egg122 NP

Officeally is affordable. I use Practicefusion and while I like it, if I had to do it over again, I would use officeally due to costs and billing/administrative functionality.

Your management sounds pretty ethically questionable given that they are accepting and keeping patients that do not meet the criteria for skilled nursing care indicated by writing, "Many are homeless people who would have been discharged home from hospital if they had a place to go." They are filling beds for cash regardless of the need or qualifications of the facility. They are not likely to change or staff appropriately in the future. Keep that in mind. You protect you.

They may be getting at the idea that the person is in the 6 week residential program and focus should be on the residential treatment and not in issues that can wait until discharge- for example long standing acne, chronic back pain without signs of a major neuro issue, OSA that the patient is aware of but never got a CPAP, routine dental care, etc. Essentially, things that can wait until discharge should wait until then. It was my experience in one of these programs that patients had not kept up on their routine health for a while then had the expectation that this would all get addressed in the residential program but they would either be missing substantial parts of the program or asking for things that required a lot of resources that this program was not set up to do. Also, if a patient has controlled chronic issues, like HTN or DM, it is reasonable for you to order the meds be continued as you might with an inpatient psych admission. It would be appropriate to consult primary care for uncontrolled diabetes, uncontrolled HTN, infections, etc.

Please look for a program that provides quality over quick and cheap- preferably one that offers real training in some psychotherapy too. I know a lot of people claim the online programs are just as good but a program that offers you training in 10 months is questionable. These are the kind of threads that end up on that mid level *** site some MDs have set up.

This is the kind of stuff that is going to drive nurses out of the profession. Why aren't administrators, managers and owners ever charged for intentional understaffing and poor conditions in their homes?

For all of these patients on controlled substance, what's your plan when Ryan Haight comes back into play? You need to have a plan to either see them in person or get them off of the med.

May I ask if you have had a conversation with them before deciding you want to report them to the board? Also, in psychiatry the customer is not always right - if that were true I'd be continuing a patient who recently came to me on Klonopin 1 mg qid + diazepam 10 mg tid+ Ativan 1 mg qid + Xanax 1 mg qd + lunesta 3 mg because their last prescriber gave it to them and "nothing else works.” Providers can decline to give meds they do not think are appropriate.

I would be cautious of accepting a DON position in a facility that has had 5 of them in 2 years- especially without prior DON experience. That is a facility that is setting them up to fail. Many times DONs don't have as much leeway with resources in SNFs as they may seem to have and the almighty dollar is the bottom line for the administrators and owners.

OP- Just curious, are you the only RN on the unit and the other nurses are LPNs? Also, is there an RN supervisor on for the house during the day or just unit managers?

Try the leaf device by smith and nephew.

I am finding everyone is calling out. It makes me crazy. I saw some of the same people putting the posts of facebook, "I'm a nurse" or "I can't stay home, I'm an essential worker" and I couldn't fathom the total lack of self awareness. I also notice management abandoning units or SNFs recently and MDs refusing to round. I sincerely hope that the department of health gets involved but I am sure that nothing will come of it. We are definitely at the breaking point in our healthcare system where years of corporate mentality have resulted in inadequate systems and a "me, me, me" mindset.

Problem solved then I guess?

Yikes. Not a HIPAA violation technically but super creepy. Has he spoken to you directly about his expectations of your work flow and why he is doing this? Does he do this to other employees?

Agreed. I had to explain to a supervisor how to reconstitute an IM medication today. They had no idea that IM medications may need that and how the procedure might work. It was quite surprising for me.

We all make mistakes in healthcare. The important thing is to learn from them. This likely did not result in any harm. If it comes it, just acknowledge you made a mistake and how you will take a different course of action in the future if a similar situation arises (such as calling the MD to clarify if you get a verbal report to hold the abx but do not see an order in the order section of the chart).