Bug Out

Whether it is safe or not entirely depends on the company and type of clientele they get. Some companies screen their customers and others will take anyone with a pulse and money to burn. Always carry malpractice insurance and practice like how you always do and don't cut corners. You are as responsible doing this as you are on the floor of the hospital. Difference now is when something goes wrong there isn't a massive juicy hospital to focus on, its just you and the generally small company.

Michigan has the Dr. Ron Davis Law which prohibits occupational exposure to tobacco smoke. Residents of the nursing home are allowed to smoke in outside designated areas and can be supervised or unsupervised. What the facility cannot do is compel someone to be occupationally exposed to smoke. They can make you supervise the patient but they would have to take measures to prevent your exposure. The below are some links to the smoking rules and a place to find information to make a complaint. www.michigan.gov/smokefreelaw https://mltcop.org/documents/smoking-nursing-home-english

I have not been impressed with French healthcare to be honest and have similar stories from France. I don't think you can say it is very good when you do not track and report basic things like SSI, CAUTI, CLABSI, VAP, etc. How do you know it is good if you are not assessing? Some hospitals will track some outcomes but whether they report those or do anything with those numbers is hit or miss. Now there are definitely some better facilities than others, Bichat-Claude for example.

The healthcare in Mexico is interesting to me in that there is a wide variety of care provided and generally, you get what you pay for. It's easy for tourists to judge the healthcare based upon the looks of the facility but I have generally found the knowledge and experience to be very good. Where they generally suffer is a lack of adoption of more advanced technologies, but that is also how you control costs. I wish your family the best.

I toured a new "state-of-the-art" hospital in Germany. As I walked through a hallway with about a team of 10 we paused to watch a surgery that was occurring. See, the ORs were only large enough to house anesthesia and the lower half of the patient so since they were operating on the patient's skull, the procedural team was in the hallway with the upper half of the patient. I was close enough to literally touch the patient's brain if I so wanted. This was not a private OR hallway but the main hallway open to the public. The problem with most European healthcare is that they generally do not track complications or outcomes nor have any other incentives to actually improve healthcare. This hospital had never had an surgical site infection or any other hospital acquired infection in it's short history. The fact that they do not look for such things is besides the point. U.S. healthcare is expensive and complicated but the one really good thing we do is we are the most open and honest about the care provided. We track and report complications and patient outcomes.

You flush with normal saline and then instill the heparin. The heparin is intended to remain within the lumens of the catheter between flushes with the theory that it will prevent occlusions. In home health/home infusion it is known as SASH. Saline (flush), Access (instill medication), saline (flush), heparin.

While I am sorry this happened to you I can find nothing obvious in that story that constitutes wrongful termination. Wrongful termination is a legal term that varies by state but generally involves discrimination, retaliation, failure to follow termination policies, or some breech of contract. Do any of those apply to you?

Never seen a nurse just stop caring and treat their job flippantly and lose respect for the importance of the little things? I see it nearly on a daily basis in my specialty. Only difference is that in RV's case the dice rolled the wrong way and there was a poor outcome and that poor outcome gained attention.

My SO works in this area in a leadership role. There are stories of this with remote positions in all industries. I can tell you though that these companies are not even remotely close to being organized enough to even consider something like this, they struggle just to keep the computers working, ha! Most companies look for things like the amount of cases your work in a day, how often you touch a case a day, etc. They don't need to watch you work. Most laptops come with camera covers and if not, they sell them at Best Buy and Walmart.

Especially some of these accounts that are brand new with very little post history that seem to revolve the same basic topic...

Wherever I worked you would accrue PTO at a specific rate per week/paycheck. Now I could take days off outside of PTO, I just would not be paid. Some places were strict however that PTO must be taken. Even if I had PTO, taking certain days off, especially holidays, typically was based off of seniority or a lottery. Having the PTO available did not always equal an ability to actually use it. When being hired you just need to be open about requiring a specific day off and negotiate for it. Be open, honest, and direct as early as possible.

I remember your posts from many, many years ago. I always appreciated your insights and pithy comments, you will be remembered and missed.

Agreed. Hospitals bear a significant amount of guilt. The problem though is that they are doing what the system wants them to do and hospitals simply remind our elected officials of that. If our elected officials actually cared about staffing and outcomes all they would have to do is separate nursing from the DRG bed rate and allow hospitals or nursing to bill for services rendered. Physicians can use RBRVS for compensation, why not nurses? If you could have billed for nursing time for the units you managed and that eliminated the cost of staffing to the hospital, or even allowed them to make a profit, do you think staffing would have increased or decreased? Hospitals today are like badly behaved children. While they bear their own responsibility the real responsibility lays with the parents (the government) who literally designed the system to work the way it does.

There are good reasons why the DRGs were introduced in the early 80's and why nursing was lumped into the bed rate. Control expense. A way to control cost was to provide facilities incentives to control staffing by providing a single base rate of reimbursement. When you look at the arguments hospitals put forward against safe staffing it typically revolves around the DRG and reimbursement. The hospitals tell the legislatures that if they want more staffing, the hospital needs more reimbursement.

I never did it from my home but maybe 20% of my patients would want to meet somewhere more convenient than their home or cleaner or whatever. I have performed services in offices, schools, and even parking lots. I could see performing services in my own home if I wanted patients to meet me in my home. For some of my services I would have a decent amount of follow-up paperwork that could be performed from anywhere. Typically I did this on the side of the road but would do it at home on occasion. This is course was not your typical home infusion case.

Everyone supports safe staffing until the legislatures have to find the funding for it.

You will definitely want the INS Standards of Practice. I read the Infusion Therapy textbook which helped. There are a couple different CRNI study DVDs/CDs as well. 70% of my studying was done with a DVD that I listened to in the car.

I was trained through our local INS chapter. Lynn Hadaway offers a course and I believe many of the major vascular access consultants offer courses. I have heard of people going through local training as well through their radiology department. This requires your local radiologist to work with you and create a course for you and then sign off. This is generally easier than it sounds since it is usually an hour or two of classroom work and then you reading a few dozen to a couple hundred radiographs.

My SO is a manager at an insurance company and I work for a company that services hospitals. We both work from home. I have generally found that working within a clinical organization, an organization that primarily receives funding from the government for clinical services, will undervalue the services a nurse provides.

Ah, makes sense. Typically falsifying records involves the deliberate or intentional altering of records, not mistakes. Mistakes happen. I am sure you know this but this is where documenting on the actual dressing can help prevent misunderstandings in the future.

Assess the dressing, does it look like it was just changed? What is the risk/benefit to changing or maintaining the dressing? Since you did not document the dressing and are doubting yourself it isn't your word versus the patient's, it's just the patient's word against doubts.

I think a question you first have to ask yourself is what do you want out of your career and how much you prioritize things like fulfillment, income, financial stability, etc? On a very basic level consider the income difference and how long it will take to recuperate that difference considering the cost of school. You make X today, Y as an NP, and school will cost N. Is it worth it given the added stress and risk? From a different perspective, would an equal investment in time, effort, risk, and money reward you even more? Both my SO and myself work in non-clinical roles but dove into our specialties. My SO makes about exactly the average NP salary in our state and I make just less than the average CRNA salary. We both have bachelors and have no clinical liability to worry about. In my opinion, NPs generally make shockingly little for the time, money, effort, and risk they take upon themselves. CRNAs are about the only specialty I have seen encountered where the real-world income justifies the effort. If you are looking for a new role because you want to make more money, there are far better areas to look. If you are looking for a new role because you would find it more fulfilling then definitely jump into it.

I typically would be paid mileage if the patient was outside of the typical range (typically greater than 30 miles).

The VA-BC is a pretty simple test so as long as you work in vascular access right now. Keep in mind that it is supposed to be an interdisciplinary certification so much of it is practical knowledge. There are several VA-BC study note cards available online if you find the notecard apps.

The rules on who is and is not on the care team are much looser than what you are imagining. You were speaking to someone about the care of the patient seeking professional advice, that is 100% permitted. The spirit of HIPAA is to prevent gossiping, not to make healthcare top secret. Seeking advice in a professional setting, in a professional manner, for professional reasons is entirely allowed.