cherricka

The on call nurse, who takes on call during the week from 4 pm to 8 am Monday to Saturday, gets a regular salary. Depending on the Position Grade of course. Within my own Position grade, that would mean between $54,171- $69610 a year

I am a home care nurse, and I have never run into this question before. I know of a close friend of the family that had one kidney removed because of cancer. He recently had some issues with a blockage in his ureter. Before he had his surgery, they told his wife that if they found cancer in the remaining kidney, they would remove that also. Luckily, everything turned out fine. I just have never heard of anyone relying soley on dialysis, without any kidneys. Has anyone actually seen a patient with both kidney's removed?

I agree with the other posts. I do not miss the company of other nurses 90% of the time. I go to the office once a week or so, and get my fill of socialization then. I also am a preceptor, so I do get a welcome break of solitude once in a while. Man, there is nothing like traveling in the car, listening to the radio, rather than gossip on your breaks!

Answers to your questions. 1. I work part time, 20 hours (yeah right!) a week. I am expected to see twelve patients 2. I would say I average about 200 miles for three days work. We get something like a .25 point if you go over so many miles a day. I have not received a clear cut answer to that one. 3. I spend about one hour on each visit. 4.We are offered a 75 cent increase a hour if we meet our productivity expectation quarterly. 5.I spend about one hour at the end of the day on paperwork and phone calls, up to 3 hours if I had an admission/recert/roc. Yes I charge them for it. 6. We get time and a half on the weekends, no matter what. We get overtime only after working over 40 hours in a week. 7. We have specific people doing chart audits, which I like. I have learned a lot from my mistakes! 8. Typical case load for regular full time people- 25-30 visits a week. Admit and ROC are counted as two, recert as 1 1/2 9. We are all on computer now. Some nurses hate it , I love it. It reduces mistakes and med errors, I think. 10. No one is denied O.T. in our agency. If you are willing to work, they have it for you. Our company continues to work on what is considered fair productive expectations--as you said, we have a lot of meetings we are expected to go to, etc. I am also the go to nurse that they ask new nurses to go with, or students from the local colleges to go with. I don't get paid extra for this, but I think they are going to change my productivity expectations when I do this, since it takes so much time. Home care---you either love it, or hate it! Thank God I love it!

Medicare will not reimburse an agency for a "lab only" visit (so I have been told). So this visit is combined with a regular visit. If I were to just draw labs, or just do a PT/INR, I would make it a non-billable visit. We also do not bill medicare for blood collection supplies or tubes, along with not charging them for the long ride to and from a lab, so this PT/INR machine saves our agency money.

No where in motorcycle mama's post, do I see her "bashing" anyone. I see that she is venting her frustration about situations that she has come across. Unfortunately, as a community health nurse (home care nurse) you see some people possibly at their worst, or in horrible situations. When you see this over, and over, your thinking does slowly change. The difference between a good nurse, and a bad nurse, is how you treat your patient, even though you may disagree with their lifestyle, choices, etc. I also have a few patients (never mind what insurance they have), who try to squeeze anything they can out of me, including paper towels and hand cleanser.

Our company has just upgraded to the CoaguChek PT Test machine. This is much better than the older ones with the cuve (I think that is what those strips were called). You use a capillary tube, after you use a small lancet--thus needing much less blood. It is so much quicker than the old machines, I have less problems. I have been told that it is more accurate than venipuncture, because you are using whole blood, without as much interference, such as how the person draws it, how much time it takes to get to the lab, right down to how the lab performs their test. I love it, especially on the days where I would have to drive 40 minutes to the closest lab. Of course, you have to fight one another for the machine, even making deals with each other, just to get it.

I know this is an old post, but I finally found the word I was looking for-Lipodermatosclerosis- This color change is due to a buildup of hemosiderin in the interstitial tissue as the RBCs that have leaked into the tissue break down. The fibrin causes skin and subcutaneous tissue to thicken and become fibrotic. I would highly recommend Wound Care made Incredibly Easy from Lippincott Williams and Wilkins to any home care nurse-It has been very helpfull to me. Cherricka

Thank-you Karen, just what I was looking for. Cherricka

I would like to ask if anyone has a risk assessment tool to use for their Long Term Home Health Care patients, to reduce the likelihood of re-hospitalizations. Any input would be greatly appreciated. Thanks, Cherricka

I was 31 when I went back to school for my RN. Boy am I ever glad I did. I was just looking through my old pay stubs, and I have almost doubled my salary. I am a single Mom, and thought I could never do it, but with the help of my parents, the government and a wonderful neighbor and friend to help me with my son, I did it. I was surprised at how fast the time went! Good luck, and go for it!

I was an LPN before I became an RN for several years, and that included working as a charge nurse responsible for 40 patients at one time. When I went to go work at the hospital after getting my RN, I thought-hey what's 5 patients when I use to take care of 40? Needless to say, over one year, my 5 pts. turned into 10 in one day. I got the heck out of dodge. I love nursing, but almost once a week, I would come home crying, and it would take me two days to recover from a 12 hour shift. I don't regret working in a hospital, I needed it , and was lucky enough to work with wonderful nurses and preceptors. I now work in home care, and for a small cut in pay, I gained peace, knowledge, and the satisfaction of really being the nurse I always wanted to be. Yesterday, I got a call from my supervisor, telling me that a patient called her up to say what a great job I was doing in their home. Now you don't get to hear that often in the hospital! Hang in there. I won't kid you, and say it will get better. But after one year of med/surg (or tele) , most employers will hire you for different positions. By the way, here is my one hint to stay organized at the hospital. I use to carry a binder with me everywhere- Each page was dedicated to each patient (or you could use 1/2 page). In the right sided margin, I had 12 boxes, one for each hour. If something happend in that hour, or if I gave prn meds, emptied a foley, did some teaching (yeah right), I would jot it down, that way when I charted, it would make sense, and be chronological. It had Pt's name, room, Dr., Dx, tests, labs, last IV insertion and night report.

I used my local library, and checked out any NCLEX book they had with a CD. THe CD's come with "mini" explanations of the rational of the answers. It is the same format as the computerized NCLEX exam, so you get used to it. Practice, Practice Practice! When it comes down to it, you have to study the way you feel most comfortable. I wish I had time to look at all my text books, but I just didn't. (SIngle mom, working full time, blah ,blah, blah). I say the following as encouragement only-remember, you can always take the boards again. I promise you , that no one will know, or for that matter care. Your new employers will have no idea if you took them once or fifteen times. And here is another tidbit. They also don't care if you got all A's or all C's. All they care is that you have a valid licence! I was a 4.0 student, and got the same job as someone with a 2.0! Good luck-and remeber to breathe and eat before the exam!

When I took my Nclex exam, I only did the cd programs over and over for hours daily, even taking my computer to the beach and camping over the summer. I never looked at my nursing books. my computer at the test turned off after 75 questions, so I must have done very well. Good luck

Currently I am using a piece of luggage, and need a new nursing bag. Any suggestions before I do a random search on the internet? I need two outside pockets for soap and paper towels, and a section for my file and 10 x 9 inch computer. And then just a place for my "nursing tools". Thanks Cherricka

You are going to love it. I stated as an aide in a nursing home, this is much more laid back. Report to your casemanager anything unusual, such as open or red areas, increase in shortness of breath with activity, urine is now dark, cloudy or smells worse, or the patient is not going as much as they usually do. Report coughing, especially if they are coughing up mucous. Not eating as much as usual, loose stool, increase in depression, their color is off, they are gaining weight, or they have some swelling around the ankles (or anywhere),increase in pain ,etc. You are the eyes and ears! You get to spend time with, and get to know these patients, and will notice changes that we don't get to see, when we are only there one hour a week. Good luck! Cherricka

I work per hour. I would not do per visit, because I take too long, and don't want to have to rush. One of the reasons I stopped working at the hospital, was so I can teach patients how to care for themselves better, and that takes time. I work in Northeast New York. Hourly rates-$20/hr-$27.00/hr Time and a half for Saturday and Sunday, even if part time. Double pay for working on a holiday, with Holiday time off also. 48.5 / mile On call-$2.50/hr-Min. 2 hour pay if you go on a call, even if your there 15 minutes. Per diem rates No mileage Visit-weekday-$29, weekend-$34 Admit-$76 IV visit-$42 Pt not home- $11 Case management or Recert-$36 Hope this is helpful, Cherricka

"It is my PERSONAL OPINION that nurses who do not use local to start IVs (in a non-emergency situation) are lazy. Good nursing care is doing what is best for the patient, not what is easiest for you" Yoga- It isn't that nurses are lazy, it just may not be the policy! I would love to cause less pain, and make the patient more comfortable. I beg PCP's to order this, but they most always resist.

Gail- It turns out that this patient may have her PICC line pulled any way! I will find out on monday. I don't know what they were thinking by putting in a 3Fr. We can't do blood draws on anything smaller than a 3.8 Fr. So this poor thing has to endure another needle stick each week before chemo. She is also mentally retarded, and gets very upset with anything you do to her, the poor thing. I think they have seen such a decline in her since starting chemo, that they don't think it is worth it. (cancer is everywhere) Thanks for getting back to me.

Ok, here is my question, which of course I will find the answer quickly through work, but I thought another "new"IV nurse may need this information too. What do you suggest for the following. I have a new patient with a 3FR non-groshong picc line with a CLC 2000 cap (so we don't need heparin). I was not able to get a blood return,but it flushed easily. I called the center where she was suppose to have chemo the next day, to suggest that they may want to use Cath-Flo before her next treatment(I also told her PCP) She ended up in the hospital with something else, and did not make it to the chemo treatment. I called the discharge planner to see if they did anything about it, and to ask if they got positive blood return. She is getting back to me, but she told me that I shouldn't be concerned as long as it flushed easily. The lumen is so tiny (which she then told me that she keeps telling the doctors to put in bigger lines), that you won't always get a blood return, but that doesn't mean there is an clot. My IV supervisor believes that this patient should automatically receive cath-flo if there is no blood return. This supervisor is very smart, and I respect them, I just would like to know the options out there. My instinct is to document that it flushed easily, that the cancer treatment center and her pcp have been notified, etc. What would you all do to cover yourself leagally?

Ok, who had to fight over the flu vaccine's this year? We had to use a multi-vial for ours this year. Did you know they are only stable for 24 hours after you draw them up? I went into the office and grabbed what I could, and did them all in one day. A lot easier than trying to get them each morning, never knowing if there would be any more available that day, after you promised you would get everyone vaccinated!

I work with both CHHA patients , and Long Term Home Health Program patients (medicaid). For their spend-downs, I encourage them to use receipts from adult diapers/pads, vitamins, medication co-pays ($2-3 a pop), I think you can also count gas to travel to Dr appt's (don't quote me on that one!). Lotions, over the counter medications,anything that is health related, or can be ordered by the doctor as needed. Humidifiers, soap, etc. Better that they use the receipts to go towards spendown, rather than sending in their check to DSS every month, with nothing to show for it.(you know what I mean)

How about using EMLA (lidocaine/prilocaine) cream. I have a patient on kidney dialysis, and she puts in on her AV shunt before she leaves the house, to lessen the pain of accessing it. It works well with no extra needles.

I love Home Health Nursing. I am pretty new to it, about two years. I work part time, which turns out to be about 30 hrs/wk. I think one of the main purposes of this board, is to obtain information from other nurses who have "been there", and to vent to people who understand. So it may seem negative when you first look around, but aren't we lucky to have so many sympathetic people? The "paperwork" has greatly improved with computers. Admissions still stink, and take me forever. But that all comes with time, at least that is what I am told. Hopefully you have a supportive supervisor, and a supportive, open team to work with. That is what makes the big difference if Home Care works or not. Here is a hint for you-The local doctor's nurses will all become your new best friends. Send some donuts or pasta their way, and they will make sure all your requests for the doctor will be taken care of! Good luck!

http://skyscape.com/estore/SearchResults.aspx?saw=international+classification+of+Diseases Best $29 I have ever spent for my PDA. Worth every dime when you are doing an admission! Cherricka