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Patient and Nursing advocate offering advice and support to Allnurses nursing community.


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  1. PA has similar regulation: PDMP Prescriber Requirements
  2. ANA is urging all nurses to contact their Senators to co-sponsor and support Title VIII nursing education and workforce funding reauthorization. ANA is currently urging lawmakers to suppot the bipartisan Title VIII Nursing Workforce Reauthorization Act, which would reauthorize nursing workforce development programs through fiscal year 2021. Title VIII provides the largest source of federal funding for nursing education. These programs are invaluable to institutions that educate registered nurses for practice in rural and medically underserved communities. The House has already approved this legislation: H.R. 728: Title VIII Nursing Workforce Reauthorization Act of 2019 Nursing Workforce Development has more info re legislation Easy to complete letter available at ANA's Action center: Tell your Senators: Support Nursing Education
  3. NRSKarenRN

    Medical billing and coding for NPs

    See Carolyn's website publication section for: Billing and Coding Nurse Practitioner Services in the Acute Care Setting Safe, Smart Billing and Coding: Evaluation and management. (2017) Medscape articles: Legal and Professional Issues for Nurses I'm Being Audited by CMS--Should I Worry? 'Incident-to' Billing Explained: Who Uses It, When, and Why? A nurse practitioner asks for a tutorial on Medicare's incident-to billing rules, wondering whether they apply to other insurers as well.
  4. Medscape Nurses , Legal and Professional Issues for Nurses Carolyn Buppert, MSN, JD January 29, 2019 How Much Should a Collaborating Physician Be Paid?
  5. Found at Chicago Tribune, Southtown news Great article with multiple examples how Certified School Nurses saved lives of students, yet due to budget being replaced by health aides, while students increasingly having serious medical conditions needing RN assessment and intervention. Karen So much more than Band-Aids: Youth health issues increasing as the average Illinois school nurse serves 2,900 students
  6. NRSKarenRN

    Medical billing and coding for NPs

    Carolyn Buppert MSN, JD is a health care attorney and author who has written extensively on this topic for nurse.com, Medscape along with her private practice.-- visit her website for articles and books. Billing Physician Services Provided by NPs in Specialists’ Offices, Hospitals, Nursing Homes, Homes and Hospice (2017) provides the complicated Medicare rules on billing for NP services as well as advice on dealing with private payers. Cost $25.00.
  7. Another article found in my internet wanderings that I thought would be helpful, especially for new NP's. Karen Calculating Your Worth: Understanding Productivity and Value J Adv Pract Oncol. 2014 Mar-Apr; 5(2): 128–133. Published online 2014 Mar 1.
  8. Found this info during my internet wanderings today; posting as have seen previous requests regarding controlled substance prescribing requirements in varying states. Karen DEA: Mid-Level Practitioners Authorization by State
  9. NRSKarenRN

    Where to start?

    Consider contacting The American Association of Nurse Attorneys (TAANA). Most lawyers advise to not discuss with others or post any further information to avoid discovery by other lawyers. Best wishes in getting this resolved.
  10. Medicare For All | National Nurses United
  11. NRSKarenRN

    What do you use to keep client schedules organized?

    I used weekly excel spreadsheet to manage my caseload. Plotted visits for week using 7 day sections Could pencil in doctor visits to avoid visit that day, had column for Visit #/ visits authorized; another for recert date; foley/trach change date, labs etc., need to offload client to prn staff to accept admit. Even with computerized scheduling, current program only allows you to see patients assigned for that day, not entire caseload if another staff seeing client, so still used Excel form.
  12. NRSKarenRN

    First job home health RN advice

    Unpredictable schedules is hallmark of home health, especially in a small agency when you are no case managing -- happened to me as I started in small start-up agency. Eventually, I transitioned to agency with 2000+ patient census and had better control over my schedule; still patients cancelled, had doctors appointments,were hospitalized or just MIA --unable to be found. I worked 9A-6PM after getting kids to school. When I covered for nurses who were off, I would get 8 patients scheduled for visits that day at 9AM and sometimes would spend over 1 1/2hr trying to contact clients often to wind up with just 2 accepting visits, then would get additional clients to attempt contact. THEN, be out in the field at 4PM, getting call from Manager to pick up 2 clients 45 minutes away! So you have to set limits with Manager for what you can do in one day. 30 yrs later, still love Home Health!
  13. NRSKarenRN

    LPN/LVN asked to be a preschool teacher to patient

    Wow... sounds like you provided much skilled nursing care for this pediatric client so his medical condition improved -off vent, oral feedings, full ambulatory -- great work. So now the goals have changed to focus on clients cognitive and physical development-- quite appropriate for nursing care in client with developmental delays IN ADDITION to them receiving PT/OT via early intervention program if not yet able to attend school. You still would be assessing for respiratory+ feeding issues, medical complications but main focus has shifted. I cared for 19yo client vent dependent@night/sleeping, had severe vision issues, wheelchair bound but our main focus was to developmentally improve their skills. I worked days/evening shift while mom worked. Built into daily schedule time with computerized vision screen to improve reading, participate/encourage them in making crafts so they could transition to attending adult workshop, instructing/observing them to make own lunch to improve hand dexterity + proper nutrition, transferring them to wheelchair for me pushing them for stroll around block to get sunlight/vitamin D as lived in basement room while encouraging them to interact with neighbors. All this was in addition to RN skilled assessment, trach + vent care, incontinence mgmt and medication administration. It was one of the most fullfulling home care assignments to see this client become slightly more independent over 2 years I was involved with them, transitioning to adult services at age 21. Maybe you can rethink this type request going forward as pediatric clients medical issues resolve and focus changes to cognitive/developmental growth.
  14. NRSKarenRN

    Are O2 sats a vital sign?

    Hpme Health: Pulse ox done as part of standing orders for vital signs Q visit with pulse oximeter provided by agency.
  15. NRSKarenRN

    National Standard Productivity

    There are various compensation models and productivity standards based on type of agency: profit, non-profit, urban, suburban, rural; some have mileage adjustments. Periodically state Home Health Association meetings will query agencies re productivity standards (Urban vs rural agency) and provide information to members. Sharing info between local agency's can be viewed as violating federal antitrust regulations so called wage-fixing agreements. From previous posts allnurses members 5-6/day appears average- that was my average with 35 patient caseload.. Compensation Models in Home Health 2014: Fazzi State of the Industry Report- Fazzi Associates What are the Industry standards regarding productivity? see page 21