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.

I don't care what anyone says, a I think a 1:30 or a 1:60 Nurse to patient ratio is outrageous, unsafe, and not sane. You very well could be putting your license in jeopardy. If something happens to one of the patients under your care, try using the excuse of "we were understaffed, boss did not want to hire and staff more help." You'll be asked why you took on the assignments if you believed that to be the case. I was hired on as an "RN Supervisor" and quickly became their kill 2 birds with one stone Nurse. They had their mandated RN hours required plus I took floor shift normally done by LVN. I found myself in an 11p to 7am 1:57 Nurse to patient ratio and only nurse in the building. I was told to start the morning med pass and glucose checks and 3am! Thanks to one of the 3 CNA's on shift I was alerted to a patient c/o chest pain and numbness. 911 was called. What if the CNA (who is too busy with own unreasonable workload) hadn't gotten around to that resident? What if the resident died? What if more than one of those 57 had an emergency? You cannot be at the med cart, on the phone, checking glucose, admin. insulin, breathing treatments, charting, and assisting emergency personnel all at once. CNAs are expected to be our "eyes and ears" but they are not trained at an LVN or RN level to assess for significant changes! Needless to say, this incident put everything else behind. By the time 7am nurses arrived, I was still occupying a med cart. Not only that, breakfast trays do not arrive until about 7:30am. I'm not counting on a glucose read from 4am or giving insulin too early before breakfast for obvious reasons. Who gets frowned upon in these instances? We do.. because "other nurses can get everything done by themselves with about 30 patients or about 60 on night shift" OR "911 emergency rarely happens on night shift." I don't see how any nurse can logistically do all... Med passes, all treatments and wound care, all the different S/E monitoring for meds documented to be signed in MAR, "target behaviors" O2 sat monitoring with and without O2, BP and pulse monitoring for ranges, I&O, meal percentages, admin. Nutren and other various supplements for various patients, and all the other entries in addition to meds in the MAR in 8 hours.. plus sign the MAR and TAR books for about 30 residents (about 60 if night shift), complete all the COC, Medicare, weekly charting, etc. in 8 hours unless they cut corners. It is logistically impossible. For nurses who manage to supposedly get everything done, I say again that it is logistically impossible without cutting corners (and I've seen cutting corners). I've seen boxes of albuterol for nebulizers with vials when they should have been done. Vitamins and other OTCs (not kept with regular med cards.. and used as "house supply") in the cart that should have been finished by now. Signing the thick TAR and MAR books to get signing out of the way, and I've suspected some 3-11pm of combining both the evening and bedtime meds (no significant drug interactions, but still). I complained about the latter because if you give Seroquel or Ativan for instance at 5pm but mark 10pm, guess who's up for the day and trying to get out of bed at 2am for the night shift nurse? Can't give them anything because they last received supposedly at 10pm. The shortcuts may not be dangerous per se, but shortcuts nonetheless. These are overworked and exhausted nurses expected to do impossible workloads. They are dedicated nurses who are forced to spread themselves thin and prioritize. In addition to the impossible workloads, a "change of condition" (new rash, a cough, wound or what not) can put a nurse an hour or more behind having to call doctor, chart, wait for doctor to call back, chart, get order, fax pharmacy, update care plan, notify family, update MAR or TAR. Nurses who are skipping lunch and breaks, clocking out at end of shift and continuing to work, coming in hours early to start treatments, etc then clocking in on time to help reduce cutting corners.. it's admirable, but it is behavior that enables the administrators who refuse to hire, staff and retain anything more than the bare bones minimum required by law. It is also used to as an example to other nurses that "see? Other nurses can get everything done!" Understand that behind many privately owned for-profit nursing homes are owners who have no clinical background and see a big chunk of profit when they can manage to stay at the bare minimum required by law in their state.Staff is the most costly expense for a nursing home. Every state has a bare minimum for nurses and CNA's (which is still an unreasonable workload). Each one also says that the facility shall staff enough employees to meet the needs of the facility's residents which is open to interpretation. A facility that maintains only the bare minimum "one size fits all" is not considering the individual needs of the residents. I dont suppose pose I'll be lasting too long at this job. I take my time and to make sure that each entry I signed is what I did, even if that means staying hours over. Before re applying at a LTC facility, I would urge you to check the facility's staffing on a site like Healthgrove dot com. A facility that staffs above the bare minimum is likely to treat their employees better too. Thats all for my ranting. Thanks for listening and I'd love to hear input.

Hello Phoenix. Who reported you to the BON? It sounds to me like the Nursing Home is trying to cover up THEIR own wrongdoing by making you the scrapegoat. If you saw the Hospice and DNR.. and that's what was in the chart, I believe you! For profit nursing homes can be ultra shady. They probably hadn't updated the chart (until afterwards) and don't want the liability so of course blame the nurse. How awful. Also.. what are you supposed to do when the patient (according to the signs you describe) is already clearly deceased for a while.. (meaning she hadn't just coded). An an autopsy could likely pinpoint the time of death. It's a nursing home too... patients aren't hooked up to monitors like an ICU where an alarm sounds if the heart stops. Nursing homes are so horribly understaffed too. So so sorry to hear that you have to deal with a BON complaint. Keep us posted!

Hi KarinBe. So very sorry about the loss of your mother. Like me the previous commentator stated, we are not allowed to give medical advice on a forum. That being said, the first thing that came to mind when I read your post is what is called "Cheyne-Stokes breathing." This type of breathing is frequently seen in dying patients. It's a breathing that can be rapid and deep with breaths followed by a period of no breaths or a "pause" in breathing. Sometimes there may be "noisy"breathing that some refer to as a "death rattle." This could (or couldn't) be what your mom was experiencing. Morphine is a drug that is given to people who are dying. It's also a respiratory depressant, meaning it could slow down breathing. Pneumonia can be serious in the elderly who may also be compromised or have co-morbidities (example, congestive heart failure). I don't know if this was the case with your mom. Im so very sorry that you are feeling guilt.

If your friend was told not to tell any of his peers, immediately calling the dean put her friend in a bad spot. Of course they could not discuss his case with you, nor should they. Instead of of focusing on the fact that your friend was readmitted into the program, you should focus on you and your own circumstances in dealing with the school administrators. You should only use whatever information you received from your friend and how he got back in as a guide on pleading your particular case, not as a tool to fight the administrators. "Well so and so also failed but got back in" is not a good defense. I'm not trying to be rude or discouraging, but it shows lack of responsibility. Having failed two courses by one point each is still having failed two courses. It seems that's the least of your concerns. It shouldn't be.

What state are you in? Check your state laws on background checks. Here in California arrests with no conviction will not show up for the fingerprinting or background checks. Or if they do, the employer is not to consider them, and a person can actually sue the background check company for releasing such info. I would say you're good to go.. arrest with no conviction is simply that. You haven't been found guilty, pleaded no contest to or convicted of anything.

Sounds like you worked at a miserable place with shady people. I agree with with the rest. Don't do it. If they keep bothering you, tell them you're going to call the State Department of Health Services Hotline for advice on their request and you'll get back to them lol.

I absolutely love being a nurse and have enjoyed all patient care in all settings. It's been the employers themselves, lack of benefits, certain areas of nursing, beauracracy, mean co-workers, drive time and homework that's been required for certain nursing jobs that I have NOT liked. Regrets? Yes. My advice would be to continue your education, get BSN, a Masters, as many helpful certifications as you can, work in a variety of settings for experience. When you get to be an older nurse who has 20+ years experience primarily in one specialized field only, you're going to have a terrible time finding other work. Think of the future and where you hope to be when you are an old nurse. Work for companies where you'll get a pension or other retirement benefits. It's a bit late when retirement is only about 10 years away. So many retired nurses have dedicated their lives to nursing, only to be left struggling to make ends meet with a social security check. Hospitals want new grads or younger nurses who can work outrageous schedules for less than what they would have to pay an older nurse. As we get older, we become more of a worker's comp risk. We can't do the things we did when we were younger nurses. In my case, my jobs required lots of driving and unpredictable, last minute work and homework. I was great at it. Age does catch up to you. Prepare. I attended a hospital job fair on fair full of hope and anticipation. I was the only older nurse there. Due to my lack of recent hospital experience, I certainly wasn't a great candidate and did not get called. Prepare re for the future because before you know it 25 or so years have gone by.

I say quit and find something you will enjoy. I was a Home health nurse, case manager, nurse consultant for 25 years. I grew tired of the uncompensated long drives and homework. Because I love geriatrics, I decided that one of the many local nursing homes would be my last job for my years leading up to retirement. No colleagues of mine had worked at nursing homes. I had no idea what it was really all about. These LTC facilities.. most are for-profit owned by greedy businessmen who only staff the bare bones minimum required by law regardless of anything. Even the bare bones minimum is substandard with logistically impossible workloads. I worked in a 59 bed facility. For facilities under 60 beds, the law in my state gives the bare minimum staffing ratio of 2 LVNs for morning and day shift, one nurse entire facility night shift. One RN 8 hours per day. I was hired for an RN Supervisor position, but they killed two birds with one stone meeting their 8 hr per day RN requirement plus having me on the floor instead of an LVN. Responsibilities included 2 med passes and PRN meds for 30 patients, wound care and other treatments for 30 patients, glucose checks, insulin admin for 30 patients, GT feeds, IVs, weekly charting, Medicare charting, etc., sign off everything including monitoring side effects of this or that med, check O2 sats with and without oxygen, apply this or that cream with diaper changes, monitor this or that. One change of condition can put you an hour behind. An admission? Good luck getting your other patient's needs met on time. Night shift 1 Nurse 59 patients. Sugar checks, med pass start at 3am. God forbid anyone has a change of condition, and hopefully one of the CNAs who is too busy with own impossible load will tell you. Ive seen nurses clock out and continue working, or come in extra early to start treatments and clocking in when they're supposed to. Its horrible for the nurses. Logistically impossible to provide all that care to about 30 patients in 8 hours. I've seen nurses sign off anyway and take huge shortcuts to prioritize care. I don't care what what anyone else says, 1 Nurse to 30 or 60 patients is neither safe nor sane. Intentional short staffing is dangerous to these frail patients. In the several months before I finally quit, we had two patients developed Stage 4 decubs. Patient falls are common. Bed and chair alarms seem to be used in the place of supervision. Treatment carts are also stocked with cheap supplies and the bare minimum. Do you think a decub on the coccyx is going to get better with daily dressing change with dry gauze to cover on a patient who is incintinent 24/7? Speaking of which, diapers are changed 2x per shift whether need be or not. Infections run rampant. You might sanitize if one of the sanitizer dispensers a patient's room even works, but what does it matter much if nobody else does? Every second of every minute counts. When workers are to overwhelmed and always in a rush to the point where hand washing is skipped, there is a problem. The one I worked at just recently stocked med carts and other areas with equipment sanitizer wipes and hand sanitizer wipes. Why? They're expecting surveyors any day. Do do the research. Find out what the minimum staffing is for your state.The facility has to post the census daily and "hours of nursing care per patient per day" (which includes and divides up everyone with a license or CNA certification whether there on the floor or not) If the LTC facility barely meets the state's minimum, consider working elsewhere. Unfortunately, for profit nursing homes are run by businessmen who seem to use the state's minimum as a maximum. Everyone suffers from the nurses and CNAs to the patients.. supplies to food. Bring up staffing to owners with no clinical background, and your concerns will fall on deaf ears. Owners make big money providing the bare minimum. They are certain to make sure we have families sign arbitration agreements on admission, to avoid lawsuits and public awareness. Fines are minuscule compared to profits. Until the the law changes, these are the conditions. I for one will never work at one again. I hope to never end up in one. I truly feel sad for the patients who are stuck in one.. and the exhausted nurses why try their very best providing care under the circumstances.

I work at a nursing home as an RN after 25 years in case management, home health, wound consulting, busy urgent care. Unpredictable schedule, plenty of uncompensated work, and too much driving got to be exhausting as I got older. I loved geriatrics and decided that a nursing Home would be my last job until retiring in about 12 years. I had had no idea that intentional understaffing, shortcuts, and outrageous and logistically impossible workload expectations were the norm for nurses and CNAs. 30 patients, 1 nurse, or even an entire facility to 1 nurse. Not safe or sane. Unfortunately, its legal. Nursing homes are for-profit and owned by corporations or businessmen:The states and government have tackled the issue of understaffing years ago to come up with a bare bones minimum staffing requirements that vary per state (which are still inadequate and outrageous) What you see as far as staffing at these places is about as good as it will get. Profit driven owners will not increase staffing until the laws change. They seem to use the guidelines as a "maximum" staffing. Ever wonder why many of these facilities will have bed quantity that ends in a 9? It's because of the staffing requirements. For instance in California you would need two RNs, one of them being a DON 8 hours per day in a facility with 60+ patients / residents. Thus, many "59 bed" facilities. More requirements for 150+ beds.. thus, 149 bed facility. Most LTC facilities that I know of are 8 hour shifts. This could be a plus to older nurses like myself who tire more easily than the youngster nurses. Or, it could be a minus because you have to be at the LTC facility more days than if you worked 12 hr. shifts. As a nurse in one of these places, you will be expected in an 8 hour shift to care for, administer all meds (usually two med passes), sugar checks, treatments and wound care for about 30 patients. You're also responsible for new admissions which can take hours worth of paperwork, leaving you totally behind and the boss frowning upon overtime. As as far as skills, there is an occasional IV. You'll also become proficient with administering GT feeds via pump blindfolded. With understaffing comes wounds.. from falls, from pressure sores. You'll get to see first-hand the various stages of decubitus ulcers and treating them. It it will be seen as a badge of honor, a loyal and dedicated nurse if you work through your lunch like many of the other nurses.. or if you clock out and continue working. You'll bring home a smaller paycheck, as these facilities pay less than hospitals. You must understand that these owners and administrators have huge Home mortgages, cars, and lifestyles to pay too. They have to juggle the per-day bed rates they get from Medicare and MediCaid (more than the cost of a fancy hotel room plus you get 2 roommates). They have to juggle the cost of cheap supplies (always running out), generic food for the residents.. it's just not profitable to pay higher rate to nurses or even consider additional staffing. You'll learn a whole lot about various isolation and all sorts of bugs (MRSA, C-DIFF, etc.). Its impossible to wash hands before and after each patient in a "fast paced" 30, 40+ assigned residents. If the hand sanitizer device in a resident's room is actually filled and in working order at all, use it, but don't count on everyone else to. One the plus side, you'll grow to develope a resistance to all kinds of viruses and infections.. eventually. These are are of course just a few of the perks of being a LTC nurse. As as far as the cons.. You may clock out and leave your shift overwhelmed, and with a heavy heart that you alone with 30+ patients in 8 hours could not logistically give each one the individual care and attention they deserve.

No, no, NO. I would not. Being friends with patient or former patient is crossing professional boundaries in my opinion. Cowokers.. maybe, but also personally a no for me. I clock in, clock out. No offense, but wouldn't want to deal with patients (residents) or co-workers on my own time and in my "outside life" after clocking out. Heck, I don't even want to attend holiday or other company parties after clocking out. No thanks.