Jump to content


ER, Perioperative

Content by totallackofsurprise

  1. totallackofsurprise

    Home Health Nurse pay??

    I was hired as 1099 employee -- 'independent contractor' which means an 'at will' employee. Meaning labor laws do not apply. Exactly! That is the exact description of the 'best' employees at my HH agency. I do find the work fulfilling, but I actually care about the patients' outcomes & preventing readmissions... so I can not work like #2. I'm the unsuspecting coworker who gets the complex wounds and actual labor. Well, I was initially... I wised up fast.
  2. totallackofsurprise

    Home Health Nurse pay??

    I have been doing HH since May and I am looking for another FT hospital or ambulatory job because I can't live on this money, as another previous respondent said. I really love the work itself... but I have bills and rent. I didn't expect my income to drop so severely. Did not expect that at all. My agency pays per visit. (That's standard AFAIK). $60 for admission; $55/regular visit for Medicare; $50/regular visit for private insurance. I do not get reimbursed for mileage. I don't get paid for travel time.* I do not get paid for all the time spent on paperwork & computer charting.** No matter how much time a patient visit takes, I only get paid the flat per-visit pay.*** I was told all home visits must be a minimum of 45 minutes. OK fine. One day, they tell me most of the HH RNs handle 8 patients per day -- and their best HH RNs have 12-14 visits per day. I didn't say anything... but I thought, "Well, then either all 12 patients live in the same building or on the same block, or she travels between patients in a hovercraft doing warp speed." Or maybe she works a 16 hour day. But I doubt that; most of my coworkers seem to work HH as a second job -- most have another FT job. (I understand why, now!) So, most likely, her visits to all 12-14 patients in a day are not the 45 minute minimum. Because if you do the math, add in moderate travel time... it's just not possible. Laws of physics apply, lol. I'm pretty bummed out. I was really looking forward to HH care. But I just can't live on what I'm making, and as the newest team member, I don't get the preferred patients or the patients in a good grouping, location-wise. Mine are spread ALL OVER. Literally from one airport to the other. But what can you do. Gotta eat. ~ ~ ~ ~ ~ * I can spend nearly 2 hours going only 10-12 miles between 2 patients (because everything outside that sweet spot of 10am-2pm is rush hour). I get no pay for those 2 hours -- and I also can't use that time to see other patients, because I'm trapped in my car going from Patient A to Patient B. **The amount of paper is incredible. Everything is duplicate (patient copies, agency copies). Then redundancy in charting: everything on paper must also be entered into our HH e-charting software. Which is the worst e-charting software I've ever used. Which is actually saying something. My agency does not provide laptops to bring to HH visits. Even if they did, they would still want paper copies of every thing. ** If I have a patient with 4+ packed wounds with wet to dry, and I have to change them all plus educate/reinforce the patient/family about proper care, toileting, dressing changes, I could be at that patient's house for 2-3 hours... But I get paid for just. one. visit. And those 2-3 hours spent with one patient is time I can't see other patients.
  3. totallackofsurprise

    Fraud? Should I report?

    Hate to sound like a cynic, but that old adage applies: "If you see something you do not understand, look for the financial interest." The manager doesn't care because 1) the agency gets paid regardless of whether or not the visits actually occur. Medicare or other insurance already pre-approved 9 weeks of visits or however much the patient could get. That's a gravy train no manager will mess with, if they want to keep their job. Remember: whatever you get paid per visit, the HH agency charges 3-4x that to insurance companies. That's a lot of $ -- which they won't get paid for each visit she didn't make. They aren't going to give that up. 2) If the manager does anything, the fraud also has to be reported to the appropriate state and federal authorities. This results in greatly increased scrutiny of the HH agency... sometimes for months or years. The HH agency doesn't want that at all. Unless the patient/patient's family calls Medicare/private insurance to report that the HH RN isn't showing up, no one will know. If there is a language &/or literacy barrier with the patient/family? They will never call. And it will go unreported. And the agency gets paid like they were going to anyway -- whether she visited the patient, or not. The manager and upper admin of the HH agency know this. Also, now that they did nothing to her, your fraudulent coworker knows they looked the other way -- essentially, they condoned/co-signed her fraud. If they try to discipline her in any way now, she could retaliate and report the HH agency for fraud... and again, the HH agency is under the microscope. But she'll be gone; it won't affect her. More than likely, though, your coworker is not the only person doing this, or management sort of gave her the idea. I've only been doing HH for 5 months (after 6 years at my previous hospital job, 12 years total as an RN)... and for a variety of reasons, I am looking for another FT hospital job. Mainly it's about HH's lousy pay (and unreimbursed mileage, and all the unpaid charting time). But I have already seen some hinky things in the short time I've been doing it. Fudging of dates. People told to chart that they did a procedure they not only didn't do, but didn't do because the MD's HH orders expressly said not to do. Again, it's the financial interest: They can bill extra for certain procedures. So based on my short time in HH, I think it is probably as susceptible to insurance fraud as any hospital or clinic -- if not more. Now, if you feel conscience bound to report this, and I don't blame you if you do, you're going to have to be patient AND careful. You must get the names and minimally the DOBs of the patients she didn't visit but for which the agency billed, and then 1) find another job and leave this HH agency, then 2) wait some weeks or months to report what you saw, so that the agency won't immediately suspect you were the whistleblower. (Which they might if state and insurance regulators are suddenly breathing down their necks right after you leave the agency). #2 is important to protect yourself. Even in big cities, healthcare can be a small world. If the HH agency thinks you blew the whistle, they may throw you under the bus and try to get you blacklisted. I know that sounds paranoid, but you have to protect yourself even as you try to do the right thing.
  4. totallackofsurprise

    Fired from my first nursing job, before one year

    A 100 year veteran??? That would make here, what, 120 yrs old? Amazing!! (just kidding!) It sounds like it wasn't worth the migraine to put her in her place a little. That being said, I do agree with you: sometimes you DO have to dumb yourself down. Because you can only control your own behavior, not others'. There's no guarantee that humility and respect will be two-way (that would be ideal, but that's not the world we live in). When it isn't, dumbing yourself down a bit essentially makes you less threatening to other nurses can help smooth ruffled feathers. Besides, you know your true level of competence, on the inside. Just don't dumb yourself down too much.
  5. totallackofsurprise

    Fired from my first nursing job, before one year

    Based on your original post, I get the impression that your previous experience was as a CNA or some other nursing support staff. If that's the case, you may have felt -- in school -- that gave you an edge, because it probably did, especially in clinicals. Otherwise, as someone else said, I don't see how you could have 2 yrs experience but only 6 months on your first job. Here's the thing: wherever you go, you will work with experienced nurses, some of whom will be bitter, nasty, unpleasant people, and enduring their presence will be a chore, if not sheer agony. They will not be up to date on everything, maybe not on most things. Maybe they graduated 20 or 30 years ago and haven't picked up a book since except for required continuing education and certifications. That doesn't mean you can't learn from them. Every experienced nurse, no matter how much you can't stand them, probably has something to teach you. You just have to be OPEN to this -- and you have to ask. You can even learn from the CNA's/nurse's aides -- IF you're open to it. By thinking that you were completely on top of things and handling it, you were closed off to learning from experienced coworkers. When people sense you're closed off to them, they close you off. Nursing is a people oriented job. Your ability to get along with people (coworkers as well as patients) is just as important as your knowledge, experience, clinical expertise, etc. -- maybe more important. That is the foundation on which your work experience will be based, because nursing is a team sport. If you act like a lone wolf, you will be treated as one; you'll have no support from your coworkers. They will give you enough rope to hang yourself -- and it sounds like that is what happened. A normal reaction for a brand new grad -- at least, one who doesn't think he or she knows everything -- would be to ASK another, experienced nurse, "Can I use my scissors to cut a pill if I can't find the pill cutter?" New grads are famous for asking dozens of seemingly obvious (and annoying) questions of their more experienced coworkers. It's not the fact that you did it that matters, it's the fact that you didn't even bother to ask anyone if that was okay to do. Had you asked, coworkers might have told you not to do it, or might have told you where the pill cutter was. The big question is: why didn't you ask? You don't mention your preceptor. Did you have one? Or did you get paired up with whoever was most experienced on your shift? If the hospital kicked you out onto the floor, on your own, after only 6-8 weeks of orientation, a) that was too little, and b) you should have asked for more, not happily gone off on your own as if you weren't a new grad. Not asking coworkers, not mentioning your preceptor -- to me, these are red flags. I'm utterly perplexed that with six months on the job you actually believed you were handling things and were as confident as you say you were. All the new grads I started with were as bumbling and confused and constantly uncertain as I was, constantly feeling like they weren't cutting it, and afraid they'd picked the wrong career. (We were hired directly into ER as new grads.) We were stressed, we were prone to backing off and letting the experienced nurses take over when we got critical ambulance runs, we were about as UNconfident as you could be. An experienced nurse, the sister of one of my fellow new grads, told us this: In your first year, your first job, you just do what you're told, and you don't understand why you're doing it. By the second year, you still do what you're told, but you start to understand WHY you're doing what you're told to do. And that is pretty much how it went for us. I didn't feel really confident until my third year on the job. So I can't understand how you could have felt as confident as you did. That's just... bizarre to me. It sounds like your perception of your abilities was very different from others' perceptions of your abilities, and that the gap between them was widening as time passed. That kind of a disconnect is troubling. As others have said, you need to think about how and why all this happened. If your hospital is part of a chain, being fired at one in the chain means you can't get hired at others. You have a tough row to hoe, here. Most hospitals do not want to hire nurses who worked less than 1 year in their first job. Agencies will hire you, but be aware that agency nurses are often thrown into assignments with little or no orientation to the hospital or unit, and expected to hit the ground running. You may also be resented as an agency nurse, which means coworkers will be less likely to help you out. (You may also be welcomed at highly understaffed facilities; it's not all bad.) If you are resented, you will not have as much opportunity to absorb "by osmosis" the knowledge and tips experienced nurses could give you. Despite that, DO NOT tell your coworkers that your experience is less than a year unless you've known them for at least a few months and you truly feel you can trust them. Most staff nurses are (understandably) suspicious of agency nurses, because in many facilities, agency nurses do not have good reputations and are not considered good nurses. Many people think that agency employees (whether nurses, pharmacists, or physicians) "couldn't cut it" in a staff position at a hospital, or can't get hired as staff somewhere because of bad references or lack of experience. In your case, that would be at least partly true. You're between a rock and a hard place. It's hard to see how you got here except by your own behavior. Your best option -- which is not a good option, but it's maybe the only option -- is to seek agency work. Apply to as many nursing jobs as possible at hospitals not affiliated with the one you were fired from. But, the economy is only slightly better than it was, so you will likely face an uphill battle trying to get a staff position. As others have suggested -- you need to reflect on this experience. Defensiveness is natural as your initial reaction to getting fired. But don't wallow in defensiveness. You really need to examine your own actions, every step of the way during those first 6 months, in order to see where you started to go wrong. Because it probably was a number of little things at first that started to accumulate before the write-up over using scissors to cut a pill. In addition to cultivating some humility, you need to develop better people skills. This is especially true if you're a male RN surrounded by females, because then you're not only dealing with people, but gender specific communication differences. I worked in IT for 12 years before being laid off and going to school for nursing. I was used to working with nearly 100% men. When I started my first nursing job out of nursing school, working with nearly 100% women was a huge culture shock for me. Huge. Especially since I was never particularly 'one of the girls' because I had been 'one of the guys' for so long. All of that nonverbal communication stuff they taught you in nursing school or any transcultural nursing classes you may have taken -- it's not just useful for working with patients. It's necessary for getting along with your coworkers. You need to be able to recognize people's social cues and clues. I suspect there were many that you blew past before the write-up and before the firing. Good luck. ETA: Forgot to say, agency nurses also sometimes get the heaviest work loads and assignments, the most complex patients. Staff nurses often figure, "Let him/her have this train wreck; they're getting paid more than me anyway." I say this having worked both as a staff nurse AND as an agency nurse (and as an agency nurse that got hired on as staff after a 3 month contract assignment). That's just the way it goes. But, like I said, it's not all bad. Some chronically understaffed hospitals are profoundly grateful to have the help, and some staff nurses are too, because then they get breaks and lunches they might otherwise not get if there weren't agency nurses helping out.
  6. totallackofsurprise

    Apparently 12 year olds can make their own medical decisions

    Awesome post loaded with up-to-date facts.
  7. totallackofsurprise

    Apparently 12 year olds can make their own medical decisions

    amen to that. no pun intended... the thing i don't understand is why people think parents should be notified if their 12-17 year old seeks an abortion or std treatment, if the 12-17 year old seeks medical attention for that problem without the parent present, in the first place. i always figure, well, the concerned parents weren't concerned enough to prevent their 12-17 year old from conceiving the pregnancy or catching the std, so not informing them of std treatment or seeking an abortion is just continuing the same parenting pattern, anyway. don't inform 12-17 year olds about sex, don't inform them about contraception, and don't inform them about barrier contraceptives as a means of preventing std transmission, and you get 12-17 year olds seeking std treatment or an abortion without their parents present. whatever message the parents thought they sent by not informing their child of all of the above, the message the child actually perceives is, "i can't talk to mom/dad about this." so they show up alone. i wonder if these parents would send their kids out to drive a car with no license, no insurance, no driver education, and no information on the rules of the road. i mean, it will be a miracle if something bad doesn't happen. i've had the misfortune of explaining to teen patients and their parents, who didn't want them to know anything about sex/birth control, the discharge instructions for herpes or threatened miscarriage. essentially the child is condemned to suffer -- potentially for the rest of his/her life, if it's pregnancy/herpes/hiv -- for their parents' poor judgement and poor parenting. i've had this argument with my boyfriend about why the government intrudes so much into people's lives. he can't stand when the police have roadside car checks for drunk drivers, people not wearing seatbelts, kids not in car seats. he thinks it's like we're living in former communist russia. i don't like it either -- in fact i hate it -- but my argument is this: if people would do what they're supposed to do -- such as protect their children -- the government wouldn't try to do it. but people don't. so that's why the police do roadside car checks. because it's the only way to get through people's thick skulls that, no, you should not drive drunk (especially with your kids in the car), yes, you should wear a seatbelt (and put one on your kid), and yes, your infant/toddler/small child should be in a car seat.* and that's why states pass laws allowing 12-17 year old minor children to seek care for stds or abortions without notifying their parents. if the parents were doing what they're supposed to, in theory, the kid wouldn't need std care or an abortion in the first place. *why? because you and your kids might be in a serious accident, and due to laws of physics (a body in motion, etc.) your unrestrained kid will fly around inside the car at whatever rate of speed you were going and suffer horrible trauma from which they may not be revived, but if they are, they almost certainly will be severely damaged and possibly unable to care for themselves for the rest of their lives, and you may also bounce around on the inside of your car at your rate of speed if you're not restrained, but you might not die, either, so all your medical care will be paid for by taxpayers if you have no insurance, and if you are brain dead but on a ventilator, that will cost all of us a lot of money for years on end until you die of sepsis from a bunch of infected decubs, unless you happen to have a living will or dnr in your back pocket when you get in the accident, because if you don't happen to carry either on you at all times, you will be resuscitated if possible, and you will be intubated/vented if you need it, and you may be meat on a machine for the rest of your life while we foot the bill. and other people, including me, should not have to pay for your stupidity and utter disregard for yourself or your children. and isn't it funny how often people who don't wear seatbelts also don't have car or health insurance? i dunno, just something i've observed working mvas in the er... ymmv.
  8. totallackofsurprise

    New grad RN needs advice on resigning

    My advice to you is to stick it out for a year at the job you have now, even though you don't like it. Let me explain why. I graduated in 2007 and worked as a camp nurse for 3 months, so I could study for the NCLEX-RN and chill before starting my first new grad job. (I already had my LPN license to work as camp nurse.) While working as a camp nurse, I met a couple of other nurses (it was a girl scouts camp -- some of the former scouts had become RNs and would come back to the camp and help out). I also met the nurse who worked the camp nurse job the summer before I did. She also sometimes came back to help out. She had graduated two years before me in 2005. She got hired at a hospital as a new grad RN with the understanding that after her orientation, she would work in their Peds unit, which had 2 openings. Of course when she finished her orientation, both Peds jobs had been filled by other nurses at the hospital. So they put her to work in Orthopedics. This was not her dream job and she did not appreciate the "bait and switch". So after a couple of months she gave 2 weeks notice and quit. She did not have another job lined up yet. She thought that she would be able to get another job quickly because of the nursing shortage. It took her 6 months to find another job because she only had 6 months of experience when she quit the hospital job in Orthopedics. She told me that basically no one would touch her because she didn't have a full year of experience under her belt. Everyone wanted to know why she left after six months. I don't know what she told them, but whatever she said, no one When she finally got another job, it was as a psych nurse in a psych facility. She had planned to move out from her parents after getting hired at the hospital that put her in Orthopedics, but because it took her 6 months to get another job, she could not move out. Keep in mind, this was before the recession hit and hospitals started cutting staff, cutting benefits, and freezing wages. Whether there is enough demand for you to get a job with less than 1 year of hospital nursing experience is greatly dependent on the region where you're working. If you are in a sparsely populated area that doesn't graduate many new nurses, you may have an easy time finding another job. If you're near a big city, you might have a hard time. We're in Chicago, which is why I think it took the other camp nurse six months to find a job -- again, before the recession hit. New grads are graduating all the time in Chicago because there are a number of nursing schools (both ADN and BSN). So there are more new grads here than there are jobs for them, in this economy. Plus many hospitals have cut staff, and some hospitals here have closed to become outpatient care centers, or cut ER services and stopped accepting ambulances. The Cook County hospitals system lost 500 nursing jobs in just 3 years (1, 700 nurses employed in 2008; only 1,200 nurses employed at present). I talked to the new public health nurse at my nearby local clinic. She is a new grad. She graduated in 2009 and it took her one full year of looking to get a job. She had only 3 interviews in that year. That's how she wound up at the public health clinic. She told me she had applied to tons and tons of jobs and still had only 3 interviews in one full year. Listen to what others are saying. Whether in nursing or in any other field -- don't quit one job without having another one lined up first. And don't quit the first one until you have a job offer in writing from the next job -- a letter of offer. If it isn't in writing, you don't know what could happen that would prevent you from getting hired. Regarding applying for other jobs -- many applications ask you if they can contact a current or former employer after you list the job. You can check "No" but if you don't have any other healthcare job references -- besides nursing school instructors -- for prospective employers to contact, that won't look good. You should always give a minimum of 2 weeks notice that you are leaving a job. Less than that looks unprofessional.