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  1. Neats

    CM initial test for certification

    Sorry this is late did you pass?
  2. Neats

    Are We Too PC?

    PC...get real. This song I agree with what others wrote it is an innocent song nothing more. I love watching James Bond this time of year the old ones (I am sure these will be a topic too to get rid of). Oh my what next are they going to be verboten (not allowed)? Too offensive? Same with Red Nose Reindeer...to sexist? We are losing reality here people. You cannot please all, heck I am afraid to just say hello and smile at someone walking down the street anymore just because I may get sued for being me. My spouse tells me it is people want their 15 mins fame. When you click on these articles it is money in their pocket so to speak each time a person reads the truth or untruth that person gets moneys, same with like buttons. I do not believe what I see or read in the print any more. Life is just a show and everywhere I go I am part of the audience watching things unfold staged or not. My spouse says there are people out there who write untruthful articles just to get paid. We are suppose to write the truth for historical value, 50 years from now no one will know the truth if it bit them in the bottom...just like now.
  3. Neats

    CM initial test for certification

    The end of this week I am taking the CM test for the first time. I have been studying but my tummy is upset. I am told as long as you study and take the practice test you should be OK, what have been your experience taking this exam for the first time?
  4. Neats

    The Grinch of allnurses.com

    We do Jewish Celebration
  5. Neats

    It's Time to Stop Nurse Bullying in Its Tracks

    I suppose being mean is not a crime, I see it is called incivility now. Mean is mean. I try to treat people the way I want to be treated. With that sais I have thick skin and appreciate feedback positive and when I need to learn. I do not take much personally as I know I cannot control the mouths of others unless it is extreme then I will stop it in its tracks. Nurses have for so long been able to get away with being rude, mean and down right nasty all in the name of protecting the nursing profession. But nurses are not the only ones. This happens in business, this happens in churches, this happens not only in the US but in Europe, Asia, and South America/North America. Human nature does not change much. I have had my share of difficult conversations with staff and with my bosses. What I have always done was not allow others to speak to me in a way that is hostile, if you have an issue with me, with my decisions then we can discuss the possible solutions, problem and come to a better understanding. I will walk away form anyone who yells at me telling them I will not take this verbal abuse and when you can speak to me in a manner that is civil we can discuss it then. If it is an emergency that is different and I will take care of the emergency then reflect and discuss later. I think the key is once you have identified an issue tackle it before it grows out of control and you become frustrated.
  6. As a LNHA and BSN I can see how you all would view this but let me shed some light on this subject. Most nursing homes profit range from 1-2 percent annually. For business this is clearly not the best scenario and a catastrophic occurrence could have that slim profit from happening...i.e. new roof, new dishwasher. I am speaking about nursing home chains not the locally owned ones. Some profit comes form the selling of land that the facility bought years ago and no longer needs or just does not have the monies to develop that land. Some profit comes from accepting Sub acute rehab for a specific amount of time on Medicare and the patient goes home after rehab. This has been a saving grace for many facilities. Most residents in SNF are on Medicaid. The reimbursement for Medicaid is this: Medicaid reimbursement is based on urban and rural factors and I think many are based on 1995 statistics and are jointly funded by the state and federal government. Paying for nursing home care costs with Medicaid means you qualify for low socioeconomic earnings, the average monthly cost for a Medicaid person is $2000.00 per month NO MATTER WHAT THEIR ACUITY LEVEL IS. There are a lot of conditions that must be met and this can differ from state to state. Typically we see what is considered spending down assets that can include car(s), or a home, and this depends on if married or not. In order to get the SNF cares you must be an individual who is unable to afford to pay for the medical care you need based on what you own, and what you have for assets. Most Medicare services covered are in a Managed Care delivery system this means no matter what the services needed Medicaid will pay out the same amount. If the patient receives higher level of services the providers receive less per service, again because Medicaid pays out the same amount. Think about this mix of say 50 percent Medicaid, 30 percent Medicare and maybe 20 percent commercial to include private. For Medicare these people stay up to an average of 90 days then go home. Commercial/private pay has restrictions and most private pay are spending down until they get Medicaid. Commercial has a set number of days before the insurance says well this is all you have, you must get the cares in your own home or private pay. This leaves 50 percent already on Medicaid and these people are depending on your care for everything. SNF are truly not a money maker. There are fraud facilities and this is what we hear all the time and fortunately this is not the norm. Most of the time we strive to give the best care we can with the limited amount of staff because this is all we can afford. The expectations of a SNF have come a long way from the days of when we tied residents to a hand rail in a posey vest. The incidents of workers comp remain high due to the hard job of taking care of these residents. There is no easy fix except with staffing rations which cost monies which the state and federal government control. It is not all big business stuffing their pockets, the reality is this SNF model is not working for our seniors, the reimbursement is not that big, and the rules/regulations often cause more work than we can afford. I do know that SNF's get a bad reputation when trying to provide services that clearly are needed (otherwise we would not have so many), that reimbursement needs to change to reflect the cares that are needed for the regulations we must adhere to. Currently we do not have that. What we have now is rules from CMS that make us jump through hoops to serve and make the resident happy, unfortunately making people happy cost monies we do not have.
  7. Neats

    Translation Services in the Hospital Setting

    I work Case Management at an Insurance Company and I use our translation line all the time with exception of the German Language (I speak that). I would rather use the translator line than have the patients family speak for them...this article is spot on for not only compliance but for accurate communication directly with the patient.
  8. Can anyone tell me what is inside your emergency bag? We have all the basic supplies including an AED. We do not keep any medication such as scheduled II narcs. We do have epi pens. We do respond with a gurney (on our golf cart). We keep laminated tags on the outside of the bag (with expiration dates) and then monthly, inventory the bag contents and update any info that has changed with a grease pencil on the laminated tag. We took out the O2 tank because of the weight. If a staff member wants to respond to an emergent call with O2 they just grab one on the way out the door. So besides the basic response equipment are there any nurses employed in corrections responding to emergencies with something in your bag that is great and you cannot live without?
  9. there is some turn over because of the nature of correctional nursing. below are some of the reasons nurses have provided me upon being terminated...both voluntary and fired. some of the following reasons: 1. correctional nursing is "too of a high stress job". 2. you now really have 2 jobs...nursing and security "i only am getting paid for one". 3. the rules and regulation you must follow as a nurse can get you "walked off the compound" just because you gave your inmate janitor a piece of fudge at christmas time. yes i did have a nurse who we terminated because of this reason. 4. "i do not want to get sued". 5. nurses (as well as other non-nursing/medical staff) get manipulated by inmates into doing something they should not and get fired/lose license. this manipulation happens on a daily basis as this is a game to inmates and most have an axis ii for a diagnosis. so we hire because this is one nurse career speciality that can be difficult at best. i have been in corrections for over 15 years on and off and just keep coming back. it challenges your nursing skills daily. you become a great nurse. nurses who do not have the best assessment skills and lack boundaries are the ones who usually leave.
  10. nursing schools teach documentation every step of the way, we just document as we go along. there are different types of documentation and how to organize that documentation. the most popular by far is the soap method. if you use this method with all your nursing experiences you should be fine. s stands for subjective...what the patient is telling you, o is objective...what you see, like skin is dry and flaky remember only the facts. a is for assessment...this is where you would document perhaps a nursing diagnosis related to the skin and finally p is for plan what you will do...refer to provider or use nursing protocols and provide some type of skin cream. this allnurses forum has a wealth of documentation info and examples. you need to practice your documentation. lastly i use the soap and what is called sbar to communicate orally and written. sbar is situation, background, assessment, response, much like a soap note but very brief, just the facts. it works best in a fast paced environment.
  11. Neats

    Diabetic care in corrections.

    i work at a state prison and am a director of nursing. our state diabetic offenders can pick a healthy diet, and can be provided a diabetic snack. they do have access to the commissary to buy what they want if they have monies. while i read the comments i must say this: we approach special needs this way diabetic classes: diabetics are invited first. if there are any left over seats then it is first come first serve. we teach diabetic learning (different topics) each month for up to 30 offenders in a classroom. the sign in sheet does not go into the medical record, we do document the diabetic education we provide to each diagnosed diabetic in their medical record. whatever your beliefs are when it comes to diabetics and their choices, incarcerated or not, it is their choice. we can only document their compliance and back it up with a1c's. i contact the food store and get a print out of the food they buy and speak to them about their choices with their food store print out in front of them. sometimes we go item by item. i only do this once. this is the benefit of working in the correctional environment. if you were to educate someone on the outside you do not have the luxury of finding out what they bought unless they brought receipts. it is not my job to "babysit" my incarcerated patients in order to police their medical care. i provide necessary medical care that is evidenced based when they request and in emergency situations. we try hard to provide sound medical care that is beneficial to our population. preventive and education medical services; is to me the direction of where we need to focus our services.
  12. Neats

    Private nursing schools anyone ?

    Well I graduated in winter 2008 from Lakeview, got a job right away in a hospital. I never had any issue with this school it is a great program that is tough. The instructors are great and take you serious as a student. Now if you do not cut it as a student nurse this school will let you know. This is at any nursing school. I learned valuable nursing skills and had well rounded clinical experiences. I went to Danville but Charleston is good too. We do have classes in Champaign together. As I have said in the past this school is a great nursing school a gem. You can search for Lakeview on this site and responses will pop up. Remember you get what you put into your education. Study hard and you will be fine. Good luck with your future nursing career. I am a Director of Nursing at a rehab hospital and love it.
  13. You have your choice of campuses. There are times you can change campuses. I was at the Danville campus and know the instructors there, again they are terrific. I do know some instructors at the other and the same goes with them good instructors. I do know the Charleston campus is more like a college campus than Danville. When you apply you can just let them know your first and then second choice. Good luck to you and welcome to the world of nursing.
  14. Neats

    Anyone working for CMS?

    so sorry you have the feelings you have for cms. i am the don at a cms facility and the staff has been great teaching me how their "pod" or nursing station is being run. to me as long as we are in compliance i let the staff handle issues their way, my job is to ensure the staff have what they need to get the job completed. i have been in health care management for many years and find the following: - where ever you go it is the same stuff just different faces - promoting/mandating a respectful work environment will decrease over 50 percent of health care staff issues - ensure staff have what they need to get the job completed - have a sense of humour - be ready to pitch in on occasion, listen to instruction and do it (as long as you in compliance) - allow staff recognition for their ideas - never let a nurse work more than a double shift per week when they are full time employee. - never mess with staff pay check - provide expectations for the employee and don for each position and speak to the employee in that position about those expectations. what this means is what i expect from you and what i expect from myself trying to assist you with performing your job documented on paper copy to you and in employee file management is not really taught in nursing school and most don's have raised up through the ranks, have great hearts and just want to make a difference. it is when they get into the position and soon realize it is much more difficult to manage people than they thought while ensuring quality nursing care while staying within a budget set by the company. this model is widespread throughout the medical field. good management is a learned skill that i feel has some inherent personality traits. a good manager can learn from their staff, is always willing to listen before coming to a decision and allows the staff to perform their duties without interference. lastly a great manager will be an advocate for their staff, the unit and their profession. it does not matter if it is cms or any other medical service unit. this is what you have not experienced with cms. again this could easily happen should you choose to seek employment with other medical service employers in short it is not only cms (it may seem like this to you though). i would ask for expectations. i would excel at my job no matter what position i hold. i would be happy at work as negativity breeds contempt. i would find a job that i truly love and stick to it for at least 4 years. good luck to you in your nursing endeavours.
  15. Anyone provided medical inservicing to correction staff regarding medical emergency such as heart attack, seizures and what tools did you use? We had correction staff call ambulance when we could have managed the situation in our medical unit. The offender came back to the facility 2 hours later feeling just fine.
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