CatHair

The Gun Laws in both Chicago and other suburbs in the surrounding area were originally enacted to enable Law Enforcement to IMMEDIATELY seize a gun if one was found at a crime scene or during an arrest. As for "Gun Laws don't work with criminals", perhaps we should just get rid of laws regarding assault, burglary, theft, and murder as well since criminals don't seem to care about any laws.

1: You are just going about your job when you hear gun shots, you look around and see a couple people holding guns. What do you do? How do you react when you see other people pointing guns? Are they the active shooters? Or are they just CC gun owners? How do you react when they turn and point their gun at YOU thinking you are the shooter? 2: Where do the bullets go when you miss your target? What or who is behind the wall/door/window your bullet just went through? 3: What happens when the police arrive and you are standing (or hiding) with a gun in your hand?

As far as "KeyWords" goes, if your resume is submitted electronically, it is usually scanned for keywords by machine, not by a human. You really do have to tailor your resume to each particular job application. I applied endlessly for any position at the hospital group I wanted to work at and the ONLY interview I got was for a position on the same floor and shift where I had done 80hrs of clinical. I really played this up in my resume for this position making sure that my words matched those in the job description. I got a call for a pre-interview, when I showed up, the HR nurse only STARTED looking at my resume and stated something to the effect of "well, so you have worked on this floor before then? oh.....I see you were a student...." Prior to me walking in the door for my interview, a human had not looked at my resume other than perhaps glancing at it.

And this goes back to the original post which was about Am I too old to start Nursing School? My answer would be no, you are not too old to start Nursing School, but if you expect to graduate and be treated the same as your 24 year old peers,… you might want to listen to those who have been there/done that. If you have current contacts that are interested in hiring you after you graduate, then go for it. At 55 I did better on my night shift clinicals than the seasoned professionals I worked next to who had been doing it for years and were half my age. But when a job came up for that EXACT position, it went to someone half my age with work experience in that hospital system as a PCT. I had no one going to bat for me. They did. They got the job. That's the way the world works. I agree, but unfortunately your belief system does not line up with how the real world works and it cannot be pushed aside by sheer will. So, don't ask, don't tell? Stop pointing it out and it will go away? I prefer evidence-based science. I worked with a student that failed the RN program TWICE. She once used a People magazine article as a sole citation for a paper. I got a lot of crap from my peers for pointing it out. She was in my work group. So much for my age and wisdom counting in my favor. She finally passed somehow and is now working in a hospital system that won't look at my life experience and wisdom. She is ~25 years old and has many friends where she works. I guess I will just keep thinking positive thoughts and pay more attention to PEOPLE magazine when I am in the checkout line at the grocery store.

As someone who is 57 and completed RN Licensure last year I can tell you that age is INDEED a factor in the workforce. When people meet me and hear I am an RN, they think I have 20+ years of experience. When they find out I am a new grad with no work experience they start questioning why I became an RN at my age. That is what comes up in the few interviews I have been able to get. As already mentioned, do you think a hospital is going to invest $50-$100K in training for you? They would not for me. There always seems to be a "hiring freeze" in effect but they will hire "from within", in other words if you are already working there in another capacity. (as PCT/CNA etc). I couldn't even get a LTC facility to interview me. Perhaps they are waiting for me to qualify as a Resident so I can pay THEM for being there?

another thing not to say: "OOPS!"

(copied from an online application I found because I did not want to type it all out...) Job Description Summary: An Admission Nurse is primarily responsible for performing the admission visit for all home health patients referred to service. The Admit nurse must have a good understanding of the OASIS C program, and have good assessment skills that enable them to recognize the need for other disciplines that may be necessary on a case and not yet ordered by the physician. They must possess excellent communication and organizational skills. They would be responsible for establishing the initial frequencies and communicate with the physician. The duties of an RN as stated below also apply, however, the role of this nurse is to work with the Intake department and admit patients. The Registered Nurse plans, organizes and directs home care services and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities. Essential Job Functions/Responsibilities: Patient Care: Completes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illness(es). Regularly re-evaluates patient nursing needs. Initiates the plan of care and makes necessary revisions as patient status and needs change. Uses health assessment data to determine nursing diagnosis. Develops a care plan which establishes goals, based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan. Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient. Communication: Prepares clinical notes and updates the primary physician when necessary and at least every sixty-two days. Communicates with the physician regarding the patient's needs and reports and changes in the patient's condition; obtains/receives physicians orders as required. Communicates with community health related persons to coordinate the care plan. Additional Duties: Participates in on-call duties as defined by the on-call policy. Ensures that arrangements for equipment and other necessary items and services are available. Instructs, supervises and evaluates home health aide care provided every fourteen days.

I get more of those towards the end of the month as their Government issued LIFELINE cell phones run out of minutes. 1st of the month comes around, they get their 300 minutes again and all of a sudden they are accessible.

It's not always HOH to blame. It can be a cultural barrier. Try calling from a phone that has a callerID that shows the HHA on it if possible. Or see if you can get the MD office to call them and tell them to expect a call from the Nurse. I have a number of patients that won't answer the phone if they don't recognize the caller. They are tired of robocallers and sales pitches using spoofed CallerID. Calling from a cell phone that only shows "WIRELESS NUMBER" to them or something will get you nowhere. They just won't pick up. Document your attempts in Comm Notes. You may have to do a "drive-by" visit to set up an appointment for the first time. I've had to do that for a few people that simply won't answer the phone.

that is what was documented at my last MD visit on Friday by the Nurse. It must be true!

Regardless of the format, you don't check what you write before you hit SEND or POST? If you rely on a program to correct your spelling/grammar/other, I have to wonder what your documentation is like if you don't go back and review it before making it available for others to review. I just had my yearly physical with my own PCP and my discharge papers show that I have a BMI of 179 because I apparently weight 1200 lbs. I am also positive for bloody stools but I have zero info in my discharge papers about how to deal with it. Both of these are big news to me and someone is going to have some explaining to do on Monday am. If you "need the money" to keep this job, I hope you are documenting properly to CYA. That includes reviewing before submitting. Anything. I make mistakes all the time but manage to catch them when I review.

As recent New Grad in the last year I can say that of all the things you listed, the CNA work experience was probably the most useful. Anyone who is a Nursing Student should be working in the field already as a CNA or PCT, preferably at the hospital or facility that you would like to eventually work at. It opens doors that would otherwise be closed. Every student from my class that was already working as PCTs got jobs working for the hospital they were at. Other students that were NOT working had difficulty even getting an interview. Work experience is a big +++++++

What was/were the specific charge(s) that resulted in this?

Well, first "time saving tip" I could offer is Reduce Your Patient Load. Are you in an Assisted Living Facility? 8/9 a day at times is taxing even when you are walking down the hall from one residence to another.

How many patient visits do you currently have in a week?

When you are doing an SOC, is the MD providing you with coded Dx to use? Or do you have to dig through the FTF and unscramble the handwriting under whatever heading the MD is using so you can add additional "pertinent diagnosis" to the OASIS form? Or does your QA do that part? I ask because I get a combination of these and I recently had a nicely done FTF (printed! no handwriting!) with 5 coded diagnosis listed in order. Both the progress notes of the MD and my own Assessment noted that the patient was depressed. There was no formal diagnosis of Depression however. Once the OASIS went through the coder, I found a Diagnosis for 311 DEPRESSION listed with the other Pertinent Diagnosis! The coder insisted that since it was in the MD progress notes it could be used. I explained that a report of "depressed" and my own assessment that the patient was depressed was not the same as an MD diagnosis of Depression. I called the MD for clarification and they agreed with me. There was no diagnosis of Depression for this patient at this time. When I explained to the coder that the MD had JUST TOLD ME THERE WAS NO DIAGNOSIS FOR DEPRESSION, he still refused to remove it! My DON even tried to justify leaving it in! Months ago the same coder tried to explain "what Medicare likes" and mentioned how Medicare "likes" to have as many diagnosis as possible. I am unable to corroborate this with any other source. Why? What incentive is there to add as many diagnosis as possible?

I have a black folding stool that I originally thought I would use to sit on, but I now bring most everywhere and use it as a small table to hold my bag. I have too many patients with cluttered homes and no place to set down a barrier for the bag other than the floor.

Old thread but I never use newspapers because A: I don't have any and it is pain to get them for free now. (well it is for me) If I am going to pay for something I would prefer something else. B: If newsprint ink gets on my hands, it is going to potentially get on patient's things. But I don't like the rubbing off on the hands part. C: Looks like you are saying that patient's stuff is contaminated and they get offended. D: I use clean newsprint from UHAUL instead: LINK There is a UHAUL store everywhere. $10 for 200 big sheets of off-white paper. It looks more professional as well. I have also found that patients will ask me what the paper is for and they say "no one else ever does that, they just plop their bags down and go to work". hmmmmm.....

I see Nurses here getting milage reimbursements of $0.56 and more to others getting nothing for milage and then others getting all kinds of things in between. The HHA I work at tosses $5 at you for each 25 miles you drive (after the first 25 miles). Does anyone know how a HHA is reimbursed for milage from insurance? Do they bill Medicare/Private Insurance for this in some way or is it just part of the pricing? I'm just wondering how some places can pay for milage and others don't do it all. Are the non-paying Agencies just pocketing milage money that should be going to an employee?

I use the CALENDAR app that is on the iPhone because it syncs with my desktop and iPad. I prefer to do the main layout and scheduling from the desktop because it is easier and faster for me, but you could do everything with Apple's Calendar app on the iPhone too. I try not to have paper if I can avoid it. That being said, a paper calendar may work better for you if you have a lot of changes. sometimes simply writing notes and crossing off things is just easier and more efficient on paper.

I only know that at our Agency when we have VA patients, they don't get SOC, they just start with Nursing Intervention visits. Also- this link: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/downloads/OASISConsiderationsforPPS.pdf states: "OASIS data elements are not required for Private Pay individuals effective December 2003." Hopefully someone else has something more informative.

And if you were to LEAVE your Agency and move to another area of Nursing, what would be the process for you, as a Home Health Nurse?

Your primary concern above everything else is YOUR safety. If you are not safe, you cannot take care of your patient(s). That being said, simply going to a run-down neighborhood is not reason enough to refuse to see a patient. I've been to really nice wealthy neighborhoods and seen people living in squalor in their homes. A complex case that may entail a lot of travel which results in less money for you is not really a good reason to refuse to see a patient if you are already scheduled to do so. The time to refuse would be before accepting the patient in the first place. I currently see a patient that is very far away and by the time I do the trip and do the paperwork and other followups, I might make $10hr. Other RNs have refused to see this patient. If you get to a home and find that they are smokers and don't air out the home, that is a threat to your safety. You CAN request that they not smoke while you are there and open the windows to air it out. Unless there is something in your job description that requires you to breathe second-hand smoke. You may get to a home and find the patient is great, the surroundings are nice but there are family members/friends present that are interfering. They may be drunk and/or belligerent. I would say that would be a good reason to leave and refuse to see the patient unless those family members are not present. Hopefully the HH Agency would have some policies on this. Mine does not.

In HH you will most likely be the Primary, so you have a patient for an entire Episode of 2 months. The revolving door at the Agency I work at has RNs leaving by A: Not taking on any new patients B: Any patients that they oversee as "Case managers" (where the patient is seen by an LPN) are transferred to another RN C: Another RN does the Re-Cert/Discharge at the end of the episode and then takes over that patient from that point moving forward. You gradually phase yourself out over 2 months. You could just up and quit, but then your DON has to scramble to find RNs to take on your patient load that you just dumped in their lap.

New Grad in HH here. Yes, it is possible. Yes I sometimes have sleepless nights wondering if I did the right thing for my patient(s). However, as another new grad working in HH as a FIRST JOB in Healthcare I would NOT recommend it for any typical new grad. Time management is extremely difficult to master when you are juggling 10 other balls in the air. I am the ONLY person in my graduating class that is employed in HH. Everyone else got into the hospital they worked at or they work at Nursing Homes. My first choice was HH despite the odds and rejections from larger agencies saying "come back after you have had a couple years experience with MedSurg in a hospital". The hospitals I applied at had to choose between me and a dozen other new grads that all worked there for 2 years as PCTs. No one wants to hire an unknown with no work experience when they have other options. I have no prior work experience in healthcare. None. But I do have other assets. So when I found a place that agreed to interview me and try me out, I jumped on it and so far have tried to put up with anything and everything. I will take any referral, go to any patient, any location, any day, any hour. Fortunately the acuity level of most of the patients in the census is pretty low. Yeah, I should get paid for orientation and training. But if I insisted on that, I would still be looking for a job. The market is VERY tight where I am. I was told I would get to shadow another Field Nurse, but that never happened. Instead I got assigned a patient that no other nurse would touch. (Really far away) Orientation consisted of a lecture on "bag technique" and then I was given a HH bag (used) with one zipper stuck due to some corrosion and an XL adult BP cuff (that leaked) and some other supplies. It was going to take a month to get a replacement $10 cuff. I just bought my own gear and use it. Yeah, I know, everything should be supplied by the agency. I should just Run Away. I recently took on (for a week) the patient load of an RN that had been there for a decade. I guess I am doing something right. Either that or this place is desperate. My DON is also relatively new (to HH) but she is whip-smart and very supportive. That helps a lot. It is part time. All the other nurses are part time and have other part time jobs elsewhere. However it is perfect for ME because if I want to take all day to figure out how to fill out the OASIS forms properly, I can. Now I just bring a paper pad to visits and can spend more time assessing and making sure I don't miss anything. If I want to spend more time with a patient, I can. Yeah, I fill out the OASIS forms at home. I don't care. I'm working as an RN. Maybe after I have worked for a few years and can pick and choose, I will choose something different. But RIGHT NOW....I'm working as an RN.