clearblue3

Thanks for the advice! I should add that the family covers shifts that are not covered but they do live over an hour away. I know that it is a major pain for them, but like you said...this job isn't my whole life. It is funny how patients seem to think it is though :-) I just wasn't sure if I was correct in thinking that as an independent nurse I could ask for a day off or if I needed to find a replacement or I was out of luck. It will be interesting to hear his response when I tell him....:-) I know he will say you better start looking for someone to cover your shift! Lol

I am not sure if this applies to working for an agency (can you request time off with an agency??) but if you are working as an independent private nurse, how do you ever plan a vacation? One case I work on has plenty of back up nurses and one nurse acts as the scheduler and you can actually request days off. The other case I am on however, doesn't have as many nurses, most of them I never met since I only work one day a week. People aren't that willing or able to pick up shifts. In situations like this, is it possible to EVER take a vacation? I work Fridays so that basically eliminates ever leaving town for a weekend. Or what do you do if you want to plan a major trip and need to get plane tickets. No one is going to pick up a shift that far in advance. What if a person works full time and needs a whole week off. That would never happen. Do you just resign yourself to the fact that you can't schedule a trip?? That just seems crazy. My patient has family that could take care of him...but he isn't really the accomodating, let me help you out kind of guy if you know what I mean. I can see him saying, "Find someone to cover your shifts if you want to have off." about 6 months before I started this job we planned a family vacation for labor day weekend this year. of course I didn't think to mention that before starting the job. Now I am thinking it will all have to be cancelled if no one wants to pick up. Any advice?

I am surprised the agency only pays for care in the home....clients often go out in the community with their nurses so is there a certain distance from home at which they stop paying? All the nurses I know are independent and bill medicaid on their own. I know the nurse that taught my vent class said he traveled on vacation with his patient. When you bill medicaid you put down your hours, but nothing to do with location. Why does it matter where you are caring for them? Medicaid is the one paying the agency right? I say whatever the patient needs and wherever they need the care should be covered. Who is to say that they can never take a trip? The only glich I know of is that Medicaid will only pay one nurse for 12 hrs a day max so clients would have to take 2 nurses with to have round the clock coverage. I am interested to hear what others have to say about this!

Hi! Sorry it took me so long to respond to your comments! Thanks for the suggestions!! My patient is AOx3 but does not have the physical ability to take his own medications. SDALPN, I am an RN, so you mentioned I can change the POC? What we have is a typed up copy. Do you just attach new orders etc.? I was able to contact the MDs office and they mailed out a bunch of clarifications/change of orders and those were put in the folder with the POC. This seems like an easy way for things to get overlooked though? Or is that how it is done, and then when the POC is re-done every 80 days or so, make the changes then? And for those of you who mentioned keeping your own record of everything....we each have a folder with our copy of the charting. Would you say this is good enough or do you make your own copies and keep them at home? Do you also make copies off all changes in orders or would just keeping them with the POC and documented at the physican's office be good enough? And maybe a silly questions...but at the vent class I took someone said if there is no copier at the home, that you could take a picture with your smartphone and keep the records of charting/orders on your computer that way?? The whole photo thing always makes me uneasy....but I suppose a picture of a form is pretty much the same as a copy...as long as you obviously never post the pics anywhere and I take them off my phone and store them on a hard drive? I am just trying to think of the easiest way here since there is no copy machine. Thanks again for all of your help!! SDALPN, sorry if I sounded crabby in my post to you....after your first post, I was feeling frustrated...and a little nervous that I didn't have the answer to my question! Thanks for clarifying the miscommunication with me :-) I was able to really clarify things (and probably annoy the nurse at the MDs office :-)) so that I felt the POC was up to date. I feel much better now! I am such a worrier...;-)

ok so don't eat me alive for this, but if you were an RN on this case and had questions but no agency, who would you direct them to? For policy questions, forms etc.?

I don't have one. I don't work for an agency. I am hired by the client and bill medicaid directly. The RN at the MD office said she would get me a verbal order for the route change today. I am just trying to contact Medicaid right now so that I can find out the policy on how long the verbal order would be good for. Thanks!

Well, thank you...I think. I don't work for an agency. Yes, lack of training can be very scary...however, you make it sound like I am risking my patient's life. I have paperwork questions. I have gone through everything on the POC and have called the RN at the MDs office to clarify many things on this POC and to have things re-written so things are very clear. I am doing things very by the book, questioning everything. Just because I don't know how the forms work does not mean that this is a "scary situation." I purposely took a client that is not vent-dependent and the skills required for the job are very new grad appropriate. Before recently moving to my state, this patient only qualified for CNA type caregivers in her home state. I understand the advice on here to not take certain clients as a new grad. I am not willing to risk anyone's life just so that I can have a job. I am simply asking how a change in an order would work for an OTC PRN medication for a cold. I was actually the one that caught that this med should not be given as ordered...by G-tube and discussed this with the patient's pharmacy. I DID NOT give the med in a different route than it was ordered even though that is how the patient has always done it. There has to be other PDN cases that do not have fax machines available. The RN said she would mail the clarifications out after talking to the MD. Maybe a dumb question, but a verbal order is usually good for x amount of hours in the hospital and then it has to be signed. I was simply wondering if this is how it works in PDN as well. Not every patient is going to have a fax machine or an agency so if you have to wait for an change in order to be mailed out, how long can you follow verbal orders? I received training on this case, but can you tell me that you will never have a question after training? I don't care if I a person has worked acute care their whole career, care in the home is different and questions will still arise. I don't work for an agency, like many other PDNs in my area. We have to rely on each other and other nurses to bounce things off of. Rather than just doing what the patient wants or how "it has always been done," I am questioning things, calling the MD and pharmacist to clarify things etc. Making sure everything is done by the book. Personally I am proud of myself for doing that. Thank you for your concern, but please also know that the way you come across is harsh and not at all supportive. I am new to this and subsequently have questions. If you would like to answer them, it would be greatly appreciated. If you just want to tell me how inadequate I am because I have questions, then please refrain from responding. I do not mind honest advice, but said advice can be given in a kinder way IMHO.

Hi! I am new to PDN so I just have a question about getting an order route changed :-) My client has an OTC cold med that is ordered to be dissolved in her G-tube but she wants to let it dissolve in her mouth as she has apparently done in the past. The med is ordered to be taken this way on the box. (She is able to eat/drink so taking it PO is not an issue with swallowing). I wanted to call the Dr. to get the route changed, but how do they give you that order in writing?? There is no fax machine in the home. If the order is verbal over the phone, how long is that good for? And how do you document changes to orders? I have her POC with her meds listed on it, but that isn't re-typed up every time something is changed is it?? It looks like this is written up every two months or so and then signed by the Dr.....how does this all work with PDN? Thank you!!!

Thanks!! I know the other nurses there are wonderful (and so is the client :-)) so I figured they knew what they were doing...but the worrier in me always has to ask :-) The experience and knowledge on this board is always priceless :-)

Also what do you do if the patient always declines basic assessments....respiratory, GI etc. This is a very stable patient who only used to have CNAs and isn't used to all the documentation and assessment or so he says. I tried to sweetly talk him into a quick listen to to lungs etc. but he adamantly refused. the nurses all just chart "patient refused." What do you do if they ALWAYS refuse?

Thanks everyone!! I don't work for an agency...so no policy there. I think that working without an agency is more common in WI?? It seems like the PDN nurses I meet are all working that way...probably because the pay is much higher and it is very easy to sign up to do so... anyways, the patient is also an adult so no parents giving meds. I don't have to actually give the supplement that is supposed to be 300 mg and is actually 1000 mg. It is calcium and obviously many people take 1000 mg but I really would like the MAR to be accurate. As for the albuterol....can I just call the Dr. on the POC to confirm the dose?? I know my client has a prescription, but I don't think he knows the actual dose...he just said "it is exactly the same as my sister's" I feel silly to be the new one on the case and questioning things when everyone else has been there quite a while. It is just awkward because it sounds like I am questioning what they are doing. I really like the other nurses, but I am new to PDN so I am not sure what to worry about and what not to! Thanks for your advice!!

Thanks! And as for the vitamin...the order is for 300mg and the one they have is 1000mg. How do OTC things work? Say you are out and about with your client and they want to stop at walgreens and buy cold meds or supplements etc. can you administer them or do you need an order? It seems like they should be able to take any OTC thing that they want...but I certaiy don't want to be liable if they have a reaction or decide to take some crazy thing they read about online lol.

Hi all! I am new to private duty and had a couple questions about meds...my client only takes a variety of vitamins and has an albuterol neb. The POC doesn't have a dose for the neb...just says "one ampule." There is a box of them in the med cabinet that are used but the problem is that it actually has the client's sisters name on the box...apparently they have the same prescription and will share them for cost reasons or something. What do I do about that? I have only been in the hospital environment so I am not how big of a deal this is but it makes me uncomfortable. The nurse I mentioned it to says it doesn't matter? My my second question is how it works with vitamin supplements. One of the vitamins is a different dose than what is on the MAR and POC. Does this matter or can a client take whatever OTC things they want? I am just a worrier and I like to do things by the book. I just don't know what things to make a big deal about and what things are really not issues in home care. Meds seem like kind of a big deal. Or am i just too paranoid? I am new on this case and don't want to cause problems right from the get go. Any thoughts?

Where I am from, I believe that NPs can also be hired to teach...at least at the associate degree level. So maybe NP would give you the option to work as an NP or teach?

Did you figure things out?? I took mine today and I am on hold too :-/

Thanks!! We had always talked about not choosing the "notify MD" answer in school....funny though since I have had several practice questions that the answer WAS notify MD. But it usually made sense compared to the other answers....maybe it was just the source I was using.

Thanks caliotter! I agree! It jus isn't worth the risk. This patient doesn't have a vent but I anything can happen! I would be so nervous all of the time! I can't believe they were leaving a vent patient alone. Scary!

I work private duty as a caregiver (not RN). Sometimes the client is left alone with an emergency bracelet on. Is this legal? I have refused to do it in the past but the other staff say it is fine. Does Medicaid require round the clock care or is it up to the client? It is an adult. I know some clients only qualify for care part of the day so maybe that is fine??. How does that work? Can they be left with family or friends then? I just would rather not lose my nursing license before I even get it! Thanks!!

I see BuckyBadger....so a case couldn't have all LPNs working on it? I also think that as an RN I wouldn't want to sign off as a supervisor of someone that was working when I wasn't actually there. seems risky? I am really new to all of this so and don't currently work PDN so I don't know much :-) Just that there are LPNs on these cases and billing the state. I am guessing by your name that you are in WI :-) Me too :-)

my group only lost maybe 4 by the half way point and then maybe 1 or 2 after that. But there were some groups behind me that lost more....second semester was tough. If you can make it through that you will be fine. Third is also a lot of work, but I don't quite as bad. CHA2 is easier than CHA1. When I started (i was part time) we had 8 week classes. Once they went to 16 it was more difficult to remember questions for the cumulative exam at the end of the semester. My advice would be to make great study guides for each test (we always got study guides, but I know some instructors didn't give them. I was on BD campus. We would divide them up btw a few of us and then basically type up an outline of whatever the book had on that topic and what was said in class. so probably like 20 pages worth, but if you divide it up it is doable. Then just read thru that, highlight what you think is most important or that you can't remember etc. ) and then after each test, highlight or make notes of whatever was on the test. It makes it soooo much easier to study for that cumulative. We had someone fail CHA2...she was on the border the whole time and then didn't do well on the cumulative...so yes, I would definitely recommend studying for it :-) Good luck!! You can do it!!!

No....they phased out the part-time program :-( yes...some worked and some didn't. It all depends on the person....do you have kids or other things going on as well?? We had students with lots of obligations do well and graduate and then some with less obligations fail out. It really all depends. And some people are naturally better at school/tests etc. Let me know if you have any other questions!! I just graduated this week :-)

yes...I see what you are saying. I really have no idea how the LPNs I know are doing things....who is supervising at their non-agency PDN jobs or how that works if LPNs are allowed to do non-agency PDN and bill medicaid...but then of course they won't have an RN supervisor...just other RNs that maybe work the same case. I did read something that care can be supervised by an RN or ordered by the physician. who knows. But I suppose that each patient has a an RN case manager...so maybe that is how that is solved and then they make sure that an RN does the above things you mentioned :-)

Well, in my state the gov. website specifically states that LPNs can do PDN and be bill medicaid with an NPI number, so no, I don't think they are doing it illegally :-) I have no idea what the application asks for though :-)

interesting....I know of some LPNs that do PDN, are paid by medicaid but don't work for agencies. Do you have a number you can call in your state...for the agency in charge of MA numbers?? Hope you figured it out :-)

job shadow, job shadow, job shadow!! I very much wish that I would have done this....and then maybe I would have chosen nursing the first time around :-) I am just graduating, and the job market has gotten better here (WI), but sometimes I wish I would have gone the PA route. It really all depends on the person...like someone on here said, pharmacy would be a great job for a lot of reasons...although I don't think it would be for me. I also start nodding off when in a room with a patient while PT is working with them. But sometimes just watching someone at their job can be boring no matter what it is because you aren't actually doing the job. Those in PT/OT do seem very happy. So my advice is don't rush!! Take time to check out everything, weight the pros and cons, ask a lot of people in those professions to get their advice. what is most stressful about their job? Does your daughter do well under pressure? How does she feel about bodily fluids and performing basic cares? Ask them what advice they would have for the person going to school for their job in terms of what jobs/volunteer positions etc. they should try to have during school to help them land a job upon graduation. And this site is awesome for learning about all kinds of nursing. Just keep in mind that it is kind of difficult right now to start in any area besides med/surg etc. Most specialties want a year or 2 of hospital experience. Maybe she would enjoy reading through some of the threads. And remember that many naturally come on here to vent, so she may see a lot of "this is what I hate about nursing." but just search "love nursing" etc. to see the other side of things :-) Good luck to her!!!