RubyRN,CHPN

I have worked for both a small private home health agency and a large hospital based agency. I have friends who have worked at the national "chain". I prefer the hospital based agency as your compensation is comparable with hospital work and it is very easy to transfer within depts. should you desire to switch positions and desire longevity with your employer.

I sent you a PM so I hope you can open it. :)

2:21 pm by grntea 2:21 pm by grntea a member since apr '11 - from 'out in the country'. grntea has 'since florence was a probie' year(s) of nursing experience and specializes in 'legal, teaching, lcp, cm'. posts: 2,225 likes: 4,330 awards: i hate to say this, so please don't take it wrong but.... ::sigh:: is this post a joke? ok, go ahead and hit me. grntea-no joke....it looks like she is reaching out network with others who are looking for similar opportunities. i have worked for rxcrossroads for a couple of years myslef and also looking for additional opportunities as well. nursin97, just pm me...i know what you're talking about. thanks.

There are compainies in the US that do specialize in alternate site clinical trials, meaning some of the collection of data and specimens is done at home vs. the actual study site but whether or not it is done when the study site exists in another country, I do not know. Might be something to inquire about. Best of luck.

I once worked for a company with a Taft-Harltley Union plan that contributed a specific dollar amt. for each hour we worked and there were vesting years that followed. I stayed until I was vested 100 percent with no out of pocked contribution ever made by myself. Unfortunately, that retirement will not survive me when I pass. I now work for a company with a 403b matching plan with a standard match in the 4-6 percent range which I can pass my proceeds on to my survivors.

We had a family whose spouse had a non functioning camera on top of one of the china cabinet. I spotted it and asked her if it was running during one of my intermittant visits because I needed to know and sweared I would never go back if it was on. Her behavior was notorious with all her husband's team including the MD office. She would act sick and take to bed where she would hold court and run her minions from her bedroom while we took care of her spouse in the other room. I always made a point to call the MD office to discuss pt. related concerns from her home as I wanted her to see I was taking action re: concerns and not calling from my car, etc. I remember calling the MD office from her home one day and giving report directly to the physician about a concern. He raved about the completeness and accuracy of my report assessment skills, then he gave me orders for treatment. LOL. I later found out that pt's. spouse often listened in on extention phone on calls to MD office, etc. It was the running joke at the office. Dr's office staff no longer would take her calls or calls from staff and put them through directly to physician. I do know at the hospice side of the agency a patient had 24h private agency care in addition to our hospice service. They did have a nanny cam. Our hospice team initiated a contract for care with the family (perhaps there were other events that led to this) requesting no taping of their staff, period, while in the home. I am firm on picture taking while I am working and don't like my picture being taken without my permission and when I am doing a home safety eval during a visit, if I spot a nanny cam I always ask for what's it's purpose. We have no formal policy against taping of staff but it sounds like on occasion it has been a problem.

Funny, I remember taking my cat with feline cardiomyapathy to a very exclusive expensive kitty cat cardiologist for care and having the vet tech or nurse as she called herself berate my plan of care for my cat because I was a RN and couldn't possibly take care of him at home, monitor respirations, give sq lasix as needed, etc. Kitty was a no code. Needless to say, she was reported and the beloved cat lived a wonderful life at home with us until his final days and NEVER returned to see that cardiolgist or his staff! At least the professionals I work with are trained to deal wth the human response to the illness and recognize the important bond people have with their animals and respect a families' preference for end of life care when it becomes necessary.

Medicare typically doesn't pay for assisted living care. ALF care is usually paid privately by the individual, LTC insurance and in some cases state Medicaid programs will cover it. Check with your state regulatory agency and see about getting licensed. It sounds like a great business!

I am pondering something like this and have considered Summit, I think they pay more than Mollen. Because I work contractually and have other contract jobs that have timelines for scheduling, how much notice do they generally give you to cancel? I don't have a problem working by myself and running a clinic. I work for other companies that drop ship supplies to my home and never have had a problem. I am curious how last season worked out for everyone. Approximately what months did you have work? Was if just flu season or did you have work beyond that?

Its HIPAA and I smell a troll

The LPN has a license and is responsible for her scope as it pertains to her license and her own individual practice. However in home health, you as the RN are responsible for the POC and that the LPN is following the POC . Therefore, if your plan of care states that Mr. Jones will recieve a foley cath change on the 15th of every month with a 16F/5cc foley filled to 8 cc and the LPN changes the catheter and doesn't follow the POC, you are responsible to clarify the plan of care with her. If the LPN was communicated the POC after the POC was up to date and the LPN inserted a 20F/30cc catheter,she is then responsible for her practice. So, make sure your plan of care and orders are up to date and carefully communicated to the LPNs. BTW, LPN's do have a license.

tow admits=8 hours; two admits and a repeat visit=10 hours; two admits and a resumption of care in 11 hours, three admits is just about 12 hours. Anything more than that=JUST PLAIN CRAZY!

Ditto..We do have scanned documents on a safety encrypted designated drive for our review only. Our EMR policy is for no personal peripherals on our computers with the exception of wireless mice only. Our discharge orders are obtained through intake and scanned onto the secure shared drive-it's part of intake responsibility to obtain when they accept the referral.

Hi, this may be a little late as well but I sent you a private message.

- The print is so small I think I might go blind ***Have your computer personnel switch the font on your laptop to make your print bigger. It is possible. Some of our staff had also encountered this problem every patient has had adverse reactions # 2 that requires MD notification via fax (the med list and full adverse reaction report), ***Yes, I heard this is a requirement. Perhaps there is a way to copy and paste that infomation to a generic Word form you save on your laptop. POC orders are a mess (long tedious guidelines to alter, etc.) ***I hear you. We use a Word form saved on our laptop that is a paper version of our request for orders. We have library text for each order stored in F10 so we add the library text items to orders (without actually making the order) copy and past them to the the Word document, print the document and fax it to the MD. You are aware you can add multiple items to a guidline and edit multiple items off the guidlines by hitting your control key and clicking on those items you want to delete, go to tools and remove. Big time saver. - typed orders will get missed when the nurse thinks they only have to do a guideline, ***See above. scheduling problems when switching appointment from one nurse to another- ***If you have a scheduler in the office, they can use the white board feature in the interactive scheduler to move patients from one clinicain to another. Then the clinicians will need to tranfer their computers to capture those changes. no one has yet to tell nurses how to do it on their end and the office is not keeping up, ***do you have access to those modules such as scheduling? At our agency only the schedulers do. having to use "search" button for everything (diagnosis, pharmacy, facilities, etc) and if you can't find it you can't free type it in and have to rely on office staff to add it in on their side..... ***there is a data change feature in notes that gets routed to appropriate personnel to add those things. Have you met with your supervisor to discuss your concerns...I know,its a very tedious and complex program. Anyone using McKesson that can give some helpful tips? ***Good luck, we've been on it for 2 years and are switching in another year to 2 to another program. Change is hard and inevitable, isn't it.

and that is why that place is my former employer....simply should not and will not be tolerated.

I have found several non mainstream contract per diem nursing jobs on Craigslist that have turned out to be with reputable employers. I look a couple times a week for new positions that appear interesting. I haven't been disappointed and from what I understand, their advertising fees are much lower than Careerbuilder and CL's other competitors.

That's a very nice, easy to use system as well. Drop of blood goes to the side of the strip vs. the top of the strip. Has a few extra steps to it's use but steps to obtain the sample are pretty much the same. Manufacturer recommends washing your hands with warm soapy water prior to obtaining sample vs. using alcohol prep. Best of luck.

It is my understanding that Levonox does not impact PT/INR results as it works on intrinsic factors (probably bettered answered by your dispensing pharmacist.) It is my understanding traditional medicare programs pay for 52 meter strips a year (one a week) with certificate of medical necessity provided by your MD. As a trainer, my goal is training a patient to best practice with their meter and encouraging complicance with their physcian perscribed medication and monitoring program. With proper training and compliance, I have seen many people be very successful at home with monitoring and have improved control with their INR readings. Like I have said, coumadin is a drug that if not used correctly and monitored appropriately, can be dangerous. Best of luck.

Good luck. No,RN licensure in my state is dependent on obtaining passing grades at an accredited school of nursing and demonstration of competency in clinical coursework, as well as passing grades on the NCLEX. The RN positions for medical device consultation and sales that I have seen require usually minimal 2 years of hands on experience and if you are working with implanted devices generally a degree of OR experiences. There is no "RN fast tract program" unfortunately and of course, you would understand why this might compromise patient care. RN's who break into medical device sales or pharmaceuticals generally have considerable experience and credentialling in some area of specialty particulary OR or ICU. Best of luck

"With further research I find that standing vs sitting can have an effect as can milking. She always has to squeeze to get the drop and has squeezed twice to get the drop and also placed a second drop when the first wasn't adequate." Lets start with the low tech approach. I would have her stop squeezing her finger to attempt to get her sample. Rather from a sitting postion have her dangle her and below chair level. Have her warm pack her hand with warm moist compress, dry her finger well, this will improve her circulation. Lance the side of the finger pad, not directly on the callused area of her finger. Make sure if she is using a lancet holder device that it is set on the highest level to ensure a deep stick. If she is using a single use disposable lancet device have her hold the tip of device fast against the skin to ensure when the device is released, the lancet goes in deep enough. She will need a drop of blood for most of the current meters approximately the size of a split pea. Use one finger stick per test, never retest from the same finger stick. Use one test strip per test, never retest over with the same test strip if you got an error message due to insufficient quantity. Please refer to your manufacuturer/DME supplier for the most updated information on your meter. Some of the posts on this thread are for 2005 and refer to possibly an outdated meter and old technology. If she is having ongoing difficulties with her testing technique, please refer to your DME supplier so that they can further evaluate the situation. I would also have her test 12 hours after her last coumadin dose and try to stick to that schedule and see if that makes a difference in her results as serum drug levels vary. Coumadin is a dangerous drug if not monitored appropriately. Not getting your sample on the test strip before 15 seconds may cause a false low.You say she takes Levonox (very expensive med) for readings below 2.0; perhaps improved tesing technique may save some on your drug bill. I am curious where she had her meter training done.....were these techniques shared with you during your meter training? I know you appreciate the assistance. Hope this helps.

We have some exceptional LPNs working in the office triaging phone calls from pt's., following up on orders, doing intake, and authorization. Have you considered moving to an office position. Some of these nurses have conditions which make it difficult for them to work out in the field. Have you considered working in the office?

I am an RN and I get paid hourly. All visiting staff LPN's included have a productivity requirement for a given shift based how many visits. RN's who work a 8 hour shift it is equivelent weighted 5 (because of case management responsibilities) and LPN's is 6 visits for 8 hours. We have supplies drop shipped and the CM usually orders those. LPNs generally do repeat visits for wound care, labs, etc. Everybody keeps track of miles, care coordination time, and travel time as well as actually time per visit. I work 10 hour shifts and sometimes I get done before 10 hours and sometimes it's over 10 hours; either way we are compensated for all our hours worked regardless.

To answer your question, a medication list from our home health agency is provided at second visit if needed to be printed on the computer. First visit we are required to provide teacing on high risk meds, provide reconciliation of pt's. meds in home and notify physician within 24 hours of any medication discrepencies, adverse med interactions, clarifications or contraindications. We carry in our forms, medication schedule to write out if it is needed on the first visit. To be honest a great majority of our pt's. are medi savy and have reviewed their hospital discharge orders. Since we are hospital based, majority of referrals come from the hospital. Usual our referral source will indicate if they believe the pt. is having a problem with med mngt. During our admission we reconcile meds and assess pt's. understanding of them to determine if there is any problem that immediately needs to be rectified.

I would think from the onset I would have a discussion with the private duty personnel as to what assistance they would be providing the pt. so our plans of care would mesh. That way, there would be no miscommunication as to whom was doing what.