LoisJean

You have made my day! Thank you for responding to my post. I am excited about the changes that have taken place over the years with my business. And, I am excited for you and the changes you are planning. I knew that no matter what kind of business structure I maintained, I would be doing foot care..and since my focus has never been on 'the money', my concerns were not great when thinking about 'what to do' as far as expanding. My concerns came when I became aware that the demand for this nursing service was growing and I might have to stop taking new referrals. That thought bothered me greatly. All I can say is that when the time was right the right nurses came along side and filled in the gap, so to speak. I call these happenings, 'serendipities'. I, too, have provided foot care in inner cities. Missions and soup kitchens have been supportive. I am hoping that with the additional nurses on board now, I can get back to doing more foot care in those areas where it is so badly needed. Nothing would please us more than being able to participate in the certification process which you mention. How would this be possible for us? If you could give me more information on this, I and the nurses who work along side of me, would be very grateful. Olive oil is a wonderful softener and conditioner for callused areas, dehydrated skin and dry, brittle nails. I lightly massage it into the affected areas after the foot soak and before filing or cutting. I found that by using the olive oil cooking spray I could cover more area and it's far less messy. Peace, LoisJean

No assumption there...I have owned and operated my business for ten years. I am known in my community as a business woman, as a nurse and as a provider of foot care--all in the same package. My business name is KNOWN on the local, state and federal level; I take my losses and my gains and continue to expand in a way I feel appropriate and correct for the type of business I own. Plans are in the works for a new business structure that will pull together the talents and skills of myself, another LPN and two BSNs. This structure will incorporate the four of us as a functioning business unit with all the bells and whistles. This is going to happen because it has been a long term goal for my business, for my clients and for the communities I have served all these years. I realize that I have reached the maximum of my ability to work solo; the time has come for my business to grow stronger; there are many more goals to reach. Because of the addition of these three most excellent nurses, I can now live with some peace in my heart that a full service of affordable care will be developed and delivered to those people AT RISK who need it the most...POOR, ELDERLY and DISABLED. I have two passions: the work I do and the right of ALL nurses (do I have to specify who is included in 'ALL'?) to practice their profession and specialties as free agents. I am committed to pursue every avenue possible to insure the Independent status of myself and the nurses who work with me, and to continue to develop a plan and protocol of care which provides optimum care for every one of our clients. To that end, I continue in…. Peace, LoisJean

Thank you so much, Tutti! I agree with you...it was tough! And, for me at times, still is. With the addition of nurses working along side of me--all with the same goal in mind and with their individual and unique talents, I am now able to realize a greater goal...hopefully for the greater good for our clients and the communities we serve. But it's a hard road and it takes a lot of determined PUSH to part the waters of ignorance and arrogance on the part of some professionals. First, I salute you, as a fellow LPN, who provides this wonderful nursing service. The fact that you have maintained your position for 3 years is testimony to your skill and to the response of the people who receive your care. It is my experience that Public Opinion is worth everything. In my geographical area, people do not respond well to those who provide a service for the sake of the service only. As I have mentioned in other posts here, we provide a complete care. We provide, as a part of our service, (that means: AT NO EXTRA CHARGE), a full assessment of the feet and legs-with appropriate care and/or physician referral for ALL PROBLEMS FOUND; vital signs; heart and lung sounds; medication reviews; assistance with environmental needs by networking with community agencies that can fill those needs. We act as a liason between our client and their docs...if we find, during our foot care visit, that the client is, say, not tolerating a medication well, we will communicate that to their doc for them...because often the patient is hesitant to do that for themselves or are unable to. From medications- to monofiliment testing- to physician interaction -to advocating- to optimum well being--we do these things and more, AT NO EXTRA CHARGE. Many of our clients are elderly, disabled, financially compromised; many of them are well off and environmentally comfortable--but, all of them are at risk for serious complications due to their respective diseases/disorders. My business does not discriminate between the haves and have nots- everyone receives the same care at the same out of pocket fee for service. We instruct. We teach our patients about their feet; if they are able, we give them pointers on self care; if they are not able we instruct their caregivers. If they are unable to care for themselves and have no caregiver, we see to it the appropriate community agency provides one. We provide our clients with information on their medications...(another area of nursing care I am HOT on)-we teach them about their meds; we teach them simple, easy exercises they can do to increase circulation and muscle strength in the lower extremities. I could go on and on about what we do at NO EXTRA CHARGE in the span of a hour to a hour and a half home visit... and that is why my business is successful. The bottom line is the client. Period. And I put THEIR money where my mouth is. Tutti, in all these things there is no competition. Personally, I believe that competition is for children playing in the sand box...not for well seasoned, talented and caring nurses who wish to provide a nursing service to the community at large. And, yes, we do have foot care clinics set up in Senior Centers and Senior Apartment complexes...all of them successful. We are in Adult Foster Care Homes and we provide foot care in LTCs as private duty care at the request of the patient's family/guardian. This is where the Entrepreneural Nurse, who wishes to provide direct patient care, shines. This is where the art and science of nursing comes together to provide a service which not only fulfills the needs of the client but also fulfills the needs of ANY nurse who is sick and tired of being denied her/his right to practice beyond the limited and egocentric scope of an arrogant minded health care system...a health care system, which in this country, is so stuck on serving itself that it ignores those who pay it to care for them. Why on earth would I want to participate in a system which I personally abhor? Am I afraid that I will starve? Am I afraid that I will go bankrupt? Am I afraid that I won't get my worthy monetary dues? Do I really think that I could get to more people if I prostituted myself to a pimping government health care insurance system? Well, maybe. But at what cost to me? What would I have to give up in principle in order to participate in what others may see as practical? Fact is, I suspect that those who continue to play the Medicare game are ultimately doing so because they like the assurance of a 'regular paycheck'. Never mind what hoop they have to jump through--and never mind that the hoop gets smaller and smaller. And never mind that the one who gets squeezed out ultimately is the patient. Fact is, it costs a health care provider more to participate in Medicare than it does to simply 'agree to serve' for an 'agreed upon' out of pocket fee for service. I like simple contracts. I like the philosophy behind the, 'Gentleman's Agreement'. My business is based on that. I could care less about what a Podiatrist says; I could care less about what some other person who speaks like one in authority says about what I might or might not do. My little business will continue to succeed because Public Opinion has made it so. I am free to serve. I am free to set my fee for serving. I am free to design a plan of nurse delivered service. Now there are 4 heads designing plans of care not just mine...(not to mention a certain head that calls itself Hoolihan who has shared with me some great ideas, too), ...how exciting is that!? And now, not just my success, but the successes of other nurses who share in my passion. Foot care is the Primary focus of my business...affordable foot care nursing services available to EVERYONE, ANYWHERE who is at risk. I would not be able to claim any success at all if my clients were not successful, too...those people who still maintain independence on two feet because the circumstance which would have resulted in the inevitable amputation was caught early and treated. They are the real success stories. I have received support, encouragement and WORKABLE suggestions and business solutions from nurses on this Board Forum since the first day I joined in. Entrepreneural Nurses understand each other in a way that is uniquely different and heartwarming. We have a wealth of experience that goes far beyond the norm. We can help each other in ways no other entity can. I, and the nurses working with me need to hear from everyone who provides this type of service. We need your input, your experience and your insights. We need to know how you got started, what procedures you use, your protocols for assessments. Everything. Peace, Lois Jean

Thank you, all of you... I can't recall how long ago it was when I first came to this forum and shared my experiences as a Nurse Entrepreneur--owning and operating my own private duty foot care nursing service. I am in my 10th year of business now. For the first 7 years I worked by my self, now I have another LPN and two BSNs on board. I am an LPN. I have been an LPN for 30 years--and perhaps, because of that, I am not easily intimidated by those who would tell me that I am not allowed to practice this worthy nursing service...a service which is so desperately needed by so many and that is provided by so few. Thank you so much Tutti and Laura for your wonderful information. It will all be shared at my next nurse's meeting and the reference materials you have suggested will be obtained so that we might better serve our clients. I am, (as some who frequent this forum know), HOT on foot care being provided by competent and dedicated nurses...LPNS/VNS AND RNS, to all who are at risk for serious complications and amputations... problems that can rob a person of his independence and often his life. I am appalled at the lack of knowlege on the part of nurses and doctors alike, who deem the body to be the proverbial temple, but consider the feet something less than worthy of even a quick peek. AND! I don't even want to go into my experiences with the podiatrists in my area... We are busy! Very busy. Nightengale, I have not forgotten you or any of you who have been with me since we first got on the subject of foot care as a Nursing Entrepreneural adventure. I will try to get back on board here--and stay on board. Peace and Brightest Blessings to All; Lois Jean

As foot care nurses we never leave home without our poloroids. Pictures are taken ONLY with signed consent from the client or the client's legal guardian. When we admit someone to our service, we ask if they will sign a consent form to photograph wounds should it become necessary. (This consent to photograph is included on the same page as the release of information but requires a seperate signature). A copy of the picture, a record of care and wound report are sent to the client's physician-the original, of course, stays in our files. Peace, LoisJean

My husband had the Roux n Y (open) 2 years ago. I have lived with this man for a long time...he was not, is not a lazy sort. Todd seems to be the one with the compassion and insight here...you're going to be a very good nurse, Todd. I like your perspective. At last count, I think, the number of bariatric surgeries performed yearly in this country is over 28,000. Our government tells us that obesity is becoming an epidemic. Fat is everywhere. We are fat, our children are fat, our dogs are fat. But someday fat will be faddish...to be fat will be to be different, radical, rebellious- a kind of middle finger thing pointed at society's good little dobees. Lots of people don't like fat. Fat people don't like fat; thin people don't like fat. I don't mind fat...except when it becomes a killer and when the person threatened with death is so overwhelmed with depression and self loathing and fear that he/she is paralyzed from the Spirit to the Brain and is absolutely powerless to facilitate any change for the better on their own. Exercise bike? Pleeze! Then of course, there is the stigma attached to the morbidly obese by those who look pretty good and seem so well put together...especially those pretty people in the medical/nursing community, who imply: 'Well, just get a grip...' What arrogance. My husband is alive because of his decision to have this surgery. He made this decision with me, his doctor, his psychologist and with a lot of support from people who experienced their own successful recoveries. Bariatric surgery is designed to be a tool for those who have nothing left of their own devices by which to fashion a release from their malady. It is not nor ever was meant to be the 'cure'. A proper bariatric treatment not only has a pre-surgical requirement but includes lifetime post surgical support. I fear in our zest and zeal to create a 'standardized norm' for social Homosapiens, we will manage to kill off our creation quicker than we can create it. I foresee bariatric surgical suites on every street corner...in one door out the other...while the Corporate Greedies rake in the dough with no thought what so ever about what it means to be a human being...why else would a hospital attempt to create a place for bariatric patients when the required beds won't fit through the doors? I can only imagine what problems using the standard issue hospital toilets will be. For those who are morbidly-(have any of you looked up that word-morbidly?) obese and who are scared out of their minds, (altho they would never tell you that), I say there is one sure cure for obesity and that is death. For some, like my husband, it came down to that choice. Peace, LoisJean

Angelbear: Take yourself and your toes to a podiatrist. Let him decide the diagnosis and treatment. There are many conditions which mimic the appearance of onycomycosis but a culture of the nail itself is the most accurate and appropriate way to diagnose. Secondly, there comes a time for most of us when pretty feet is no longer the norm. Our feet take terrible punishment over time...let me just say: thank the gods we don't walk on our faces! Where I come from we have a saying: 'the only ugly foot is the one that isn't there'. Have a professional check your feet...forget pretty and think "functional". Just a suggestion. Peace, LoisJean

Greetings! and all is well, but very, very busy- (which is a good thing and would be an even better thing if I were 20 years younger!) I have a foot care client who is a Veteran. He has IDDM and can be considered brittle. When my services were requested by his physician, he was in the healing stage of a ulcerated corn. He had a history of ingrowth of both great toes. The Veteran's would not pay for nor reimburse him for the added depth shoes that I suggested he wear and which were ordered by his doctor. However, when he developed Charcot's Foot, the expense of added depth shoes and brace were completely covered. This puzzled me. There has been somewhat of a stir in the nursing community over the idea of Orthotic Specialities as a career change. It's a very interesting field...might be worth investigating. And, once again, for Raduda and others interested: LPN's too, can provide foot care. If you question this please PM me. To give an example of one of our foot care clinics set up 2 x a month at a local Senior Center: I set a fee for service. People sign up. Care is given and payment is made. 10% of my earnings are donated back to the center at each clinic visit. (This center does not request a rental fee from me...so, I donate an amount to them in appreciation.) I will try to get back onto this board on a regular basis. With a new nurse on board and a huge increase in referrals, I have had to spend almost every waking minute 'on the job', so to speak. Miss all of you so much...but, I'm still here...still going strong! Peace, Lois Jean

Well, here I am again....I wanted to add: Since the addition to my nursing staff here, we have set up new foot care clinics at 3 Senior Centers, gained 2 more senior apartment complex clinic sites and, in 6 weeks time have realized a 5% increase in private in home referrals. This means that not only am I seeing a growth in my business but the nurse working with me as a self employed contractor is realizing full time work and decent pay for service...pay that is hers to do with what she wants. I think if referrals continue we will need another free lance RN or LPN by late fall. We are preparing to offer med set ups on a q 2 week basis and monthly IM injections (B12, etc) for an additional fee for service. We already offer fingernail trimming for diabetics, the blind, stroke victims--(any one who can't do their own safely); and we provide full vital signs with each foot care visit along with med reviews as part of the whole foot care package. (Just had a guy yesterday who was absent of breath sounds ® upper and mid anterior lobes plus a couple other symptoms I didn't like. I called his doc, got him an appointment for the afternoon and took care of his feet. His wife called this morning to tell me he has pneumonia and, "thanks for being here". See, this is what I'm talkin'. Peace, Lois Jean

Hi, Guys!! Erin, it's the way of this world....Canada, Germany and a few other European countries all have nurses trained in the delivery of foot care...and the government provides payment. But not here. Hey, I've been in touch with kernow via PM. The video ought to be up and running by late October. It will be a professionally done video and I'm scheduled for the taping in mid September. I know this has been long in coming.. my initial idea was to have a family member do a 'non professional' type thing, but I was slowly coaxed out of that notion. I want to be in a position where I can sell the thing to people with big bucks. (the exception, of course, will be the sales of this video to nurses for a very low charge- probably shipping and handleing). My promise to you is that as soon as I get it, you'll be the first to know via PMs. Pity the podiatrists! They do not get recompensed for ROUTINE foot care. Not by any insurance provider. So, they do not soak the feet, they do not massage the feet; they do not get paid for the routine trimming of toenails. They are paid per Medicare on a q 2 month basis for foot care on Diabetics and others who show a required number of symptoms relating to various diagnosies. These various diagnosies must be certified by a MD/DO before the pod can be compenstated for his work. If the required number of symptoms are not present, the pod does not get paid. Therefore, many podiatrists in this country falsify thier documentation. This is a fact of life which occurs not only with pods but with other Professional entities who feel they need 'mo money. Often they bill an atrocious amount hoping to reap at least half. This makes the average consumer of podiatry care quite unhappy because when they see what the pod charged for a basic xraying and 10 minutes of nail trimming and calous cutting they feel, and rightly so, that somebody is getting cheated. Well somebody is: namely Mr. and Mrs. America who see money taken out of their paychecks to pay Dr. Pod. For many pods to get paid for ROUTINE foot care they have to charge an out of pocket fee which can range from $75. - $175 per foot (and sometimes more depending on where and on who). I don't care how far and wide a pod might travel to provide in home services-- he is not getting to the majority of those who need him and what little service he provides leaves little desire for the patient to have him back. Podiatrists have their place: their place is in foot and ankle surgery, orthotics- (an up and coming speciality which some nurses are looking at seriously when thinking of a speciality), diagnosis and treatment of disease processes--(fungal nails, gout, calcium deposits, etc); basically the things that took them 6 years of school to learn and obtain Professional licensing for. But, routine foot care is a definite nursing function which relates directly to health, comfort, hygiene and the overall prevention of more serious problems which can occur if there is not regular inspection. By regular inspection I am talking about the ideal advantage of either monthly or qom foot examinations and basic care. This is neither excessive or unnecessary in light of potential risk factors. I frequently see a problem one month that wasn't there the month before. We keep accurate records on all of our clients including wound care assessments and progress sheets. Rapid referral to the client's physician has resulted in treatment that other wise would have been delayed. 75% of all our clients are elderly and diabetic. 23% are elderly and suffer other debilitating problems such as decreased vision/blindness, severe arthritis, cardiac problems, stroke, neurologic disorders and so on- many of these are on blood thinning agents such as Coumadin. The remaining 2% are people who may be elderly, may have some difficulty caring for their own feet, but who are basically not at risk. They simply want the care given by a nurse. Out of the total patient numbers seen, 32% are homebound, require 24 hour care givers, and of that number, 18% are the frail and elderly dependent upon Medicaid for health care services. We give good care! We soak the feet--that feels really good and relaxes the muscles and tendons as well as softens the nails, corns and calouses. It also cleanses, removing bacteria from the skin surface which helps to decrease contamination. The nails are cleaned around the outer edges and under nail tip. Removal of the debris between toes is done. After ascertaining that the client is not sensitive to alcohol or betadyne or that their are fissures or cracks on the skin, we swab the entire foot including between the toes with either of these agents, (nurse's preference), that kill fungus on contact--we want our work area clean! The entire foot and leg is inspected. We look for not only the obvious problems but also the ones not so obvious. Often, a foot care nurse will spot the signs of early cellulitis and refer promptly. Pedal pulses need to be present--if they are not readily felt the foot is observed for other evidence of circulation present or absent. People need to see their docs PDQ when pedal pulses are absent or faint or not in sync with the radial/apical. We provide monofiliment testing every 6 months. Not only on diabetics but anyone who presents with circulatory embarrassment. We ask alot of questions regarding pain, cramping, ambulation, and so on. We check shoes. We look for mold, worn heels, nail heads or other protrusions, etc. We keep a check on medications and do reviews every 3 months. We trim the toenails. Straight across if possible, but always the way the nail naturally grows. Nails often will grow in a crooked or off center way when the digit is affected with arthritis or other cause of misalignment. A nail should never be 'force cut' to grow contrary to it's position on the nail bed. We inspect corns and calouses. We smooth them down using an emory type file. We look to see if there is any evidence of ulceration underneith, we want to know the degree of pain the person is having when walking or standing. We will provide a padding right away and send them to their doc for further treatment. Everything is done by hand. We never use battery operated appliances such as dremmels--these things are evil and ought to be destroyed. They do nothing but damage a sensitive nail plate and can cause destruction of tissue surrounding a calous or corn. We never use razor blades or scaples. We never invade tissue. To do so is beyond our scope of practice- number one -and number two, it can further worsen the the situation. Movement is important. If their feet hurt or if they have peripheral neuropathy, they are subject to falls. We observe them walking. We can see where there is a problem with alignment. We can refer them to a Orthopaedic Surgeon for evaluation. Perhaps a brace for additional support is needed. Perhaps they simply need a tripod or walker for added support. Point is, we can refer. We massage. We know how to massage the feet of the elderly...the kind that gives them visions of younger, more orgasmic days. It feels so good to them. It completely relaxes them down. Increases circulation, decreases strain and stress on the spinal column, energizes and gives a long acting sense of well being. We do not mess around with the idea of pressure point massage which affects other problem areas of the body. Often, with our clients who are elderly, the increased pressure is painful and not tolerated well. We simply massage, keeping in mind that there is a right way and a wrong way to massage the feet. Proper foot care when provided by a nurse- including the time for assessment and evaluation--ought to take approximately 45-60 minutes. I challenge anyone to find me a podiatrist who will take that kind of time to provide this kind of care for $20.00 per person. And, finally, we act as a referral and networking agency. We provide a means for our clients to enlist the help of other supportive agencies if the need arises. We can assess a living environment and can ask questions regarding need. Our clients are usually very open and honest with us about these things because we have generated a care for them which is personal yet professional. They talk with us. We see them on a regular basis without fail and this has helped to build up their confidence in us. Foot care needs to be looked at again as a viable nursing procedure. We need access to a means of certification for this kind of care (and I mean for LPNs as well as RNs. Because if LPN/LVNs are not included in the mix, I will burn my license and sever my legal status as a nurse, in protest). With proper certification health care insurances might provide payment for service or at least offer a reimbursement to the client paying out of pocket. Some, if not many or all, podiatrists are inherently, it seems, leery and a bit paranoid regarding nurses doing this work. I am at a loss regarding this because it would be finacially benefial for them to make nice with us because we provide the referrals based on nursing assessment....however, since in my area they aren't so nice, I refer my client to his physician of note or to a orthopaedic surgeon. I can do this because I work for myself. In fact, it is my business policy that all nurses working under my business name do this. If the MD/DO wants to send them to a Pod, fine. Most of them do not. It does not take a rocket scientist to learn foot care. Actually, I take care of feet the way I want my feet cared for and the way I took care of feet when foot care WAS a care provided for patients in hospitals and LTC homes by nurses and nurses aides. I simply have added the extra employment experiences of geriatric nursing, home health care nursing, med/surg nursing, CCU/ICU nursing and a whole bunch of other stuff garnered over 30 years as a nurse; I acquired excellent assessment skills (my teachers were RNs just like many of you)... None of us would be interested in self employment if we didn't believe that we can, within the essence of knowledge and experience, provide something for others in a far better way on our own rather than through the restrictive modalities foisted upon us by employers with corporate mentalities and methodologies. Most of us detest the shackles that bind us to those blocks. Most of us working in conventional employment scenerios become restless, irritable and discontent on a regular basis no matter how many different places we work, no matter how many different clinical settings we work in, no matter how many degrees or certifications we acquire...eventually we get bored, pizzed and basically burned out. We keep trying different venues but nothing seems to work right for us. Mostly, we are people who heartily disagree with management protocols. We find that those protocols leave us over-worked, under-paid and worse, not allowing us to provide for our patients in a manner which we know we ought to and in the way we were taught to. Often, the nurse with the Entrepreneural spirit inside of her or him, cannot understand why the higher up they go in thier profession, the deeper down they go in depression. Perhaps this has been the way for some of you, too. What everyone needs to know is that NOT ALL NURSES WANT TO BE SELF EMPLOYED, BUT ALL NURSES CAN BE SELF EMPLOYED. At any rate, and I know this has been very lengthy...sorry..maybe I oughta write a book. Peace, Lois Jean

lunakat: Yes, I had been diagnosed with depression some years before I was diagnosed with ADD and had been taking Zoloft for it. However, I know now that the depression was partly (and maybe all) due to the symptoms of ADD which were worsening as I aged. glascow: I don't understand why your psychiatrist said that to diagnose you with ADD as an adult you had to have been diagnosed with it as a child. My doc told me that more and more adults are being diagnosed now with ADD who had no way of being diagnosed as children because ADD was unknown then. I wanted to say too, that my 87 year old mother has all the earmarks of ADHD. My mother is now unable to give me any description of herself as a child d/t dementia. But I interviewed her sister (my aunt) and discovered that Mom was a "very difficult to understand" child and was always "getting paddled" for "acting out and not paying attention". I am 100% certain that my mother has it. My 37 year old daughter has been diagnosed with it and so had her 7 year old son, Carter. My 39 year old son also shows symptoms which seem to be worsening. He has read the books and listened to me explain the heridity factor involved. Neither my daughter or my grandson are on any medication for this. She, like me, will take a Ritalin only when the symptoms become severe, but she prefers to use focus training and other concentrative exercises for herself and Carter. It is working well. I think each of us could write a book about our personal adventures with ADD. I know that before I knew what it was I thought I was the most incapable person on the planet. Today, I must say that I have some fun with it...and it's always a learning experience for me. For instance, there are times when I'm in conversation with some one and say: "Excuse me, but I have Attention Deficit Disability, (I prefer the word 'disability' instead of 'disorder'), and I'm having difficulty following you. I need you to speak slower to me so that I don't lose one of your words" (or)..."Doctor, I have ADD, I need to be certain I have understood you correctly. You have ordered......." It's amazing to me how many people respond with good nature. Before I had this diagnosis I would have never wanted anyone to know the difficulty I was having understanding them--keeping their words straight in my head. Even note taking became a confusing way to do things and then more times than not I'd lose the notes or worse, question what I had written down. If it was a doctors order I would have to call back to confirm what I had written...(not cool). Thanks all for posting. I know this sounds familiar and probably silly, but I thought I was the only nurse in the world with this thing. Peace, Lois Jean

Greetings, fellow ADDers. I was diagnosed with Attention Deficit Disorder two years ago. I am 56 years old. I belong to a generation of people who were not diagnosed in childhood because there was no such diagnosis- and certainly never such a diagnosis for females-not even when it was first cited as a disorder in the '70s-it was believed that it was a 'boy thing'. Some of the adjectives used to describe me, to my face and behind my back, by parents, teachers and schoolmates when I was a child were: lazy, stupid, flighty, precocious, rebellious, stuck-up, daydreamer. Other unattractive adjectives were added on by others and myself later in adulthood. Like many with this neuro deficit (or 'faulty wiring'), I exhibited certain difficulties: I mixed up my lefts and rights; I had numerical dyslexia. I could not tolerate nor respond well to increased levels of visual and verbal stimulation--like two people talking at once or more than one thing going on at once. Then again, if someone was talking directly to me or showing me something which my brain wouldn't let me understand, I would drift off into some kind of 'other place' and would lose all sense of concentration. I stared out of windows alot. These symptoms and many others led me to believe that I was 'different, wrong and not-as-good-as'. (Remember, in those days kids like me were considered under-achievers, mentally lazy and difficult.) As I reached adulthood, I had learned many coping skills to 'hide' what I believed were my failings and shortcomings. This continued on into nursing school where the internal stress of 'proving' myself as competent and capable forced me into a kind of brain numbing exertion-propelled by sheer fear- to produce excellent grades and clinical evals. During my many years of clinical nursing, I always worked in high pressure areas of hospitals because the greater the pressure the more I had to force myself to concentrate. During these years I found that when my thinking processes were in high gear, my body would respond in kind...therefore giving the appearence of 'together' and 'quick'. I had little tolerance for slow paced units or areas where I could easily go into my 'daydreaming' mode. My insides demanded a high speed life and boredom was intolerable for me. Thus, I lived my life this way. Until I could no longer live that way...because, as I aged the symptoms become worse and my coping skills weakened-- (I always remember that the defination of 'cope' is: "to struggle to produce some kind of success"; it is also a word which describes a 'covering' worn by priests to symbolize the covering up of sins. So, the word, 'cope' is no longer in my vocabulary.) I had been self-employed as an Independent Nurse for 6 years prior to my diagnosis of ADD. I found that working my own schedule, creating my own notation forms, working in an environment of my choosing had done wonders for my sense of control. I still had great difficulty keeping paper contained, schedules straight and so on, but at least when I screwed up I had only myself to yell at. I absolutely thrived in this type of working environment. And I was successful as a Nurse Entrepreneur. My business grew- and so did requirements to keep it going. Two years ago I found that I was losing important notes, forgetting appointments, showing up at the wrong place at the wrong time, missing personal and professional appointments...all this while continuing to take on more and more work. My office environment was indescriblely bad! I bought books on how to remove clutter from my life, I scrounged the stores and alleys for cardboard boxes to collect all my crap in--I think I collected at least 200 boxes because I was on a MISSION-but I forgot that the mission was to remove clutter-instead it became a mission to collect boxes! I rearranged the furniture at least 5 times a week and ended up with even more of a mess. I fought headaches, fatigue, joint and muscle pains and that ever present haunting sense of personal failure. I ranged from hyper to blob-like. I would think: "Today I am going to finish cleaning my office and get every file in place"; instead I'd find myself at the computer playing cards for hours on end...by the time I realized how much time had gone by, all of my resolve to clean and sort had gone out the window and had been replaced with a sense of 'why bother'. I sought out a psychiatric councelor because I found my mind trying to contrive a non-messy suicide-one that wouldn't impact too many people. As I tried hard to explain my life to her, (verbalizing feelings was always difficult for me as I would be given to fits of a kind of stuttering and mixing up my words), she saw something in me that she had in herself. So, she had me tested that day and sure enough....ADD. Because I was suicidal at that time, she got me in that day with a MD who deals with Adult ADDers who immediately put me on Effexor and then Concerta. Within 4 weeks the change in me and my insides was incredible. I have researched ADD and have read many books about it. I find myself everywhere in the description of ADD. It answers so many questions that I had about myself and ultimately it has brought me great relief. There isn't a day goes by and I'm not recognizing another action (or inaction) related to ADD. I have learned how to deal with my symptoms without the benefit of Concerta - altho I don't leave home without it-(I also have a bottle of shorter duration Ritalin); I have found that from time to time my brain will kick into overdrive and I become unfocused and scattered beyond my control. I continue on the Effexor. I actually like working WITH my symptoms and discovering ways to kind of override them. Professionally diagnosed ADD in the adult is recognized as a legally acceptable disability. Therefore, BY LAW, schools, colleges, universities and workplaces must provide the appropriate accommodations for people with this disorder. I'm so glad to hear from other nurses who have suffered (or still suffer) from ADD. When I first saw this thread, I got the same feeling I had when I first saw the Nurse Entrepreneur forum....JOY! Any of you feel free to pm me if needed. And, yes, lets try to keep this thread going--perhaps we can help someone because I believe this disorder is very prevelent and very undiagnosed in many adult men and women. Maybe we should see if Brian will start a new forum..like, 'NURSING FOR NUTS' or 'IT'S NOT ME, IT'S MY WIREING!' Peace, Lois Jean

My MD was a nurse before going to med school. She came up the old fashioned way....nurse's aide, LPN, RN, MSN then MD. She's so very good with her patients...and she's not afraid to say, "I don't know, but I'll try to find out." Then she does. Her name tag gives her full name then MD; RN. Peace, Lois Jean

The kind of 'customer service' insisted upon by corporate hospitals is geared to do nothing more than make that business look good to the average consumer who partakes of their services. The nurse, (and every other employee), becomes no more or less than an 'agent' for that enterprise. May I ask: are you compensated an extra amount in your paychecks for acting as 'customer service representatives'? No, I didn't think so. You know, this really saddens me a great deal. It's truly a low rung that health care facilities stand on when they use their personnel-and, pardon me, their NURSING personnel especially, as the washrag to keep their faces looking clean. Makes me sick, actually. I'm grateful that I'm not in that scene anymore. Peace, Lois Jean

In 1932 when my Mom was in nursing school, they were responsible for the dietary needs of their patients, too. Among all the other duties-including mopping, dusting and laundry detail, special diets were prepared ONLY by the nursing staff. Broths, teas, purees- (which were, "hand mashed and vigorously whipped")-and every other special diet food were hand made, cooked, boiled and steamed. It was the nurse's responsiblilty to be certain her patient ate- and so, not only did the nurse fix the diet she also fed her patient as well, if needed. Mom is 90 years old and can still recite word for word the nutrient value and receipe for diets specific for every gastric disease known to man, colic, cancers, pneumonia, arthritis and gout, dementia, all manner of skin disorders, TB and so many other infectious diseases that I can't remember them all. I can still recall when I was a wee girl and was sick, she would be in the kitchen chopping, boiling, mashing and mixing together all kinds of weird stuff and then hand feeding it to me! Peace, Lois Jean