50kn

I have been working for this SNF as a per-diem RN for about a little more than a year. This SNF schedule me to work only once in 1-2 months, I have worked there only several times so far even though I was hired last year. For example, in this year, I worke there one day in February, two days in April, and they are asking me to work one day in August. I have another full time job at a hospital, but the nursing skill that I use for my current job is almost limited to only GT, so I chose to work at this SNF because I can still gain experience to do IVs, IMs, subc, etc... But problem is that I sometimes feel uncomfortable working there (especially night shift). Because I work there only once in a while, I don't really know the patients well. The patients are mix of Medicare Pts, long term Pts, and Hospice Pts. Also, I feel this SNF job is way too busier compare to my current full time hospital job. If I work there at night shift, I pass meds to 40+ patients plus do IVs and usually I am the only RN working. If I can work there more frequently, I would be able to know the patients better and feel more comfortable but now I work there only very occasionally, I usually try to go there at least 30 minutes before I work and get information about the patients. If you were me, would you still work this SNF to gain experiences or quit because it is kind of scary to take care of the patients that you don't really know at SNF? Is there somebody work at SNF only occasionally like me? Or will you quit this SNF?

Are they different because travel nurses go to a hospital at other state but local per-diem nurses go to a hospital more close to their area? Or does the main difference have to do with a time period? Such as 12 weeks for travel nursing vs. longer period (one year?) for local hospital contract? If you go to a hospital as a local per-diem contract nurse, will you be treated more like a hospital employee (receive training & longer orientation, feel closer to other employees, etc.) than going as a travel nurse?

What are your primary skills you use when you work with hospice patient? I was asked from my agency if I want to work for a hospice patient (private duty night shift). When I asked to my agency if I can have a brief orientation (to see the patient before I accept the case), they said "no, no orientation." And they don't give me the patient's information unless I accept the case. So, you give pain meds to make a patient comfortable,,, ,, but is there anything else that is very different when you do a private duty for a hospice patient from the patient who is not a hospice patient? Or just the same, not so different--depends on a kind of treatment and medications that a patient has,,, ? I have never done a private duty for a hospice patient.

i think so too, probably nobody wants to go to the house. as i saw the medical record when i went to the house last time, previously several lvn had worked with the patient, but after 2- 4 days every lvn stopped visiting the house. last week nobody worked there except me working on saturday. i don’t know the real reason why lvns who have been sent to the house keep quitting, but the lvns might have seen cockroaches, then they quit. and opening is not only 5 days; actually the scheduler says that there are 7days opening at the house. anyway, i can work there only 1-2 nights, but i cannot deal with cockroaches any more than that.

i was assigned this private duty case (night shift) ---the patient is a 5 months baby. my company said that the case is lvn case and pays only at lvn rate. i am an rn but other patient's houses are far from my house, i just vaguely accepted the case. at the house yesterday, while family members were sleeping, i was with this baby, and saw a huge cockroach. i have seen cockroaches only a few times in my life, but this one was so big and had light brown color. i was so terrified. i saw cockroaches twice throughout the night though i don't know if they were the same one or different roaches. anyway, i am scared of cockroaches. according to my company, i was supposed to work with this patient 5 days a week but after i saw the cockroaches, i decided to call my company tomorrow and tell them i would not be able to work 5 days a week, probably i would be able to work only two days a week. (i actually don't' want go back to this house but until i found the next job, i should work at least a little). is there somebody who refused the case because of horrible environment (such as cockroach, spiders and ants...)?

thank you caliotter3 for your response. i agree. i want my prospective employer to just call my current employer to do an employment reference over the phone.…j i called my current employer (owner) again this morning because the interview is scheduled on friday (today is wednesday) and i need to bring my employer’s evaluation. if i cannot get it by friday the interview will be cancelled. the current employer (owner) said that she would talk to some nurse if she can write an evaluation. when i asked the owner “do you think you can do it?” she said “i don’t know i am not a nurse i need to talk to some nurse.” today is already wednesday and there seems no way i can get the evaluation before friday. so, i will probably lose an opportunity to have the interview. it is sad to hear that my current employer even does not know if they can write a evaluation for me or not.

I have been sorting for this home health company for more than 6months as per-dime. But because i wanted more shifts I recently applied for several other places. I got a phone call from one place. They said they want to interview me, but they also need me to get my nursing evaluation from my current employer otherise they don't interview nurses. I have asked my current employer 3 times and also sent e-mail, requesting a nursing evaluation. I explained why I needed it also. However my current employer have never given me a nursing evaluation yet and therefore I might loose opportunity to have the interview. But I really want to get the job and I had better get an evaluation soon. Is there any way I can get my current employer to write a evaluation? I already asked them four times but it looks like they won't write it. They have just ignored my request. I need some advise.

regarding a private duty's case...., my agency tells me a patient's address and shift & days of a week i work and asks if i can do the case. they don't give me any other information such as age of the patient, what kind of diagnosis the patient has, and what kind of treatments a nurse is likely to give, etc. unless a nurse decide them if she/he accept a case. how is your agency? is your agency the same as mine? p.s. i have not accepted any patient from this agency yet because the patients that they have introduced me have had addresses too far from my home, unfortunately....

i had an interview with 2 homehealth agency (a & b) in so ca area. both of them use paper documentation. a agency said that soc $75 per visit and rn follow-up visit $55 per visit. but a recruiter at the hr said that because they (a company) have many nurses, every nurse are recommended to call a staff coordinator at lease 2-3 times a week to remind her you are available if a nurse wants a case. othersise there may be no visit given. very competitive to get a visit. b agency said that soc $60 per visit and rn follow-up visit $30 per visit. i think that the rate is very low. but looks like they have many cases and even a nurse doesn't call the agency they give a nurse plenty of cases. i now work for the agency that doesn't have much cases and i want to have more home health company to work for as a supplement. i think i can work for b home health agency because obviously they are busy and i will get many cases, but is the rate too low? or is it worth a try under my situation? i really don't' like to call agency to demand a case (like a agency said). but what do you think?

thank you caliotter3 and susan317 for the information!!! now i understand that home safety assessment should include physical assessment (temp, bp, lung sound etc.), adls assessment, environmental assessment, medical history, etc. (kind of comprehensive). i was frustrated the fact that when i contacted the patient, the patient was totally unexpected a home nurse visit and asked me why i needed to be visiting her. so i did not want to do anything unnecessary for the patient. also this is my first time to conduct home safety assessment. now i am clear about how home safety assessment works thanks to you.

i had an interview with this home health company a couple of months ago but i haven't been given any orientation so far. they suddenly called today and asked me if i could do home safety assessment for the patient who was just discharged from a hospital. i said yes. i asked the company what i should do to complete the home safety assessment. then they sent me a 2 pages initial assessment form (include adls, medical history, environmental hazard check list), patient's name, address and phone number by e-mail. i contacted the patient to schedule a visit. i asked the patient what was the reason for the hospitalization. the patient said that she can tell me about it when we meet. i don't know if the patient has a wound or ivs or physician's order or something else. the home health company does not have any information for the patient either. is it normal for home health nurses to make a first visit to a patient without knowing anything about a patient's condition? and more question,,, how does the initial assessment (my company called it home safety assessment) work? who writes an order for home health? because there is no orientation, i am a little bit confused.

Does your company reimburse you for the expenses? Or nurses are supposed to prepare all suppllies on their own?

the w2 form that the agency wants me to send is 2007’s and 2006’s, about several years ago’s:). after i quit these hospitals i have worked for a few different places until now. when i was hired by these newer places i have never been asked to submit any w2 or paystubs, and other companies that i had an interview with did not ask me to do it either and that is why i feel a little reluctant to do it. i will probably submit them eventually though because i want more jobs!! i have another interview next week with a different agency and will see how it goes too…

thank you, caliotter3, justbeachynurse as a matter of fact, for some reason, i am also kind of reluctant to submit w2 forms & pay stubs to them because i don’t know if they can really hire me yet. and the agency is located very far from my area. as you said that there should be other ways the agency can verify my past employment (they could just call the hr!!!). my w2 & paystubs did not include my job title as i saw them now. maybe i might need to make sure if the agency sent the form to the right places as you suggested. i will think about whether to send them over again for a few more days.

i had an interview with this home health agency about 2 weeks ago. they called me yesterday and said that they have trouble getting references from my past hospitals that i worked for. they said that they have faxed a reference request form (?) to these hospitals but the hospitals have not faxed it back to the agency yet. the agency then asked me to submit my w2 form and my pay stub from these hospitals to verify my employment. i thought the agency could just call the hr of these hospitals to ask my past employment status, but, anyway, if the agency do not call, i just need to send w2 and pay stubs to them. i will send my copy of w2 form and pay stubs to them today as requested. i am just wondering whether submitting w-2 and pay stubs to prospective employer common.

3~5 agencies! wow, i am encouraged to work for more agencies!

i have been working for one agency as a per-diem for the past several months after i quit my previous full time job. this agency pays per visit. so far they have given me cases between 4 visits per month (earn less than $200 a month) and 15 visits per month. i have more time to work for different agencies and started looking for them. but, may question is how many agencies nurses usually belong to to manage a schedule? for example if you have a visit on a certain day for a agency and after that b agency called you to offer a case, can you just refuse the case for b agency by saying that you have a case scheduled at that day for a agency? one agency is not enough. but, how many agencies do you belong to? and what is an ideal combination? two or three per-diem agencies to belong to? or one per-diem agencies plus one more full or part time agency? or one intermittent home health agency plus one private duty agency? if you work for more than one agency, do you tell each agency that you are belonging to deferent agencies and depending on the schedule you might need to refuse a case that are offered because you have already booked? can agencies usually accommodate your situation?

thank you susan317, your response helped me a lot!! i have one more question. the company i went to interview for prn is located very far from my apartment (about 3 hours) but they said that they occasionally have some patients close to my place. i asked them how nurses submit the documentation to the company after they finished a patient visit. the company said that nurses could either fax the document, mail them form a post office, or scan them and send them via internet. are these methods of submitting a documentation normal when the nurses work under a similar situation? (i don’t have a fax machine at home though).

1. when i went to an interview the interviewer emphasized that "in our home health company, nurses open a case." is there somebody who opens a case other than a nurse at other home health companies? 2. the interviewer said that "we don't use oasis, we only use paper documentation. the main nursing skills that nurses use at our company are wound care, would vac, iv insertion, iv atb, some patients has infection at a central line site, etc." i believe a company uses oasis when their patients are medicare patient. is there any difference of the patients' condition between medicare patient and non-medicare patient who still needs skilled nursing care? is there any difference of the nature of the disease between patients at t home care that uses paper documentation and patients at a home care that uses oasis? 3. if a patient is not medicare patient, who usually pays the medical fee? who decides if the patient is a medicare patient or non-medicare patient, and how? a lot of question. thanks a lot in advance.

i used to work night shift at a few skilled nursing facilities. some of the patients were hospice patients. when the hospice patients passed away i called their physician, families and hospice nurses to let them know. i have never seen hospice nurses came to see the patient when the patient passed away at the midnight or like between 2-5 am. or at least i don't remember if they came, or i might not have noticed when they came. do hospice nurses document the fact (the patient passed away) and discharge the patient after they received the phone call but not normally visit the patient? or depends on the situation, they visit the patient as a night time on-call? i just wonder.

have you ever needed to refuse to take a certain patient because you cannot drive to the patient's home? i am ok with driving far but i have extreme difficulty driving on mountain roads with narrow paths and steep hills. narrow roads are sometimes not wide enough for two vehicles. i sometimes need to ask my agency to reassign the patient who lives in mountain to some other nurses because i cannot drive to get there. my car's brake and engine are not good enough to drive such a mountain road. also i am not so good at driving on mountain roads even though i have no problem driving general roads and freeways because i am from a city where i did not have to drive and i could just use public transportations until i moved here. does anybody have a similar driving issue?

the doctor hires only 2 people ---his receptionist and an rn who he wants to pay as though the rn were an ma who can give an anesthetic injection. currently there is an rn working in his office who will quit soon and the doctor wants a replacement. maybe the rn gets paid the similar amount/hr? maybe i should keep looking.

i had an interview at a dermatology clinic. according to the doctor at the office, he wants to hire ma but also he wants somebody who can give anesthetic injections for a biopsy and that's why he is looking for an rn. the pay is $13/hour. he said that the reason why the pay is only $13/hour is that other than giving anesthetic injections, the job can be done by ma. i am an rn but never worked at dermatology office and have been interested in working at a derma office. my concern is that i live in ca and it takes 80 minutes (one way, about 40 miles) to get there and need to use much gas. do you think it would still be a good idea to work there if you want to get your feet wet?

I was beginning to think the same thing, like mileage, depreciation, etc. When we claim tax deduction for mileage what is the best way to prove how much you’ve drove? And if a car is used almost every day with so many miles, the car can be depreciated quickly and you might need to buy the next car soon.