Benedina

OP, you definitely have the manners and grace to handle disappointments, so every best wish for your future. Those same manners would be an asset to almost any employer. But your statement that you're not planning to publish in peer-reviewed journals might be a reason to reconsider your career goals. Professors in my alma mater's school of nursing were expected to hold research doctorates, with a proven track record of publishing and of obtaining grants for their research activities. Clinical instructors might only holds MSN degrees, but there was no question of their living off their earnings as instructors, an activity that paid only about 5K/semester. You might consider, instead, nurse educator positions in a clinical setting, or other positions where formal academic work isn't the goal. Benedina

One of the GREAT benefits of HH is more autonomy over your schedule. Sometimes I'm still working late at night on my charting but I genuinely love every minute of HH. (And sometimes I'm taking a long lunch with my daughter!) Good luck! Benedina

I'd save some of your questions for after their initial job offer to you. Questions that win you the job focus on THEIR needs: 1. What skills do you look for in your nurses? (Their answer is a GIANT clue as to what parts of your resume will be of most interest to them) 2. What challenges should I expect in this job? What resources should I draw on to make sure I succeed at this job? 3. How would you describe the strengths of this agency? Etcetera. What I'm getting at is you want to genuinely show your interest in *them.* Once they make the offer, that's a great time to get nifty gritty about pay, hours, and other benefits. Benedina

I'm paranoid about giving away too much personal information but a respectful salute to all my 90-something patients who are active, friendly, intelligent, wise, and just plain fun to be around. They've turned my ideas about old age absolutely upside down. Benedina

Paper first. We have consents bound into a book with safety information, contact information, fall risk reduction, all kinds of useful things, so it's very natural to make this the foundation of our first 15 minutes of conversation. Benedina

This roughly matches our company's pay schedule, and I find it just fine. We have clunky software and only manage about 5 visits per day, so much less income. In our part of the world? Plenty of money to get along with. Benedina

Accept the M/S job, and if you get a better offer from the HH company in the same time frame, give respectful notice to the M/S job. It's a business negotiation and it's okay to jump ship for the right offer. That's not common advice around here, but there's nothing unethical about negotiating for what you want most out of your career. Of course, it DOES pretty much slam the door to working at that second hospital in the future, so make sure it's what you really want to do. Benedina

We accept private pay patients, too, so in addition to regular patients I have a few private patients who get once a week or biweekly med fills, weekly lab draw, etc. that Medicare won't cover. I also see some patients once per week for 1-3 weeks toward the end of their care to assess response to the plan of care and do discharge education. Benedina

It's much shorter, isn't it? This is what I did, and it made me an RN in 24 months. It could have been 18 but I elected the traditional path in order to work at a paid internship for one summer rather than take courses and graduate one semester early. Our school required 5 semesters past our general ed courses. My BA fulfilled all the 2 years of general ed courses. I hesitate to differ from you, though, Klone, because you are pretty much always right! On the other hand, OP, it sounds as if you don't have your BA yet? In that case, doing a BSN is going to take you the whole 4-year nine yards. No point in getting your BA first unless you have only a few courses to go. Benedina

Eileen Fisher. It's as comfortable as sweats while making me feel as if I'm a stylin' granny. And I'm old and can afford it. Well--I can afford it when it's on clearance or eBay or in the local thrift shops. Benedina

I pretty much only check out AN when I'm procrastinating on projects, but I always looked for your posts. Happy nursing, and best wishes. Benedina

I think it's your hourly wage that makes the problem, personally. I'm paid per visit--roughly 150% of what you're paid per hour--and that visit time is meant to include travel time, charting time, case management time as well as visit time. In addition I get paid a small amount of extra money for in-town trips and a slightly higher amount for out of town trips. If I manage my time well--it's fair compensation, over time, for me. Benedina

Bucky Badger RN took exception to my suggestion that older parents will be pleased to hear from their kids, text speak and all, and wrote: "When will that day come, just so I'm prepared. I'm in my mid 40's, my older kids are 23 and 20. All 3 generations call and text on a daily basis. What may be your experience within your own family is not an indicator of how all families function." When you reach a dignified age, youngster. My oldest is *your* age, so: just wait. (Or, possibly, take a remark intended as playfulness in a playful spirit. This one is intended as playful, too. Possibly a mistake on a Monday morning!) Benedina

Some of our phones are still not text friendly. I care passionately about language; my first career was in publishing. But I have a work-issued phone that requires you to punch the 7 button 4 times to get the letter "s." This is why text speak was invented, and it was a useful innovation. And all you intransigent moms who insist on complete sentences from the kids: that's perfectly good parenting. But trust me, the day will come when you will be so pleased to hear from your (adult) kids that you won't even notice the text speak. Benedina

My kiddles are grown, so I sign up for holidays often--I'd like the younger nurses to have that time with their kids, and the older nurses to have that time with their families! We generally only do emergency visits on major holidays. We're expected to sign up for first call at least one night a week, one weekend every 4-6 weeks, and second call one weekend every 4-6 weeks. You get to open clients when you work weekends so it's a nice way to build your client list. D

I worked at my first career for more than 20 years. I enjoy still doing a few freelance assignments in it every now and then. Like the extra money, too. Dina

Telling the OP that it has nothing to do with HIPAA when her school IS telling her it is concerned with HIPAA strikes me as unhelpful. Telling the OP that she did, in fact, commit a HIPAA violation strikes me as unhelpful. I wouldn't presume to know what the OP thinks, feels, and intends with respect to the insulin error. Since the OP has gotten more than enough advice about that situation, I'm going to limit my response to the HIPAA issue. OP: nothing in your account suggests a HIPAA violation except (to me) one small detail: don't ask your precepting nurse but your clinical supervisor for permission. He or she is the one to make the clinical decision about whether or not it's appropriate. In my clinical rotations, set in teaching hospitals, permission would almost certainly have been given--but the clinical supervisor would have set it up. In fact, he or she would have gone to the patient herself, asked permission to bring in a gang of us, and then done so. We discussed, without identifying information, EVERY patient each of us had at clinical conference. That's what clinical conferences were for. However, in my opinion, either your clinical supervisor should have spelled this out before clinicals or your precepting nurse should have answered, "I really don't know if it's okay or not with your supervisor. Ask her/him." Students are expected to ask, but you did ask. I think you should have received a different answer, but I think you acted responsibly with the answer you got. To other posters: student observation of patients not directly assigned to them is fully covered by HIPAA. Some examples of policy from assorted institutions: Observers in the clinical setting On occasion, observers may be present in the clinic, operating room, or other patient care areas. These individuals must first sign a HIPAA compliant Confidentiality Agreement. From the University of Chicago Medical Center: ...physicians and staff can use PHI, without a patient's written authorization, to teach medical residents, medical students, nursing students, and other clinical students or trainees, subject to the following guidelines: The Use and Disclosure Must Be Internal: The PHI must stay within the UCMC (Medical Center and BSD) It can not be shared outside the UCMC (including to students, faculty, and staff of non-BSD parts of the University of Chicago), at professional meetings, conferences and lectures, and for non-UCMC courses, etc. Minimal Information: The amount of PHI used must be the minimum amount necessary to conduct the training. And so on. I think the best advice you received, OP, was to "double down," as it were, with this second chance. From the heart: best of luck to you in surmounting this difficult challenge. Dina

This plastic file box, with plastic 2-pocket folders for each client and plastic files for other forms, patient education materials, clinical info, etc. (Plastic folders are also my working surface in the home--easy to open to a 11 x 17 surface, easy to wipe down.) The little pencil box on top holds pens/markers/stickies. This Golite bag, with gloves in one front pocket, phone & pens in the other. Vitals equipment & disinfecting wipes in main area, with other supplies added only as needed for particular patients, to keep it light: Also an open-top black shopper basket that holds: 1. an insulated lunch cooler with blood collection supplies; 2. all my remaining equipment: scissors, wound care supplies, ace wraps, whatever. This is what I draw on for particular patients. I keep all these extras to a minimum and replenish PRN, usually weekly. Anything extra, like oil for the car, goes into a wicker basket at the back of the trunk. And I loved putting together my nursing toys. I have a slight organizing fetish! Dina

I bought the ones I wanted, such as my med-surg book, my pharm book, and my clinical diagnostics book, all of which I still use. I borrowed the rest from the library. (In grad school, too.) If I liked it, I then bought it, preferably used, preferably from the locally owned bookstore to try to keep them in business. (Yes, more expensive than Amazon.) Dina

I'll be the contrarian, here. Many years ago I was offered (first career, publishing) a plum editorial job that would require a daily 60-mile one way commute. I already had decent, salaried work that allowed me to work all but one day from a home office. I had three children, and, while I was thinking over the offer, found that a fourth was on the way. I turned it down. It was never offered again. (I don't want to minimize what I lost: I turned down significantly more money and opportunity.) I chose to keep the decent at-home job while my kids grew up, and through their high school years. Not until my youngest was off to college did I decide to pursue a significant career change that would take me out of the home most days of the week. It was the right decision for me and my family. I know all kinds of people who have made the other kind of choice work beautifully for them and their family both, but you get to look at your own life, listen to your own heart, and choose what's best for you and yours. You might be focused on the part-time regular work because that truly is the best choice for you--or you might just be casting an understandable, heartfelt sigh at a life you've loved as you prepare to move. Best wishes with whatever you choose! Dina

An essential preparation for any patient education, including the excellent talking points of AHRQ's clinician summaries, is awareness of your patient's/family's health literacy and effective tools for education. I would recommend two resources: 1. The AHRQ's own Health Literacy Universal Precautions Toolkit Health Literacy Universal Precautions Toolkit | Agency for Healthcare Research & Quality (AHRQ) 2. The RNAO guide to Facilitating Client-Centered Learning: http://rnao.ca/sites/rnao-ca/files/BPG_CCL_2012_FA.pdf Wonderful to see AHRQ beginning a forum here. Dina

I create a Word document on my laptop for each patient. In the home, I open the software chart and use it to fill in vital signs and physical exam directly. Anything extra, I write notes into the Word document ("call MD @ WOC orders, dtr worried about approp snacks")--that sort of thing. This is a good compromise for me: I can do the care plan & visit note later from my notes, but I have hard data already entered into the computer.

Congratulations, Nurse Sand Dollar!!! Makes it all worthwhile, yes? Best wishes, Dina

Yes to the recommendation that you stress your familiarity with EMR, and I'll go one step farther: show that you are comfortable with up-to-date technology and computers. How you communicate that is up to you, but it's a persistent negative stereotype of older employees that we're unfamiliar with technology. Don't let that be you: "I was the EMR go-to person on my unit." "I'm the computer nut in my family." "I love to learn new ways of doing things, especially on the computer." And not to be too prissy, if none of those are true for you, consider putting yourself into a class or situation where they could become true for you. It's a terrific selling point. Dina

Thomas Aquinas recommends: "suitable" pleasures, a good cry, a sympathetic friend, contemplation, a good night's sleep and a nice bath. And a glass of wine. Dina