HisAlone

Wow, I just kind of got a shocker. I'm an LVN out here in California and would like to move to Maine after recently losing my husband. I've just gotten off the phone, was talking to a few perspective employers (My chosen vocation is home hospice). Everyone I've spoken to so far is lumping LPNs in with CNAs, with the duties and pay being in a similar ballpark. Out here in California we are NURSES and get paid almost as much as the RNs in Maine. I know the cost of living is much lower in Maine, but I'm really concerned with the lack of respect that I'm picking up on regarding LPNs. I worked my backside off to get my license and do most of what an RN does (with the exception of hanging meds) out here. Are LPNs really so low on the totem pole out there?

2 patients with MD private duty in the home.

After 25 years as a data communications engineer I decided to retire and go into nursing. So far after just 2 years I am horrified. Can't go back to engineering because everything changes so fast while you're out of the loop - it'd be like starting over in kindergarden. So I found myself stuck in a career that I was totally disgusted with. No problems AT ALL with patients, just the other nurses, management and staff. Then I learned three beautiful words: HOME HEALTHCARE NURSING I now spend my entire day with my lovely patients and pop into the office for maybe 1 hour a week to pick up supplies, drop off paperwork, etc. Tis a beauteous thang! Also, I HIGHLY recommend "The Gentle Art of Verbal Self-Defense" series of books written by Suzette Haden Elgin. Excellent techniques on how to avoid and diffuse verbal abuse in the workplace. A MUST for anyone going into nursing.

I just accepted a position in Oncology with a $5000 sign-on bonus. I get $2500 after the first month, the balance after 6 months. The committment is 2 years - if you leave before the 2 year mark you only have to pay back the prorated balance. It's a great hospital with good benefits and this unit has an excellent reputation for employee satisfaction and retention.

Hi Josh, I'm just up north from you in the Ventura area. You can go to http://www.bvnpt.ca.gov/provlist.htm to find lists of those who are authorized by the State Board to provide IV Therapy and Blood Withdrawal. Some can only offer IV, others can offer both. There are lots of places in the LA area. I went ahead and got both and am really glad I did. IV cert usually means at least $1-2 more per hour to start. The class I took also did a good job of deepening my understanding of a lot of fundamental issues that are really important in nursing (i.e. F&E and acid-base imbalances, fluid types, TPN, IV complications, etc.) I can't imagine trying to work as a nurse without being absolutely solid in these areas. Starting pay ranges up here vary from $15.00 to $18.00/hr for days, higher for night shifts. Some facilities have sign-on bonuses: my hospital pays $3,000 for days, $5,000 for nights. Surprisingly, the non-union shop pays more than the union shops in my county. This info is specific to acute hospitals - I'm not sure what can be expected at area LTCs. Most of the home care and temp agencies that I've spoken to want you to have at least a year on the floor before they'll hire you. I'd have to agree with them on that issue. It's really important to have the experience on the floor putting you through your paces on skills before going into a field that requires a high degree of independence. Most home care agencies will not allow LVNs to be case managers, so you generally just make runs for the RNs. But you are still treated as a valuable member of the interdisciplinary team. As far as duties, we do most of what is considered bedside care. We can hang IV fluids (including blood) with nutrients, vitamins and electrolyes - but no meds (unless you are in a hemodialysis, pheresis or blood bank setting). We cannot do IV pushes. The hospital you work for usually has its own limitations (i.e. LVNs can hang no more than 20 mEq of KCL in our facility). Of course, we work under the supervision of RNs, so the RN will also have her own idea of what you can or cannot do - which is fair because it's her licence on the line. Each hospital has its own policy regarding the use of LVNs. One hospital uses LVNs in ER, Postpartm (Mother-Baby), and even NICU. Other hospitals use them only on medsurg floors and geriatric units. My hospital uses LVNs in both Telemetry, DOU, and Oncology. Most hositals will not hire LVNs in areas of extreme acuity like ICU or PACU. You'll see alot of variety in this area, so if you have a particular area of interest you have to shop around. Up here, I'm actually seeing a trend of MORE LVNs, as opposed to cutting back on them. I wouldn't recommend a facility that strictly limits the duties and areas of opportunities for LVNs because that kind of implies an institutional attitude that may not be positive and may even lead to an eventual scale-back. We have one hospital that only uses LVNs for their auxillary facility that serves LTCs, not in their main Regional facility, for example. Make sure you talk to as many people as you can - some facilities (and RNs) LOVE LVNs, some don't. I would definitely recommend that you take your time and chose carefully - your first position is extremely important in terms of building your confidence level and setting the tone of your career. Once you get in, work your buns off to prove your worth to the RNs on your unit. Do everything you can to make your RN's life easier. I've seen a few LVNs get cocky with the RNs and they paid for it. I think you may be disappointed at the differences between the military and the civilian world. Out here we are extremely valuable, but we are not RNs, and need to keep BOTH of these points in mind. You have to be both assertive and very skilled at diplomacy - at least until you have proven yourself (which takes time). Start getting your prereqs done so you can continue on to become an RN at some point in the future. That's not to say LVN isn't a great career choice, I just can't imagine why anyone would not keep going on up the ladder. It also shows your employer that you have initiative. Whether you are an RN or an LVN, the education never ends, so why not direct it toward a higher pay rate and more opportunity? Good luck! Yer gonna LUV it!

I see this all the time in hospice. We have a small facility for those patients who cannot be cared for in the home. When we admit them we automatically get out the supplies for wound care and fecal impaction. Nearly every patient we take in requires this attention. These patients are coming in from both home and LTC. Some of the worst offenders have been the Board and Care residential facilities. A lot of these patients do not even qualify for Board and Care (able to independently take meds, B&B, ambulate, etc). Nearly all of them have S4 decubiti with extensive undermining and about 200 lbs of impacted stool (exaggeration, but you get the point). The staff in most these B&Cs are unlicensed, uncertified and incompetent. I really don't understand why they are permitted to exist.

Wow, it sounds like my nursing program was BOOT CAMP compared to some. We hit the floor at 0545 to gather info on Dx, H&P, recent orders, med lists, labs and diagnostics for the last three days, etc from the patient charts. We had to have manual vitals and a quick assessment done and written up to give to the RNs at report. We did total patient care throughout the shift on from 1-5 patients: head-to-toe assessment, all ADLs and linen changes, all meds and treatments, all documentation, etc. We had to do hand written med cards from Davis on every med and report on each to the instructor as we were prepping them before giving them. At the end of the shift we had to provide the assigned RN with a written report that included VS and pain assessment, I&O, diet consumed, BMs, Meds held, any significant assessment findings, etc. (Of course we had to document throughout the shift and report anything significant - in writing - ASAP). Each morning we had to hand in a 5 page report on the Dx and patient care performed (from the previous day) in charting format, a report on the results of all the labs and Dx, a list of 3 nursing dx in each of 5 patient categories and full care plans on the top three. When we left clinical we didn't go home - we went to four hours of lecture and testing. By the time we graduated we were also certified for blood withdrawal and IV therapy. And this was an LVN program! The biggest problem I had with the floor nurses was having to continuously apologize profusely for our instructor. We took a lot of grief over that. She was a real drill sergeant.

Oh! OK, the hyperlinks are created automatically. Kewl.

I can't seem to figure the hyperlinks out, but here are the links to the bills to ammend: Michigan Senate Bill 0609 http://www.legislature.mi.gov/mileg.asp?page=getObject&objName=2003-SB-0609 REFERRED TO COMMITTEE ON JUDICIARY 7/3/2003 Michigan House Bill 4850 http://www.legislature.mi.gov/mileg.asp?page=getObject&objName=2003-HB-4850 REFERRED TO COMMITTEE ON JUDICIARY 6/17/2003

What an emotional roller coaster! And how can anyone wonder why? I think we all have to remember that for many of us this case was not in our own personal spotlights until recently, but for these two families it has been going on for 15 years. None of us can wear those shoes. But I can certainly imagine – which is what we are all doing right now. And it is my imagination that is driving my perspective on this whole thing. I understand the parent's desperate and frantic behavior perfectly. This is their baby girl for crying out loud. Before the malpractice suit there were plans in place and agreed upon. We're going to fix up the house for her, all move in together and take care of her. The parents spent a significant amount of whatever money they had preparing the house with the understanding that Teri's young husband would pitch in to defray those costs once the award was received. I can imagine their surprise when after the checks arrived Michael decided to trash all those plans, stop all of Teri’s rehab, warehouse her in a nursing home and start court proceedings to end her life. Michael wanted his sexy vibrant wife back to the way she was before the “accident”, the parents wanted their baby whether she was sexy or not – her smiles were enough for them. 15 long years tick by with Michael becoming more determined to win – watching the money that was awarded for the purpose of Teri’s rehab being frittered away on lawyer fees. In the meantime their daughter was just lying there in a nursing home with nothing but the most basic care measures, her body folding in on itself with contractures because he wouldn’t allow ROM or handrolls, while he moves on to sexy and vibrant girlfriends and babies. Babies that are not their grandbabies. Year after year of the court turning a deaf ear to their pleas to save their daughter’s life. The husband wasn’t even fulfilling his legal requirements for filing annual guardianship reports – according to Florida state law he should have been cited with contempt of court and had his authority revoked long ago. The Schiavos weren’t meddling where they didn’t belong, they had legal grounds to challenge Michael’s guardianship based on Florida law. But the judge who was responsible for auditing these reports all those years failed to do so and refused to revoke guardianship rights when this issue was brought up in court. He is also on record as fighting to having those records made unavailable to the public. I still haven’t heard why an exception was made on that issue in this case. Whoever it was that posted the police report that was filed that night failed to mention that despite the quotes that the poster highlighted, it was routed to homicide NOT to File. I’m still waiting to hear what homicide did with it. Multiple fractures at varying degrees of healing are a CLASSIC sign of abuse. This is the kind of thing that WE would report immediately. Why wasn’t it routed to DPS as soon as the radiologist read it? When this bone scan became available, which wasn’t until a year after the original police report was filed, and was taken to court why was it deemed insignificant? When the Schiavos finally gained access to it they took it to the police and were turned away based solely on the statute of limitation on spousal abuse. I’m still waiting for answers to all of this. I’m tired of people quibbling about today’s definition du jour of PVS because the judge in this case invented his own definition instead of using the definitions already given by Florida law and the Supreme Court. It wasn’t his job to expand the criteria in order to arrive at the judgement he deemed appropriate; it was his job to use the definitions existing in state law to guide his rulings. The original definitions are still in place and have never been changed and yet this case was decided on this judge’s own definition. At the time he first started pursuing this in court Michael had plenty of financial incentive, but after 15 years of litigation the old well has been dried up by legal expenses, but he can’t back down now, especially with so many eyes watching, questioning his motives. I imagine he IS furious. I think it was Roland that mentioned in a post about the smirk. I want to slap this husband through the TV screen every time I see him. This is about WINNING for him. And his attorney is constantly filling his ears with all of his talk. Felos’s book reads like something written by Jim Jones – cultish to the bone. I want to run up and take a shower every time I hear him making one of his little speeches. Along with my own personal memories of a number of absolutely PRECIOUS patients that I have cared for in a similar condition, these are the kinds of things running through MY imagination, fueling my emotions, and informing my opinion. How can anyone possibly think that anyone in either of these families could simply set aside their differences? And how can anyone wonder why emotions are running so high out here in the public? I’ll admit it right now. I’m FURIOUS about this whole thing. There are way too many things that stink in this thing. I am still waiting for a lot of concrete answers and no one else’s opinion on this whole thing matters a whit to me. (Stomps foot, sticks tongue out, and says “so, there!” :-)

OK, so it wasn't the parents writing the book...it was their lawyer! Sorry. The book to which I was referring was Litigation as Spiritual Practice written in 2000 by George Felos, Michael Schiavo's attorney.

God rest her sweet soul. I just have this huge lump in my throat thinking that over the weeks and months to come, all of the unsavory details of this whole episode are going to come out bit by bit and shed light on all of the procedural irregularities and conflicts of interest that were involved in this fiasco. There are just too many passionately committed people involved at this point to think for a minute that it is a closed book. I've been reading excerpts from Felos's book and have already started hearing about connections between him and various associates of the court being traced back to this hospice. What if, at the end of this all, we learn that the whole thing was orchestrated by a euthanasia movement? What do we say to Teri's parents? Ooops? Sorry?

Loss of feeling in LLE s/t salami strapped to inner thigh and pants too tight to get off. Tx: cut pants off and unstrapped salami.

I'm confused. Way back in like post #21 or so someone was kind enough to post a link to this bill. So I went up and read it. Sec. 11. (b) A health care provider shall not assert an objection to providing or participating in a health care service based on the classification of a patient or group of patients protected under the Elliot-Lorificen civil rights act, 1976 PA 453, MCL 37.2101 to 37.2804, or based on a disease or other medical condition. So then I went and looked at the Elliot-Larson Act, which is the standard catch-all Act referenced in bills to ensure civil rights: MICHIGAN ELLIOTT-LorificeN CIVIL RIGHTS ACT Act 453 of 1976 AN ACT to define civil rights; to prohibit discriminatory practices, policies, and customs in the exercise of those rights based upon religion, race, color, national origin, age, sex, height, weight, familial status, or marital status; And then I took a peek at pending bills: Michigan Senate Bill 0609, House Bill 4850 (Passage Pending) Civil rights; general discrimination; disability, sexual orientation, and gender identity or expression; include as categories protected under the Elliott-Lorificen civil rights act. So why is this bill being characterized as being aimed at the homosexual community? Or any other people group? The only references made to specific issues that I read was to abortion and the morning-after pill. The bill came about after at least one nurse that I am aware of that was fired for refusing to administer the morning-after pill. The bill takes great care to stipulate that the conscientious objectors must give ample advanced warning of their objections and that patients be protected in emergency situations. It also protects employers in that it defines specific job areas where potentially objectionable duties constitute a majority of work responsibilities, implying that those jobs will be classified as unsuitable for conscious objectors. OF COURSE Christian Groups lobbied for this bill - to protect Christian healthcare workers from being fired - NOT to advance an agenda for withholding treatment from ANY people group. To suggest otherwise is simply being provocative. Who else should have lobbied for it? Who else WOULD have lobbied for it? Disability Rights advocates lobby for bills to protect the disabled. Homosexual Rights advocates lobby for bills to protect the homosexual community. Etc. That is how the system works to protect us all.

I personally found that most hospice organizations (and home health agencies) prefer that you have at least a year on the floor to get you up to speed on your skills. I would recommend telemetry or oncology but I think medsurg would be acceptable as well.