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This is something you'd need to discuss with the agency you apply to. Remember there are sometimes labs (ie vanc troughs) and IV medications that require visits by 830 or 9am so you may need to work around that some. May want to consider being the after hours nurse - ours starts her day at 5pm and does admissions or revisits that need to be done after hours. She works M-TH 5pm-8a on those days. Very rarely does she go out after 10, but it does happen sometimes.

I've been in a management position with HH for 4 years now, and I had field experience of about 6 years. My suggestion would be to make sure you find out exactly what you'll be responsible for and know that your orientation will only be a drop in the bucket. You will have much to learn and most of it will be learn as you go, or that's been my experience. MCR/MCD are constantly changing so be ready for the roller coaster. I will tell you that the agency I work for is trying to be proactive with the economy so those of us in management/salaried positions are expected to pick up visits when clinicians are out to help decrease use of PRN staff. Good Luck!

Home health is one of those either you really like it or you hate it kindda jobs. You'll be going into homes of all types..some that will leave you wondering how people live that way. You will find that some patients almost become a part of your family. My husband and I helped one of my patients get a handicapped ramp and took him Thanksgiving dinner. There have been times I've bought groceries or gotten meds for some of my patients. That being said, you have to get to the point where you realize everyone can't be saved and some of them really don't want to live any differently. Paperwork/computer work is a booger! Sometimes it does feel like more than the hospital. I worked L&D and never thought anything could have more paperwork than we had to do for a delivery. The flexibility is one of the perks but remember, you are on the clock until 5pm(may need to clarify that with your manager) so if you're home with the kids and one of your patients needs a PRN visit before 4pm you may be required to take care of it. Home health is no longer one of the areas where you can see your patients, go home and be done. At least not around here anyways. Good LUCK!

Our nurses don't carry any IV supplies, we don't stock them in the office either. Anytime we get an order for IV meds everything comes from Infusion co or DME with Pharmacy. Since HH is not an emergency service any patients requiring IV fluids before all of this can be arranged are sent to the ER. Ideally all home infusion patients have a PICC, PAC or other access. Unfortunately this is not always the case, so we do have to start some peripherals in the home. Hope that helps!

If you have SW on staff that should be your first call before leaving that home. If no SW on staff to assist you- talk to daughter and firmly but caringly tell her the dangers to both her parents and others. Mother cannot care for herself much less anyone else. Give the daughter the opportunity to make other arrangements, give her names of agencies who provide private duty nurses or sitters. Check back with her the next day to see if there have been any changes. If not or if you cannot reach the daughter most definitely YOU MUST call APS. We are seeing this situation more and more, often times with patients who have no children.

At any point the nurse sees any indication of distress, ie decreased variability, decels (early,late,variables) the patient should be assessed. Has she progressed? membranes ruptured? does repositioning help? has she had pain med? what kind and when? Depending on that assessment there are times when it's appropriate to completely stop the pit ie if your assessment indicates a baby and/or mama who is in acute distress. Otherwise the pit should be decreased as already mentioned. Reading the FHR tracing will vary somewhat from nurse to nurse but everyone should know the signs of non reassuring tracing- there's no such thing as not that non reassuring. The doctor should ALWAYS be notified of ANY non reassuring tracings.

:angryfire As one of the "experienced nurses" I'm not real impressed with your response. While there are some "hateful,snooty" nurses, not all of them are the ones with experience. Would you prefer the hospital with the experienced nurses or the one who "replaced" all the experienced ones with new inexperienced grads for your loved ones? What happens when your best with the knowledge you have(right out of school) is not enough and results in a dead baby or mama? Doing your best does not mean much to the family of that patient or to their lawyer. FYI- hospitals are not "replacing" the experienced nurses, they are asking them to take cuts in pay1-5%, taking away shift diff, and asking them to take furloughs as ways to save money. Which I might add most of us are cooperating with so that our patients will receive the best possible care and so we have a job. To teens mom I am sorry you're not having a good experience. You'll find that nurses in specialty areas are territorial, and can be very overbearing at times. I suggest you #1 do not repeat any of the post about replacing them #2 Talk with the yelling preceptor- ask her to tell you how she would've handled these situations and request she share any tips with you. #3 If that conversation does not go well talk to your nurse manager. Don't "complain" about the other nurses but ask for her guidance in how to handle some of these situations. #4 Concentrate on your patients and giving them the best care, which sounds like you're doing. You have prioritized and that's one of the biggest challenges of L&D. Sometimes everything is important all at the same time! I agree that you need to stand up for yourself- let them know that you WILL NOT be intimidated- you are there to care for your patients- when you're being reprimanded just look at that nurse and ask, well, since I'm still learning can you tell me what you would've done differently. Ask questions, lots of questions, you might find her to be helpful after all. You have to earn their respect,you'll do this by standing up for yourself in a professional manner,and taking great care of your patients. Good luck to you!

I've been a nurse for 16 years and have worked from ER, med surg, L&D, NBN and now in home health. There is ABSOLUTELY NO excuse for that to happen to any patient. However, it happens more than you know. As more and more people loose jobs you see them going into the "medical profession" b/c there will always be jobs there, right? and the money is good, right? Needless to say long story short some people go into nursing to "make money" and not to care for patients. That nurse has a supervisor and there's always a DON- part of being a good nurse is being a patient advocate- sounds like you did everything you knew to do. Hang in there and take this as a learning experience and a view of the "real world."

The old fundal pressure. As SmilingBlueEyes said this should not be done. However, when I started in OB many years ago we did this frequently. Even had a little stool we used to stand on especially for difficult deliveries. This isn't something that I've done in years but am familiar with. Hope that helps....

I'm with SmilingBlueEyes! Nothing beats laboring down. It's better for mom and baby. :)

Congratulations!! She's absolutely beautiful.... thanks so much for the pictures.

Everyone deals with grief differently. I'm not sure nor do I even want to think about how I will react when I lose a parent or heaven forbid if I have to bury one of my children. My grandmother who is a very prim and proper southern lady literally lost it when her father died several years ago. She said she could hear someone screaming and after a couple of minutes realized it was her. She did get a hold of herself then. As for the family not coming when called, well....I've learned from dealing with my husbands family and my father's family that some people are real good at denial. If they don't see it or acknowledge it then they don't have to deal with it and maybe it'll go away. It being anything from money problems, family problems, sickness and even death. I've learned to be patient with them but I've also learned to be politely and gently blunt. So far it's worked ok....but I only do this with them because they are family and I can. You are upset because even though you know you did everything you possibly could someone died. It's a natural thing but when we get to the point where it doesn't affect us we're in trouble. It's called compassion and that's what makes you a good nurse.

Did anyone try to talk me out of being a nurse....You bet! I had the administrator of a diploma program tell me I wasn't cut out to be a nurse and I should look at something else. I had nurses tell me how terrible being a nurse is. I got married and had a child and was told how hard that would be. Needless to say I didn't listen! I'm slightly stubborn and bullheaded and extremely determined. Telling me I can't do something is like putting gas to a fire....so...it's been 13 years now since I graduated from nursing school. That being said, nursing is a very trying, tiring, frustrating, rewarding, exciting and ever changing profession. My husband at the time was very against my getting my degree, he was afraid I'd leave him if I had an education. I ended up leaving him so I could get my education. (I'm in no way recommending that for you) I depended heavily on my parents for help with my son during that time. You need the support of your spouse and your family, it takes everyone during school and afterward. Working twelve hour shifts that often turn into 14 or 16 hour shifts is difficult on any family. If this is something you want to do.....Go for it!! Don't let anyone or anything hold you back. Just make sure you're going in with eyes wide open. It's gonna be tough and you're going to need help, encouragement and support but you can do it. As for the LPN vs RN issue, as a new grad many years ago I depended on and learned so very much from the seasoned LPN's I worked with. If you can do the RN or BSN program it does open up more career opportunities and you make a little more money but you have to do what best fits your needs at the time. Good Luck to you! Marie

Mermaid, sorry you were injured and I'm sure this wasn't funny to you at the time but the visual sure did give me a chuckle this morning.

My standard reply lately has been "not today, today I'm just a big people nurse so mommy will have to get all the shots today." The kids love that and of course then I come in with a coloring book or something for the kids.