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Mudwoman

Mudwoman

Certified Diabetes Educator
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Mudwoman has 20 years experience and specializes in Certified Diabetes Educator.

Mudwoman's Latest Activity

  1. Mudwoman

    Questions for Diabetes Educators

    I also wanted to mention something I thought of today. The nurses that work in Cardiac Rehab cover for diabetes education on the weekends. Check with your employers to see what department covers on weekends for your diabetes educator there. It could be another opportunity to get hours needed for your CDE and get your foot in the door.
  2. Mudwoman

    Questions for Diabetes Educators

    It is not an easy field to get into, but it will happen if you work at it. When I decided this was what I really wanted to do in 2011, the first thing I did was join AADE (American Association of Diabetes Educators). You do not have to be an educator or CDE to join. Next thing I did was contact my state representatives and the governor of my state and just let them know that we have all these health initiatives for reducing diabetes in our state, but for those of us that want to be a part of that; well, it is almost impossible. It is hard to get a job as a diabetes educator if you aren't already, and you can't become an educator without all the hours as an educator. From those contacts, I was invited to be on the Diabetes Advisory Council in my state. Then, I started looking for ANY job that was for a diabetes educator whether it was PRN or part time. After a year and a half, I got a part time job in the hospital I work at as a diabetes educator and from there was able to get all my hours to sit for my CDE. If you have a diabetes educator in your hospital or one of the clinics in your area, talk with the person that does the hiring. It is hard to find someone to cover for these people if they have to be out on vacation or sick leave. You might just be the person to get trained to cover PRN. That would also give you a foot in the door. When I applied for the part time position, there were 9 other people that applied. What got me the job is that I was almost done with my BSN, I was already a member of AADE and had been taking their free online seminars, and I was on the Diabetes Advisory Council. I stood out as serious. This position is still part time and it is a real sacrifice financially!!!! I had been full time and I'm the sole support of my family. However, I am now putting together my own online business from this that will supplement my income and allow me independence that would not have happened otherwise. There are about 12,100 CDE's in the US. There are currently just under 600 outpatient diabetes education clinics in the US. Be sure to add yourself to Linkedin. I have received 3 job offers in the last year from Linkedin. I was just not willing to relocate. All of the positions were at hospitals. One was in Oklahoma, one in New Mexico, and one in the Dallas/Ft Worth area. There are also jobs with insurance companies as "health coach" that will allow you to work as long as you can get your CDE within a year. You just have to be actively looking all the time. Hope this helps you.
  3. Mudwoman

    Diabetic Educators: Structuring and Tracking

    Our program is certified by AADE. We are dictated that we have to teach all 7 areas of self care management per the AADE to keep our certification. We have data that we have to keep and turn in to AADE every year for our certification. We track A1c, weight, and yearly eye exam at this time. If our program were certified by ADA, it would be different, but likely very similar.....I don't know. Classes are 2 hours each X's 3 classes. One on One is more of an "assessment" and there is certain information we have to obtain to fill out the assessment questionaire. Otherwise, the patient is there and has a lot of questions.......mostly "what can I eat?" They care little about anything else.
  4. Mudwoman

    How to get into the Diabetes education

    It is hard to get into, but not impossible. Join AADE (American Asso of Diabetes Educators). You do not have to certified to join. Find out if the state you live in has a Diabetes Advisory Council. It is usually a division of the Department of Health in your state. Ask to join and start going to the meetings. Get on a committee. If you work in a hospital or clinic, they usually want you to be certified and that is where the 1000 hours comes in. You can't sit for your certification test until you have 1000 hours of teaching under your belt. However, as an RN, your scope of practice says you can do diabetes education. That leads me to this. If you are in an area that has a mentor through the NCBDE, then take advantage of that. If not, then consider putting on some classes. Do some classes at local churches, or organizations. There are clubs that are always looking for a speaker. Have people sign a sheet with their name, address etc. Then you start keeping a log of all the time you spend teaching. Get the education books from AADE so that you follow that format for teaching. You have to follow up with your "students", so you take the sheet and contact them a week or so after the classes to see how they are doing and see if they have questions. Follow up again in a month or 2. Keep records. Have the person that arranged for you to do the class, sign a paper that you did indeed do a class. If you do a 30 min class for 10 people, that is 300 minutes of "teaching". Keep looking for job opportunities. I had to take a part time position in diabetes education to get my foot in the door. I did not have a BSN or a CDE at that time. I was so nervous because my budget just didn't fit a part time income. But I wanted this and so I just went for it. It worked out. I wouldn't have thought I could cut my budget as much as I did. The Capella Education is just going to cost you a bunch of time and money and isn't going to get you a job. Networking with your local pharmacies, Department of Health, Diabetes Advisory Council will eventually get you some leads. Be pro-active. You are going to have to do some Pro-bono teaching for a while.
  5. Mudwoman

    Gestational Diabetes Treatment

    I've seen lots of GDM patient's placed on Metformin too. None of these medications have FDA approval for use with pregnant women, however, doctors are prescribing them for patients. OB docs I've talked to say there is no evidence that these oral agents cause harm and because the criteria has changed so that more women are given a diagnosis of GDM, insulin is not always appropriate either. There is too much risk of hypoglycemia. Evidence based practice is in play here.
  6. Mudwoman

    Medicaid reimbursement?

    In Arkansas, Medicaid does not pay for any education unless it is by the physician in the clinic setting. Then the physician can charge a level 3 visit for including the education. This year, Medicaid no longer pays for blood glucose testing supplies either. (in Arkansas). How crazy is that. Medicare will pay for 13 hours of education the first year the patient is diagnosed and then 2 hours of education each year thereafter. The patient's deductibles and co-pays apply. Medicare pays us 20% of what we charge for education. Lots of private insurance companies no longer pay for Diabetes Education either. They will pay for Medical Nutrition Therapy by a Registered Dietician. Many insurance companies provide some type of diabetes education for their enrollees at no charge. If they do pay, it is often a one time payment.
  7. Mudwoman

    How do you collect CDE hours?

    It used to be that 400 of the required 1000 hours could be volunteer hours. The big thing is to keep track of what you are doing as far as teaching. If you are teaching a patient while working, keep a record somewhere and the amount of time you spent. Watch for the requirement for the assessment, education plan, intervention and outcomes. You may need to call the patient on your own time later to see how the patient is doing and document that. Be sure you don't violate HIPPA. Do not have patient info that is not private. So, whatever you use for documenting your education, must be locked up. Have you thought of doing community classes and charging a small fee? I know a CDE that got a lot of her hours by doing just that. She charged $10 per person. New requirements may let you get all of the 1000 hours volunteering (not sure, check on this). Consider doing some diabetes education for church groups or a local club etc. If you do that, have people do a sign in sheet to verify attendance. You can count the amount of time spent.....let's say 1 hour times the number of people. So, if 10 people show up for 1 hour that equals 10 hours of teaching. You must be at least a RN. You do not have to have a BSN. Join AADE. You do not have to be a CDE to do that. I was lucky to find a job working at a hospital as a diabetes educator. I was working on my BSN, but the thing that got me the job was that I was a member of AADE. It just showed to the person hiring that I was really serious about a career in diabetes education. After a year of working as a diabetes educator, I got my CDE. Go for your dream.
  8. Mudwoman

    Celiac Disease and type 1 diabetes

    I recommend patients use a phone/web app such as Fooducate that can tell them if a food has gluten. There are other apps besides this one, it just happens to be one I like. They are looking for anything with wheat, oats, barley, rye as an ingredient. They should not share any food that could be contaminated. They need their own dishes and utensils etc. If the family eats toast (bread) and uses the margarine or butter, then the margarine or butter or jelly is contaminated.
  9. Mudwoman

    Pre-Diabetes education/programs

    Steve, On the Centers for Disease Control website, there is info on their Pre-Diabetes/Diabetes Prevention Program. You have to attend a certain class and get certified to do the teaching. It helps to work with your local YMCA or other exercise facility. As far as getting paid, once all this is in place, you can apply for a Grant to cover your costs. You have to keep records and get a certain amount of people signed up and do the program for 4 years. It is part of a research program being done by the CDC.
  10. Mudwoman

    Do you ever hold Lantus?

    Lantus is a basal insulin. It acts the way the pancreas acts between meals and during the night. It lasts 24 hours. It is important that it be given at about the same time each day. The dose may need to be reduced, but never "held". Give the patient an additional snack of 30 grams of carbs if there is worry about hypoglycemia, but never, ever not give the Lantus (or Levemir). Unless there are standing orders on parameters for holding insulin, you would never not give insulin without consulting the doctor or APN and getting an order to do so.
  11. Mudwoman

    Humalog only, no background

    Something is wrong. Are you sure that he is seeing his physician every 3-6 months? Are you sure that the physician has not ordered additional diabetes medications? Is there an issue with him being able to afford the medications ordered? If he is on Medicaid: they do not cover Lantus at this time. If he is injecting that much Humalog, then he is likely really, really insulin resistant. Part of that resistance is his muscle atrophy. The specialized cells that allow the uptake of glucose/insulin are in the liver and the skeletal muscle. He may not be aware of episodes of hypoglycemia if his autonomic nervous system has been affected by his diabetes. I have to wonder how often he tests his BG........if he even does. Is getting his testing supplies an issue for him? He could benefit from Metformin or Januvia to help with insulin resistance. If cost is an issue, he could still benefit from an insulin like NPH that costs less than a basal insulin. Whatever is going on, this patient is self managing his diabetes (not very well), and needs to know there are more options that would give him better control. He also needs to work more closely with his healthcare team....doctor, educator, nurses, pharmacist etc. I'm shocked that even his pharmacist hasn't questioned such a huge amount of insulin usage. There are some new Continuous Glucose Monitors coming on the market that are intended to be used by physician offices similar to a heart monitor. The CGM would be placed on the patient by the doc or nurse, and the patient could wear it for up to 7 days. The monitors take a BG reading every 5 minutes. This is an example of a patient that would really benefit from the information gained.....provided it was followed up with good education with him.
  12. Mudwoman

    New grads shouldn't work in ICU?

    A recent new grad that went to work in our ICU decided that since the patient was NPO she would put all his meds under his tongue and allow them to dissolve sublingually. The patient aspirated the meds and then needed a STAT Bronch. For every new grad that shouldn't be hired right out of school for a specialty like ICU, there are lots that just have the aptitude to be there. I think a lot depends on the orientation program that is available and the support of the other seasoned nurses, as well as the new grad. So, if you love ICU, then work and study hard to be a really good ICU nurse. If you don't like it, then find the area of nursing that you do like. Not everyone can work ICU, just as not everyone is cut out to work in ED or LTC or Education. Everyone should find where they belong, regardless of how long or short they have been a nurse.
  13. Mudwoman

    Out of Work Nurse

    Half of the estimated $1 trillion dollars that Obama care will cost will be funded by cutting Medicare payments to hospitals. In 1997 when the Balanced Budget Act was implemented, Medicare paid an average of 18% above hospital cost. In 2011, that had dropped to almost 5% under cost. In 2008, hospitals spent $3 Billion more delivering care than they took in. The biggest factor in the financial conditions of a hospital is payer mix. The Obama administration admits that 10-15% of hospitals will not survive under Obama Care. The hospitals that do survive will have to evolve into high-performance cost-cutting machines. Don't be surprised if you find that inpatient care will no longer be the main function of any hospital. The goal of Obama care is for health care to be performed as much as possible in less expensive locations outside hospital walls. Obama was quoted "we are moving away from a healthcare system based on illness, and towards a healthcare system based on prevention and wellness". So, if you get a chance, read the Wall Street Journal article about Mercy St Vincents Hospital in Manhattan. The article was written by Mark Levine called St. Vincent's Is the Lehman Brothers of Hospitals. Published in Oct 2010 I work for Mercy St Joseph's in Arkansas. We have been "for sale" for some time, but May of 2012, we had a contract with Capella Healthcare to acquire us. Then in June of this year after trying to do everything to make this deal happen, the FTC would not approve the sale. Their reason was that a For-Profit hospital could not purchase a Not-For-Profit hospital; leaving only a For-Profit hospital in the area. We have lost most all of our upper management. Many of our physicians have retired or left. Currently the board of directors is looking at 2 possible outcomes. They are trying to find a hospital to transfer ownership to and they are also trying to "re-imagine" our hospital downsized and more sustainable. Mercy has said that they are not willing to continue to support us because of our losses and going forward with Obama care......our payer mix is 85% Medicare/Medicaid. However, they are willing to look at the above proposals. We are promised that we will know by Sept 30 whether another hospital is taking us over, whether we are being downsized substantially, or whether like St Vincent's in Manhattan, Mercy will close the doors. Hope this info helps
  14. Mudwoman

    Rn to bsn

    Wow, that is horrible. Sounds like the professor I had for a Biology class. I had a female teacher for Statistics and she was wonderful!!!!!! I hope EC reads the course evals. There are so many good teachers there and when we get a rotten apple I hope they take notice and get rid of them.
  15. Mudwoman

    Rn to bsn

    I have to tell you I did Statistics thru EC and the teacher was just awesome! I made a high B in that class and without her I don't think I would have passed. So, just hang in there! Charlee
  16. Mudwoman

    Rn to bsn

    Just finished the Capstone Aug 17, 2013. Now just waiting for all my graduation paper work and my diploma. I have to tell you that it was easier to get the BSN than it was to get the AAS RN. The classes were a whole lot more interesting and a lot easier. Even stuff like the writing requirement and the Research in Nursing were a piece of cake. Statistics was the only thing that gave me a headache. YES.....it was worth it! Charlee