guest1143647

Back to the question, I don’t think mom was being manipulative. I think she was really just concerned about having a permanent nurse. Maybe she is just tired of the agency saying they have a permanent nurse for her, but then they never send one.

Remember that other thread you asked about the BSN? This is an example of why it is good to have just in case.

Night shift is 11pm-7am Im not sure what would happen if the previous shifts missed them

While I have my BSN( obtained Aug 2021) been an RN for 14 years, and an Lpn four years prior to become an RN, I struggle to get hired into a med surg position. I’m not sure what’s going on with the hospitals in my area. But the only companies I do receive calls backs from are homecare companies and some LTC facilities. Most of my experience is in peds Pdn working with trachs and vents. I worked per diem at a nursing home in 2009 for a year. I also still work PRN making skilled visits for two companies. I’ve done skilled visits for 1.6 years now. I starting working in an subacute rehab facility for six months now, but it’s boring. They don’t have enough high acuity patients. No vents, barely any feeding tubes and IV. I tried to find hospitals that were willing to train non acute care but experienced nurses that want to work in acute care settings.

A good idea. Whose to say that homecare won’t move to an all Lpn model?

60ml x 24 hours is the hourly rate. That part was clear to me,but I guess orders are written differently depending on the setting

I don’t see how anyone could think 60ml is the volume, because 1000ml is listed as the volume. The order I wrote is the exact same one I saw in the chart.

It’s so interesting how we all interpret the order differently,although I had to squint at the posters saying the rate isn’t specified.

I think nursing employment is moving toward outside of the acute care hospital model again. I read somewhere that hospitals are not the main employer of nurses anymore. The hospital based nursing employment is actually newer than you think. Most people prior to 1900 were actually taken care of in their homes. So home care is where most nurses were employed before hospitals became a thing. It’s the original nursing specialty. The first private duty agency I worked for gave a really fascinating history of Pdn. It mentioned nurse registries and that families could call and hire nurses. It is really interesting.

60ml is the hourly rate

So, does NJ Governor Murphy’s mandate for healthcare workers apply to nurses in non congregate settings?

I wondered this myself but eventually got the BSN. I have about 27 years more to work before retirement. I started out in private duty but did work occasionally in a LTC facility until 2009, so it was all I knew. I now work in a rehab facility, and I don’t like it. I do not like the paperwork required, my time management sucks, but most importantly I hate supervising CNA’s . I’m totally not cut out for that. I like being responsible for my work ONLY. Not to mention there are not enough CNA in the facility, so I end up changing residents and still have to pass medication. I don’t mind changing a resident, but I can’t do both. Having the BSN allowed me to try the other side of homecare- skilled visits. The VNA in my area only hires nurses with a BSN. I say get it just in case. What happens if private duty agencies require a BSN in a few years? What happens when you get tired of the low pay and want to earn more? At year 15 of working in PDN,that’s what exactly happened to me. I got tired of getting no raises, astronomically high health insurance, and not to mention my skills outside of Pdn were going “dry”. I felt like a new nurse all over again when I started working in the rehab center. WOW! was a Lifevest? Cardio net? How do I draw labs from a PICC? What is a bladder scan? I didn’t even know how to do a 12 lead EKG because we don’t really use any of those skills in Pdn.

I wasn’t the nurse who started the order. The IV fluid had already been running 9 hours prior to me arriving on shift. I didn’t write the order nor start the fluid. By the time I started my shift 9 hours had past already.

Thanks so much. Since Governor Murphy announced last week that healthcare workers must be boosted I assume this still applies to homecare nurses. He only mentioned congregate settings though.

Because the doctors do not like us to call them at night unless an emergency. I got written up for calling a doctor about a fall that didn’t result in injury. I asked supervisor and she stated the 1000 meant the volume in the bag. That didn’t make sense to me either.

IV 1000ml D5 1/2 NS 60ml x 24 hours I read it as D5W 1/2 NS at 60ml hour. Total volume to be given is 1000ml. However, 60 x 24 hours is 1440. So after 1000 was given I hung an extra bag to cover the 440ml

I can’t believe some people are justifying this. We have to follow standard precautions in homecare too. I am not wiping poop without gloves. Come on now….. I don’t care if it is a private client.

Homecare has an even more severe shortage of nurses than hospitals. Home care is brutal and low paying. My gosh the paperwork alone is painful. Oasis

Yes I know I wrote a silly word in the nurses note but that was a very stressful night. As a matter of fact, it was Christmas Eve

I got written up for saying poop. It was one of those nights and instead of saying” large, hard bm” I said “poop”. I just didn’t think it was a big deal. But apparently it was. The DON printed up my nurses note and explained why it was unprofessional. This is weirding me out. This is a place that can’t keep nurses btw.

In home care Pdn this hold thing is even more complicated. I had a parent that refused to let us nurses give her daughter with a trach and vent albuterol at night. That had been going on for months before I got there. Not sure of moms reasoning. When I told the supervisor if she could just ask the doctor to d/c the nightly albuterol she just said to keep initial it and circle it in the MAR, no need to call the doctor.I thought that was stupid, but hey she was the supervisor.

Love the article, but how about touching on the fact so many of us have to work two and three jobs to make ends meet because we don’t get paid enough? This is especially true of long term care nurses and homecare nurses. The nearest LTC facility to me is offering experienced nurses the same pay as new grads. How do I know? Once when I sent them my resume and went in for the interview, the ADON told me that. He told me that as soon as he greeted me.

So my patient has an order for Oxycodone 5 mg po every four hours for severe pain. They also have an order for tramadol 50mg po every four hours for moderate pain. I gave the oxy at 0300 for a pain level of 8. I went on break at 0330. When I came back at 0415, she said the patient was still in pain so she gave the tramadol at 0350. There is no order to stack pain meds that way. She stated it was OK to give. Who is right? In home care we had to have an order to do it that way. For example,a nurse I worked with gave ibuprofen 1000mg at 2pm and then turned around and gave tylenol 500mg at 3pm for pain. (Pt had orders for both, for pain) The homecare supervisor stated it was a med error because we don’t have an order to stack pain meds that way. She said the nurse should have waited the 4 hours and then gave Tylenol or called the doctor.

When a patient refuses a med, I just state patient refused.

At my facility night shift does 24 hour chart checks, where we look at the whole day and determine if an order was missed. So today, an evening nurse wrote that she noted the order in the physicians orders but she didn’t not place it in the MAR. It was a telephone order for a one dose order for Kcl 20mg PO. She told me in report she gave it on her shift. My question is, how am I supposed to write order that on the MAR if I didn’t give it? We still use paper charting at this place. I’m my previous nursing career in home are, I never had to deal with writing other’s orders nor doing 24 hour chart checks.