Cheez-It!

I'm curious about CareStar. I've read some other threads about it, but they turn into arguments about stuff I'm not really interested in. I'm curious about as an LPN, how nurses handle things like, billing, state, etc etc. State visits facilities every month, do they require interviews or something with you? What are the wages like? How do you handle your taxes and billing? How do you handle patients that have wounds, such as dressing? Are those supplied by the patient or Medicaid? Do you do things for the patients like pick up meds for them? Do you call the doctors against their wishes, or do you have to go by what they want? Can you bill for mileage? About how much time on average do you get to spend with your family? What happens if you're needed on certain days, and you're not available for one of those days? This is the kind we are both curious about. In general, what's it like to work in a day as a CareStar nurse? I can read until I turn blue in the face on the CareStar websites, but it doesn't really tell me what it's really like! My mother is an RN who has had multiple back surgeries. I was thinking this would be an awesome way for her to get back into the nursing field, and could help me out in the meantime. (I'm an LPN.) For her, I'm assuming not a lot of bending/stooping/twisting would be needed for her. I've read some about CareStar. My understanding is it's basically starting your own business. I don't want to bite if it's more than I can chew. I have 2 small children, a whiney husband (don't we all?), and my mother to help out. I was hoping I could stay at home a bit more than my current three 12hour nightshifts a week I have now. I'm just looking for some "real" information I guess. Oh, and what happened to the site that had all the consumers in your area? Do they no longer list those?

We had a new resident admitted with dx of MRDD and jump from 3rd floor window ... what's the ICD9 code for that?

i had posted this elsewhere: I had a resident that had BenGay PRN. She was requesting it so I smeared it on her back and a shoulder. I ripped my gloves off to help her back into bed. She said something about one of her knees may need some also. So i just gooped some on my hand, and smeared it on her knee. I did the usual wash hands, leave room, finish treatments, wash hands between residents. Later on that night I took a break. My eye was a little irritated and dry, so while rubbing, God love contacts, my contact popped out. Went to the treatment cart, grabbed some NS, and started cleaning my contact in my palm. Rinsed contact off between fingers, crammed contact into eye. OMG! I had the most severe pain in my entire life, including child birth! Needless to say, Bengay is a lil' harder to get off hands than thought, and I did my last medpass minus one contact and a red/puffy eye. Genius ... pure genius ...:smackingf

Yeah, kinda like when the administrator thought it was real funny when i let one of the residents sing on the intercom one afternoon too. She was singing the eygyptian themed song about the people in france don't wear any underpants ... I didn't know he was still upstairs *shrug* some crap about it being degrading or some crap. The resident started it! hehe :rotfl: hehe I don't care, the residents are happy and stay amused LOL

or my favorite, I'm not really a nuse, or i've never done this before, but i did sleep in a holiday inn last night. I've got some residents the hold fingers out as soon as they see me coming, I just tell them i'm here to add another hole ... We also do a lot of stupid dances and such to get the occassional reluctant shower done.

I work psych ....i worked nightshift, we had telemarketers calling BAD at ALL hours it seemed. I answered to a woman with a bad accent wanting to speak to one of our residents, who was slightly demented. (alzheimer's, schizo, psychosis etc etc) I tried to explain to the woman that it was a LTC facility and he wasn't capable of talking etc etc. She argued with me, and he just so happened to wander by the nurses station, SO, i handed him the phone. He went through a barrage of questions and apparently was answering all of them for her. Needless to say, I got reprimanded the next week I came into work. Some crap about a satellite company being very PO'd about coming all the way to our facility to find out a resident wanted a premium package. :rotfl: BTW, we keep all the full moon dates circled on every calendar in the facility. We stay prepared!

Hrmmm ... I concieved my current 19 week pregnancy after a Lynyrd Skynyrd/3 Doors Down concert ... How's that for rhythm? :rotfl:

you know, I'm 25. I worked with a male 50's y.o. nurse. Not only did he "obey" and conform to authority, he thought all of the younger nurses below him should bow to him. Which considering he has more years experience than I have been alive, I was always open to suggestions and always was respectful. But you're right, I never bowed to him. There were more than one occassion where i'd find pages in the communication book i had written come up missing. And, our DON seems to think we all should be working more, spending time with family less, and I totally saw myself in this:

If it's like the bottles we have at work, the drug itself is clear. We had a hospice pt that had it ordered, and the hospice nurse actually put a drop of food coloring in it so we could count it better. It beat holding a flashlight on the other side of the bottle trying to count. But, you also have to remember that's going to add another drop to your count.

Reading the little bit that I have, they'll still need LPN's. They can't do meds through any sort of tube, g/ng/etc, no inhalers, they can't split pills, no injections, they can not start a new order, can not touch peds, and it's repeated over and over, they can not touch class 2. I didn't actually read it anywhere, but it looks like they can't do any sort of PRN's either. Makes sense though. They wouldn't be trained to make that call. I'm not feeling too threatened because I work in a psych facility. It would probably be a bigger hassle to have a med aide considering 90% of our residents get narcs at all med passes, and a lot of them recieve PRN injections on almost a daily basis. It goes on to talk about an LPN may only delegate to an aide if the RN supervising the LPN can delegate to that aide. It does state the nurse has to delegate giving PRN's ... so i wouldn't feel to threatened. They are very limited in what they can do.

You need to check your state laws. Here in Ohio, as an LPN, I'm not allowed to so much as think about touching a central line. I'm not sure about being IV certified, since I'm not. But, one thing I learned in school, don't do it if you're not comfortable doing it.

Exaclty, I'm pregnant, and i feel stuck is the only reason i'm not leaving. I don't have enough time to build vacation time to take maternity leave anywhere else. I am the main source of income to my household, or else I would leave. But seeing as how this is bound to happen where ever i go, not to mention the fact that this is a small community, and i have no idea what she has done to my reputation. It's just bad to be threatened by someone that no longer works there. She actually called the VP of the corporation, not the DON. THAT'S the scary part. And he of course, not knowing anything about anything, wanted it investigated. SO... i'm beginning to hate nursing. Which is sad. I enjoy my job, i just hate the crap that comes with it.

Something that just happened to me here recent ... I got in report a couple of residents had temps. The nightshift nurse had given them tylenol. I went to assess the two, and one had a temp of 101 and the other 103. Both residents had lungs full. One had the lovely green snot crusted to the inside of her nose and hanging to her lap. So, i got the chest xrays ordered called the doc and family etc etc. Got antibiotics ordered and started from e-box. Got the results back right before the same nurse came in to relieve me. Both had infiltrates. Imagine that. She actually looked at me and said, "Well, I gave them some Tylenol, and I didn't want to wake Dr. X up."

Myself, LMAO ... total dumb@$$ attack here. I worked nightshift. I had one resident that had some PRN Ben-Gay. Per her request, I smeared the nasty crap all over her back and shoulders. She was happy, I was happy. I ripped off my gloves, and she said something about one of her knees. So, I jus squirted some more out on my hand, rubbed it on her knee, helped her back into bed, washed my hands well, went on about my business. I finished up the rest of my treatments for the night, washing my hands between each patient, etc etc. I went on to my lunch break. During lunch, a couple of the aides and i were smoking. Smoke was irritating my eye, so i started rubbing my eye. God love contacts, my contact popped out. So i grabbed some saline, my contact, and headed to the bathroom, cleaned the contact off in the palm of my hand, placed it on my index finger and crammed it back into my eye. Never in my life have i ever had anything more painful in my entire life including childbirth. Needless to say, I did my morning med pass minus one contact and an extremely red eye with a little puffiness on it. Last time I EVER put Ben-Gay on an ungloved hand. :selfbonk: :lol_hitti :doh: :smackingf

Any little bit of advice helps. Thank you. I just wish/wondered if there are any laws to help prevent this. The facts to all these stories would make it huge post, so i left almost all out. But, all were bogus allegations. Abuse case was d/t my mother reprimanding the aide for coming in late, which she was notorius for doing. Among a few other things she had done, not done. Left people wet at shift change etc. The second story about the pills was because of similar reasons. The aides had been reprimanded, and he was related to me and my mother. The reasoning behind me, i'm sure it has to do with the fact that she lost her job and has burnt her bridges because of similar reasons in all the local facilities. I'm related to the other two nurses, and i still work there. she feels my mother is the reason she lost her job, and it wasn't. She's the reason she lost her job and no other reason. So, now she feels she needs to take it out on me i suppose. We live in a small community, people know people. Word travels. I know where and why she has been fired. She indeed has had several incidences of abuse cases on her, so i guess she feels she's been wronged. I must admit, our facility, before having the corporation re-vamp, was a facility where the aides ran the building. We as nurses, couldn't make any reprimands because we had no one to back us up when they occurred. The nurses that tried, are now gone. This nurse is now afraid to say anything to any of the aides becuse i fear for my license. I'm about to go to the local Wal-Mart and apply for a job.

LMAO i love this. I used to feel this way. The first IM injection I EVER gave, was in my mommy's butt! LMAO BUT, whoever mentioned drawing Ativan up, yes, it's like drawing up pancake syrup! What I do, God only know's I'll get in trouble for this one way or another, but our residents get cocktails. I dilute the Ativan with some Haldol or the Cogention. Much easier to draw up that way. Just keep going, don't give up. I work a behavior facility. I give injections to sometimes, the same residents 3 and 4 times a day. Eventually it'll become second nature. Just go for it and don't second guess yourself. That's the worst thing you could do.

I had no idea where to stick this thread, so I stuck it here. Sorry if it needs to go elsewhere. Anyways, my mother, and an uncle, and I were all three working in the same facility. (I still do.) We have all been accused of one thing or another.(Only us, no other nurses in the building) Abuse, and passing meds without orders. All have already been investigated and found absurd. The abuse case was found false, and investiated by the facility on top of state. It was once again found false. Later on the attorney general was brought in. One particular aide in the story had written statements saying the accusation was false, and has said so in front of other staff members on several occassions. When the attorney general was in, she stated she was in the room and saw the whole incident happen and my mother was guilty. Knowing she had lied either to the facility or state one, she was "let go." I've been told she has been calling the facility on Sat. nights drunk and talking to staff. She was heard saying she was going to "bring it all out now." Monday, when i went to work, i was AGAIN questioned by a new DON passing meds without orders. This incident happened LAST YEAR! This is ridiculous. I still work in the facility, so now she's working on getting me in some sort of trouble and she no longer even works there and hasn't for months. I know the laws are placed to protect the residents. I know abuse needs to be reported and i have no qualms about that. I totally disagree with abuse and believe people that are found guilty of abuse should be punished to the full extent of the law. Especially in a behavior facility like ours. They're there for a reason. They can't help what happens to them, or their actions. My question is though, where do the laws to protect licensed professionals come in? Where is my protection from mad ex-employees? What can I do to protect myself? How can it be legal for someone who is obviously disgruntled to make accusations like this? I have never had any complaints made about me except this. I have never been wrote up or been corrected when it comes to the residents. Is it legal for her to do this? And if it is, how can i stop it? I'm pregnant, and have worked there for almost 2 years now. I don't want to leave the facility. I like it there and those residents know me, i don't want to abandon them because of her. What can I do?!

This one just happened last Monday. Keep in mind I work in a geriatric psych facility. Everyday, our activities hands each resident a one dollar bill to buy pop. One older femal resident I'm pretty close with asked me to help her to the restroom. I'm not busy so sure, why not. I help her to the bathroom, and low and behold, they had corn for supper yesterday. Wonderful. One XXL BM. So I'm helping her get cleaned up and notice something else in the toilet bowl. You guessed it, a lovely green one dollar bill floating amongst the logs of BM. Wonderful. Of course when she stands up, she sees it and is instantly in tears because he pop money is covered in corn chunks. Well, Nurse Sassy(she always calls me this because of a tank top I have, she never lets me forget it.) to the rescue. I got her cleaned up and back in her chair, held my breath and grabbed the bill. She was giggling in excitement. I folded my glove over and walked out into the hallway with her behind me. I handed the glove to house keeping and requested it be washed. Housekeeping almost made another BM in the middle of floor. This resident is now asked daily by half the staff if she can poop out a few fifties or atleast a few twenties. She gets the giggles everytime. And another one, from a few weeks ago... I was having a crappy day, WAY to much phone ringing. I had the psychiatrist in all ready and he had to see everyone. Everyone had 1000 orders a piece. So i'm working on my umpteenth million order and the other doc walks in for his weekly rounds. I promptly told him to get out. The phone's ringing off the hook. I've got charts piled up so high I can't see over the desk ... my hair I'm sure was frizzed out to the ends. He asked if he could help. Nauturally I said "Sure, just take care of the phone for me for justa couple of minutes so I can ge these last few orders done." So the phone rings two seconds later. Doc picks up phone, says, "Wal-Mart, can I help you?" ... My head hit the desk. If that didn't beat all, a few hours later, I answer the phone to a lady requesting the social services director. She says, "I tried this number earlier and someone said it was Wal-Mart!" I couldn't reply to her, I slammed her on hold and choked.

I work 7p-7a in a psych unit ... it's never a dull night. Last week, one of the residents come to the nurses' station, and started whispering about his hemorrhoids. He asked if i could let the short bald doc know he needed something for his hemorrhoids. I faxed our shourt bald medical director a quick note: "Dr. Q, "John" wants me to ask the short bald guy if he can have something for his hemorrhoids." A few hours later I got a fax in reply: "Tell "John" that hemorrhoid cream makes your hair fall out." I thought it best not to put this one in the residents chart. :roll

From Washington Court House, psych nurse and loving it =)

Currently, our guidlines for acceptance into our facility are that they must be able to "get around" by either w/c or ambulation or only x1 assist. Right now, most of our residents are high functioning Alzheimers/Demntia residents. Which is what assisted living was intended for. But, in order to please families, make money, etc etc, they just take whoever can walk, not thinking about the psych adjustments that may need adjusted/changed. I'm currently thinking of changing jobs. May have a job in a psych facility where I know these things do not happen. Job maybe harder, but anything to get out of that huge liability. Atleast until I finish school. It's really a shame. It's a great facility, and could be one of the best in the state as far as I'm concerned. But from where it's heading now ...

And to go to the opposite end :) I work in assisted living. I still pass meds, Accuchecks, vitals, med orders and the "normal" nursing duties. But my duties do differ a little. I am not allowed to do treatments. Assisted Living is unskilled. I do a lot of patient care like a CNA/STNA, which i enjoy. I handle setting and scheduling of appointments for residents, which requires close contact with the families. I inform doctors of changes in patient status, needs, etc. (families also) I do A LOT of paperwork, involving annual assessments, quartley assessments, referrals for home health agencies, hospice, physical therapy, or whatever service is needed. I do documenting and charting, by exception, which means only when necessary or something out of the ordinary happens. I also have a lot to do with the employees. I have to make sure their yearly paperwork is complete. I do everyone's yearly Tuberclosis testing, residents and employees. I do a lot of miscellaneous stuff on the weekends that no one can get to during the week. Things like, checking the med cart for re-orders, making sure the ATC rolls are loaded correctly and the correct dosages are loaded, check first aid supplies, and reload med boxes, check for outdated things here and there. I make sure the charts are comliant with state, and make sure the staff stays in compliance. I am a supervisor, so that fits in that category. All nurses have to delegate in one manner or antoher. If a resident is going to an appointment, I make arrangements to get them there, or I just take them myself. If they are going out over the weekend or something, I usually pack them, including their meds. I do much more than this, you do need to be more specific. And I work in a MUCH smaller facility than most people on this board, atleast I would think. So my job is much more laid back than most. No less busy, just more laid back. :chuckle

He DOES play games. He will tell you he's not "going to do it, just becuase I want him too." If you leave him to do it on his own, it doesn't get done. As far as the other residents, the already run when they see him coming. At meals he sits alone. Everyone refuses to sit with him. He has no "friends" in the facility like most residents do. I'm at a loss. I have no idea what to do with him. I have spoke to the administration and all they say is, "Teamwork." It takes teamwork." What does that have to do with anything? They're missing the whole point. What it comes down to is he's neglected. If my shift can't get him done D/T behavior, the next shift will try. As soon as he raises his voice, they leave, write in the book refuse, and that's it. He's an issue, liabilitly, and I just plain do not want him in the facility anymore. As far as becoming seriously ill, I doubt that also. But what about skin health, and his UTI's? I just recieved yet another order last night to do another UA. This makes the third UTI in the past 3 months. The man won't get up out of bed but for, on an average, I would venture to say five to six hours a day. The rest of the time he lays in bed. I see ulcers in someone's future .......

It's funny that someone said something about my hours getting cut. I went to a normal full time position of 32 hours down to 30 and once again i'm down to 28 hours a wk. Wonder what I did? :chuckle I document faithfully everything I do. I call every family member I can when any situation arise, even something stupid as PT not coming in for a resident. This resident's daughter is fully aware of the situation. She has tried to talk him into getting into the shower. She also knows that he's no longer appropriate for AL. She has also mentined taking him home to her state for more appropriate care. She knows it's time. It truly amazes me how horrible the AL facilities are. I personally believe they should be done away with. I took this job in the hopes that I could do "real" care. I hoped that I could sit with my residents and enjoy a cup of coffee with them, do a crossword puzzle, converse about the "old days," paint their nails or whatever they wanted to do. when I first started working there two years ago, I got to do this. It wasn't out of the ordinary for the aides to have nothing to do, so they spent time with the residents. I got to spend real, quality time, with these people. And now ... the corporation has decided to "flag" our facility. Meaning we're not bringing in the moolah. Their respons was to cut hours, mine and the aides, cut the food budget down, and overtime is allowed what so ever. If you have it, there better be a d*mn good reason, such as someone's dead or the building's on fire. I've had four residents die within hospice care, I've had residents with restraints, residents that can't stand without 2x assist, more fx'd hips and falls in this facility than any other two facilities combined ... Where does it end? They just don't care. They just seem to make exceptions for the ones they know that have the money and are willing to pay. Screw patient care and safety. I'm supposed to be super nurse, able to catch a falling resident in a single leap and bound, when the truth is, they shouldn't even be there. The real truth is, on some days, I don't even have time to look at some residents. I have to shove pills down their throats and run to the next. :angryfire I just recently had a resident fall and break her hip. She could hardly stand with x1 assist before the fx, and now they're talking about her plan of care when she comes back. (she's hopspice too) There's no way this woman will be able to qualify for assisted living, but because the family has money falling out of their ears, and because the family insists she doesn't go to LTC, she'll come back! Not to mention, their last name is known extremely well in this small town. And we, the poor staff, are going to have to deal with her. I've actually pulled this woman around behind my med cart (W/C) so I would know where she was and to make sure she wasn't trying to stand on her own. I've also put her in the nurses station with me, for hours at a time. Are they nuts or just plain dumb? AL was a good idea at the time, but the laws are so vague. I've actually started having panic attacks, and had to be treated for anxiety. This whole "situation" has totally turned me against nursing. I finally had enough and decided to go to back to school to get a bachelors in Technical Management, specifically for Computer Information Systems. I hope I can take my medical knowledge and combine it with my new computer knowledge and begin a new career. I just hope to get my degree, start anew, and then contact everyone I can and have this facility audited as much as I can. I'm going to do something about it, as much as I can without being fired. It's bull. Everyone says the residents in LTC have little care, try an AL facility.

In our facility, we've got the gel everywhere you look. I think it's great considering the type of work I do, there's not always a sink available/near. I still do the antibacterial soap after the using the bathroom (I'm hoping everyone is doing this anyways :chuckle ), coming back from break, personal care, etc. But while passing meds, it's a must. I've noticed the aides in our facility are using it a LOT more. Some have even bought their own small bottles to carry in their pockets. I like it