Kaisu

I got a phone call at 1:15 this morning from ****** County Jail. My daughter has been arrested for possession of meth amphetamine. I am devastated. I live 2000 miles away on the other end of the country. We graduated nursing school together and she had been working as an RN in a SNF. I had my suspicions, but it is not only the user that is in the grips of denial. My question - Is there a process whereby she can retain her license? I know she needs rehab, counselling, etc to recover from this horrible horrible disease. I would imagine she should get a lawyer when she notifies the Board. I am relatively certain that she must notify the board. Can you give me any indication as to what sort of mountain she must climb, besides recovery/abstinence, to salvage her life. Thank you in advance for your assistance.

Did the patient have a living will? Who is the POA?

Fall assessment is a critical component of the admission. You can use timed up and go (Tug), The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) or any one of many standard stratified screening tools. I would not do an admission without one.

I personally went from home health to hospice. Please do not refer to SNF nurses as drug monkeys. I know intelligent, excellent nurses providing care for SNF patients. They are specialists in their areas and deserve tremendous respect and more support than they get.

We are not attorneys... to find out if you have a legal case you have to ask a lawyer.

I know it doesn't feel like that now, but this is a good thing that has happened to you. A company that complains that you have made too many visits is a red flag. As a professional, we make the visits the patient needs. It's hard to look for another job when you already have one, despite there being problems. It reminds of the story of the frog in a pan of hot water. If you put one in when the water is hot, it jumps out. Put it in when the water is cool and slowly turn up the heat and it boils to death. Working for an agency that supports their staff is a wonderful thing, and in the work we do, crucial to us. I see great success and happiness in your future. This agency will get what karma has coming to them. Good luck.

Bless you for being there for your grandmother. I know how truly difficult that can be and you are making wonderful decisions for her. Being with her, talking to her and caring for her will make processing the grief after she moves on so much better. You will have moments with her that you will treasure forever.

Do you not have case conference with your peers to help you decide that?

Not for my agency. I got paid by the hour and driving time was included.

The agency I worked for started everyone on an hourly rate because they wanted quality over quantity, especially when the employee was new. Within months, employees were offered a PPV option. I think that was very fair. Productivity was very rarely emphasized or even brought up for that matter.

Sounds like the appropriate response to an abusive employer....

I got paid by the hour, so documentation time was paid for. I was given the option of going to PPV, and would have made a lot more money, but I transitioned into hospice where pay by the hour is standard. Most of the nurses are salaried, but I prefer hourly because that way I don't feel guilty saying no when I am full and I don't feel bad when I have heavy weeks because I know my bank account will fatten.

Gotta say - Love your attitude

I think you made an error in tact. When they said as often as they like to, that is where I would have left it. It's subtle and not a huge error. Learn from it.

Way too many points. You are a valuable employee. Say NO.

You are absolutely correct. You are held to RN standards when looking at that patient in front of you. If something is wrong, and you miss it because you did not do the assessment, how well do you think saying "The LPN didn't mention it" will go. You are responsible for the actions (and inactions) of your team. The lack of support from your employer is a huge problem. It is your clinical judgement that is expected - otherwise, why bother with an RN supervisory at all? Why does the employer think RN supervisories are mandated? Run girl - run.

I managed 24 with 3 LPNs. It was a temporary situation (lasted about 2 months) while new staff were recruited and onboarded. RN case manager mandated to visit Q 2 weeks for the supervisory. Obviously, new admissions, transition patients, uncontrolled symptoms, etc. required more frequent in person assessments and adjustments to medications and plan of care. That supervisory visit required a total assessment and I was prepared to spend a lot of time in the home. I had to check everything for myself. The LPNs were great nurses, but, there are responsibilities beyond LPN scope. Great communication was key. Not withstanding, some things fell through the cracks. I would not recommend it long term. I was exhausted, my team was exhausted and I am glad it is over.

Thank you so much. I appreciate the response.

Zippy 83 - Off topic, but I am curious. What three software programs do you use and which one do you like the best.. and why? If you don't mind answering.

It is a difficult job. I've been doing it for two years and I have caught myself wondering if the constant contending with death is healthy for me emotionally. I love the job. I love my patients, but there is a part of me that wonders how far I have traveled from most people - who do not really consider death until they are forced to. Am I getting to the point where the only real connections I have are with other hospice nurses? Food for thought. Thank you for a beautifully written article.

This is BS. 12 points a day is ridiculous. Our expectation is for 6. You are doing the work of two.

I'm lucky. I love to drive. The idea of being stuck in a facility or an office for even half a day makes me itchy. LOL

I like the facility patients. With the demographics in the area I work in, patient safety, adequate caregivers are a constant headache. In the facilities, I know their meds are managed correctly and patients are safe. I enjoy the team work and collaboration with the facility staff and generally, can manage patient care without worrying that the caregiver will fall over dead from strain and their own health problems before my patient does.

Home health PPV can be very lucrative. In the beginning, when it takes you 3 hours to document an OASIS admission, it is not practical. A good agency would give you an hourly rate as you learn the ropes, then allow you to transition to PPV when you are proficient. At 4 months in, I would have made substantially more on a PPV than hourly, but I was moving into Hospice and thus did not make the switch. One of our home health nurses who is extremely good at her job makes over 6 figures on PPV.

It sounds like you voted with your feet. That was an unacceptable arrangement. Good for you for leaving.