Mel in MO

I work as a Healthcare Specialist for a DME right now, and we can't do that. Medicare has specific criteria for 02 and other equipment, and they require a desat of If we don't have the qualifying testing, and the patient is set up anyway, they will have a 'heart condition' when they get the first bill. Of course, that's here, in the heartland of the US. I realize this is an international board, so it may be different in your area. Smiles, Mel

This is long, and if you don't want to read the explanation, just skip to the last couple of paragraphs for the value and warnings when working with DME's: I am an LPN working (slowly) toward my RN. I was a charge nurse in LTC, but changed to a more "family friendly" job with a Durable Medical Equipment supplier. Actually, I dearly loved the other job, with wonderful residents and the use of a wide variety of nursing skills daily. I changed because of staffing and admin. issues. (12's and qo-wkend, but w/ no-shows and falls, you stayed into most nights, unable to go home). They have gone through several other nurses since, and I hope have fewer no-shows now so those who come are actually able to go home at some point. My husband was having some serious health problems at the time, and my son needed me to be home at some point during a day. Anywho, I basically quit (switched) before my family quit me. I went to an interview with this supplier for a position called "Healthcare Specialist". You have to be an LPN, RN, or RT for the position, with current licensure. (More on that later.) Listed as M-F, 8-5. In the interview, they said that I would be part of the "sales" staff, but with a focus on pt teaching (COPD, CHF, O2, Cpap, BiPap, nebs, etc,. for all ages), which is their version of increased customer service. I was told I was to do all Cpap and Bipap set ups, and may occasionally need to do an 02 or neb setup if it was a ped, I was on-call, or the 02 Tech (delivery guy) couldn't. Not real often. But my main job was to be overnight oximetry and helping with compliance, and overnights would be contributing to "Oxygen Growth", which is the meat and potatoes of the company. I was told there may be an occasional later evening if a BiPap went down or I was on call, but mostly would be 8-5, and that I could keep my trips logical, clustering as much as possible to keep mileage under 2000 miles/mo. (all that's reimbursed). Okay, it sounded great, and paid a few dollars/hr more than the other, and I LOVE pt education. So I switched. Who wouldn't? Of course, I never get home on time, got in at 8 pm last night, it's par. After the first month or so, I was told that I would be doing ALL O2 setups, and almost all neb set ups, because the manager had gone to a seminar, and I needed to do them so I can do a full assessment. ( I questioned this, and was basically told, you will, or you will be fired). Lugging the concentrators across rocks, stairs, and through the rural landscape of our clientelle has killed my back (no good body dynamics work on those suckers!) The normal nursing compliance rules were kind of poo-pood by my manager, because they have their own strict compliance, due to abuse of insurance and such of these companies for years. I was told that many of these things needed to be done by a "licensed" personel, then found that the state board of nursing actually considers this to be working "outside of my scope of practice", which I find terrifying! They don't even have to consider it and renew my license if they don't want. I drive whereever they tell me to, sometimes a few hundred miles a day over several counties, with no logic allowed. And all of this I can live with. (Okay, I have aps out, but I can live with it for a while ) I'm threatened almost daily with 'discharge' if they don't have at least 5 new 02 pts a month, and I'm supposed to find these people amongst current customers with the company. If they just don't need 02, I still get in trouble ("you just must be doing something wrong". A true quota-sales position, not a nursing focus! What concerns me is the attitude. If you are a nurse in a hospital or Dr's office, you will have salesmen come through. And they will have some real value to offer you. Our company has great pt education (I know, I spend WAYYY longer than I'm supposed to making sure pts are completely comfortable with why and how to use their equipment That is a wonderful part!) Our COPD and CHF programs are comprehensive and excellent. There is also a pharmacy program for neb meds that delivers to the home, and Medicare pays for them (unlike a lot of inhalers these days). And the overnight oximetry can really tell a lot about heart rate and sats in a home environment, which is much more realistic (with deeper sleep) than office or hospital may tell. And it is usually free or nominal to the pt, and easy because we take it and pick it up. So it's not all bad. If a pt needs 02 or other equipment, REALLY needs it, they are catered to, because they can change companies easily, and take their insurance money with them. There are several companies in our small town alone, so it's very competitive. Early intervention with CPap or O2 has been shown to improve or lower risks of CHF later, by taking strain off of the heart. BUT: please understand that we often retest and retest these people, some every 30 days! And if they qualify, even by a second, the push is on for an 02 order, hard. Especially those on CPap and Nebs. And they could just be having a bad day! I know we have people on 02 now who just have a cold or who's asthma was active, but 90 percent of the time, they are fine. And once they get 02, it's VERY hard to get stopped. A doctor's order to d/c will do it, but they don't do it often, because they ordered it, or to avoid liability. Any one of us may have 02sats under 89%, cumulative, over the course of a night, if we are having a bout of bronchitis or something. Those are the patients I don't feel good about. And when they feel better, and want to d/c, comments like "whatever, they think they grew new lungs" are made. So, use DME's like another diagnostic tool, a warehouse for supplies, etc. And pick one who gives the best customer service. But know the goals are the same, and don't let them push you. They come across as "medical" but they are, always, "sales" at heart. Doesn't mean they don't care, but they have pressure from corporate on a daily basis to make numbers. I'm hoping I get a call back soon, but live in an area with few nursing jobs and plenty of nurses, so it's taking a while. Prayers will be answered, I'll end up where I'm supposed to be. Probably did this time, too. I have some wonderful patients that I care deeply for. Just wanted to confess here, and give a head's up. Smiles, Mel

There are no stupid questions. And if my airway were obstructed, I certainly would prefer that you had taken the time to ask . If not, you wouldn't be the only red face! It is actually a very simple and complicated answer... It depends on what the problem is with the airway. Are they choking? Remove the object, do the Heimlich, get them to where they can get a trach or suction on them. Have they just stopped breathing? Do rescue breathing, bag them, get them vented, whatever it takes. Is it an asthma attack, or are they anaphylactic? Get them epinephrine, steroids, or their rescue inhaler (if they have enough air to take it in). Bottom line is, no matter what it is, you have to keep the oxygen flowing to the brain before you move on to anything else. It sounds obvious, but when you have someone just 'falling apart' on you, you really do have to prioritize that specifically, and very quickly. Good luck, and keep asking questions :) You may be my nurse some day, and I want you to know! Smiles, Mel

I've thus far done Home Health and Geri Psych nursing. Most of my Home Health were geri or long-term chronic. I stopped mainly because of the way they paid (screwy company), and the smoke in the homes (Love them COPD/O2 via NC clients!) Now I work for 8 or 12 hr shifts (in theory.) When I went to nursing school, it was with the specific goal of wanting to work w/ geriatric people. I hate to, but I have to take breaks, so I just leave my hall to go hold hands and get smiles from the geri people on the other halls. My favorites are always the "problems". The ones who yell, the ones who are angry a lot, the ones who are miserable. We lost a two this past week, and I was happy for them. I have yet to shed a tear for any of them when they have passed on. They've earned their peace. We get hit, kicked, and spit on pretty much every day at some point. And we get hugs and kisses and Thank You's even more often, if we stop long enough to let them. They have psych issues, but they also have the same health problems of 70-90+ yr old people everywhere. It's just harder for them to understand, and harder for us to help them at times because they don't understand. And 8 hr days turn into 15 hr days with all of the paperwork, and falls, and emergent issues. Most of the other nurses here are so.....competitive? Overworked? Burnt out? Tired? I say 'most of' not as a generalization, but because I can run a mental checklist and only think of 4-5 out of 25 who really show any love for the people they are there to help. But I'm really and seriously just honored to be there. And when I come home covered in every body fluid there is, most of it put there on purpose, and have to go back and do it again tomorrow (probably for way longer than 12 hrs), I will, with pleasure and passion. I DO have bad days. I did yesterday. And my family is kind of over it, because we can't plan anything, because I can't pass ANYthing on to the next shift, even stuff that happens 5 mins before the end of your shift (they won't do it, and they'll tell you they won't!). But I'm off today. And I'm just dying to know how everybody is. I hate to leave my "people", because I have come in and found them bleeding all night after several falls, blows to the head, bleeding from the eyes, and just sitting in a chair in the MDR, given a couple of Tyl ES for pain. My CNA's call me at home to see if I can come in and "Do Something" at times like that. Because it's a pain in the butt and lots of paperwork to transfer, and the hospital doesn't want to deal with them, either. My husband asked me last weekend whether the other day nurses leave on time. I said "For the most part". He asked "How?" "Because they just leave, no matter who is bleeding or what is going on.". He said "Then you need to do that.". My answer: "When I can see a person who trusts me to help, who is bleeding or sick or unable to breathe well, and I just leave.....I will quit. I wish they all would." He also says that he wishes he could find something like I have, that he could feel so fulfilled and passionate about. So he is getting over it. If I can come, I come. If not, he is learning to go anyway. I wish I had pursued drama and acting, it was my first love. But I didn't. And there aren't a lot of parts open for an overweight 40 yr old ingenue... Or my second, but I never learned to play guitar, so I can't really go for the rock star thing....So Nursing will have to do Good luck. I hope you find your passion. And there are SO many kinds of nursing, if you aren't passionate where you are, try another area! I'm going to keep working toward my masters in rural family health, I want to be a small town nurse practitioner eventually. But I'll be happy where ever I am as long as there is a glowing wrinkled face smiling up at me! Mel:nurse: