TXRN44

As a small town home health nurse I am in the position where I know everyone and everyone and their uncle know me and my family so since I have been on Facebook a number of years I have found myself frequently involved in care for patients either on my Facebook friends list or their family. During that process I will have sweet patients and their family wanting to thank me, etc and I feel it to be a serious gray line regarding HIPAA. I explain to the patient that it is really not appropriate to mention me as their nurse or to try and take pictures of me (which has happened frequently with me not allowing) but it always happens. If I am tagged I will hide it, but other than shutting down Facebook all together I don't know how to stop it. Like I said, I have so many people on my facebook from my town that I would have to delete all of them pretty much. I enjoy facebook and do not involve work in my statuses so tell he how you have handled this when it comes up.

I am from Texas and also have a story similar to yours. I defaulted on $40,000 worth of student loans and was able to take the NCLEX. I did however get them out of default by having them refinanced at a much lower interest rate. I have been paying them off for years now. Its just a lesson learned. Expensive, but a lesson none the less. Good luck in your career.

I am having a hard time wrapping my mind around my patient's weight gain. 2 scales used. I have weighed myself to be sure the scales are correct and both scales are. I have seen this patient numerous times. I noticed 3+ on Friday to BLE and the Wed. before I saw this pt on Fri. he was 148. When I saw him Friday he was 164. Pt sent to MD and blood work done, no changes until evaluated by cardio. Called Saturday to check up, caregiver weighed him, he was 188. Pt assessed and the legs were still 3+. Same two scales. Same clothing, no shoes, only robe and boxers. It is boggling my mind. I am a nurse, I went through the training... I just cant understand how it is humanly, physically possible to gain FORTY pounds in 3 days! He is being treated appropriately I just need someone to do a little refresher course with me or something. He has been urinating frequently and not taking in a lot of fluid. WHERE is this weight coming from??? I am starting to wonder if it is the house floor, but then I am always the same weight on the scale.

I would like to ask you, how is it possible to see more than 7 patients a day on a regular SN visit? That is just bad nursing imo. How can you do a full assessment? How can you actively engage and teach your patient? It takes me almost an hour to do one regular visit and with BCBS they demand you do an hour visit and we have a few of those.

I work for a company that is transitioning from paper charting to computer charting. Before I would do my visit in roughly an hour, jotting down key items and filling in the Oasis key parts and then completing my narrative after seeing the patient. Now that we have computers, we are expected to finish the entire SOC or any visit for that matter in the home. Maybe its because I am new to the concept, but I find the computer charting in front of the patient very distracting. I feel as if they are watching me, I feel uneasy and there is no comforting flow to it. I feel as if I am putting them off while I type for 2.5 hours in front of them. Also I know that staying in a patient's home for 2-3 hours I am going to have to eventually pee and if you could see most of the places I visit, you would understand why I not only want to sit there for 3 hours, or pee there. I would like some info on what your company considers policy. Are you expected to be 100% complete IN THE HOME, or do they allow you to go out in the car and complete your documentation, or wherever for that matter. What is your experience with making the computer charting less impersonal.

I made the decision you did. I came from an extremely poor family and even working as a nurse extern through college, I still managed to get $58,000 in student loans. I am paying them. It is just one of those decisions that I made. They payment I make is about $350 a month as I took the LONG option because my interest on my student loans is 2% and I invest the money I would be paying extra on the student loans in my 401K and another investment that is double the return of paying them of faster. It is just another monthly payment to me. To be honest I make $29 an hour and the $350 a month doesn't stress me out. It hasn't been hard to make the payment and save quite a bit of money along the way. Live your life and do what works best for you :) If you love nursing, maybe think of a cheaper, ADN program and go back for MSN when you can pay cash?

Googled the "She-Wee"... LOL oh my. When you gotta go, you gotta go I guess.

I've been doing this for about a year now. I do rural home health and often drive 30 miles with no stores between towns to see my patients. Now my post void residual is >100 ml and my urologist says its a "nurse thing" and he sees it frequently with nurses who hold their bladder. No damage done yet, but I do have trouble completely emptying my bladder when I do get the chance to go because it is so full. He says if I don't start urinating more frequently that I will have problems later on. Anyone been through this mess?

In nearly every situation I encounter the children of the elderly patient are the ones told of the condition and not the patient. It maddens me.

I hear that A LOT from the children of elderly patients who have recently been diagnosed with whatever disease process.... Many, if not all of them are able to grasp the diagnosis and deserve to know. It is their right, however the Doctor will inevitably tell the children and they will run us nurses down and tell us "please don't tell mom, we just don't want her to know she has cancer" or whatever it may be. I even had a daughter tell me not to let her mother know that she has been diagnosed as a type 2 diabetic. To top it all off, some of the doctors kind of go along with it, leaving it up to the family members to decide what to tell the parent. I am a patient advocate and so of course my patient is my focus, but it is very hard with family dynamics. This in particular has been getting me lately. I know that it is a horrifying diagnosis to hear "cancer" at any age, but pretending that it doesn't exist in your elderly parent doesn't make it go away. How do you deal with family members who demand you not speak of diagnoses to the patient?

Thanks for the great advice. I have decided to take it a couple of classes at a time and stretch it out over the next couple years... I need the education hours anyways to renew my license next year.

Not sure where to post this so steer me in the right direction. I finished ADN school in May, I have a good paying job and I want to pursue my BSN however it is $4000 per semester for 2 semesters and I need to save for a house. I know that my earning potential will go up, but I am currently working in Home health at $24/hr and while that may not seem like much it is pretty good for around here, and all I have is my ADN, and there is no special treatment or pay raise for a BSN. I love home health and do not plan on going to the hospital, but I want my MSN eventually because I know it will be worth it and such an accomplishment. I want to save $20,000 for a down payment on a house, but if I get my BSN that is going to cost me $900 a month for a year which is a pretty good hunk of change, and I am not doing a loan. So this is just a "what would you do" question. Would you... Go ahead and go for the BSN then MSN and put off your dreams of a home for another 2 years (SO SICK OF BEING IN SCHOOL and ready to start seeing the fruits of my labor) or would you put off school a couple of years, save for your home since you have a job and are making decent money for your area on the degree you already have, focus on work and advancing in the company? Thanks for any advice!

Thank you, and I agree... I just waited so long, I am now 32 and feel so darn OLD lol. I know it is not a race, but I feel as if I am playing catch up on the ten years I let slide by without going to school. I started doing ADN pre-reqs 4 years ago, so all I have known is school, so I must be lost without it :) or a glutton for punishment.

I work at a home health company and I am a new grad (graduated in May, passed NCLEX in June, got my first job June 21st) and I am working full time 8-4 M-F, I have a 5 year old, a husband, a life, the whole nine yards.... I have all my pre-reqs and can get my BSN in two semesters from a university here but I will have to take a full load. 4 classes in fall, 5 in spring and one summer elective and graduate August 2014. I have been told by coworkers that I will not need a BSN for home health, but I do want to get it, I am just wondering if I should do it in 2 years rather than the one? It will cost me $4000 out of pocket for all the classes and books after my scholarship so I am trying to weigh my options. I would like to eventually get my MSN, but I am at a new job, trying to learn the ropes and I am afraid that adding a full load will kill me, but then I don't want to drag it out either. Its all online... has anyone done the RN-BSN in a similar situation and time period? Was it worth it?

$68,000.... What is sad, is that not a penny of it is from nursing! I got a crappy degree right out of high school, parents made too much money, went to school out of state, yada yada yada... Got a jobless degree and BAM, $68K after I consolidated at 2.5%... Whats funny is that I worked my way through nursing school and never borrowed a penny. Wish I'd known what a student loan really meant when I was 18-22 :) Now here I am paying $600/month for 10 years at 31 years old and a new nursing grad. Luckily I got a decent paying job and that is not a horrible chunk out of my paycheck, although I will not be able to buy a new car, etc. etc. and will have to make sacrifices smart people would not... but hey, hind sight is 20/20 right? No sense dwelling on the past. Keep your head up and write that check and make that money. Good luck to us all.