starintn

OK, I thoroughly screwed up but at the time, I didn't know and I'm still not sure how to do this. I was to collect a specimen for culture from a woman who stated she had drainage from her breasts. The MD tried to express the fluid from the breasts but with no success. In a separate room, the patient stated to me that she could express the fluid for collection. She really had to squeeze the breast HARD and LONG. After about 20-30 seconds I finally saw a very small clear drop form. I collected on a sterile swab and inserted into the gel tube. I learned later that I contaminated the sample with skin cells. I could barely see the drop when collecting-I was collecting based on leap of faith-that I was seeing what I thought I was seeing and I am sure I touched her breast during the collection. The end of the swab turned a light grey color so I knew I collected fluid. Does anyone have any pointers if there is a next time I have to do this? Should the area around the nipple have been cleaned with alcohol or saline? I've done wound swabs before but from the inside of a wound, nothing like this. I'm not a wound care specialist and we do not have one onsite. Thanks for any pointers!!!

There are numerous job postings and school advertisements for Certified Medical Assistants. Education ads list training time as full associates degrees (2 yrs). I've also seen programs listed for Certified CLINICAL Medical Assistants-their training time is about 6 months. I've tried searching for both job titles; typically if I enter Certified Clinical Medical Assistant, I get listings for Certified Medical Assistants. What's the difference? There has to be some major difference based on the education-an associates vs 6 months? Thanks for any input-just trying to get my head wrapped around titles/abilities.

This is all good info but no one has addressed the original question-can an LPN go for this certification or is it an RN only certification? Thanks,

Does anyone know of any sort of ambulatory care certification for LPNs/LVNs? I checked the American Academy of Ambulatory Care Nursing website-just saw where LPNs/LVNs are used for staffing but nothing about any sort of certification or advanced training. Thanks!

We typically call only if a physician instructs us to call a pt re labs (either high, low and needs med changes or additions, dietary changes) or if the physician wants us to pass long good news such as a previously out of range value is within normal limits due to pt compliance with meds/nutrition. Otherwise, when we draw the labs, I instruct patients that if all values are within normal limits, we do not call them but that we will call if the physician requests us to call as described. Many times we schedule a patient's appointment for a lab draw a week before their appointment with the physician or nurse practitioner and the results are reviewed at that appointment.

In response to the drowning/over tasked. We have a WONDERFUL staffer in our office who handles the pharmacy assistance program and the referrals to other physicians altho we don't do too many of those. She also handles scheduling any special testing after the nursing staff completes the orders plus a lot of other tasks as well. If there are special directions for a test (fasting, drinking water an hour before test, etc) then those directions come from a nurse. We also instruct patients when drawing labs that if all labs are WNL then we do not call them or the physician instructs us to call with new medication instructions. That helps a ton! But we still get a few calls about labs that were WNL. We also ask patients to have their pharmacy fax in refills-many times we'd get calls for refills, we check the chart and find they have refills-they may not have checked the label on their med bottle. This also helps lessen confusion on which pharmacy and which med. Hope this helps-nothing like feeling what you see as the opportunity of your career not being so.

Thanks to all and to all the suggestions on keeping a basic patient triage to as short a time as possible. I had been using several of the tips mentioned (YAY on my part!) but it was good to get the back up from those of you in the same boat or with more experience-feel like I am on the right track. The biggest help so far has been to ask them to tell me their main problem today in just a few words "the doctor/NP will review and discuss this with you in much more detail; I just need a few notes so the doctor knows where to start." Boy, does that help and it is the truth. The part that is still slow going is the med review-we ask patients bring in all their medications but that can be inconvenient. Some will bring in a list. Even with the meds there in front of you, you find out they've only been taking something once a day instead of twice or twice instead of once or prn instead of daily. You just want to hug to death those with a complete list and taking as directed! Star

If you are looking for a Spanish language experience, consider an area in the US with a large Hispanic population low income or free clinic (inner city, western or southern US)that accepts volunteers-most will require a license in order to work in direct patient care. This may help for that time after passing your NCLEX and deciding what to do or finding an out of country mission. Even in our area, we have a number of Spanish speaking patients that keep us practicing our language skills. Also, 2 success stories from our clinic-we had 2 newly licensed nurses start volunteering with us as soon as they received their licenses-within 1 to 1 1/2 months they both had jobs in areas they wanted to work! Hated to lose them as volunteers but glad we could help them along the way and thankful for their help while with us. Star

I've worked with the uninsured for about 3 years, gee, the same length of time I've been a nurse. My experience has been mainly with a free clinic for those with no insurance and meeting our financial limits. Big issues in this environment have been already addressed-failure to return for office visits, inability to contact patients, knowing local resources and patient compliance. Not in any particular order. At each visit we ask the patients if they have a new phone number-some will give you a new number, some will just say no. Ask if their current number is ….. and repeat the number you have along with the address. We live an area without public transport other than a state funded van system. Often patients don’t have the gas money to make it to appointments. Local resources-check out every local resource thoroughly! Get qualifiers for food banks such as what the client needs to take for id or proof of income and when they accept new clients, fees and requirements for low cost dental care, clothing closet details-number of visits per month. Many states have state assisted pharmacy programs-LOTS of details on these. Ours is a good program for our state but there are limits. Also, don’t hand a person a list of resources without knowing if they can read! Did that once and was very embarrassed! Patient compliance is a huge problem. Refusing to take their diuretic because they work and can’t take frequent bathroom breaks. The lowest cost pharmacy is too far for them to walk to-especially in areas without public transportation. They take several meds and can’t remember how to take them-this is sometimes a problem with low comprehension. And some just wanted that pack of cigarettes more than they wanted to buy their medications. Diabetic Grannies who are raising their grandkids and end up eating what the kids want to eat, when the kids need to eat and on the cheap. The list goes on. Something we started a few months ago-we only accept pharmacy refill requests that come via fax. Often patients would call to tell us they were out of meds-either they didn't know they had refills or we find out they did not take the med as prescribed. This has helped a lot! Every now and then I can come up with a solution so I guess that’s a win. One thing I still have not achieved is getting thru a quick triage. We ask that they bring their meds with them but if they don’t you’re working on memory and there are a number who are taking meds on their own directions. We are often their sounding board-a sympathetic soul that they can talk to that is not a family member or someone they live with. We don’t want doctors waiting for a patient but building the trust involves listening. A point made by an instructor I had several years ago, at the end of the day, can you walk out and say to yourself that you did everything you could for your patients? Even if that means a short triage but they do get to see a doctor, reviewing how and when to take meds again with the hopes that it will sink in, teaching on making better lifestyle choices. In the end, I try to reach out as much as I can with the time I have and maybe that is the best I can do that day. Best of luck! Star

A little late in coming but check the Volunteers In Medicine website. Also, several states have organized groups for free or sliding scale clinics-sort of a 'support group'.

I'm an LPN and I work in a primary care office. We have been told to tighten up on the time we take to collect vitals, review allergies, tobacco habits, review meds (including dosages, frequency and need for refills) and collecting the main complaint or reason for visit. My pattern is to cover the vitals first, I review allergies/tobacco habits while getting the BP, then review the meds. We ask that patients bring in all meds from us or other physicians. If the pt is diabetic, we do a fingerstick glucose, if on Coumadin, we do the fingerstick PT/INR, if on inhalers, they get an SA O2 and 3 peak flow readings. Then after all this I ask the reason for the visit. Sometimes I'm lucky and it's a simple need for refills, f/u for hypertension or diabetes, lab or test review. But there are those days when the patient wants to ramble on. I check the notes from the last visit to see if we can hone in on the reason and ask if this is a f/u for that problem. Any pointers for controlling the rambling on types? I remind them that the doctor will review all details of the problem with them but some still go on and on and on... Thanks for any pointers!

Cathy here's the skinny in Tennessee, I see you're from Columbia. I work for the Free Medical Clinic of Oak Ridge (TN). 95% of our nurses are volunteers and one actually holds a volunteer license for Tennessee. You can contact the Administrative Director, Board of Nursing. (615-532-5166). SHe helped us walk thru the process. The nurse was an RN who was retiring but wanted to continue volunteering. We only allow medical staff with active licenses to be involved in direct patient care. The volunteer license gives you full rights to practice, doing everything you ever did before but without paying the license fee. You have to have had an active license before starting this process. Hope this helps, Star Lakavage, LPN.

Oh, I wish I'd known you were coming! I've been to the Bristol and the Knoxville clinics this year. If you come to another RAM clinic in TN, please keep in touch! Who knows, we might be able to have lunch together or next time, if you're still a student, we can get you involved in something a little more medically inclined. Hope you enjoyed your time! Glad you stepped forward and checked out RAM! If this type of volunteer work really interests you, look for a free or sliding scale clinic in your area-you won't believe how much you will learn even if you don't work on the nursing side of the clinic. One place to start looking is Volunteers in Medicine. Best of luck and again, thanks for helping us-as you can see, there is a HUGE need! Star

Have you looked into Remote Area Medical-check their website. They staff a women's health clinic in Guyana plus, on occasion offer other international opportunities. I've volunteered at their weekend clinics in Tennessee-the group is really well organized, like the SWAT team of health care-they come in, set up, treat, break down and are gone in the night leaving behind good results. I've also volunteered at their main office in Knoxville, TN-an old school they rent for $1/year.

I keep an occasional eye on the volunteer comments under All Nurses. Many are looking for over seas opportunities. As we've heard before, think locally first! I'm a part time employee at a free clinic in east Tennessee-we have a team of part time (paid) nurses and volunteers. There are a number of such clinics in our state. Don't know about the others or other volunteer staffed clinics but we could ALWAYS use a few new volunteers. Nurses drop out due to job changes, shift changes, continuing ed, life changes and sadly, their own health issues. I started my medical career at this clinic as a volunteer-taking appointments then helping with patient interviews for demographic info and their health history. Not sure what happens at other free medical clinics but our nurses triage patients, assist with procedures, perform blood draws, place orders, give flu shots, provide wound care, perform diabetic and insulin use training, assist with PAPs, know all the places to purchase the most inexpensive meds, perform EKGs, nutritional and medication counseling and reassure, reassure, reassure. We help our patients meet their challenges to resolve their health care problems. The Volunteers in Medicine website lists a number of clinics across the US. Typically clinics are always in need of volunteers; our volunteers commit to as much time as they want to volunteer and select their own schedule. Thank God for retired nurses! It's a great use of their knowledge, skills and years of experience. Some states have special licenses for retired nurses who work only as volunteers-a benefit is no licensing fee! If you're looking for that special feeling of fulfillment, consider a local clinic. Think of the other benefits-you can volunteer on a more regular basis and more frequently, no special shots or passports, typically no language barriers AND you get to sleep in your own bed that night! Thanks for 'reading me out', Star