Latest Comments by jbudrick - page 4

jbudrick, MSN Pro 3,377 Views

Joined: Aug 18, '08; Posts: 74 (61% Liked) ; Likes: 113
Nurse Practice Educator; from CT , US
Specialty: 15 year(s) of experience in Certified Nurse Educator

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  • 0

    I am an RN, BC, in Psychiatric/Mental Health. I got the certification independently because my job changed from working with the mentally ill to working with the geriatric population. I wanted to capture that experience for my resume. I was laid off from my job. I got a new job as a supervisor in LTC working with dementia patients. I don't know if certification was a factor in my selection for the job. It did look good on my resume. The cost of certification was tax deductible.

  • 2
    Intern67 and RNKPCE like this.

    At my facility we are required tp use a hoyer lift for any patient that ends up on the floor no matter what their mobility status. You might want to suggest your facility obtain a hoyer lift.

    Good luck.


  • 0

    I graduated from Excelsior BSN in 2001. I completed the physical assessment test and it did not require an exam room. It can easily be done in your home. I took the course through Athabasca University and all equipment needed was sent to my home from their library for the duration of the course. I completed the video in my home using my husband as the patient. It is an exacting test requiring a complete physical assessment including verbalizing normal findings. It took approximately 90 minutes and I could not stop the tape and no special effects were allowed. I was only allowed to refer to notes 10 times in the session. I was required to prepare a written report of my findings. It sounds much easier than it was. It required knowledge and practice of a detailed physical assessment. It is definitely doable. Excelsior also offered onsite testing where they provide the patient, exam room and patient if the student wanted and paid the fees. There was also an option to complete the requirement through another school or on the job. Excelsior is very good at finding a way for students to complete the requirements with their available resources.

    Good luck with your degree.

  • 4
    tvccrn, David13, thinwildmercury, and 1 other like this.

    You did the right thing by documenting the aide's report and your findings in my opinion. The DON would probably be telling you something different if it was reported to her that the aide told you that the patient had not voided and you did not address the situation. Hindsight is always 20/20. Best wishes with your job.

  • 0

    I went into home care immediately after I got my RN license. I did try to get hospital and acute care jobs and quickly discovered that Mothers' with children who need daycare can forget about shift work. Where I live there is daycare available from 7am to 6pm. In 2001, it was the beginning of the nursing shortage and I received wonderful offers that I could not take. I was under the impression homecare nurses needed a BSN so I had not even considered that option. While looking through the paper I found an ad for a homecare agency that encouraged new grads to apply. I was chosen for the job and received a very good three-month orientation. At first it was hard with so much to learn but after one year I was comfortable.

    After four years I thought I was missing out on not having that acute care experience. I got a job working four days per week at a rehab facility that specialized in dementia patients. The pay and benefits were terrific. No overtime was required. All of the aspects of nursing I loved disappeared. In homecare the emphasis was on teaching and assessment, wound care, new diabetics and people trying to regain their independence. In rehab the emphasis was on getting the meds out and making sure the patients didn't do anything completely unacceptable. Nurse "bullies" who were truly ignorant tried to undermine me.

    It was not the experience I had hoped and I quit after four months. I got another homecare job and got my BSN. I have been at my current job as a case manager/primary care nurse for five years. In retrospect, I gained knowledge of the various types of dementia and I can usually tell which dementia the patient has after the admission visit, even it wasn't on the paperwork. In my current position I help patients and their family with the goal of keeping the patient in the community with chronic conditions and I became an ANCC Pyschiatric/Mental Health Nurse.

    From my story, I hope the graduate nurses realize that the first year of nursing is hard no matter what the work setting. Homecare can be ideal if you receive a throrough orientation and are willing to put the work and time in to develop good assessment and teaching skills.

  • 1
    kocheli likes this.

    Hopefully they would not reject you. There are some nursing jobs that are more physically demanding than others. Hopefully some OR nurses will provide more information.


  • 1
    kocheli likes this.

    I worked in LTC for a short time and they did have a physical test. First I had a regular physical: drug test, BP, temp, medical history, etc. Then I was sent to physical therapy where they gave me a real workout. I was not dressed for it because I did not know what was involved. They had me lifting 50 pds over my head, running on a treadmill and climbing a ladder. They actually had me try to lift a person from the floor holding on under the arms with another person holding onto the feet. I was not in the best of shape and nearly 50 years old but I did pass. I only worked the job for four months. It was a learning experience. Home care is my nitch.

    Best wishes with your new job.

    Diana :heartbeat

  • 1
    mamamerlee likes this.

    When visiting a dirty/infested home, I spray my shoes with insect repellant. I take the minimum necessary into the home. Always wear machine washable clothing. I actually jump around and shake myself off before getting into my car. If its really bad, when I get home I remove my shoes and wash them in the laundry sink and remove my clothing and take a shower. Keep hair up in a bun. Use disinfectant wipes on items you must bring into the home. Use hand sanitizer - some homes are so bad you get dirty washing your hands. I have called the health department in severe situations - no running water, obvious insect infestation. The health department has been responsive. Other resources are Child Protective Services, if children are living in the home, and Elderly Services. Good luck in your home care career.


  • 1
    George_MSN likes this.

    You need to realize you are not dealing with ordinary people. I imagine that any nurse going to work in a prison is not allowed to talk to patients until extensive training is done. You are dealing with potentially violent and manipulative individuals who are in a controlled setting for a reason. There are undoubtedly many procedures and practices in place to keep you safe so you can work in the prison.

    If you really want to interact with patients in an uncontrolled setting, try home care. You can autonomously assess and teach. Unfortunately you are in their uncontrolled environment and you may be visiting the potential inmate of the prison.

    In any setting in which you work there are risks and methods to manage those risks. You need to work in the job and complete orientation before you are really aware of what the risks are. As a new RN you are considered a new nurse. You are lucky to have that LPN experience to give you an boost in your new role.

  • 4
    leslie :-D, homedoc, Zen123, and 1 other like this.

    I have grappled with this dilemma many times as a home care nurse. I generally provide the information that I have that leads me to believe the patient is dying within the next six months to the physician. If he agrees that it is more likely than not that the patient will die within the next six months, he gets to choose who tells the patient and family. There are times when it is clearly obvious that the patient is dying but the physician chooses not to pursue alternative care or discuss the matter with the family. I suspect insurance issues or the physician's assessment of the family situation play a role in this decision. I send in a social worker no matter what the outcome and, if possible, I refer to hospice home care. There are times the patient or family prefers to continue with our agency and we continue to provide care until the end. It is very difficult to provide end of life care when the family is in denial.

  • 0

    Nurse Jackie is on the edge. In one shift she obtains drugs illegally and uses them, forges a signature to make a person an organ donor, accuses a MD of killing a patient, has sex in a closet, steals money from a patient and steals boots from a colleague. I would think she will end up before the BON soon.

  • 3
    eriksoln, Mr Ian, and MAISY, RN-ER like this.

    At the beginning of nursing school, everyone I talked to thought care plans were senseless exercises. For some reason I believed that. My nursing instructors tried to tell me how important care plans were in the real nursing world but I found it hard to believe.

    As an experienced home care case manager, I now know the value of care plans. Care plans justify the nursing visits that are taking place, provide direction for nursing visits, allow me to recognize when are goals are met and the patient needs to be discharged. When per diem nurses see one of the patients I case manage, she can follow the plan and determine what needs to be done. Medicare can look at the plan and documentation to justify payment for my services.

    My instructors were correct about care plans. They are essential to communicate our goals and our actions to achieve the goals. How else can other members of the care team, payers for services or even patients themselves know what it is we are doing. How could a different nurse go to do a home visit for a patient without a plan? Something as simple as wound care needs a plan. The frequency of the wound care, frequency of wound measurements, duration of wound care before other options are explored. Even to order supplies for the wound care requires some sort of plan.

    The longer I am a nurse, the more value I see in care plans.

  • 0

    I have been a home care nurse since becoming an RN in 2001 and I love it. I have been at my current job for almost four years and make a good salary with benefits. Per diem visits and on call are offered to full-time nurses so there is the opportunity to make more money. Raises and bonuses occur yearly. I case manage a group of medical and behavioral health patients and actually can help people. It is terrific to be out in the real world instead of cooped up in a windowless clinic or hospital.

  • 1
    Hooked on ER likes this.

    I took both the DSST and the EC tests and was granted credit for both. The DSST was considered lower level and the EC was considered upper level. It was the one subject I used a publishing company guide book to see if it was worth the cost. It was the only publishing company book I did use. I found the free study guides for the tests are best.

    Good luck in your pursuit of your degree.

  • 0

    I have completed the Excelsior RN to BSN. I would enroll before I took any classes. You want to be sure to get your advisor's input so that all the classes you take are applicable to your degree. Also, when you enroll formally the requirements for graduation are set and you should not be affected by any future changes to the requirements. I suppose it might save money to just take the classes you think are needed but you also take the risk that the classes you are taking are not the right ones. There is a fee for yearly advising. To me it was worth it to pay the fee. The advisors helped me to choose the right classes or tests taking cost into consideration. They are really knowledgeable and helpful. Advisors are well worth the yearly fee.

    Best wishes in your pursuit of your degree.