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

Sorry, I haven't checked the site for some time-obviously. I should now add that I am now employed 2-3 days a week at the same clinic I volunteered with. I still do some jobs for them as a volunteer plus I volunteer several weekends a year with Remote Area Medical (RAM). If looking for an opportunity, try RAM-they list their clinic calendar on their website. If still looking for a free clinic to volunteer with, we'd LOVE to have you but we are located in east Tennessee. We are organized under the Volunteers in Medicine guidelines. Visit their website for other clinic locations organized under the same set of guidelines--volunteersinmedicine.org Our clinic had a strong group of local volunteers, primarily from one church BUT we are not under control of the church. We have a varied group of board members-from many walks of life. Much of our funding is from donations, we also get funding thru our state safety net program. Hope you find an outlet! There are definite challenges in working at a clinic like ours in all areas. Even tho there are things that drive me crazy about working in this 'scraping by' environment, it's the patients and medical volunteers that make the aggrevations bearable! Star

Considering that I changed from 27 years in engineering field to nursing after a year or two of volunteer work in health care, I'd say volunteering can definitely help you 'set your sites'. I went back to school and completed my LPN program. I continued to volunteer while in school at a free medical clinic in our area. After obtaining my license, I kept volunteering while working PRN at paying jobs. After a year, I was hired on a part time basis at the clinic-my original job goal met! Since I was changing careers, I thought the volunteer work would help me when applying for a paying job-to show I was sincere about this major transition while in my late 50's and to show initiative. At several interviews, people would review my resume and ask if I had done 'any real work' in nursing. I responded with my volunteer experience working as a licensed nurse and as part of a medical office staff. Most would respond, "Oh, so you haven't done any real work." even after they read the list of tasks I performed. Moral-not all employers understand the work of a volunteer so don't be surprised if they do not put any value to your work. I guess they think we just sit around and fluff magazines. Hmm, how does "diabetic and insulin use training' translate to sitting around fluffing magazines all day? All that said, I still volunteer with Remote Area Medical and offer my services as a volunteer when possible at the clinic where I am now employed. Volunteer opportunities can get you back to seeing we all don't have the same options for medical care and how do we provide the care many people need. How do you help an insulin dependent diabetic-who lives in their car? Star

Can anyone direct me to a downloadable PPD measuring tool that we can print? We sort of got caught with our pants down--we are running our first testing for our office/nursing volunteers at our free clinic this week. We thought the measuring tool would come with the serum but it didn't. I can order from the CDC for next year but right now we need something we can use by the end of this week. Our mistake! In the meantime, I'm going to check with our county health department and see if they're feeling generous enough to donate one til we get our own. Thanks for the CDC information-we can actually download cards from them for next year. Star

Well, the responses on who gets phlebotomy training or how one gets phlebotomy training are all over the page. I finally coughed up the money to take a 2 day training class and I've completed over 100 unassisted draws as a volunteer in a free medical clinic in our area. Good news--I was recently hired by the same clinic! Woo Hoo! Not making much but it's work I wanted to do. I'm not certified, our state doesn't require it but I'm looking into what it takes this summer. I still have a few RNs who come out of school who have never performed phlebotomy but all in all, at the LPN level, it's a skill that you can gain, should gain and can open up many doors. I've had 2 calls for interviews since I can check 'Phlebotomy Skills'. One would think that if an LPN or RN takes IV therapy that the course organizers would add the phlebotomy training in the same course since we had to do 2 or 3 successful IV insertions in my IV therapy class. Now that would be beneficial!

About 80% of my 'work' is volunteer work--primarily at a local free clinic. I'm an LPN but that does not limit what I do. Our patients meet our clinic criteria-no medical insurance (Medicare, Medicaid or state health insurance) and financial criteria (I believe it's an income of We treat primarily chronic conditions--COPD, hypertension, DM type 2, arthritis, lower back pain. We triage each patient (vitals, a why they are here interview, and update med lists). The MD/NP/PA sees the patient, we then take over the checkout with med review (how to take, is this on the $4 list, are there samples or substitutes we can give), we do insulin usage teaching, nebulizer teaching for those who cannot get enough inhalers from the pharmacy assistance plans, we draw blood to be sent to the lab, we help with PAPs, pregnancy and urine dipstick tests, we run ECGs, do fingerstick glucose, HbA1cs and PT/INRs, provide nutritional guidance, give flu shots. Sometimes a little wound care. We call in Rx's if approved by the MD/NP/PA, we order x rays and ultrasounds. We do a LOT of reassuring and some chastising. And we chart, chart, chart-we don't have an EMR. Brush up on any language skills if you have them-we are in a semi rural area and we have a number of Hispanic patients. Some come with interpreters, sometimes we try to provide one but most times we can muddle thru. Sometimes the interpreter is a young child (under age 10). On a job interview last summer at a regular primary care clinic, I had an office manager tell me "So you haven't done any real nursing?" Gee, I thought I did... Best of luck-out of all my jobs, it's still my favorite. Star

I'm going to participate in giving the Flu Mist to a county school system this fall/winter. Can anyone provide any tips for giving the flu mist? I don't have a lot of experience working with kids and figured this would be a good chance to gain that experience. I'll be working with teams of nurses who have done this before but I'd like to be a little more prepared before the clinics start. Since we're doing so many, I'd like to have a few tips on giving the flu mist as efficiently as possible well as handling difficult kids. I've worked school physicals before and the worst thing that happened there was a little boy who did not want to have his blood pressure taken using a pink cuff. I just passed him on to someone with another color cuff. Easy enough! Thanks for any help, Star

I'm struggling with this phlebotomy issue right now. I completed my program in April 2011 and have my license. I've been applying to physician's offices but they expect us to pop out with phlebotomy training. We had IV therapy including inserting the catheters into brave fellow students and instructors but that was a separate course. I took that class. I've had several job interviews and as soon as they hear that I have no phlebotomy training, the handshake and thanks for coming are seconds away. I've investigated several options--a local community college (40 hours over 6 weeks), a local tech school (36 hours over 5 weeks), a one day one stick class and today found a 2 day class. I'm investigating the 2 day class. All the classes cost within $50 of each other--the 36-49 hour classes tell you they will prepare you for the certification, the 1 day and 2 day do not. I just want to confidently learn to draw blood. I can't find anything on the 2 day program--I searched the company on the web but only found their site, no other skinny on them. Any advice would be helpful! Star

I'm trying to pick up some phlebotomy training. I found several programs in our area, one thru a community college (40 hours), one thru a local tech training school (36 hours), a one day class that gets you 1 stick and a certificate and just today on Craigs list, by accident, I found a listing for the Southern VeniTech training coming soon to our area. They offer a 2 day class for about the same fee as all the others in our area are charging. I looked up their website (www.southernvenitech.com) but didn't find anything else on the web when I searched for the company name. Their site lists a number of 2 day classes thruout the southeast. Their site describes the class as including: safety procedures/regulations to protect yourself basic A and P of the blood supply equipment and supplies venipuncture techniques special collections potential complications practice (on training arms and fellow students) a practical test and an exam They never hint that you could become a certified phlebotomist--and that's OK with me. I just want to be able to confidently draw blood in a small clinical setting if I have to. I'm a new LPN and I would like to work in a clinical setting (physician's office). I do a lot of volunteer work in free clinics and I've had several interviews but as soon as I tell them I can't draw blood, I can see the handshake coming and the exit signs. I've got several PRN jobs and I hate to have to commit to 5 or more weeks of classes if I can get what I really, basically need from 2 days. I know, there'd be no certification possibilities after this but I'm not sure that's what I need. Any guidance/advice, skinny on Southern Venitech? Are they reputable? Do they do a good job? Thanks! Star

Thanks--I checked the site and I've gone thru 2 of the courses-one on diabetes and preventing complications, one on working with older diabetic patients. I plan to go thru a few more. One feature I particularly like is that you can download the pdf of the slides-one course even had the lecture notes included. Thanks again!

I just completed a practical nursing program and passed my state boards. This is a major career change for me. I've done a lot of volunteer work over the past 2 years and during my clinicals for school, I see how rampant diabetes is. I'd like to pick up some online courses (hopefully some with CEUs) on diabetes. Can anyone recommend any? Footcare, meal planning, tips for teaching self insulin management. I had to teach a patient last week who is new to using insulin--the RN on shift watched me and said I did well, even including how to dispose of the used syringes in an empty plastic bottle with a lid. I've been able to sit in on a half day program for meal planning but I know there's a LOT more to learn. I found the post providing a number of websites but haven't checked on those yet. Thanks for any help!