lilu678

I have no experience whatsoever with affinity or drug testing. This is mostly a related rant. I have drank tea with kava in it before, I found it mildly calming much like other herbal TEAS. That being said I do know a sick young man whose very sick (mentally) mother overdosed him with kava concentrate on a nightly basis causing irreversible liver damage. I find it strange that some would classify it as a hallucinogenic or hypnotic...it is a sedative with mild euphoric effects. That's from the DEA website. Any other addictive substance or behavior can also have euphoric effects.

Thanks Cate this is a helpful comment. I'm trying to work with this system. Also using Byram.

yup, this exactly. see my next thread about returning to work home health in a "bottom feeder" agency. they don't get any Medicare pt because they can't get reimbursed...and yet my work done in the SOC, OASIS assessment, narrative notes, creating care plans and case management remain the exact same effort (because ETHICS) even though my compensation is crap. Boss does not have a background in healthcare and is wishing for the golden age of home health when RNs would visit 75 patients a week (as he tells it). Pigs will fly before I visit 75 patients a week.

I am recently returned to home health nursing after a hiatus of 2 years. The agency I just started with is a smaller one and in the past two weeks I have learned quite a bit about the differences...this agency says they are Medicare-certified but we are mainly serving Medicaid and managed care patients. The reasons are quickly becoming obvious. There is a lack of clinical oversight and no billers/coders...the quality of the OASIS/Medicare data that is being sent out is not good enough to get reimbursed by Medicare. So we get alot of long term medication set-ups and mental health clients. My problem is with the wound care clients. I am a certified wound care nurse and take pride in my work. The agency has basically provided me with no wound care supplies whatsoever. I was given a few pack of non-sterile gauze (already opened!) and two small bottles of NS. I was told these supplies were "donated" from former patients. The reason I was given is that we provide the skilled nursing/assessments but patients must obtain their own wound supplies from a DME with a provider's orders. I am sure you all know that for Medicare patients this is untrue and HH agency must provide the supplies, since we are given lump sum payment for an episode of care. And my boss agreed with me and said they will buy some more gauze! But they will not buy any tegaderm, foam, alginate, xeroform, contact layers or any type of advanced dressing, despite the fact that these advanced dressing are in fact the standard of care in many cases. For the Medicaid patients its even more grim because although I do have experience with getting providers to order DME, this is a process that can take several weeks. This can seriously impact chronic wound healing, as they could become infected or colonized while being sub-optimally treated with gauze or worse. And a smaller wound such as a skin tear or surgical wound could be healed with proper application of moist wound healing principles in the time it takes to get the supplies. I do understand that the dressings will not "heal" the wounds and many patients have other factors that are in fact more important such as nutrition, pressure relief, compression/elevation etc. Wound care supplies were sometimes an issue at my former agency, and occasionally I would have to argue with someone at corporate about how Kerlix + Coban is not the same thing as two layer compression wraps. But I never imagined I would work somewhere that provided no wound care supplies to speak of whatsoever, and that even when my boss admits they should order supplies for Medicare patients they will not provide anything to Medicaid patients, thus creating a two-class system of patients? America, this is getting really grim! We need a Single Payer System now. But in the meantime, does anyone have suggestions for how to get my patients some decent supplies? Or how to convince my boss to at least stock some Standard of Care supplies? Oh, and also no provisions of PPE and standard precautions beyond VINYL gloves. No chux, no bag barriers, no alcohol wipes, no Cavi wipes, no gowns, no masks...the nightmare just continues.

Dear Beats per Minute, I am so sorry to hear that you are struggling because I think you are a really great nurse! I am going to share my two cents from years of struggling with people pleasing, burnout and other codependency issues as well as professional experience working with people with severe, disabling mental health, trauma and substance use issues. 1) Medications can help, but they won't be the only answer. You work in a stressful, high paced, socially fraught environment. You have a history of trauma. The right combination of meds might improve symptoms and mood stability but will only be one "piece" of the pie. The system is broken and we are all working in it...on to the next bullet 2)You are not broken and don't need to be fixed. You are an amazing person who has been through hard things, and for some inexplicable reason other nurses are bullying you (immature). 3)Get honest with yourself about what you like and don't like about jobs you have had. Zoom out and take a macro view. Don't like working with petty, immature nurses on the hospital floor? There are positions in home health care, occupational health where you will essentially be a "lone wolf" and rarely have to interact with other nurses unless desired. You can focus on the patient, trust yourself, communicate with the docs and do your own thing. I am sure other members here have great alternate career suggestions. 4)Get the best treatment you can afford for your top issues. I received mentorship from a yogi nurse in nervous system regulation and burnout that was incredibly helpful. I attend regular family support meetings to help myself as a child of and spouse of an addict. Recently, I went through a round of hypnotherapy with another nurse coach, this time focusing on issues of self-sabotage and self-doubt. Unfortunately none of these treatments were paid for by my insurance but they have been literally invaluable and helped me not only in my personal relationships, but with overall life satisfaction and workplace issues as well. Wishing you luck and myself as well. It's hard out there why not be kind?

I moved to California about 4 years ago with 2.5 years of LTC/Skilled rehab under my belt. While I found it impossible to break into the hospital environment out here I have had no trouble finding other types of RN jobs. I have worked in Summer camps, home health, worked for an agency supporting homeless individuals, consulted for an adult day care program and also worked in an LTAC. Try to be flexible and imagine diverse roles for yourself, especially if you don't want bedside. Case Management by nurses is exploding in popularity, you can get certified in this as well to boost your hirability. Clinic nursing might also be a good fit for you.