BirdieBird

Hi Brich, I am in the same process, but in the state of wisconsin. Here, I am pursuing the "Independent practice nurse" so that I may provide skilled nursing visits in homes in the community. I, like you, have an LLC. I also have an NPI number and an EIN number, plus an active registered nurse license. With all this in hand, I applied to Wisconsin Medicaid for certification. This certification allows a nurse to provide skilled nursing in a patient's home under only a physician's order and then submit for payment directly to Medicaid (one does have to submit for prior authorization though). With all that said, that's just what one needs to get started. There's many more pieces I have yet to set in place before I'm really ready to proceed, especially figuring out which EHR to use (and pay for). Best of luck to you!

Does anyone know, is it possible to provide skilled nursing visits for people in their homes and directly bill Medical assistance in the state of Wisconsin? If so, can anyone direct me to a starting point? Thank you in advance.

Hello, do any nurses out there have recommendations on how to best serve demanding residents in long term care? I work in assisted living and have a resident who experiences what he perceives as health "crisis" on a daily basis. Every morning, following breakfast, this resident will either call for nurse assist or simply show up at the nursing office door. One can be certain that I spend about an hour or more on his needs each day; that's quite a bit for assisted living. He is impatient and becomes upset if I am not immediately available to him. Each day, he arrives with a new concern. These concerns range from "look at my toe, does it look bigger than the other one" type concerns to "I think I have a mass in my throat". Generally speaking, I just stop what I'm doing and tend to this resident to avoid his verbal outrage. I know this is not the best way to approach this matter and would appreciate any advice on how to best work with this type personality.

Yes, it would benefit me to think through my thoughts further and speak not from my own standpoint but with the patient in the front of my mind. The way one refers to a patient should be kept professional and not endearing.

Just take my apologies on this entire thread please.

I would appreciate having someone sit and listen to me while I share my history in hopes of helping others. But I think it would be exhausting to be this emotionally real with most people.

Thank you.

I meant no offense in my posting. My apologies.

Virtually all nurses are aware of a huge problem in our long-term care settings. Our residents are growing older and becoming more debilitated in their final years of life. As nurses, we can typically determine through our assessments when a resident has progressed to a level we can no longer keep healthy or safe. When this determination is made, nurses and residents face another problem: there is no where to discharge to. Skilled nursing facilities are filled to the max and are just barely staffed. As Nurse Manager in a large assisted living complex, I encounter this fact routinely. The end result is that my assisted living now closely resembles a nursing home. Really, we don't struggle with the physical declines as badly as we do with the progressive cognitive declines that are becoming more apparent every day. I do my best to create some pretty in depth Risk agreements, but that's about all I can do while we wait. Can anyone recommend on how to best prepare unlicensed staff for this change in acuity levels of residents? That would be our major struggle right now.

SkyDancer, I can relate to what you describe with some nurses being very difficult to care for. Even with over a decade under my belt, I still get a little nervous when I see "nurse" as their prior vocation. I should note that I manage a high acuity assisted living, so these nurses are sticking around for awhile. Anyhow, I know that my apprehension is just due to my own insecurities. I have 3 different nurses, and I get along just fine with all of them for varying reasons. First thing, I never say "you were a nurse". Once a nurse, always a nurse. This shows a sense of respect right off the bat. When one presents with health concerns, I take their report as good as mine; they have a profound body of knowledge, who am I to dispute? And here's the key, these women get ANGRY. I can't blame them, they are no longer a care provider but a recipient and this KILLS them. I listen to these frustrations until the gals are emotionally empty. In times of crisis, some of these gals have come forward and offered to assist our nursing department however needed. Of course, they get a hard no, but it's the offer that counts. In short, respect and active listening, and just being empathetic go such a long way.

COVID. Over the last six months, our campus has seen very little of this nasty little virus that we all know as COVID 19. So much so that the powers that be allowed us to unmask for a brief period- two days to be exact. Oh gosh, the smiles that followed this announcement and practice change could not be matched. My eyes tear up at the images that cross through my mind as I watched staff bear their full faces to our resident population for the first time in over two years. It was such a joyful moment, a moment that signified such progress in our battle against this illness. I really felt hope. My mistake. Two days later, transmission rate went back up and masks were back up. That was too bad. I feel such sorrow over what happened. Complete outbreak status ensued about 4 days later. Room after room was set up with PPE and quarantine was implemented for many. Many residents understood, some did not. The hardest were my cognitively impaired residents. Some believed we were holding them against their will, some just exit/entered their apartments with constant reminders from staff of quarantine. In short, as we all know, it's hard. And that's all I have to say to all of you nurses out there; this is hard. I'm thankful that the strain this year is nowhere near as virulent as past strains, don't doubt that. However, I myself contracted the little bugger this time around- first timer here. I didn't like it, I feel as though I failed somewhere in the mix to have landed my tookus here in my home office doing all I can from home (county contacts, state correspondence, nurse guidance, etc). But even I know this can happen to anyone, including me. The hardest part is not being able to be there, helping my staff, caring for my residents, reassuring families, just all the little things we nurses do to help on a daily basis. How have other nurses dealt with this guilt? Any comments or thoughts are appreciated. Thanks.

We were all there once, fresh and new registered nurses with hopes to change the world for the better. I graduated in 2012 from a four year nursing program and had already leaned into the idea of non traditional nursing roles. I began my career in home health care. There is no denying that this position prepared me to deal with anything. For instance, there I was just 3 months into practice when I was assigned a new tracheostomy patient. We were in her bathroom doing trash cares with the straps freed for just a moment. Of course, what happened in that moment? Yep, she coughed and out flew the trach tube, right on the bathroom floor. No one had prepared me for this and smart phones were not yet a thing. I punted and luckily all went well. However, I soon realized that I was not yet prepared for this level of autonomy. I applied to a local hospital and was hired into neurosurgery. Homecare had nothing on neurosurgery as it turned out. As we all know, you never know how a person with a TBI will work out. I loved it though and continuously excelled in my cares and performance. I was offered night charge nurse on the twenty bed unit and accepted with some apprehension. I was accustomed to going to the charge, not being the charge. At night, it could be even tougher as there was only skeleton staff. I was committed to giving it my best shot and signed the six month contract, all nights 7PM to 7AM. I learned a lot during this contract, especially the importance of a tight team. Only in numbers could we succeed in providing the highest quality patient care. I learned to lead, but not due to my title. In my practice, I pulled my peers near to me with kindness and respect. I taught whenever I could, whether it was a nurse or a CNA, or even a committed family member. After all, it takes all of these parties to provide holistic and individualized patient care and its important that we are all on the same page. I could go on about my history forever, but for time's sake I will move forward with my story. After a few years at the hospital, I decided to move into long term care in a skilled nursing facility; this is where I learned to book it as a nurse for over 20 frail and elderly individuals. Once again, after a few years, I decided to try my hand at case management. I learned the art of communication and care coordination. Then, one day as I was headed to visit one of my patients in an assisted living complex, I was approached by the campus director and offered the opportunity to apply for her nurse manager position. Of course, this was a difficult choice for me to make. As you may have noted, I had succeeded in nearly completely avoiding any type of actual management my entire career. Believe me, I had seen the miserable expressions my prior managers had held and their constant stress. I had never had any interest. I do believe in signs though; I applied and was hired on site. That should've told me something. I received a crash course from multiple nurses on how to manage the 43 apartment complex. They were all very nice, but most just wanted to chat about extraneous whatever. I learned my role by reading the state regulations, policies and procedure manuals, and the guidance of a select few old school float nurses. The role seemed to start to come to me after a short time. One of the most valuable tools that I found myself using was that kindness and respect I referenced earlier. These two qualities are what a leader needs to pull the team together in tough times and what residents need to trust the nurse. I did it and continue to do it. I love this part of my position as nurse manager. However, I love being a nurse, not a manager. In fact, I dislike the management portion so much that I handed in my resignation a few weeks ago. Residents and staff reacted quickly and strongly with their opposition to my resignation. Our CEO stepped in to offer me a "program coordinator" to handle day to day operations and management function. So, here's my question... What am I now that I'm not the nurse manager? All replies are welcome. Thanks!

Hi there! So, I also have been a nurse manager for about a year. It's going very well thus far. Regarding organization, here's how I do it. Daily routine: arrive at office and check notes from staff so I know what I need to follow up on. Check voicemails and return calls starting at 8 AM, check email to see what needs to be addressed, check on staff to assure shift is going well, touch base with my supervisor, contact pharmacy with any requests, prep for any assessments due that day, complete any assessments for the day, and then again check and respond to VM and emails. This list flexes throughout the day and allows me time to visit with in need residents throughout the day. As you know, expect the unexpected.

Hello everyone, I’m taking some time today to reach out to you all in search of some good advice. I am the nurse manager at an assisted living facility in our area. Roughly 46 elderly people depend on my team and I to get through their day to day activities and maintain both their health and safety. I have been in this role for a little over 9 months at this time and this is my first true management position. For the first 10 years of my career, I avoided management with everything I had; I very much preferred the bedside aspect of nursing and was very good at it. I also did not want anything to do with the responsibility that a nurse manager bears. Less responsibility equaled less liability in my mind. However, after working in acute care, long-term care, and community health, I decided to take the plunge and give this management thing a try. Some days are great, most days are good, and some days just suck. However, if there’s one thing I’ve learned, it’s that the best teachers are those that have been through it. Therefore, I’m asking all of you nurse managers out there for any tips or tricks that would help my somewhat committed team of assistants morph into a solid team of healthcare providers that are not only committed to a high level of resident care, but just as strongly committed to each other and the team. Any advice to help a girl out?

Do you use outlook? Without my calendar full of daily tasks and responsibilities I would be lost.