lpn164

I guess I didn't respond to your final question. I am not going to tell you my name, but if I were in a doctors office or hospital I really don't care if you call me by my first name my last name or if I am called miss or mrs. I am glad you are in front of me providing me care. I care about a name and DOB when it comes to verification that's it.

I am in ambulatory internal medicine - I am not on a floor treating a patient for a 12 hour shift and potentially for several days - If I were then I would want to get more personal. I see 26-30 patients a day. I would rather spend more time asking them about their health maintenance and ordering correct labs than asking what they prefer to be called.

So I am going to be "Frank" for me I am so annoyed with anyone who has a problem with what I call them. If it is part of your name it is your name, I do not know your preference, I do not know your marital status, I do not know if you are a doctor, I do not know if you want to be called by your first name and not your last. That being said I 95% of the time call patients by Mr. or Mrs. even if they are younger than I am (I have been a nurse since I was 20 and am now 31) and I try to pronounce it the best I can. If I am totally oblivious on how to pronounce I will say the first name only which is rare because I will attempt to try it and be respectful. I have patients who have argued with me for pronouncing their name wrong - my best go to now is to show them my badge and ask them to say my last name - I have a very hard Italian last name thinks to my husband ?. And it usually ends in a touche'. I have had a former military officer yell at a float nurse because she called him by his first name and he made her cry because he should be addressed as Mr. he tells me about it every single time he comes in. HIPAA laws prohibit us from saying first and last name together it is either one or the other. So if we are uncertain on a pronunciation especially after being berated for saying it wrong we are now bullied into being scared to just call a patient back. I called a retired MD back - had no idea at that time he was a doctor - I treat several doctors - some tell me do not address them as a doctor b/c they do not want patients in the waiting room to know who they are. Once I called a retired doctor back by Mr. ____ and he literally yells across the waiting room to me that I am to refer to him as Dr. _____ because "all the time I put into becoming a doctor and working until I was 65, I deserve to be called doctor". I honestly was baffled and didn't actually know how to respond especially after being chastised in front of a lobby of patients and coworkers. He harassed me through the entire visit and kept bringing up the fact that he is was a former doctor. I finally said to him I am sorry that I am not a mind reader and I had no idea you were a physcian. I don't think he expected me to say anything so he actually started to APOLOGIZE. Still baffled to this day from that one. I always strive to be respectful but I also should get respect back. Like I said before I have a complicated last name I am used to being called by my first name more often than not - if I hear a last name called that sounds like someone is trying to say my name I get up. If you feel that entitled then you are the one that sucks.

Hi everyone, I am an ambulatory LPN in a very fast paced Internal Medicine office. We are under our hospital standards. We are up for a mock survey this week for JACHO and are in the window for the real deal. For some reason I feel like our office is being picked on as they have been doing biweekly checks for potential JACHO visit by our education team. Every single week they have some new insane rule and I am curious what goes on at other ambulatory offices when it comes to meeting standards. Currently I feel like we are being punked. We have to have our sinks marked "clean sink" (to prove we don't pour urine down it). We have to mark 12 inches between the sink and the urinalysis machine even though the outlet is right next to the sink. We had outlet covers on all outlets but we have now been written up for having outlet covers and they have all since been removed. We have to clean our blood pressure cuffs between each patient for a full 2 minutes then we have to bag the cuffs in ziploc bags at all times when not actively taking a BP. We cannot have medical scissors, tape measurers, or any other mutli patient item in a room unless it is in a ziploc bag and marked clean. We cannot have table liners in our bed drawers. The EKG machine cannot have one single bit of adhesive found on it from the leads or automatic write up. Our wheelchairs have to have a tag on them that says clean when not in use. This is just a few items of the many many many rules that keep getting thrown at us every other week. I have gone to other offices within the same company and NONE of this stuff is being done at other facilities. We got written up for having a desk fan because it was only a 2 prong not a 3 prong plug EVEN though our U/A machine is only 2 PRONG. I am super frustrated and very curious of other practices experiences, when we ask we are told "It's a JACHO rule".

This is old but hopefully my response will help future nurses. We have a LONG running LPN in our office 25 years+ in nursing if not more, you would think she would be a great educator or mentor to go to but she is the complete opposite. She calls 911 all the time it is so embarrassing. I am so glad I don't work close with her. She scares the patients to death in the process and 50% of the time they do not make it far past triage before getting sent home. Don't overthink it. She recently called 911 for this EXACT thing. Male in his 50's/60's had a vagal episode in the exam room while attending his wellness visit - no complaints. She never documented repeat vitals (not sure if she checked them or not since no documentation) and didn't use any skill to obtain a glucose or EKG.

That would be lovely. However insurance is the controller of who and where a patient can go. Typically it seems the harder they make it for the patient the more money they get. Sad but true.

I predominantly room patients and perform basic POC testing. I use to huddle with my provider with a printed schedule and write down testing or questions that needed to be addressed but now I know my doctor like the back of my hand so I just huddle by myself in regards to the rooming aspect. I just jot down what needs to be addressed or a quick description of why they need to be seen like a hospital or ER follow up, etc. I know that if someone is coming for dizziness or bleeding/anemia I am going to automatically do orthostatic's etc. If I see a complex patient in a visit with an inappropriate amount of time I speak with my lead before hand so she is prepared to potentially step in and know what is going on ahead of time or get my next patient back for me. We have a phone policy but it is not enforced. I barely am ever on my phone because I am far too busy but I have it on my desk and check it. We have some nurses that I see looking at their phones like it is their job. They don't huddle and do not prepare for their next patients so I guess that is how they have time. I don't like to go into a room blind and my patients often thank me for knowing so much about what is going on and being prepared for visits. I think it is very important to huddle however I think it comes down to each individual's drive to do a good job or a mediocre one.

I am so thankful to no longer have to do referrals as my current employer has a dedicated person to do this and we also have a concierge service now as well. However I have done my fair share for sure. The biggest problem that I witnessed (and learned the hard way myself) is that often the nurses call and waste so much time on hold or getting to the right place and they are missing information. You must do the research - you have to pretend you are the patient and you need to know why you need this exam or medicine and why you cannot do an alternative - once you can investigate properly and provide proof with the right answers / codes that are needed it is SO much easier. I also always kept a cheat sheet for all the insurances #'s the option #'s etc. Before long I never got denials on procedures (some meds we had to do trials). I maybe had to do a peer to peer 5 x a year max. Hope this helps and hopefully your office will realize how much good work and patient care could replace this by hiring someone for this. Good Luck!

One of the bigger problems in privately owned practices are just this. The doctors can mold and train anyone to do anything if they are willing to do it. A lot of times the person does not know that they even have a scope of practice or that they might be overstepping it. I don't doubt that the MA is not very knowledgeable she probably is with her experience. I agree that there was a potential near miss and this is likely why they are looking for a an RN however she cannot sign off on any of your skills or competencies that requires equal or higher role. She may be able to supervise the office in other ways but not clinical in your situation.

Why can't you call the translator and have them listen to the message?

I definitely think it is rather insulting to anyone to tell them to wait outside the lobby. If they are in the hall/elevator etc the people in the lobby will likely travel those same places within 2 hours anyway. Also if they have the rash in awkward places - could lead to a risk issue trying to take a look in a hall or lobby. Our practice has a dedicated room for these type of situations and a prepared bag of disposable gown, shoe covers, and mask for the patient and staff if needed. Usually more triage is done prior to appt to get a better idea of what to expect.

Id say NOPE and move on, they are looking for someone to fill a larger position and use them to do an underling position as well then blame you when your main job is not done correctly. RED FLAGS

I would stick it out until after delivery, upon return - do you like this job other than this one person? if so I would take it up with management again and demand something be done to correct the toxic environment.

We don't have any alert system in our office but as a whole we have different teams, I am not sure how each team operates however my team (2 LPN's, and 1 MD) have an established plan if needed. We currently will have one person preferably the MD stay with the patient in distress while one calls 911, 1 LPN gets the AED & oxygen upon returning I am on chest compressions if CPRis needed, MD is on bag mask, while other is helping with 911/AED/family members/minutes/ with a plan to rotate every 2 minutes of chest compressions until 911 arrives. I have mentioned in the past a practice scenario and suggested each team also plan and practice this to avoid chaos and delaying CPR, however my management has done little to follow up which is why my team developed the plan we have as for-mentioned.

We don't have any alert system in our office but as a whole we have different teams, I am not sure how each team operates however my team (2 LPN's, and 1 MD) have an established plan if needed. We currently will have one person preferably the MD stay with the patient in distress while one calls 911, 1 LPN gets the AED & oxygen upon returning I am on chest compressions if CPR is needed, MD is on bag mask, while other is helping with 911/AED/family members/minutes/ with a plan to rotate every 2 minutes of chest compressions until 911 arrives. I have mentioned in the past a practice scenario and suggested each team also plan and practice this to avoid chaos and delaying CPR, however my management has done little to follow up which is why my team developed the plan we have as for-mentioned.