From r.valverde at sbcglobal.net Tue Dec 9 20:15:55 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Tue, 9 Dec 2008 20:15:55 -0800 (PST) Subject: [NP-Corrections] NP in emergent care area Message-ID: <549281.1933.qm@web83604.mail.sp1.yahoo.com> I know this list is not too active, but I have a few questions.? I work in a female institution.? I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room.? Do you cover it alone with only phone MD collaboration or is there a physician right there with you?? Do any of you take call for medical coverage?? How do you handle cases that may fall outside of your scope of practice.? We are having changes at our institution and I am gathering info in case my post is changed.? Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC -------------- next part -------------- An HTML attachment was scrubbed... URL: From galdena at sbcglobal.net Tue Dec 9 21:48:03 2008 From: galdena at sbcglobal.net (Dena) Date: Tue, 9 Dec 2008 21:48:03 -0800 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <549281.1933.qm@web83604.mail.sp1.yahoo.com> References: <549281.1933.qm@web83604.mail.sp1.yahoo.com> Message-ID: <045d01c95a8a$ded186f0$7de0b545@Dena> Rhonda- I used to work Max Security in a Federal prison complex (included a minimum, medium, and maximum security prison as well as a prison camp) which might certainly work differently than where you work. Our one clinic in each of the prison buildings functioned as ?everything??we didn?t have separate triage, treatment, urgent care, reception, or clinic areas-- and they were staffed with providers (6 NPs and 1 ? MDs for the 4 prisons on our site) during the daytime only (handling early morning sick call, clinic appointments, and any emergencies brought in). Each NP rotated call for nights, weekends, and holidays. The MDs rotated for back-up call. For any real emergency, the patient was transported to the nearest contracted ER on our orders or, if needing less emergent but urgent treatment or specialist care, they were transported to the university hospital 90 minutes away. Due to the huge security risk of transporting our bad boys out of the facility, the amount of money and manpower it took to transport them, we tried to do whatever we could to keep them in house. I think in the year I was there, I only had to call the back-up MD probably once basically, if I couldn?t handle the problem on my own, I figured it probably needed to be sent out. But to be perfectly honest, I think the only times I actually had to go in to see a patient when I was on call was to suture wounds or do a sexual assault exam?and I didn?t need a MD?s help for any of that. And, of course, during our occasional fights/riots, everyone was called in to help evaluate injuries and stitch up the wounded, including the MDs. I think whether the MD needs to be there on the grounds or not with you is probably guided by your state Nurse Practice Act if you?re working in a state prison. Dena Galler _____ From: np-corrections-bounces at nurse.net [mailto:np-corrections-bounces at nurse.net] On Behalf Of Rhonda Valverde Sent: Tuesday, December 09, 2008 8:16 PM To: np-corrections at nurse.net Subject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Wed Dec 10 17:56:25 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Wed, 10 Dec 2008 20:56:25 -0500 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <549281.1933.qm@web83604.mail.sp1.yahoo.com> References: <549281.1933.qm@web83604.mail.sp1.yahoo.com> Message-ID: Dear Rhonda: I work in corrections also. Our institution has an urgent care area. There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make the decision to send an inmate to an outside hospital, but will usually get criticized later by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP Date: Tue, 9 Dec 2008 20:15:55 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC _________________________________________________________________ Send e-mail faster without improving your typing skills. http://windowslive.com/Explore/hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_speed_122008 -------------- next part -------------- An HTML attachment was scrubbed... URL: From steffcatron32 at hotmail.com Wed Dec 10 20:02:41 2008 From: steffcatron32 at hotmail.com (stephanie catron) Date: Wed, 10 Dec 2008 21:02:41 -0700 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <549281.1933.qm@web83604.mail.sp1.yahoo.com> References: <549281.1933.qm@web83604.mail.sp1.yahoo.com> Message-ID: Dear Rhonda: I manage the health care clinic for a rural jail in the State of Montana. N.P.s in this State are not required to have a physician on-site, or even MD supervision. Our peer review can be done by another NP. We collaborate and refer inmates who require Specialty care, such as Urology or Infectious Disease with our HIV patients. All meds are prescibed by myself and dispensed on BID med pass by nurses in the facility. This model has worked well in our State and several other jails use the same model. The nurses take call after hours clinic. If there is an extreme emergency or an inmate is having a serious health issue, the Officers call 911 and send the inmate to the E.R. after clinic hours. Any case I feel is outside my scope of Practice, I refer to a Specialist in the area of concern. For example: HIV patients are treated by an infectious disease specialist. Often brittle diabetics are seen with a Diabetic Specialist and further consultation is handled via telephone with the clinic nurse and the Specialist. We do not often have to refer outside the facility, but are willing to do so if the inmate needs a Specialist's evaluation. The Dept of Corrections has a Physician on staff we can contact and who is very helpful if we have questions or concerns about care in the correction's setting. You should attend a National Conference and network with others in your field. The next one I think is next year in Florida. Stephanie Date: Tue, 9 Dec 2008 20:15:55 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Wed Dec 10 20:21:07 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Wed, 10 Dec 2008 20:21:07 -0800 (PST) Subject: [NP-Corrections] NP in emergent care area Message-ID: <721592.57059.qm@web83603.mail.sp1.yahoo.com> Shelby, ? What state did you work in, was it a local jail or state facility? Thanks Rhonda ________________________________ From: Shelby Havens To: np-corrections at nurse.net Sent: Wednesday, December 10, 2008 5:56:25 PM Subject: RE: [NP-Corrections] NP in emergent care area Dear Rhonda: I work in?corrections also.?Our institution has an?urgent care area.?There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make?the decision to send an inmate?to an outside hospital, but will usually?get criticized later?by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP ??????? ? ________________________________ Date: Tue, 9 Dec 2008 20:15:55 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions.? I work in a female institution.? I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room.? Do you cover it alone with only phone MD collaboration or is there a physician right there with you?? Do any of you take call for medical coverage?? How do you handle cases that may fall outside of your scope of practice.? We are having changes at our institution and I am gathering info in case my post is changed.? Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC ________________________________ Send e-mail faster without improving your typing skills. Get your Hotmail? account. -------------- next part -------------- An HTML attachment was scrubbed... URL: From steffcatron32 at hotmail.com Wed Dec 10 20:27:10 2008 From: steffcatron32 at hotmail.com (stephanie catron) Date: Wed, 10 Dec 2008 21:27:10 -0700 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <721592.57059.qm@web83603.mail.sp1.yahoo.com> References: <721592.57059.qm@web83603.mail.sp1.yahoo.com> Message-ID: I work in the State of Montana. My Facility is county, inmates who are awaiting trial. But there are two other facilities in the State run by NPs which also house Federal, State and County inmates. Stephanie Date: Wed, 10 Dec 2008 20:21:07 -0800From: r.valverde at sbcglobal.netSubject: Re: [NP-Corrections] NP in emergent care areaTo: np-corrections at nurse.net Shelby, What state did you work in, was it a local jail or state facility? Thanks Rhonda From: Shelby Havens To: np-corrections at nurse.netSent: Wednesday, December 10, 2008 5:56:25 PMSubject: RE: [NP-Corrections] NP in emergent care area Dear Rhonda: I work in corrections also. Our institution has an urgent care area. There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make the decision to send an inmate to an outside hospital, but will usually get criticized later by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP Date: Tue, 9 Dec 2008 20:15:55 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC Send e-mail faster without improving your typing skills. Get your Hotmail? account. -------------- next part -------------- An HTML attachment was scrubbed... URL: From barbara_brubaker at yahoo.com Thu Dec 11 01:35:06 2008 From: barbara_brubaker at yahoo.com (Barbara Brubaker) Date: Thu, 11 Dec 2008 01:35:06 -0800 (PST) Subject: [NP-Corrections] NP in emergent care area In-Reply-To: Message-ID: <22970.6084.qm@web110812.mail.gq1.yahoo.com> Hi.? I work in a state prison in Indiana.? I am on call every 3rd week. I rotate on call with two physicians.? During the day, we each take days to cover our urgent care department.? Our urgent care deals with the usual emergencies, that I am sure most of you deal with, injuries like lacerations and fractures, over doses, heart attacks, acute illnesses, and suicide threats or attempts. We have an infirmary on grounds, that we can admit patients for observation and treatment.? We have a local hospital that we can patients with send serious problems for treatment. There is usually a physician available either on the premises or by phone, to consult with if needed. Indiana, nurse practitioners do not require direct supervision by a physician, but we have a collaborative agreement.? I hope this helps.? Barbara --- On Wed, 12/10/08, stephanie catron wrote: From: stephanie catron Subject: RE: [NP-Corrections] NP in emergent care area To: np-corrections at nurse.net Date: Wednesday, December 10, 2008, 11:27 PM #yiv857243486 .hmmessage P { margin:0px;padding:0px;} #yiv857243486 { font-size:10pt;font-family:Verdana;} I work in the State of Montana. My Facility is county, inmates who are awaiting trial. But there are two other facilities in the State run by NPs which also house Federal, State and County inmates. Stephanie Date: Wed, 10 Dec 2008 20:21:07 -0800 From: r.valverde at sbcglobal.net Subject: Re: [NP-Corrections] NP in emergent care area To: np-corrections at nurse.net #yiv857243486 .ExternalClass DIV {} Shelby, ? What state did you work in, was it a local jail or state facility? Thanks Rhonda From: Shelby Havens To: np-corrections at nurse.net Sent: Wednesday, December 10, 2008 5:56:25 PM Subject: RE: [NP-Corrections] NP in emergent care area #yiv857243486 .ExternalClass .EC_hmmessage P {padding:0px;} #yiv857243486 .ExternalClass body.EC_hmmessage {font-size:10pt;font-family:Verdana;} Dear Rhonda: ? I work in?corrections also.?Our institution has an?urgent care area.?There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make?the decision to send an inmate?to an outside hospital, but will usually?get criticized later?by the medical director because of the expense. It isn't a very good situation. ? ? Best Regards, ? Shelby Havens, ARNP ? ? ? ??????? ? Date: Tue, 9 Dec 2008 20:15:55 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] NP in emergent care area #yiv857243486 .ExternalClass DIV {} I know this list is not too active, but I have a few questions.? I work in a female institution.? I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room.? Do you cover it alone with only phone MD collaboration or is there a physician right there with you?? Do any of you take call for medical coverage?? How do you handle cases that may fall outside of your scope of practice.? We are having changes at our institution and I am gathering info in case my post is changed.? Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC Send e-mail faster without improving your typing skills. Get your Hotmail? account. _______________________________________________ NP-Corrections mailing list NP-Corrections at nurse.net http://lists.nurse.net/mailman/listinfo/np-corrections -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Thu Dec 11 03:26:23 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Thu, 11 Dec 2008 06:26:23 -0500 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <721592.57059.qm@web83603.mail.sp1.yahoo.com> References: <721592.57059.qm@web83603.mail.sp1.yahoo.com> Message-ID: Rhonda: I am in Florida. I work at a state prison and reception center. Thanks for re-activating this listserve. I thought it was defunct! I am finding the conversation interesting. Let's keep this list active, if possible! Happy Holidays to all, Shelby Havens, ARNP, CCHP Date: Wed, 10 Dec 2008 20:21:07 -0800From: r.valverde at sbcglobal.netSubject: Re: [NP-Corrections] NP in emergent care areaTo: np-corrections at nurse.net Shelby, What state did you work in, was it a local jail or state facility? Thanks Rhonda From: Shelby Havens To: np-corrections at nurse.netSent: Wednesday, December 10, 2008 5:56:25 PMSubject: RE: [NP-Corrections] NP in emergent care area Dear Rhonda: I work in corrections also. Our institution has an urgent care area. There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make the decision to send an inmate to an outside hospital, but will usually get criticized later by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP Date: Tue, 9 Dec 2008 20:15:55 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC Send e-mail faster without improving your typing skills. Get your Hotmail? account. _________________________________________________________________ Send e-mail anywhere. No map, no compass. http://windowslive.com/Explore/hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_anywhere_122008 -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Thu Dec 11 21:30:09 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Thu, 11 Dec 2008 21:30:09 -0800 (PST) Subject: [NP-Corrections] NP in emergent care area Message-ID: <917229.7489.qm@web83604.mail.sp1.yahoo.com> Shelby, ? It would be great to keep this list more active.? Not sure how others feel, but at our facility we feel very isolated almost disconected from the other institutions and what their experiences are.? The only things we hear are rumor and the ever popular patient/inmate gossip about medical conditions at the other female institutions both county and state. Happy Holidays to you as well Rhonda ________________________________ From: Shelby Havens To: np-corrections at nurse.net Sent: Thursday, December 11, 2008 3:26:23 AM Subject: RE: [NP-Corrections] NP in emergent care area Rhonda: I?am in Florida. I work at a?state prison and reception center.? Thanks for re-activating this listserve. I thought it was defunct! I am finding the conversation interesting. Let's keep this list active, if possible! Happy Holidays to all, Shelby Havens, ARNP, CCHP ?? ? ________________________________ Date: Wed, 10 Dec 2008 20:21:07 -0800 From: r.valverde at sbcglobal.net Subject: Re: [NP-Corrections] NP in emergent care area To: np-corrections at nurse.net Shelby, ? What state did you work in, was it a local jail or state facility? Thanks Rhonda ________________________________ From: Shelby Havens To: np-corrections at nurse.net Sent: Wednesday, December 10, 2008 5:56:25 PM Subject: RE: [NP-Corrections] NP in emergent care area Dear Rhonda: I work in?corrections also.?Our institution has an?urgent care area.?There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make?the decision to send an inmate?to an outside hospital, but will usually?get criticized later?by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP ??????? ? ________________________________ Date: Tue, 9 Dec 2008 20:15:55 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions.? I work in a female institution.? I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room.? Do you cover it alone with only phone MD collaboration or is there a physician right there with you?? Do any of you take call for medical coverage?? How do you handle cases that may fall outside of your scope of practice.? We are having changes at our institution and I am gathering info in case my post is changed.? Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC ________________________________ Send e-mail faster without improving your typing skills. Get your Hotmail? account. ________________________________ Send e-mail anywhere. No map, no compass. Get your Hotmail? account now. -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Thu Dec 11 21:58:13 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Thu, 11 Dec 2008 21:58:13 -0800 (PST) Subject: [NP-Corrections] California NPs Message-ID: <357213.71876.qm@web83605.mail.sp1.yahoo.com> Are there any California Nps that are working in CDCR.? If there are it would be great to chat and see what is going on in your corners of the world. Thanks Rhonda Valverde? -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Fri Dec 12 02:47:47 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Fri, 12 Dec 2008 05:47:47 -0500 Subject: [NP-Corrections] NP in emergent care area In-Reply-To: <917229.7489.qm@web83604.mail.sp1.yahoo.com> References: <917229.7489.qm@web83604.mail.sp1.yahoo.com> Message-ID: Dear Rhonda: I have worked at a female institution in the past, but not recently. However, I'll be happy to pass along any pertinent information I receive. We have an accredited 150-bed hospital (a rare thing!) inside one of our reception centers in Florida, with all the specialty clinics, and although it is a male reception center, female inmatess do go there for admission to the hospital and/or treatment at a specialty clinic. The hospital even has chemotherapy, a surgical unit, etc. Best Regards, Shelby Date: Thu, 11 Dec 2008 21:30:09 -0800From: r.valverde at sbcglobal.netSubject: Re: [NP-Corrections] NP in emergent care areaTo: np-corrections at nurse.net Shelby, It would be great to keep this list more active. Not sure how others feel, but at our facility we feel very isolated almost disconected from the other institutions and what their experiences are. The only things we hear are rumor and the ever popular patient/inmate gossip about medical conditions at the other female institutions both county and state. Happy Holidays to you as well Rhonda From: Shelby Havens To: np-corrections at nurse.netSent: Thursday, December 11, 2008 3:26:23 AMSubject: RE: [NP-Corrections] NP in emergent care area Rhonda: I am in Florida. I work at a state prison and reception center. Thanks for re-activating this listserve. I thought it was defunct! I am finding the conversation interesting. Let's keep this list active, if possible! Happy Holidays to all, Shelby Havens, ARNP, CCHP Date: Wed, 10 Dec 2008 20:21:07 -0800From: r.valverde at sbcglobal.netSubject: Re: [NP-Corrections] NP in emergent care areaTo: np-corrections at nurse.net Shelby, What state did you work in, was it a local jail or state facility? Thanks Rhonda From: Shelby Havens To: np-corrections at nurse.netSent: Wednesday, December 10, 2008 5:56:25 PMSubject: RE: [NP-Corrections] NP in emergent care area Dear Rhonda: I work in corrections also. Our institution has an urgent care area. There is a physician assigned there, but sometimes a nurse practitioner gets stuck there alone when the MD is out sick or on leave. When that happens, a physician at a nearby institution is available by telephone. The NP can make the decision to send an inmate to an outside hospital, but will usually get criticized later by the medical director because of the expense. It isn't a very good situation. Best Regards, Shelby Havens, ARNP Date: Tue, 9 Dec 2008 20:15:55 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] NP in emergent care area I know this list is not too active, but I have a few questions. I work in a female institution. I am curioius if any NP's are covering the TTA (triage and treatment) area it is sort of like the institution's urgent care since we do not have a real emergency room. Do you cover it alone with only phone MD collaboration or is there a physician right there with you? Do any of you take call for medical coverage? How do you handle cases that may fall outside of your scope of practice. We are having changes at our institution and I am gathering info in case my post is changed. Currently I work in the reception center clinic, I am the primary provider for this area and am very happy there, but change affects us all. Thanks Rhonda Valverde, F-NPC Send e-mail faster without improving your typing skills. Get your Hotmail? account. Send e-mail anywhere. No map, no compass. Get your Hotmail? account now. _________________________________________________________________ You live life online. So we put Windows on the web. http://clk.atdmt.com/MRT/go/127032869/direct/01/ -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Fri Dec 12 21:29:00 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Fri, 12 Dec 2008 21:29:00 -0800 (PST) Subject: [NP-Corrections] Patient Load Message-ID: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc.?? May I inquire how many patients on the average do others in corrections see daily.??The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers.? What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc?? Our clinics are being reorganized so I am curious how other facilities clinics work.? Thanks Rhonda Valverde F-NP -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Sat Dec 13 05:34:43 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Sat, 13 Dec 2008 08:34:43 -0500 Subject: [NP-Corrections] Patient Load In-Reply-To: <162616.29448.qm@web83606.mail.sp1.yahoo.com> References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby Date: Fri, 12 Dec 2008 21:29:00 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP _________________________________________________________________ Send e-mail faster without improving your typing skills. http://windowslive.com/Explore/hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_speed_122008 -------------- next part -------------- An HTML attachment was scrubbed... URL: From steffcatron32 at hotmail.com Sat Dec 13 12:20:32 2008 From: steffcatron32 at hotmail.com (stephanie catron) Date: Sat, 13 Dec 2008 13:20:32 -0700 Subject: [NP-Corrections] Patient Load In-Reply-To: References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: Dear Rhonda and Shelby: The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time. Occaisionally they will bring two at a time from the same block. 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system. In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too... Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby Date: Fri, 12 Dec 2008 21:29:00 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP Send e-mail faster without improving your typing skills. Get your Hotmail? account. -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Sat Dec 13 15:10:20 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Sat, 13 Dec 2008 18:10:20 -0500 Subject: [NP-Corrections] Patient Load In-Reply-To: References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: Stephanie: I agree. If security cannot or will not bring the patients, it can lead to medical emergencies sooner or later. A medical emergency is never convenient for anyone, especially the patients! When I was younger, I used to try to see as many patients as possible, sometimes working myself into an exhausted state. Eventually, I learned that if you get all your work done, then you will get more work. With multiple providers, the faster ones tend to pick up the slack for the slower ones. That always got on my nerves. So when I turned 50 this year, I decided that I am only going to do the amount of work with which I am comfortable. In order to stay employed, I only need to see the same amount of patients as the slowest provider. We have some people who are pretty slow (and who have been working there for many years). When I first transferred to my current clinic, the physician came into my office late one afternoon and shoved a cart full of medical records that needed chart reviews (labs reports, etc.) at me. She announced that she was going to sit outside for awhile because it was hot in the building. I rushed like heck to finish those charts, and found myself feeling panicky and upset. The next day, I decided to slow down. At the end of the day, I told the nurses that I was returning the charts I had not reviewed to the Medical Records Department and that I would finish them the next morning. We have to get overtime approved by the medical director in advance, so I am (fortunately!) not required to stay late. The nurses were pissed off at me, and sat there scowling as I walked out the door. The following afternoon, the doctor came into my room and told me that if I couldn't finish my charts, I should give them to her and she would stay late and finish them. I said "fine!" Then my assignment got lighter immediately. I suspect things had been divided a little bit in her favor before then. The goal is to see up to 20 patients a day, but the chart reviews can take a couple of hours. Best Regards, Shelby Havens, ARNP, CCHP From: steffcatron32 at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 13:20:32 -0700 Dear Rhonda and Shelby:The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time. Occaisionally they will bring two at a time from the same block. 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system. In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too...Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby Date: Fri, 12 Dec 2008 21:29:00 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP Send e-mail faster without improving your typing skills. Get your Hotmail? account. _________________________________________________________________ You live life online. So we put Windows on the web. http://clk.atdmt.com/MRT/go/127032869/direct/01/ -------------- next part -------------- An HTML attachment was scrubbed... URL: From steffcatron32 at hotmail.com Sat Dec 13 20:30:08 2008 From: steffcatron32 at hotmail.com (stephanie catron) Date: Sat, 13 Dec 2008 21:30:08 -0700 Subject: [NP-Corrections] Patient Load In-Reply-To: References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: Dear Shelby and all: Wondering what the pay range for NPs and RNs in your area is?? I am thinking Corrections pay is higher than pay on the outside...Our NPs average between $42-$46 dollars and hour with benefits. Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 18:10:20 -0500 Stephanie: I agree. If security cannot or will not bring the patients, it can lead to medical emergencies sooner or later. A medical emergency is never convenient for anyone, especially the patients! When I was younger, I used to try to see as many patients as possible, sometimes working myself into an exhausted state. Eventually, I learned that if you get all your work done, then you will get more work. With multiple providers, the faster ones tend to pick up the slack for the slower ones. That always got on my nerves. So when I turned 50 this year, I decided that I am only going to do the amount of work with which I am comfortable. In order to stay employed, I only need to see the same amount of patients as the slowest provider. We have some people who are pretty slow (and who have been working there for many years). When I first transferred to my current clinic, the physician came into my office late one afternoon and shoved a cart full of medical records that needed chart reviews (labs reports, etc.) at me. She announced that she was going to sit outside for awhile because it was hot in the building. I rushed like heck to finish those charts, and found myself feeling panicky and upset. The next day, I decided to slow down. At the end of the day, I told the nurses that I was returning the charts I had not reviewed to the Medical Records Department and that I would finish them the next morning. We have to get overtime approved by the medical director in advance, so I am (fortunately!) not required to stay late. The nurses were pissed off at me, and sat there scowling as I walked out the door. The following afternoon, the doctor came into my room and told me that if I couldn't finish my charts, I should give them to her and she would stay late and finish them. I said "fine!" Then my assignment got lighter immediately. I suspect things had been divided a little bit in her favor before then. The goal is to see up to 20 patients a day, but the chart reviews can take a couple of hours. Best Regards, Shelby Havens, ARNP, CCHP From: steffcatron32 at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 13:20:32 -0700 Dear Rhonda and Shelby:The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time. Occaisionally they will bring two at a time from the same block. 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system. In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too...Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby Date: Fri, 12 Dec 2008 21:29:00 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP Send e-mail faster without improving your typing skills. Get your Hotmail? account. You live life online. So we put Windows on the web. Learn more about Windows Live -------------- next part -------------- An HTML attachment was scrubbed... URL: From venable at cox.net Sat Dec 13 20:43:54 2008 From: venable at cox.net (Samantha Venable) Date: Sat, 13 Dec 2008 20:43:54 -0800 Subject: [NP-Corrections] Patient Load References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: I work in Orange County, California at the county jail rather than a prison. Our NPs make $51.57 per hour plus benefits. There is also .75 per hour for hazard pay and bilingual pay if you qualify. We are all scheduled on day shift, but if you cover an evening, it is an additional $2.50 per hour. Samantha Venable ----- Original Message ----- From: stephanie catron To: np-corrections at nurse.net Sent: Saturday, December 13, 2008 8:30 PM Subject: RE: [NP-Corrections] Patient Load Dear Shelby and all: Wondering what the pay range for NPs and RNs in your area is?? I am thinking Corrections pay is higher than pay on the outside...Our NPs average between $42-$46 dollars and hour with benefits. Stephanie ------------------------------------------------------------------------------ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 18:10:20 -0500 Stephanie: I agree. If security cannot or will not bring the patients, it can lead to medical emergencies sooner or later. A medical emergency is never convenient for anyone, especially the patients! When I was younger, I used to try to see as many patients as possible, sometimes working myself into an exhausted state. Eventually, I learned that if you get all your work done, then you will get more work. With multiple providers, the faster ones tend to pick up the slack for the slower ones. That always got on my nerves. So when I turned 50 this year, I decided that I am only going to do the amount of work with which I am comfortable. In order to stay employed, I only need to see the same amount of patients as the slowest provider. We have some people who are pretty slow (and who have been working there for many years). When I first transferred to my current clinic, the physician came into my office late one afternoon and shoved a cart full of medical records that needed chart reviews (labs reports, etc.) at me. She announced that she was going to sit outside for awhile because it was hot in the building. I rushed like heck to finish those charts, and found myself feeling panicky and upset. The next day, I decided to slow down. At the end of the day, I told the nurses that I was returning the charts I had not reviewed to the Medical Records Department and that I would finish them the next morning. We have to get overtime approved by the medical director in advance, so I am (fortunately!) not required to stay late. The nurses were pissed off at me, and sat there scowling as I walked out the door. The following afternoon, the doctor came into my room and told me that if I couldn't finish my charts, I should give them to her and she would stay late and finish them. I said "fine!" Then my assignment got lighter immediately. I suspect things had been divided a little bit in her favor before then. The goal is to see up to 20 patients a day, but the chart reviews can take a couple of hours. Best Regards, Shelby Havens, ARNP, CCHP ------------------------------------------------------------------------------ From: steffcatron32 at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 13:20:32 -0700 Dear Rhonda and Shelby: The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time. Occaisionally they will bring two at a time from the same block. 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system. In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too... Stephanie ------------------------------------------------------------------------------ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby ------------------------------------------------------------------------------ Date: Fri, 12 Dec 2008 21:29:00 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP ------------------------------------------------------------------------------ Send e-mail faster without improving your typing skills. Get your Hotmail? account. ------------------------------------------------------------------------------ You live life online. So we put Windows on the web. Learn more about Windows Live ------------------------------------------------------------------------------ _______________________________________________ NP-Corrections mailing list NP-Corrections at nurse.net http://lists.nurse.net/mailman/listinfo/np-corrections -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Sun Dec 14 00:09:06 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Sun, 14 Dec 2008 00:09:06 -0800 (PST) Subject: [NP-Corrections] Patient Load Message-ID: <374793.77930.qm@web83606.mail.sp1.yahoo.com> It sounds like the number is pretty standard.? We are to have 20 scheduled appointsments not including walk ins and people off the bus that need immediate assessment.? 20 seems like a reasonable number but for me this includes at least 8 complete physical exams including preventive health, dealing with chronic diseases?and sick call issues, sick call is not as simple when the majority of patients have 3-5 complaints, remember I deal with women. ?Custody is not as great an obstacle since we now have a lawsuit that deals with access to care issues, they are required to escort.? Even if a payient has three chonic illnesses we are only allowed to count that as one patient, you may spend an hour with that patient but it is still only one.? We also currently do all of the patient education and are required to document that they understood in their own words the plan of care which can require we read a handout to them in its entirety if they are unable to read.? Rhonda ________________________________ From: stephanie catron To: np-corrections at nurse.net Sent: Saturday, December 13, 2008 12:20:32 PM Subject: RE: [NP-Corrections] Patient Load Dear Rhonda and Shelby: The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time.? Occaisionally they will bring two at a time from the same block.? 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system.? In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! ? Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too... Stephanie ________________________________ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: ? Thanks for keeping the conversation going! I think that networking among corrections NPs can be?a valuable source of support for us all. ? Our medical director has set a goal of 20 patients per day (per provider)?for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young?healthy men for tinea pedis or?an ankle sprain, that is vastly different from seeing?several seriously ill patients with HIV or cancer. So it's all relative. ? We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. ? In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them.?Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. ? Everything changes over time. It is?getting more difficult for me to adapt and keep up as I age. I?am hoping to retire at the end of 2011, if the economy gets better! ? Happy Holidays to all my fellow correctional NPs!!! ? ? Peace, ? Shelby??? ? ???? ? ________________________________ Date: Fri, 12 Dec 2008 21:29:00 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc.?? May I inquire how many patients on the average do others in corrections see daily.??The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers.? What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc?? Our clinics are being reorganized so I am curious how other facilities clinics work.? Thanks Rhonda Valverde F-NP ________________________________ Send e-mail faster without improving your typing skills. Get your Hotmail? account. -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Sun Dec 14 00:12:36 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Sun, 14 Dec 2008 00:12:36 -0800 (PST) Subject: [NP-Corrections] Patient Load Message-ID: <437323.19122.qm@web83602.mail.sp1.yahoo.com> I have worked in the correctional setting for over 8 years, how many patients do NPs in "the free world" see a day? Rhonda ________________________________ From: stephanie catron To: np-corrections at nurse.net Sent: Saturday, December 13, 2008 12:20:32 PM Subject: RE: [NP-Corrections] Patient Load Dear Rhonda and Shelby: The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time.? Occaisionally they will bring two at a time from the same block.? 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system.? In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! ? Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too... Stephanie ________________________________ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: ? Thanks for keeping the conversation going! I think that networking among corrections NPs can be?a valuable source of support for us all. ? Our medical director has set a goal of 20 patients per day (per provider)?for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young?healthy men for tinea pedis or?an ankle sprain, that is vastly different from seeing?several seriously ill patients with HIV or cancer. So it's all relative. ? We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. ? In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them.?Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. ? Everything changes over time. It is?getting more difficult for me to adapt and keep up as I age. I?am hoping to retire at the end of 2011, if the economy gets better! ? Happy Holidays to all my fellow correctional NPs!!! ? ? Peace, ? Shelby??? ? ???? ? ________________________________ Date: Fri, 12 Dec 2008 21:29:00 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc.?? May I inquire how many patients on the average do others in corrections see daily.??The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers.? What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc?? Our clinics are being reorganized so I am curious how other facilities clinics work.? Thanks Rhonda Valverde F-NP ________________________________ Send e-mail faster without improving your typing skills. Get your Hotmail? account. -------------- next part -------------- An HTML attachment was scrubbed... URL: From shelbyhavens at hotmail.com Mon Dec 15 02:48:47 2008 From: shelbyhavens at hotmail.com (Shelby Havens) Date: Mon, 15 Dec 2008 05:48:47 -0500 Subject: [NP-Corrections] Patient Load In-Reply-To: References: <162616.29448.qm@web83606.mail.sp1.yahoo.com> Message-ID: Stephanie: The salaries are low here in Florida. We are a backwards and conservative state. Salaries range from $37 to $55 per hour for an NP. Maybe $60 to $75 without benefits. But we have no state income tax, which is nice! My salary is at the low end of the spectrum, even for corrections. But our retirement plan is awesome. We're in the hazardous duty retirement plan (same as the state troopers), and we can be fully vested after six years and draw our retirement pay at age 55. I turned 50 this year, and have my eye on retirement at 55. I will have 20 years of state employment at that time. Best Regards, Shelby From: steffcatron32 at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 21:30:08 -0700 Dear Shelby and all:Wondering what the pay range for NPs and RNs in your area is?? I am thinking Corrections pay is higher than pay on the outside...Our NPs average between $42-$46 dollars and hour with benefits. Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 18:10:20 -0500 Stephanie: I agree. If security cannot or will not bring the patients, it can lead to medical emergencies sooner or later. A medical emergency is never convenient for anyone, especially the patients! When I was younger, I used to try to see as many patients as possible, sometimes working myself into an exhausted state. Eventually, I learned that if you get all your work done, then you will get more work. With multiple providers, the faster ones tend to pick up the slack for the slower ones. That always got on my nerves. So when I turned 50 this year, I decided that I am only going to do the amount of work with which I am comfortable. In order to stay employed, I only need to see the same amount of patients as the slowest provider. We have some people who are pretty slow (and who have been working there for many years). When I first transferred to my current clinic, the physician came into my office late one afternoon and shoved a cart full of medical records that needed chart reviews (labs reports, etc.) at me. She announced that she was going to sit outside for awhile because it was hot in the building. I rushed like heck to finish those charts, and found myself feeling panicky and upset. The next day, I decided to slow down. At the end of the day, I told the nurses that I was returning the charts I had not reviewed to the Medical Records Department and that I would finish them the next morning. We have to get overtime approved by the medical director in advance, so I am (fortunately!) not required to stay late. The nurses were pissed off at me, and sat there scowling as I walked out the door. The following afternoon, the doctor came into my room and told me that if I couldn't finish my charts, I should give them to her and she would stay late and finish them. I said "fine!" Then my assignment got lighter immediately. I suspect things had been divided a little bit in her favor before then. The goal is to see up to 20 patients a day, but the chart reviews can take a couple of hours. Best Regards, Shelby Havens, ARNP, CCHP From: steffcatron32 at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 13:20:32 -0700 Dear Rhonda and Shelby:The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time. Occaisionally they will bring two at a time from the same block. 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system. In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too...Stephanie From: shelbyhavens at hotmail.comTo: np-corrections at nurse.netSubject: RE: [NP-Corrections] Patient LoadDate: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: Thanks for keeping the conversation going! I think that networking among corrections NPs can be a valuable source of support for us all. Our medical director has set a goal of 20 patients per day (per provider) for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young healthy men for tinea pedis or an ankle sprain, that is vastly different from seeing several seriously ill patients with HIV or cancer. So it's all relative. We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them. Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. Everything changes over time. It is getting more difficult for me to adapt and keep up as I age. I am hoping to retire at the end of 2011, if the economy gets better! Happy Holidays to all my fellow correctional NPs!!! Peace, Shelby Date: Fri, 12 Dec 2008 21:29:00 -0800From: r.valverde at sbcglobal.netTo: np-corrections at nurse.netSubject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc. May I inquire how many patients on the average do others in corrections see daily. The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers. What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc? Our clinics are being reorganized so I am curious how other facilities clinics work. Thanks Rhonda Valverde F-NP Send e-mail faster without improving your typing skills. Get your Hotmail? account. You live life online. So we put Windows on the web. Learn more about Windows Live _________________________________________________________________ Send e-mail anywhere. No map, no compass. http://windowslive.com/Explore/hotmail?ocid=TXT_TAGLM_WL_hotmail_acq_anywhere_122008 -------------- next part -------------- An HTML attachment was scrubbed... URL: From r.valverde at sbcglobal.net Mon Dec 15 20:16:43 2008 From: r.valverde at sbcglobal.net (Rhonda Valverde) Date: Mon, 15 Dec 2008 20:16:43 -0800 (PST) Subject: [NP-Corrections] Patient Load Message-ID: <556904.87479.qm@web83605.mail.sp1.yahoo.com> Is most everyone paid hourly/? We are salary paid monthly.? Since we are under federal recievership (California) our salaries were finally brought up to the community standard or a little higher if you are at top of scale.? Initially I took a huge pay cut since the retirement and other benefits tipped the scale.? We are also given recruitment and retention since we work in a high risk environment.? Salaries range $9048-$9948 monthly. Rhonda ________________________________ From: Shelby Havens To: np-corrections at nurse.net Sent: Monday, December 15, 2008 2:48:47 AM Subject: RE: [NP-Corrections] Patient Load Stephanie: The salaries are low here in Florida. We are a backwards and conservative state. Salaries range from $37 to $55 per hour for an NP. Maybe $60 to $75 without benefits. But we have no state income tax, which is nice! My salary is at the low end of the spectrum, even for corrections. But our retirement plan is awesome. We're in the?hazardous duty retirement plan (same as the state troopers), and we can be fully?vested after six years and draw our retirement pay at age 55. I?turned 50 this year, and have my eye on retirement at 55. I will have 20 years of state employment at that time. Best Regards, Shelby???? ? ________________________________ From: steffcatron32 at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 21:30:08 -0700 Dear Shelby and all: Wondering what the pay range for NPs and RNs in your area is?? I am thinking Corrections pay is higher than pay on the outside...Our NPs average between $42-$46 dollars and hour with benefits.? Stephanie ________________________________ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 18:10:20 -0500 Stephanie: ? I agree. If security cannot or will not bring the patients, it can lead to medical emergencies sooner or later.?A medical emergency is never convenient for anyone, especially the patients!? ? When I was?younger, I used to try to see as many patients as possible, sometimes working myself into an exhausted state. Eventually, I learned that if you get all your work done, then you will?get more work. With multiple providers, the faster ones tend to pick up the slack for the slower ones. That always got on my nerves. ? So when I turned 50 this year, I decided that I am only going to do the amount?of work with which I am comfortable.?In order to stay employed, I only need to see the same amount of patients as the slowest provider. We have some people who are pretty slow (and who have been working there for many years). ? When I?first transferred to my current?clinic, the physician came into my office late one afternoon and shoved a cart full of medical records?that needed chart reviews (labs reports, etc.)?at me. She announced that she was going to sit outside for awhile because it was hot in the building. I rushed like heck to finish?those charts, and found myself feeling panicky and upset. ? The next day, I decided to slow down. At the end of the day, I told the nurses that I was returning the charts I had not reviewed to the Medical Records Department and that I would finish them the next morning. We have to get overtime approved by the medical director in advance, so I am (fortunately!) not required to stay late.?The nurses were pissed off at me, and sat there scowling as I walked out the door. ? The following afternoon, the doctor came into my room and told me that if I couldn't finish my charts, I should give them to her and she would stay late and finish them. I said "fine!"?Then my assignment got lighter immediately.?I?suspect things had been?divided a little bit in her favor before then. ? The goal is to see up to 20 patients a day, but the chart reviews can take a couple of hours.? ? ? Best Regards, ? Shelby Havens, ARNP, CCHP??? ? ?? ? ?????? ? ________________________________ From: steffcatron32 at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 13:20:32 -0700 Dear Rhonda and Shelby: The frustrating part of seeing patients in the jail setting for us, is getting them to clinic. Each inmate is escorted by an Officer and if they are busy this can be difficult, one inmate at a time.? Occaisionally they will bring two at a time from the same block.? 20 patients face to face a day in corrections is a dream unless it is set up quite alot differently than our system.? In the private practice clinic I own, 20 patients a day is super busy and they come and go on their own!! ? Often a chart review and Kite (medical request) review can be enough for minor changes without the inmate being called down to the clinic. This should be counted as a inmate visit too... Stephanie ________________________________ From: shelbyhavens at hotmail.com To: np-corrections at nurse.net Subject: RE: [NP-Corrections] Patient Load Date: Sat, 13 Dec 2008 08:34:43 -0500 Dear Rhonda: ? Thanks for keeping the conversation going! I think that networking among corrections NPs can be?a valuable source of support for us all. ? Our medical director has set a goal of 20 patients per day (per provider)?for the outpatient clinics. However, as you can imagine, this has nothing to do with reality. If I am seeing a patient for three chronic illness clinics (asthma, hypertension, and seizures, for instance) I count that as three encounters. If I see twenty young?healthy men for tinea pedis or?an ankle sprain, that is vastly different from seeing?several seriously ill patients with HIV or cancer. So it's all relative. ? We have a lot of support staff, mostly LPNs and data entry clerks. Not a lot of RNs. ? In the old days, physical exams had to be done by an MD, PA, or NP. Now the RNs can do them.?Patients over 50 got an annual PE and those under 50 got a biannual PE. Now I think it is every three years for 50 and over, and five years for under 50. ? Everything changes over time. It is?getting more difficult for me to adapt and keep up as I age. I?am hoping to retire at the end of 2011, if the economy gets better! ? Happy Holidays to all my fellow correctional NPs!!! ? ? Peace, ? Shelby??? ? ???? ? ________________________________ Date: Fri, 12 Dec 2008 21:29:00 -0800 From: r.valverde at sbcglobal.net To: np-corrections at nurse.net Subject: [NP-Corrections] Patient Load Since we are trying to keep discussion going and bridging to gaps of isolation and discovering fact from fantasy etc.?? May I inquire how many patients on the average do others in corrections see daily.??The push lately seems to be all about "the numbers" while maintaining community standard of care given the setting and the barriers.? What type of ancillary staff do you have in your clinics or do you spend endless hours filling out all the forms, tracking down labs, dictations etc?? Our clinics are being reorganized so I am curious how other facilities clinics work.? Thanks Rhonda Valverde F-NP ________________________________ Send e-mail faster without improving your typing skills. Get your Hotmail? account. ________________________________ You live life online. So we put Windows on the web. Learn more about Windows Live ________________________________ Send e-mail anywhere. No map, no compass. Get your Hotmail? account now. -------------- next part -------------- An HTML attachment was scrubbed... URL: From rallison17 at cox.net Mon Dec 22 19:48:08 2008 From: rallison17 at cox.net (Cox User) Date: Mon, 22 Dec 2008 20:48:08 -0700 Subject: [NP-Corrections] Remove my name from your list Message-ID: <650E7AA966404374A6676831FF8606E1@DellUserPC> Please remove my name and e mail address from your list serv. no longer interested. thanks -------------- next part -------------- An HTML attachment was scrubbed... URL: