rn_nxt_dr

"Most vendor management contracts prohibit subcontracting from one agency to another. As the traveler, you are two steps removed from the hospital in the usual scenario you are in: hospital>vendor manager>your agency>you. So I'm not understanding how there was yet another agency involved." The other "agency" involved was the internal recruiter for the hospital/organization and contracted with outsourced company # 1. Undisclosed by originating agency, do you really think they are unaware?...I don't think so. I was told of company #1 but not company # 2. How sick is that? And they turn around and still want to keep me? Makes me sick. But thank you for enlightening their process, however, we do have better options than to be exploited this way.

I had my last horrible travel experience in SoCal last June when I was outsourced to not 1 company but 2 until I got to the jobsite. Undisclosed by the originating company. What did you experienced if any as horrible as this? Decided to go perm after this disgusting last travel contract. For those who are just starting out, ASK if you will be outsourced and to connect with that company's counterpart to learn more of your fate. Otherwise, if your originating company refuses and make excuses as to why you are prohibited, don't go for the contract. Find a different honest company who will level with you. I was prohibited from speaking to outsourced company # 1 ---- I know now why. Do not make the same mistake as I did.

If you have no worries in life like a small child, a husband ---- go become a Travel Wound Care Nurse. There's tremendous need for your experience. Go for it! I would again....after I obtain and become CWCN. Forget about the SNFs....they're a pain and low pay. Go for it!

Thanks David! Healing from the inside out that is always underserved. We need more nutritional assessment and follow through with this and diligence. Not only what the eyes can see.

Wounds are not considered "healed", it is closed or newly epithelialized until granulation is achieved which is the sign of would healing. Only open areas are measured.

I suggest petroleum gauze or adaptic dressing and secondary dressing of conforming gauze roll.

You should juggle several companies but be upfront on the assignment process, esp. if you do not like the city and state. I experienced taking the last resort place to be, spent 3 weeks, got sick and was charged MISSED SHIFT, I did not go back due to health issues, they bad mouth me and I set the record straight with the facility. I was with AMN and left them just last month, if you don't know it yet, you will...read some of the topics on them. They don't care about their employees, they are just about the money. Don't think you have to be loyal to them, you have to let them know you have contact with others, that puts them on a tail spin bec. it's not that easy to find nurses to staff their needs. I juggle 4-5 companies but be upfront on the process.

Modesto is in the Central Valley area of Northern CA, not the best city though, flat and boring. If you know the hospital where you will be working, take the zipcode, check crime rate, as well as with housing if you take it. Always, get local papers and read though about the city. If you are already committed, ready to leave, good luck.

I worked for them for until I left them recently. Do not at any circumstances just accept whatever they want to offer you, juggle 4-5 recruiters to get the best place where you want to be and not settle. They have on the contract MISSED SHIFT that you have to pay them $ 18/hr that at anytime you did not work those hours whether your fault or no fault, they get paid first and whatever difference in base rate is yours. Even when you get sick. Be aware. When a company is more concerned about financial losses than their employees, then it's not the right place to be.

Yes, I am learning these now. They are all too good to be true. I will just do this few more rounds and settle down with something perm.

AMN Missed Shifts that charges you $ 18/hr.---outrageous! Even when you're sick! I can imagine my fault for missing a shift but being sick is over the top. This is total GREED! Remember to take Housing Stipend than taking their offered housing because you may not have the option but whatever they'll offer you----then you're stuck! There are better companies out there.

It was with AMN. They are even threatening to contact past and present employers I had been that I was ill and that I have to present a medical certificate clearing me and without physical limitations. You cannot recoup missed shifts within the pay period because departments has set schedules, you cannot make up for it even if you want to. Well, fellow Travelers disregard this company or any other company that are all about corporate greed, without nurses who wants to come on board with them they have no business. They should be told that it is inhumane, we are not machines, we are humans who get sick. At least have certain sick calls be included on the contract.

My company makes me pay them 70% of base hourly rate. The missed shift is allowed to be made up within the same pay period but the most egregious is including when you're sick. It made me feel sicker! Please share your experiences so we may all rise up to change things and be treated with dignity, after all, what good are these companies without nurses who wish not to travel if they learn that company coffers first and last priority, even when you're sick. Thank you.

Look for a company that pays hourly and not per diem if you want steady pay, I had experienced being exploited because I needed the nursing experience, and I got the break I needed, but not without the price to pay. I eventually found an FT position as an HH case manager, then went into Traveling positions which I believe pays very well if you want adventure and flexibility. I'm in CA, and it pays the best rate, as far as I know. Understand the basic principles of HH by asking your supervisor, Director of Client Services, read CMS guidelines for homebound patients, and follow doctors' orders. However, you have to be clear with your supervisor when you get an order, not all primary care physicians listed are the actual PCP when you talk with patients. Therefore, the orders on the d/c instructions may negate your actions. Meaning there could be an "order," but then you have to have the authorization before the next visit and whether the PCP will sign off on the Plan of Care in the meantime. What do you do with the discharge orders??? be very clear with your supervisor because I have seen that agency will follow a d/c order from the hospitalist and then subsequent orders from PCP, and if they decline, then what happens? You will learn all this in time but be receptive and ask a lot. Good luck.

I started in HH without med-surg experience. I trained in theory and shadowed another RN and that was it. No book will tell you about HH other than the actual experience. You seemed very motivated. I suggest the following; 1) get a good medical history outside of the OASIS form, this will help you with all other conditions of the patient. And always obtain record of PCP's H&P from clinic, all lab work done and other pertinent tests and procedures done. 2) always reconcile your pt.'s medications with PCP's, and other specialist; review medcs. actions and s/e for pt' teachings later. 3) know their diet bec. it plays a big role on most conditions, pls help pt. modify their eating habits. 4) take all SN, PT,OT,ST,MSW,CHHA mobile nos. to communicate directly after their initial visits---knowing you are on top of the case will keep them at bay. 5) get hold of a client teaching guide particularly for HH care and good nursing care plan book. It will assist you in your narrative SN notes. 6) get wound care training and invite medical supplies in-service to complement wound care. I hope it helps and good luck!

I recently experienced a similar situation in Orange County. The owner will change her contract every month, change per diem rate bec. of low census, etc. I finally got fed up and quit. I realized most newer companies 2-4 years in the business are having a hard time coping. They all seemed to be the same. I feel so sick and this is my official RN experience since being licensed. I am again in a newby company doing per diem work with owners without medical backgounds but only money focused. Why are these people in business????

I am inspired by all of your comments. I had my CNA in the 90s and did not retain it after not completing CEUs. In 2009, got my RN license and I cannot penetrate any acute care jobs at all w/o the 1 year recent clinical experience. I got into SNF for a month and did not work out---perhaps I was too slow to adapt to the medication pass and treatments redundant routine or I just did not come across interested. Now, I plan on doing the CNA, acquire the clinical exposure and work in a hospital as a CNA and I hope I can penetrate the acute care setting this time. Wish me luck! Nursing here I come......

I think we have to face the reality of a termination if such a thing happens. It just depends of the company policy for 1st offense. But admitting mistakes is more for the patient than for yourself because detrimental consequences could have happened and thank God this wasn't the case. Honesty will get you a long way even if it hits you hard but in the long run you can live with yourself.

To KateRN1 Accepting new grads is not the problem. The problem lies on people who hire them and not provided adequate training for a period of time. How else would new/old grads get their break if they are seen as "Know-nothing-nurses"?; how would they learn if they are not given a chance? I had a break in a SNF and I'm an RN being trained by an LVN (new grad with barerly 1 yr experience) showing me how to pass medcs. from another patients medc. packet bec. the other patient that I'm about to give the medc. is out. Including insulin. I got so disgusted that I had to raise the issue with the DON. They got scared that I could blow the whistle---I was not given a new schedule after 30 days. What's wrong with the picture? They said, " if it's not documented, it was given". Well, b.s. because clearly there's fraud being committed. That when a nurse takes away medication to give to another patient doesn't justify that you did your job. That constitute stealing---and what about the vicious cycle? The never ending stealing from one's packet to give to the other. Who pays for that? and who keeps tab? I will not work in SNF ever again!

To Sehille4774 What State are you at? Not in CA at least or in the big cities. I would imagine that in the suburbs. That is good to know.

I've never heard of HHA accepting a new grad for HH. In CA, 1 year acute/clinical experience is always required and that really makes it hard to get a job, new grad or old grad. Read as much as you can about your case, esp. medications and drug interactions, make sure all care plans are performed. Ask your DON/supervisor for training if she has time at all. Ask a colleague to assist you on paperwork that SHOULD coincide with patient's condition. Good luck!

Check out Job Fairs all the time. If you are amenable to go into Assisted Living----google the most prominent companies or simply google job fairs in CA. Search Assisted Living.

Correction on previous posting; 1. Staph. aureus is not a normal flora but a COLONIZER. 2. Pyogenic MEDIATED....... 3. THEIR instead of there (not thinking....).

Staph. aureus is a normal flora of the nares. MRSA is a highly virulent strain of S. aureus. Colonization of such bacteria if there is open/abraded skin. Hand washing is surely helpful but it also eliminate the normal flora that occupies there normal spot only to be invaded by a virulent form. It works both ways. But remember that Staph. aureus has several virulent factors; toxic shock syndrome toxin that causes TSS, enterotoxin that causes food poisoning, exfoliatin that causes scalded skin synd., and the pyogenic medicated by enzymes causing inflammation and necrosis. The best prevention is diligence in all the things that you do and how you will react when you see someone who just touched or picked there nose. What do you do next?

Being new in LTC needs getting use to. I worked in LTC for 30 days, my med pass was terrible. I was bounced from tasks to tasks until I never got a call back for another schedule. I'm glad it was over too but at least I didn't quit. When you spend a long time in LTC, it would be hard to get a hospital job. At least, that's what they say. However, there's a technique that I learned while working in LTC. Consolidate all your enteral feedings first, take all your Bld. sugars and start with the patient with the least medications to get it out of the way. Give your CNAs the list of patients that has anti-hypertensive meds. bec. BP is needed before you administer their meds. If you have time, since no nurse has ever read patient charts---I don't think, if you want ask your supervisor to spend time on your free time to read through them. That is if you want to, otherwise, you will always work with a catch-up mode. Rather than knowing their medical history. Good Luck! You'll do just fine.