yrmajesty3

I just started my PICC insertion orientation. Yesterday I saw my first four as I was only scheduled to observe at first. I do have a few questions for you experienced gals. First...I saw the nurse use the same needle at least 4 or 5 times in search of a viable vein in the same arm. Is this an acceptable practice? Should she have used a different catheter with each attempt? Second...When you use lido to numb the area of introducer insertion, do you inject one area (one puncture) or all around the insertion site( several punctures)?

My understanding is NO, you do not have to take the test. Many practice without it. You do need to show that you have been trained though. Keep your curriculum materials to prove that you have this knowledge. I encourage you to take the exam though... it shows competency.

Hello Amy, I am just beginning my PICC training. I'll be visiting often to read responses to your question as I expect to be running into the same type of problems when I finally make my first insertion attempts. My first thought to your dilemma is spasm. Is that a common problem and does it present the same?

I dont believe the lurkers are other nurses. My experience with other foot care nurses has been nothing but positive. In fact, all of us have willingly shared our business models, policy and procedures,forms that we independently develop, brochures and business contacts. It's a phenomenal community of professionals as we are all learning together. I've been told that the lurkers are podiatrists posing as nurses to get information, especially about policies, scope of practice and $$. This has happened on 2 other blogs I was a member of...both now defunct because of it. One podiatrist informed me that I was making more $ in a visit than she was being reimbursed by insurance company for the same care. She took MUCH issue with that which subsequently made her wonder what else was I doing to warrant my $75 fee. But then again, she doesn't do hour-long home visits like I did. Don't get me wrong, I'm not bitter, just wise to how others are getting information and thereby inadvertently sabotaging a practice by kicking off an investigation. Some see private duty foot care nurses as a threat/competition to their businesses. But others have genuine concerns that nurses might be practicing beyond their scope. But you are correct, this attitude tends to come from practices that are not thriving. Podiatry practices that don't offer surgical care are the ones that depend on routine diabetic foot care for their bread and butter. So you can see how a nursing foot care biz near them might be a problem. Where I live, there are an overabundance of podiatry practices all competing with one another for business and nursing home contracts. They tend to utilize podiatry school residents as their "help"...not independent nursing collegues. No reason for them to refer to you if they can keep that business under their own roof with free help. Places where these professionals aren't as abundant, seem to be the places that nurses do well...no competition. The important take-away is that foot care nurses are practicing well within their scope and we shouldn't let other foot care professionals tell us otherwise. If any of you should be investigated because of this suspicion (as so many of us have already), just know that all you need is to show good policy and procedure documents and proof that you have been appropriately trained to provide this specialized care. So far, that's all we have had to do in these cases. I simply handed over a copy of my business binder. In that binder, I had proof of my training and CFCN certificate, P&P's for my care and sterilization procedures,MDF form for chemosterilant, examples of my assessment and consent forms, 5 or 6 simple nursing care plans for most common problems, patient education handouts, and several articles outlining the studies regarding value of nurse run foot care clinics. Hope that sheds some light on my particular experience.

Hi Bizi, You may not be hearing from some owners because there have been podiatric lurkers who have used these forums to initiate investigations on some independent foot care nurses( approximately 5 that i know of). I was told this by a podiatrist friend. So for that reason, I no longer feel comfortable sharing unless its a PM. Hope all is well with you.....its been a long time since I've posted here.

After starting a new job in a busy GI Lab, I was told by staff that Danskos were the way to go. Fast forward 9 months later...I am now being treated for plantar fasciitus my podiatrist thinks was caused by those shoes. Danskos do not offer half sizes. I had to order up a half size to a 9. The hard arch support that Dansko is so famous for hit my plantar surface in the wrong spot causing inflamation. Also, I ended up with some nasty corns due to the rigid body of the shoe. My podiatrist now wants me in a sneaker with a semi custom orthotic.....sooooo much better!

Hi NC29mom, I used LEGALZOOM to set up my LLC. They take care if everything including the naming and licensing. It was fast and cheap. There is no reason to employ a lawyer because this is not a complicated business arrangement. I paid $270ish as opposed to my friend whose lawyer charged $1200 for the same service. My accountant charged me $100 fora "business consultation" in which I was told to use Quick Books. He also explained the differences between LLCs and other types of business licenses to help me decide which I should go with and why. The LLC was the least complicated. Feel free to PM for more info at [email protected]

Hello Oye, My daughter and I attended the open house and we were quite impressed. You may be interested to know that the new Dean is from Drexel and is wonderful ( per a friend who is a Drexel nursing Professor). The one negative thing that might be said is that the NCLX passing rate is low...high 80's for the past few years. We've been assured that this will be immediately remedied with the new Dean onboard. Because of that, my dear daughter felt confident in accepting the offer to attend. We also live 5 hours away in Eastern PA, but it was an easy& pleasant if long drive.

When I first researched this business idea, I assumed that I would have to register or notify the Dept. Of Health about my foot care practice. It turns out that I did not. Apparently, the fact that I am an RN and governed by the Board of Nursing, it is assumed that I'm qualified (as foot care falls well within the scope of nursing as ADLs). To be sure I didn't miss anything , I created my LLC through Legal Zoom who researches all that is required for your particular state. As it turned out, all I needed was a business license and nursing license (I added business insurance). The biz license does not need to be renewed every year according to my State Department. You just need to make sure that you renew insurance every year and nursing license every two years. I guess that the Board of Nursing and the Department of Health could investigate a nurse if a complaint generates it. Other long standing foot care nurse practices report never hearing from DOH. However, count on being investigated by Boards of Podiatry who are suspicious of CFCNs in business. They are worried that we are practicing medicine without a license. That "inquiry" alone is enough to generate the investigation that takes place by the State Department (it's never generated by patients...they LOVE us). Ultimately, I think some podys are more worried about protecting their turf (really their bread and butter ). No biggy though...State department Bureau of Investigations and enforcement just visit you OR you get "invited" to visit them with proof of credentials, policy and procedures, and eidence that you are using the nursing process. If anyone cares to know how I prepared for my investigation, just PM me. I received a letter in the mail last week clearing me of practicing medicine without a license. JEEz, I guess some think you need a doctorate to do basic foot care .

I'll echo the above statements....not a stupid question. I actually worked almost exclusively with vent kids. I never needed to use the non-rebreather mask (even though I was a "pulmonary" nurse) until I started working in a GI lab. How embarrassed I was to not have used it properly coming out of an ICU! But your right, prepping the bag was a small detail that was never really taught to me either. I thought it just did what it had to do on it's own after you hook it up to the O2 source.

Excellent! Congrats! Did ya get the question about the paperclip? A little "dark ages" I thought. LOL

Hi stepnurse01, I am not pursuing relationships with podiatrists. Sadly, the Board of Podiatry does not seem to be open to coordinated care with nurses. They seem more suspicious than anything else. Interestingly, so far, my clients are either nurses or parents of physicians and were found via non-medical homecare companies and word of mouth. So that's where I will spending my marketing $ and effort in the near future. For now, I am concentrating on recovery efforts re: Sandy. Until then, my biz is on hold.

Hello Dawnma, Too much info to share in one short response. I am happy to have a chat with you about what we did and are still working on. It is definitely a work in progress. If you haven't already done so, peruse the entirety of past Allnurses foot care threads. They go way back. I found lots of interesting and useful info. About a national organization...there's been lots of talk about it by some of us but it just hasn't happened yet. Start-ups always require a lot of time (something nurses tend to be short of). I have personally cold-called foot care nurses I've researched on-line for some networking. You won't find a more generous and helpful group of nurses anywhere....without exception! All have willingly shared practice and business experiences. One day, I hope that this informal network might grow up to be a full fledged association. About the exam...Make sure you get the Salon Professionals Guide to Foot Care by Godfrey Mix, DPM. It was packed with info that popped up on the exam. Also be sure to check out Dr. Overstreet's web site . She generously offers tons of free info and video clips. I used these to prepare along with a review of Emory's material. BTW, aren't those Emory instructors wonderful! I really enjoyed that course. Good Luck

:cheers:PASSED!!! CFCN box now checked off! YAY!:w00t:

Nurses nurturing nurses....I love that! Thank you all so much for your pearls of wisdom !!! I especially appreciated knowing more of what the patient experiences per Brillohead....muchas gracias. I LOVE your nursing intervention of "cloth-in-crack"...lol! (So simple yet so effective. I wonder why I haven't seen this offered yet.) Having never undergone these types of procedures myself, it's INVALUABLE to hear a "nurse-as-patient" perception. I also agree with you that I would be best served by observing each procedure now that I am a little more comfortable in the unit. My unit manager has agreed to allow me the time to do exactly that.