Salter444

I never hear physician extender ever. Midlevel is used in my setting only to describe a group but not an individual. The medical Director may say we expect to hire 4 mid-levels. However, I have never been referred to a patient or other provider as a mid-level, they will introduce me as NP or simply provider. I think of it more as a category and not a slight.

I was told by other NPs NEVER sign a non-compete. Perhaps if the money was sick I may consider it, but there are too many places to work to be worried about a non-compete. Plus, half of the PAs and a few NPs moonlight and I think a non-compete my prevent that - in case you wanted that option

The problem with finding your own preceptor is that the student does not care if the preceptor is good, knowledgeable or knows what the hell they are doing. The only important issue to the student is that they are available and with that these schools do a disservice to the student. Does this mean that schools whom place students are finding the cream of the crop - NO, but at least is there is a dud in the mix the student can provide feedback and this can be addressed.

Depends on the unit and which facility. But typical day. 1. Arrive and find assignment 2. Find night nurse to get bedside report and review gtts, lines and GCS 3. Assess patient 4. Review labs 5. Chart assessment to stay ahead of the game 6. Pull and administer meds 7. Multi-dis rounds (have questions ready) 8. deal with crazy family 9. Argue with slow pharmacyy 10. Yell at lab for losing your specimen 11. Tell family member not to mess with the vent, IV or dressing 12. shove food in face and ignore phone for 10 min lunch 13. haul patient to CT 14. Transfer orders - yes 15. spend 90 minutes trying to get a step-down nurse to take report 16. Field calls from ED on why you cannot take the new patient 17. spend 15 minutes answering stupid questions from new Step-down nurse 18. Transfer patient 19. Pt arrives from ED and room not clean - give stink eye to ED nurse 20. Tell family of new patient to stay in waiting room so you can situate patient 21. Roll eyes at family member who ask you to get them coffee and then tell her the facility is too cheap to provide coffee 22. Call resident and let them know a 20mg push of ativan could possible kill your 88 year old COPD ESRD patient and have order change 23. Lab calls to question why your Trauma patient has a Hemoglobin of 4. (roll eyes and feel sharp pain in temple) 24. Draw odd labs every seven minutes as resident writes one as he is googling the disease management 25. PEE 26. Try to organize notes and pray your night nurse gets there on time 27. Wait 15 minutes as the night nurse chats away with friend in breakroom 28. Give report 29. Race to car as fast as you can 30. Get to car and see you have the PCA key and phone in pocket (cry softly) 31. walk the 8 miles from the parking garage back to the unit to return the key and phone 32. Ambushed by night nurse who did not bother to listen to report and now has questions 33. Answer questions (right eye twitching from continued rolling) 34. Leave unit, go to garage, find car and go home 35. Wonder *** was I thinking when I decided to be a nurse 6

The students with less RN experience probably benefit from a traditional brick and mortar setting where those with extensive nursing background do not need as much hand holding.

Everyone is entitled to their opinion. His opinion is based on his view and not on research or facts - so take it with a grain of salt.

The real question is WHY would anyone choose to work in Ohio?

If we start pulling at strings here (LOL) and deciding what we should be paying for and it impacts us. I have to share the cost for people having children and sending those rugrats to school. I do not have kids and never do I want them but still am taxed and assessed for the little snotgobbers. So, those of you who bemoan the transgender folks remember many of the benefits you enjoy are by those who are paying for some of your lifestyle, whether they approve or not. Plus, I thought religion taught is to judge not lest ye be judged. I use to care for prisoners and I made it a point not to want to know what they were being incarcerated for as I did not want to let that shade of judgement creep into my head. Bottom line it was NOT my place and not my call. So, I made every effort to treat them like actual people. It was not always easy and sometimes I did know their offense and sometimes I did judge, but I fought against it and I am only human and full of faults.

I checked with by BON and have been told this state has no such restriction in practice. Ethical? I am not following how you claim it is an ethical issue.

we may all be speaking Russian by then.

The consensus model sort of died and has not taken hold as was promised.

This reminded me of the nursing students who use to follow me as a ICU & ED nurse. Me: "where would you like to work when you graduate?" Student: "I want to work in CVICU or SICU" Me: "sounds ambitious, what shift?" Student: "Oh, I will only work days and no weekends or holidays." Me: "yeah, good luck with that!" They would actually believe that they could waltz into a hospital and demand Monday thru Friday dayshift without weekends or Holidays. This was not just one student. When you decide you want to work in a particular area or speciality you research what it requires and being the newbie you are bottom of the totem pole and you pay your dues and if that is not acceptable there is always the clinic life.

Yes, it should. The delivery of healthcare is guided by science and not convenience. Again, these are guidelines and in a critical care setting we look at each patient individually. I worked as a nurse at a magnet facility where foley discontinuation was a nursing driven policy based on guidelines, but common sense was omitted. An example...a trauma patient who was to undergo multiple surgical interventions. Per the guideline the bedside nurse was removing foley next day post op only to have the patient be re-inerted the next day for an additional surgery and so on and so on.

From cradle to grave per the brochure ....however, your individual results may vary.

I worked in a few HCA facilities and we were always short and it was not uncommon to be doubled up. The goal was to be 1:1 for the first 6 hours as there were serial labs and lots to monitor. We had shifts where you land a heart and maybe get 2 hours before your second CABG comes rolling in. It was not everyday but too often. Usually you have one stable patient then take the next heart. What made it more bearable is the open heart portion of the unit was an open 12 bed unit and it was easy to keep an eye on everyone at once - so if a nurse had a crashing patient you had many hands helping without the need to call anyone.