nursearoo

Private Duty in MA , (company I work for) $30.31/hr (RN) during weekdays, on evenings, weekends and nights $32.75/hr........holidays time & a half........ I was in FL (same company) rate varied...anywhere from $16/hr to $20/hr depending on the case.....no differential for evening, night....holidays were only $5.00/hr more than your base pay. IF you were an RN and worked on an LPN case, you had to take the LPN pay..........reason why I left FL after moving down there, stayed for only 5 yrs because the pay sucks.....

Well, I'm a case manager, and we do them for ALL pt's 18 & over......probably is my company's policy....have no idea, I just know we do them for ALL 18 y.o and over .....been doing them for as long as I have been at my company...

SOC is the date on the 485...basically the 1st day a nurse walks through the pt's door, even if it is only an orientation...... all the dates have to match .....the only date that doesn't matter is the "initial assessment " date...the date you go out to assess the pt for services ( such as private duty nrsing, home health aide services etc) The nurse case manager is the person who generates the 485/POT ...based on the pt specific information.....you look up all the diagnosis codes for all your pt's medical diagnoses and those go on the 485....usually if you don't have an exact date of diagnoses ( some pt's or pt's parents don't know the exact date) so you would just put the SOC date. The OASIS is for any pt 18 or over 18 yrs old.......that is done for SOC, as well as if the pt goes in the hospital and when they come out, also every 60 days, and upon discharge and also if the pt dies or is transferred to a facility permanently. Oasis is done whether pt is on Madicare or not.....

Ph paper is the best way to check for proper placement...gastric Ph is below 5.5......also if the pt is on any meds like Pepcid, Zantac etc..anything like that it WILL affect the Ph so you should ask the MD what the acceptable Ph would be for verifying proper placement...years ago we used to do the air swish to check placement, however because it isn't really reliable, Ph is the best indicator for proper placement..... :-)

PSA does both adults and peds at most locations...there are some branches that only do peds.....some branches do home health aide cases as well...it all depends on the location.......I have worked for them for several years, and let me tell you, the location I work for has a very strict skills competency check off.....and they will send people home if they don't pass on the skills check offs....case managers have to sign off the staff before they even work on a case AND the new staff have to have orientation on any case they go on.....it can be an entire shift or several if need be...we also do in office 1 on 1 training for those who feel they need more training....and also if someone is a certain level, they cannot work on a higher level pt ....not even walk through the door of pt without coming in to be signed off on the needed skill.....and the case managers are very strict because they are signing their name off on the staff who is trained. It's not an easy walk in the door & be hired process.....people have been sent home even near the end of the orientation which is an all day thing......I even tell people up front when doing something such as vent class before we even start....that they WILL be sent home if I feel they aren't getting it or are unsafe......end of story... I worked for an agency before ( a different agency) and they had a couple of videos you watched on working for the company,,,,nothing on actual nursing tasks....and then you were hired.....and sent on cases even if you had no experience or never worked on that type of case before......that's scary.....PSA wants only competent safe staff and they ensure that those who get hired are just that. They are a good company to work for. I worked fore them as soon as I graduated & was licensed....yes I was a brand new nurse BUT I had years of experience caring for my own vented/trached/gt child so I wasn't "green" so to speak...even though "technically" I was a brand new nurse. When they want at least 1 year of experience, they mean for nurses who have never done nursing work at all and are fresh out of school. They are actually one of the best, if not THE best home care agencies to work for... :-)

Try PSA Healthcare...they pay the highest....HOWEVER...in FL you will get low pay...I worked for them and the pay rates when I left were...$15 an hr for LPN's...and $16/hr for RN's...on holidays you only get $5 an hour more than your base rate....plus if you are for example an RN and you work on an LPN case...you have to take LPN pay.....you get no shift diff either for working evenings, nights, or weekends. I lived on the Gulf Coast for 5 years....think very carefully before you do move.....I moved down there from the NE thinking I'd never go back ....wrong. All the rents are now higher than up north, food costs more....even things like the monthly water bill was $60 a month ....crazy!! Try living somewhere for 1/2 the pay but everything costs the same or more..... We left because we were sinking.....The hospitals pay more and IF you can get in one...they do pay shift diff etc......I don't know if you would be renting or buying, but rents were all up to $1200-$2500 a month......we suspect because of the multiple foreclosures, people HAD to move so landlords took advantage of that....you used to be able to get a big house with a pool for around $700 a month to rent.....not any more......Not trying to discourage you but really research before you decide for sure. Look on Craigslist or rentmeflorida to see the prices to rent (if that's what you are doing) and don't go unless you have a job secured ...because jobs are far & few down there.....I found (and many of my former co workers as well) that if you don't have exactly what they advertise for you WILL NOT even be given the time of day. I have a nurse friend who is amazing...she has done every area of nursing for well over 30 years.....could not get a job in a hospital....and she has done hospital nursing for many years, then peds homecare for the last 4.....(She was doing peds homecare at the time, needed a reliable schedule & job)....went for a job in adults, and she said the person interviewing her kept saying "but your a peds nurse"...she had to keep redirecting the interviewer that she has done adults for many years.....and has done everything from oncology to med surge......they didn't care. It's tough down there. ....So please just a supportive word of advice really research everything before solidly deciding......oh and plan on driving pretty far to go to and from work depending on where it is.......sometimes I would drive 75 miles one way......so 150 miles per day just for work......gets old real quick!.......Plus in HH PDN...you can be out ....of work with no notice for a couple of days to a month or more if you care for one pt who happens to go into the hospital...so also keep that in mind...........I may sound like "Debbie Downer" and i'm not trying to.....I am just letting you know the facts based on what I dealt with down there........... Others may have had a great experience, but lots of people I know who have moved down there...including myself...have moved back to wherever they moved from.......realizing it wasn't all they thought it would be.....and it's like a whole other planet down there......lol just sayin' Best of luck with whatever you decide to do :-)

Well, I can answer that.....I do this very job.....it's basically mostly paperwork, doing POT's, clarifying MD orders, calling staff nurses, HHA's etc into the office & "counseling" them.....basically a write up they have to sign & get put on "probation", you go out & do 60 day & 30 day case management supervisory visits on your patients,you also go out to "assess need for services" and determine if the person (potential pt) is eligible for services i.e HHA's PDN, SNV's..etc...then if they are you "open the case"...make POT/485, go back out & have all paperwork signed by the pt or family depending on age/medical condition etc.......sometimes if you have patients that cannot be without a caregiver & no nurses are available to cover a shift ( if private duty) you are the one to go cover the shift ....again THAT depends on YOUR particular agency & it's policies.....you also do OASIS paperwork for all pt's over 18 yrs old.......you also hunt down people who don't turn in their paperwork in the timeframe ..i.e every xxxx day after the prior work week. You also have to deal with complaints from patients & their families that you MUST address no matter how stupid the complaint is....and there are some real doozies...you literally sit there & say..."really???????"........and you can be on call if that is part of your job......my company has a rotation so every person in the office has on call duty, usually 1 week during closed hours....so whatever calls come in...call offs...goes to a scheduler....clinical issues go to whatever case manager is on call...& if they can't answer the question or figure out a solution they then call that specific pt's case manager..... and sometimes in a crisis situation you would even have to go out to the pt's home physically...however that doesn't happen except usualy on very rare occasions..........it can be very stressful but it can also be a great job as well.....I am lucky & work with wonderful people..... I used to do case management before as well ...I was a field nurse & would do supervisory visits on my non PDN shift days....so I got a little of both.....it is a lot of driving unless you live where pt's aren't too far away.....if you live in a rural area you could spend a whole day doing only a couple of visits...it's just that the driving distance is what eats up most of the time........my place now luckily has CM's usually overseeing pt's closer to where they live themselves.....some are far no matter who lives where.........Getting out on the road also can be a nice break to split up your day.......sometimes you'll be out all day doing visits and not even make it to the office....other times you may go to the office 1/2 the day & leave to go out on visits later........it's not bad if you have a very organized & well running office where everyone works together...... :-)

See, what I have found is when a family has only a couple of nurses, it will be harder to staff in the event someone is out sick or whatnot, a perfect example I just went through myself, the case had 2 regular nurses, one does 4 nights out of the week, the other does 3....the one who does 4 nights just got into a very bad car accident on the way to work, so that nurse has been out for about 2 months now......so 4 nights a week are not able to be staffed, until I ended up filling in ( family is rude & just plain nasty now) so for me personally I prefer a bunch of different places, that way IF someone is out ( like my example I gave) then the better chance of having the shifts filled.....I totally understand "revolving" door issue & having a bunch of different people in & out ( I had home nursing myself for my child who has since passed away), but when there ends up being only a couple of regular staff, it makes it nearly impossible to get the shifts filled in the unfortunate event that someone is unable to work......alot of people seem to not think outside the box like that....

Wow, CoudySue, the family I mentioned is poor, so that really shocks me even more so.....I can totally see the wealthy families acting like that...the one I mentioned used to be super appreciative and would practically trip over themselves to show their appreciation.....I literally have said it's like someone flipped a switch because it's like going to a totally opposite house than when I used to be there.....it's really bizarre.... I just try to bite my tongue because this family actually has me scared they are trying to find any reason start trouble out of their anger & frustration, and they are directing it towards the nurses who are there to help .......it amazes me because with the way they are acting no nurses will ever want to work there.....I actually am distancing myself.....oops not available....yeah I don't get paid nearly enough for this nonsense, and it amazes me because every single place I have ever worked the families raved about me, wanted me full time permanently.....I have never been treated so horribly ever at a place I have worked....they actually used to say they would only keep a new nurse coming to work if "I" thought they were goo enough, so I would go over on MY own time to meet the new nurses and tell them that nurse was fine ( why I have no idea) then I get this nonsense now........*sigh* When I never work there again they can think why.....i'm slowly distancing myself out of there, hopefully I will not be back there within a very soon time frame.....I am literally worn down from the stress they have caused

Yes, be careful with some of the families because they WILL try to take advantage.....give them an inch & they will take take take.....and some of them can be really nasty, and treat you like a second class servant.....Sometimes if you do things above & beyond, and out of kindness & courtesy for your patient, the family will get it in their heads that ALL the nurses should be doing the exact same things.....and when you try to explain things such as what they are expected to be doing as the family with the patient that is not your responsibility they will get nasty......it will drain you believe me. They will try to pull the old " we were never told that" routine...so beware! I have worked for many families and have only dealt with one family who has just worn me down to the point that I feel like an abused whipping post...everything explained is challenged with " I want proof" etc etc etc......I think they are angry because sometimes shifts just aren't able to be filled, and they ( the family) somehow think they are "guaranteed" coverage, which when they signed their admission papers it clearly states the company does not guarantee coverage every shift BUT will do their best to fill shifts. Yeah it's really ridiculous how they think this...then treat the nurses like garbage because they are mad at the agency.......like a kid throwing a temper tantrum...... You'll see, you WILL have a family like that at some point.....It really makes you want to say " why did I ever become a nurse".......lol...... Good luck! When you get in with a great case you will love it....most nurses end up staying for a very long time when they find a good case & the family is great......

It depends what area you work in.....home health PDN south fl area....They are now hiring PLN's at $15.00 per hour I've been told from acquaintances who have nurse friends applying for a job....hospital I think pay more...down here anyway. Also if you work for a PDN nursing agency most of which serve medicaid/medicare clients..the insurance determines pay ...for example..if an RN works on an LPN case, they get paid LPN wages.......also they only pay you $5.00 hr more on a holiday....I think hospital pay time and a half....so choose wisely. I lived up north & made double and a little more than double for hourly pay....It's very tough here .....and the jobs that are available are far & few between and a few co workers who have been looking for new jobs tell me if you don't have exactly what the job advertises for you will not even get a second look, so your basically stuck in one area because of it.....it's horrible! I am outta here as soon as I can be......If I only knew before I ever moved here I would have saved myself a huge headache.....we are so deep into debt since coming down here...it's ridiculous...and they work you like a dog too......it's insane..

I would call the CM you spoke to OR the director of the agency you work for..... did that nurse document this as her opinion or just what the facts were????? Anytime I have taken care of a patient who had any bumps, bruises, etc...if they happened when nursing was not present, I just documented in my notes exactly what was stated and by whom, then exactly what I observe, such as area, measurement, behavior etc.....In the end the bottom line depends on your agencies protocol for this.....if their protocal is report any injuries, then yes .......maybe check your company policy.........

Reminds me of the nurses who pull the " I don't do nights or weekends".....or my all time peeve " I've paid my dues" in reference to working weekends.......ugh! If that's the attitude then maybe they should have done something else as a career......

I have a close friend who is an LPN who works at a VA hospital in the Tampa area...she LOVES it there.....says the benefits are great...health insurance effective immediately....she use to work private duty home care and put in 72+ hours a week...after going to the VA she quit the homecare job(s) and just works at the VA....she sounds very very happy...and especially not having to work more hours than being home......she grabs an overtime shift if she feels like it but never feels obligated.....

I have 1st hand experience...my own child got this at 3 weeks of age.....perfectly healthy prior to getting sick. This is a really bad infection for anyone, but especially a new baby. She was bent backwards with her feet touching the back of her head....in a donut shape...and stiff as a board. We were told she was not going to make it....almost 2 months in the hospital....sent home to basically die. She made it but not without severe disabilities from the after effects....quadraplegia, feeding tube, seizures, unable to regulate own temp, legally blind.....she lived to be 21 and passed away a month after her birthday from sudden kidney failure..... I would never wish this infection on anyone....it really is one of the most horrible illnesses that can happen to a new baby........ I became a nurse though because of her.......