adaptation

Check out Mayeroff's (1971) 8 Caring Ingredients. Very helpful. Then look at Anne Boykin's book "Living a Caring Based Program" (1994). There is even a chapter on "Creating a Caring Environment for Nursing Education". Hope this helps! Addie

Are there any psych CNS' in private practice out there who could be kind enough to share your experiences here in South Florida? I recently moved here. I have previous experience as a successful psych CNS in private practice. I do not have prescriptive authority (and do not know about eligibility or how to go out getting it), nor was I educated as an NP. I would appreciate hearing about what will need to be done in order to get established (including the nitty-gritty), keep going, and what you think the income potential might be for independent practitioner like myself. Thank you!

In my first day of graduate school, they asked us how many were first borns or "onlies". 28 out of 30! They didn't ask details about our family histories. Speaking for myself (psych RN), I am first born out of 4. My father is bipolar and self medicates with alcohol, but is not an alcoholic.

Hi, everyone, I'm a independent CNS (APRN) with more than 25 years of experience and have been approached by a consulting firm who has a corporate client. They would like to speak with me about some clinical issues (general information, not specifically client related) over the telephone. They want to know my usual fee for this service. I know what hourly rate I charge when I provide direct nursing services, but I do not know how to bill for something like this. Should it be at a different rate? Higher? Lower? Any ideas you have, (maybe along the expert witness, LNC range) would be most appreciated.

Hi, everyone. I've been a nurse in one specialty, psych, since 1978. I have my MSN from an excellent program. I've worked on and off through most of my life, but haven't worked as a nurse for about eight years due to the fact that I'm bipolar, unstable, with rapid cycling, and have fibromyalgia. I'm a "clinical person", not an administrator. I love patients and not paperwork. I think I have too strong a need to be liked to be a manager. You knew me....I was the one always getting in trouble in meetings for cutting through the c__p and telling it like it was when no one wanted to hear it. People didn't like my "style", but when pressed to explain what that meant, they never could really say. When I was working, I was good at what I did. My performance evals were fine. I got good feedback from patients, their families, my students, peers. I never let my illness get in the way. If I was too ill to work, I knew it before anyone and didn't work. I got fired at least twice for extended absences. I was a good public speaker and author. My last hospitalization was 3 years ago, when I required ECT. I remain on a fair amount of mood stabilizing and antidepressant meds. Self disclosing is out of the question-the stigma of mental illness is all too real. But I can't work as a nurse anymore. I can't handle the stress, pressure and hours. I can't do shift work because I can't get my days and nights mixed up (it aggravates the bipolar). My hands shake from the meds. I panic easily. It's hard to find casual work. And I don't drive. That being said, it seems to me that a master's prepared nurse with more than twenty years experience and a good record ought to be able to do SOMETHING with her life related to nursing. I love nursing. I wish there was something I could do in my chosen profession. I want a job! I need a job! My finances are in the pits at this point. Does anyone have any ideas? I'm so depressed thinking about what a waste my life is and how I could be so much more than who I am. I know I still have a lot to give. I'm just so frustrated and lost.

Several years ago, I was "laid off" (fired!) from a nursing management position at a large downtown teaching hospital- because they said I was "redundant". Very interesting, considering that there could have been two of me, and there still would have been plenty of work to do. I have not done hospital nursing since, nor would I, ever again, in this city. The Chief Nursing Officer where I was working could speak at Queens Park, conferences, and the universities about the state of nursing in the world, the country, the province, the city and across the street, but was clueless (or in denial?) as to what was going on down the hall in her own hospital. JMHO. I think there are lots of "Prima Donnas" in Toronto nursing administration and academia who are more interested in furthering their careers and looking good on paper and in the media, than they are in truly fixing what ails nursing in this city. Personally, I would suggest Home Care, if I was going to move to Toronto. You are more likely to be able to get full time work and relatively decent hours. There are still plenty of issues and problems there...high on the list are safety issues, the pay scale and reimbursement for mileage, cell phone use, etc., but at least you are doing lots of direct patient care and there are more days than not, when you go home feeling really good about being a nurse and proud of what you've done. You can be more creative and flexible, and have a lot less BS and politics to deal with than you would working in hospital.

This Action Alert came to me as an Action Alert from the Registered Nurses Association of Ontario: On November 15, the Libyan Supreme Court will hear the final appeal of the five Bulgarian RNs and one Palestinian physician who have been sentenced to death on charges of deliberately infecting hundreds of Libyan children with the HIV virus in a hospital in Benghazi, in northern Libya. The health-care professionals, who have been jailed for six-and-a-half years, insist they are innocent and that the only evidence against them was extracted from them under torture. Expert medical testimony, supported by the World Health Organization, concluded that the transmissions occurred because of poor sanitation, such as a lack of adequate sterilized equipment. If the six lose this appeal, they are scheduled to be executed by firing squad. How you can help: Call the Libyan Embassy and register your objection to the jailing and death sentence of the nurses. Call (613) 230-0919 (M-F). Through the Registered Nurses Association of Ontario website below, send a message to Libyan leader, Colonel Muammar al-Qaddafi, and other Libyan officials. This letter will be cc'd to Prime Minister Paul Martin and Ontario Premier Dalton McGuinty. http://www.rnao.org/policy/alert_bengazi_six.asp

This was not the worst public bathroom I ever used, but it was definitely the worst in-home one. (I would use the pt. washroom in dire circumstances-and only those I knew were in pristine condition.) Wrong! :chuckle It was Friday afternoon at 5:00. I had two more clients to see. I was doing psych, spent almost an hour with a borderline client (who I thought I knew well). I got ready to leave, had my hand on the doorknob, but really had to pee. I asked her if I use her facilities. She told me to go right ahead. Mistake! :chuckle When I walked in to the washroom, it looked like a scene from "Helter Skelter"! There was fresh blood EVERYWHERE, the walls, floor, toilet seat, sink...like someone had been doing spatter painting with it. And we know who that was! I was FURIOUS! (Just a little countertransference there! ) I came out of the washroom and confronted her. "Let me see what you did"...and in that sheepish, manipulative borderline way, rolled up her sleeves. I saw lacerations on both arms, none needing suturing, but definitely needing clean up and attention. Don't forget this is Friday at 5 with two more to go. I asked her why she "forgot" to mention this behaviour during the regular hour I was just there. She in this little girl voice, "I didn't want you to be mad at me. I'm not suicidal, I'm just in terrible pain and this helped." In my best "dealing-with-a-two-year-old" voice, I said, "I am not mad at you. I am mad at what you did and that you didn't tell me about it earlier." Aarrrgh!...... Anyway, I was one minute away from making a clean getaway and probably not having to deal with this. All I had to do was find the nearest McDonald's! I never used a patient's washroom again.

First of all, I have to say thank you to all of you who have put up with my b******g and m*****g and gave such good advice about being a very overworked and underpaid hh psych nurse. I am happy to report that last Thurs. was my last day! :-) I officially resigned three weeks before that, as I thought it was the correct thing to do, given that I was the only psych RN in the agency. My boss was quite incredible; she said she might be able to get me more money, would I stay...hello?????? She did this while I was resigning! BTW, I haven't spoken with her since. Show me the money! It just didn't happen to exist when I was WORKING and so unhappy. Honestly, it wouldn't have made a difference. She was also concerned about my clients, would I follow them until they found a replacement for me or were discharged? At first, I said yes. Then I figured "no way!" I could be seeing these people endlessly until next Christmas! (I managed to discharge all but 2, who are very stable and will not need hh care for long.) I did tell her that at this point, considering the salary (or lack thereof) and amount of hours I was working, especially unpaid, that it would be more lucrative for me to work at Walmart right now. And she didn't even argue with that! Ironic that my case managers offered to take me out for a goodbye lunch. They said, "we knew when you had a case, we didn't have to worry about it." (More feedback than from my boss-who I doubt will even spring for a coffee.) I am sad and a little lost now that I am not working. It's not that I don't have plenty to do. This experience, I think, was the last straw. I really don't want to be a nurse anymore after 25 years. I've "had it". When I went into it, I had a specific motivation and goal, and that ended a long time ago. I am lucky to have the freedom to pursue something else. But...being a nurse is part of who I am and it's not so easy to just walk away. I have never done anything else but psych, which puts me at a distinct disadvantage. (Shift work is out, medically I can't work nights) Finally, can I have some advice? My specialty is postpartum depression and I have a small (almost non existent) private practice. While I was working, my boss reluctantly paid for me to go to an all day PPD inservice, since I did have PP agency clients. The inservice was really of no benefit to my own pvt. practice. She asked me to do an hour and a half PPD inservice for the non psych RNs before I quit. I said yes. Now it's scheduled for next week and I don't want to do it. I'm sure I won't be paid for it since she paid for the original inservice, and now I've left. Do I owe it to her (especially considering what she owes me)? Should I even mention that I want to be paid for this, or just do it and figure I got 7 hrs. of "free" CE under my belt? Thank you for your patience in putting up with this long post. I appreciate it. I hope you will still allow me to consider myself a hh nurse!

Hi! I'm an psych Home Health RN and I positively hate the initial Nursing Assessment Form we use for all first time visits. First of all, it is on 2 pieces of long paper, vs. the rest of the chart which is normal sized. Lots of repetitive information. Doesn't "flow" well. Takes TOO long, more than the hour or so we are allotted. I am the only psych RN in the agency (don't ask), so my manager said I can do anything I want with the form to make it more user friendly. I'd like to hear about your admission paperwork, and if you would be kind enough to share your form with me, I would really appreciate it. I am very familiar with inpatient forms, so I'd really prefer those which are used on an outpatient/HH basis! I find that the documentation standards in home health are much more lax than in the hospital. (Here in Canada) Thank you!

Hi, everyone, First of all, I just LOVE this forum! It keeps me feeling that I am not alone out there in the wilderness. Thank you for your candidness-please don't stop! You might recognize my b--ching. Sorry if I'm too repetitive. I'm a HH psych RN. Get paid per visit/hourly rate. No $$ for travel time or mileage, reporting, phone calls, etc. You get my drift. Most visits should average 45 minutes. Average 6 or 7 a day. Yeah, right! Clients are pure psych, no acute medical problems, wound care, caths...good thing! I haven't done med/surg in 25 yrs.! BUT I CAN'T GET OUT OF THE HOUSE IN LESS THAN AN HOUR!!! It's more like almost an hour and a half. I keep an eye on my watch, start with the goodbyes and next appt. times (I book them myself) at about the 40 minute mark, but it never works. The family comes in, clt. produces a paper they need me to sign but "forgot" to give it to me at the beginning, the "waterworks" are flowing copiously, the baby is screaming and her mom with PPD looks like she is going to jump out the window.... I am practically working for free, but I feel guilty lots of times about leaving, even though I know I should be out the door. I'm always behind. My husband says to "act like a psychiatrist"- TIME'S UP, no matter what trauma the client is reliving at the 40 minute mark. He suggests a watch with an alarm. I'm not quite sure how that would work if I had to reset it after every visit or if that's even doable. I've also been considering an oven timer with a bell, setting it for the right number of minutes, and putting it in my briefcase. Is this too crass or unprofessional? Anybody else out there with the same dilemma? How have you solved it? I'd love to know!

My caseload is purely psych. The first time a patient is "not found" (not at home)- we are paid for that visit. (But only if we set up an appt. in advance). After that, we are on our own. No pay. A pattern of not found visits is looked at an individual basis before the pt. is discharged. Did I mention that we are truly expected to try and FIND a not found patient? Bang on the door, try to find an open window, call next of kin...they're worried pt. might be dead on the floor. I've had a pt. drive up while all this is going on. "Oh, did we have an appt. today? Sorry, I forgot."

I'll re-introduce myself since I haven't posted for a while. I'm an MSN prepared psych nurse and work part time for a Home Health Care agency in a large Canadian city. I feel lucky, since I am not burdened with insurance stuff or my documentation having to conform to certain codes (like you guys). I get paid per hourly visit. If an admission takes an hour and a half, (which it always does) I get paid for one hour's work. I worked twelve hours seeing patients this week (and you know how IMPOSSIBLE it is to get out the door with mental health patients). One actually held on to my leg and was dragged on the floor as I tried to get out! I did six hours extra this week of 1) phone calls to my case managers, families, patients, doctors, the office 2) paperwork 3) driving (mileage and time not reimbursed). I will NOT be paid for these 6 hours, this week or any week. I try and do my verbal reports on my cellphone while I am driving. Not a good idea safety wise and I have to pay the bill for it, anyway. I am FURIOUS. I am the only mental health nurse because no one else has even applied, so my geographic area is quite large. I think they think I will put up with anything, because I do have some perks around my scheduling, and no weekends, or call...But I can't even contemplate asking for more money; I've already asked, and my boss has said I am too compulsive and pay too much attention to detail and all these extra hours are because I am not managing my time well. I love my patients and the job itself for the most part. What should I do? I feel like I am going crazy. I do work at night like a teacher, calling families, leaving messages, paperwork, etc...I can't work less or do it any more efficiently, but at the same time, feel SO abused since my time is not recognized financially. How can I not make these calls or do this unfinished paperwork? It's a no win. Don't you just hate the "well if we do this for you, we'd have to do it for everyone" style of management? That's what I get. My husband thinks I should bring a kitchen timer in for every visit and when the bell goes off, "we'll have to stop" and I am on my way. :) I should mention that some of the med-surg nurses do 15 minute visits, get paid what I do per visit, but see 15-20 pts. a day. I understand they are making close to $ 100,000 CDN a year!!! What's wrong with this picture? I'd really appreciate your comments and suggestions. Anything that will knock any extra unpaid time off my day would be heavenly! Thanks!

Your employer sounds stupid, stupid, stupid! With a nursing shortage and no one lining up to do home health care (at least not here), why on earth would they get rid of someone because of their documentation skills??? Slow documentation never killed a patient, for G'ds sake! If you were as good as you say you are, and I believe you must be, or you wouldn't say it...why didn't they invest the time and effort in helping you "get with the program" vs. firing you? Do you have any recourse? Like up here in Canada, there is such a thing as "wrongful dismissal" and an employer would be in deep s--t financially and otherwise if the court decided you were not given enough coaching, support, etc. that you needed to do your job. Maybe you could see if there is such a thing and if it is worth pursuing. It might help restore your dignity. Take care of yourself. You know that if you don't, the bipolar stuff will raise its ugly head. Don't get stuck in the trap of self blame or beating yourself up. Life's too short; they were the morons, not you. Just remind yourself how much your patients liked you and what good care you gave. That's the most important thing at the end of the day. It's like being knocked down. You are a little worse for wear, but you have to get up again and get back into things that are good for you. Work is filled with enough struggles, inside and outside of us. Add more than the usual (like your charting) and that is a set-up for disaster! Maybe they have done you a favour. Just hold onto your self-esteem; no one can take that away.

Hi, everyone, I'm new around here and am I ever glad I found you!!! I really need some help and I hope you will indulge me. I'm a MSN prepared psych hh RN in a suburb of a large Canadian city. I get paid per visit and since things are slow (the agency just starting taking psych pts.), I can organize my own schedule. It's supposed to be one hour per patient, not including travel time (and I've only been working since April-can't imagine what that will be like with snow.). However, I get paid the same amount for an admission as I do for a regular visit. Paperwork takes at least an hour and a half extra (unpaid). Then I have to call and give an initial report to the case managing agency (oversees the one I work for). If I have to call the family or doctor after the visit, that's unpaid, too. So, I am being paid one hours salary for at least three and a half hours of work. Regular (no admission) visits are a little better...maybe only a half an hour extra past my alloted hour. But no overtime for anything. And you know that you can't rush "in and out" with a psych pt., even if you set clear limits about how long you can stay! I asked about increasing the visit time for an admission to one and a half hours pay since it is at least an hour and half work...and was told that if they did that for me, they'd have to do that for everyone. (As soon as I hear that progressive style of management, I'm already half out the door!) Right now, I figure I'm making a little less than $ 10/hr. Mileage, travel time, and cell phone are unpaid. There are no other benefits. And this will sound nitpicking (forgive me), but it just adds insult to injury. Discharged patients' charts go back to the office, one hour away (round trip). I have no other reason to go to the office, and I figured it was cheaper to mail the (usually only one) chart than the gas and my time would be. ($ stamp cost=1.00-not reimbursed!) We keep psych charts on us vs. leaving them in the home. I'm like a teacher, doing my charting and paperwork and calling families at night and on weekends! Is it that I'm too compulsive and thorough??? Should I settle for the bare minimum? But that's not me. I don't know what to do. I love the patient care, and the hours, (I can't work nights-health reasons, and have not been hired for 2 jobs because of it) but I do NOT like being abused. I also think I am "beating a dead horse" when it comes to trying to negotiate with my manager, who is obviously not willing to budge, even though I've been told that they haven't been able to find anyone else to hire. Duh! Wonder why? (I better watch it, maybe that's why they're keeping me!) I don't want to keep whining about these issues (especially to my boss), but I am FED UP! I don't want to quit because I need a job and like the other aspects of it, but will if something doesn't "give". Any ideas? Maybe not so much how to handle my agency, but how to handle my workload in a more "time efficient manner" (their advice, even though I think it is them, not me). I'd really appreciate any of your comments or suggestions. Thanks...and looking forward to getting to know you.