lpncal

I've believed for some time that a facility should provide and launder all their employee's scrubs. Think of the germs we bring in from out in the community, places we go prior to work: gas station, 7-eleven, grocery stores, day care, etc. Then we take those germs in to our patients. And obviously, why would we take the C-diff, MRSA, VRE, from our patients back to our homes? If the hospitals truly want to cut down on cross contamination, wouldn't this help??

Sounds like your only recourse is to do what the Ky BON told you to do. You could apply for a license here in Hawaii. I think its the weed capital of America. Probably 50% of healthcare workers probably smoke pot. The BON here might be more lenient. Finding a job, on the other hand, might prove more difficult. Good luck to you.

For 30-35 clients, our local office employs about 20-25 CNA's. I don't know how many CNA's the main office has, but I'm sure its well over 60. There's very little work for the RN's to do, other than supervise, and maybe a few clients need their medication poured for them, or insulin shots given. That takes like 15 minutes? So there is no standard ratio in home health, as far as I know.

so mainly your patients are underprivileged, uninsured. are they geriatrics? what is the typical problem (if there is one): diabetes, stroke, trauma, etc... diabetes is rampant on this island, but we only have a few clients that are diabetic. most are elderly, not quite ready for the ltc facility. are they usually male, female? i'd say its 60/40 female/male. do you know how many nurses your main agency employs? or how many patients they serve? thanks! our main agency, on honolulu, has 2 or 3 rn's on staff as far as i know. i'm not sure how many clients they have. our office has around 31-35 on any given day, so i'd say they have closer to 80-100 clients.

1. describe the setting you worked in/for (no agency names please) i'm currently employed by 4 different home health agencies. my main job, with my primary agency, is "relief rn". i work 20 hrs/wk mainly supervising cna's, making sure the clients like them, etc. i also have a couple clients of my own that i visit to either pour their meds into weekly med boxes, or give insulin shots, or do diabetic foot care (massaging feet and legs, nail care, etc.). on top of that, i do semi-annual re-certifications on our clients, which consists of having them or their poa sign paperwork, doing a quick head-to-toe assessment, vitals, etc., finally i go visit clients when they come back from the hospital or have something unusual happen to them (skin tear, elevated bp, etc.). one of my other agencies has a client that is total-care, i take care of her occasionally, tube feedings, nebs, meds, chest physiotherapy, incontinence care, etc. the other 2 companies use me mainly to open new cases, which consists of a quick head-to-toe, vitals, paperwork, home safety assessment, etc. 2. describe the types of settings you worked in: mainly the office, where i do paperwork, put client paperwork on msword, play on facebook (j/k...not really, i do). other than that, i visit client homes to do supervisor visits, as described above. 3. describe the types of clients you served: many are underprivileged, medicaid recipients. some are va, some private pay. some have money, most don't. 4. daily nursing routines/activities in collaborating and coordinating care for the home health clients: most i described in #1, but sometimes we have to have an interdisciplinary meeting with the medicaid field service coordinator, caregiver(poa), family members, seldomly does the md ever come, but sometimes a nurse practitioner will. in these meetings we discuss an issues that are affecting the care of the client. 5. roles of other team members (i'm thinking md, pt, ot, st, sw, cm): our office doesn't employ pt, ot, st's, but md is usually contacted via fax, and faxes back any order changes we ask for. if there is a medication change, usually the family makes sure the rx gets filled and implemented. sw's let us know how many hours per week we can go into the client's homes, and what they are paying us for. there are 2 categories for cna care: pa1- chores, pa2- hands-on care. if a nurse is necessary, that is a whole different pay scale. rarely do they pay for that, because its expensive. 6. methods of client/family education: we try to educate our clients and family with each supervisor visit, but most of our client's and families are surprisingly well informed as to their conditions and medications. some aren't, and have to be educated little by little in the basics of diabetic lifestyle changes, healthy living, etc. mainly we use verbal teaching with some written handouts for them to read on their own time. 7. what is your opinion of the characteristics of successful planning and coordination? the key is to get the family involved if they aren't already. mainly we are there for respite care, not to care for the client 24/7. mostly the family has been doing the job for several month/years and are just needing help finally, so they call us. therefore, they already know what they are doing. make sure the different cna's going into a home are all on the same page. make sure they don't badmouth each other to the client in order to get more hours, or have the client ask for them only! make sure the client/caregiver knows when you are doing a supervisor visit (i've had more than one family member get miffed at me for not calling ahead before coming).

i just got a job as well, working in ltc. i worked in another facility as an lpn and didn't think i would like it. mainly that was because my mom was an rn in a nursing home, and i would go visit her as a child and saw all the "zombiefied" people walking around, or in wheelchairs and it burned that image into my head. after moving here, ltc were the only jobs around for lpn's so i took it. it was a really nice facility, and that made a lot of difference. once i got to know the residents, the job became much more fun. its all about building relationships with the residents. to me, ltc is good because there isn't as much stress as hospital work, yet you don't totally lose your skills either. i've yet to start the new job....waiting on the background check, but i'm hoping its as rewarding as it was when i was an lpn.

My agency pays nothing extra for on-call, unless you actually get called. Then you get a visit rate.

In Hawaii, its according to the company. NurseFinders (now Bayada) requires 1 yr exp. Other agencies don't, and will almost hire you on the spot in some cases.

You have been a staff nurse on a cardiac unit at a medium size hospital (300) beds in an urban community for the last 6 months. Among the hospital's cardiac services are open‐heart surgery, invasive and non‐invasive diagnostic testing, and a comprehensive rehabilitation program. The open‐heart surgery program was implemented 14 months ago. During the last 3 months, you have begun to feel uneasy about the mortality rate of postoperative cardiac patients at your facility. An audit of medical records shows a unit mortality rate that is approximately 30% above national norms. You approach the unit nursing and medical directors with your findings. They become defensive and state that there have been a few freakish situations to skew the results but that the open‐heart program is one of the best in the state. When you ask the medical director to examine the statistics further, he becomes very angry and turns to leave the room. At the door, he stops and says, "Remember that these patients are leaving the operating room alive. They are dying on your unit. If you stir up trouble, you are going to be sorry." My question is, what is our responsibility as a nurse to do in this situation? Is this an issue for JCAHO to look into or what? Is this something I am supposed to be aware of as a future RN or is this someone else's responsibility to deal with?

I worked at Lifecare in Kona. When I started there in Feb 07, it was a well run facility that showed great love and care for their clients. Since that time, a new ED has taken over and (from what I hear) it is bogged down in so much paperwork and tedious rountine that it drives the CNA's and nurses batty. There are still a LOT of great people there, however. If you do apply, I'm sure you will find it a welcoming atmosphere from your fellow employees.