KateRN1

Hint: When you stop thinking of nursing in terms of tasks performed, you will have a much better understanding of the differences in scope of practice.

Check with your state's home care association as each state has different rules.

1. Do NOT talk to your supervisor first. 2. Contact the Employee Assistance Program and request an immediate evaluation by a psychiatrist. 3. File a work comp claim if you haven't done so already, contact HR or your employee handbook for where to go. 4. Then talk to your supervisor. I cannot give our specific legal or medical advice per the TOS of this forum, but in most cases, this is a work-related injury and should be treated as such, just as any other physical injury would be treated. Depending on your state laws, you are likely entitled to treatment and time off through your work comp policy. If you have your own malpractice insurance, you may also need to let them know and may be able to obtain representation through that policy. If you don't have your own, please research available policies and make that investment. 5. If nothing comes through for you via the above, you are still entitled to FMLA leave, although it is not paid. PM me directly if you need to talk. I haven't been through it myself, thank heaven, but have helped others in similar situations.

That's like asking "how long is a piece of string." Not all software programs are created equally and what one does well, another may not. Sorry, I just can't answer your poll question the way it is written.

I volunteer at a free clinic at the mosque that serves indigent and uninsured people. I adore it and really feel like I've made a difference. I don't think it's helped me find a job, but it has helped me to keep my skills up and network while unemployed, plus helped keep my self-esteem up and keep me out of full-on depression. I've always wanted to give back to my community. I wish I could do more but finances are not such that I can donate anything other than my time and talents.

I use disposable thermometers and a Littman stethoscope. I see no need for an electronic steth unless you have some serious hearing problems. I've had every manner of thermometers known to man and I like the disposables. No germ transfer, no batteries to replace, no probe covers to run out of, and they work.

Definitely much easier on the body. I don't want to get into my physical issues on a public forum, but that's one of the reasons that I stick with home health--that and I love it!

Wow, there are so many reasons that a clinical background is helpful for a marketer. First, just understanding how nursing works is a big step. Being able to talk to the nurses at any facility or doctor's office in their own language and be able to understand and be understood is a huge help. In most states, an LPN can take telephone orders, which cuts down on the number of phone calls that need to be made to facilitate the referral and to coordinate care with other agencies, such as pharmacies for IV cases. You wouldn't have to take a clinical person with you for presentations to answer clinical questions because you'd have the knowledge. In every home care agency I've worked at, the marketers with a clinical background understood the business and generated more and better referrals than those without a clinical education. I think it would do your agency a world of good to have a marketer who is also a nurse. You could even do visits for extra money and/or to follow up on patients for your referral sources. I would love to see it a requirement that marketers have a clinical background, it definitely makes a huge difference in my opinion.

And Kinnser is absolutely tedious in terms of documentation, which does not help with your time management. Part of being new to home health is learning to be independent with what you're doing. Coming from a facility, you're used to having someone immediately accessible for questions, concerns, or to confirm your assessment. As a home health nurse, you will need to learn to function without that immediate gratification, unless it's really important to the immediate care of your patient. You will need to learn when and why to call your supervisor, the physician, the patient's family, etc. It takes time and experience. Keep asking for feedback and try not to get upset when people tell you that you need to be more independent. You'll get there.

First, what kind of agency is this? If this is a Medicare agency and you are doing Medicare visits, then the pay is way too low, no matter where you are. Plus, you should be doing more than blood draws as phlebotomy is not a covered skill for Medicare visits. If these are insurance visits that only require a quick assessment and a lab draw, then $20 is probably all you're going to find anywhere. You do not have to accept visits that are outside of the distance you're willing to drive. And you can claim mileage on your taxes, be sure to keep a log. I'm not trying to be mean, but the idea that you didn't know to check the expiration date on the blood tube is a good indication that you are not ready to be a home health nurse due to lack of experience. (And they need to have a better handle on their supplies. Whoever does their stock should be removing expired tubes before the nurses can get them.) Please keep looking for a job that will provide you with a good foundation for future practice, you deserve it.

Be aware that Gentiva is a national company which is under investigation for Medicare fraud. They have already paid a large amount in fines.

I think I managed to get it sent out to everyone who requested. It's hit and miss how often I make it to AN due to work schedule, kids, and general mood, so feel free to email me with questions. Email address is posted earlier in the thread.

Be very careful. Staffing agencies rarely hire new grads as the agencies generally don't provide any type of orientation or skills training. Generally, they only hire experienced nurses with verifiable skills with at least a year of experience in any speciality area (like Hospice). Please discuss with them what kind of orientation you will receive, how your skills will be verified, what sort of ongoing support you will have, etc. Please be sure that you will get a lot of orientation, including ride-along visits with other nurses, help with documentation, and that you will have a nurse support person at the hospice agency as well as at the staffing agency. You will need to educate yourself in all matters hospice and be very careful. If a hospice agency is going through a staffing agency and willing to accept a new grad, either they don't know you're a new grad or there's some reason that they can't get experienced nurses.

It was a long time ago, but I went through nursing school (ASN program) during my daughter's preschool years. I was a single mom, no family nearby to help, only a couple of really good friends who babysat for free and a boyfriend who was a great cook. I was broke to the max all the time, only worked weekends as a CNA in the hospital and worked my tail off the summer between 1st and 2nd year. I learned to take whatever help was offered, spend time with my daughter when I could, and study whenever I was able. I learned that I am worthless in the evening but was able to retain what I studied in the morning, so most nights I was in bed by 8 or 8:30 and up most mornings around 4:30 to read, study, and write careplans that were due in a couple of hours. There was one semester that I had to be at clinicals before daycare opened, so I dropped my daughter at my best friend's house and she took her to "school." I think that if I had been a "traditional" student, I could've made straight A's, but I did pretty well for myself with all the stress I had and graduated with a 3.4 or so GPA. Then I finished my BSN as soon as I could afterwards. Now my last child is starting kindergarten and I am trying to figure out how to go back to school for my MSN! It can be done, but each person has his/her own way to do it. You have to figure out what works for you and your family, prepare to make sacrifices, and just do it.

Check with the elder services networks in your area as well as professional bed bug exterminators to see if there are resources in your community if you don't have an MSW to do these things. Check with Geriatric Care Managers in the area, as well. Most have a lot of resources that many people would never dream of. Unfortunately, I'm not sure that the barriers will really have any effect on containing the bed bugs and I can't say that I blame the PT for not wanting to see the patient any more. I'm not sure that I would be any more generous until the infestation is eradicated. I can't afford to have my home exterminated and/or replace my furniture.

Technically, you should be asking for a verbal order to continue to see the patient/recert. Many agencies just recert and send the paperwork, but the correct, by-the-book way to do it is that any change in visit frequency needs to be made based on an order from the physician. That includes recerts, unless you have standing orders included in your 485 that allows you to recert automatically--which may not pass muster with your state agency, accrediting body, or other surveyor.

Ha! Never found any but have toyed with the idea of making my own for several years. I worked for one national agency that used them but they were so badly written in terms of grammar, speclling, etc., that I just hated to have to use them. And they were not visually appealing for the patients at all. I would love to be able to put someting together that has graphics, small bites of information, reasonable goals, concrete teaching plans, etc. But I just don't have the creativity to do it myself.

Maybe I'm an overachiever, but I always check an apical pulse, even in clinic setting. Not sure why, just the way I do it.

*warning -- harsh words ahead* I'm just taking a guess, a wild shot in the dark, but by the comments of the preceptor that you posted (eg "So you still think you can handle it?") that you might have presented yourself as something of a know-it-all or not really in need of instruction. If that is the image that you presented of yourself, then I'm frankly not surprised that your preceptor would be a bit abrasive. As a new grad, most students don't really have the skills to operate independently in a hospital environment. Experienced nurses know this. Most new grads should know this. Some don't realize this and become very difficult to teach. As I said, this is just a wild guess and may or may not apply, but here's some food for thought: You say that your preceptor was a bad teacher, but were you a good student? Did you seek out learning opportunities or did you wait for them to come to you? Did you ask for assistance, instruction, feedback? Did you jump in to help where you were comfortable and competent? Did you research meds or diseases that you weren't familiar with? Spend some time honestly assessing yourself and your behavior in this situation and try to see how you contributed as well as what you could've done differently.

I have been in your shoes and I have also been that brand new nursing instructor, overwhelmed with the tasks at hand. As a professional, have you tried talking to the instructor about her previous clinical experiences, areas of expertise, and/or expectations? Find out what she knows, expects, and expects of you, then discuss how realistic it is. If you have some ideas about how the student experience could "flow" better, by all means write them down and make suggestions. I don't know jack about this particular instructor or your situation, but in my experience, instructors get zero orientation to anything. No orientation to the classroom, how to create lesson plans, how to create an exam, and certainly no orientation to the clinical sites unless we have the foresight to create it ourselves--which many sites won't allow anyway. It sounds like she needs some basic orientation to your facility, including policies and procedures, common tasks, rehab schedule, patient goals (independence), and any other quirks of the facility that a newbie would need to know. Everyone will fare better if you approach this from a collaborative standpoint instead of an adversarial stance. If she truly is incompetent, versus just in over her head, then that it a different matter and should proceed up *her* chain of command--contact her supervisor at the school and explain your concerns.

A little off-topic, but sounds like you need a good wound care consultant. Daily dressing changes should be few and far between, interrupting the wound bed that often is more likely to delay wound healing.

I also do this in a PRN capacity and have not had any problems. I go in, assess the patient, sit down and talk to the caregivers about the home health aide, ask if there are services they need that they aren't receiving, etc. The complicane piece involves reviewing the HHA's notes, comparing to the care plan, and making sure that the HHA is documenting only what's on the care plan and not acting outside of scope of practice. It's not a difficult position, but you should still have your own malpractice/liability coverage.

Everything you ever wanted to know about Medicare and Medicaid: Home | Centers for Medicare & Medicaid Services

It's renewal time again! Unfortunately, I lost my job about 2 weeks ago when the company closed unexpectedly, so now is not the best time to have to shell out $$ for CEUs and the like. I've found some really great sites for annual subscriptions for CEUs, but all I really need is the 2 hour prevention of medication errors. Let's contribute our favorite free or nearly-free CEU sites to get those CEUs done at a minimum of expense! I like nurse.com for its huge library of courses, but at $44.95 for a one-year subscription, it's a little pricey for me now. RN.com is $34.95 per year and has some great offerings as well. RN.org is $19.95 per year and has the mandatory CEUs plus a few others. Any other suggestions?

I'm an RN with back problems. In my experience, HH has been less hard on the back than med-surg floor nursing.