University Hospital ICU Nurse Extern to Long Term Care RN.
My journey to Legal Nurse Consulting & how it will benefit your next case.
My career in critical care medicine began during my nurse externship in the Neuro-Trauma ICU (NTICU)/Intermediate Unit (NTIMCU) at Thomas Jefferson University Hospital. This is where I fell in love with neurological, trauma, and critical care nursing. I worked in this role for two years, during which time I completed my B.S.N. and passed the nursing boards. Due to a union strike and hire freeze TJUH couldn’t hire me when I obtained my R.N. I figured “Carpe Diem!” and took off across the country to Oregon where I established my home and career for the next decade.
It took some time to get established in Oregon, I quickly learned that Portland was not going to treat me like Philadelphia. Obtaining the job of choice, with no RN experience, was impossible. Nowhere cared about my externship experience, I don’t think they even understood what it was. I knew my goal and how to achieve it, so I found a job at a Long-Term Acute Care Hospital (LTACH).
My externship at TJUH had taught me to be a very prepared new-grad R.N., and my first job at the LTACH was teaching and providing me with much more than I could grasp at the time. There was no way I could have know nhow useful that experience was going to be when I became a Legal Nurse Consultant.
Critical care trauma nursing compared to long term acute care nursing, is a very different aspect of nursing. During the time I worked at Jefferson, patients went from endotracheal tube to tracheotomy and peg tube at bedside within an hour. Change in mental or respiratory status and you can be in the CT within minutes. If a patient needed a specialist of any kind, there was always someone close by. Any resource we needed, we had. Evidence based practice and education was always incorporated, we were encouraged to be the best and deliver the best care. Patients and families in this setting are filled with fear, anticipation, and hope. Family and friends are often present during this time fulfilling the patients’ psychological needs, supporting the care staff.
By transitioning to the LTACH as my next job I rapidly learned that all nursing experiences are not equal. Care staff play the roles of cashiers, scanning patient care materials for charge before leaving the supply closet. If someone starts seriously deteriorating, they need to be transferred. Insurance coverage is discussed more often than it should be. Education and practice are more about getting tasks done. The impossible often demanded when it comes to quality of care related to time available to deliver that care. Patients in a long-term setting are typically and rightfully frustrated they have been in the hospital for so long, family and friends get back to their normal routine, visiting less frequently. Yet, these patients require more attention and time due to their psyche, and the nursing staff only has time to get the physical care needs met, leading to an even more frustrated patient.
Management, support, protocols, and type of care are all very different in these two very different hospital settings. These differences taught me a lot that I carry into my Legal Nurse Consulting work. The goals and standards of care are different, insurance coverage is different, resources available are different, protocols & policies are different, everything about an LTACH is different from a standard hospital. By working in such a drastically different environment early on I was able to see the nursing world much clearer. This clarity has gifted me with the following three attributes which serve my Legal Nurse Consulting work.
Anticipating the differences of standard of care provided, in relation to the type of facility and level of care a patient is receiving.
Greater awareness of health care facilities varying capabilities and responsibilities, in relation to the level of care and resources available.
Insight to how MD’s and/or facilities can, and will, adjust the patients care plan based on the amount of insurance coverage they have available.
Outside of patient care, the brief list above are three main qualities that working at the LTACH gave me. Qualities that will benefit your next medical malpractice case if you choose me to be your Ground Control RN, Legal Nurse Consultant.
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