Latest Comments by salvadordolly

salvadordolly 6,413 Views

Joined: Mar 22, '13; Posts: 208 (35% Liked) ; Likes: 163

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  • 2
    Libby1987 and caliotter3 like this.

    There is a government-mandated moratorium on Medicare-certified HH agencies in FL for the past few years in FL and a few other states. From what I gather, there is no shortage of Medicaid agencies. I would research how many other agencies are in the area you're looking at and determine if it is really needed. HH is not the business to be in these days.

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    Just wondering if anyone has taken home health assignments for a travel agency?
    I am very experienced in home health nursing, however I have never done travel assignments?
    How much training do you get?

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    I am sorry you find yourself in this position. You are a new grad, also, which makes it harder. You need to get a proper orientation to function on your job and it doesn't sound as if you can get it where you are.
    You state you got clarification from the DON. Did you get a written job description and an orientation checklist? From the situation, you seem to specifically state tasks that are not within your job description, which I agree with. You are obviously not the one requiring "clarity". Having this paperwork and taking it to your supervisor will acknowledge that you are aware of what your responsibilities are and may make her back off on her requests to perform tasks outside your scope.
    Is this the only RN Supervisor? If you have another one on your shift, you could request to change your schedule and request to be on her shifts during your orientation.
    It is hard to tell from your post what behaviors you have taken in response to the situation when you deal with the Supervisor directly.
    I have a strong suspicion that you are not in a very good facility. It's hard to believe a DON would tolerate this behavior from an RN Supervisor, which makes me believe they tolerate it because they have chronic issues hiring and staffing. You may be with this person because other LPN's won't deal with her. It is a disaster waiting to happen.
    Are there other LTC facilities in your area? I would look into this. This situation is too problematic on your first job. I hate to see you end of in trouble because of this supervisor, and you will. Try another facility and because you are a new grad, request a more structured orientation.

  • 3

    I have heard many FNP's struggle with onine learning and those with limited bedside nursing struggle as FNP's. Med-Surg or clinic work is enormously helpful for being an FNP. Md's complain that FNP's without clinical experience and online training have very poor assessment skills. One of my friends just experienced a huge paycut because of this, as the MD has to scrutinize her assesments, which takes up too much of his time and exposes him to liability. Another nurse I just hired at a home health agency is an FNP working as a staff RN because she felt inadequately prepared to perform as an FNP and is gaining experience in home health. She was a direct-entry having a Biology degree and went for the FNP-DNP route. She couldn't use the DNP for teaching, as in my area they wanted PHD's for this. I am in Milwaukee, however, and we have a ton of brick-and-mortar colleges in the area that are top-notch. So in my area, online FNP's are looked down upon somewhat because employer can pick and choose.
    Also, as an person in administration, I have to tell you, those who choose the direct-entry and online FNP's have this fact exploited and are paid substantially less and scrutinized more.
    It seems your FQHC background would be adequate, but you may be able to transfer to a position of Urgent Care or triage, which would boost your skills and your confidence.
    Don't underestimate your confidence level as a big factor in your early success.
    The reason I think many of those who took this route wish they would have went to med school is because they would have been more adequately prepared and better compensated for their time and financial commitment, which is often similar to a FP MD.
    Being an NP seems to confer all the disadvantages of an RN and an MD, without the benefits of either. .

  • 1
    AngelNurse2b likes this.

    It sounds like the "X" is on you. The first time I ran into this, I attempted to work it out to no avail.
    Nursing cultures among hospitals vary widely. I use PIP rather than write ups to offer advice to improve practice, offer practical advice and retain the employee, however, I have seen them used in many settings as a response to some subjective garbage and to start the papertrail to terminate someone.
    Try doing what you did in your post. In writing, layout your goals for yourself and how you will obtain them. Do it in a word document and save it to your computer if you need to take it to the union or explain yourself to your next employer. If you can, leave your own papertrail by e-mailing it your supervisor and request a meeting with the NM and educator to discuss it. This shows initiative, pro-activity, willingness, and non-defensiveness.
    It may work, but if it seems the microscope zooms in closer and your become the recipient of more subjectivity, then you should probably move on. Employment-wise, it may be better to then involve the union to work out a transfer as a best compromise to avoid vindictiveness and decrease threat of locking horns with your manager. I have never worked in a union environment so I am unfamiliar with how yours might work. I also don't know your particular NM or hospital culture, but does this manager have a h/o harassment, high rates of termination? How have other issues on your unit been dealt with?
    Good luck and be careful. You are wise to be looking for a new job. Act quickly, though, to avoid termination.

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    Yes in most places you would have to be written up. It is against LTC regs to leave medications out. A facility could be fined and cited if this family member reported it to them. It would be cited as an IJ (immediate jeopardy) by state surveyors and would require a lot of paperwork for the facility to prove they fixed it. Also a surveyor might find other things during the survey, so no facility wants to risk all this trouble. It is considered "immediate jeopardy" because the potential for harm of having someone else take the medication. Many other types od cites in long term care will be relegated to a less category if they in fact did not result in harm. Medication issues are taken more seriously, and are cited harsher in regards to potential for harm. In your case, if another demented resident took the medications, harm may not have been done being that it was Senakot, but you would have learned the lesson from a lot of scowling CNA's lol.
    Survey enforcement and quality measures are heavily reported online and drives consumer choices about where to put their loved one, so no facility also wants this to decrease their subacute (higher paying) referrals or jeopardize their relationships with referral sources. This will affect their bottom line and therefore, yours as well
    You will find in healthcare an increase of heavy regulation that drives the behavior of managers in LTC and HH settings. It is not that personal against you. Nursing is a long curve of developing that judgment and understanding. A profession based on use of judgment will naturally have a higher amount of criticism when you use your judgment - it is part of shaping your judgment and improving it.
    If you look up regs such as OBRA, Medicare PPS, Medicare conditions of participation on and your state regs for LTC (usually Dept of Health), nursing home compare, etc; you will understand the larger context of the issue. It may help you align your behavior to meet the expectations better. It will also maybe run like hell from management lol.

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    I worked in Denver in the 1990's. Sounds like little has changed. The Rocky Mountain States have traditionally been the lowest paying in the nation. IN terms of hospital culture, all the places I worked tended to be rigid and micromanaging than other states I had been in. Highly dysfunctional and poor work environments for nurses. In the seven years, I was there, no jobs allowed nurses to actually take a vacation. And yes, the pay! IN 1995, $15-16/hour. I moved to Wisconsin in 2000, my pay for the same job started at $36.50/hour with good benefits, nice work environments, able to take vacations, and far better management!
    Pay only increases there out of force. East and West Cost hospitals tend to keep up with cost of living. Pay increased in early 2000's only because of mass attrition from the profession. Because of all the influx of wealthy people moving there, employment in retail and restaurant businesses were in high demand. The starting pay was higher than that of LPN's and only slightly less than RN's. The tech and comm industries allowed nurses to switch professions also.
    If you talk to other nurses there, they don't disagree with you, but they are quite passive about changing things. Historically, nurses there just vote with their feet. Denver experiences intense shortages rather frequently. Because of the rise of large systems that dominate, any employment difficulty at one facilities leads you to be locked out of the entire system for other jobs, so you will be forced to move anyway.
    If you are having this reaction already, working in Denver probably won't work for you. although positions may be easier to obtain than in California.
    Another poster made a slightly snarky comment, but may have been trying to help you. I noticed as this poster did that California nurses don't like working in Denver and usually went back. They also missed being around water or other recreational outlets.
    I looked at this post because I am in the same place as you, most of my family lives in Denver and have asked me to consider coming back as I have fallen on hard times. I have been hesitant to leave the Midwest as nursing culture and health care are better here as well as better schools, lower costs of living, more kid-friendly, etc.
    Good luck!

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    Vespertinas likes this.

    Had a doc that used to do this all the time. We would call the nursing sup and the medical director. He eventually lost his privledges, then his lisence a few years later.

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    You did the right thing! Where is this guy/owner coming from?

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    A&Ox6 likes this.

    I'm with the people who don't want to advertise. I'm only going to be a nurse while I'm on the clock, not off. I do understand why people get those plates, but I think it just opens you up to unwelcome attention.
    I don't put any relgious, political bumper stickers or otherwise on my car for the same reason.
    My favorite by the way is a psychiatrist at our hospital that drives a rusty early model camry with the plates "RUNVS"

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    neverbethesame likes this.

    As someone who performs evaluations, I can say without a shadow of a doubt that there is no reason to bring the online material into play with the following exceptions:

    ~~Material posted is in clear and blatant violation of HIPAA.
    ~~Material posted either names institution of employ or names it clearly without using words based upon geographic or architectural markers. i.e.: I work in a 292 bed level III hospital in a little town near Mobile. In which case anything negative reflects poorly upon the institution.
    ~~Material posted makes deducing identities of employees or physicians simple and is done in a slanderous manner.
    I would agree with this. Otherwise, an employee has a right to post whatever they want. I'd be very careful with using social media posts as part of an evaluation. If they posted under an assumed name, they may have "reasonable expectation of privacy". You could get in trouble for using them. I would do your regular evaluation and advise her at the end that she may want to be careful with what she posts on the site.

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    red flags - no training is provided, no orientation minus how to enter notes, being offered multiple jobs before my drug screening has been completed, being given a badge the first day I applied, all nurses there are new grads, and several other signs of general shadiness
    Yes these are red flags. It sounds like you have good instincts about what is a reputable agency.

    This was a good thread on here

  • 1
    SurvivorRN likes this.

    Staying with your current facility will soften the learning curve a bit because you know the staff, resources and polcies in your hospital.

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    Most of the clinics in my area are staffed by Ma's and Lpn's. Rn's work in the more specialized clinics like cardiology and oncology. You have to have experience in these areas before you can move into a clinic job. The PHD in our state requires a BSN. Someone mentioned home health - independence and teaching opportunies definitely.

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    I know that it really is not what you want to hear, but you may need to postpone nursing school until your babies are old enough for pre-school. In the meantime, you could complete the rest of your general ed courses slowly enough to ensure you have that top-notch GPA you'll need to get in to the program of your choice
    Good advice. Your time with your kids goes fast - it will amaze you. I could not have done nursing school with babies. I'm going back to school,but when my daughter is in kindergarten.