits on half-day or non-clinic days for suture and staple removal, reassessment and education. As I have said in the past, I feel like chief, cook and bottlewasher! There is almost never downtime for lunch or even a bathroom break at times....... If it were in my power to design a staffing model which accomplishes the end of excellent patient care and running the clinics smoothly, I would have MAs partner with RNs (1-3 depending on the patient load and clinic schedules)where the MA spends 85% of their time in clinic, 5% of their time stocking, ordering supplies and straightening up rooms, and 10% of the time returning calls that are appropriate to their experience level as well as doing some of the coordination of care--setting up exams, tests and such. RNs would continue to do phone triage but would also see all new patients to establish a relationship, obtain a history, and identify specific care and educational needs. Return patients should also have access to the RN as needs are identified. I believe that RNs are terribly under-utilized when they are "chained to a desk" and never see patients or perform hands-on care or teaching. Every office or practice should be evaluated individually, and the question of how a RN is utilized within the practice should be asked during the interview. I would also find out how flexible they are about having RNs develop educational programs and actively perform teaching and other care responsibilities during clinics. Good luck to you in returning to Nursing!

I'm here at home thinking about how much I DON'T want to go into work today--to another day of 50-60+ phone calls, disability and FMLA forms, scheduling cases at several different sites, following up on patients who are scheduled to have procedures this week who HAVEN'T gotten their labs and preops sent in, as well as the usual Monday crap hanging over from the weekend! I work in a huge multi-specialty group practice for 2 neurosurgeons--1 is extremely busy with procedures and a high-anxiety population of cerebrovascular patients, and the other is a functional neurosurgeon who has lots of chronic pain patients. I am seeing patients in clinic 4 days a week plus my own nurse visits for wound checks, suture removal, etc., as well as anything not major enough to see the surgeons about. I am one of 3 nurses who have a 2 physician practice--the remaining 4 have one physician assigned to them. Of the 3 of us with 2 docs, 2 of us have UNREAL workloads that lead to 10-12 hour days, no lunch breaks, etc. Our clinic is a mess from the ancillary support standpoint with no MAs, lousy phone people who can't get basic information correctly from callers and who like to hit that transfer call button rather than get information and put the message on the computer so we can triage the calls. Consequently calls end up in voicemail that may not get checked all day if we are seeing patients. The checkout people will only schedule a follow up appointment--they will not assist patients in scheduling scans, tests or other procedures so the nurses end up doing it. We have spoken with the nurse manager a number of times both separately and as a group, and she is very good at taking the path of least resistance when it comes to dealing with the business-based practice administrator. Our exam rooms are filthy, unstocked--we run out of suture removal kits on a regular basis--and the red trash bins and needleboxes are usually overflowing. It's an embarrassment, especially considering that we are supposedly the "mecca" in this area........HAHAHAHAHA!:rotfl: :rotfl: :rotfl: At any rate--having been a manager, I see most of this for what it is (keeping budget under TIGHT control so our docs and administrators get their $30,000+ annual bonuses), but I am tired of feeling like I am being beaten to death every week--there isn't enough of me to go around! I come home in the evenings and my husband says I look like I've been through the war! I realize I have the option to walk, but I am just 5 months short of being 100% vested for retirement (if you leave beforehand, you lose it all, and I've worked too hard for that money--they aren't keeping it!!!!!). I am just disgusted that more and more the business end of healthcare is the only thing that matters, and that the administration here is so damn greedy at the expense of the staff and the patients (who are no walk in the park--lemme tell ya'! Wealthy, entitled, and very full of themselves--they are the ONLY ones who matter and will tell you so! ) I am feeling increasingly burned out. I've survived 28 years of healthcare, but am at my saturation point now. Do any of you in outpatient nursing experience the same thing? Are nurses usually chiefs, cooks and bottlewashers in most practices? I apologize about the length of this--I really needed to get this off my chest before I jump in the shower and head off to the salt mines. Thanks for taking the time to read this.......

prmenrs--I hope your organization survives the Hunter Group. My former place of employment did not and is one of those mentioned in the article you cited. Like many others on this board, I have seen these groups come and go--West Hudson, Hunter and a few others--and when they leave, it's like the path of destruction and ruin in their wake. I hope never to have to run into another of these groups again in my career! Good luck--I hope your job is still intact when they get done with your place!

I recently had a bilateral L3-4 laminectomy with foramenotomies for severe stenosis (the neurosurgeon said he'd never seen nerve roots so compressed in a 44 year old before). Before I get into the care issues, I should preface this story by saying that this is occuring in a "world-class" hospital and that I was on the unit I formerly managed during my post-op stay. The doc and his nurse were terrific--no complaints there--everything went smoothly and I was prepared well for the surgery. Of course, as often happens, my period started with a VENGEANCE the morning of surgery. Post-op, I had a 6 hour stay in the recovery room due to no beds on the unit. The nurse kept me well-medicated, got me an inspirometer, and helped me change my peripad when I asked. When I got to the unit, I was still feeling pretty good from the Marcaine they inject into the operative area before they close, so I got up and voided, changed my pad and walked the length of the hall and back. Well......all that changed when the local anesthetic wore off several hours later and I began having the most unimaginable nerve pain and spasm in my right hip (due to retraction of the nerve root) and down the leg, as well as in my left leg. I couldn't get into or out of bed using good body mechanics and was absolutely miserable. My IV was also phlebotic and extremely painful. It took 8 hours to get the IV site changed and the resident "wouldn't order anything for the spasm because I had been under anesthesia that day". What a bunch of BUNK! I asked to see the resident, but he never came in. Through that horrible night and into the next day, I couldn't even turn myself over despite q4 hour Percocet. My urine hat was full, and no one ever emptied it--I just would struggle to get into the bathroom (it took WAY too long for anyone to respond to a call light) and sit down in the puddle of urine and let it overflow into the toilet. I asked 3 aides and a RN to help me with pericare since my pad hadn't been changed since the recovery room and I had bled all over and had clots everywhere. Everyone said--"oh, OK, sure, be right back." Of course no one ever bothered to show up. I never received a water pitcher, bath basin, but was finally given a pack of OB pads after asking for help with changing my pad. The day shift RN walked in as I was getting out of bed the morning after surgery and just looked at me like I was a bug and said, "Oh my God....you are a neuro nurse and your body mechanics are just terrible. You know better than that." I promptly growled at her, "RIGHT NOW I AM NOT A NEURO NURSE--I AM THE PATIENT IN SEVERE PAIN, AND I SUGGEST YOU SHOW ME WHAT TO DO!" She jumped back about 5 feet and coached me through getting up and down out of bed. She ran in hurriedly about 2 hours later, gave me some Percocet and had me sign the D/C orders. I never saw her again. When my surgeon showed up the morning after surgery, I simply said, "Fred, when I am not in so much pain and can put a little distance between me and this situation, you and I will talk. Please discharge me--I will get better care at home." He obliged, ordered me Valium, Vicodin, and Flexeril (use whatever works) and put me on a Medrol dosepak when none of the above decreased the pain. The first time I got any care was when I got home and my husband and parents saw the excruciating pain I was in and met my needs. I was so embarrassed that my 70 year old mother was cleaning my perineum and putting a clean pad on me, that I just cried like a big old baby. My family members were awesome in providing me with everything I needed once I got home, and as soon as I started the dosepak, I had relief of the extreme pain within 12 hours so I was able to provide most of my own care. Now for the best part......some statistics that may blow your mind as much as it blew mine...... The unit was at 22 patients when I was there (23 is max census). Neuromedical, neurosurgical and complex ENT (there were no ENT pts. during my stay). I used to run the unit with the following: 7-3: 4 RNs/3 NAs 3-11: 4 RNs/2 NAs 11-7: 4 RNs I had to fight for that staffing and went to all the upper management with statistics supporting the addition of RN staff and NAs on nights, but could never get anything for my floor. I left after 2 years because I couldn't take the headbashing anymore. The killer is, this was and is the current staffing on the unit while I was there: 7-3: 6 RNs/3 NAs plus a unit based Case Manager and Social Worker 3-11: 5 RNs/3 NAs 11-7: 4 RNs/2 NAs My point in all of this is that staffing doesn't always have direct bearing on the care that will be given. Just like the patient who needs their hair washed to feel better (I spent three weeks in a hospital on bedrest while pregnant without washing my hair, so I have some knowledge of how atrocious this feels), controlling pain and making the patient feel cared for is an enormously critical part of what we do. I have worked many shifts "short-staffed", but tried never to let a patient or family member with questions feel as though I didn't have time for them or couldn't meet their basic needs at least. I assure you, the staffing on my former unit allowed for very reasonable ratios, but I felt like I was alone and on my own to meet my own needs. All I know is that we never did that with our patients on that unit when I managed it. Thanks for those of you who have been patient enough to allow me my rant. It feels good to get it off my chest, and I hope it will make us all a little more sensitive to the needs of our patients. Suzanne

I am currently separated from my husband of 2 years (second marriage for both) after being together for 5 years. I knew when I married him that I would continue in the pattern we had established of my working 12 hours and then coming home, fixing a meal, doing whatever chores needed to be done, and basically having no time for myself. I thought I could keep going, and that this was what it was all about.....taking care of everyone and doing everything. About a year ago, my back became so bad that I could no longer work, lift even a laundry basket or go grocery shopping. But, because I allowed him to be dependent on me, I found myself being very angry and frustrated that he wouldn't help with things I had always done. There have been a number of other dynamics that have played into this, not least of which was trying to blend 2 families with teenage kids.....bad move on our parts, since we didn't see eye-to-eye on childrearing. When the hostility and anger at home got to be too much, I became very depressed and decided that I had a greater obligation to myself and my daughter to provide a healthier environment for both of us to live in. I am now living in an apartment with her, and although I miss aspects of the relationship with my husband, I feel a sense of relief being alone again. I have always had that "rescuing" behavior in my relationships with men, and it's worn me down over the years. I am too tired to care for everyone but myself, and now is my opportunity to start caring for me again. Selfish? Yes....but in a good way. It feels good not being stretched from A to Z anymore!

Also need to consider how frequently blood is being drawn and pt's H&H, esp. with kids. I generally draw 5 cc on a normal weight, non-volume depleted adult from an art line or other heparinized line.

In the places I've worked, we assess the situation, along with Child Life and Social Work to determine whether or not the child is emotionally and developmentally ready to see the parent in the ICU. In my experience, when the child and family and well-prepared, the visits usually go very smoothly, and are generally brief. It's a very individualized process based on family dynamics, maturity of the child, etc...... I don't think there is any right or wrong with regard to children visiting--just make sure they are ready to handle it.

It sounds like you may have developed some compression. Which level was fused? Have you had RECENT films done of your neck? Is there any plan to re-MRI you for another look at those nerve roots? Have you had PT or OT yet? It's not unusual for there to be some residual symptoms following surgery (especially sensory sx), but it sounds like you have a new motor deficit, and that is definitely NOT normal, especially this far out from surgery. Please, for your own sake, follow kc ccurn's advice and get another neurosurgeon to look at you. Let the WC folks know about your problem--and your plan, since they are the ones paying the bills, and think about getting an attorney. Good luck!

I've only been to the Carribean on vacation, but always thought it would be an interesting option to work there during the nasty midwest winters! I don't have any inofmration to offer you, but wanted to wish you both the best as you pursue what sounds like a dream retirement!

The arguments pro and con for WLS are all valid. It is truly an individual decision that needs to be made with full knowledge of the lifestyle changes required and the potential for complications, including death. I have fought my weight all my life. I have had sustained periods of normal weight which required severe calorie restriction and heaps of exercise to maintain. It all went to hell when I went on steroids in 1995 for disc/compression problems in my thoracic and lumbar spine. I am now in my mid-40s and have mild to severe degenerative changes throughout my spine, including cord compression and severe lumbar stenosis which makes it difficult to walk. Standing stationary for a minute or two produces bilateral leg numbness. It ain't pretty, that's for sure.......which leads to my argument for WLS. I am at a point where cardio exercise, except water exercise, produces more injury and pain. I've gained about 50 pounds over the past 3 years, and am hypertensive on meds. I am 280# on a 5'9" SMALL frame--literally DOUBLE what I should be. I realize there are no guarantees, but I think reducing my body weight to a reasonable range would alleviate a lot of my spine pain and compression. I am also hoping to experience the other physiological and psychological benefits. It's like I am trapped in car that is functioning poorly and on it's way to the mechanic to be fixed.....just hoping I'm gonna' make it that far! I remember being a thin person. I remember walking into a room and having heads turn. I remember being able to go out and run a 10K marathon and swim a mile. I remember being able to go out and shop for size 8 instead of size 22. I am not a lazy fat slob who sits on the couch all the time eating cheeseburgers and bonbons. I work full time, deal with my pain as best I can, do my back exercises, and eat a balanced diet. I feel that the WLS tool is what will help me able to acheive some sense of physical wellbeing again. Do I expect miracles? No......I realize it will be a long road post-op. Still, I feel that it is my best option at this point. I don't think this is a surgery that should be done without meeting the criteria established by the ASBS--it has way too much potential for complications. 'Nuff said.......I'm getting off my soapbox now.........

(((((Jenac))))) I'm so sorry to hear about your dad. Not knowing anything about your dad's medical history, age, etc., it is difficult to know why TpA wasn't used, however, if he was over 4 hours into the stroke (4 hrs. from onset of symptoms), there is already permanent damage done. TpA then becomes dangerous to use, because of the tissue necrosis in the region of the stroke, and greater chance of bleeding into the area. You then have a much sicker patient--hemorrhagic on top of embolic stroke, and the prognosis isn't nearly as good. I don't know where you are located in Ohio, but if he is in one of the tertiary care centers like University Hospitals or Cleveland Clinic, they have protocols in place to ensure that a workup is done to try to determine source of the embolus. Diabetes is right up there on the list of contributing factors for stroke, as is carotid stenosis, atrial fib., as well as a number of other diseases. No doubt he will have carotid duplex scanning and a 2D Echo, in addition to lots of labwork to help identify other potential risk factors. It sounds like they are already doing all the appropriate stuff with initiation of rehab. Since he has no gag and is aphasic, I assume they are feeding him enterally. He has a long and challenging road ahead, and so will you and your family. I wish you lots of patience--it's not easy being the nurse and the daughter! Good luck, and feel free to pm me anytime.

How about Seymour Bones RN?

And I thought I was the only one bothered by that! I can't STAND to listen to GWB talk about "nucular"! You'd think one of his speech writers or SOMEONE would tell him how to say it and then work with him till he got it right.......

don't like the sound of this at all...... in addition to what everyone else has said, there is blatant falsification of record going on here when she signs off your name on meds that she's given. this nurse is 10 miles of bad road......document everything, report her, and keep documenting if nothing is done. then start going up the chain of command if you have to--the administrator would bethe next step, and if no results, then contact the state directly. there are programs in all states for impaired nurses. protect your license--you worked hard for it, i'm sure! good luck julie!

Good points EdwardIL......and Advocate is seeking Magnet status, but does not have it at this time. Cook County is also under collective bargaining, as is U of I. I don't know who else has unions.

P.S.--I should also add that the staff work their a**** off as well! They get their pound of flesh, for sure!

I worked at IMMC and found it a good place to work, overall. Once you got past the corporate BS and understood that it rarely carries over into the real world, it was tolerable. The senior management is very corporatized and middle management works their a**** off and drown in paperwork most of the time. Everything seems to be about the almighty budget, but I think most places are like that anymore. If you want to work Peds, how about Children's, Cook County or U of C? I can't guarantee how much better they are, if at all, but they are some places to consider and the corporate rhetoric isn't as thick as it is with Advocate. Good luck and let us know where you end up!

Here goes...... I worked for a hospital that became part of Advocate a few years ago. There were good and bad things about the acquisition as is often the case. Here's the bottom line though: Peds ran 1:4-1:6 on our general floor and 1:1-1:3 in the PICU. I wouldn't imagine that Christ is altogether different. Medical benefits are Humana HMO or some new PPO they've gone with this year--you contribute part, they contribute part. Dental is First Commonwealth PPO or HMO (don't go with their HMO). Life insurance equal to your annual base salary, $3500/yr. tuition reimbursement after 1 yr. of employment, ST and LT Disability after 6 mos. of employment. Salaries are competitive with other Chicago hospitals. New grads come in around the $19-20/hr. mark I believe. Shift diffs are $1.50/hr for eves, $2.00 for nights, $2.00 for weekends, $1.00 for charge. Advocate is out there to make money just like any other hospital system, and they do scrimp at the bedside where and when they can. They also save money by not offering some of the excellent benefits other places do. For example, University of Chicago or Rush offer 100% reimbursement of tuition expenses for pursuit of a nursing degree or masters. Some places offer better retirement benefits, etc., but you'll need to shop around to find that out. Christ is a big place (over 700 beds I think) and from what I've heard, not a terribly friendly hospital. The area it's in is a diverse population, ethnically speaking. It can be gotten to most easily from I-294, or if you live on the south side, via major streets. I don't know any recruiters there, but go to the Advocate website: http://www.advocatehealth.com and submit an online application. Good luck!

I am new to this thread and have a few questions about distance learning, so if any of you could offer some insight, I would really appreciate it! What is RUE? How did you pick a program? How do future employers/future programs (master's level, etc.) view distance learning? Thanks in advance for any insight you have!

I've had this happen to me from a professional standpoint--I heard the rumors when I was the new manager of a couple of units, so I came in at 3:30a.m. when this doc started his rounds. I stayed just out of his line of sight while he "rounded" on one unit. "Rounding" consisted of the charge nurse following him around with the chart rack, his standing in the doorway of the patient's room and asking his awake and alert patients, "How are you doing?" He never put a stethescope to anyone's chest, touched a single patient or reviewed a single chart. His famous trick was to do his rounds and then demand that the nurses run the charts over to his office in the next building in batches after he was finished. And IMAGINE.......his charts had a complete assessment documented! He could auscultate lung sounds from the hallway! SUPERDOC!!!!!!!!! Imagine the look on his face when I showed up for "rounds" when he arrived on the next unit!!!!! He looked dumbfounded and asked me what in the name of hell I was doing there at that hour. I just smiled and told him that being new in my role, and with him being the primary physician admitter to my units, that I wanted to have the opportunity to make rounds with him. During my brief stay at this hospital, I saw him actually making patients ill and then "curing" them--he'd bring in a well patient for a "physical" but chart that they had chest pain. He'd make them NPO, do a cardiac workup which would be negative, start a full GI workup, load 'em with IV fluids for dehydration, put them into overload, dry them out with Lasix, make them hypokalemic, replace their K+, and discharge them. This was generally a 10-14 day process. He could also schedule and see 50 patients in 3 hours in his clinic--how can that be done? I reported him to administration, but it was a good old boys club, and he was the big admitter to this hospital--not to mention "one of da boyz". I got them through a JCAHO survey and then they let me go without notice......there's a surprise, huh? As soon as I left the region, I reported him to Medicare and the State Board--don't know what happened, but hopefully he's no longer practicing medicine. Scary situation to say the least..........

Yes, we do it in surgery for rectal surgeries. It's done exactly the same way we do the D&Cs, hysteroscopies, etc.

Zoe and Spine CNOR: Thank you so much for your insight and wisdom--I will make good use of your advice! I'll keep you posted on how it goes!

I start my new job in the OR on Tuesday and am kinda nervous.....I've never done OR nursing before, and although I'm an experienced RN, this is a whole new gig for me. I am not one to take a lot of guff from docs--I try to be "pleasantly assertive" with them when I need to flex a little muscle, so I'm not too worried about being able to carry myself with that, but what worries me is memorizing everything--the case carts, instruments, knowing what to anticipate in cases, etc. Any tips from all of you experienced folks would be very much appreciated! Thanks! :kiss