Saifudin

Thanks for your feedback. I can take the exam but will need 150 CEU hours first. I'm still licensed but to practice I have to get certified again. I was certified for 24 years then moved in different directions, all within healthcare and I am now in home care and getting practice skills back. I'm wondering how to set a study program. I'll probably start with a systematic system review, chronic diseases, a pharmacology review, which 25 of the 150 CE requirement must now be pharmacology. I'm thinking to take an NP review course closer to the time I want to take the exam and thinking about taking the board sometime in the fall, and before the ANCC ANP end date of end of Dec, 015. For all my years in healthcare and being an NP since 1982, I continue to consider myself an NP and will now try to get my credentials back and move into practice with wound care an interest but I'm a clinician at heart. At least that's the plan.

Greetings, Has anyone re-certified years after leaving practice? If, so, how did you prepare for the ANP exam? Thanks

If wet to dry dressings are being used less due to removing new granulation tissue, how could 'rough scrubbing' be of benefit? It sounds like a form of sharp debridement. And no prepping the patient with pain meds sounds pretty sadistic.

I am caring for a client with a Stage IV Ischial pressure ulcer who requires a wound vac. My agency is not happy about the amount of care he requires and you do take a beating financially if a patient requires an excessive number of visits, as well as supplies that may or may not be reimbursed. It seems the 'big players' refer to us when they either cannot accept new home care cases do to staffing or do not want to either take the financial hit or believe the complexity of care may result in re-admissions or other problems that may lower their quality scores. I'm also interested in pursuing wound care and am looking for live training in seminars, skill labs or now thinking to see if I can spend a few hours a week in a wound clinic. Even if I don't get certified, the knowledge/experience is a great thing to have, especially for the care of patients in their homes.

I started in home care on October, 2014. No orientation and what followed was a nightmare, that I have nearly recovered from, but it wasn't easy. I lost an inch on my waist, between the adjustment to working in non-clinical environments and the three hours it would take me to complete the OASIS SOC. I have come to appreciate home care for what it is, a highly specialized form of nursing and medical care, perhaps one of the most important when we often serve as the bridge between what is frequnetly highly fragmented care, overwhelmed patients and living environments that often do not support proper care, support and safety of the client. I find it a huge responsibility that I take very seriously. Of course there should be an extensive orientation but given the highly competitive nature of home care and the balancing act many of the 'mom-pop' home care agencies try to maintain by 'beating the bushes' for patients, often with a disregard for available staffing, I have found that you can get stuck with seven day work weeks, long distances and hours of uncompensated documentation time, not to mention how concerns for your patients can get 'into your head', at least, that is my experience. It is unethical and dangerous to not orient nurses to home care.

Sorry, but I wasn't clear from your first post that your business is a non medical home. I don't know much about it but did some reading. No doubt you know much more than me about this. I think as a business it is a great idea. I'm also interested in care of seniors and it seems to have a great future considering our graying society (myself included). Is the RN a Virginia requirement? If your using care givers, they do not have to be nurses from what I understand. Perhaps you need someone to evaluate medical needs clients might have, such as chronic diseases, medications, etc. Sorry I can't provide more but I wish you all success.

I agree with the others that you should build a solid foundation before moving on. I left direct care NP practice in 1995 but in my positions following that as a Director of Nursing and most recently as a Director of Quality Improvement and Patient Safety, and now, as I ponder the direction I want to go in my career, I have and continue to consider myself a clinician. The mix of nursing and being a medical provider was a perfect fit for me. The nursing foundation is far different then medicine. The aspect of patient teaching and the caring element inherent in nursing for me was an excellent foundation for then learning medicine and providing an advanced level of care. I may go back to it. I also think that with healthcare in such flux with the nursing profession losing what many of us once felt was a 'recession proof' profession, I think that given the acute need for primary care providers that will continue to grow, NP practice may also provide more employment stability, but, time will tell. Either way, focus on the rigors of studies that lie ahead.

Ouch...yep..pre-NCLEX for you 'young'ins' means state boards administered their own exams. It was not standardized and of course, not computerized. I might have good news. I wrote the the Michigan Nurses Association and what I was told regarding have to test again might be wrong. They are supposed to get back to me tomorrow. Either way, I don't mind a good review anyway and a refresher course is probably necessary. That's not a bad thing even if I don't return to practice. I haven't worked as a staff nurse since 1983, after completing my NP program. I might try to get back to NP practice which will be another intensive review.

Thanks again for the quick response. I worked overseas for 18 years and now back I may be going back to my roots in nursing...

Thanks ChazzW for the reply. I spoke to someone in the licensing division in Michigan and she said I have to take the NCLEX. Actually, I don't find their website very helpful. If you don't mind, I'd like to ask your opinion on NCLEX prep books. Older versions say 2010 are much cheaper than 2013 books. Do you think there are significant changes in 3 years or so make buying the most recent materials better to purchase?

Has anyone who has been an RN for some years (pre-NCLEX days) had to take the NCLEX in order to get licensed in another state? I'm licensed in New York and now want to get licensed in Michigan. I was informed that I must take the NCLEX first. Is this the case in all states (other than compact states)? I don't mind taking it. The review will be good. Any thoughts on this.

I'm curious how do you break into the field. I've been in healthcare for 35 years. I'm an adult NP, worked as a DON in addiction/mental health and most recently, lead a QI and Pt. Safety department in a community hospital. Last two positions were overseas in the Gulf. Positions advertised usually ask for experience. Will certification potentially open the door?

Great for you for going into business. Your post, however, doesn't provide a great deal of information about the services you provide in order to offer suggestions. I'm not clear on what services you could provide to patients in a nursing home, unless you mean patients in for short term rehab and are expected to eventually go home. What services do you provide, how much competition are you facing, are your services different or the same as your competition, can you provide niche services, etc. Have you defined what the next level is? These are some questions that come to mind in response to your asking for help and suggestions.

My suggestion is go for what interests you the most, what you think will bring you the most satisfaction and then look at the money. For me, despite being out of direct care NP practice since 1995, I still consider myself a clinician. The knowledge and skills I gained while in practice were invaluable as a nursing director and most recently in quality improvement and patient safety. Anesthesia vs. providing direct care are apples and oranges. If your a very people oriented type of person and get satisfaction from not only providing care but the feedback from those whom you provide care for, then I would go with an NP or a PA program. I believe the money is quite good in all three areas with anesthesia likely higher but so is the stress.

Let me take a broader view of this since the story is brief. Perhaps this student has not encountered a patient in this condition before. It can take some time to get use to the more unsavory aspects of nursing care, so perhaps we can go a little easier on this student. In fact, she may never get use to it and eventually seek to work in nursing in an area that does not have to provide this very personal care. What this poster did by taking control and going to the patient is far more instructional than any class room discussion or lecture on culture, etc., could ever provide. There are little things I was taught back in the 70's (1970's that is) that are still with me today. I had a phlebotomy nurse teach me that you can draw blood, and even give blood through a 23g butter-fly. Later, when I was in NP practice, in both the ED and OPD I used 23g butter-flies for nearly all blood draws except trauma cases. 'Back in the day' when I trained in a hospital program, after the the first semester we were allowed to work as aids and orderlies, in fact we provided important staffing and living next to the hospital, they always had enough aid staff. Training and working in the same hospital, you learned all the basics of care and by the time we graduated and went to work as professional nurses, we did it all without question, including what I always felt was one of the worst things we could do to a patient, and that was manual dis-impaction. I suggest patience, compassion and as Tramore35 did, teach by example.

No nurse or care giver should expect that abusive or injurious behavior is part of a job. It can and does happen in the course of nursing care, particularly in mental health, but it is never part of a nurses job description. That is just a ludicrous expectation on the part of your employer. The bigger question is why this patient is agitated, combative, etc., beyond the diagnosis of Alzheimer's. Has this patient been thoroughly assessed medically and psychiatricaly? Underlying conditions such as infections, certain medications (and combinations), pain, etc., may be causing increased agitation, acting out, etc. Was the patient placed in long term care for this reason? Read the file, do your own careful assessment, raise these questions and if appropriate, (sure sounds appropriate) request antidepressants and/or antipsychotic medications that will help protect the patient and staff from harm, as well as hopefully allowing the patient to rest and be more relaxed (not slogged out). If all else fails, I agree with others, start job hunting.

You need to have some information about your employer. Were you hired through a recruitment agency? Do you have to register with the Saudi Council for Health Care Specialties? (all medical, nursing and paramedical staff must be registered with the Saudi Council, which is in effect a license to practice. You must take a nursing exam before being registered.) If the employer states you do not have to register I would be sure you are actually going to be documented as a nurse. Here in Saudi you receive an Iqama or residency permit which ties you to your employer. Your work or profession must be on this Iqama. It is not uncommon to be hired under one title and placed in another. This is OK if this is explained up front and it is with a legitimate employer. This can happen if the organization cannot get a visa in a particular job class but can bring an employee in another. I strongly advise you to check this before traveling. Will this private duty be in one home? If so, be sure again that you are hired as nurse and not to do maid duties. Also, once under an employer you cannot switch jobs easily and almost never within the country. You will have to leave and to return, you may require a No Objection Certificate (NOC). Although a law was passed several years back stating an NOC is not required to return to another job, often times Saudi embassies will not give the visa without it. This can vary from countries. If your from an Asian country expect needing an NOC. Finally, be cautious and check out the employer. Be sure that what is stated in the contract will be what you receive once in Saudi.

Interesting post. I'm American, revert to Islam. Was Jewish and became Muslim 27 years ago. I've been in Saudi 15 years and after 14 years as a DON in one of three addiction hospitals I have transferred to a Military Hospital as Director of Quality. This is a great career move. Working in addiction for 14 years I know about the home brew but as a Muslim I know both the reasons why it is forbidden Islamically and from the social and health points of view, the devastation of alcohol is well known. I had a patient who partied several years ago on 'home-brew' and destroyed his optic nerve and is now blind. Islam in saudi is not extreme, some Muslims may be on both sides, in their quest to "modernize" Islam and on the other side, the radically try to establish it, but Islam is pristine. The Muslim you dated certaintly is not following Islam, in fact he is disobedient to Allah and His Messenger Muhammad and sinning. A Muslim adhering to Islam correctly will be a person whom you will be secure with, safe from, helped when needed, cared for if necessary and he/she will be exceedingly concerned for your welfare, particularly in the Hereafter, henceforth, the reason for giving the message of Islam. Judge Islam from its sources, the final revelation , the Quran and from the teachings (sunnah) of God's Final Messenger Muhammad and not necessarily from Muslims unless you see they are examples from these 2 sources.

I have also recently moved to QM as TQM Director. I joined the American Society of Quality (ASQ). They offer a wealth of information. They have an extensive book list as well. An excellent manual is the Health Care Quality Handbook. It is excellent for preparation for the CPHQ certification exam. http://www.jbqs.com/shop/20092010-24th-Edition-Healthcare-Quality-Handbook-p2.html

I recently left a position as DON in addiction and mental health facility in Saudi Arabia. I was there 14 years. Never worked in addiction practice in the States. However, in our facility in Saudi, our addiction units had gardens for patients to go to, specifically for smoking. Most patients in addiction centers are stable and ambulatory so going to an outside area is not a problem, unless they have other underlying or co-existing conditions that would make going outside, particularly in poor weather a relative contraindication. Here in Saudi, when it rains, it is an event and most people, especially the Saudis rush to go outside, especially to desert areas. The smell of rain is such a wonderful change.

Saudi has its nuances like any other place. And, there are many goods and its share of bad things in this country as in any place as well. Then there are issues that are more specific in behavior, attitudes, etc. I have been working in Saudi since 1995 and my children have grown up here. For them, this is home. I was a DON until a few months ago then moved into Quality Management. There are good opportunities here and a decent way of life. For me as a revert to Islam, it suits my and my families lifestyle very well and is the main reason for coming here. If a person is open to a new way of life and open to Islam and Muslims, it is an easy place to be. If things like not being able to drive, covering the body in a modest way, no dating, no drinking, no churches, etc., are to difficult to deal with, don't come. Professionally, if you are a bit on the perfectionist side in your work and demand things be done a certain way, be sure you get information about the place you are offered work. There is a big mix of expats from many countries and with different ideas of standards, quality, etc. Last, be very careful about working in the private sector.

Morte, It is a moving article. The incident, I suspect is not an isolated one given the perplexity of our health care system. It should be in a training manual (of sorts) for health care providers to enlighten them of the realities of what happens when we become cavalier in our duties to serve others. It is also, at least for me, just one more reason to repair the health care system. As I am moving into quality management, I will save this article for future referenc

This is historical (circa 1975-78) and a diploma program on-site in a small community hospital, but we were the main source for nursing aids and orderlies for the hospital. After foundation I, first semester, we could work and I worked most weekends. Also, male students (4 at the time) carried restraint keys. We had a pscyh unit on the top floor (5th) and anytime there was a "dr, strong 5 B" call, i.e. out-of-control psych patient we were expected to respond if we were in the hospital. In my senior year got hired in a larger teaching hospital and after graduation went f/t GN then RN.

Re: $100,000 in student loan debt? "I can't believe the emotional investiture that you all have in this topic! It astounds me, actually" Lets add another '0' and see what happens...

"Thanks so much for your answers.... The scarf would be underneath my scrubs, it would only be on my head and neck. And I have no problem with scrubbing and having my forearms exposed, I just want to be able to keep my head ears and neck covered." As salamu alaykum sister, I am glad to see concern for your hijab and not forgoing it for the sake of work. As your brother in Islam I would like to advise you to consider all of the awra in your covering and the arms are included in that.