AnnemRN

I totally agree. You aren't stealing patients, it's their decision if they want to change agencies. As long as you're not asking them to switch agencies I see no problem.

"Military is even harder than civilian nursing to get into by a LONG shot. The pay and benefits are good and with the wars dying down the services are full. Minimum 2 years experience to even have a shot with the Army right now. I love when people suggest the military as a last resort when they have no clue what they are talking about. " Dranger, Your last sentence is unnecessary and comes across as rude.

Many companies are hiring for flu clinics now. It's not a long term prospect, but better than sitting home and will be something you can put on a resume.

The agency I worked for did require LVN's who had become RN's to have 2 yrs of hospital experience. The rule applied to an LVN coworker who had worked for our agency for several years, she ended up leaving until she got the experience required. The agency then rehired her.

I am so glad to hear this, PPV is a huge ripoff for nurses. I worked per diem for an agency that told me the mileage was included in PPV rate and wanted to send me to an out of town visit. I refused to go unless they paid me separately for the mileage, they finally gave in. I no longer work for any agencies that are PPV. I hope you win big.

I've had similar experiences where my agency sent me to discharge a pt "who was threatening to shoot the nurses." Thanks guys!! I also had a security guard who asked me to pick him up before we went into a very bad part of town to admit a known gang member to our service. The guard stated "I don't want any gang members following me home." I guess it was okay for them to follow me home. I agree that our safety is not always of utmost importance.

Honestly, the paper system was faster,but no more driving to the office to drop off documentation with the computer software.

Those are good points. Wound vac's require a lot of practice so, ask if you can do a few of them during your training before they cut you loose. I've also found that using lots of skin prep helps to keep the dressing in place.

I have made referrals to adult protective services if I have any concerns regarding patient safety even if the patient is being cared for. In the past, I had a pt who was being cared for by a live in caregiver. The caregiver kept her clean and fed, environment was clean etc. I just felt that the pt appeared fearful, but she wouldn't say anything negative. I made a referral to APS who followed up and it was found the caregiver was performing financial abuse. Caregiver had pt sign over all her property to him, it later became a legal battle after the patient died and I was contacted by an attorney. I would play it safe and make the referral and leave it up to APS to make determinations.

Here's the KCI website specifically wound vac application videos. It will help you with the steps, but it won't replace hands on experience. Wound Care Education and Training | KCI

Do you have your social worker and chaplain involved? The situation sounds dangerous, I would refuse to go back for safety reasons, but I am also worried about the patient being exposed to her unstable son. In this situation, I would definitely make a referral to adult protective services.

I think it's very doable if you're only seeing 3-4 pts a day and they are usually within 5 miles. Most agencies have you seeing 5 to 6 pts a day within a 25 to 50 mile radius. I think you're pretty lucky. It has been my experience that many times a paper system can be as fast or faster than a computer program.

You should ask bayada about their wound vac training also, contact KCI for their literature. Wound vac's aren't difficult, but changing wound vac dressings can be very hard on your back hopefully, they'll limit you to one a day. I worked for an agency that many times had me doing 2 wound vac's a day which is very time consuming. I don't have back problems, but my back was killing me by the end of the day.

First of all, I've seen this same problem in California. I mentioned it when I worked for the county, but no one wants to see the big picture - it's cheaper to hire not only new grads, but experienced nurses for these positions and retain them. I was told the county says it's cheaper to hire travelers or registry because they don't have to provide them with benefits. I'm not sure how much they think they're saving when the hourly rate for the agency/nurse is sky high. Once again, as stated in this article is the "nursing shortage". The public has been brainwashed.

It wasn't always this way in fact, when I graduated in 1990 the hospitals did "seek out employees". Every person in my class had a job with a local hospital before we even graduated. Of course, that is not how it is today. One of the problems I see is that nursing is constantly in the news as being recession proof and one of the best careers available. I know of so many people going into nursing because they believe they will have no problem finding a job and they will be making lots of money. The truth is, most places want someone with experience. The reason being it takes less time to train them which makes it very cost effective. Another thing, there are hiring freezes everywhere so, even though a job may be posted it may not be available for a long time. It makes me wonder why they post them at all. Very frustrating, I don't think I could hack starting out as a new nurse in today's world.

I've worked for agencies that use a scheduler and I fully understand the problems you're dealing with. I would approach the branch manager in person and tell her the scheduler created a scheduling conflict by telling the pt you would be at the home at 9am. I know you attached the scheduler's email, but I would approach the manager because she ignored your email. I would also let her know the ongoing problems you're having with the schedule and be specific. I would add that sending 2 nurses to the same location 50 miles away on the same day ended up costing the agency double in mileage and driving time. I think by focusing on how much poor scheduling is costing the agency will make her pay attention to what you're saying instead of her thinking you have a personal problem with the scheduler. I've had the same complaints in the past when I worked for an agency that had a scheduler and no real scheduling system in place. The nurses I worked with all complained before anything changed. We eventually changed to assigning pt visits by zip code and keeping the nurse assignment within the same or neighboring zip codes. It not only made the nurses happier, but it saved the agency a ton of money.

I completely agree with tewdles and EquestrianRN. You need to get out right now, I think you've already stayed too long. Manager's like you describe not only are detrimental to your career, but also to your self esteem. It's impossible to project self confidence and competence while being emotionally beat down on a daily basis. Cut your losses and move on. You will be able to find a better job and you'll probably wonder why you waited so long. Good luck!!

1. How many on-call shifts do you have each week? I don't do call now, but in the past was required to do call once or twice a week. 2. How often are you required to handle weekend on call duty? Usually weekend call would be once a month and only one day - either saturday or sunday, but not both. 3. What hours are considered on-call/afterhours? 5pm to 8am 4. What's the pay structure like? I was paid 3.50/hr and then it would be time and a half if I had to make a visit. 5. What area of the country are you in? California

I'm always leary about salaried positons because with HH you can end up with a lot of overtime that you will never get paid for. You could find yourself putting in a lot of hours on your days off to catch up on your documentation. I would want to know if you'll be required to do overnight call in addition to your other hours. I would also like to know how you will be doing your documentation ie; paper system vs computer program (will they provide you with a laptop or tablet if it's the latter?) another thing to ask is if they supply you with a cell phone or at least reimburse you and are there limits on the amount of reimbursement. You need to know how long your orientation will be and their expectations re: case load. Please don't forget to ask about mileage reimbursement which is currently 56.5 cents per mile. I find most of the time agencies make sure that they make the best deal for themselves and aren't necessarily looking out for the nurses they hire. Those are the agencies who have a large turnover rate.

I can tell you from experience as a former case manager that the once a month catheter change patient's did not stay once a month for long. I do think the caseload is extremely important as well as the acuity of your patient's. All the agency's that I've worked for require their nurses to make anywhere from 5 to 6 pt visits daily. You will see that many patient's even if your caseload drops as it's not uncommon for them to see other case manager's patients to fill in the gaps. The agency where I work now does not have a scheduler. Each nurse is required to schedule their patient's themselves.

Unfortunately, a lot of home health agencies are disorganized. A red flag should go up if a home health agency is constantly advertising for nurses,they are the agencies that give poor orientation and have high turnover rates. Thankfully (like Isabelle) I am also prn and about 99% retired. My agency's case managers carry up to 22 patients and they schedule their own patients. I know from experience that anything over 25 patients is spreading yourself too thin. There are a lot of agencies that have the case manager seeing the patient's only once a week or once every 2 weeks and have an LVN doing the bulk of the visits. I don't agree with this practice especially if the patient is experiencing complications.

It might be something in the intake department. Many agencies have only LVN's taking the referrals. The EMT might be some sort of assistant.

I don't think you'll have any problems making the transition from Oasis B to C. The differences are listed at the following website: About OASIS Answers - Links Choose the Oasis- B1 to Oasis- C crosswalk pdf to see the changes.

Absolutely!

I agree with you, since the cell phone use is business related the agency should cover the cost. I have a cell phone that is 100% paid for by my home health agency. I use it only for patient or physician related calls although the agency doesn't mind if I use it for personal use as long as I don't go over the allotted minutes. We should not be absorbing agency expenses. I've known too many nurses who have said their personal phones were costing them more because of patient related calls and the agencies were covering less. Agencies are more than happy to dump their responsiblities on the nurse in order for them to make more money. Thank god my agency treats their nurses right.