HisTreasure

Is your hospital currently hiring PCTs? As a student you may be able to be employed as a tech which will bring a lot of useful experience and opportunities to learn. You will already have a working knowledge of the technical aspects behind phlebotomy and tele which will prove invaluable once you start skill labs and clinical. Your employment as a tech may also count towards your overall tenure at the hospital once you become licensed which may help you get moved into an RN position of your choice or give you preferential standing if you apply for a BSN residency program at your hospital once your pass your NCLEX. After your first semester you can probably challenge the CNA exam and get certified. This will be useful if you want to work LTC or perhaps rehab. There is a lot of value in going that route, as you are the first line care giver and the time management aspect of floor nursing will be lessons you learn early on. There is still a likelihood of future employment as a nurse, especially if your facility is associated with a larger hospital system that you can transfer within, should you so choose. Working in acute rehab I was able to better mentor the CNAs, especially the student nurses or those who showed an interest in completing school in the future. CNAs are able to form a closer working relationship with both the staff and the patients, as they are longer term. Maintaining multidisciplinary relationships and perfecting your bedside manner are important skills whose importance should not be overlooked or underestimated. To think outside of the box, I know a gentleman who finished his pre-reqs then took an EMT course in the interim between pre-reqs and waiting for his time to start nursing school. He would do 24 or 48 hour shifts while in nursing school. The pay wasn't what he hoped but he said the experience was invaluable all around. The schedule was also a good fit for his education and studying. He still works pre-hospital on a volunteer rig a couple of shifts per month for our town. He's a great guy, planning to go for his PA in the next few years since he does have an interest in the medical model and feels he can be a better provider coming for both an EMT and nursing background.

Worst job was as a child care associate. I loved the kids- always had a tender place in my heart for them, always will, however, this center was poorly managed and inadequately maintained. I didn't know about child-adult ratios at the time but I knew it wasn't right for a 17-year-old to be left solely in charge of 6 toddlers for any long stretches of time. Sometimes the main teacher would be floated to another room and I would have the whole 2-year-old room from nap time until around 4, 4:30 when kids started going home and the rooms could be combined. The director was mean and nasty from day one, and the last straw (or close to the last straw) was when I witnessed the main teacher withholding lunch from one particular baby for the third day in a row for "misbehaving." I thought it was cruel the first time it happened, but by the third day I realized she just didn't like the little boy and would use any excuse to abuse him. I reported her to the director, who in turn wrote her up on suspected misconduct and the teacher started being really mean to me but at least she left the little boy alone. I quit a week later.

I'm no longer in Atlanta. I'm back in NY. I have to update my info. However, if I were still in Atlanta I wouldn't bat my eye at an hour's drive because most commutes are at least that, especially if you have to take the Perimeter during rush hour. Back here an hour is a big deal.

I have a job opportunity for a private client about 1 hour away. Part of it thinks it would be great because 3 shifts would be over $800 a week but I would be commuting 6 hours a week, which I'm not sure I'm too excited about- especially in the winter. How far is your/would you commute to do a private case?

$24.31 for low tech/adults, $33.71 for high tech pediatrics. No benefits and no taxes taken out (independent). However, I rarely work PDN. I work in ALF as a supervisor making $20.50 with benefits. It's not the highest pay I've ever seen but it pays the bills, especially as an LPN. When I work agency I make $22-23/hr. In the end, however, it's not how much you make, it's how much you spend. I have CNA friend ecstatic to make $15.50/hr and are living quite well.

Emesis and flying sputum. Emesis engages my gag reflex EVERY time, even if I eternalize it; and adult sputum with the open trachs that they insist on coughing across the room and everywhere in-between. Really, dude?????

I have been prescribed diazepam as a muscle relaxant for some time. I prefer it to others because I don't have a lot of the negative side effects I had on other musculoskeletal meds and I am able to function and actually work, which I NEED to do. Yesterday I went to an "interview" for a private case for a baby who is still in NICU. It sounds like a nice case to have every other weekend. Anyhow, Mom asked for a copy of my BLS for HCP and when I reached into my purse to get my wallet my pill bottle for diazepam fell out unto the floor. Dad picked it up and (WHY?!) looked at the label before handing it to me. Neither parent said anything at the time and said they would call me to set up a time to meet again after the baby came home. Today I received a text message that reads: "What mental illness do you have that requires use of valium?" I couldn't stop the tears from laughter. I replied simply, "none, that I know of." I haven't heard back. I can tell now, this case will not be a good fit.

Sometimes, if you want good help, you need to go a bit out of your way. If it's affordable, and won't be a major inconvenience to the family. Most things you listed are not major inconveniences to many people, but I guess it would depend on the family and their individual needs and resources. With that said, we always provided a Keurig, K-Cups, snack basket, mini-fridge with bottled water and juice inside, microwave, TV, digital cable, Wi-fi, Netflix password, glider with ottoman, etc. to the nurses. Not a huge deal to us, but we chose to be in a situation that warranted having nurses in the home, and thus, we prepared adequately to provide a warm and welcoming workplace. Yes, the home is a HOME, but it's also someone's workplace and we wanted our nurses to want to come to work. We budgeted for the extra snacks on the bill, the faster internet, and the extra microwave and fridge in the home. We didn't notice a difference in the electric bill, but then again, when you're running a vent, compressor, feeding pump, and charging backups around the clock, you probably wouldn't notice the small bump in usage from a MICROWAVE. And honestly, I never heard the microwave over the compressor. EVER. How could you? Perhaps, and I don't know this family's story so this may not be possible, you can discuss your concerns with your agency to see if there are reasons WHY this family is being so unaccommodating? Is there a negative nursing history? Are they fearful of possible distractions? Are they just woefully ignorant in regards to how difficult staying awake in these conditions can be? Do you have the rapport to bring it up to them in a non-threatening way? Personally, I think access to WIFI isn't necessary, but I do think it's standard, at least in these parts. It's not difficult to setup a guest account and post the credentials for the nurses to use. When or if you feel like it's being abused or misused you change the password or lock it down fairly easily and quickly. Idk... I feel bad. In my humble opinion, this family is not working in the best interest of their child. Good nurses often seek good cases where they feel appreciated. It doesn't take much to show a nurse that you appreciate their worth...

I really like you SDALPN! You have this PDN thing DOWN! I had a mom rearrange an entire feeding schedule so that the last feed of the shift ended at least an hour before the end of the shift so that the child would stool before the nurse went home. Seriously! I had a mom upset with me because her child aways had a bowel movement after my shift ended. She said she was tired of cleaning his "s***" and that's what the nurses were for. First she was going to extend the shift an hour but we nurses couldn't accommodate the later start and/or later end, so she changed his feeding times (and that was OUR fault, also, since we had lives outside of her case). Poor angel had dumping syndrome.

I have been chatty in the past and it has backfired. I knew so much about the family and their lives, their financial struggles, their marital problems, and dysfunctional in-laws, that I felt comfortable, and almost obligated to talk about what I considered to be benign personal stuff: pets, kids, husband's new job (at the time), the trials of car shopping or house hunting... It was all used against me in one way or another while I was on this one particular case. That mom just had a great way of taking a snippet of a conversation and regurgitating it back in a very unsavory way. I decided to buckle up my upper lip. Soon after she asked me to leave the case because I became "cold, distant, and unsociable." No, I was just tired of having something I may conversationally and organically mention during an hour drive to the specialist about the rude car salesman I encountered over the weekend becoming an opportunity for her to lament about how much money I was making off of her son and my priorities being out of whack because of the types of vehicle I was researching. On the flip side, I did ask questions about family life, hobbies, other obligations, and general interests of the nurses who came through my home. I asked, not to be nosey, but to learn about what may or may not be taboo. I try hard not to step on toes, to be considerate of others, and I am extremely non-confrontational, so if I know that you spend your weekends I church I will feel comfortable expressing myself fully in my own beliefs and I won't EVER ask you to work a Saturday or Sunday (based on when I know you worship). Likewise, if spirituality is something you aren't comfortable with the I will limit my speak, music, religious activities during your work shift to make sure your environment remains comfortable for you. Additionally, I like to give small tokens for a job well done. If you tell me that you LOVE French vanilla lattes, then you may come in to work on a random Tuesday and find a $5 Tim Horton's gift card attached to the communication book with a "thank you" note for all that you do, or if I know that you have kids and your daughter is really into The Disney Princesses right now and you love to garage sale, I would feel completely comfortable offering you (free of charge) the princess costumes that I planned to donate to my mom's garage sale that my daughter has outgrown but are still in perfect condition. Stuff like that... :)

I had to leave the group after less than an hour of browsing. I am on foster parent support groups and one is for foster parents of special needs/medically fragile children. That's going to have to be good enough. My initial thoughts when I was added was "wow, this sounds like a great group to be in, and I'll get some insight into what's working/not working in other SN homes with working parents, health concerns, students, etc." which isn't really addressed completely in the groups I currently belong to since so many of those foster parents are stay-at-home parents or work part time only. I'm working per diem (but usually done in two doubles and a sporadic single to get full-time pay) and I'm in school full time. We were going to wait to go back to fostering but that would mean waiting YEARS until I finish my Master's and there is a great need for medically specialized homes here and an even greater desire to go back to it so we're doing it now now. We just have to find a way to make it work. I hoped the group would help with that. Super disappointing. I *did* get a great document that is essentially a "manual to our home" that a parent made, when imported into Pages was gorgeous and will make a great template for something to give to the nurses coming into our home (with many modifications, because I tend to be a bit more laid back than most) so it wasn't all bad. But, bad enough.

I was invited to join a group on FB for parents of children with special needs. This group was back-to-back inflammatory messages about home nurses, LPNs vs RNs vs Sucky NEW RNs, etc. It was so distressing I had to leave the page in tears. I don't understand! I've worked as a PDN and still do, occasionally. I have had nurses in my home in the past and I plan to again in the near future. I have had my share of "not-so-great" coworkers and "not-so-great" nurses working with my foster babes but I would never go on a site and tell NICU moms awaiting discharge, already concerned to "watch out for those horrible home care nurses" or "Maybe you can try it without nursing, you'll be better off..." or "get cameras. Most likely the nurses you get won't even be properly trained." I don't know where I'm going with this message. I just feel sad. So many upset parents! I understand people are more verbal when they're dissatisfied, but geez... *sigh* I feel horrible that there is a group of nurses that disgusted with nurses.

There are no supervisors. We're all independents. There is the "Primary" who established and maintains the PA (the day nurse) but she isn't the actual supervisor.

You raise valid considerations. I can't speak to whether anyone else has addressed these issues with mom. I haven't personally, but I don't know mom very well. When she was venting about the sleeping nurses I was listening empathetically and I shared a bit of my experience with nurses in the home, which I think she appreciated, but I did not ask her to elaborate on why she felt so anxious. It didn't feel like an opportune time to discuss it, if that makes sense. The conversation didn't flow in a way that fostered therapeutic dialogue.

I don't plan on going back on the case but I may. Money is money. It's just really uncomfortable there... even though I never actually saw a camera... She has a bunch of stuffed animals in and around the crib and I wonder if they are inside those. My husband said the evening nurse may be a ****-starter who is trying to discourage me from joining the case full time and she may be lying about about the nanny cams, but joining the case was never my intention. I know a lot of nurses try to get an "in" with being a fill-in, but that's not my end game at all. As am aside: I am a foster parent. I've had nurses in the home and agency mandated video monitoring in the rooms the FKs slept in. The video cameras (baby monitors, actually) were NEVER used to catch the nurses doing [anything] and I fully disclosed at the meet-and-greet that the cameras were there and why. Only a few nurses opted out, which I respected, and one nurse told me she NEVER works cases with cameras but since I was so upfront about it, she would try. She didn't last long but it had nothing to do with the camera issue. Cameras I'm fine with. Hidden/nanny cameras and blatant paranoia that someone is WAITING to do something evil or negligent to your child, I cannot.

Don't you hate it when a bad nurse (or even a few of them) makes the whole profession look bad? I don't know if this family is paranoid or really had some bad experiences, but I kind of think it's the former. Went fill-in on a private case as a favor to a family member. So far I've been called 5 or 6 times in the past couple of months but have only been able to pick up 2 of the overnight shifts. The first night I worked (after a 4 hour non-paid orientation) mom "fell asleep" on the living room couch (baby is in the dining room, which is adjacent) and woke up 4-5 times to check on the baby and every time the vent or tube feeding alarmed. I didn't overthink it because I was a new person on the case and the baby hadn't been home long. Thursday I was available for a call-off but went in early because family member advised there had been some changes and I should get there early to get an updated orientation of the case from the evening nurse. I get there 2 hours early and follow the nurse around but she's being very, IDK, overly meticulous and careful with everything she's doing, especially considering neither mom or grandma are home. She shows me the updated "To-Do" lists we have to check off as we go, the whiteboard where we are to jot down "Deets" (how many soiled diapers, the exact time meds were given, when the feed was stopped, times the child was T&P, etc. Stuff that's in the narrative and on the med sheets but whatever...) She showed me where to sit now- a hardback chair with a tv tray on wheels, instead of the glider that was in the dining room for the nurses last time I was there and is now nowhere to be seen. She says loudly that there are new nursing notes the family generated but she left them in her car and she would go get them when the family came back. When mom arrives the nurse asks me to come outside with her because she's late to her next job and doesn't have time to come back in. When outside she advises the family utilizes multiple nanny cams and sometimes the family likes to leave and watch the live streams remotely just to try to catch people doing something wrong. She hates the case and feels paranoid, but the pay is good and her other case is very unpredictable with the child's health status. She gives me the paper, which she pulled out of the bag she had in the house. Yay, for nurses who like to give a heads up! I go back in to relieve the mom and she goes upstairs for all of 10 minutes, comes back downstairs with a blanket and her pillow and beds down on the couch. About halfway through the night, as she has woken up for every alarm or semi-loud movement, she says that she's over lazy nurses and can't get any sleep anymore because she's tired of nurses sleeping in her house and getting paid more than she makes to do it. She informs me that she's been sleeping on the couch sporadically since baby came home and every time she feels safe to sleep in her bed she regrets it because she catches the nurses asleep. It was very awkward. Mom finally went upstairs around 5 because she really wasn't getting any quality sleep. I can't be sure she wasn't up there watching me... I was so relieved when the day nurse came. I was giving report when grandma came downstairs and sat on the couch. She turned on the TV like she was about to watch Fox News but really kept staring at us as we did the small narc count and day nurse got the tube feed ready for the day. Day nurse told me that grandma watches everything she does almost all shift, sometimes taking notes, and this nurse has been their primary since baby came home! Crazy!!!!!

I recall having a parent ask me to be "very detailed" about my interventions. This was some years back. I did as I was asked, as I am always open to constructive criticism. A day or so later she came back and asked AGAIN. As I mainly worked late evenings and overnights I didn't have a lot of the same duties as the earlier shifts so I really had nothing more of value to add. Told parents this, who asked me to embellish how many times during the night the patient needed suctioning, how often he had episodes of emesis and/or desats, how often he had diaper "blow outs." Being a fairly new nurse I worked hard to appease them: I changed him more (even when he didn't necessarily need it and it disrupted his sleep), I suctioned when he really was capable of clearing himself, etc. That went on for about a week (3 shifts) before I told the parents I didn't feel especially comfortable. Not much later they "found reason" to ask the agency not to send me back. Years later I get referred to a family as an independent just to get my toes wet in PD again and the name sounds familiar. I drive down the street the day before the interview as a normally do (to see if it's a safe neighborhood, has parking, travel time, etc.) and it all comes back to me. It's the same family! I mention it to a local nurse that they're looking but weren't a good fit for me and she reveals she's already working the case. Here's the kicker: They get 18 hours per day of nursing and 24 hours a week for respite. Their plan worked, and parents are still requesting nurses "over document". Kid has a trach and mist collar now, g-tube fed overnight, PO feeds by day, hypotonic. Cognitively 1-2 years delayed, but only in certain areas. I know full-time vented children with severe TBI, full time GJ feeds and contractures who get fewer hours...

Has a family ever asked you to chart more interventions than required or done during your shift in order to make the patient appear more fragile than than they really are so they won't "lose hours" or in some cases, to get even more hours? Don't purger yourself if you have, but if you have a story to tell please do!

Seriously!!!!! And it took him two attempts for a barely competent job. When I was roomed in ED I was advised the one he got in was kinked! LOL! The otherwise super rad medic said I was a hard stick. I looked at him incredulously. I'm like, "dude, I'm a Coumadin patient. I get blood drawn on a regular and 'hard stick' is a term I've never heard in relation to myself!" Plus I could visualize a couple good IV insertion sites on myself and I was barely looking!

Yesterday, against my will, my job called EMS because I was having a full blown asthma exacerbation after two doses of albuterol inhaler. I refused transport to ED, and the paramedic (because they called in ALS) said, "You're a nurse? Well imagine this: your patient has NO air moving in their lungs that can be auscultated in either lung, they're diaphoretic, slightly cyanotic, and their O2 sat is 86% after two inhaler treatments. What would you recommend?" I was silent but truly the rig was already moving. " I really think you need to go to ED." LOL, yeah... 2L of O2 via NC to maintain my sats, chest x-ray, two boluses of NS and two "1 and 1" nebs later I left with a RA O2 of 96% RA, steroids and nebs at home. Plus the fun diagnosis of "walking pneumonia" which is really nothing. I escaped, at my behest, sans antibiotics because my pneumonia is very mild. Anyway, as I was leaving the awesome DC nurse said, "you are so pleasant and I enjoyed caring for you but I heard about the hell you gave the medics about 'just' giving you a neb tx and letting you go back to work so they can go take care of someone really sick! [LMBO]. Nurses make the WORSE patients to SOMEONE on the team." LOL. Love it! THEN I got a text from a non-medical friend who told me to "be a patient, not a nurse today." I love it! Seems to be true true! And I thought of you guys the whole time~ I always do if I have to go to ED or urgent care. Medical professionals make the worse patients: Agree or disagree?

I sincerely hope she does, too. She actually mentioned going back to reapply with some of the agencies, including the infamous "M" because she has a family to support. However, those who live in NY and bill independently know that agency rates are nowhere near as high as MCD reimbursement rates and she would need to put in lots of hours with likely pretty crappy cases in order to maintain her standard of living. The tears she cried... oh, my gosh. She feels so hurt by the family and even called around to others on the case to see if she could get other coverage but it was impossible last minute on Easter. Her next scheduled shift is tomorrow 6 AM and she's debating whether she should just show up because she knows that the shift is probably uncovered. But then again, independents can be very vulture-like when it comes to hours and if the parents truly took her off the schedule those hours may have been gobbled up instantly. Every time I even hint at sticking my toe back into PDN something like this happens and I realize I just don't have the time or the patience for the madness.

I had a mom that counted everything. Think I spoke of her before. ;-) She bought the "select-a-size" paper towels and in addition to counting how many paper towels we used, she had it written how many segments were allowed for specific uses. For example, cleaning the suction catheter and then drying our hands requires only ONE section because the vinegar used on the canister is actually good for us and "a little vinegar water left on [our] hands to air dry is good infection control". In the latrine we may use "up to three" with a maximum of six bathroom sections per shift. No jokes, no drama, no exaggeration. She was tired of "wasteful" nurses, too.

Hmmm, this is a new one. At least for me. My cousin has been doing independent PDN for the past 8-9 years. She's very savvy and usually diversifies her cases so she isn't dependent on one client however this past year has been very difficult in the independent arena and she only has two clients, one of which is mostly full time, the other she fills in 1-2 times per month. She's been with this 3/4 time family for years, since the little one came home from the hospital and the child is fairly stable so I guess she got comfortable. Well, she and I just had the saddest FaceTime session EVER. She lost her job. She normally works every other Sunday but traded this Sunday with another independent because she was invited to Sunday service by her brand new fiance's family. Towards the end of this week the nurse she swapped with developed a stomach bug and the family won't have her back until she is symptom free for 48 hours. At this time it's obvious she's not going to make the Sunday deadline and therefore the Sunday shift reverted back to my cousin. My cousin, who is usually so sweet and accommodating told the family she could not and would not work Sunday because she already has very important plans. The family told her, paraphrased, well, if you don't come on Sunday don't bother to come back! You nurses are so insensitive, don't you understand trach parents deserve holidays, too?! ...and nurses don't? So now she's down to her fill-in because she will not choose work over her new family and I don't blame her. I just feel sorry for her but I can guarantee she will go back to having her hands in several pots as soon as she can! As for the family: I have never!!!!!!

I could be wrong but I *think* she relayed everything as if she did it but it was another parent who did it all, including calling the agency. I'm not sure, to be honest. I haven't followed up. She lied to me and kind of used me. I'm done at that point.

I totally deferred to the agency when she called, honestly because I was caught off guard and I didn't want it to go back to anyone that I said this, that, and the third. However, she is a parent that I do hear from periodically. I am not working PDN but she has called me several times to find out if I am willing to be fill-in on her case (as an independent, as I am not currently affiliated with any home health agency) but I always decline. I was one of the first nurses she had when she brought her child home over 5 years ago and she has always mailed me Christmas cards with updates, pictures, etc. even though I haven't been on the case in years. I guess that's part of the reason I feel lied to... WHY LIE? We have always had a pretty good professional relationship. Have no fear, I would NEVER throw another nurse under the bus, but I DID tell her to call the agency with her concerns. She said she already called on-call and would call first thing this morning to talk to the desk staff.