GapRN

GapRN's Latest Activity

1. 

   removing wound vac from dummy

   GapRN posted a topic in Wound

   My wife is teaching wound vac class and is spending hours at home removing the tegaderm from dummies. adhesive remover and acetone don't seem to help. Tips?
2. 

   Doing refresher course or start dialysis?

   GapRN replied to ReeShee's topic in Urology

   I know this thread is old but I thought it was important to warn people off of a refresher course unless it is free and you don't have anything else to do with your time. I graduated 2009 during the recession and was unemployed for 1.5 years. Admittedly I did network with some students who pointed me towards home health but the course itself was a waste of time and money and it took the promise of removing my yelp review to get a refund when the promised preceptorship fell through. I think all of these private "colleges" that rent space out of retired high schools are scams looking for gov't and student debt handouts.
3. 

   cover letter advice

   GapRN posted a topic in School

   Hi everyone! I was looking for work and saw a school nurse position that could actually pay my bills so I headed over here.... and spent the next 2 days reading this forum. I'm impressed by how active you guys are here and your job sounds interesting! I'm coming from 9 years of home health and I see a lot of parallels in skills (from my cover letter: Building rapport with patients & families, implementing appropriate protocols, triaging with no back-up, organizing resources from outside agencies, detailed paperwork requirements, and operating in environments I have little control over.) For a couple of years I audited nursing visit notes - more CYA for the company, but I did a lot of peer education and it gave me a solid grounding in implementing/documenting ADPIE and organizing myself. I don't expect much problem on the medical side shifting from geri to pedi but there will be a learning curve and I'm not sure what employers will think about that. Also I have a 3 y/o and in nursing school i baby-sat for developmentally disabled kids <5. My question is what should I emphasize on a cover letter?
4. 

   Vaping

   GapRN replied to JenTheSchoolRN's topic in School

   I quit smoking 8 years ago and love my vape. Kids vaping instead of smoking seems like progress to me, but no drugs would be better obviously. My thoughts here pertain to nicotine since kids obviously should not be doing THC! The situation is not helped by government propaganda like stillblowingsmoke.org which is packed with so many fallacies that any critical thinker would write off the whole anti-vape argument as BS. The recent rash of pulmonary problems I hear touted by the media only aggrivate this problem - parents will hear "vaping bad" and stop listening, while kids (who are great at arguing) will look deeper and stop listening after they realize that the pulmonary problems are actually linked to illegally sourced THC vaping products. @tiningI checked out the website above and did not see anything new along these lines, though it was a bit less BS. They still mention formaldehyde which from what i have found is only produced under conditions that would make it painful to inhale the vapor We do know a lot a lot about nicotine - It is addictive. It is expensive. If I was looking at this from the perspective of a teenager, erectile dysfunction is the thing that would make me pay attention. There is also new research finding that cardio impact of vaping may be similar to smoking but kids probably aren't going to worry about that too much. Individual flavors seem to be the big unknown and the source of concerning chemicals BUT public education fails us here; instead of saying "don't vape flavors A, B, & C" they say "Aughh! Flavors are scary! you better stay away!" Stopping vaping would be great, but can't we try to mitigate the consequences in the mean time? What I've learned from nursing: You change patient behavior by educating. You educate by being a trustworthy source. You'd think we would have learned our lesson from the war on drugs by now.
5. 

   Home Health Nurse pay??

   GapRN replied to Okie51's topic in Home Health

   Home health give you 2 options: 1) Do your job well, DC patients with goals met who can take care of themselves, and enjoy a fulfilling pt care experience helping people. But you don't get paid much. Labor law does not seem to apply and each bit of work you put in just cuts into your hourly pay in the pay-per-visit model. 2) Run around doing VS and collecting pt signatures as fast as you can. Unload complex wounds and other visits that require actual time consuming labor on unsuspecting co-workers. Create fraudulent documentation about patient education that you didn't really do. Pull down $120 K and don't worry too much about you license because oversite is a joke as long as you're not actually falsifying visits.
6. 

   Where to go from home health?

   GapRN replied to GapRN's topic in Home Health

   Thankyou for the advice! @Kaisu - sorry. I did not mean to disparage the entire SNF field. That's just the job I had! they hired me as a PRN admission RN which i thought may help sharpen my assessment skills BUT between hiring and starting, a new DON started and I spent a month running around for 8 hours handing out pills and being taught to not bother with VS before digoxin "cuz you don't have time and I know that guy is stable."
7. 

   Where to go from home health?

   GapRN posted a topic in Home Health

   Looking for advice on what my resume is good for. I never planned on doing home health, but graduated during the recession and it was either home health or SNF drug monkey. Now I have 10 years of home health and feel like my education is too rusty to go to med sure even if they are willing to take me. the only nurses I have seen advance in HH have gone in to HH management and I can't imagine any dollar amount being worth the 24/7 life drain that HH DON looks like. I can't participate in the required corporate double speak anyway. I have become very good at wounds, head to toe, documentation, care planning, setting goals and completing a POC. BUT I feel like experience never helped me become more efficient. Any efficiency I gained was more than replaced by learning more about my responsibilities that I need to do. It also seems like in the past 10 years they have piled more and more responsibilities on nurses as the internet enables them to have nurse do things like ording supplies that otherwise would be done by hourly office staff. The worst thing is that PPV means nurses who do a million visits instead of actually doing their job get $ and praised by management while I get paid half as much by actually discharging patients who can verbalize how to manage their disease processes. any advice for someone who just wants to work an honest 8 hour shift and feel like I'm having a positive impact?
8. 

   Home Health and expectations

   GapRN replied to BrianLee73's topic in Home Health

   Expectations are poorly managed. You need to start with sales reps educating MDs on what we can bill for. I tell my intake coordinators over and over to emphasize independence, length of SOC, and medicare requirements that probably go beyond CG's expectation of me changing a bandaid and leaving. Discuss DC goals at SOC and don't be shy about threatening placement if Pt/CG can't/won't do things we can't bill for. But... be nice about it I have gotten a HHA visit scheduled before every nursing visit in cases where extensive wound care set up is needed, and if your agency won't spring for that I would refuse to do a second visit AND call your co workers so the office can't just pass around the hot-potato until they find a sucker. Sadly, sometimes you just gotta accept that Pt/CG will not meet their responsibilities as described in your SOC packet and DC. We all know that dependence spirals downward if you let it get out of control. DC may be just the kick in the pants they need. And if not - at least my taxes aren't paying for the guy sitting on his pressure ulcer all day.
9. 

   National Standard Productivity

   GapRN replied to mukluk2's topic in Home Health

   federal law says 30+ hr/wk is full time and >40/wk is OT. It is industry standard to call HH nurses exempt employees but this is just fraud if you have any hourly pay, even if you are primarily PPV. every job I have had (x4) says I should work about 60 hours per week for full time status. But they say "when you get some experience you can finish in 40." That is true if you swallow your integrity and start looking at home health as a game of Get VS, Drive to Next Pt, Commit Fraud in Documentation. My last job said SOC had equal value for my full time status as RV! My contract could theoretically expect me to work 120 hr to be full time. But they don't pay OT /RANT We got a pay cut for private SOC because they bill less. Oddly, for some reason the BRN doesn't seem to say I have less responsibility if I am taking care of private patients. Oddly, for some reason we pay medline the same amount for these private Pt's supplies. Oddly, for some reason I would feel guilty if I put 75% effort into a private case. Not odd at all: they cut labor costs, and refuse to even discuss it. /ENDRANT BUT If they hire you full time and say "you're not getting enough points" they can have you sign something that says you are part time (but why would you sign?!), or they can fire you. But they don't have nurses knocking down their door so... SO To hell with their metrics. Stop working after 40 hours unless you get over time. And I include on call in that too.
10. 

    HELP! What do you think I should do, fellow HH nurses?

    GapRN replied to oceanmermaid05's topic in Home Health

    @oceanmermaid05 I would use that state hotline in the SOC packet.
11. 

    Home care pay

    GapRN replied to LauraRn's topic in Home Health

    Federal law says they gotta pay for time worked (in your scenario) plus OT for > 40hr/week. In California OT is also for > 8hr/day. There's case law that found BECAUSE we get paid hourly for weekly meeting that even if we are paid per diem we qualify for overtime SO KEEP TRACK OF ALL TIME WORKED. Your emloyer will try to say you are an exempt employee but this is incorrect. I talked to a labor lawyer who said A) I'm right and B) it's not enough $ for anyone to take the case even if I'm willing to take a loss for the principle! BUT I have gotten payouts from a couple of past jobs after a class action law suit. You can claim unpaid wages for 2 years. The most profitable course (other than leaving HH!) would be to document time carefully, including time spent documenting till midnight and that 6th day on call every other week, and then sue them yourself after 2 years. And make sure you don't get trapped in a class action law suit. In our data rich industry the medical documentation software could track all this pretty easily. All we really need is a government that gives a flying-enema about enforcing labor law.
12. 

    Auditing nursing documentation

    GapRN replied to GapRN's topic in Home Health

    Re: caliotter3 I apologise if I seemed insulting. I would expect all nurses - LVN too. to know ADPIE. especially now that I have Googled "acronymns for nursing process" and only found ADPIE in the top ten results. Because my post is about $, it seemed important to point out I was a BSN, and how i feel i contrasted with my LVN/ADN peers. admittedly, this is my first job, so my sample size is small. some of my most competent coworkers are LVNs - and not just the RN immigrants - other than my boss, my peer that I respect most is a nerdy LVN who should have been a doctor except for unfortunate life circumstances. (I just had a post blocked for an old-timey swear word. Please understand, for my generation, for my geographic location, for my culture, nerd is a compliment of the highest order)
13. 

    Auditing nursing documentation

    GapRN replied to GapRN's topic in Home Health

    we are a very small company. family business. We don't really have a Quality Improvement Manager. Our quality control involves (quartly?) check lists that are rushed through in a time-crunch panic. My "reporting" is pretty much confined to if they remember to ask me if I have any problems when they're thinking about the topic. My only official responsibility is to make sure our paperwork doesn't get us in trouble, and change document status from "sent to office" to "completed". everything else I do is pretty much just stuff I think may help with that goal. My boss is OK with me changing paperwork however I want. I am NOT comfortable with that. I change typos, pedantic details, and stuff that i check with the nurse in question. If your new grad get $30/hr, then what does the educator make? I would love to go on visits with new hires, but can't imagine having the time for that. They tell me they've been looking for someone else to work with me (for a long time now) I bet we could find that person if we describe the job like you did.
14. 

    Auditing nursing documentation

    GapRN posted a topic in Home Health

    I hope I'm not double posting here... I saw a couple pay check threads, but more for visiting nurses than office staff. My HHA hires new grads (including me 3 years ago) Our field staff document really badly. most are 2 year RNs or LVNs and don't know how to document. I once asked in a meeting of ~25 nurses "What does ADPIE mean?" and NO ONE KNEW!!! at my school, every lecture ended with "and then you apply the nursing process and what should you do class?" I clean everything up, spell out the nursing process, dot the t's, cross the i's (If you catch the typo, maybe you can be a documentation auditor too!), make sure that problems have interventions; I'm amazed how many nurses notes look like a rubber-necker describing a car accident rather than a HCP identifying and solving problems, interventions have orders, goals are being met with reasonable efficiency and send it back to nurse for confirmation. (and did you hand write an incident report for that fall?) Because we are a growing HHA, I focus on teaching the nurses, because In two months there will be a new batch of new hires and I can't be fixing everything for everyone forever. It's not just paperwork - unfortunately I'm usually looking at notes that are 3 weeks old, but I see lots of pt care issues and make sure that they get fixed. better late then never, right? TEACHING is always my focus, both for patients and nurses. I think I was worth $30/hr 18 months ago, and I told them. I just got that "raise" last week. Especialy in the past couple months I feel like the value of my 4-year degree has really started kicking in and I am as much a nurse educator as an auditor. If you do this kind of work: 1. where are you? (I'm in northern california) 2. what are your responsibilities? what else to you do? 3. the important one: $?
15. 

    home health as new grad or wait it out?

    GapRN replied to eatsleeplove_nurse's topic in Home Health

    Feel free to wait it out... I hear the economy is better these days. But I hope you have free rent and a hobby to kill time with. I graduated '09 and spend the next 2 years handing in job applications and playing video games. Now I've been underemployed in home health for the last 3 years. It's good work, gratifying pt interactions, very flexable schedule, but low pay. The patients are generally stable, so it's OK to 1) assess the pt (KNOW YOU HEAD TO TOE), 2) go home and document (ASAP!!!!! you should buy wireless internet card or tether your laptop so you can document in car), 3) realize you forgot something vital, or tell your boss you don't know what's going on, 4) and then make a phone call, or schedule another PRN visit tomorrow and fix whatever you screwed up on. That pretty much sums up every visit I made in the first 6 months of my job. -It was crazy stressful, but in school they said that's what your 1st year will be. say goodbye to your friends for awhile. the schedule is just like school - you're not always busy, but you always have **** hanging over your head -you must be able to look stuff up and teach yourself. google "how to google well" and learn how to find stuff. My school books got more action on the job than in school. -photo consents and a WOCN co-worker who you can text the wound photos to are a must. -review head to toe assessment over and over. -every time you document anything... run it through ADPIE. then call the pt to tell them what you forgot during your visit. and act like you're going the extra mile, not making up for something you forgot. They love that! -prove that you're worth it, then DEMAND HOURLY PAY! per diem is ******** (Assuming you're RN? LVN does better perdiem) and you'll end up making $10/hour. just being on hold with the VA phone system will kill your hourly rate if you're RN.
16. 

    HIPPA and the phone

    GapRN posted a topic in Home Health

    How often are you told by someone on the phone that you can't get the info on your patients because it violates HIPPA? I just wasted 20 minutes finding this: http://www.hhs.gov/hipaafaq/providers/smaller/482.html It seems like a good resource to refer stubborn phone people. I then i call back to refer them to this address, and another person answers the phone and gives me my information, no problem. Actually, he didn't even ask for DOB, or anything, so that's even worse. Anyone have experience getting around stubborn people on the phone citing HIPPA? I run into this every once in awhile and it wastes so much time