LJ85

I’m considering this position but I’m looking to learn more about it and what the biggest challenges are. I have experience in ER, Homecare and hospice. I like challenging positions and have done jobs with on call responsibilities most of my career so I don’t mind that. I’m wondering about the family interactions and how hard it is emotionally. I would love to take part in something that brings joy and happiness to people rather than just ushering them out as I do in hospice.

So I work for two home infusion companies and they both have different policies on how to titrate IVIG. Company A says they titrate IVIG as follows: 15ml @ 30ml/h x 30 min, 30ml @ 60ml/h x 30 min, 45ml @ 90ml/h x 30 min and the remainder at 100-120/h Unless pharmacy states a specific rate Company B says they do: 5ml @ 20ml/h x 15 min, 10ml @ 40ml/h x 15 min, 15 ml @ 60ml/h x 15 min, 20 ml @ 80ml/h x 15 min and remainder strictly at 100ml/h unless pharmacy specifically states a higher rate. The websites for the actual manufacturers state much higher rates and it’s not usual procedure for pts to infuse this quickly and fast rates tend to cause symptoms like headaches and flu like symptoms in pts. Every time I go in to a new case that had a nurse prior to me the pumps are set differently so I am just wondering if there is a standard way? The pharmacist I spoke with once said they don’t recommend more than 10mg/h but I’m wondering more about the titration as IVIG is a blood product.

Anything is probably better than hospital pay lol

That sounds awesome! I love holistic and functional medicine! I hope the trend in people starting to lean more toward healthcare and not "sick care" continues.

Hi guys, So I started my own health care service firm, licensed to provide medical and non-medical care to patients at home. I oversee certified home health aides and companions. I try to follow every rule and reg (and there are a lot of them) but there are a lot of questions that go unanswered. I am still trying to find out what the right way is to do certain things, one of them being administering ppds to my employees. Right now I ask that they get them at their PMD, but it would make it a whole heck of a lot easier if I could just admin in the office and read. I cannot purchase the vaccine without a Drs order, I don't know how to get a doc to write it for me, or how to ask them to right it...I'm hitting a wall, I wish I could get some help! I got through all the red tape with starting the agency, but every single day is a challenge! I hope it will all pay off someday, that is if we make it through the mass exodus of agencies who are not CMS regulated. Right now were al self pay, not sure how much longer that will go on before the regs change..again. If anyone has any advice HELP!

Shouldn't everything that happens with the patient be in the chart? If it's something that needs to be communicated to help you care for the patient it should be in the chart as well.

Sounds like us ER nurses are in the minority here (we're used to it) but the issue comes in because we are ALL short on time. I get it and I do try to understand, but what is the point of sending an SBAR And taking the time to include every detail if I just have to repeat the entire thing over the phone. It's frustrating and ER nurses are pressed to get the patient up ASAP. It's nothing personal but for some reason there is constant flack..

I can guess which organization this is...it's seriously an insult to offer that to an RN...:***:

I'm an ER nurse for now. I may decide to test the waters in other specialties but I started in ER and tried to branch out leading me to start looking for another ER job soon after. I am always looking for change, if something becomes routine I start looking for something new...it's like an inborne instinct to keep moving...

As an LPN staff nurse at the time, it wasn't my first priority to find out how the clients were referred. I hadn't been thinking about starting my own agency then and I was just graduating RN school at the time the idea was conceived. Trust me, I did ask the office, they weren't jumping at the chance to give me any information about anything that didn't directly relate to me providing patient care and I made the mistake of confiding in a coworker about my thoughts of starting an agency during the time we were just getting going as a company and I was immediately viewed as a competitor and an enemy. At that point I respectfully resigned to reserve my status there and to retain a good review as I was also just graduating RN school and looking for a new job to pay the bills while I started my home health business. We are now a year in and I have leaned a lot. We are still struggling to make it a successful business but we are going in the right direction. I am just apprehensive because I have no one to look to for guidance and I want to do things the right way.

Do you still work there?

Hello Everyone! I am looking to my fellow nurse entrapenures for advice in this department. I applied for a NJ license for a health service firm aka home health agency able to provide non-medical and skilled nursing services in the state of NJ. We are not yet accredited to provide care servicing Medicare or Medicaid clients due to the stringent requirements but we are working towards that. Currently our clients are private pay or insurance. At the current time we are working with a very tight budget. Non of us (I have 2 partners) have any marketing experience. I have 7 years field home health experience as a nurse. I need some help learning how to market this business to acquire and maintain clients. I feel like we've gotten past the first hurdle but we're at a stand still right now. I don't know how to go about getting referrals from Drs offices or rehabs, we have passed out flyers door to door but I'm just not sure what else to do. We also go to networking events in the area...any tips?

First off, in my ER I had very little training in holding pts..I would suggest learning floor nursing for a few days at least to get the hand of the flow and the other software...Second, the patients absolutely get neglected. The orders have to be scanned, then the pharmacy has to put them into the system, and I spend a ridiculous amount of time trying to get the meds from pharmacy for each patient. Patients get snarky...families get impatient...it all gets dumped on the holding nurse and makes for a grueling day. Its hard to mentally prepare for this and lately nurses are calling out on a daily basis...it just plain stinks.

I am a new RN (6 months). I worked as an LPN in home health with pediatrics and adults for 7 years before I went back for RN. My first RN job was in the ER that I currently work in. I struggle every time a code happens with my emotions. I dont care if its an 89 year old person, its a life. Somebody loves that person. I am an emotional person to begin with and this always gets me, I always tear up and have to compose myself to carry on with the day...It seems like most of the other nurses just get over it without an issue...maybe it will get easier in time but I dont want to become calloused, but I feel it looks unprofessional to lose composure...

Thanks for the feedback...I guess I tend to be too hard on myself sometimes but I feel its for good reason. I take my job very seriously. If I dont know an answer to a question, I look it up. And you can bet I will never make an error with epi. Ive memorized the dosages now. You guys really help build confidence in a new nurse . I spoke to a few of my colleagues about it since the incident and Ive had to come to terms with the fact that not every nurse is equal. Not everyone seems to take things to heart like I do. Some people I spoke to about it agreed with me when I suggested we get critical care training on pedi even tho we do not have a pedi unit, we still treat pedi in the ER and we get critical care training for adults so..I know the ER is fast paced but I will be sure that safety is not compromised. As far as not giving a med another nurse draws up, I'll have to put my own worries aside about offending another nurse and just stick to my instincts and my comfort level of giving only what I draw. I am learning every day, thanks again guys!

In critical or code situations in my ED it seems that is protocol. One RN draws it up, one gives...when I have worked anywhere else I never gave a med that I didn't draw up..I feel much more comfortable giving meds I draw up vs someone else.

Thanks...this near miss still makes me feel like it was too close a call. I guess I just have to be thankful and move on. This is how experience is gained I guess. I think I'll be studying up on the cpen after I'm done with the CEN. I do not like not knowing things when it comes to keeping my patients safe.

FYI if you wear danskos or other patent leather finish shoes those wipes will wipe the finish right off

Wow it really is a thing...lol. I'm a little surprised!

I have to vent somewhere about this...maybe I'll get some good advice. Ok, so I'm new to the ER and a new RN (6 months). I had a 4 y/o come in in respiratory distress and wasn't getting better with treatments. Doc possibly wanted to intubate. We do not have a pedi unit in our hospital so we were sending the pt out to another hospital. Transport was currently on route. While I was out of the room the doc apparently asked another nurse to draw up 1:1000 epi. The nurse looked at the code cart booklet to compare the child's weight to the dose. She drew up 1.7ml. I entered the room at this point and she handed me the syringe and said to admin sc. There was also an anesthesiologist in the room at this time. I said "that seems like a lot" and repeated the dose out loud to the doctor and showed it to her and she confirmed "yes". Something inside me said it wasn't right. That was a lot of liquid and epi is a strong drug. I had given it to an adult having asthmatic symptoms before and it was way less than that. The anesthesiologist said hold up no thats not right. I looked and the sheet the other nurse had been referring to and saw that it said "ET" next to the dose. The anesthesiologist said it should have been 0.17 ml of the 1:1000 epi. I am upset because this was a near miss. I had asked the charge nurse in the room about it when it was happening and I do not feel like I got the support I needed to make the right decision. If that anesthesiologist was not in the room I'm afraid I could have made a fatal error. I would like to think I would have stuck with my instinct but I'm not sure I would have refused to give a drug the doctor ordered. There has to be a better way, a way to prevent this in the future. I'm besides myself. Luckily no harm was done but I need to find a way to make sure I maintain safe nursing practice at all times and not to ignore my instinct.

Nicki- why do you recommend tncc first before CEN?

Hi, I was recently approached to be a partner in starting up a home health agency from scratch. The two others in the partnership have zero experience in the medical field. We have gotten as far as receiving the state license, which is a great accomplishment, but as for the business end, were really struggling to find clients and get out of the red. Does anyone have any suggestions? I'm grasping at straws here...

I pay very close attention to detail, have excellent bee side manor, always working harder to perfect clinical skills and I like fast paced environments.

Thanks so much for your input I will definitely include these!

JerseyGuy2 still working there? Trying to get some info about what it's currently like there...