AnOldsterRN

Ok so here's a follow up to original post. I work for about 12 to 20 hours per week as an RN at a non profit I love. The pay is pretty low, but I love the job so I won't be giving it up in favor of other full time work. I need to supplant with a couple of days of regular work. I did my 2 day, 8 hour orientation on the floor at the SNF sub-acute last week. I'm assuming these will be paid for since I filled out a time card. The job was "weekends only" but they told me I need to come two weekdays and then would start weekends either 03/31 or 04/01 (Friday or Saturday or Saturday and Sunday) and they would email schedule. I did their two weekday orientation days putting my other job aside. The other "'mandatory orientation" out many miles away for 8 hours UNPAID at their other facility was just yesterday. I notified them that I would not be able to attend due to work at my other job and needing to get paid. I've emailed asking for my schedule with no response.. or the runaround "will tell you tomorrow" which hasn't happened. Either they are retaliating over my inability to go to work for them for free, or they don't have shifts available this weekend. Either way they've wasted my time and cost me other jobs I declined so I could work for them weekends. If no hours schefuled, what now? I'd like to pick up my 16 hours of pay owed to me and be done. Its so darn frustrating dealing with cheating employers!

That's what I thought. If it's mandatory, so is the pay. They simply won't. End of story. I do not feel like taking up an entire day to drive many miles for "mandatory" training for a place that won't pay me a dime for the honor of working for them. It's a financial burden and it's just plain wrong. Nobody else speaks up. I think ill I'll be using the day to apply elsewhere.

I'm an older nurse fairly new to "shift work" at facilities. I've spent the past 20+ years is Home Health, wound consulting, case management, group homes. Too much uncompensated homework and driving. I thought I'd spend my last year's leading up to retirement at a facility, work my hours and be done. Hasn't gone too well. I recently got hired at a sub acute SNF. They are well-staffed with RT's who handle the vents, trach changes, etc. The RT's are very helpful in so far as caring for the vent patients' respiratory needs and orientating the rest of us. I do still remember how to change a trach. After being hired I was told that I must take the facility's mandatory ventilator orientation, training, class. It's an 8 hour class that they hold twice per month. It's about a 100 mile round trip for me at their sister facility. No pay. They've even made their RT's go and RT's are already trained. So I need to fill up my gas tank, put a bunch of mileage on my car in horrible traffic to and from, spend the day sitting in on a class I don't want.. for free. Their comeback is that they give CEU's for a class we'd have to pay for elsewhere. ? I feel like like they should have put in their ad under requirements that "applicant needs to have taken a vent training class." Oh and by the way, we have training at this location and time. Its a mandatory class in order to work at their facility. It's orientation and training from their facility for a job at their facility that we have been hired for. We should be paid. Not only that, we're entitled to mileage reimbursement from the facility to their class and back but I won't push that. Am I being unreasonable?

i do have the experience I claim and I know exactly what she meant. She wants pointers on how to get the nurses to change their assessment questions to reflect a lower functional status. The questions on the OASIS are pretty clear cut.

No, you're not being picky! I did Home Health as an RN for over 20 years. A lot has changed. There are so many home health agencies opening up, fighting for patients. Fraud has become a problem to the point of the Feds opening up task forces to deal with Medicare Home health agencies nationwide, and some areas even have a moratorium on new agencies. I predict that you will see that the "per visit" pay is not worth all the work and the expenses incurred. Your own phone, your own computer, pay for your own physical and TB. You are only paid "per visit." That covers the visit itself, the drive time, phone time, gas, and the time spent on the extensive amount of paperwork / homework. You may just come away with about minimum wage if you factor in the actual time and expenses. Home Health is a rip off. Glad I chose to get out after so long. I work one place now, do my 8 hours and leave. I loved Home Health itself, but it's nice not to have homework and work well over 40 hours with no pay and no added expenses. Also, don't let them 1099 you. That's another scheme Home health agencies are doing.. classifying you as a self-employed private contractor. They pay no taxes, no workers comp, no unemployment, no social security, Medicare, and you are stuck with a huge self-employment tax. Demand to be W-2. Of all the fields in nursing, home health seems to be where all the fraudsters are, opening shop and hoping to score big on Medicare money.

I don't think you messed up your opportunities at all. I think many of us really confused about exact dates of previous employment on application. After 20+ years, I simply put month and year and tell them I'm not sure of exact dates going many years back. I doubt they believe that you were trying to deceive them, especially since you are emailing trying to correct. Recruiters (as opposed applying straight to an employer) are there to help you find a job, which helps them fill a need. They're there to help. Best of luck!

No, it does not make sense. The OASIS assessment should reflect the patient's functional status AT THE TIME OF THE ASSESSMENT. There is nothing to separate on "how things should be." Respect your nurse's clinical judgement and find another patient you can send PT, OT, and CHHA to who actually needs it.

I worked in Home Health 22+ years. It's not what it used to be. The "per visit pay" does not account for all the "free" drive time, gas, phone calls, and homework (the extensive amount of paperwork). Home Health agencies pop up everywhere fighting to contracts and fighting to stay open. The last straw for me came when I discovered the owner breaking into my OASIS to edit, backdating items and orders expecting RNs to sign, upcoding and sending LVNs to do unneeded visits.. all reported to the proper authorities to deal with. So please excuse me if I come across as harsh. RN's are trained professionals who are perfectly capable of assessing the ADLs portion of the OASIS. While I realize that a change in functional status would necessitate a change in coding, sending out OT, PT and CHHA which will give a bigger per episode rate with Medicare, having nurses change the way they assess functional status is not right. It does not sound like your nurses are having a "hard time with the ADL questions." It sounds to me like the owner is having a hard time accepting the answers. The OASIS is to reflect the patient's condition and functional status at the time of the assessment. If the patient is able to groom self unattended, the OASIS should reflect such. There is also the 2nd option that grooming utensils must be within reach.. or clothing needs to be laid out. If there is no caregiver as you state, then how do you justify having the nurses mark that the patient needs extensive help with no one there? The Medicare fraud in Home Health has reached such an extensive level that task forces to deal with Home health have opened around the country. The Feds have put a moratorium on the opening of Home health agencies in some areas. Your nurses are are perfectly capable of assessing the appropriate functional status. Let them do their jobs without a boss trying to think of ways they can change their answers to what would be more profitable. Again, my apologies for coming across as harsh.

I did Home Health for about 25 years as an RN. It's not what it used to be. There are hundreds of agencies opening up shop and fighting over contracts. Most small agencies do not survive. Visits are further and further apart. There is also a lot of fraud in Home Health as I saw with the last agency I worked for who was the last straw for me. Owners pressure to make more visits, do recerts, add PT (they get more money per episode by upcoming and adding PT). It's gotten so bad that the Feds have opened task forces across the country just to combat home health agencies. i left to work at a SNF while also applying elsewhere. I miss the "flexibility" and not being stuck in one place for 8-12 hours. However, I do my work, I clock out, and I am done. No homework, no calls to go and open a case or other visit. No feeling like I am working 7 days, pressure to take what the agency wants me to take in order to make ends meet because you don't know if another case will come along, etc. You are are correct about the job instability. The paperwork has has gotten so extensive over the years too. The pay is a rip off at "per visit." Last one 1099'd me on top of it and I was hit with self employment tax, no unemployment, no workers comp., no overtime, no basic employee rights (which I'm disputing with the IRS as I believe we were misclassified). Flat per-visit rate. No accounting for drive time, gas, phone time, paperwork time. Count all of that time and money plus the visit time and you're often making minimum wage or a bit more. My my biggest regret was staying so long in Home Health. I don't think I'll ever go back.

CNA is not a license, it is a certification. RN and LVN hold licenses. I would recommend doing whatecer you can do for higher education in nursing since that seems to be your goal. Best of luck!

Why oh WHY do nurses take shortcuts or come in super early to start care care then clock in on time, clock out but never leave for lunch then clock back in, lock out and continue working? I absolutely won't do that. I suspect I'll be let go due to that. If more nurses stuck together with regards to the impossible workload, perhaps things might change.i don't see that happening though. It's going to take the law and their are bones minimum staffing.

I honestly don't think it was anything you could have prevented. Pneumonia is a bad thing.. can be deadly with older patients. The breathing leads me to believe that she was at end of life. The fact that she was receiving morphine under the circumstances would lead me to believe that she was end of life and on "comfort care." I have no no idea why the second dose wasn't charted. Like the other nurse said.. it's used every hour at end of life for comfort care. Perhaps it wasn't ordered to be given. I can only speculate. I live with guilt too and it's been almost 10 years. Hurts terribly. My grandmother hated being poked. Doctor suggested a PICC line (inserted and used long term for IV administration). She didn't want that either, but I talked her into it. She was post operation for removal of cancer in her colon. The cancer didn't kill her. It was sepsis traced to the PICC line. Either someone did not use sterile technique when they inserted it, or proper technique when changing the dressing or administering meds. Intruly feel for you. I'm so sorry for your grief.

Thank you amoLucia. Yes, you are correct. First LTC position. In all my years of nursing how come I hadn't heard about LTC facilities and what their really about? After many years in the home health, clinic, wound care consultant sectors, inthought it would be nice to sign up to work at one of the many nursing homes and stay put until I retire. No homework, no driving, work with the geriatric population that I love. Boy oh boy.. LTC is insanity. It's also extremely frustrating given impossible workloads. I feel for the staff and for the patients. Gosh, we get off easy.. CNA's change O2 concentrator bottles and piston syringes. Ah yes.. the calibration book for glucometers. Don't forget E-kits! And yes.. the monthly cycles and restocking meds. Insanity! I can't wait to get the heck out!

I would absolutely bring it up! But that's just me. I would set up a meeting with the powers that be and ask for at least equal pay. You are training this person as well, so that shows that you are valuable to the company. I would be straightforward and honest. They really cant discuss another employee's pay with you or why the person is paid more, but I would still bring it to their attention. You can can start off by saying, "I've become aware that _______ is receiving ______ more pay than me. While I realize that you cannot discuss another employee's pay, I would like to discuss a pay raise for myself and why I believe I am deserving of at least _______ as a dedicated, highly qualified and knowledgeable employee." That would be my advice. Mention what you have learned, but make it more about yourself than the other person. Let us know how it goes!

Well good for you! Congrats! If you enjoy nursing, my advice would be to to start taking your prerequisites for the LVN or RN program. Best of luck to you.