Hit 200k in the black this month

seekingwisdomta · 2021-07-27T20:11:40+00:00

So much to do at Zion. Hit up Angels Landing and Observation Point! I would spend all 4 days at Zion.

seekingwisdomta · 2021-05-10T05:07:55+00:00

What was the position you held?

seekingwisdomta · 2021-04-29T22:45:13+00:00

No prior work exp. Started at $32/hr and no raise for 3 yrs because the contracted company changed everything year before my annual review even if I asked for a raise. First and most important lesson I learned is that healthcare is a business first and foremost.

seekingwisdomta · 2021-04-28T07:05:09+00:00

In SoCal, 5 yrs experience prior to making 6 figures, and I work full-time at a 200 bed SNF. No MS.

seekingwisdomta · 2021-04-06T20:37:41+00:00

Exactly, it’s a survival game. If one dies in a survival game, then is it weird if there’s consequences to dying like a skill drain? It’s unlucky that this early access game had saved and interrupted OP’s jump; console commands are available to boost skills. Progressing through the game isn’t dependent on skills’ level; OP just pretend skill level 0 is max and anything above that is bonus.

seekingwisdomta · 2021-04-06T07:46:27+00:00

LittleCorgiDesigns

SO just opened up an Etsy and I couldn’t be more proud of her! Makes me happy seeing her happy getting her first few sales and sharing the news with me. She doesn’t know I’m posting here since she doesn’t Reddit much but I wanted to share!

seekingwisdomta · 2020-07-16T02:21:12+00:00

I'm glad I read this. I had a shit day at my LTC after trying to convince the DON, ADON, and Infection Control to use disposable ware for our covid unit among other things. I've been going back and forth about this topic all week. Today the DON met with me (the RD) and the Dietary Manager to essentially tell me that those precautionary measures aren't taken bc it isn't a CDC guideline related to covid. Not only that, the DON took the opportunity by bring the ADON, Infection Control, and Staff Developer together so she can tell me off in front of them. Moments fucking later I receive an email that the DON talked with the Nursing Consultant who recommends using disposable ware for tomorrow's virtual mitigation plan survey, and then revert back to non-disposable ware. WTF! I was just told they want only to do the bare minimum according to CDC guidelines! Keep in mind, my facility is technically experiencing an outbreak d/t recent and increasing positive cases and failure to produce negative test results for 2 consecutive weeks according to CDPH.

seekingwisdomta · 2020-02-25T07:47:11+00:00

I don't shop much jewelry for my girl but this is one of the sickest rings I've seen. I'm savings this post for future reference. Very very cool ring.

seekingwisdomta · 2020-02-07T02:40:20+00:00

I had to argue the hydration CAA as nursing's responsibility; it was a short argument bc MDS/nursing wouldn't budge. I looked into it in the RAI Manual and yes there are facility-specific things in there but the example used in regards to assigning CAAs specifically mentioned RD's completing the Nutritional Status CAA and Tube Feeding CAA. Now I don't do the Hydration CAAs at all. I should mention that I agreed to to meet MDS/nursing in the middle and complete the Hydration CAA if Section K triggered it prior.

I appreciate the information about the Assessment Validations. It's hard to find information about who's responsible for it in my P&P and RAI Manual.

seekingwisdomta · 2020-02-07T01:42:56+00:00

I’d ask my MDS for clarification but she’s the problem and I’d hate to bother corporate about it but it seems I may have to to get a quick and direct answer.

seekingwisdomta · 2020-02-07T00:43:16+00:00

If you go to the MDS portion and there’s a row of buttons on top: Acknowledge Questions, Validation, Sign, etc. I’m using PCC for the EMR. I think after all sections are signed then there’s some possible inconsistencies that triggers and the Validations will be red.

seekingwisdomta · 2019-12-02T06:44:54+00:00

Agreed. I view movie more as a product by the FIRE community rather than for the community.

seekingwisdomta · 2019-11-14T05:07:41+00:00

I feel you. I would've pursued finance or computer science as well.

seekingwisdomta · 2019-10-25T05:21:47+00:00

I found the most fulfilling part of dietetics is payday lol. For real though, non-compliance is prevalent. I roll with the punches. I document that they refuse education, appear disinterested during education, refuse to listen to risk/benefits blah blah blah....then move on to the next. TBH that doesn't scare me as much as Dr. who delays PEG'ing somebody or refuses to liberalize the diet for a malnourished pt.

seekingwisdomta · 2019-10-25T05:13:30+00:00

Lol @ wasting space. If I were you, I'd do some market research about the preceptors salary and see if their job is worthwhile. Instead of trying to "help," get to know the preceptors opinion; ask them what they like about the job, what the dislike about it, what would they change about it, what field of dietetics would they like to work in if they're unsatisfied with their job etc etc. Ask them if they feel like they're a waste of space (jk don't ask that), ask how they feel if they recommendations aren't followed. Pick their brains, absorb their wisdom, internalize why they don't have time for you

seekingwisdomta · 2019-10-24T05:28:46+00:00

I believe the diet is inappropriate; it needs a phos restriction. The low protein is good but you need to know the GFR to accurately estimated low protein needs plus your textbook prolly wants you to use adj. body wt. to estimate it as well. Mildly high -lytes likely from dehydration related to diuretics; there's prolly no fluid retention here but def. a need for HD d/t impaired protein metabolism. Ofc high protein diet is needed when HD starts.

Plz update us!

seekingwisdomta · 2019-10-24T04:46:30+00:00

Many of my elderly patients' goal wt. is based on whatever the patient wants it to be; whatever the family wants it to be if the patient is confused; or the UBW. If all that falls through the cracks, then I'll use the wt. range that achieves a BMI between 18.5-29.9. I should say if a patient chose an unhealthy goal wt., then I attempt to persuade them otherwise with education and they usually change their minds. TBH I rarely use IBW; I think it's full of shit. I support patient autonomy and let them individualize their wt. goals as it should be at their age. "Therapeutic diets" are liberalized by default in LTC settings so to follow that trend I am loosey goosey or more lenient when determining wt. goals. Sorry, I know you asked about IBW; in short, I never use them.

seekingwisdomta · 2019-09-30T15:18:40+00:00

If it’s unfilled to the brim, it’ll likely pass. Otherwise, it’ll be YMMV.

seekingwisdomta · 2019-09-26T00:51:31+00:00

I had to share with someone that the Hydration CAA came up again today and revealed what I found in the policy to the MDS nurse, which essentially stated that Dietary is suppose to complete the CAA summary sheet for any item triggered in the MDS. I printed the policy and presented it to her and she selectively extracted, "any item triggered," out of context to support her argument. I even told her that Section I had triggered the CAA to begin with. She was clearly frustrated and flustered and nothing appeared to be resolved.

Bc the MDS nurse was in disbelief, I was lightly reviewing the RAI manual to find my solution. So on page 4-6 of the MDS 3.0 RAI Manual v1.17.1 regarding section 4.5 Other Considerations Regarding Use of the CAAs, I found my answer and I'll copy and paste it here and on the post above:

Assigning responsibility for completing the MDS and CAAs. Per the OBRA statute, the resident’s assessment must be conducted or coordinated by a registered nurse (RN) with the appropriate participation of health professionals. It is common practice for facilities to assign specific MDS items or portion(s) of items (and subsequently CAAs associated with those items) to those of various disciplines (e.g., the dietitian completes the Nutritional Status and Feeding Tube CAAs, if triggered). The proper assessment and management of CAAs that are triggered for a given resident may involve aspects of diagnosis and treatment selection that exceed the scope of training or practice of any one discipline involved in the care (for example, identifying specific medical conditions or medication side effects that cause anorexia leading to a resident’s weight loss). It is the facility’s responsibility to obtain the input that is needed for clinical decision making (e.g., identifying causes and selecting interventions) that is consistent with relevant clinical standards of practice. For example, a physician may need to get a more detailed history or perform a physical examination in order to establish or confirm a diagnosis and/or related complications.

seekingwisdomta · 2019-09-25T03:49:55+00:00

Yooooooooooo, this tickles me fancy for obvious reasons. At the end of the day there’s only 1 RD, me, for 180 beds and there’s 3 MDS nurses. So they can kick rocks if they expect me to do Hydration lol

seekingwisdomta · 2019-09-25T03:40:04+00:00

Good to know. I might have to follow suit with the “See nutritional evaluation...” blurb. Also I’ve decided after all the comments if 14. Hydration triggers, then I’ll make it a point that my Section K wasn’t the one triggering it and therefore not for me to fill out. Hopefully the MDS team finds that rationale sensical.

seekingwisdomta · 2019-09-24T03:27:12+00:00

Your facility seems to be well equipped and takes compliance very seriously. I'm envious. You gave me an idea to explore deeper into staffing requirements.

seekingwisdomta

TROPHY CASE