rnkalee

1) Are you profit or non-profit? For Profit 2) What is your pt case load? What is your census? Census 60. Caseload 10-14 per RN 3) Do you have an on-call staff?Yes, two full time RNs. They work 7 on/7 off. Starting Monday at 1630 and ending the following Monday morning at 0800. The case managers rotate through back-up call, so about every 6 weeks they are on back-up for 7 days. 4) If you take call, how are you paid? By visit, per hour, salary? Full time on-call are salaried. Back-up case managers get paid their hourly rate starting at the time a call comes in. 5) How much do they pay you for your visit? Is it more for death visit? See above. 6) Do you get paid if it is just phone calls? Yes. $1/hour to carry the pager. 7) How many on-call shifts do you have to do a week/month? How many weekends? See #3. We also have a holiday rotation where everyone (including full time on-call RNs) are included. 8) How many nurses do you have on-call on a given night or weekend? One primary, one back-up and one administrator (who covers multiple offices) 9) How is your on-call scheduled? Does your supervisor schedule you? Do you self-schedule? Supervisor schedules.

I have a 5 month old and have been back at work and pumping since she was 6 weeks old. A few tips...get your pumping supplies ready ahead of time, assemble to bottles, put on the tubing, etc. Take a picture or two of your baby as well as a piece of her/his clothing that smells like her for letdown purposes. This helps make the process faster so you can decrease the time you're away. Ask around your unit to see if other people have pumped in the past and look to them for support. I've found it's best just to say to your co-workers, "hey, I have to go pump right now, would you mind covering for me?" I haven't had anyone say no yet. When I first went back, I pumped three times in a 12 hour shift but that quickly got to be unrealistic so I am now at twice a shift and it works for me. I feed the baby on both sides right before I leave for work, pump around 11 and again at 4 and then feed her as soon as I get home. Fortunately, I work in Labor/Delivery/Post-Partum so it's really the perfect place to be a breastfeeding working mommy. I either pump in one of the physician call rooms or, if I'm on the post-partum unit, I pump in one of the two breastfeeding rooms for the intensive care moms. Like someone else said earlier, make sure that you pay it forward and help out other mommies in the future. Also, for now, make sure that you go above and beyond to help your co-workers out when they need it, so they are more likely to want to help you out when you need a pump break. Good luck and congrats! karen

I'm about to finish my 12 weeks of training in L&D/PP/Nursery. I've had an amazing preceptor who has taught me so much and been very supportive and I want to show my appreciation. Is it ok to get her a small gift (like a restaurant gift certificate) along with a card thanking her. What do you think? karen

Thank you...for both your information and your well wishes! Women's health has always been my passion and I'm hoping to jump into this specialty soon! karen

I'm an RN looking to change from my current specialty into maternal-fetal medicine at a local clinic. I found information from the National Certification Corporation offering credentialing in areas such as EFM and RNC. Is this a valid program? I wouldn't qualify to do the RNC yet, but am interested in EFM to gain more knowledge in this area. Before I speak with my prosepctive employer about this, I need to know if it's a recognized certification. Thanks! karen

We take call apx. every 6 weeks. We get paid $1.50/hour base pay just to carry the pager. Then from the minute we get paged until the situation is resolved and we are back home (whether that be phone calls, responding to a patient in need) we get paid our regular hourly rate. We also get paid milage door to door. We used to get paid $65 for each after hours admission and $50 for each after hours nursing visit (less for the LPNs) but that has thankfully changed. There is also always a secondary back-up nurse on call who gets paid $1 per hour to be back-up but rarely gets called. Forgot to add, we are on-call from Friday 5pm until the following Friday at 8am. If we go over 40 hours of work, the additional hours are paid at time and a half. We do *not* do scheduled visits. We are all either case managers, LPNs, or the admissions nurse (me). karen

Thanks for all the thoughts...here's some additional info: Her edema is +4 in her feet, but only +1-2 in her calves. Pt refuses lasix because she has to constantly transfer herself to the bathroom and it interferes with her life (again, she has CP and additionally she continues to work full-time, believe it or not). We have done pressure stockings and fluid restriction which has decreased the calf edema (which used to be +4 bilaterally). She also keeps her legs elevated in her wheelchair. She has two open areas that were blisters that opened. One is about 3 inches in diameter and the other is 2x1 inches. Currently she is being treating with just ABD pads to legs and keeping open to air at night. Prior we were doing unna boots and kerlix. Prior to that it was unna boots wrapped with Coban and kerlix. I'm going to request an antibiotic in case of cellulitis. She is also now having neuropathic pain in both legs/feet for which she now has gabapentin. Thanks again for all the help!

Who do you contract with for a wound care consult? A local hospital? Like I said, I'm new at this and no one in the office has mentioned a wound care consult, although it sounds appropriate to me. Patient has seen her primary care MD for the wounds once, he was the one who rx the unna boots, but basically told us he doesn't know what to do so we can do what we think is best.

I have a patient with breast cancer with mets to the liver. She was also born with cerebal palsy so she's wheelchair bound. She has edema in her lower legs and feet. Within the past month she has developed blisters on her calves that leak clear fluid. The largest blister is about 3 inches in diameter, the smallest is probably 0.5 cm. Originally her MD had her in bilateral unna boots which we changed twice a week. She covered the unna boots with kerlix but had to change it frequently because it would be soaked. Now we have discontinued the unna boots because they don't seem to be helping but she continues to have these blisters and extreme weeping. I've tried silver-impregnated products, I cleanse with wound cleanser every time. Now they are wrapped with ABD pads and changed frequently. The weeping is very odorous and the patient is miserable. It doens't seem to be getting better, only worse. Please help! I'm a hospice newbie (only 5 months) and am tapping into the resources of other nurses with more experience but we've not been able to really help this woman. Any ideas you have would be great!! thanks karen,

I saw a home patient yesterday who had a new pressure sore on her little toe. She requested Duoderm and I had some in my car so I cut some small ovals, applied one to her toe, and left the remainder for her to use. I charted a progress note on it. My D.O.N. said that I should have gotten a physician order before applying the Duoderm. She said I was practicing medicine without a license. Is that true?? I come from an neurosurgical ICU background and could use supplies such as Duoderm as I saw fit so this was news to me. Thanks for the help! Karen