RNikkiF

Can anyone give me any information about typical pay range for a Wound Care Utilization Review Nurse position that is remote? I'm looking for a remote position, but I think that as certified specialists, we should still get paid accordingly. Just wondering if anyone has any insight on this. Thanks.

OP was never in rehab, so there's no documentation. Also, no legal trouble, so there's no record at all. OP took it upon him/herself to quit because they were aware of the potential of a severe issue and impending trouble. To the OP: Kudos to you for recognizing and addressing your issue. I think it speaks to your character and any employer is lucky to have someone with that kind of tenacity.

Congratulations! That was certainly hard earned. Forget about the number of questions. It's a pass/fail. I passed with 75 questions and I know a lot of others who did too... that doesn't mean any of us are a better nurse than anyone else, it means we test well. Don't worry about it. Your employer doesn't care how many questions it took. You passed. That's all they see or care about. Congrats! :)

Soap and running water is the ONLY way to remove it from your hands. Bleach will kill the spores on hard surfaces. Make sure your residents wash their hands before eating, after toileting and before leaving their rooms. Everywhere I have worked, they use the "C"s. That patient is cognizant (alert and oriented... not confused), continent and contained (IF on the off chance the patient is incontinent, the accident is contained in a brief), they can leave their room. Check your facility policy and ask your employer for more education about c-diff. Stay off of Google, there's too much misinformation out there.

Honestly, I don't really like it when other nurses touch my pumps. I appreciate their intent to help, but I need to know what's going on with my patient. If my pump is beeping, just call me, I'll handle it.

Even if you know what the problem is, it is outside of your scope because it requires assessment. You can always straighten the patient's arm and if the pump doesn't stop beeping, then notifiy the nurse. You just don't want to get yourself in trouble. I know it seems like a simple thing, but what if there is something really wrong, even if it looks like a simple problem? You could be opening yourself up to some serious trouble, not to mention potential harm to the patient. If the nurse gets frustrated that you won't do it, just let her/him know it is beyond your scope. If they continue, take it to your manager and let them handle it. You can never go wrong by following your scope of practice.

I can relate to an extent, to what you're going through. I am also 43 with health issues that have forced me to take a less physically demanding position. I've actually sought advice right here in this forum for the same reasons. I'm dealing with leaving the floor right now. I start a new clinic position tomorrow. My advice is this: Ignore the rude, snarky comments like the first one. There was nothing even remotely constructive in it. As nurses, it is so easy for us to pigeon-hole ourselves. We limit ourselves to a certain patient population or we can't see beyond the bedside. I struggled with that myself. You have a plethora of transferrable skills and there are numerous non-clinical or non-bedside nursing positions that need someone with your experience. You have top notch critical thinking skills, time management, I'm sure you can spot a change in patient condition rapidly. You have delegations skills, people management skills. All of these things are critical to non-bedside positions too. Check out Donna Cardillo, google it. She's a nurse who gives career advice. She has tons of ideas. As for your options... (any manager would chomp at the bit to get someone with your experience, btw)... there's dialysis, blood centers, clinics, school nursing, insurance nursing, case management, unit management. Your options really are boundless outside of your physical restrictions. It took me a long time to see beyond the bedside too. Losing what you love to do is sooo hard!! I've "only" been a nurse 8 years and I sobbed on my way home from my last day and promptly came home and posted in All Nurses! LOL I don't know what is coming for me. I don't know if I'm going to love it. I hope I do and I'm going into it with an open mind. It's all we can do. Know that despite some ugliness that comes out when people don't understand (and they can hide behind a fake screen name), there ARE people out there who understand and are there to support you, not nitpick every little thing they see. That crap is about them and their insecurities. Not you. You have so much to offer. You just need to find the next step for you. And if you want to teach, do it! *Forget* the ones who try to shoot you down.

Have you considered school nursing? Clinics may be good too, if you can handle a fast pace. There are also blood centers, dialysis, there are work from home positions for insurance companies, etc, but those usually require experience in whatever acute field the position serves. Obviously, I know nothing about you other than what you've told us, but it sounds like school nursing could be a good fit for you! Helping students manage chronic diseases like giving insulin for diabetes, helping heal minor injuries and illnesses and promoting wellness!

I forgot they were in the ED. That certainly makes a difference.

I'm sorry that you're going through this. As for what do you do now? Learn everything you can from this, even write a little paper for yourself to reinforce the information if you need to. Then, when you have your meeting with your NM, you can point out where things went off track and show what you learned from it. If your preceptor really did yell and glare... that was very unprofessional, but I would leave that alone for now. If it were to occur again, you could make your NM aware that instead of teaching you, your preceptor is yelling at you. Was your preceptor aware the patient's blood sugar dropped so low? If so, why wasn't she guiding you? You mentioned that the patient refused food and drink and (I don't recall your exact words) had fluid in her lungs and showed swallowing issues... Never, ever give anything by mouth to a patient showing those signs. A call to the MD would have been in order for the blood sugar combined with the signs of swallowing difficulties. Also, don't hesitate to wake a patient during bedside rounding, especially after a situation such as this. Bottom line, just learn from it and grow as a nurse. Good luck.

LTACH is exactly what you describe. Acute care patients who need longer than their insurance will allow in a traditional hospital. Many of these do have limited therapy available for patients. Skilled Nursing/Subacute Rehab is a rehabilitation unit in the same building as a skilled nursing facility - patients typically get about an hour of therapy a day. Patients of any age can be sent there. Some may need continuing therapy, but no longer require three hours a day, which is what they'll receive in Acute rehab. Some will go home, some will stay at the nursing facility for life. Acute Rehab patients receive three hours of therapy, six days a week. They also still have ongoing medical needs that have to be managed and their medical status can change quickly. You get a broad range of patient populations in all of those settings, but if you're looking for intense experience, at an LTACH you'll see PICCs, PEGs, VENTS, TRACHS, the ENTIRE line of medical diagnoses. In the acute rehab I just left, we had strokes, amps, trachs, LVADs, spinal cord injuries, brain injuries, MS, Parkinson's.. we literally saw it all. Acute rehab patients require a LOT of physical assistance. You'll be transferring patients who require assistance from two people for everything they do, some will need a hoyer or other device, some will need a slideboard. Your main focus will be time management (critical skill!) because your number one priority after medical needs, is ensuring your patients are ready for rehab on time. Your day will revolve around your therapy schedule. You have to ensure your assessment, AM meds, toileting, morning cares and meals are managed and that the patient has enough time to eat, rest, visit, pain managed and that the doctors are aware of any needs the patient needs addressed. It is 100% about time management. That's day shift. PM shift, you're still managing the schedule, meals, etc. and you're also getting the patient in bed for the night. If your facility has 3 shifts, NOCs of course manages the patient's needs during the night, pain management, sleep needs, toileting and they also have an important morning role with helping ensure patients are ready for breakfast and therapy if they have an early start. Labs are usually drawn in the early morning as well. So, as you can see, every shift has an essential role that is affected by the therapy schedule. Day and PM shifts interact with different disciplines frequently throughout the day. Teamwork is a must. There are also additional Medicare requirements that have to be met and the nurses play a big part in both of those. There are team conferences every week that the nurse has to be at. There are also scoring systems that the nurses have to know and document on to track the patient's progress.

Most schools have their own requirements, so you'll need to check with your school. It also depends on if you're getting ADN, BSN or MSN...

I guess I don't understand how moving slowly is not pulling one's weight...

As someone who has faced the possibility of having to leave nursing when I really didn't want to (health reasons), try to understand from her point of view. Being a nurse isn't what we do, it's who we are. If she has no kids and no husband, this may be all she has left. You didn't say that patient safety is an issue. If it isn't, just support her the best you can, but be a friend like you said you would and maybe instead of telling her she's "slipping", you could say something to the effect of "I see you seem to be struggling, is everything okay?". If patient safety IS an issue, talk to your manager discretely. It really isn't up to you to say when she should retire. Whether or not she gets written up is up to the manager. I think it would be fine for you to voice your concern to her that you don't want her to get in trouble and maybe suggest (IF you're good enough friends) that maybe she stay PRN so that she's not entirely out of nursing. I know from experience it's a scary thought when you're facing losing something you love so much.

I recently worked with a woman who has Lupus. She certainly struggles, but she makes it happen. You can make it happen, but you need to keep in mind that nursing can be very physically demanding, so you need to keep your own limitations and triggers in mind and try to find a position that will hopefully fit within your limits. Maybe a clinic position or even case management, etc... That is if you think working multiple 12s a week may be too much. Just saw that you're an LPN with a lot of experience. If you can do that, why wouldn't you be able to do RN? You've already overcome a big challenge with that.