Jolly

renerian, I'm not educated on the Medicaid system, since I've never had to deal with it in any of my roles as a nurse. I understand, however, there are many regulations, and that recently, at least here in New Jersey, changes occurred in January that resulted in more regs and more cutbacks - which, I am sure, has created more work on behalf of the nurse. As far as how one is paid, the position I interviewed for is per diem and pays per-visit - there is a $10 difference between an admission and a repeat visit. Laurie

Can you please clarify 'outside case managers' - do you mean other services that may be in the household such as skilled nursing, PT?

Hi Ann, Thanks for your response. I'll try to clarify my original post. I recently interviewed at a facility that provides home health aide services only - the RN's role in this facility is to first, assess the need for HHA services, and then, once the HHA is in the household, the RN supervises the care given by that HHA. If I'm not mistaken, this facility accepts Medicaid only. The RNs do not perform skilled nursing - if the RN assesses that the individual is in need of a nursing skill, a phone call is made to that individual's MD, and a facility that provides skilled nursing is brought into that individual's home. As you can probably already tell, the paperwork is minimal; it seems like a good opportunity for someone who is employed full-time and needs to supplement their income - as is my case. Any thoughts? Laurie

Anyone familiar with facilities that utilize RNs for supervisory visits of home health aides ONLY and NOT to provide nursing skills/patient care? Can anyone give me information about this?

Adults - the majority of the clients are chronic, and their illnesses run from A to Z. Currently on the unit are people diagnosed with major depressive disorder with psychosis and suicide ideation, bipolar (admitted in the manic phase and is now stabilizing), schizophrenia, and dual diagnosis with heroin/ETOH/cocaine addiction. All ideas will be greatly appreciated.

I just started a new position with an acute mental health facility. One of my responsibilities is to hold an educational group for one hour each day. What are some ways you have held groups and taught your patients?

Thanks to all of you for your responses. I worked 3 - 11 several years ago, and, as I stated earlier, I had a very difficult time adjusting - getting home after midnight, raiding the refrigerator till 2 AM, sleeping till 11 AM or 12 noon, and then getting ready for work - I felt like all I was doing was working, eating, sleeping, working, eating, sleeping, working, eating, sleeping, working . . . . after about a year, I switched to 7 - 3 - - but that wasn't great either 'cause I, too, hate alarm clocks, and I really can't get rolling at that hour of the day. I now work an 8 - 4:30 nursing research position, but I am so out of my element due to very minimal patient care and contact - Soooooo, I applied for and was offered a psych nursing position on the 3 - 11 shift -- am so excited about the position and the facility (great working environment, great behaviorial-care unit, excellent reputation -- NO WEEKENDS! -- and psych is the reason I went into nursing), but I have been concerned about the hours and the fact that it is an hour's drive (was glad to read that two of you drive an hour each way - really am impressed by the one who has a change in time zones - that is different!). You know, I guess it's all in how you look at things - attitude. I AM in a different place with myself than I was several years ago, therefore, I think I can discipline myself to make the change. If not, I can always bid for the day shift after a year (and go back to an alarm clock? -- no way!!). Again, thanks - your input has helped.

Would really like to hear from those who work the 3 - 11 with regard to how you plan your days prior to going to work - do you sleep until late morning? do you do your errands? do you get the kids off to school and are home for their lunch? And, after work, do you find you can't get into bed and fall asleep until 2 in the morning, or do you crash as soon as you get home? I just want to know how other people handle this schedule . . . I find it quite difficult and somewhat disorienting, and just wanted some tips on how others handle it. Thanks.

Thanks Minty! That was very helpful. Laurie

I posted this on the dialysis nursing board, but there doesn't seem to be much activity there, and I really would like some opinions regarding this . . . First of all, is outpatient/chronic dialysis nursing considered a critical care specialty? If so, is there any nurse out there who finds this news to them? (as I did). Has anyone heard of critical care nurses not being able to "hack it" in dialysis? And, would anyone not recommend this type of nursing to someone without a critical care background? I am speaking strictly of outpatient/chronic dialysis. Thanks for your input! Laurie

Hey Hoolahan --- I lasted 6 months in homecare and left because of the lousy, stinkin', god-awful paperwork -- I spent anywhere from 4 to 6 hours PER NIGHT and every night documenting, documenting, documenting. What an absolute nightmare. When I left the hospital to go into homecare, everyone warned me about the paperwork, but I figured how bad could it be? OMG! - it's bad, bad, bad. Much happiness with the new career - can honestly say that I understand wanting the change.

I feel nursing consists of doing your job twice - first, you do it, and then second, you write practically every detail about it; I understand the necessity of it to promote continuity of care, but beyond that (insurance reasons, JCAHO, blah,blah, blah) is a major time waster. What other career insists that this be done? Without it, imagine how much more time there would be for patient care. . .