Claver

There are many agencies in New York City that work with this population both adults and children. You would have to be registered here. Go on the internet and review such agencies as United Cerebral Palsy Association (UCP), Services for the Underserved (SUS), AHRC, YAI, ARC, just to name a few. Claver

As I have posted before we are making the necessary corrections for our 60 day letter. Any of you who have been through this process understands how stressful it is. For the 60 day letter we were cited in every area except financial - so you know the amount of work that has to be done. The Residence Manager has not taken a very active part in what is going on. He always appeared to be lost or on a cloud somewhere. So we are putting the POCA book together, and many of the areas that he was supposed to work on has not been addressed, especially in the physical plant area. So last week, he had to go and pick up a discharged client from the Psy in-patient unit at the hospital. When the AMAP staff called me about medications, he had brought home the client without any discharge instructions. He had sat in the car and sent a new staff to collect the client from the unit. All that she could tell me was that they had given the client some injection to make him sleep. This was about 5.30 pm. I tried calling the hospital to get the Doctors, but only got voice mails. In frustration, I called the Area Coordinator, as I was planning to send the client back to the ER - so I had to explain to her what had occurrred. She spoke to the Residence Manager and told him to go back to the hospital and get written instructions. He went back, got the instructions, did not give a copy to the AMAP, so that she could call me. He placed the instructions on the Assistant Managers Desk, lock the office and went home. By the next morning they had asked him to resigned. Now he is blaming me for losing his job.

Do not worry about being an ADN and how people will feel about you. First try to pass your boards (we all take the same exam). Then try to learn and be the best nurse that you can be. No one goes around asking for an ADN vs BSN- all that patients require is that you know how to give good care and meet their needs. Passing your state boards determines that you have the basic requirements to do just that. The rest is up to you.

As DON you definitely need to have some HH experience. The field is not an easy one to work or to manage. I worked with two agencies in HH but both of them were part of a larger organization. 1 was part of Health Insurance company, and the other was a large MRDD organization. Both of them were able to get referrals for their HH division so that we always had cases. For your self you need to understand the regs, compliance, medicare/medicaid reimbursements, oasis, admission, 60 days, readmission, discharge requirements etc. It can be done, but you should have some idea of how it is done.

Respect your friend. Quit looking to see if she has pass or not. Just be supportive.

I RECEIVED THIS AS PART OF A JOB DESCRIPTION FOR RN POSITON: Must be able to engage in the following physical activities on a daily basis: able to walk and stand for entire day with some sitting, turning, twisting, bending, stooping, crouching. Must be able to reach, hold, lift, push, pull, and/or carry up to thirty (30) - fifty (50) pounds. Some responsibilities require sitting, grasping, fingering, receiving and handling of equipment and/or supplies. Must be able to talk with clear diction, have a good field of vision, depth perception and good hearing. Must be free from infection. Occasionally may be exposed to infectious diseases. Must be able to work in cool temperatures. Occasionally will have to work around wet, slippery floors,some X-ray exposure and work around chemical hazardous properties. Some surgical procedures involve the use of the laser. Must be able to move and push stretchers, wheelchairs, recliners, video/TV equipment, rolling carts, bovie, laser, microscope, anesthesia machines. Protective equipment includes: protective eyewear glasses, gloves, gown, lead aprons, shoe covers, hats, and mask.

I am not sure of the exact information that you are seeking - but the Office of Professional licensing -State Education Department should be able to answer any of your questions. Their website: www.op.nysed.gov - E-mail: oprau@mail,nysed.gov

I feel compelled to respond and then I feel why bother?. If as nurses we are going to have this old argument when NO MATTER WHAT DEGREE - WE ALL HAVE TO PASS THE SAME STATE BOARDS!!!!!

Many years ago as a stressed out staff nurse on a medical unit I gave a patient a triple dose of NPH insulin - for his evening medication. I had misread the order. Lucky for me the MD was right on the unit so when I told him what had happened he gave glucose via the IV and we checked the blood sugars until they were within normal range. I was very disturb by it all - so I can imagine what you are going through. Both of my daughters are lawyers- and they have advised that you consult a lawyer IMMEDIATELY- a few of the other posters have recommended this. Next, just try to calm yourself - review what has happened in your mind and try to develop a plan on how you could avoid making these mistakes again. You need to get away from ICU - if you feel overwhelmed it is not good for your emotional or physical health - and there are other areas that are just as satisfying- finally, if you are a praying person just pray to God for strength to get through this period. Good luck.

As a nursing supervisor in community care, I once found myself in charge of over a 100 clients with only one nurse to help. I thought I was doing a very great job of keeping every thing under control until the State Auditors came in. Everyone got their medication, and no one died - but attention to labs and test results, follow up appointments, specialty clinics etc. had all gone by the wayside. Sometims we take on too much and kid ourselves that we are able to manage. We have to learn to say NO, NO.

We have just spent two days responding to the POCA - some of these auditors are ridiculous - they cited us for not having enough choices of deserts - the only place has more than one choice for desert is a restaurant- and they say that these people are living in a "home environment" - any way I have three more audits to get through - may be by tomorrow they will be in another one of my houses - I will just thank God when it is all over.

Hi Patrick, I remember the days when there was a head nurse on each shift and a supervisor for the floor. Now 1 person is doing the work of three. I too was in management about four years ago. I had held the positon for about three years. One day I went for my annual physical and my doctor informed me that my blood pressure was elevated. By the end of the week I had handed in my resignation. My blood pressure returned to normal limits. So good luck.

The most important element of nursing is passing your state boards - Diploma, ADN, BSN all take the same boards - this indicate that we all have the same basic educational requirements - I am a diploma trained nurse - trained in the days when this was the minimum requirements for practice - with my years of clinical experience I would say that I need to be paid more than any BSN - because on the job we are doing the same thing and I have years of clinical experience, supervisory, independent, consultant, educator etc. - but that is not the point I want to make - many diploma and ADN nurses have furthered their education in health related fields - and this mean that many of them have the skills and ability to be managers - I have a bachelors and a masters degree in health adminstration and am currently enrolled in a Phd program. We cannot get rid of the "old" without considering where we have come from - We need to stop this debate and look to see how we can empower ourselves - and a million degrees are not going to do this - as posted earlier we must be seen as 'BILLABLE HOURS" and so we have to work on getting hospitals etc. to acknowledge this - Many people who rise to top positions do not necessarily have all of these degrees - the former police commissioner of New York City, the National Security Director in New Jersey under the former administration - and we can go on and on. Let us think seriously about this degree business - not that it is not needed - but BSN'S just think of this - in the next 25 years someone will be saying that you need A MSN to enter practice - DIPLOMA AND ADN'S WILL BE EXTINCT - BSN'S WILL BE GRANDFATHERED IN - THEN IN THE NEXT 25 YEARS - A PHD WILL BE THE MINIMUM TO ENTER PRACTICE - BSN'S WILL BE EXTINCT AND MSN'S WILL BE GRANFATHERED IN and on and on WE NEED TO UNITE - accept our history and diversity and MOVE ON :rotfl: :rotfl: :rotfl:

Hi RoseKas, The whole team is still employed. We have to come up with a plan of correction (POC) and submit it to administration. I believe that the reason we are not fired is because they appear to be after the agency. Some of the citations were ridiculous - not having mugs for the clients to drink a hot beverage from - forks that were bent - a client who is smoking outside the home on the steps was not given an ash tray - Snow was not cleared from the back yard- None of these are life threatening - for my medicals -they cited because I had crossed out the date on a semi-annual and did not initial it - and also for not having a lab - a few missing signatures in the MAR - etc. Programming issues - community inclusion, goals, physical plant, data collection, incidents were our main citations. So we are beginning to clear up this mess and move on. And you are right I do like working with this population - to me it takes all of your skills and knowledge to try to provide nursing services to a population that is predominatly non-verbal, and to supervise AMAPs who have taken a 2 week course in medication administration. I have two more houses awaiting audits, so I am going through my paperwork with a fine tooth comb. The thing about these audits, you are never sure what angle they will be coming from. I will keep you informed of progress. :uhoh3:

Here are some of my favorites - Ineffective individual coping - what on earth is this? Altered nutrition - less than body requirements - risk for fluid volume deficit - impaired social interaction - self-esteem disturbance - and the list goes on and on Who thought up these things? Who uses them?

We have been issued with a 60 day letter yesterday - by Monday we will know if we still have our jobs -

I am a diploma trained nurse. I was trained in the days when this was the accepted level of education to be a registered nurse, under the British model of training. In our training we had to cover much of what is done today - anatomy and phsiology, chemistry, mathematics, unit management etc. It was a three years program consiting of pratical training on the unit and class room. By the second year of training the student was given some responsibility for management of the unit and supervision of other staff, usually on the evening or night shift. It was rigorous, demanding training, and those who could not make it were weeded out along the way. But we developed a lot of clinical and management skills, by the time that our training was completed. Since coming to The United States I have felt the need to gain a college degree as this is the accepted level for many entry level jobs. However I have not felt the need to do a BSN. I believed that I needed to expand into different areas. So I have a bachelors in Community Health and a Masters in Health Administration, along with my diploma training this has enabled me to acquire all of the analytical skills etc. Currently I am enrolled in a PHD program in Human Services. I do believe that in this century the BSN should be the entry level for nursing practice. For those nurses with their diplomas, ADN, other health related degrees should be accepted. Most importanly as nurses we have to respect each other no matter our level of education. I have worked with ADN, BSN, MSN, PHD nurses and believe me that the degree does not matter when there is a code blue for example - just how you respond. And it has nothing to do with your degree, but your skills and experience as a nurse is what enables you to successfully manage the situation. So education is important, but let us respect all levels and support each other.

I had started work on my doctoral degree via an online university about two years ago but had to withdraw for personal reasons. I have reapplied and have been accepted. From my previous credits I have completed 48 of the required 96- so six courses from now I should be ready to begin work on my dissertation. Please share if you are a nurse who is exploring other areas of study :Melody:

I am into my third day of a state audit with a possibility of a 4th on Monday. These auditors are so rude. We have been sited on every possibility that there is - a 60 day letter is being issued - I do believe that some jobs are on the line. It would appear that they are coming after my agency with the iron rod - all of our recent audits have been long 3-4 days. The auditors are very demanding - I want this document in 10 mins and are not allowing any flexibility at all. I have never met a bunch like these. Any similar experiences out there? Please share. :uhoh3:

I would add my voice to all of the others who suggest that you get 1-2 years of pure med-surg experience. In the home you are on your own - the coordinator in the office will depend on your ability to make an accurate assessment of the situation so that she can advise you - so you need to get this skill in place. Also you have to be very careful in going into the home and managing yourself in that environment - one example - I had a client who was very visually impaired - On my visit after checking his vital signs - he was in his bedroom - I placed my BP cuff and stetoscope on my work area on the table and went to wash my hands in the bathroom - by the time that I came back to the table the stetoscope had vanished - the aide swore that she did not see it - you also have to be careful with the external environment especially in high crime areas- and my favorite gripe - it kills your car - goodluck

I sent in my application to the Florida Board for license by endorsement 6th of January 05, and received a temporary license for 90 days on January 20th.

I am a diploma trained RN with bachelors and masters degrees in community health and health administration. I have been following discussion on these boards in relation to getting a BSN. After reading all the discussions from the various boards on this subject, it would seem to me that the BSN should be the entry level for all new students into nursing because this is the way of the future. For registered nurses they should have a choice of pursuing a BSN or some other health related degree. They have already proven that they have the basic knowledge by passing their state boards, and progress in nursing is based on experience. Currently I am enrolling in a PHD program in Human Services as I believe that this will broaden my experience in other areas. I would welcome responses from those who have taken other routes in their education. :Melody:

It can happen to anyone - I probably would have refused the drug test myself - let me share my experience with all of you- last year I went on vacation the last week in August to the first week in September returning the day after labor day. In my absence one of my clients ( I am in residential care) was sent to the hospital for elevated Depakote levels - this was towards the first week of my holiday - he was admitted and the agency did an investigation for possible neglect - by the time that I returned to work he had been treated and discharged from the hospital - Now the week before I went on vacation this client had a depakote level that was within normal range - but get this I was accused of patient neglect - when the client went to the hospital it was reported that he had made certain statements to the doctor that he had been lethargic and disoriented for 10-15 days - this is a client who is severely mentally retarded and non-verbal - he cannot make a sentence - further more the investigator had attributed many statements that I had allegedly made to him(I was on vacation)_ and disciplinary action against me was recommended. Well, I had a time fighting this one, although the record showed that I was on vacation, I was out of the country at the time, and had no knowledge that this client was in the hospital - it was still tough getting anyone to believe me - I thought that I was in a world of lunatics - although all of the evidence clearly showed that I was not at fault I had a time with my work place - But I have been around for a long time so I went to battle with them - eventually I threatened to sue them - yes that is a good word to use sometimes - the state came in and investigated and cited them for gathering false and inaccurate information and so it came to an end - fortunately my supervisor (she is not a nurse) was on my side and fought with me to the end - so it can happen to anyone - just be careful and make sure to keep your private malpractice coverage at all times.

(This happened to a coworker) - it is 6 am and dark on a cold winter morning. You pull up in your SUV, and pull out your cell phone, and begin leafing through your address book to get your client's number. You hear a tap on your window and look up to see that your SUV is surrounded by men, one of whom is holding up a police badge and motioning for you to roll down your window. When you do so you are told to keep your hands away from your bag and to step out of your vehicle. You try explaining that you are a home care nurse - but to no avail - you are not allowed to go for your ID - Meanwhile your client who was looking out for you is upstairs yelling "that is my nurse. Are all of you crazy?" After the confusion you are allowed to go to your client - apparently they were on a drug bust and thought that you were the contact person. :rotfl:

It is a bad visit when the agency asks you to cover a case - SIMPLE WOUND CARE - you step into the house and this elderly client is hooked up to oxygen, nasogastric feed via a pump, is on a water mattress, has in a catheter, is barely conscious, has bedsores everywhere, and a crazy daughter as caregiver, who insists that her daddy does not need skilled care in a supervised setting- three hours later you emerge feeling so dirty you do not even want to step into your car or your house -Of course I called my coordinator ranting like a lunatic - her response was that the daughter was trained to do all of the above and the nurse was just to monitor that it was being done correctly - the daughter also did the dressing changes when the nurse was not there - we were going in 2-3 times weekly -SIMPLE WOUND CARE -