NevadaFighter 6,080 Views
Joined: Feb 17, '11;
Posts: 164 (29% Liked)
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It's usually not what you do, by what you don't do.
What if you had done that hourly round on time? What if you had called the doctor sooner when you weren't sure? Vitals were OK at the start of your shift, what if you had rechecked the vitals again? Did you miss something in assessment or assume symptoms were benign, when something bigger was going on?
It's usually these kind of mistakes that nurses are more likely to make than directly killing a patient.
A few months ago one of my coworkers casually said, "I'm going to punch out and finish up my charting. I don't want management to get mad at me."
I responded, "The company made tens of millions of dollars in profits last year. This company is making lots of money and I want to be paid for every minute that I work." Another coworker overheard my statement and agreed with me.
I have never been reprimanded for staying clocked in while finishing up undone work. If every nurse remained on the clock while completing their work, this would make corporations deal with high nurse/patient ratios, unbearable workloads, and so forth. It is easy to target one nurse who stays on the clock, but it is way too hard for administration to fire every single nurse in the facility who remains clocked in while finishing up. This would amount to masses of nurses who would need to be replaced and properly trained.
Power comes in numbers. All nurses must stop giving away their free labor by working off the clock. They are making themselves poorer while making healthcare facilities wealthier.
I'm in St. Louis and just made the switch from hospital to HH for multiple reasons and I'm loving it so far. The money is surprisingly comparable here. I'm starting out prn and am also in the process of getting signed up with an agency to do some local agency in the hospital to keep up my skills. HH is a HUGE change and there's definitely a learning curve along with tons of glorious freedom Before I made the switch I did a ton of research and read through every post I could here in the HH forum....very helpful.
I do home health and hospice, and even though I love the nature of the work, I was at first very miserable, broke, and fairly certain that I was going to have a stroke before I was 40. I have learned some valuable things, and here's my Ultimate Guide to Enjoying Home Health:
Work for several agencies at once if you are Per Diem- Donn't give one agency a monopoly on your time. This way you can be a little more picky on accepting patients and you can keep your service area within a reasonable distance of your home, or in less trafficky spots. This also gives you more job security as the patient load fluctuates throughout agencies, you have more control over keeping steady income.
Become super ultra organized. I made myself a huge binder with reference to data like lab values, wound assessment, and common home health and hospice diagnoses and interventions. No matter how much experience you have or how good you are, your brain will be fried after a long day of work and traffic, and it helps to have the data right in front of you so that your mind can go straight to the critical thinking and planning.
*Like previous posters have said, you must to do your charting in real time, otherwise you will be charting when you should be sleeping or spending time with your family. I have learned to put nothing off. I used to try to see several patients in a row and then block out time for charting and giving reports, but something always gets in the way, there is just no way to plan other than to expect the unexpected. So I do spend part of each visit with my face in the computer, or the paper chart, depending on the agency, but I still manage to find some time to visit to listen and engage with the patient and give a thorough assessment, and even though this makes it feel like the visits are longer by charting on site, my days are anywhere from an hour to three hours shorter by forcing this habit of finishing all charts and reporting on the patient before even thinking about the next patient.
*Also regarding organization, the back of my car is literally a mobile supply closet, with everything I might need for visits. My nursing bag is huge and organized as well with everything from my paperwork to paper towels, hand sanitizer, small trash bags etc. so that I don't have to spend a lot of time asking the patient and family for things when it comes to my infection control measures, wound care etc. I pretty much just need to find a workable surface and I have everything that I need in my bag. I went to a lot of trouble to invest in specific plastic bins to organize things in a way that makes sense to me personally in the back of my trunk and my car used to literally look like a trash dump, so I finally got into the habit of always bringing my supplies from the visit and putting them directly into their place in the trunk, and keeping a food trash bin in the car for eating on the road.
*And I also used to do a lot of drive-thrus for coffee and food, BECAUSE IT'S SOOO TEMPTING when you drive past all of your faves all day, and you technically have the time to stop if you want to. and I now save sooooo much money and time by taking a little extra time in the evening or early morning to prepare food for myself, and I bring a couple large thermoses as well as a reusable Starbucks cup with all of the coffee and tea that my heart desires, as well as lots of water and lunch and snacks, because for some reason I just get so hungry out on the road. Any "quick" stops are surprising time suckers. Making my own food has also helped me to stay healthy and lose a little bit of weight and I spend so much less.
if you are a contractor, which you almost always are per diem except for very rare cases, take advantage of this and keep all receipts and write everything off on your taxes. I mean literally anything that you bought that you're using in the course of your workday. You are essentially your own small business, the government is taxing you accordingly, so it is literally giving money away if you do not write off the same expenses that any other small business would write off.
And last but not least is boundary setting- Of course when you are brand-new you don't have a lot of options, you are at the bottom of the food chain, and that's natural in any job. But after almost 3 years in the field, and garnering a good reputation from coworkers and from patients and families, I was able to start demanding more. I now set a bar for what I will accept in pay, including additional mileage for distance or extremely complicated cases with a lot of wound care and/or complicated family dynamics. So it pays to work hard, go the extra mile, but then do not let a company or administrator run you into the ground.
Like previous posters have said, the turnover is very high. These companies are not stupid. Whether they are clearly willing to let people go in order to find new people to abuse, at least half of the companies that I've worked with are smart enough to see that when you have someone who really knows what they're doing and can save everyone's butt in certain situations and/or train other staff , and help them pass survey; often times they will be willing to pay that extra bit, meet your demands, because they are after all saving so much money by being cheap in any way they can, unfortunately. Remember, since they have chosen to go Per Diem in order to be cheap, that also gives them the disadvantage of not having control over their nurses' time. Most of these companies are extremely disorganized and chaotic when it comes to having nurses available for distance cases and after hours cases, or they have a lot of turnover very suddenly. This is why working for several agencies is important, that way you won't feel desperate when one company is asking a lot of you and you know it's because they have a nursing shortage, you can turn the tables and say "sure I'll do these visits for you for X amount of additional pay and mileage, etc." Any visits that go over 1.5 hours, or are so outside of the area that my round trip plus visit is 2.5 hours total time from the next patient or the agency office, I get authorization for increased pay for my time. They'll agree when they know that you are thorough and you won't end up costing them time with QAPI problems or having to send out another nurse because you missed something, or if they simply have no one else to go.
I often am not fond of some of the agencies that I work for and their practices, but I have learned that regardless of Home Health, SNF, Hospital, almost every nurse I know is burnt out and feels that the company they work for is money over people. So instead of trying to take on the whole system myself, I just try to give the patients my absolute best, and take comfort in the fact that regardless of what else they experience in healthcare, that they at least received quality, genuine care while I was assigned to them. And then I make sure to take care of myself as well. I have friends and family who depend on me, so I am not doing anyone any favors by allowing some money hungry company to burn me out and make me a less effective mother, friend,etc.
The $$$ -I've done the math on my current status, and I am making approximately $27 an hour as an LVN in Los Angeles in home health and hospice after my travel and other expenses are figured. This includes factoring in unpaid time at the office, meetings, and the rare occasions that I do have to go back into the chart when I'm not "working". ( RNs can make $50 per hour after expenses, based on their visit rates at my agencies, if they follow the same system. But of course they have a more volatile schedule since the nature of their visits are different and can be harder to anticipate ) This does not include any benefits, so if you did the math on what I'm paying out-of-pocket for my health insurance and considering the lack of vacation, sick time, and other benefits, it would probably be the equivalent of $25 an hour at a salaried position. Another major plus is that I have a lot of flexibility and freedom, even though I don't have paid vacation, I also don't have to miss work to see my son's school performances, attend his field trips, or attend any other important family gatherings or other things in life that matter. Essentially all I have to do is reschedule my patients and I can still get my hours in around my personal life. Also pays big time to make allies at your companies, cover for them if they do need to have you see their patients for a day or week, and it'll get you some extra pay, and then you can rely on them to see your patients at times that you can't or don't want to reschedule if you are going out of town or sick etc.
As much as I want to pull out my hair a lot of the times, I hear the same complaints from my friends who work in hospitals and SNFs about horrible management, unpaid time, and stress, so based on the overall freedoms I enjoy in the field, I can never imagine going to a salaried position again.
Keep doing what you're doing; it's not a "you" problem, it's a "them" problem. They shouldn't talk down to anyone who steps off a medic unit, even before they know you are an RN. Just stay professional. Your job sounds great, I am envious.
Just don't waste your time. Lots of people believe stuff that isn't true, and you're not going to change their minds.
The second job has better overall compensation, but the commute is pretty long. That being said, I don't think there is enough money in the world to get me to do pain mgmt, especially if you can't do procedures. I see that as a fast burn out job. Can you move any closer to the cardiology job?
I am paid salary as well. It is based on an hourly rate for 40 hours. I get extra for mileage, on-call time, on-call visits. Do have really good benefits - PTO, sick time, tuition reimbursements, holidays, etc. Starting salary depends on location and somewhat, experience. I do not usually work over 40 hrs by much, and some weeks WAY under 40 hrs. Different every week. But I love the flexibility, autonomy and daily variety that home health offers. I enjoy doing visits much more than extended care/shift work ( have done both). And, I would not care to be in a facility again either. Even my weeks that are over 40 hrs - still way better than me working in a hospital.
What you're describing is a delayed sensitivity reaction, not an IgE mediated allergic reaction. Based on the Antibiotic Stewardship programs everywhere that I've worked, this wouldn't justify a switch to another antibiotic since this doesn't signal a potential life threatening reaction, if the rash is poorly tolerated then they might add benadryl or also famotidine, but they would need to stay with that antibiotic. Rashes aren't fun, but antibiotic resistance due to misuse is a very serious problem.
Just wait until someone rips a sock off in front of you, and you experience the wonders of dry foot flakes snowing down upon you/into your mouth/hair.
i work full time for Planned Parenthood now, so am not doing births.
My changing views have evolved slowly over time, as I have become more scientifically literate and experienced in the field. I realized there was something off, when I really started to think about how strongly I valued science in most every aspect of my life, but yet was so quick to dismiss medical science in favor of prescientific and/or pseudoscientific belief systems.
I remember one time reading on a nonvaxxing mommy message board, and seeing a conversation about chemtrails which then further devolved into anthropogenic climate change denial and mass conspiracies. That woke me up a little, enough to take a step back and wonder where, exactly, my beliefs about alternative medicine were coming from. I was a tree hugging hippy type as a teenager and a rejection of mainstream medicine fit in perfectly with my belief that natural was better. I believed that vaccines were bad, because it fit in with my world view. I believed in homeopathy because I didn't understand enough about science to realize how insane it was, and the idea of a vital force appealed to my naturalistic spirituality. I was deeply drawn to the naturalistic fallacy, and my ignorance led me to believe I actually understood the issues in a way that mainstream health care somehow did not- dunning kruger is always lurking lol.
Here I was, defending climate science because I trust the process and understood I was laughably unqualified to fully understand the data myself... but yet I was dismissing the medical consensus because.... I really like nature? Because I don't like the idea of giving my kid a shot? Once I really became aware of that contradiction within myself, all my closely held beliefs became fair game as I became devoted to the process of scientific skepticism, and working to understand the world from a perspective far broader than my own personal bias.
Anyway, teal deer lol. My attitude toward medicine changed as a result of my devotion to the scientific method of understanding our world, coupled with a deep desire to provide effective and compassionate care for my patients. A lot of it was just the normal process of getting wiser with age. We are all kinda dumb in our 20s. And I am sure 40 year old me will shake her head at my current self as well
People commonly gripe about astronomical salaries that celebrities (actors, pro athletes, singers) receive. Celebrities' pay rates are regularly compared to those earned by nurses, teachers, police officers, military servicemen and women, firefighters, social workers, and so on.
Here is my controversial view. The vast majority of people in American society are not overly preoccupied with their health, safety or welfare, which are the very facets addressed by nurses, police, soldiers, and social workers.
Many of these same people in society bicker about taxes, yet it is tax revenue that pays for public school teachers, cops, military, social services, and the nurses who work in city, county, state and federal government.
On the other hand, most Americans love to be entertained. The American public places an enormously high value on an optional part of life such as entertainment. The American public places a lower value on mandatory aspects of society such as public safety, healthcare, and education.
This is evidenced by the quadrillions of dollars people collectively spend on movie theater visits, Broadway shows, cable/satellite TV, live sporting events, music, live concerts, Netflix/Hulu, and other forms of entertainment.
Some people are so dedicated to celebrities that they know their dates of birth, filmography of film actors, discography of singers, and statistics of players on their favorite professional athletic team by pure memory. They pay big bucks to join fan clubs, obtain autographed memorabilia, and buy replica sports jerseys.
A harsh truth is this: if the majority of people are passionate about something, that is where the money goes. Will Smith and Johnny Depp receive multimillion dollar paychecks because people willingly empty their pockets to be entertained by them. Nonetheless, people will not readily pay good money to observe a nurse conduct an assessment, or a police officer issue a citation, or a teacher prepare a lesson plan.
Again, why do celebrities receive higher pay than nurses, cops, social workers, military, and teachers? It is because we get what we pay for. It is because the public has shown time and time again that they prefer entertainment over health and safety, as evidenced by the massive amount of money they spend on movies, music, and professional sports.
Nobody in this questionable society of ours would spend $100 million on tickets, food, beverages, parking, and souvenirs to watch nurses or enlisted sailors at Yankee Stadium. They would, however, spend that money to watch professional ball players, or Beyonce at the concert hall, or the A-list actor at the movie theater.
So, how much are nurses worth? Per the American public, we are worth a heck of a lot less than the quarterbacks on their favorite NFL teams.
Illinois won't grant licensure except by endorsement, and only after at least 2 years clinical experience
HH is not without stress, but my worst day in HH is still better than my best day in the hospital.
I would recommend at least one year experience.
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