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GoNightingale BSN, RN

Med/Surg, Tele, PCU
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GoNightingale is a BSN, RN and specializes in Med/Surg, Tele, PCU.

GoNightingale's Latest Activity

  1. GoNightingale

    Onboarding with Parallon

    I applied with Parallon a month ago. Signed all the onboarding documents, did the Drug Screening test. My recruiter now states that they are going to send me another link for I don't know what else. Some people have told me it takes forever to actually start working with them. Can someone who works for them give me an idea of what the norm is to finish this whole onboarding process? Or are they just giving me the run around? I don't know what to think. I remember telling my recruiter I could start 3/1 and she said" Oh no,you won't be ready by then". Would really appreciate the input from colleages out there! Thank you!
  2. GoNightingale

    Hospital per diems for WOCN

    I would like to apply for an open per diem position at a local hospital. Just wondering if a per diem works the same for a WOCN than for a regular floor nurse. In other words, when a WOCN is called in per diem, is she/he paid for a full 8 or 12-hour shift of seeing wound care/ostomy patients or is he/she paid per case that is seen on that day. If it's per patient seen, does anyone know what the average rate is here in Florida. I know it's going to vary but...on average..anyone out there done or doing per diems? Your input would be greatly appreciated. I'm pretty new at this and would like to know a little more of how per diems work for the WOCN. Thanks folks! Look forward to your reponses, opinions, chats in general.:)
  3. It's my understanding that only Nurse Practitioners can bill directly. So I would have to work under 1 or 2 podiatrists. But I noticed on your post that one of your posdiatrists went private pay only. Is the Medicare reimbursement that low? Thanks!
  4. I'm doing my research to determine if having my own FCN Business is profitable. I know that I would have to work under the "umbrella" of a podiatrist. I'm wondering if you onw what the average Medicare reimbursement for for foot care for patient's with diabetic neuropathy? I have found the CPT codes for the billing and I know Medicare pays 80% of reasonable and customary but i don't have actual dollar numbers. I'm also wondering if you know how much of the reimbursement does the podiatrist share with the CFCN since she did that work. Thanks in advance
  5. I'm an RN in the State of Florida. Just received my Certification in Wound, ostomy and Continence Nursing through Emory University. Part of thre Program was Foot and Nail Care. Really enjoyed it! Am considering opening my businesss on a consulting basis under the umbrella of several podiatrist. My question is, does anybody know what Medicare reimburses Podiatrists for Foot and Nail Care for qualifying diabetic patients? i'm just wondering if I can make a living out of this-causer I really like it! If I can, I'll get officially certified.
  6. GoNightingale

    CVICU for Nurses 59 years old and older

    I became a nurse late in life. At age 51 I received my BSN and quickly progressed from Med/Surg to Telemetry, Cardiac Step Down which is now called PCU. While i do love bedside nursing and the Heart and anything heart-related is my love, I have to confess that now, at age 58 (going on 59 in a few months) it does take me a little longer to recover from a shift. I am also a night nurse- I definitely find that the day shift is way too hectic for me. My admiration goes out to the day shift in any area of nursing. While the night shift can get very hectic (the nurse to patient ratio can get as high as 1:6 and sometimes with just one PCA to the whole floor), I find that it is a different type of care than day shift and is more manageable for me. I am trying to shape my career path for years to come- hopefully to retire at 67. Thank God I am healthy and fit at this time. I have quite a bit nore energy than some of my younger colleagues, but still, with some of the total care patients i need help when I have to change them. I am trying to stay fit by doing yoga, eating right and hiking. Still, when I work 2 nights in a row, I'll sleep the entire day folllowing that shift and I still feel a little tired on the following day off. I would really like to stay in direct patient care and cardiac care as these are my passion. is there anyone put there is their 60's doing CVICU? I would love to hear what you have to say. It would be ideal if I could just work 2 shifts a week, but my budget does not allow it. Thanks in advance for your input.
  7. Hi folks! I'm so excited that I have landed an interview for a position in Open Heart Step-Down; I've been a Tele RN for 4 years and have really been putting my feelers out there for a more challenging position. I love Cardiac. I'm really nervous about the interview cause........well...I really want the job! In helping me prepare for the interview, I would very much appreciate the input from the folks that are in or have worked in Open Heart Step Down. I'm interested in knowing like how much training I can expect since I'm coming from a Telemetry Floor. Also, what does administration expect you to know right off the bat.....or...what is the norm for nurse to patient ratio. Also.....what should I brush up on for the interview with regard to clinical knowledge or anything else. Yeah...I'm nervous and excited at the same time! I welcome any and all input! Thanks everyone! Happy belated Nurses' Week! :redbeathe
  8. GoNightingale

    CVICU interview tips

    I would like to transition into CVICU or CCU (I'm a tele nurse) but I really fear having to withdraw life support from a patient; although conceptually I know it is the right thing to do when they have advance directives specifying those wishes, my heart says otherwise. Don't get me wrong, I admire ICU nurses tremendously; it is very important to honor a patient's wishes. As a tele nurse, I have dealt with DNR's but quite frankly I've only had one DNR patient die on my shift. She really did go "naturally". I did not have to withdraw from calling a code or even removing the nasal canula. I guess my question is, do you have to withdraw life support in CVICU or CCU? Is it very common? I really want to transition into one of these units for the reasons you have mentioned. I sure look forward to your input or anyone lese out there reading this that works in ether of these units. :redbeathe
  9. GoNightingale

    Fair Patient assignments

    Great input everybody! Thanks!
  10. GoNightingale

    Fair Patient assignments

    Hi everyone! I'm not a charge nurse and don't aspire to be. I am a telemetry nurse, but as everyone knows, we also take patients with other disease processes including stroke patients. Of course nurses that are not stroke certified are not assigned the stroke patients. I have always been curious as to how the charge nurses (and/or whomever assigns the patient load for the next shift ) conclude or come to a conclusion as to what nurse is going to get what patients. Is there some kind of standard method. In some places I hear it's done in the level of acuity of the patient. In other places I hear they do it by keeping each patient load at close proximity to each other roomwise. Where I work I think they do it by trying to keep the nurse with the patients close to each other so she doesn't have to run around so much. On the other hand, I 've had nights that I have 6 total care patients or patients that require constant monitoring, or 6 patients with Peg tubes ( we allknow how long thattakes), etc. On patient loads like that, it seems like the patient load has not been evenly distributed. If there are any charge nurses out there, I would enjoy hearing from you. Thanks.
  11. GoNightingale

    Peg Tube Nightmare

    Hi everyone out there in my all-nurses community! I thought the GI nursing would be a good specialty to get advice regarding the Peg Tube nightmare I had on last night's shift. I will begin by stating that I work in a very hostile environment where nobody wants to help the other. I started there 6 months ago, thought I would give it time, but have decided to start looking elsewhere. Well, regarding the peg tube nightmare. I am a floor nurse and last night I had 4 stroke patients and 3 peg tube patients. Peg tube #1, get on report that it's running at 40ml's/hr from 1300 until 0900 the next morning. I'm a night nurse by the way. So when I go to give meds throught the tube at about 2200, I check for residual and I get 280 ml's of residual. Wow! Auscultated for placement, o.k. it's in the right place. Next I pushed my very,very, very well-crushed meds mixed with water throught the tube. Then I go to give it a flush with 50 cc's of water. Oops, Darn, Dang! Freekin thing doesn't flush! Clogged maybe? O.K. how do we usiually onclog a tube, coke, maybe sprite, cranberry juice. Tried all 3- still wouldn't flush. So I called the physician told him about the residual and the fact that the tube appears to be clogged. He says no worries stop the feeding and I'll deal with it in the am. I know this patient and his tube is always clogged. Allrighty then! By the way, I relay all this info. to my charge nurse.I always like to relay problems to the charge nurse either for new ideas and/or so she can pass it on report to the next charge nurse. Peg tube #2- On report I'm told this tube gets a 250 cc bolus freewater flush q4hrs x4. 2 of those flushed had been done by prior shift. When I asked why he's getting these flushes, nurse didn't know why. Quite frankly, I had such a heavy patient load that night, that I didn't have time to ask why. I just followed doctor's order. Does anyone out there know why a doctor might order that. I work in such a hostile environment, that even if would have asked, I would not have received an answer. Anyway, I check the tube for residual, residual was minimal. I auscultate for placement, so far so good. I push through my finly crushed meds mixed with water. All good. I go to flush with the 250 cc bolus (the 3rd of the 4) and dang! No can do! Darn thing won't flush! Dang! O.K. let's do the coke and cranberry dance! Butthis little sucker just won't flush! So I stop the feeding. At this point I should have told the charge nurse. But I thought I would try unclogging it throughout the night- unless placement is off, usually coke and cranberry juice have worked for me in the past. Peg tube #3- thank God..all good with that one! Comes about 0600 and I couldn't get the tube unclogged. So I tell the charge nurse to see if she's got any ideas. She said she would try to unclog it. I asked her if she had any new ideas techniques that I could try other than what I had already done. She didn't answer. This is very typical with her-not only with me but with others. She is very well known for never making herself available to the nurses under her charge. So now, about an hour later, we are into shift change and the Nurse Mgr. is at the nursing station. She I think overhears me relaying to the physician of patient of Peg #2 that the tube didn't flush throughout the night. That I tried everything. I explained to him that I had oberved that the patient uses accessories muscles to breath (bad COPD patient) and that every time he expired, stuff would come out of the tube. Yet I did not get residuals nor was I able to flush. This was very puzzling to me and to the physician. He said, no worries. I'll request a GI consult and let's see what GI wants to do. Obviously feeding had been stopped throughout the night. While I'm giving report to the same nurse who had these peg tube patients the day before, I inform her about Peg tube #1. She appeared surprised to hear about the 280 ml residual, but was not surprised that the tube was clogged. She said it had clogged up on her as well. I told her I couldn't get it unclogged using coke and cranberry juice. She didn't offer the technique (if any) that she used to unclog when it happened to her. When I tell her what's happening to Peg #2, she was I'm not sure-surprised and I think she must have been thinking..."gee, what a hassle I'm gonna have on this shift!". Suddenly all hell breaks loose! My unfriendly nurse manager apparantly went to both Peg Tube patients and quite frankly I don't know what she did. In a very demoralizing tone-like implying that I didn't know what I was doing-but she is all-knowing- she stops me in the middle of report and directs me with her into Peg #2's room. She gives me the flush syringe with about 10cc's of water in it and she says o.k. flush slowly. I did, and the 10 cc's went in. I was impressed, surprised, happy! I asked her, what did you do to fix it? She never answered. Then she says Peg #1 was fixed also and to start the feeding!Never once volunteering the method or what she did to fix the Pegs. The intent here between the charge nurse (who never showed up to try to fix the problem) and the Nurse Mgr. was to make me feel stupid. I was very upset with the attitude the Nurse Mgr.'s attitude as well as the charge nurse. Onde of the nurse's who heard and saw the whole thing said to me," You know they are just trying to make you feel stupid. I heard and saw the whole thing and she did nothing different han you did. It may just be that the coke/juice that you used may of taken time to work and when she went to flush she got lucky. I have thought alot about this problem (since it really bothered me and is the final spin to get me looking for a new job) and I wonder.....when she gave me those 10ml's to flush into Peg #2, did she even attempt more than 10cc's before calling me over? On Peg #1..what did she do? Is it really unclogged because........ there was 280 cc's of residual early on to the shift. Was 280cc's partially in the stomach and partially stuck in the tube? This is why I am seeking explanations from my allnurses family because Icouldn't get answers at work and...I am definiteky not a peg tube expert. Thanks in advance :heartbeat
  12. GoNightingale

    What's Happening to Home Health Care?

    Thanks for both suggestions. I will apply on Gentiva's website and see what hospitals have their own home health care department. Thanks a bunch! I love this site because I can always come here to feel connected with other nurses.
  13. GoNightingale

    What's Happening to Home Health Care?

    I am a Telemetry nurse trying to get into Home Health Care to eventually make it my full-time job. I have been trying to find agencies/companies that are dedicated to Home Health Care. I am in South Florida. What I have found is that either staffing agencies have "some work" through hospital systems, or hospital systems hire home health care nurses to work for them; but I have only found 2 true 100% home health care agencies- one is Interim and the other is Gentiva. Interim is a franchise scenario where each office is really having a difficult time staying afloat. I'm not sure what's going on with Gentiva- I sent my Resume, called the area director and have not heard back. I guess what I would like to know is what is the politics of home health care competition? How are the hospitals distributing (and to whom) their business when they discharge a patient with home health care? I've also heard that with the new Medicare changes alot of home health agencies are going out of business. Can someone out there fill me in to what's going on and what they feel or think will be the future of home health care? Thanks alot.
  14. GoNightingale

    Board of Nursing Actions

    Wacondo, thank you, thank you, thank you for all of your very true and actually quite profound. I wrote this yesterday after some additional rude awakenings. I'll tell you the truth, I've been quite delusional about myself and life for a long time. I thank God that Ii have experienced everything I have for these past 2.5 years as a nurse because....they have made me a much more informed, strong person and nurse and ......life has taken an entirely new meaning for me. Thanks to you and everyone who has so generously come out to say a few kind words. Question, when I apply in an institution with the truth, do you know if HR reports this to my resident state board (which is not the state where this whole "thing" happened. Don't know if you know, but if anyone else knows, it would be helpful.:redpinkhe
  15. GoNightingale

    Board of Nursing Actions

    Thanks Keekeedt. I'll tell you, from day 1 I have been swimming upstream in this field i still feel blessed to be a part of. I have had to request deferrments and/or forebearances in the past. Yes, it can be done on the phone, but it costs $150.00 with Sallie Mae. Don't have the money. But you know, it's o.k.; i still believe God has a plan for me and that divine intervention has a way of turning negatives into positives. Thanks for your input!:heartbeat
  16. GoNightingale

    Board of Nursing Actions

    I don't even reside in the state where the "action" occurred. I have another license in the state where I reside. To be honest with you billibob, I've only been a nurse for 2.5 years and it's been rough. I' ve tried obtaining 2 jobs and get excuses for not hiring. It's hard to see me doing anything else but nursing at this stage of my life. I'm 56 (I was a late bloomer- maybe I shouldn't have bloomed!)I am now jobless and I have an $80,000 student loan debt on my shoulder (ouch! my shoulder hurts!). Thinking bankruptcy..thinking where am I gonna get a job topay next month's rent? Thanks alot for your input:heartbeat