Job Offer Questions

JustBeachyNurse, LPN · Jan 7, 2016

New grads should reconsider doing independent work like PDN. You are it. Especially in pediatrics some of these kids are seriously complicated

Training/orientation is sometimes minimum wage not uncommon. Especially when precepting you are not primarily responsible for the client. The agency cannot bill for your hours.

There is no overlap. If shift is 7-3 & 3-11. PM nurse arrives at 2:55 for report (standard payroll rounding rules your start is 3p. ) outgoing nurse is gone by 3:05 (which is also 3p). If you cannot give/receive report on a single patient in less than 10 minutes you should not be doing 1:1 care.

Define light housekeeping. Cleaning up the work area and what you use for the patient is a reasonable expectation. Including taking our garbage you create, changing the patient's linens, cleaning equipment etc.

New grads should only be working in PDN with a structured training program that includes classroom, skills lab, field observation, and extended precepting and mentoring. My agency it's 1-2 months classroom, skills lab & observation. 3+ months with a clinical preceptor then 6 months mentoring with an experienced nurse. It's a lower wage during training and preceptorship but it's extensive training once cleared to work independently the nurse starts at the first level nurse pay rate.

beekee · Jan 7, 2016

Thanks! I appreciate the feedback. The training is extensive, but I think you are right. PDN doesn't seem like a good place to start.

JustBeachyNurse, LPN · Jan 7, 2016

There are a select few with unique backgrounds that can work PDN as a new grad but you don't know what you don't know. Many new grads don't realize that.

Try LTC LTACH acute rehab subacute rehab

AdobeRN · Jan 7, 2016

All agencies are going to be different. The one I work for (PRN) pays the $10/hr "training" wage - this would include any training in the office (skill checkoffs, etc) or if I were to take on a new patient and needed to shadow the nurse for a few hours/meet the parents.

Light housekeeping - I only clean up what I mess up - any dishes, syringes, supplies etc that I use during my shift are cleaned and put away before I leave for the day. The area where I do my patient care is tidied up, beds made, supplies put away etc before I leave.

I record the exact time I arrive and leave and expect/do get paid for it. Sometimes report for the next nurse may run 10-15 minutes later - I document in the narrative notes the reason for staying that extra time - it doesn't happen often - so maybe thats why my agency hasn't said anything to me. I try to never have the need to stay even 5 minutes later than my shift ends - the last hour of my shift is spent doing my final clean up, making sure my patient is dry & settled & finish up my charting - this helps alot with getting out on time. Once you get on a regular case you will usually have the same nurses relieve you - so its not a long report because everyone is familiar with the patient.

JustBeachyNurse, LPN · Jan 7, 2016

Just to add if everything is status quo, my report takes less than a minute sometimes literally as we pass each other entering/leaving. Even report to parents is any issues? Secretions? How many diapers? Any BM? See you next time.

The few times it took longer (we are rounded to the quarter hour so 5 minutes +\- is negligible?) it was complex and my documentation covered what happened and office was aware. Once a patient had a major bone fracture and required 2+ for transfers. We overlapped by 30 minutes to shower the patient and safely transfer. It was non-billable but I got paid my full rate. The office wrote it off as courtesy patient care (though it would have been justified billing with the unique case and proper documentation/assessment)

SDALPN · Jan 10, 2016

New grads don't belong in PDN. It's also fraud, since some require you to have a year of experience. What you asked about above is typical. PDN agencies will also promise you the world, but rarely deliver. Sure, they have plenty of work...but other nurses already have those shifts. Get experience first! You will need it. Read through the forum to see why experience is necessary.

brillohead, ADN, RN · Jan 18, 2016

New grads don't belong in PDN. It's also fraud, since some require you to have a year of experience.

You say this all the time, but it's certainly NOT the case universally. There may be a stipulation to that in YOUR state, but it is NOT a federal requirement.

If you want to make factual statements, how about, "if you're working in such-and-such state, it's considered Medicaid fraud for you to do Medicaid-paid PDN if you don't have X amount of experience"????

SDALPN · Jan 21, 2016

You say this all the time, but it's certainly NOT the case universally. There may be a stipulation to that in YOUR state, but it is NOT a federal requirement.
If you want to make factual statements, how about, "if you're working in such-and-such state, it's considered Medicaid fraud for you to do Medicaid-paid PDN if you don't have X amount of experience"????

That would be why the word "some" is there. I did leave out the word insurance though...now that I'm looking at it again. I never stated "all". It may vary state to state. Either way, obviously there is a reason or it wouldn't be a rule in SOME places. Also, reputable agencies (no matter what the insurance rules are) won't hire without experience. It is just not safe.

brillohead, ADN, RN · Jan 22, 2016

That would be why the word "some" is there. I did leave out the word insurance though...now that I'm looking at it again. I never stated "all". It may vary state to state. Either way, obviously there is a reason or it wouldn't be a rule in SOME places. Also, reputable agencies (no matter what the insurance rules are) won't hire without experience. It is just not safe.

No "may" about it -- it DOES vary from state to state.

And if you want your original statement to be accurate, you could state that "it MAY be fraud" instead of "it's also fraud".

Words matter, and the order they're used matters. Conditioning it after the fact with the word "some" doesn't negate the inaccuracy of your statement that IS fraud.

If you want to say, "It may also be fraud, since some require you to have a year of experience," then I wouldn't have any problem whatsoever with your statement.

I do, however, have a problem with people who jump down newbies' throats saying that PDN is no place for a new grad. There are cases that get PDN care that are NOT complex and are NOT overly fragile and would be excellent places for a newbie to get their start.

Do I think that a newbie should be with a hypoplastic left heart infant on oxygen and a ventilator with a trach and multiple meds and multiple feeds and multiple treatments and constant suctioning? Of course not.

But a newbie can certainly handle a stable kid with a Mic-Key and tube feeds, etc.

Definitely advocate for people to make sure they have adequate training for ANY assignment they choose to accept -- we all need to look out for each other.

But bullying new grads into avoiding an entire scope of practice just because you have a narrow line of thinking isn't the best way to go about things. And lying about the law CERTAINLY isn't appropriate in any circumstance.

SDALPN · Jan 22, 2016

No "may" about it -- it DOES vary from state to state.
And if you want your original statement to be accurate, you could state that "it MAY be fraud" instead of "it's also fraud".
Words matter, and the order they're used matters. Conditioning it after the fact with the word "some" doesn't negate the inaccuracy of your statement that IS fraud.
If you want to say, "It may also be fraud, since some require you to have a year of experience," then I wouldn't have any problem whatsoever with your statement.
I do, however, have a problem with people who jump down newbies' throats saying that PDN is no place for a new grad. There are cases that get PDN care that are NOT complex and are NOT overly fragile and would be excellent places for a newbie to get their start.
Do I think that a newbie should be with a hypoplastic left heart infant on oxygen and a ventilator with a trach and multiple meds and multiple feeds and multiple treatments and constant suctioning? Of course not.
But a newbie can certainly handle a stable kid with a Mic-Key and tube feeds, etc.
Definitely advocate for people to make sure they have adequate training for ANY assignment they choose to accept -- we all need to look out for each other.
But bullying new grads into avoiding an entire scope of practice just because you have a narrow line of thinking isn't the best way to go about things. And lying about the law CERTAINLY isn't appropriate in any circumstance.

Angry much?

A subject can be debated without attacking. I simply stated fact. You may disagree with it, but you still have to follow the law. If you don't like it, talk with your law makers. Attacking me isn't going to change the law. As far as my opinion, it won't change. New nurses don't belong in PDN. Others have said the same thing, however you choose to attack me. Seems like you have some issue with me, rather than the topic. Jesus wasn't liked by everyone, but it didn't make Him wrong (making a point, not for religious debate. Believe He is real, or believe it's a mythical book. It's simply to make a point and not to discuss religion).

brillohead, ADN, RN · Jan 22, 2016

Angry much?
A subject can be debated without attacking. I simply stated fact. You may disagree with it, but you still have to follow the law. If you don't like it, talk with your law makers. Attacking me isn't going to change the law. As far as my opinion, it won't change. New nurses don't belong in PDN. Others have said the same thing, however you choose to attack me. Seems like you have some issue with me, rather than the topic. Jesus wasn't liked by everyone, but it didn't make Him wrong (making a point, not for religious debate. Believe He is real, or believe it's a mythical book. It's simply to make a point and not to discuss religion).

How is pointing out a falsehood in your comments "attacking" you or "angry"????

The law is NOT the same in every state. What constitutes Medicaid fraud in your state does NOT constitute Medicaid fraud in my state. That is simply a fact. It's a fact that you don't seem to understand, but that doesn't change the fact that it's true.

And where did I say that I had a problem with the law???? Why would I need to contact my lawmaker to change a law that does not exist in my state??? Where did I say that I disagree with the law that doesn't exist in my state?

I'm not sure what's going on here... you're arguing about something that I never even stated.... but you're claiming that *I* am the one arguing and attacking. I just don't understand what you're going on and on about?

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