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SDALPN 12,371 Views

Joined Apr 10, '07. Posts: 1,043 (50% Liked) Likes: 1,401

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  • Sep 28

    Please post if you are an LPN doing a job that isn't the typical clinic, hospital, LTC, PDN type job.

    I'm thinking of changing my area of nursing. I have no interest in the typical jobs. I'm getting burned out with PDN. I prefer working alone or with a few people. I don't want the risk and pressure of LTC. I don't want to work in a clinic doing vital signs all day. And I'm sick of the nutty families in PDN...dealing with them in short bursts instead of constantly is fine and I'm tired of them having control over my hours. I prefer a job where I can wear scrubs. I hate dressing up for work.

    So far I have applied to 2 plasma centers as I'd enjoy doing assessments all day. And I have applied to an assisted living facility for management experience.

    So what do you do that is different from the typical LPN job? What is your day like? If you are comfortable discussing it, what is the pay like? Any other job suggestions? I'm in NC if that makes a difference. Thanks!

  • Sep 4

    That requires lots of money. A friend of mine used to own an agency. She said at minimum you need 6 months salary for you and any other employees because reimbursement can take a long time. On your own, you will need an RN if you are an LPN. Its not easy. I've chosen to work for agencies because there is too much involved.

  • Aug 25

    Quote from edwardsrn62
    Ok, so I just graduated nursing school then passed the NCLEX... I got hired over the phone with a "home health agency" although I actually am a private duty nurse doing 8-12 hour shifts. The service is paid for by medicaid. Medicaid pays my company and then the company pays me. I clock in and out using the clients mothers phone (my client is pediatric).

    On 2 separate instances (once in August and once in September) the clients phone was unavailable, so as instructed by my supervisors, I called management, with the fathers phone, and they were supposed to clock me out. In BOTH cases the managers never clocked me out and I received a call from the office the following mornings wanting to know why I had not clocked out. I never got paid for these two days. I spoke with the owner of the company numerous times and she insisted they would be on my next paycheck. But paycheck after paycheck came and the hours were never added.

    Then, the owner calls me just last week and tells me she will not be paying me for those two days as she had just found out I have been taking a lunch break. I was told by the woman who hired me, the pt's mother and the nurse who has been working for this company that lunch breaks were allowed. There is NOTHING in my contract that says we are not allowed a lunch and I have not even taken a lunch everyday. I might get to take a lunch 2 days out of 5 that I work. I spoke with the medicaid case manager about it and she said the company was paid for all of my days, including the two where the office had to manually enter my departure time the next day. The owner of the company said that the only way she will pay me for the two days is if she goes back from my start day (over 6 months ago) and takes 1 hour lunch out for every day... Which would make me owe her money!!!!

    So just to summarize, the company was paid during every lunch I took, and was also paid for the two days where my managers did not clock me out, but I was not paid for the two days because "of the lunches" i have taken. I am no longer taking lunches now that I know that it is not allowed, but I was counting on that money and I feel its not fair that the company was paid for doing nothing while I am being shorted for almost 25 hours of work! I am still a new nurse, this is my first nursing job and I just feel like it isnt right.

    They have hired 7 nurses total for this case and I am the only nurse who has stuck with it. The rest of the nurses quit due to pay issues as well, but this has been my first negative experience. I have had several people tell me they are not allowed to just take my pay like that. Does anyone know legally or from any aspect how all this works?

    Thanks in advance for your help!
    First mistake, new grads don't belong in PDN (home health is visits, PDN is shifts. Neither are good for new grads).

    Next, this is PDN...you don't get a lunch break. You work straight through your shift and eat as you can. Insurance requires you to be in the same room with the pt at all times. If you aren't doing this and you are taking a break away from the pt to eat while still getting paid, its fraud. It also means you left your pt unattended. If a parent is giving you a break and you leave for a lunch break, you must clock out.

    We can't give you legal advice per terms of service. If that's what you are looking for, you should contact a lawyer or use your local resources such as the labor board, and insurance compliance line.

    This stuff happens all the time. This is one reason why new grads don't belong and why its important to know insurance requirements and how PDN works. Medicare/medicaid also requires one year of nursing experience (although that could possibly vary by state). If you are representing yourself as a nurse with a year of experience, that is fraud in some states. Sounds like you are learning a tough lesson and you have much more to learn.

    You would be better off working in a facility for a while and learning how things work before trying PDN. Learning what insurance requires of us will also help. Nursing school doesn't teach this stuff. Nursing school just gives you a snapshot of the larger areas of nursing. Nursing school gives you the minimum you need to know to be a nurse.

    Good luck.

  • Aug 17

    Its interesting that the nurses posting haven't worked private duty or have only worked a few cases. Not all parents are like that. But the ones that are like that act entitled and unappreciative. It does make a nurse frustrated. A lot of parents like this type if parent are the ones living off the system and taking advantage. Then they get mad if they don't get their free services. Some of these parents get 20 hours a day. 4 hours is not too much to ask the parent to do. If they can't handle that, they need to out the child in a facility. Saying these parents are scared is an excuse. I've seen the type. They aren't scared, they are lazy. If they are that scared, they have no business taking care if their child. I watched 2 parents in a case who stayed home all day with 20 hours of care. They also took a nap every afternoon after an exhausting day of watching TV. Then they got up and watched more TV. Then would sleep for 12 hours. As long as they slept they were happy. If they were interrupted from even watching TV, they let the nurse go.

  • Aug 17

    Its interesting that the nurses posting haven't worked private duty or have only worked a few cases. Not all parents are like that. But the ones that are like that act entitled and unappreciative. It does make a nurse frustrated. A lot of parents like this type if parent are the ones living off the system and taking advantage. Then they get mad if they don't get their free services. Some of these parents get 20 hours a day. 4 hours is not too much to ask the parent to do. If they can't handle that, they need to out the child in a facility. Saying these parents are scared is an excuse. I've seen the type. They aren't scared, they are lazy. If they are that scared, they have no business taking care if their child. I watched 2 parents in a case who stayed home all day with 20 hours of care. They also took a nap every afternoon after an exhausting day of watching TV. Then they got up and watched more TV. Then would sleep for 12 hours. As long as they slept they were happy. If they were interrupted from even watching TV, they let the nurse go.

  • Aug 17

    That behavior is common. Nobody tells these parents how things should work because the agencies are scared if running the parents off to another agency. Right now I'm lucky that I have a parent that is involved without being over the top. But she is home all day, sleeps til 2p. Then watches tv the rest of the day. She whines about how hard the work is to take care of the patient. But acknowledges the hard work we do. She complains about how hard 4 hours is with the patient while we do 12 hour shifts. But I've seen worse. We enable these parents to avoid being parents sometimes. We do need to be there so they can go out at times. A babysitter wouldn't be able to do what we do and give the parents peace of mind. However, so many take advantage that it ruins our view of things. I have some parents that refuse to change a diaper. They walk in and tell the nurse to do it. But then they don't change the kids diaper and wait for the next nurse to arrive hours later. We are there to be nurses and give the parents a chance to work our take a break. But so many get greedy and take advantage. Then they go through nurses quickly and complain they can't keep nurses. The good families keep nurses for years. Sometimes I wonder if these parents with special needs kids weren't meant to be parents but our medical technology saved the kid. I had another case where the parents flipped out if they didn't get a nurse on Fri nights so they could go out. They both were home all day living off the system. But they couldn't be flexible to choose a night when they had nurses and be appreciative of that. They act like its owed to them. Luckily not all parents are like that. Its just hard to find the good ones. But yes, it can be extremely frustrating dealing with that day in and day out. It may be time to find a new case or float for a while so you can find greener grass!

  • Aug 8

    Yep, I understand totally. Just recently found out the state took a child that I reported. Many reports had been made by others, so I acted as a mandatory reporter and thought nothing would happen. But my experience/observation for what I reported on was bad enough that they went to court and the child was taken away. I felt bad, but it was best for the child. I just heard the child is now gaining weight and starting to reach developmental goals. I even got to see a picture and that made it all worth it. The child looks so much better. So now I know I did the right thing even when it didn't feel good at the time.

    I've reported other situations as well. Its never easy. I guess if you are in this job long enough, you will have to make a report at some point.

  • Jun 26

    Quote from chickengirl1977
    Hi! I am currently working for a HH agency that deals with pediatric patients. I have worked for them for 8 months. I consider myself to be a "new" nurse as I have only been practicing since November 2011. I am with the same patient on a full time basis. My patient is medically stable, but at risk. His primary caregivers are wonderful but are his grandparents so there is the mom and dad that are divorced involved as well. I'm needing advice on my charting, etc. My patient is 7 and has state and federal agencies that are involved in his care who are stating they want more charting. I chart every 2 hours as required, but also when we do walks etc. I do not chart his every move, and he is an active little boy. But apparently they feel that all he does is sit around watching TV and playing games. Any advice I can get on charting would be appreciated!!! Thanks in advance!
    Without seeing the 485 or other details its hard to be specific. But every two hours is the least amt of charting allowed by medicare/medicaid. You would benefit from a documentation class...better if the class is specific to PDN.

    My notes always start with received report from.... Then I document what I observe walking in. That includes what is/isn't connected to the pt. I document that the emergency equipment is checked and functioning properly. After that, I do my assessment. The assessment is supposed to be done in the first 30 min according to medicare/medicaid. Then that is documented. I document meds/feeds given and if the tube flushes easily (to document patency and placement checked). Any diaper changes and if it is urine or BM. I include color, odor, quantity, etc as it applies. I document that the skin is intact or whatever applies. AM care is documented. I document activities throughout the day. My favorite note that always sounds great is "developmental play encouraged" and insert therapy "____ therapy exercises reinforced per therapist instruction". I document changes. If the pt requires sxn, its required to document each sxn. My sxn note (change words as it applies to pt) sxn x2 for lrg amt of thin, white secretions from trach. O2 sat ^ to 99% after sxn. I document transfer to wherever the pt goes or moves to. The nursing hours are decided on based on the number of skills done in a time period plus the pts diagnosis/condition. At the end of my shift I document to cover myself. I write NAD. VSS. Trach midline, patent, ties secure per agency policy. Resp even, unlabored. O2 sat 100% (or whatever it is). Pox probe on left foot. GT patent. Diaper dry. Denies pain. End of shift tasks completed. Equip plugged in, charged, and working properly. Emergency equip at bedside. O2 tank full. Report given to...., who assumed care.

    You can also ask your boss for an example so you can see how it should be done. National agencies usually give you am example when you have orientation. Look at the other nurses notes and compare. The other nurses may or may not be charting correctly, but you will get the idea. I hope that helps! :-)

  • Jun 22

    It's typical. It sets up nurses with boundaries for failure. The agencies only care about the money. So if the family is happy, the agency turns their heads. I've lost plenty of cases for keeping boundaries.

  • May 3

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.

  • May 2

    The only commitment you have is the shifts you agreed to work in advance. I request my days off before the next schedule is made. My agency does 6 week scheduling. You don't need to worry if the parent doesn't have 100% coverage. When someone has a child, they make a choice to have that child and to take on that responsibility. There is no guarantee the child will be born healthy. There is no promise that they will qualify to have a nurse. Their child is their responsibility. Scheduling is the responsibility of the agency. Your responsibility is working the shifts you have agreed to work. You cross boundaries when you are concerned with issues that aren't your problem. What happens when a parent has a healthy child in daycare that gets a fever and has to go home until afebrile for 24 hours? Or the babysitter that gets sick or goes on vacation. Most parents have a back up plan for that and it should be no different for a parent with a special needs child. You work for the agency, not the parent.

  • Apr 24

    They should want us. We're the ones that have mastered the art of dealing with the difficult/nutty parents. We could raise their satisfaction scores dramatically! On top of that we work well independently as well as a team. We are resourceful because we have to be. We have great respiratory skills since we border into the respiratory therapy area. We can and will do total care and may be the type to actually help the CNAs. Our assessment skills have to be top notch being that we are the doctors eyes and ears. If they can't see that, its their loss!

  • Apr 24

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.

  • Apr 24

    I have the same personality type. It surprised me when I saw the post since its not very common. I've run in to some of the same issues as you have mentioned. I have done mostly private duty work which allows me to work one on one with a child and be more independent in my work (besides having an RN available by phone). It does get old and boring. But when the family of the patient are out working or whatever I don't have to worry about the social stuff as much. I'll be interested in seeing what others have to say. Right now I'm looking for work and wondering where to go next and what will go well with my personality.

  • Apr 23

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.


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