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coco3299's Latest Activity

  1. coco3299

    Time to step down from management?

    I love my job and made a natural transition into management from a staff nurse to lower level management (supervisor) to finally manager. The reason why I am going to be leaving (aside from the fact I have a new degree I want to put to use) is that we have spent the last 4 years talking about the same thing and circling the drain with the same issues! It is almost nauseated to sit at mandatory meetings where voices are not heard and the agenda of investors and shareholders is priority but if the just listened to 'the people' they would realize even greater potential of not only money but employee and customer satisfaction. We have taken on a mentality that everyone is expendable and work good people until they quit and spend time and money finding new people instead of just preventing that from happening. My job has been really supportive and I have done things I always wanted to do (get better at being a leader and managing and organizing processes) but beyond that there is little room for opinions on how to make real change work. I've seen so many people come and go I am tired of picking up the slack, training people, answering to why something impossible didn't happen. Companies need to learn the difference between lifting their 'lid' and being delusional.
  2. coco3299

    Nurse Injector

    I'm here looking for corporate owned places that may be in ga other than American laser but you should try there on their site go to ABOUT and search careers they have some states hiring, not mine though.
  3. coco3299

    Obese patient with lymphedema to legs

    So the long story short is I have an obese pt who continues to insist she was told in home lymphedema therapy is available for her. I am home health nurse and we only do compression for wounds and then pt is offered long term option such as compression socks they can manage alone but we dont do long term swelling management only heal wounds. So my question is 1. Does Lymphedema ever go away? What is long term goal for pt with lymphedema? 2. Is home health used in such situations, again she is morbidly obese and I think this is her main problem rather than lymphedema. 3. How could this pt even have ABI? 4. I am not even sure her large legs could be compressed if her ABI was satisfactory. 5. She has no caregiver and 5. Cannot go to outpatient clinic but primary MD is frustrated with her and MD has offered to write orders if home health can assist. I have discussed with CWOC over phone but went back to order joint visit but over phone she stated this would be unlikely for pt and Lymphedema is usually managed by clinic where pt is seen often not home health where the pt only sees MD sometimes once a year. Pt even states clinic did indeed tell her this about being able to ambulate to clinic often but again she says they told her home health can do this but offered her no company names which lead me to believe she is fibbing and refusing to accept responsibility for her obesity.
  4. coco3299

    Stage 3 with undermining

    Hey guys, thanks for any help in advance... I am a home health nurse and while I was in orientation I was seeing a patient who is very pleasant and concerned about the wound. It has gotten to a certain point, like 4x2.5 and undermining and stopped healing. THe patient is only 80 lbs. Iodoform has been used with mesalt for quite some time. It was SLOWLY closing last I saw her but I had to change areas because her regular nurse was back off leave. SHe was none too pleased to have that nurse back and I am finding this nurse may not be as into such patients as this one (and one other wound pt) as she should. Recently at team meeting she said the wound was in DECLINE again. Ugh. What can be done for this lady to see what the problem is, she lives a sedentary lifestyle but will stay off the sacrum if requested, she says she doesnt know and does not know why this year old wound is not healing. When a wound is anemic, what does that mean exactly and how can you know for sure? Does silver nitrate have usually good results? When is mesalt used? How long should one dressing be used?
  5. coco3299

    Hospital Recomending Pharmacy

    So in addition other seriously illegal concerns I have with one particular institution, this has now surfaced. To add to their work load they day nurses (well all, but mostly will effect day shift) will now have to ask the patient upon d/c if they are interested in having their script filled at a certain pharmacy located near the hospital. If yes, then the nurse is to go through this new process of notifying the facility's pharmacy and they will then contact the neighborhood pharmacy and have the scripts ready to pick up within the hour. I mean, doing this in light of transportation or availability of a pharmacy per the patients concerns facilitated through social workers as usually in their scope of practice is one thing, but seriously asking 'hey, would you like to use xyz pharmacy around the corner' seems strange. Immediately I was thinking how un-ethical this conflict of interest is. Then I was wondered who's pockets were gonna get fatter from this deal with the large pharmacy chain? Anyone else experience something like this? Doesn't Medicare strictly forbid things like this? In addition to Medicare who else? I remember in working with home health patients had to understand they had the right to choose whatever company they wanted regardless of outside influences. Is this unethical or what?
  6. coco3299

    entering ipn

    LOL, I find this info hard to believe about CALI. The facts are the facts and the evidence is evidence. How do you know that you won't encounter this problem in FL even if it is occasionally, you will inevitably be tested, then what. Find out why you keep testing positive and get a lawyer. Good Luck.
  7. coco3299

    Recreational THC = now starting IPN!

    Good for you
  8. coco3299

    entering ipn

    A. You need a Lawyer B. There are several websites that indicate ETG cannot be used as a SOLE determinant in deciding if you were drinking. I read a newsletter a while back from the Alabama Physicians something that basically sent out a newsletter about this. I know its stressful but if you are not drinking something is going on and you need to stand strong and fight the powers that be. Nothing has been easy in the IPN I am sure, and this is just another obstacle. C. Florida sux! They will take you through loops no other state will. I would do everything I can to stay in laid back Cali as opposed to down south, old school, Florida. I let that license go because of their rediculous demands-asking me to do psych evals and the whole nine yards all over again and I havent worked there in years!!! Never even renewed after my initial stent there!!! They are rediculous, but I think the housing market is crazy too, so I feel you situation. Try, try try is all I can say. Good Luck.
  9. coco3299

    Licensure by Endorsement States and RNP

    So they endorsed it when they got good and ready, but did they make you do a probation all over again?
  10. coco3299

    Licensure by Endorsement States and RNP

    OK, thanks for the replies, but to be more specific- what if the endorsed state is contacting the nurse while she is on probabtion in the orginal state asking for a large sum of money and to be evaluated by a psych and the whole nine yards, when this is something nurse has already done in the original state. Even saying she has to be eval in person by their board. The concern is that they will try and initiate their OWN RNP type monitoring even though the nurse is near the end of her 'monitoring.' I was just wondering because we were discussing this at work and I dont see how someone can be tried twice for the same crime sort of. Was wondering if anyone ever had to do that. Will the endorsed state accept the original states paperwork or make her do probation all over again? I mean its pretty finite to give up a license altogether even if she hasnt worked there in 3 years and never renewed.
  11. coco3299

    Prescriptive Authority

    So I live in La and a few of my friends are considering FNP. I am juggling the idea at current. But the LSBN website seems to indicate the need to work as an APRN first (500 hours) before applying for prescriptive authority, or am I reading something wrong? How does this work in your states? I thought writing scripts came with the territory. So is it common for APRN to work in areas where writing scripts is not usually necessary? Any help in understanding this for down the road is welcomed. :)
  12. coco3299

    giving report to rude nurses

    You must realize that this nurses attitude had nothing to do with you. It happens more often than one might hope, but hey its her license if she wants to sign orders she has not went over with you. If you feel really pressed about it talk to your supervisor and request to remain anonymous but arguing with this nurse is going to be a waste. She has a problem and it has nothing to do with you!
  13. coco3299

    Scheduling and shifts in other hospitals

    Yes, my last few jobs have been self scheduling as well. It is great, being that I am usually PRN (and there is a shortage at every hospital imaginable) I schedule the minimum six and pick up the rest when I feel like it.
  14. coco3299

    Dialysis Transport

    Thanks for replying. My question is what percentage of dialysis patients have you seen that are a)ambulatory, just needing transport for one reason or another or b) in a wheelchair, not obese. Thanks.
  15. coco3299

    Scheduling and shifts in other hospitals

    I have worked in Miami, Atlanta, and New Orleans and all these places require 12 hour shifts and its either day or night, no swinging with every other weekend required. I usually work per diem which requires 3 weekend days with a total of 6 shifts per month. I can't imagine working 8 hours again let alone swinging. How is the pay?
  16. coco3299

    Dialysis Transport

    Thanks krups. Do you think the patients pay for this service or their insurance is billed?