JNJ

Renerian: I'm sorry the professionals you talk with have had difficulty finding work in Ohio. Perhaps they are simply nursing professionals and lack the skills and knowledge to successfully become independent. Indie nursing takes marketing and moxie and tenacity and humor and thinking out of the box and research savvy and . . . get the point. You may want to direct them to the National Assoc. of Ind. Nurses independentrn.com where access to the forum requires membership, but oh how we share the above qualities and most of us are/are getting there with a little support from our friends. Power to us all. JNJ

Rachel: In many states, the Medicaid program uses the term "independent nurse provider" (INP) to designate a nurse who is self-employed. I am an INP for Medi-Cal in CA. INP means that I provide nursing care independent of employee status with a healthcare organization. I obtain an order signed by my patients' physician(s) which legitimizes the administration of medications, treatments, and other procedures by an RN. I practice nursing within the CA Nurse Practice Act by maintaining MD orders on my activities. I think the terminology "independent" may have come from the IRS which uses the term "independent contractor" (IC) along with their rules and regs. for self-employed people of any profession. The National Association of Independent Nurses (NAIN) at independentrn.com defines "independent" as self-employed. I hope this clarifies the independent RN situation for you.

About a year ago I was head hunted for a senior position with a company that shall remain unnamed, active in the business of procuring RNs from other countries to work in the USA. I didn't feel comfortable with the company's work base at that time and I still do not. Incidentally, fifteen years ago, as an experienced RN in the UK, with double registration and working as a UK faculty member, I was not only expected to take NCLEX, but also Test of English as a Foreign Language. That still rankles.

If you can get hold of a current copy of NurseWeek (dated April 7th, 2003) there is an article on just the sort of questions you are asking. It's called "Coming to America" by Heather World on page 26. The only web link posted is http://[email protected] (That's H underscore world- as it does not show when underlined). Another method might be to sign up with one of the foreign recruiting travel nursing agencies. American Mobile Healthcare comes to mind as doing this sort of thing, although please check out the travel nurses' opinions on this company, as I know little about their operation except that they do recruit abroad from the USA and assist their people to get jobs, visas and NCLEX. Good luck.

You should contact the Board of Registered Nursing in the state in which you wish to become a Registered Nurse. States vary in practice, but most do not now require CGFNS. In most states, you will probably be asked to submit a formal application for a license (which may include taking NCLEX-RN (CAT). This is a long procedure, but the only certain way that an evaluation of your training and education can be completed with accuracy. Just contact the BRN of your choice of state - there are links from this web site's home page. In any case I would recommend that you take the State Board examination in the state/country in which you graduate. You may find it simplifies issues as you progress thru your careers. Fifteen years ago I was a UK foreign graduate with years of experience and graduate education. I was required to take NCLEX and TOEFL (Test of English as a Foreign Lanugage) prior to licensure, by the State of Illinois. Other states varied in their requirements at that time and they still do. Good Luck.

I recommend ibsgroup.org (first located as a link from Mayoclinic.com). It has an active forum (divided by predominant symptoms) with a lot of useful, if anecdotal, information. IBS is very idiosyncratic to the patient who has to be his/her own detective and disease manager. I believe bezoars are fiber related.

Wasn't there a media expose recently concerning pharmaceutical companies that put early expiration dates on their supplies, not to protect the public, but to increase orders? The real expiration dates of many, many items sampled were years away from those printed on the items. This sort of dilemma is typical of working in charitable situations. Sometimes the choices are obvious - I was once given huge quantities of a food substance nine years out of date for an orphanage! That was an easy call. Can you ask for a team decision on these sort of issues? So often it will come down to the RNs best judgement. Remember Florence and "first do no harm."

Something from me again that's a little away from your first enquiry, but as an experiential offering I volunteer the following info. about myself: I entered a Ph.D program (I hold MSN) shortly before turning 50 and completed about one third of it. I found the work busy rather than too challenging and was full time faculty myself at the time. I had promised myself this degree for 20+ years and was initially so excited to be doing it. After a couple of years I began to think about quality of life issues; the time and money spent on the Ph.D. versus what else I might achieve before I retired. I was never under the illusion that the degree would recoup the dollars I spent on it, because I really did not see myself in academia until retirement. I had always said that I wanted to finish on a clinical high rather than an academic low. I had seen too many Ph.D. nurses in academia under huge pressure to publish and teach, still paying off their study loans, and with limited expectations of tenure. My husband, the engineer, stated that the rest of the Ph.D. would remodel the kitchen (I enjoy cooking), or fund some exotic vacations etc etc, but the choice was truly mine. I gave it up and have never looked back. Not doing it freed me to return to independent practice, to work part time and to enjoy myself in the now-gorgeous kitchen. Just food for thought. I do agree with the 'follow your heart' posting too.

I've worked with both in traditional academic settings and non-traditional nurse learning environments. I do not see any difference in general treatment, but I do not know for sure any of the traditional academic issues involved. I worked with an ND curriculum consultant who was recommended by the BRN. Not definitive, I realize, but a little background for you.

Many states now allow RNs and LVNs to be independent contractors to Medicaid recipients. In CA I work in the EPSDT system - that's pediatric home based shift care. I work as an independent and love the control over my client choice, hours of work, patient relationships etc. I believe Texas has one of the most user friendly application processes, on line, of any state, but please check if it is also for LVNs. Hope this helps.

I was going to post, but then read that Edward, IL had done a much better job and included more points. Thanks Edward for a thought provoking posting.

Not quite on topic, but it's quite a story: Close friend of mine, RN of many years pediatric experience, ends up taking a fragile looking child to the on-floor nurses room with her to lunch as he looked so sad as his mommy needed to leave the hospital for a while. Two-year-old is on TPN, with nothing by mouth related to long history of vomiting, no real Dx yet. During her lunch, the kid grabs a cracker and wolfs it down. My friend is alarmed - she's broken all the rules. (However, I'd trust her instincts over rules most days). Kid is smiling, asking for more. She's going off to confess, when suspicion strikes. To cut the story short, ipecac found in mother's bag after mother covertly observed to take something from her bag and give it to the child. Mother taken off by law enforcement, screaming at my friend. Kid now in foster care; huge legal trauma for my friend who started the (correct) procedure for dealing with such an incident. Horrible incident, but the RN probably saved the kid's life long term, and certainly his health. Took it's toll on my friend. Not sure if Munchausen by proxy - as this is officially called - is really a law enforcement matter. Seems to me the mother needs a psyche consult more than anything.

Any chance there is confusion over PIC (peripherally inserted line) and PICC (peripherally inserted central line). Otherwise mjlrn makes sound statements. However, if the docs. and protocol are not sensible, it's up to the RNs to work up a presentation for change. I recently accessed CDC guidelines for PICCs and they were surprisingly unspecific (related mainly to infection control issues.) So back to the manufacturer of the line most commonly put in in your unit. Can the rep. help you here? The flushes/waste blood amount mentioned in above posts sound huge to me. The volume in these lines (in pediatrics) is really small, around 0.3 ml per manufacturer. Absolutely agree with nothing less than a 10cc syringe. Both pushing in and pulling out, smaller syringes create more pressure. I've demo'd this to students with a removed line. I now work with an 18 month old PICC line with two ports which is maintained on a 30 lb child with obsessive attention to technique. We draw blood x 2 weekly, small pre and post flush of saline. Patency is maintained with q24h with 3 cc heparin. Valve change q3 days. 10 cc syringes. I cannot imagine managing her care without a PICC. Incidentally, anyone out there with a line older than 18 months? What's the record on this?

Bonnie: Interesting information, thank you. Makes me think back to oncology units I have worked in . . . If the nurse, as you say, 'forgets' to sign out the drug, isn't this caught at the count at change of shift? What prompted you to post this?

You might want to look at the "Kaplan" thread in the Nursing Educator forum of this site. There were some general and some specific comments related to NCLEX-RN (CAT) during that discussion. I've taught for many years and taught for a test prep company and wrote some qqs for a Board to consider. It's important to remember that NCLEX is just about testing that you are safe to practice - it's something along the lines of a consumer confidence issue that there is a national test of standards. There are no trick questions or deliberately weird stuff. Pass rates are higher than you might think and published by the Boards. Stop talking about the numbers and start thinking about what the Board might want to know from you about safe practice. You can do this!