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  1. Traveler

    RSD Opinion????

    Also be very careful before you assign these patients as having "psych components" to their conditions. If you had pain so severe that even a gentle breeze blowing could send you into screams of agony yet many people dismissed your pain and no medication could control it- don't you think you would develop issues? I certainly would.
  2. Traveler

    Is a DON position realisitic?

    I don't think that every RN who has excellent clinical and assessment skills makes a good DON but I do think that every DON should have some experience out on the floor and needs to have good clinical and assessment skills. In LTC there are usually not a lot of other RNs to go to if you can't get an IV started, foley in, line flushed. There aren't doctors routinely making rounds that you can request to check in on a patient who may be going into CHF crisis. It is most helpful if the DON can function well in situations like this. The DON is going to lose a lot of respect really fast if unable to perform clinically and it is not a benefit to the residents either. Of course the DON needs to have good leadership skills as well, but the clinical skills need to be there first.
  3. Traveler

    Pay per visit or Salary? Which is better?

    Patient acuity seems to be increasing. I have done per visit and salary and would prefer hourly then per visit and then salary. I have had WoundVac visits take several hours, complicated IV visits take 3 or 4 hours, completely overwhelmed family members with very sick family members. You have to stay and do what you can. I think salary often gets the VERY short end of the stick. It seems like many agencies are reluctant to pay hourly but I think it is the most fair for all involved. Just my opinion from 6 years in the field. Ann
  4. Traveler

    Anyone else thinking of leaving home health?

    After doing home health for six years for two different agencies I just turned in my 30 day notice last Friday with mixed feelings. I am burned out and I don't want my patient care to suffer, ever, because of it. I have always taken excellent care of my patients and been the most productive nurse in the office. I have just reached the end. The paperwork is tremendous. I am tired of taking it home night after night. We are required to do our own coding and I sit and look through the coding books and do my best to get a case mix on any patient that I can to increase reimbursement. I try to do the best job I can. Problem is, I don't feel like this is recognized or appreciated. During the time I worked in hh I went back to school and earned my BSN and am now working toward my MSN with a focus in education all on my nickel. The company did not even recognize that I did any of this. The CWOCN certification has interested me and I asked if the co. would support me in getting this (it would benefit the co. greatly) and I was turned down flat. I feel like there is no upward or even lateral mobility with my company and I'm sure not recognized for the job I do right now. I'm also getting so so tired of hearing about everyone's ailments and having to go through all of the cabinets in the house to get all of the meds together. I'm tired of getting wet, cold, jumped on by dogs, chased by roosters, having to watch for meth labs, etc. I'm tired of 6 years of one week on call a month and having to go out at all hours to strange places. I may go back to hh one day and I have some wonderful memories of it. I am such a better nurse clinically because of home health. My assessment skills are superb now and the way I interact with patients has changed because of home health. I need to get out now before my memories become bitter. Ann
  5. Traveler

    Pay per case

    I hope someone here can give me a little guidance. I have been offered a job to do some part time cm. This is for patients in a relatively large geographic area who would be receiving services in the home instead of a nursing home. I would help to coordinate these services intitially and monthly would call to check in on them. Every 90 days I would have to make a face to face visit. This is really more of a sw job, but they require a RN. I have done hh in the field so I know the pitfalls of being on the road. Now, I will be home-based for office work. They will supply me with a computer and a phone line. I will get a flat rate for each case. No mileage, etc. So, hypothetically, if I have 20 cases then I will be doing 20 visits in a 3 month period, 40 phone calls and will get the rate times 20. Am I understanding this correctly. What is a rate that I should be looking at? This is a rural area and we're probably talking a 75 mile radius with patients being pretty far spread out. Any advice is appreciated. I want to go in with my eyes wide open. Ann
  6. It sounds like the norm in hh to have messed up paychecks. When I started with the company I'm with now 2 years ago I was paid per visit. Should be pretty simple to figure out right? Not, the checks never matched but I knew about what the amount should be and it was always close. Now I am salaried and, except for my call time/call visits, and cell phone reimbursement, my check should be easy to figure out- not. For some reason it is still divided up by different types of visits and now travel time and office time. So far the checks have been off but in my favor. Is it possible they pay more if we exceed our quota? Ann
  7. Traveler

    Average # of visits

    I have been with my present agency for 2 years and have almost 6 years in hh. The field nurses are salary and we also are the case managers for our load of about 25 patients. The cm takes additional time, but we are still expected to get 25 points/week. Admission-2, recert/ph/dc-1.25, sn visit- 0.75. We are very busy and they do expect a lot (we also have to do all of our own coding), but they pay very well for this area. I have 9 patients tomorrow (2 labs, 6 regular visits, and one recert) and that is a pretty typical day. Ann
  8. Traveler

    What's Vanderbilt like?

    I live in East Tennessee, but spent about a month at Vanderbilt with my 11 year old daughter this spring. Obviously we were not in the NICU and I can't speak as a staff member, but as a parent. The facility is beautiful- one of the nicest hospitals I have ever seen. It is very family friendly. The staff that I spoke with seemed very happy there and they had spectacular continuing education opportunities. My daughter was in 4 different hospitals from Nashville to Knoxville to Philadelphia for 2 months, so I have seen the nursing care at a variety of places. The nurses at Vanderbilt were the best of the 4 hospitals that she was in. It is a teaching hospital, so the doctors and nurses are on their toes, see lots of interesting things, and are very professional. Children's Hosp. of Philadelphia seemed to do more hi tech and new stuff, but it is a much larger hospital than Vanderbilt. Ann
  9. Traveler

    I feel like I'm always working...anyone else?

    I have been doing home health for almost 6 years now and still love it although I too experience some of the drawbacks that you were talking about. It is hard to separate work from home, especially if you take call. We take call one full week out of every month. I have coding books at home because I do most of my paperwork at home since the office is too distracting for me. I usually spread out after everyone has gone to bed. My daughter, who is in sixth grade now, said to me the other day: "I don't remember a time when you didn't do paperwork at home." I have found that using my time wisely helps. If I know that I will be taking one of the kids to the doctor, waiting for them during and activity, etc. I bring my paperwork with me- it seems like I always have my nose buried. But, I love being able to be on the road and not be trapped in a building all day, so it's worth it- at least for now. Ann
  10. I am interested in hearing from those in the field which case management certification I should look into obtaining. I did a quick search on the Internet and see that there are several out there. Which one is considered the industry standard? I have done case management in several home health positions for over five years, but have never bothered to look into the certification. In browsing around for jobs, I see that in many positions the certification is desired. Any thoughts? Thanks, Ann
  11. Traveler

    University of Phoenix MSN Program

    It is hard to double up on classes, but I did do it with some of my BSN classes with UoP. I always participated in the teamwork and was usually one of the two on the team that did most of the work- very frustrating. It was difficult to double and I did have to pay some out of pocket. I went everywhere with either paperwork from work or reading and papers for class- every school event I went to, every spare moment I had I was taking full advantage of. I have two childre (11 and 13), work full time 32 hours a week in home health, and usually drive in excess of 500 miles a week. My schedule is pretty full, but I always take my classes very seriously and participate in all of the group work. Ann
  12. Traveler

    University of Phoenix MSN Program

    I finished my BSN in March of this year and it is a hard program. I overlapped classes for about the last 6 months of the program and actually finished while staying in the hospital while my daughter was very sick. It was tough, but I wouldn't have been able to do that in a traditional program. I had planned on starting on a FNP/MSN program this summer, but my daughter remained very sick and was in and out of hospitals for a total of about 60 nights inpatient. So, plans got put on hold. After the experience with my daughter with the mis-diagnosis, etc. I decided that I wanted to now concentrate on teaching (I can always decide later to get a postmaster's NP). She has reflex neurovascular dystrophy and we ended up with the top doctor in the country for it at Children's Hospital of Philadelphia. The other children and parents in this program all had the same story as ours of mis-diagnosis and worsening health and tremendous stress, pain, and financial burden. The only thing different about our story was that Samantha was diagnosed and treated relatively quickly compared to most. Anyway, I decided that I want to teach because I think nurses are the ones who have the most potential to impact our healthcare system. I am starting in the MSN/ED program on August 29th. I am going to try to get done in a year and will just have to see if that is do-able. Ann
  13. Traveler

    RSD Opinion????

    This is one that means a great deal to me. My daughter had several sore throats on and off until Feb.11 of this year when her voice was gone and the pain was severe. The doctor noticed a goiter to she had u/s that showed the r lobe was larger. All other thyroid tests normal. Then we went to an endocrin. who said it wasn't her thryroid. This whole time the pain is spreading to encompass her whole neck and she's losing weight because it is too painful to eat. ENT admits her to Children's Hosp and does laryngoscope after which I am told "she has selective mutism. She could talk if she wanted to" They kept her 8 more days and when the MRI and labs showed clean we were out the door. Problem was, she was literally in a ball on the floor screaming in pain. Sometimes she would get a rash there and sometimes not. We packed her back in the car for the five hour dirve (hell for her) to a large teaching hospital. Almost upon presentation they said RSD. Normally it's in the arms or legs, but hers was in the neck. She ended up having to be on a feeding tube for her weight loss, they worked on her endurance and then lots of PT, but the pain still hasn't gone away. We are in the process of investigating many other options. My sweet little girl became a monster. She said she was going to kill herself. The psych people were interested until I told them that if I was in her position I would be the same way. They told her she wasn't talking because she didn't want to (further labs showed her muscles were locked and could not move until voice/speech worked with her.)Nobody took her pain seriously and when they did, no medication could treat it. She was in hospitals for 48 days- who wouldn't be a little unbalanced? RSD is real and it is devestating for the patient and the family.
  14. Traveler

    Genex Services - does anyone work for them?

    How much of your time is one the road and how much work do the cm's for Genex usually do at home? Are there regional meetings, etc? Does Genex compensate for home office expenses?
  15. Traveler

    Upset!!! write up and patients marijuana

    I truly understand what both sides are saying. I have been into more than one pt's home who were using marijuana for medicinal reasons- both had end stage cancer. They always put it away when I came and, even though I knew what they were doing and they knew that I knew, we never talked about it. I never reported it since I felt that they had a right to their privacy. However, the original poster describes something a bit different. The patient is not trying to conceal it in any way and it is illegal. If there happened to be a search of the house, arrest, etc. then it puts the nurse in a bad position if she/he 1. Knew about it and didn't do anything 2. If the nurse happens to be present if some type of legal action happened. I don't know if I would have called the doc, but I certainly would have gone to my supervisor and I would have documented all in the pt's note. As far as violating pt privacy, the patient signs a consent form on admission giving permission to share info. with the doc. I might not have done exactly what the op did, but she did what she felt she had to do and I don't think she did anything wrong. There is a lack of respect from the patient toward the visiting staff in my opinion.
  16. Traveler

    NP's in their own practice with no MD

    I thought Florida was one of the more restrictive states about scripts, etc.