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ERCat

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Everything posted by ERCat

  1. I would absolutely not test the patient for COVID-19. This wouldn’t even be considered in my hospital. Clinically I don’t think it makes sense (but would like to hear rationale for why it does make sense?) VERY very sad scenario.
  2. I work in the ER. Been a PA for 4.5 years. There’s no “requirement.” We have slower PAs and faster ones. The docs love us all equally - we all do a good job. But nursing staff and hospital admin? They like the fast ones. The speed of the providers does get brought up in meetings. We do hear complaints sometimes. But really, no one has been threatened to be fired for not being fast enough unless they were realllllly slow (I.e. one patient per hour slow). We’ve actually had more issues with providers (not PAs... NPs specifically... just being honest) who were way too fast and careless and
  3. Sorry if this has been posted before. I am involved in quality improvement at two hospitals and already review charts as a lead PA. Thought it would be cool to take a side gig reviewing charts. Anyone know any companies that would hire a PA? My Google search doesn’t come up with much.
  4. The abdomen was checked an hour and a half prior. During that hour and a half, I saw maybe five other new patients and talked to a few other specialists, followed up on labs, discharged old patients, etc. I did my initial examination and was in the room with the patient updating them on results and was about to reexamine them when the surgeon called...
  5. Of course I did my belly exam...this is the ER. I wouldn't have ordered a CT without doing a belly exam in the first place. This was an hour and a half later when everything came back. I was in the room talking to the patient about their results when the surgeon called me. He asked for a repeat belly exam, which I hadn't done because I had done my exam an hour and a half before and moved on to other things.
  6. The other day I was in a patient's room letting him know he had a small bowel obstruction and that I had put a page out to a surgeon for him. The surgeon called me while I was in the room, so I answered and politely mouthed to the patient "This is the surgeon!" I sort of stepped aside in the corner of the room to have my brief conversation with him but stayed near the patient in case I needed to ask the patient questions on behalf of the surgeon. The surgeon asked me a few questions that I already knew the answers to, and then asked me another question I needed to run by the patient. I told hi
  7. I have not had any issues. My pay checks and my employee name at work is my legal married name. But my charts and prescriptions show up as my maiden name. DEA and NPI are maiden name. No issues.
  8. I agree that it is probably mainly about liability. When the gynecologist gets sued because he screws up someone’s toe after doing an ingrown toenail procedure the first thing that he will he asked in court is “What kind of doctor ARE you? A gynecologist? Is ir within the scope of practice of a gynecologist to treat an ingrown toenail...” I agree with you. But realize so many providers choose to “stay in their lane” not because they don’t care and want to shrug your concerns off; it’s all about FEAR of potential malpractice.
  9. HOLY CRAP. Are you joking me? You are the ONLY one for a good chunk of the day? In all honesty I can't even fathom that. So you're running codes, sticking in chest tubes, intubating, starting pressors...by yourself? One thing I lack as a PA less than four years out is critical care skills. Even though I work in the ER...I never have to do that stuff because the docs do it. I legit can't imagine. How long have you been a PA? Thanks, everyone, for the responses. Never thought about working in a lower volume facility but it sounds tempting and maybe worth the drive...
  10. So much of what you’re describing is... my life. I have been doing ER for three and a half years and still usually feel like I am running around like a chicken with my head cut off because there’s six things to do (I need to discharge room six, close the laceration over there, and crap - I am getting a phone call from the orthopedist). It’s like that all the time. I stopped eating on my shifts and am lucky if I get one bathroom break or a drink of water. I also get very annoyed when patients perseverate. You have the ones who seek needy and hold you hostage with questions... and you swear they
  11. I just wrapped up a fourteen hour day today. I am frigging exhausted. My shifts are twelve hours, but I stayed late charting. I only saw about 26 patients, but a lot of them were nightmares and very labor and time intensive (huge dog bites on the legs, two distal radius and ulnar styloid fractures that required multiple attempts at reduction, a cervical laceration that would not stop, a hypotensive upper GI bleed... I could go on and on). I have been staying super late in the last year, and I am sick of it. Usually an hour, two in a blue moon. I think it all started when we started to ge
  12. Thanks for this. Strangely it is comforting to realize maybe the expectation is I am a representative of the APPs rather than a manager. That kind of takes a little bit of the pressure off. Maybe I am the one creating unrealistic expectations.
  13. You are not a jerk! I am confused by what my role means. I think I am a little more than a scheduler, though. I do the interviewing and hiring (hiring with approval of the head doc, of course), chart reviews, working with the hospital to determine credentialing requirements, helping find coverage in emergencies, addressing behavioral issues, setting up educational lectures, those kinds of things.
  14. I have been the lead PA for my small group of ER PAs for a couple years now. I think I was chosen because I am smart, do a good job taking care of patients, I don’t miss things often, and I was the one who gave a crap about the group and going to meetings. Unfortunately I am finding these traits don’t translate into being a great leader because I lack other traits that matter. I am disorganized at times. Not very proactive. When I’ve tried to be proactive in the past a few times, I ended up making a decision that was overruled by the physician director, which has totally killed my credi
  15. Yikes, this thread is making me think twice about my documentation of EVERYTHING I do for the patient. My entire chart for every patient is CYA. If they have an allergy to penicillin and I am giving ceftriaxone, you'll see a note in there that states something like "reaction to penicillin is a mild rash; has had cephalosporins before" (even though we all know the low rate of crossreactivity - CYA!). If I have given a patient a narcotic, I document that they said that they had a ride home. I document reasons for delays in labs and CTs. Therefore it is obvious that I document anytime I spoke wit
  16. Try dealing with this in the ER. The triage nurse CAN'T turn anyone away for fear of an EMTALA violation. So a patient will come in for something like an IUD removal (I don't do that...see a gynecologist), an MRI of the knee "because mine isn't scheduled till next Thursday," or a skin biopsy of a mole that has been on their arm for a year...he or she will be brought back...and will be told, by me, "There's nothing we can do here because this is an emergency department and these things are done on an outpatient basis...please see this doctor...okay...bye" and get the cursory brief physical exam
  17. I am in shock reading that article. In shock. I have never believed that physician assisted suicide is okay, because it literally involves someone "playing God." Stop treatment if the patient wants, and do not resuscitate. But it is not a physician's job to end someone's life. I understand why someone might consider this if they had a terminal illness, but depression? In a SEVENTEEN year old girl? Her brain has not even been fully formed yet - how can she make a decision that she wants her life to be over? Not to minimalize her trauma because it sounds terrible, but many teenagers go through i
  18. Wow... ArmyVetDude... I think “somebody has a case of the Mondays.” No need to be a jerk to BoatSwain. It seems you advocate for PA independence so that the nurse practitioners don’t overshadow us and take our jobs. But is it right to advocate for independence just because the NPs are doing it? No - not a good enough reason. How can a PA or an NP a year or even five years out of school practice without supervision? It’s ludacrous and dangerous. Personally I think the fact that we are supervised only adds to our credibility over NPs. Anyway, I am not independent and if I wanted to be I would ha
  19. They asked you for malpractice info?! I would have crapped my pants... like... why do you need that as a Good Samaritan?
  20. Pay off your own loans you chose to take out or pass the burden onto taxpayers? I don’t mean to sound judgmental, but if you think about it, that’s exactly what these programs do. The debt doesn’t just vanish. Of course the right (and probably wiser, especially given the uncertainty of the program) thing to do is to just pay off the debt meaning you just live within your means and make paying off debt a priority.
  21. Great post. I have been thinking about this a lot myself lately. Some of the stuff we do in the ER we know damn well is fluff but we keep doing it. For chest pain with URIs? I often don’t order any labs at all if the history suggests a viral URI and the patient is young and healthy, and looks well (ie doesn’t look like they have myocarditis... LOL) Usually just a chest x-ray, and sometimes an EKG for these patients (and a flu swab) but otherwise not a lot. For asymptomatic hypertension, you’re completely right but I cannot get away from ordering my EKG, BMP, and urinalysis. Nothing
  22. So I think the salary is really, really low for the ER - probably the lowest I’ve heard of in a long time to be honest. The benefits are amazing. Paid vacation? Sign me up. You get holiday pay? Believe it or not these things are not common for all ERs. So those things are great. But still, if you calculate them into an hourly rate, it’s somewhere around 50ish bucks an hour which is, again, low AF for the ER. THAT SAID! ER is terribly hard to get into as a new grad, and when you do get into it, it’s easy to get into a situation with minimal support. Having residents and an attending M
  23. Just wanted to chime in here. So I bought a house right out of PA school and only put five percent down (I know, I know). My mortgage is 30 year at 3.6 percent (And yes, I have been paying PMI for a few years but given that the house has appreciated in value I might be able to stop that soon). As soon as I started making dough I had anxiety about paying off that mortgage ASAP! Making extra payments! However I spoke to a financial advisor about this and his response was WHY? He said my rate is so low I am far better off investing. Even with the historical average of 6 percent return a
  24. Thank you so much for your very helpful tips.
  25. I consider to be myself a good PA and have always thought I was one of the high performers. I am in terms of productivity, but just found out today that my discharge length of stay sucks. Any tips on how to decrease that number? The problem is I feel like I am already working my fastest and hardest. I see people at work laughing with each other and chatting about their weekends but I literally don’t do any of that. I barely even have time to run to the cafeteria to go to the bathroom. I feel like I am busy every single minute of the day. So decreasing my times seems kinda insurmountable..
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