Hospital at Home

A new model of nursing involves providing hospital level care for patients transitioning to living at home. This model can improve the efficiency of hospitals and other facilities by lengthening the time between hospital stays and facilitating better medical outcomes. The recovery of any patient in the context of their own home will always feel better. The care plan can thus be carried out with minimum discomfort of the patient. And lack of malaise will always trump pharmaceuticals, or so many psychologists believe. Patients can therefore meet the demands of their illnesses and meet their healthcare challenges without having to encounter a fearful hospital experience and culture shock.
The patient eligible for Hospital at Home must have sufficient oxygen flow and non-ischemic chest pain or absence of chest pain. After meeting clinical criteria for eligibility, the Hospital at Home patient will part of a new and progressive service model for acute-care candidates. The resources such as oxygenation and infusion are mobilized, the service performed at the patient’s home, and the nurse provided for “outpatient” aftercare. Thus the patient receives the best in skilled postprocedural nursing, without the awkward and often uncomfortable (and frequently painful) transportation hiccups, to and fro.
The patients feel they have more control over their lives while in their homes, while a hospital is a sterile and unwelcoming environment that maximizes the unknown element of any serious medical procedure. The room in a hospital may have to be shared with another person the patient find threatening. Occupying a hospital bed in a room with a stranger can be overwhelming for a patient already uncertain about their outcome. The noise and intrusions of people such as nurses. physicians, housekeeping, technicians, phlebotomists, administrators, case managers, and records clerks, can be annoying. The coming and going of such people in their space can keep patients awake, disturb their slumber patterns, and fan anxiety.

Hospital at home involves skilled-nursing level care and aftercare attributes without high hospital costs. Hospital at home allows a patient to receive nursing facility level care, specialty treatments, and adjunct technical nursing services in the comfort of familiar surroundings. Often just the proximity to friends and family can assist patients in recovery and recuperation. Hospital-at-Home is rated highly by caregivers, nurses, patients, and family members. This factor alone should become a consideration when reviewing scenarios for medical procedures.

Medical centers across the country favor Hospital at Home (Hah!)as a way to ease the burden on limited-bed hospitals and medical costs the patients at the same time. Hospital-at-Home is a care model that can be adapted for metropolitan or suburban community recommendations. Usually these costs factor into the overall cost of any hospital stay. By shaving the expense of hospital level services with adjunct mobile providers, health management organizations can more feasibly recommend in-patient stays and facility admissions without the likelihood the procedures will be rejected on a basis of cost.

Not every patient adapts to services in a hospital environment. Privacy, communication, access to the physician and a case manager can complicate the overall scenario. Reducing the cost by up to one-third is one advantage of Hospital at Home. But in addition to cost concerns, a patient can regain the rights of residency and all the benefits it confers. Patients can use their home phone, computer, receive mail, host pets, and receive visitors any time of the day or night. Patients can enjoy all the benefits of their home surroundings while getting optimum care. These can be important advantages when a patient envisions a planned and necessary medical procedure.

    Many people are not comfortable in hospitals and grow nervous at the thought of staying in one

. The may have negligible confidence in the “system”. Distance, cost, and awkward transportation issues may make the whole idea of a hospital procedure, no matter how needed, become a horror. And many seniors are homebound and have limited access to hospitals and other needed. Given these problems, a decline may be envisioned by the physician recommending the procedure. But Hospital-At Home is likely to be sponsored by the HMO the patient belongs to, on a cost basis alone.

The complete package of services and the organization necessary may be beyond their grasp. But Hospital at Home allows for these vulnerabilities and assists many seniors and homebound others to gain their medical services without negative outcomes. And many patients rightly fear the contagion and infection that many medical professionals know is present. Hospital admission and continued skilled nursing can present many more problems than a patient is willing to deal with. But pre-treatment in a clinical setting and follow-up services after the performed medical service enables patients to receive vital and necessary treatment, and then recover in the comfort of their own home.
The modern world allows technical mobile access to treatment and lab services like phlebotomy, radiography, dialysis, and skilled nursing bedside care. Acute medical problems grow scary for the individual patient uncomfortable alone in a hospital bed, surrounded by strange noises, equipment, and people. Just the sound of their home and natural surroundings and resuming regular living patterns can ease patients back to recovery. The outcome of any hospital procedure or service will be improved for every patient. Additional follow up testing, such as EKG, PICC line placement or removal, X-rays, ultrasound or others, can be dealt with at home.

Evaluation of HaH candidacy starts with the Emergency Room staff. They will be trained to identify the patients that require inpatient services but may benefit better by being treated at home. The clinical eligibility criteria will be part of an attribute list developed by the Hospital at Home model. A team will be assigned to prepare the patient for Hospital at Home services and scheduled in conjunction with their medical procedure or treatment. The quality of the ultimate outcome can be radically improved on a per-patient basis. Less stress, fewer complications, reduction in the mortality rate, and more value for each element of care should contribute to the Hospital at Home model being used more and more. Satisfaction from use of the Hospital at Home model is had by the patient, by the caregivers, and by the HMO, and ideal result.

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Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

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Drug Diversion Case Studies

The previous article on drug diversion explored the ways in which professionals in the nursing occupation respond to temptation by stealing medication from patients. This occurs when environmental security in a hospital, nursing home, or home health situation is not sufficient to detect and/or prevent this crime. Drug diversion is doubly dangerous because in some cases the patient suffers. The therapeutic value designed into the patients’ care plan is degraded severely by drug diversion.
Nurses who pocket or take medications cheat their patients of needed pharmaceuticals. But the nurses may also succumb to the near-universal lure of addictive pill-taking behaviors that impair their ability to think clearly and conduct their nursing activities responsibly. Opiate addiction is a global problem, and nursing can be a gateway career for addicts.
Drug diversion occurs when a nurse makes a decision to go against his or her better judgment. When this happens, day to day patient care is compromised. Since single-staff nursing plans don’t allow for auditing, the problem of pilfered medications will get much worse before it gets any better. Detection is the first method of arresting drug diversion. Symptoms of missed medications may blend with the patient’s pain spikes or be termed mood swings by distracted nursing staff.
Patients who vocalize extra pain or think that the nurse missed a pill may be disregarded.
Nurses who practice drug diversion may be in a position to target patients that nurses dislike and have no sympathy for. It may be some time before patient complaints are heeded and med counts correlated. And many nurses may move on before any official action can be taken.
Official complaints are the second step to take action against suspected drug diversion. Yet an official investigation by state or local nursing agencies is cumbersome and time consuming. And nursing homes go to great lengths to cover up their internal problems. When faced with legal liabilities a hospital may nullify patient lab reports or other evidence the patient’s care was impaired.
In instances when drug diversion takes place in home health scenarios, the abuse may never be discovered. The privacy and isolation of a home health environment are ideal elements for a nurse planning drug diversion. In any case, the patient will suffer. And the family members may never know why the patient is struggling for relief.
The third method to control drug diversion is peer policing. Nurses must take a stand from inside their community to cite and counsel nurses guilty of this crime. Leaders on every nursing staff should set an example of how to intervene and/or report drug diversion suspicions. Nurses who witness palmed medications should document what they see, and report the incident to the human resources director or the State Nursing Board. Anonymous complaints are allowed.
The most likely medication targeted by nurses for drug diversion is narcotics, painkillers, and opioids. These medications can alter mood and hinder feeling “down” effectively. Nurses practicing drug diversion are in fact trying to medicate themselves.
These pharmaceuticals are not only targeted for personal use. Drugs like Fentanyl, Dilaudid, Vicodin, Morphine, and others are highly marketable among addicts. Nurses may use pilfered drugs as currency among junkies with access to illegal street drugs. When a nurse is desperate enough for cash, students looking to maintain a high grade point average are good cash customers for diverted drugs. Students who reject shady contacts and promote a drug-free persona can utilize their nurse contact on the sly for ‘lifestyle enhancements’.
Case Study #1
Valery Gomez is an LVN working 4 days a week at a metropolitan hospital with high patient turnover. Valery started working six months and ago nursing is her first job. Her husband prefers her to have weekends off and her two children are taken care of on the days she works by her husband’s mother and family. Valery Gomez usually works the morning day shift.
Although initially Valery is bright, funny, and congenial, lately her personality when dealing with patients has changed. After twelve months on the job her nursing skills have not improved. Among the nurses hired in tandem with her, most have risen to supervisor or specialized posts. Valery’s peers have graduated to more complex work responsibilities,
It has been observed by the nurses on staff that Valery is often ” sitting doing nothing” and shoulders little of the actual individual tasks requied of desk nurses, and her charting and case load is usually poor or unfinished.
Lately several incidents with patients and Valery have brought unwelcome scrutiny to her employer from the County Health Department. The Ombudsman has received complaints about problems with Valery’s patient, problems that remain unresolved despite past counseling. Valery shows no remorse for causing great difficulty for other nurses and extreme physical stress to some of her patients.
Valery rarely lends a hand to any other nurses. She exhibits fits of temper when meds are requested and denys patients their needed painkillers without explanation. Valery makes a practice of hanging around the desk when the med-cart is adjacent and unattended. Valery recently has requested changes to her work assignments to shifts where the majority of staff wre gone.
While Valery made comments initially that she prefers a schedule with weekends free, now Valery has requested work on Saturday and Sunday. This is when most of the staff are gone. One of the patients, Nancy Lee, remarks that in private conversation Valery always told her that Valery’s husband wants her free on the weekends to entertain and care for the children.
Nancy Lee is a patient who recieves very heavy pain medication for multiple conditions. Nancy Lee has documented painful needle sticks from Valery. The Nursing Director has counseled Valery about not delaying Nancy’s med pass routine unnecessarily. The D.O.N. has repeatedly received complaints of Valery denying Nancy Lee her needed medication.
Valery alone of the many med-pass nurses resists the instruction to inform Nancy Lee how many Fentanyl she has left on her pain management precription. Mancy Lee has made complaints to the State Nursing Board about the matter.The local authorities have substantiated Nancy’s complaints.
Nancy Lee is articulate, alert, and ambulatory. She notices that paperwork in her chart written by Valery is inaccurate and incrimminating documentation concerning incidents with Valery has been removed. Nancy Lee hears from other nurses that Valery has refused to chart for them on occasion and also has refused to cooperate with requests from other nurses to perform tasks for them while they do her work.
Nancy Lee steps outside her roomn one day and observes that Valery Gomez visits the trash room frequently. Since the housekeeping staff normally do this, Nancy wonders why Valery alone of all the nurses disappears from the nursing desk floor while on duty. In the past, when Valery was Nancy’s nurse strange pills would be found in the floor. Nancy wonders why Valery avoids the closed circuit camera view so often.
In the past, Nancy Lee has noticed that many of the CNA staff hide in the supply room or the trash room and text to friends, play video games, or talk and use their cellphones. Nancy feels strobgly that Valery Gomez has been pilfering and experimenting with pain medications intended for the patients.
Nancy feels that Valery watches for opportunities to steal, hide, and ingest patient medication while on the job. Nancy has noticed that
Valery has lost weight and taken an interest in a handsome young nurse new to the facility. Nancy sees Valery drift through the weekend avoiding family responsibilities.
Suddenly it is found and told to Nancy that repeated impropriety concerning her pain medication has caused the med cart run out many months in a row. The pharmacy cannot account for the errors.

Nancy wants the D.O. N. to order a drug test for Valery after a weekend where the nurse repeatedly goes into the trash closet. Nancy sees Valery glaze over while another nurse is calling her name. Nancy sees a pill hit the ground after Valery comes out of the trash closet. When the good looking male nurse calls in sick, Nancy notices that Valery loses all interest in her work, snapping at peopke and gruffly answering the phone.
Does Nancy have the right to do this? How should the D.O.N. respond? How should the other nurses at the facility act at this time? Who should act, what should they do, and when does this become an investigative problem for police? How do the three methods to limit drug diversion, as outlined above, operate here?
Case Study #2
In a large hospital near Los Angeles, one of the patients in the SNF Alice. has noticed something disturbing. In the morning at 5:45 a.m. every day moans and screams start rising from the patients in the other rooms. The nurses tell this patient that many of the other patients are addicts who start yelling for their opiates and pain drugs too early. The nurses say that if they start giving out the pain medication for other patients too early, the next day the same thing will happen again and the patients will use up all their pain medication too early. The patient observes that there are no general administrator on duty at this time of the day.
After three months,the same thing happens very day. The patient notices how the exact same staff work the 11 to 7 a.m. shift daily even though alternates regularly appear on the other two shifts. Alice notices the call lights and alarm sounds series at this time, unlike at any other time, are often allowed to build and be ignored. The charge nurse responsibilities are shared beteeen a close knit group of nurses.
Soon the patient believes that the hospital does not know anything about how bad this problem seems. After months of different patients coming in and out the sane phenomena occur. On the day and afternoon shift the moans and screams do not recur as they during the “dawn patrol”.

Over time the patient fears that the hospital has suppressed recording this issue. Alice thinks that these SNF patients acting in this manner and reporting pain is being concealed and not documented so that their staffng acuity will not shift. This appears to be a cost cutting measure administered when no officials, visitors, or ancillary hospital staff can witness the outcry at dawn.

What questions should the hospital adminstrators be asking about why so many patients in the SNF are demonstrating this scale of pain indicators without a investigation or compassionate care response? What responsibilities does the facility have to monitor quality of care?

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Drug Diversion in Nursing

One of the most serious challenges in the occupation of nursing is resisting the lure of addiction. But with the sheer availability of narcotics and opiods in nursing occupations, it is the casual use of pilfered ( and very strong,) pharmaceuticals that can springboard casual abuse into an unhealthy drug habit. Mood elevation and stress relief by the pill method can begin a nurse’s journay to drug dependency.
In the dark bolgia of drug addiction, factors such as affording drugs and the need to go to work can often prevent an overdose in the making. But in the case of career nurses, attendance, daily habits and the nursing lifestyle can feed a habit. Nurse may see evidence that another nurse is stealing meda, and using patient medications, without understanding what these behaviors mean.
Other nurses may shrug off strange behavior and mood swings that occur while otheers aee them doing unsupervised med pass duty. Nurses may not realize that state discipline records for regulatory infractions will follow them around their entire career.
Ideally nurses are caught and disciplined by management for incidents of drug diversions. But where oversight is slack and cost-cutting eradicates supervision, some nurses will slide down a slippery slope. If a nurse commits one act of drug diversion anf getsv away with it, they are likely to do it again.
Usually the casual abuser or recreational user of drugs stops short of a worsening a habit through exhausting their resources. But all a nurse has to do to feed their habit is to go to work. This fact doesn’t even begin to be able to address the difficulties that drug diversion makes for the patient.
People might expect nurses to know better. But when the only thing between a nurse and a drug overdose is a thinly spread staff and an unlocked medicine cart, problems will occur. Sometimes the nurses doing the drug diversion are on too-friendly terms with the individuals doing the closed circuit camera scrutiny
And many nurses fall victim to addiction by the dint of by having immediate access to powerful and clinically addictive nedications. Because the world of nursing is suffused with tasks consisting of interactions handling drugs. The temptation is impossible to ignore.
Once a drug habit forms, superhuman strength can’t make it stop
And nurses are only human.
About 80% of theft in retail or service professions is estimated to be internal. As value-based medical service models replace community benefit models, facilities that dispense drugs to patients become part of those crime statistics.
While police officers do not patrol nursing corridors and hospital wards, the goods are much more stringently restricted than folded sweaters or designer handbags. Electronic handprints and punch codes for med cart access cannot eliminate instances of drug diversion. Rather, unsupervised access to schedule one and two drugs such as narcotics enables any nurse to abuse their pharmaceutical access. Each nurse can elect not to exercise discretion in palming this or that pill or stealing an unwanted drug dosage.
Technical specifications and licensed nurse training are designed to prevent the mishandling of drugs and pills. But medications in the dosage sizes given to patients are usually a tiny pill or two. These are so small that drug diversion is not physically difficult. Such pills can be concealed in the mouth, hand, fingers, pocket, or even a hairband or cellphone cover.
Many nurses feel insulated from the threat of detection or capture due to the small community or office space that nurses inhabit. Nurses who filch medication from patient dosages may feel that the presence of other nurses in a small staff or closed community discounts the risk of getting caught.
There is an old saying that “familiarity breeds contempt.” Familiarity with the nursing homr or hospital workplace may orient a nurse to oversight shortcomings. Daily nurse work can bring forth feelings of antagonism against patients and causr anger and aggression against the facility owners or operators.
The angle of security cameras and the known infrequency of the facility to review the security footage may encourage drug diversion. Also, in a facility where narcotic record keeping MAR fidelity is poor, certain nurses may exploit these circumstances to pilfer patient medications.
In the nursing world, theft of drugs from patient dosages is called “drug diversion”. This practice indicates by its name how nurses behave as if they are following routine med passes. Drug diversion usually occurs in a busy hospital or care facility where oversight responsibilties are routinely overlooked.
Three case studies below illustrate how nurses can exploit vulnerabilities in hospital and long term care facility. But it is not only medical institutions that must be wary for drug diversion. Home health nurses operate in an environment even more probable to experience drug diversiin. The isolation and probable unlikelihood of detection creates a temptation some nurses may not be able to resist.

The legal liabilities that any nurse opens themselves up to, when caught committing drug diversion, are significant. The legal problems such nurses may create for a hospital group or long term care facility management corporation may be career-ending lawsuits.
Not every nurse steals medication. Some nurses are so wary of falling prey to drug use and drug diversion temptations that they make sure to dispense medications under closed circuit cameras and in the presence of another person or a group of nurses. But drug addicts are prone to secrecy and stealth to support their habit.
The possibility is also very high that some nurses are using employment in long term care facilities as a means to skim narcotics from their routine pharmaceutical distribution. If a nurse has a predisposition to emotional problems, job stress, or drug addiction, they may seek out second-rate facilities where security and supervision are slight.
(see the following article for case studies in Drug Diversion).

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Should You Be An E.R. Nurse?

An E. R. is a challenging and high pressure work environment that involves high stress and heavy patient turnover. But nurses coming up through the ranks should seriously appraise whether or not an Emergency Room is the proper career choice for them.
The hiring convention to screen candidates for professional nursing E. R. jobs is to hire from within. Or to hire nurses with commensurate nursing experience from Emergency Room or Urgent Care assignments elsewhere.
The hospital may depend on direct referrals for staffing its Emergency Room. There are some fast-track programs available. The hiring managers from a given hospital or Urgent Care clinic may want to review a student nurse’s transcript if they apply before graduation. If the compensation is particularly desirable, a second interview may be required after references and NCLEX test scores are reviewed.

All E. R. nurses do not operate in a real time work place at the same level. An E. R. can be a daily test of patience, nerves, and professionalism.. The skill sets for an E. R. nurse applicant should be above average in quality and the personality type of the nurse candidate adaptible. But those who can’t function in the fast-paced and demanding hospital or clinic E. R. should face facts about the suitability of their destination job title.
Of all the stressful career choices in the world, an Emergency Room nurse ranks directly behind police officer and firefighter. The Turn-and-burn mentality of many high volume E. R. facilities can wear out the freshness of a newly qualified nurse and age them prematurely.
Some nurses stay in this line of work out of feelings of dedication and trying to make a difference in the world. All too often, such nurses experience stress snd occupational burnout.
Also, the associated risks of depression, addiction, and alcohol and drug abuse for nurses working in the Emergency Room is far higher than the more sedate clinic or the long term care facility nursing pace. The work in an Emergency Room by nature does not absorb nursing errors and the consequences of nursing carelessness can be disastrous.
E. R. employers are not as forgiving of mistakes as normal-pace-type nursing employers might be. Patients in an E. R. setting present a challenge to any nurse lacking in “people skills”. Nurses must often deliver very difficult news to individuals or groups of people already crippled by lack of a family or support system.
Emergency Room nurses put in almost double the performance intensity of clinic desk nurses or long term care med pass nurses. The hours can be brutal and the schedules can make home and family commitments impossible. Physicians will demand near-perfect nursing performance from E. R. nurses at all times. No matter how fatigued or overworked the nurse is, he or she will be required to have a seamlessly professional attitude, critical thinking skills, and alert demeanor.
An E.R. nurse is the Gold standard” if nursing. More than any other kind of nurse, except the Home Health nurse, an Emergency Room nurse is the ambassador for the entire occupational body of nurses worldwide. Patients new to the world of medical care will see more interaction with E. R. nurses than with any other provider personnel.
Student nurses aiming for Emergency Room tenure need to honestly evaluate their skills. Performance in practicals skill development and internships will yield qualified feedback. The unpredictability of the E.R. work environment demands heightened nursing skills, quick thinking, and stamina.
If the feedback a newly qualified nurse gets from their nursing school professors, supervisors and peers falls short of the mark, nurse candidates should rethink applying for work in an Urgent Care setting. Student nurses browsing their career choices should review their strengths and weaknesses when selecting their occupational nursing career environment. Career counselors can answer further questions along these lines.

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