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aspiringrn1987

aspiringrn1987

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aspiringrn1987's Latest Activity

  1. aspiringrn1987

    Finding a following MD

    I really just have to know if I’m being gaslighted by this company. Because they keep telling me this is how it’s done in the city where I just moved, but I’ve worked for 3 agencies in the past and never been required to perform so much work for free or so many administrative duties. I’ll preface this by saying my company primarily accepts managed care plans that require continuing auth for everything we do. So first off, if I have an SOC, I have to confirm the following MD. As in, we have no idea who it is, I have to track them down based on the patients statement of who their pcp is and get them to verbally confirm they are following the POC. If the patient hasn’t had a F2F or has no pcp, I then have to do all the leg work of coordinating with the liaison and patient to send a mobile MD so that they can follow the patient for the POC. additionally, if I am assigned an SOC and the patient doesn’t discharge on time from the hospital, I’m responsible to continue to follow up and coordinate with the patient/hospital/facility/case manager, obtain delay orders, etc. some of these patients never end up being admitted after I spend an hour or more working on the case for which I am not compensated in any way. So I make no money to perform that work. We are a large agency with an intake team who I’m told doesn’t do any of these functions because once I accept the patient it’s my responsibility until they are either admitted or a nonadmit, at which point I make $0 for anything I’ve done. It’s also a big monumental issue every time I am assigned an SOC on a Friday who doesn’t discharge from the hospital as expected. I either have to see them on Saturday or “get permission” from the clinical manager to have the patient reassigned. Why would I need permission not to see a patient on my scheduled day off? It’s very strange to me. Most of these things were functions of the intake team or liaison in past agencies I have worked for. How can I be asked to continue to follow up and perform administrative duties with no pay for SOC that don’t work out or fall through? Am I totally losing my mind or is this not normal?
  2. aspiringrn1987

    What would you think if you saw this patient?

    I would need more assessment data to decide. How are his vital signs? What is his PMH? What you are describing could be a stroke, or it could be bells palsy or any number of other things. My gut leans toward sending him to ED for further assessment, but I don't have the entire picture here from your post. EDITED TO ADD: Now that I read through some more of your postings and see the hx of brain cancer I would have opted for sending the patient to the ED via ambulance.
  3. aspiringrn1987

    Unprofessional to mention you have other patients?

    This actually reminds me of a recent story and it makes me snort every time I think of it. Recently had a small fire at the facility where I work. We were literally evacuating the unit where the fire was located through this hallway where another patient kept putting on her call light. I went in to make sure she was okay and just to reassure her that FD was on the way if she was concerned about the alarms. She says" I need a pain pill." I said "ma'am, there is an emergency at the moment, We are evacuating patients because of a small fire. You are safe here, but we are evacuating the adjacent unit. As soon as everybody is safe, I will make your nurse aware that you need a pain pill." Her response? "But I have OSTEOARTHRITIS and I've been asking for a WHILE." *facepalm*
  4. aspiringrn1987

    Unprofessional to mention you have other patients?

    I usually avoid stating that I have other patients, but I do say the same in a different way. I might say "Give me just a few minutes to give these medications and then I will be back with your fresh ice water." Or whichever pertains to the specific situation.
  5. aspiringrn1987

    GCU RN to BSN capstone course

    Good golly, I have gone through GCUs entire program with no difficulty. This capstone course requires a 'mentor' and it is literally taking a ridiculous amount of my time setting up paperwork and documentation they require after going through numerous local contacts with which the school has an 'affiliation' that the facilities know nothing about. Has anybody else had this issue with the capstone course at GCU? I'm about fed up which is sad because it's my last class.
  6. aspiringrn1987

    Help Needed - Rehab Nursing Clinical Documentation Guide

    I do if this is helpful or not, but it depends on the patient. A note for me would say something like "Patient is A/Ox3, able to voice wants and needs. Takes meds whole and tolerates them well. Patient c/o pain this AM and was medicated with PRN norco per orders with effective results. Lung sounds clear bilaterally to auscultation with no cough or SOB noted. Bowel sounds active x4 quadrants, abdomen is soft and non-tender. Patient requires extensive assistance with ADLs. Continues on PO cipro 500 mg daily for UTI. No s/s of adverse effects from ABT. Respirations unlabored, no body rashes and patient remains afebrile. Patient has 200 mL output clear amber colored urine, offers no c/o dysuria during this shift. Patient continues on neuro checks following fall on 5/12. ROM remains unaffected, vital signs WNL, and patient remains A/O x3. Will continue to monitor."
  7. aspiringrn1987

    New grad as a unit manager

    That sounds very different from how things work at my facility. So I guess you just can't compare different facilities?
  8. aspiringrn1987

    New grad as a unit manager

    I respectfully have to disagree with what you've said here. I know all facilities are different but the floor nurses at my facility have to use a lot of clinical judgment and critical thinking. The acuity in the "subacute" rehab setting seems to be ever increasing. We take care of patients with multiple IV drips, g tubes, lots of s/p surgeries, we regularly have multiple patients only a week out from stemi and nstemi. Sometimes I walk in and the unit looks like a med surg floor but the nurses have 15 patients and much less resources than they would in a hospital. I regularly send patients out for blood transfusions, respiratory failure, AKF, and the list goes on and on. And they are only able to go out and get treated for these things because there is a nurse providing close and careful assessment of those patients. There are no doctors on staff 24/7. They rely on us to be their eyes and ears and to notify them when a patient is going south. And they do. ALL the time.
  9. aspiringrn1987

    New grad as a unit manager

    After reading some of the more recent comments I will add some insight. I have proven myself in my months on this job as a fast learner and a good, thorough nurse. That is not to say that I do not often ask questions and second opinions from more clinically experiences nurses. The company culture where I work is phenomenal and very supportive. I think I was selected for the job for a few reasons. 1, I work in a field and at a facility that employs a lot of LPNs and I am an RN which is that preference for the position per corporate. We actually have many other RNs at the facility as well as many LPNs. Only one other RN showed interest in the position. I have worked in the facility long enough to have a decent rapport with the physicians we work most closely with as well as to have a good understanding of processes and policies in the facility. One of our other excellent nurses was promoted to ADON around the same time, her having much more clinical experience than I though not in the same setting. We have several new grad nurses and most of the nurses who have been with the facility the longest are LPNs, most of which did not express interest in the position. While I acknowledge that I was possibly in the right place at the right time, I also know I was a good candidate for other reasons. The person who really suggested and pushed for me in the position was the other unit manager who worked closely with me for the several months preceding the job availability. I appreciate all of the honest feedback I received from you guys. I just am unsure if I made a poor career move going into a management position early on with my more limited floor experience. Though I do think I could consider my position to be clinical experience, my career goals at this time are to become a FNP and I wonder if my CV will now hinder me from being accepted into a program.
  10. aspiringrn1987

    New grad as a unit manager

    I don't have a month of experience, it is nearly a year experience and I am now already in the position.
  11. aspiringrn1987

    New grad as a unit manager

    I haven't had any naysayers so to speak. I work in a very supportive environment and do know when to get help. I work closely with another manager for the same unit who has decades of clinical experience and has been a huge mentor to me. I just wondered if it is a negative to go into a management position early in the career if, for example, I wanted to move to acute care as a floor nurse and decided at any point NOT to continue on a management path.
  12. aspiringrn1987

    New grad as a unit manager

    I work in a subacute rehab facility. I'm a relatively new nurse with less than a year experience. Recently a position opened up at my facility for a unit manager and my supervisor and some coworkers recommended me to apply for it. I applied, went through the interview process and was hired into the position. I know that I was hired for the position because I am a good, prudent, capable nurse. I also have non-healthcare related management experience. I have seen numerous posts in the past saying that you aren't truly competent until a couple of years of clinical experience. I have been in my position for about a month and am doing fantastic, I feel confident, I know when I need to utilize my upper management team for support or opinions. My DON has complimented me and told me today that she is more impressed with me each and every day in the new position. A big part of why I was interested in the position is because I think that the experience looks great on a resume. Is it possible that clinical competence/critical thinking just comes earlier for some? Do you think moving into a management position early on in the career, and in a subacute setting looks positive on a resume, or could it be a negative in some instances? I am interested to hear other opinions as I build future educational and career goals for myself.
  13. aspiringrn1987

    New Nurse, New Job, Advice Needed!

    Watch what the nurses do, especially for your shift, when you are orienting. When you get on your own, try to organize yourself in the same way. As you get to know your residents and their personal routines, you will find your own methods.
  14. aspiringrn1987

    Being Ordered to Give Whiskey

    I've had a LTC patient that was hospice and has orders for 4 oz of vodka PRN q day. The order specified not to give narcotics and vodka within 4 hours of each other.
  15. aspiringrn1987

    What are your biggest pains/ problems as a nurse?

    I know I already mentioned this in earlier replies to this thread but, here is my latest nurse vs PT scenario: Today at work PT wanted to know why we could not place an indwelling catheter in a patient just because she was incontinent and in a brief. Kept expressing concern about her getting a UTI because her brief was wet when he entered the room. When asked why he was extremely concerned about a UTI for this specific patient, answered "because a UTI would be detrimental to her recovery." When I explained that incontinence is not a dx to support indwelling catheter, he asked what were the diagnoses for it then? And finally, when I stated that I would be more concerned about UTIs with a patient who was incontinent of bowel than bladder, he wanted to know why. I really dont don't understand why therapy is always trying to interfere and argue with nursing judgment. It just grinds my gears! Edited to add: Not to mention that an indwelling Foley catheter puts a patient at risk for a UTI, does not prevent it. *facepalm*
  16. aspiringrn1987

    Patient death

    This really made me feel a lot better about the situation. I do not quite remember, but I believe she was previously on the anticoagulant due to a hx of chronic afib. The swelling to her legs I do not think was from a clot. Rather I think the edema masked the clinical presentation for the DVT, but in hindsight that must be what was occurring with the discoloration and pain to the one extremity. The patient had a LOT of other issues going on. The acuity in the SNF setting is sometimes astounding to me. I have had shifts where I had 20+ patients with numerous ISO/c diff, multiple IV abt, IV fluids, fluid restrictions, daily labs being monitored, and 5-6 wound care treatments on my shift alone. Not to mention all the Coumadin orders I have to chase down, sometimes 3-4 a day from multiple different physicians, the med pass, the family members, the dementia patients, and oh the charting. But I really do love my job. It gets less overwhelming every day.