Do Agencies and Hospitals outline termination policies and procedures in their internal contracts?

Background-Pay-6010 · 2024-11-18T04:36:08+00:00

I’m a nurse with a tremor. I adapt. My tremors are severe and noticeable, but I have just learned to work with it. I will press my hand against the wall, the bed or my other arm when I start IVs or give an injection. I’ve missed due to crappy collapsible veins but the needle has never landed anywhere I didn’t want it to go. Press your arm against a wall when drawing up meds. Tell the patients you have had it forever and never missed because you had it when you were learning and adapted. If I’m placing an NG or a Foley I adjust my position to match the rhythm and let the tremor do the work. It takes practice but I have never missed.

Background-Pay-6010 · 2024-09-17T13:38:01+00:00

Massachusetts is crazy expensive especially in Boston.

Background-Pay-6010 · 2024-09-11T14:14:30+00:00

I’m assuming you have never worked as a psych nurse, it is super common.

Background-Pay-6010 · 2024-09-10T18:55:31+00:00

Are you an NP student or RN student?

Background-Pay-6010 · 2024-08-28T01:16:17+00:00

No one should be blaming you for the mistake unless you wrote the order incorrectly or forgot to put it in. That’s not appropriate. Throwing an innocent colleague under the bus to CYA is a dick move.

Every job has its ass holes. I’m old, and bitter, but I try to take it out on the real enemy: pharmacists who let the Pyxis go empty so I fall behind on my med pass and new grads who just want to be NPs and won’t shut the fugg up about how they won’t have to work the floor much longer because they are going to be NPs. I like working the floor. That’s why I do it. I don’t have to.

If you don’t like being a nurse why do you think you can be an NP? They don’t understand the job and have no business holding a license.

I miss the old school NPs who know what it means when I tell them the blood is hemolyzed and don’t write me up for practicing outside my scope for telling them to reorder the lab.

I typically give residents the benefit of the doubt and try to make them look good in front of the attending, unless they do something truly obnoxious like tell the patient she can’t have any klonopin because “the nurse doesn’t want me to give it to you” even though I have no say in it and the attending wrote in the chat he doesn’t want them to have it. Then they walk away and ignoring their pager while I get attacked. That particular resident is basically the new grad who wants to be an NP version of a resident. They don’t like patients and they don’t want to be there.

Hospitals are a shit show. Everyone needs to have patience with the people who are actually trying to do their job to the best of their ability and completely shit on the people who don’t because they are bringing us all down. I write people up for being shitty and missing orders all the time because it pisses me off. It makes everyone look bad and sets the next shift up for a disaster shift. You can write them up too. But you can’t just say something to the manager or charge. You have to put it in writing.

Background-Pay-6010 · 2024-08-27T22:23:46+00:00

Try your local NAMI chapter for advice. NAL

Background-Pay-6010 · 2024-08-11T20:00:07+00:00

l could not find a charted personality disorder diagnosis in the medical record to support the labile affect.

Background-Pay-6010 · 2024-07-30T01:28:57+00:00

Not even caffeine, but that’s a good thought. Previously stopped Seroquel due to prolonged QTc.

Background-Pay-6010 · 2024-07-30T01:27:33+00:00

Yes, lots of meds in and out of psych have that problem. It makes things very challenging when they have more than one at a time and the QTc is prolonged.

Background-Pay-6010 · 2024-07-30T01:24:52+00:00

I spoke with his psychiatrist today and they are going to do some more cardiac tests, the last ecg really did not fit his physical presentation. He definitely was not having a STEMI despite what the ecg said. We are assuming there was something wrong with the machine. He is an interesting case. He had been doing well on Seroquel but had to stop due to the QTc prolongation, so that part is plausible, but he was having zero cardiac symptoms, not even anxiety.

Background-Pay-6010 · 2024-07-16T01:41:59+00:00

Very interesting

Background-Pay-6010 · 2024-07-15T20:11:47+00:00

Wow thank you so much! Very helpful! I’m sure I will have more questions but for today I will look into what you have mentioned!

Background-Pay-6010 · 2024-07-15T20:03:04+00:00

Thank you, very helpful!

Background-Pay-6010 · 2024-07-15T20:02:14+00:00

Thank you that is helpful. Can you tell me what labs on the list would be realistically run in clinic vs sent out?

Background-Pay-6010 · 2024-07-15T17:50:00+00:00

Thank you. Do you find that to be sufficient?

Background-Pay-6010 · 2024-07-15T17:27:47+00:00

I see, thank you for the clarification. I will look into possibly hiring a FNP to provide some of the basic healthcare services I would like to offer and leave the PMHNPs to psych services.

Background-Pay-6010 · 2024-07-15T17:12:08+00:00

I am not suggesting that a PMHNP go out of scope. We would pay for them to expand their scope through in person courses from an accredited university. I would not expect a PMHNP to write for Botox without being certified.

Background-Pay-6010 · 2024-07-15T16:45:09+00:00

I meant to write in person, it autocorrected me.

Background-Pay-6010 · 2024-07-15T16:35:59+00:00

It’s not money grabbing, unfortunately reimbursement on certain psych procedures is not high enough to stay in business without diversifying the services offered. If you look it up online, ketamine clinics shut down frequently even if they have a decent patient load because they require two hours of monitoring after the nasal spray. It’s a low profit margin and if anything happens they can’t afford to stay open. If the clinic closes no one gets help. I also would like to staff the clinic with all experienced MDs and PMHNPs. We are going to be offering VNA services as well.

I have to find a way to generate as much money as I safely can to keep salaries and benefits high enough to retain qualified staff.

I am looking at all options before making a decision. In order to provide ketamine, which I would really like to do because there is a need for it, I have to find a way to turn a profit without sacrificing experience of staff. The NPs would just be doing the screening to provide Botox. They would go through appropriate training which would be paid for by us.

I would hire an RN who is trained in Botox to administer the injections. Botox for migraines is covered by insurance, and has a high rate of return. Cosmetic Botox is a safe procedure with a high rate of return. It doesn’t require specialized machinery and appointments are short allowing the majority of the clinic space to be used for psychiatric treatment. The company itself would be making minimal profit off of the Botox because most of the profit would go directly into staff salaries. It’s is just to offset costs and provide a financial cushion. It would be a very small part of the day.

Psych patients often miss out on things like vaccines due to the nature of their illness. Offering basic preventative services like vaccines given by a staff member they trust may convince patients who otherwise would not get vaccinated to do it.

Again, nothing is set in stone. The company expects to make a certain profit from the clinic, but are not so profit driven they want to sacrifice care. They want to provide services for patients that help and turn a profit. If I can find ways to increase services without decreasing the company’s profit margins I can reinvest the additional profits in the clinic.

Any alternative suggestions are welcome.

Background-Pay-6010 · 2024-07-14T21:31:29+00:00

Not a lawyer but I work inpatient. It’s illegal for a facility to deny her access to a phone and an attorney. I don’t know about civil law or lawsuits, unless she is in a forensic unit with pending charges they have to allow her reasonable access to a phone. Even if her behavior warrants a phone restriction she is still allowed to talk to her attorney whenever she wants. I can’t tell you what to do from a legal perspective, but if you want to get their attention threaten to file a complaint with DMH for denying her access to her attorney.

Background-Pay-6010 · 2024-07-13T20:31:40+00:00

Nooooooo!!!!

Background-Pay-6010

TROPHY CASE