What’s going on in healthcare technology?

by Ryuichi Matsushita

Healthcare has come a long way but is considered by some to be the last industry to accelerate with technology. In other industries, technology has been able to reduce costs, increase efficiency, change entire business models and give birth to new strategies. This gives rise to a new question, why are healthcare costs going up? According to the LA times article A sick rise in health costs, Sep 20, 2016, the overall price of medical treatment increased by 1% in August (highest since 1984) and 1.7% increase in hospital services, the highest since October 2015. This hike goes across the board all the way from prescription meds to out of pocket expenses by Americans and increased monthly premiums.

What’s going on here? Is the medical industry so different than other industries that advancement in technology for one industry means cheaper and better whereas advancement in healthcare technology means more expensive? According to the Henry J. Kaiser family foundation article written in 2007 titled Snapshots: How Changes in Medical Technology Affect Health Care Costs, there are many complicated factors that contribute to increased healthcare costs related to technology advancement. One factor would be the impact on the cost of treatment to an individual; does it replace, substitute, or completely change existing treatment? A second factor would be the level of use the said new technology achieves? This can impact both the type and amount of healthcare an individual uses in their lifetime.

So what is the answer? What solution do we have? If there were a solid solution, I can almost promise that the company or person would be right up there in popularity with Steve Jobs and Bill Gates and we would be hearing about them in the media. Take for example Elizabeth Holmes. Despite her company undergoing criminal investigation, if her technology for blood testing was actually a success, imagine what that would have meant for healthcare. Unfortunately it would have turned over an entire sub-industry in healthcare, but it would have made an impact in this industry as any other new technology has done in other industries, making it cheaper, better and faster to an extent. Unfortunately we haven’t gotten there yet.

Don’t be too discouraged; it’s not all bleak. Today, healthcare has embraced the entrepreneur and their contagious ambiance for innovation. I imagine it is only a matter of time before the Steve Jobs of healthcare surfaces to spin the industry around. Until then, we can only watch the trends of mainstream healthcare moving into telemedicine, augmented reality, home health, robotics and the do-it-yourself healthcare with smart phones, health bands and eclothing. But then again, with all this new innovative technology, why stand in the sidelines and watch?


Ryuichi Matsushita worked as an LVN/LPN in SNF, Home Health, hospice and military healthcare sector. He is currently a student at CSULA graduating in December 2016 with a dual major in Business Administration with a focus in Entrepreneurship and Computer Information Systems with a focus in information systems. Ryuichi currently works on a healthcare startup that is focused on nurse staffing.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


7 Questions to Ask During a Job Interview

by Ruth Pankratz, MBA


Job interviews are challenging because every organization has nuances, a unique culture, politics, and some unspoken expectations. Start your next career adventure in the right direction by asking some of these key interview questions.

  1. How is success measured for this role?

An interview is the perfect opportunity for a hiring manger to learn about a candidate AND for a candidate to learn about the hiring manager and the organization. It is important to understand how the hiring manager will measure success. Allow the hiring manager to articulate what he/she is really looking for regarding role success.

  1. How does this role contribute to team and company goals?

Many candidates focus discussions on the job opening while forgetting the importance of contributions to the organization’s growth. Understanding the answer to this question can provide insights that could help you quickly align with future decisions or realize the job may not be headed in the direction you thought.

  1. Tell me about a few challenges this role will provide and the biggest team issue you encountered in the past 12 months.

Every role solves a need or a problem so it is best to understand how the hiring manager believes the right candidate should handle issues and contribute to the team. In some cases, the answer to this question can help you learn if the job opportunity is a good fit.

  1. What do you enjoy most about working here and what keeps you motivated?

Asking the hiring manager to talk about his/her self is a great way to learn about the person and understand how he/she views the organization. Some candidates have been shocked to learn that the hiring manager has plans to leave or that the hiring manager has been in the same role for more than fifteen years.

  1. What is the organization’s customer/patient service philosophy?

Beyond what is stated on the company website, it is helpful to get inside knowledge about how customers/patients are viewed and treated by the employees.

  1. Who is the most successful team member and why?

This is a good way to learn what success looks like for the hiring manager and to understand who is viewed as a top performer.

  1. What are next steps in the process?

Many candidates leave an interview without knowing when or if they will be contacted again. Job interviews are competitive and can feel cryptic if you don’t have key details. Be sure to ask questions about the interview process, next steps, and timelines.


Ruth Pankratz, MBA, is a dual certified resume writer and a certified interview and job search coach. Her resumes have won international awards and Ruth’s cover letters, resumes, and LinkedIn profiles have been included in a variety of publications. Contact Ruth at www.GabbyCommunications.com.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Kim Spering

Meeting a Patient on His or Her Terms…and Their Dogs

by Kimberly Spering, MSN, FNP-BC


Looking back on my NP career in Family Medicine, Women’s Health, and Internal Medicine, I recall how patients came to see me on MY terms.  MY turf.  My rules (oh, OK, the office rules for a visit).  Patients had to fit into MY schedule, among the many others that I would see in a day.  If patients were late, that would mess up the schedule.  I’d try to see them anyway, but get back-logged for the rest of the patients.  Lunch was a rare luxury, as I would return phone calls, triage labs and test results, and generally have no “down-time.”

Then when my Palliative position started, I was blessed with many luxuries.  TIME to spend with patients and learn their goals of care, the workings of their minds, the limitations and challenges they faced.  The ability to LISTEN to their hopes, dreams, fears, and worries about the future.  The ability to CHERISH even small moments of success, when patients faced some of the darkest times in their lives.  The ability to APPRECIATE my own health, family, and the comforts of living.

Truly, so many of my patients lack even the bare necessities…how could I not be appreciative of my blessings?

Then, there are the “other” benefits.


Yes, you read that correctly – dogs.

I have two golden retrievers – one 9 ½ years old, one 3 years old.  My older girl is laid-back, sweet, and loves nothing more than a hug and to be petted.  My three-year old is a terror…mostly to his sister, but much more challenging in the behavior department.  He’s “ALL boy,” as they say.  I love them dearly.

One of the perks to doing home-based care is that I get to meet these patients’ dogs on their own turf.  Often, there will be a discussion between the patient and me when I arrive.  “Oh, she’s harmless and all “bark.”  Or an apologetic, “I’m so sorry.”  I tell patients, “I have two goldens…it’s all good.”  Chatting about our dogs is a great ice-breaker.

There may be a little yappy poodle…or a big German Shepherd, a pure-bred, or a “mutt,” but somehow, these dogs must sense that I’m there to help their owner.  Knock-on-wood, I’ve never had a bad experience with the dogs.  We have our meet-and-greet, lots of kisses…and sometimes wary looks, but usually after 15 minutes or so, the dogs settle down.  I just saw a patient with two dogs, both of whom were very “vocal,” and one who jumped up on the loveseat next to me…lying on my computer keyboard.

Just like my 3 year old pup.

Watching the interaction between the patients and their pets is priceless.  Often, I hear, “she keeps me going,” or “I don’t know what I would do without him.”  Pets provide such valuable social interaction with owners – no wonder patients love their “furry children.”

Anyone who sees patients can ask about their pets.  Doing so makes us seem more interactive, “human,” and engaged in the patient’s life.  I actually include pets in my social history for the patient, such as “lives with a poodle-mix named Lucky.”

Acknowledging these things helps our patients realize that they, too, are human, with very distinct needs and concerns about their pets.

And hey, a sloppy kiss or a bit of dog hair never hurt anyone.

Of course, I get the “once-over” by my two when I get home.  They seem particularly attuned to noticing when I visit homes with cats.  (smile)  I’m fairly certain that they love the extra attention from my reassuring them that they are both #1 to me.


The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


Buy and Sell: How to Strike a Balance in Your Medical Clinic’s Finances

by Brooke Chaplan

Brooke Chaplan

Striking the perfect note in your medical practice’s finances is one of the more crucial parts of running a profitable clinic. It allows physicians and staff members to identify and subsequently correct operational inefficiencies that are affecting cash flow. It’s often very tricky to balance out these expenses and revenues in an industry where even the most minor of mistakes and changes can affect human life. You don’t want to be spending too much on supplies and procedures, but you also don’t want to skimp to the point that patient care is drastically reduced in quality. Here are a few tips to get you a better balance in your clinic.

Take a Closer Look at Your Payroll
Staff salaries can take up as much as a quarter of your clinic’s revenue. Knowing this, you should make it a point to drill down on an accurate and updated numbers. While offering less over time and cutting back employees are good measures to manage overhead expenses, it is not the most effective way to do so. Look at how efficient your staff members are working. Even if you employ less than 10 people in your clinic, costs can remain high relative to performance levels and output produced by inefficient and incompetent employees.

Identify Fixed/Variable Costs

It’s ideal to create and implement a budgeting format that sets clear distinctions between revenues and expenses of variable and fixed nature. Variable expenses are those that change from month to month, while fixed expenses are those that remain the same. Fixed expenses will usually include lease payments, management salaries, subscriptions, and contractual costs, such as marketing. Variable expenses will include utilities, office supplies, and repairs/maintenance.

Work with a Good Medical Supplier
Medical supplies will impact your practice on a grand scale. Poor quality supplies can lead to inaccurate diagnosis and unsafe treatment. Work with a good medical supplier who you can work out a mutually beneficial contract with, particularly one that strikes a balance between monthly expenses and revenues. Places like CPI International offer not only good supplies, but environmentally safe options as well. See if this could be a good idea for your business as well.

Get Business Insurance
Business insurance can cushion the financial blow when operations turn out for the worst. Secure business insurance for your medical practice and make it a point to update the coverage features on a quarterly or yearly basis to avoid unnecessary costs while ensuring your business is covered adequately.

Striking a balance between medical expenses and revenues is a worthwhile milestone for your practice. It allows you to determine inefficiencies that are gradually draining your revenues per month and subsequently gives you solutions for those identified issues.

Brooke Chaplan is a freelance writer and blogger. She lives and works out of her home in Los Lunas, New Mexico. She loves the outdoors and spends most her time hiking, biking and gardening. For more information contact Brooke via Twitter @BrookeChaplan


The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


How Public Health EHRs can Change the Industry

by Aiden Spencer

As EHRs develop in to bigger databases containing patient data, there is an argument, which can be presented that if the public health sector was to use that information it could help further research be more detailed.

With an EHR designed specially to help the public health sector, there has genuinely been a step forward towards provide the right kind of care for patients. The normal EHR cannot cope with the requirements of the public health system, because it is meant to cater to the physician, and not particularly for the patient. The public health EHR on the other hand is designed to fulfill the needs of the public health system.

Compared to a normal EHR, the public health EHR can do wonders for the patients,

  • Providing different scales of payment

The birth of EHRs redefined the way doctors keep track of payments. This reduces the hassle of more unnecessary documentation.

Furthermore, what is required from local health departments has increased, since every patient is to be registered into a specific program. Now the system itself will sort patients automatically into different scale for payments, which is based on certain specifics. The technology has moved so far that patients can now sign their declaration of income electronically.

  • Clinical Forms

There are a huge variety of clinical public health forms that an up-to-date EHR must have, which aren’t generally included in the regular EHR. The technology has the ability to make automated forms for every department, and allows for data generated to be structured for reporting even at the federal level.

  • Billing and Financial Compatibility

A practice that wants to operate without a hiccup needs to have billing and finance coordination. A public health EHR will drop denials and actually make everything much more coordinated. Just make sure that you should meet all the required prerequisites.

  • Reporting

The problem that providers have is that it is more difficult reporting to state or even federal agencies, so one has to be careful. This is where the modern time technology outshines any of its counterparts, in the way it facilitates the public health sector. The amount of detailed set of reports that a public health EHR makes, helps providers deal with these agencies.

  • Always want more

Don’t just look for an EHR that meets all your requirements, instead look for an EHR that goes above and beyond your needs. This way an equipped advanced EHR will always be ready to meet the requirements of the changing industry.

How are public health EHRs changing the industry?

Ultimately, when moving in this direction that the industry is headed in, there are a lot of changes that have been coming about, like the ICD-10 grace period ending, and the entire industry moving towards an electronic IT revolution means that you need to keep up with the times.

In the very recent future, because of public health EHR, we could move into the phase of “predictive epidemiology” which will let health authorities prepare before an epidemic strike. But to make these kinds of predictions, the government or agencies working on this, will need huge amounts of information to predict possible outbreaks. Even on a lower level than epidemics, a general trend, or a viral fever could be detected in a particular part and actually be prevented or at least treated by sending extra medical supplies to that area.

All this information will be provided by the EHR technology, and this will undoubtedly change the industry towards an unprecedented direction which could lead the way into the future.

Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, Medical Practice management and patient health data. You can get in touch with him on Twitter: @AidenSpencer15 

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


Getting the Right Match

by Tom Davis, CRNA

“What counts in making a happy marriage is not so much how compatible you are but how you deal with incompatibility.”  ― Leo Tolstoy

Neil Clark Warren is a name that you may not know, however, when you see his face and hear his voice you will say, “Oh yeah, that guy.” Mr. Warren is a clinical psychologist, Christian Theologian, seminary professor and CEO of eHarmony.com. Most likely you know him from over a decade of TV commercials.   As a marriage drwarrencounselor, Neil worked with couples who, despite their love for one another, had compatibility issues.   The eHarmony.com web site was designed to assess the basic character and values of each person and then match them with a partner based on compatibility. The success of this online dating plan has been impressive.   Compatibility is foundational to every good relationship, including work relationships.

Compatibility is just as important in the workplace as it is to your personal life.   Being in the wrong job is like being married to the wrong person…lots of work and not much fun. All too often production pressure inflzuences a manager to hire a person primarily to get them on the job and working quickly.   After months or years of frustration, the manager realizes that the employee is not compatible with his leadership style or the institution’s values. Both are unhappy and neither is as productive as each could be.

As healthcare managers, Chief CRNAs have a vested interest in ensuring that employees are fully engaged in their work.   Engaged employees provide consistent, high levels of productivity. They are your problem solvers and proactively identify ways to streamline workflow and improve patient satisfaction. They embrace the vision and values of the organization and are on board with your management style.

In contrast, disengaged employees are actively or passively against just about everything. They believe that they are right and everybody else is wrong and would rather hold on tightly to the problem than fix it. Most people reading this article can name both engaged and disengaged co-workers.   As a manager, you seek to increase the number of workers carrying the load and to reduce the number of those who put a drag on the system. Your goal is to have a fully engaged workgroup, and employee engagement starts with the hiring process.

As my mother used to say, “It’s easier to avoid getting into a bad relationship than it is to get out of one.”   As a manager building a team, the Chief CRNA must assess compatibility of every applicant and stay out of bad relationships. Always remember, there are highly qualified, fully capable applicants who have the work experience that you seek but still may be a terrible fit on your team. Compatibility is as important as capability when assembling your team.   Building compatibility into your team begins with the application/interview process.

Competence and capability are foundational for any employee to become a valued member of your staff. Competence is evident by the applicant’s having the education and skills required in the job description, however, capability relates to the willingness to work and the quest for professional growth. When interviewed, an engaged applicant will ask about your expectations and will also ask about taking on more responsibility.   The person will want to know how you define and reward excellence.   When you follow up with calls to references, ask about work ethic and ask for examples of when the applicant went above and beyond the basic requirements of the job.   If all the person does is show up, earn a pay check and go home, don’t expect to see an attitude change after becoming your employee.

An applicant’s Commitment to the mission, vision and values of the larger organization aligns them with others in the workgroup and provides a stable platform for future interaction. When you interview, ask the applicant why they want to work with your group. Are they committed to the group values and are they committed to a long term work relationship or are they passing through until a better option arises? Before the interview ends, get a verbal commitment that the applicant supports the values of the group. Regardless of their competence, if the applicant cannot commit to the values of the group, the person is not a good fit.

Compassion and caring about the welfare of patients and co-workers are signs of emotional health.   Having a sense of happiness and a good sense of humor will elevate the mood of the entire group and make your hospital a preferred workplace. Build your team with people who appear happy, who support one another and have a desire to connect socially.   The interview is your opportunity for a conversation with the applicant that is relaxed and easy.   If the interview is stressful or there is not a free flow of thoughts, the applicant is not a good fit.

Compensation to include both pay and benefits is important to the institution and to the applicant. The offer should be competitive with the local market and the applicant should be satisfied with the offer. Employees who feel that your offer is too low will feel under-appreciated and may quickly become under productive. Not only do they become a drag on your system, they drag others down with them and create discord on your team. Don’t apologize for your offer. If the applicant does not gladly accept it, they will not fit in and will jump ship at the first opportunity.

Communicate with people who know the applicant and their work ethic. The applicant will provide a list of people who can be relied upon to give a glowing testimony.   When you interview, ask the applicant for names and contact information for current employers/supervisors. Follow up with a phone call to validate the things told to you during the interview.

Just as Neil Clark Warren uses eHarmony to assess values and characteristics of people to increase the likelihood of compatibility, the Chief CRNA must have a working knowledge of the values of the institution, conduct a focused interview, and follow-up to assure that the applicant is a good match. A happy, healthy and engaged workgroup is founded on a compatible partnership.

Remember, it is easier to teach technical skills to the right person than it is to change the basic personality of a highly skilled but wrong person. For eHarmony in your workgroup, do your diligence and make a good match.


Tom Davis, CRNA is well known throughout the Nurse Anesthesia industry as a clinical anesthetist, writer, speaker and leadership developer. With experience both as a Chief Nurse Anesthetist and Nurse Anesthesia Educator, Tom has touched the lives of hundreds of CRNAs who are now practicing throughout the Nation. Experienced working across department lines, he is now in a unique position to provide management and leadership techniques in both healthcare and business communities.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


Good Employees are Like Good Horses

by Gregg Martin

Employee disciplinary policies and procedures are normally very clearly defined at any large company and in achieving the goal of weeding out undesirable employees they are very effective.  But they can sometimes weed out the extremely desirable employees too, and very early on in the process.  To prevent that from happening, managers need to be more than just managers…they need to be leaders.

Being a “manager” is generally safe.  If you follow the rules to a “T,” regardless of the outcome there is no personal risk.  Strictly following employee disciplinary policies and procedures will keep you out of hot water, and 90% of the time will have the desired outcome.  It takes a “leader” to know how to keep what happens in the other 10% of the time from not costing you your best employees.  I’m going to use horses to illustrate how that can happen.

A well-trained horse with a good attitude desperately wants to please its owner.  If you ride horses and have had the good fortune to own such a horse, you know exactly what I mean.  As soon as you sit in the saddle and collect the reins (in English riding), the horse knows it’s time to work. He knows to assume a certain stance and posture, and to pay attention for the “cue” that is about to come, letting him know what the rider wants him to do. 

 In English riding, a “side pass” is cued when the horse is at a halt, and when cued, the horse moves laterally/sideways to the right or left depending on the cue, but remains facing forward.  A side pass to the right would be cued by placing the left rein midway along the horse’s neck and by pressing the rider’s leg midway along the horse’s body.  The “good horse” will immediately know what is desired of him and will begin executing the side pass.  A “bad horse,” however, will think to himself, “yeah, side pass…I get it…is that all you’ve got?  If so, I’m gonna put my head right back down and eat some more of this yummy grass.” 

Clearly, the “bad horse” needs strict application of disciplinary procedures and policies…pointy spurs and a sharp tug on a bit designed to “encourage” a horse to behave.  By correct application of those disciplinary procedures, a smart “bad horse” will think, “oh, you meant now!  Well, let me get right on it” and will execute the bare minimum to keep from getting spurred again. 

Occasionally our “good horse” will have a lapse of attention or bad day, and will not immediately respond to the side pass cue.  If our rider applies the same disciplinary procedures just discussed that were applied to the “bad horse,” the outcome will not be a happy one.  He will become nervous, fidgety, and fearful, and he will be thinking, “what??  What did I do??  I’m so, so, so sorry!”  Tell me again, but PLEASE don’t hurt me again.”  Enough of this kind of discipline and we’ll have a “good horse” that will never do a decent side pass again, and that no amount of horsey Prozac can fix. 

A leader needs to know who his “good horses” are and take care not to ruin them.  Am I saying the good horse shouldn’t have their errors and mistakes pointed out to them?  Absolutely not.  But if the goal is to have an effective labor force with good morale that intrinsically wants to give the manager their best performance, it needs to be done differently.  Since I’m a nursing home administrator, I’m going to use a scenario I might encounter as an example.

 “Melinda” is one of my top CNAs…maybe even the best…but she is also sensitive to criticism as so many of the best workers are.  She is assisting a resident walking near where I’m standing at the nurses’ station, and I look up to see that the gait belt isn’t correctly applied.  When she has the resident safely seated, I call her over and say, “Melinda…I saw that you didn’t have the gait belt correctly applied.  I know we’ve inserviced all of you CNAs on gait belts numerous times, so there really isn’t any excuse. Now this is a verbal warning, but if it happens again, it will be in writing.” Not at all inappropriate for the “offense,” but if I handled things that way, Melinda would turn into a puddle of nerves on the floor, feeling horrible at the thought that she disappointed me, and the high spirits and confidence that made her an excellent CNA will vanish forever.  I will have ruined her.

Instead, I call Melinda over and say, “hey, how did your youngster do in that soccer game?  I know you were excited about that!”  (she gets excited and starts to tell me about the game)

 I break in and say, “wait a minute before I forget…the way you had that gait belt on the resident…”  and I won’t even need to finish the sentence. 

 She will put her hands to her face and say “I’m so embarrassed, I realized when we finished walking that I had it on wrong, I’m so, so, so sorry!”

I will reply, “oh, I just wasn’t sure if I was seeing correctly…don’t worry about it!  Now tell me about that soccer game…”  And Melinda will never, ever, ever make that same mistake again.  She will continue to feel like she has my complete confidence in her, and she will continue to be the hardworking, loyal CNA I have been fortunate to have in my employ.

 If we as managers don’t know when to appropriately make these slight adjustments to disciplinary procedures, we’ll still get rid of the bad.  But we’ll also ruin the good.  And all we’ll be left with is mediocre.

Gregg Martin is a retired navy chief petty officer who, through a weird set of circumstances, ended up being a nursing home administrator.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


4 Things a Master’s in Nursing Can Do for You

by Lizzie Weakley

While there are plenty of jobs that one can get with a BSN in Nursing, your marketability can multiply many times over when you earn a master’s degree. This article will reveal four jobs that you can get after you receive your master’s degree in a nursing specialty.

  1. Nurse Practitioner

    If you would like a position that is in high demand, one job in nursing that you will want to consider is Nurse Practitioner. Nurse practitioners are both specialty and primary care providers. While many nurse practitioners work with physicians, some states allow them to run their own practices.

    Nurse practitioners can perform up to 80 percent of primary and preventive medicine. Most nurse practitioners can be found in women’s health, geriatrics, pediatrics, acute care, and family practice.

    Salary: $78,000

  2. Legal Nurse Consultant

    If you’re not interested in working in a hospital, look into becoming a legal nurse consultant. Many legal nurse consultants work either from law offices or even from their own homes. Some other nurses work in insurance companies, private corporations, and government agencies.

    Certified legal nurse consultants work with companies and attorneys in order to share their healthcare knowledge. Many of them help with health-related lawsuits. These nurses can do research, review records, find expert witnesses, and prepare summaries and reports.

    Salary: $62,000

  3. Nurse Researcher

    This is another job that you can consider if you’re keen on research. Nurse researcher is a great advanced position in the nursing industry that is non-clinical. What nurse researchers do is analyze and create reports from research taken from various medical and pharmaceutical practices. Nurse researchers do this work so that medical services and healthcare is improved for the better. Many nurse researchers gain employment from both private corporations and health policy nonprofits.

    Salary: $95,000

  4. Nurse Anesthetist

    Nurse anesthetists are among the highest paid nursing specialists in the industry. This is because they administer and maintain anesthesia for patients during their surgeries. They work with anesthesiologists, surgeons, and dentists to administer anesthesia.

    To become a nurse anesthetist, you will need to have experience in critical care, as well as your completion of a 2-year anesthesia educational program. You will also need a master’s degree in nursing, as well as an official certification from the National Board on Certification and Recertification of Nurse Anesthetists before you can work as a nurse anesthetist.

    Salary: $135,000

When you’re a nurse who earns their master’s degree, you will have plenty of career options available to you. Whether you love legal research or working alongside surgeons during surgery, you will be able to find a nursing career that fits your unique interests.


Lizzie Weakley is a freelance writer from Columbus, Ohio. She studied communications at The Ohio State University. Lizzie enjoys the outdoors and long walks in the park with her husky, Snowball.


The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.


What Kind of Pie Do You Have?

by Jacque Young, APRN, DNP

When reading the headline, do you immediately think about food? Well, that is not the kind of pie I am blogging about. Think of pie as a metaphor for your career plate. Do you have only one kind of pie on your plate? Or do you have different types of pie on your plate? Some medical providers are old school and prefer only “apple pie.” But as the world of technology advances we must be able to accept and conform by eating several different pieces of pie at the same time in order to stay relevant. I recognize most people think we should not indulge in apple, cherry, pecan, and pumpkin pie all at the same time, but this is truly what healthcare is evolving towards. With social media and the internet, we are now able to reach millions with the click of a button.

As a provider in healthcare many of us work several jobs at one time. From time to time we are working multiple jobs without being conscious of the responsibility we are undertaking. It becomes second nature and almost robotic. For example, we may work in the hospital during the day and teach in the evenings. With online education becoming the norm, many of us can now teach without leaving the comfort of our living room. Some clinicians contract themselves out as on call for medical groups for a fee. Also, as providers, we can consult with major chain hospitals who value our expertise and opinions. Consulting has become a major player in the healthcare realm. Some healthcare consultants are commanding a six figure salary.

There are vast arrays of opportunities in healthcare beyond bedside care. Find your niche and you can be compensated for doing what you love in medicine. Eating too much “pie” use to come with a negative stigmatism, but now it is completely acceptable. The key here is to diversify and to maximize your earning potential before your waist line gives out.

Jacque Young is a Board Certified Nurse Practitioner, freelance blogger, and motivational speaker. She enjoys spending time with her husband and wonderful 3 children. She can be booked for events @www.linkedin.com/in/jacqueyoungnp



The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Marcos A. Vargas, MSHA, PA-C

Patient Advocacy: Your best defense against an Assembly Line Medicine Culture

by Marcos A. Vargas, MSHA, PA-C

As clinicians, we expect our patients to present us with clues (signs & symptoms) we need in order to make accurate & timely diagnoses. Yet, as we all know that clinical luxury is not always part of the initial encounter, nor listed on the triage sheet or explicitly expressed by the consultation requester facilitating this activity for us.

Reflexively upon entering the room we quickly scan for signs that help us confirm or refute the acuity of the complaint listed. Likewise, we do the same when scanning over the brief history given or obtained by the assessing MA or LPN. All while juggling in our heads the long list of differential diagnoses & hoping to give us a road map and a point of reference to the right pathway when embarking on our diagnostic quest.

In fact, it’s hard to “slowdown” or pause for a moment and consider looking things from a much broader perspective than the one possibly believed by the patient. After all, they know what they’re feeling, and what they are going through. But thank goodness, on the day I entered the exam room and met “Robert” I had a gut feeling there was more to the story than he was willing to share with. See, Robert successfully sold his story to a triage RN at the end of her shift. He told the RN he had pulled his back, without admitting he was basically a non-compliant patient with his anti-hypertensive regimen. Instead, he related to her that he was experiencing a new-onset LBP of a tearing type after some minor yard work at home that day.

At age 56, hypertensive throughout his lifetime while being morbidly obese and physically unfit, he admitted he had never been screened for an AAA. He sought medical attention only as problems arose. He had come to our ED because he told the RN all he needed was a prescription for Vicodin and relieve his back pain “flare-up”. Convinced that he was going to sell me the same story he pleaded with me to curtail my Hx taking since he had (allegedly) family waiting outside and he had to work early the next day. He reassured me he was uncertain of any specific trauma but was sure that he “must have twisted his back incorrectly earlier that day.” As I decided to probe further, the remainder of his review of systems was negative for any acute cardiac, pulmonary or renal and/or spinal emergencies, which at that point was intriguing me considerably. Especially when he was visibly mildly diaphoretic and uncomfortable.

His impatience was mounting, but it wasn’t until I began my physical exam that a few disturbing abdominal cues (a palpable pulsatile mass measuring >4.5 cm & a lateral renal bruit) led me away from his lumbar strain home made Dx. This, coupled with his tachycardia, diaphoresis, and inability to be comfortable in a recumbent position reminded me to be aware of framing biases offered by patients that sometimes can obfuscate our clinical-decision making process if we aren’t vigilant. At this point, he became more exasperated when I became highly suspicious for a leaking AAA and I urged him to undergo emergent diagnostic testing and rapid IV lines placement given the gravity of the possibility. As I discussed this briefly with my attending and was making all preparations for stabilization, and emergent vascular surgical intervention he still threatened to leave AMA if I didn’t bring immediate closure to this encounter since he had “family waiting” and he was self-assured he had “pulled his back” early that day.

Luckily and fortunately, I managed not only to abate his fears, but also gain his trust & surmount his pre-op denial for surgical intervention after a rapid CT scan revealed/confirmed the “leaking” AAA. Moreover, I sidestepped a medical heuristic, one with legal ramifications if I would have not been cognizant of the various “framing biases”.

Prior to being transferred to the OR, he came to terms with himself. He requested to see me for a few seconds. Now, he was a different person, unashamedly he was a tearful man, yet joyful and very appreciative for my “thoroughness” as he expressed. Moreover the fact that I stayed 2 hrs post my shift’s end was greatly appreciated by my attending as well as his family. He humbly conceded and quickly apologized for “giving me a hard time” as he was being wheeled away by the OR staff. As I was wrapping things up, my ED attending confirmed my worst fears. Robert had a significant AAA leak that probably would have cost him his life if I would have taking his chief complaint at face value. He remained in the ICU for a few days given his longstanding medical co-morbidities and prior poor medical compliance. Several days later Robert was finally weaned, extubated, and discharged home to follow up with his doctors.

Sadly, I never saw him again post-operatively. Afterwards, through various sources I learned he was able to be reunited with his estranged family. Since that day, I’m always thanking Robert for reminding me that not all LBP pain is musculoskeletal in nature—a concept similar to the old adage about asthma: “Not all that wheezes is asthma.” To this day, while no longer an Emergency PA, I still I thank him for reminding me to be cognizant of those diagnostic derailers lurking in the background, always seeking to sabotage our hurried patient encounters & clinical decision-making calls.

On can easily see that on a busy day with many patients to see and care for, it’s quite easy to fast-track patients easily without a second thought by embarking on the wrong diagnostic path. This incident brought this message home especially when you might see 2-5 patients with a similar chief complaint on any particular day or shift. Beware of “diagnosis momentum”—a costly medical heuristic to both the provider and the patient as well.

Obviously it goes without saying that we can never let ourselves get so caught up in the rush of the day-to-day activities that we could miss seemingly clinical red flags or some other small details. Our patients expect more than that—in fact, they deserve it and their lives may very well depend upon it.

After all, it’s our job to be advocating diagnosticians. To this day, even when I feel pressured to “see more patients” or even “keep the numbers up”, due to employer or teammates expectations I immediately remind myself of this case. Truthfully, we must make a concerted effort not to get too caught up in what patients believe is wrong with them nor practice “assembly line medicine”— seeing a patient every 10 minutes or so because an employer expects it.

Rather establish rapport, look at the patient, listen to what they say, and take the time to avoid cursory history taking and/or do keyhole physical exams as we have all done in this business of ours. Those are not only hallmarks of “assembly line medicine cultures” but also the underlying stigmata of both, bad and negligent medicine.

Remember people are not widgets on a conveyor belt. Patients are parents… siblings, children…spouses…etc.


The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.