NorthNurse

I thought it was an inhaled opiate, because he was getting sedated and his pupils were pinpoint when they put him in the heli, just a guess, But, if anyone knows for sure, hope they write in. NN

I thought it was an inhaled opiate, because he was getting sedated and his pupils were pinpoint when they put him in the heli, just a guess, But, if anyone knows for sure, hope they write in. NN

Hi Lenora, I have been involved with a committee for the last 3 months debating those very questions, my agency had been per visit, not per diem, and prior to PPS it wasn't a bad system, the company made money as well as the nurse, now that has all changed since reimbursement is now capped and if you have too many visits per patient, your agency is going to be out of business in a heartbeat, so the whole point now is to work smarter, and spend more time each visit to get that patient independent and discharged as soon as possible, (same as DRG's)the per visit system will not work any longer in lieu of PPS, my agency has developed a plan to go salary, with a flexible model based on points. At least that's what is being proposed to HR, it should be in effect by April, although, I will not see this work to fruition, I have had to find employment elsewhere due to a drastic pay cut for me personally with the salary model, I am going back to hospital nursing after 10 years in the field, which I did love,(NOT THE PAPERWORK THOUGH!) but the salary I would make now can not come close to what I made per visit, since I was a high productivity nurse, I had been making 47,000-53,000/year and my pay will drop to 41,600/year. Unfortunately I need to maintain the same income. Good luck! NN

12.00/hr as a CNA would be great here in Northern Michigan, As a RN, (18.94/hr base, mileage,with benefits, although not the best) who has a sister who is a CNA,(8.65/hr,no benefits)in a ECF, this topic is hotly debated in my family, I too started out as a CENA, then LPN, then ADN, and now BSN, somedays I wish I could go back to just worrying about giving so and so a bath, the mental stress and responsiblity is the difference really, my sister hits the road when her shift is done and no more worries,(although she does care deeply for her patients) I on the other hand have to worry about making sure everything was done and charted, and wait for that Dr. to call me back,at his convienence, anyway, the CNA's where my sister works are always calling off, and or are late, and really have no vested interest in their jobs, I feel if they were paid better, or even were given good benefits, the quality of CNA's would improve, my sister complains about all those "LAZY NURSES" sitting at the desk charting all night, well she doesn't see the other side, although she also complains about her coworker-CNA's calling off, all the time too so, with her I just can't win. But like other posters have said it takes a Team to make it work, and with the HHA's (top pay about 8.00/hr, mileage and benefits)I work with and supervise as a Home Health Nurse, its a great feeling knowing the patients, at least those at home, are very well cared for, by RN's and aides alike. NN

The problem with everyone being labeled nursing staff, is the deception to the public, on who is, or is not, a professional registered nurse, I personally want to know who I am dealing with, case in point, notified by my son's new school, his Hep B series was not given appropriately, called the Dr's office about it, spoke to a MA, she checked the record and said the chart says last shot to be given 4 mo after 2cd, my son had it about 2 months later, by a previous MA in the same office, and she didn't know what to tell me, I asked if they could draw a titer and if it would be acceptable for the school, she didn't know, told her I would find out myself and I called the Public health dept, told by the person answering the phone, that he would have to get another series, I asked, "Are you a registered nurse?" she got huffy and said I will tranfer you to Sandy, anyway this very knowledgeable RN, explained that there is an accelerated schedule for HEP B, but she would have to check with head officer in Lansing and Call me back, she did in about 10 minutes, and said it was 59 day interval that is allowed here in this state, (MI) and he was 57 days, so unfortunately he would require another injection, this was outstanding I thought, and I was very glad, this RN knew about the accelerated scheduled and checked, it might have saved him another shot, I felt compelled to report the phone answering lady, giving immunization advice, and not being a RN, which is illegal in most states, as for MA's doing Nursing functions, only under delegation in this state, and there are several legal implications if a MA poses as a RN. I think MA's are not paid to do what they (Dr Offices and clinics) expect them to do, but they do it anyway, and these Dr. offices figure as long as they don't get caught its ok, because they make more money, although putting unsuspecting patients at risk. By the way they didn't charge me for the 4th Hep B injection, naturally everyone can make mistakes, but now I make sure its an RN (with Pediatric specialty preferred)I am dealing with when it comes to my kids. NN I didn't know there were M.A.s until I had about 2 months left in nursing school. I'm an LPN. I was shocked and upset. If I had known about the M.A.s I would have done that instead of spending all that time in nursing school. Maybe LPN's make more money, no one likes to divulge their salaries. I did my clinicals in 3 different facilities and there were M.A.s in them and they were just as capable as the nurses at their jobs. The only way I knew they were not nurses is if I asked them. All the staff in these facilities did not have LPN or RN on their badges, it said, "Nursing Staff." With the shortage of nurses, we nursing techs. I wish we had some where I work now.

As one of the posters has already mentioned, asthma does go hand in had with other autoimmune diseases, steroid creams have been very effective and not caused the severe systemic symptoms, I would send him to a dermatologist, one I know mixes his own concoction of kenalog,lidocaine, and topical antihistamine for his patients and it really works well, also atarax is prescribed often, best to have him see a dermatologist or two. Good luck, and don't give up till he finds an effective treatment. NN

2 Books available that discuss in detail your subject are:Legal and Ethical Issues in Nursing, third edition, by Ginny Wacker Guido chapter 11 encompasses Nurse practice acts,Licensure,and Scope of Practice; Nursing Now! Today's Issues, Tomorrow's Trends, second edition, by Joseph T. Catalano, Chapter 2, discusses The evolution of Licensure, certification and Nursing organizations. Hope these help you. If you can't find these where you live you can get them through Lake State Superior University Campus shoppe in Sault Ste.Marie, MI 1-888-800-LSSU. NN

In my experience its not related specifically to the pp, although circulation definetly plays a part,but,rather to the potential for osteomyelitis, and prevention of it. I have had several patients that had cultured positive for a multitude of bugs d/t extensive pressure wounds related to pp, all were placed on antibx prior and after surgery, all were referred to infx control specialist per their surgeons and lately the drugs of choice are augmentin with cleocin for 8 weeks post op. NN

Who'd a figured they had something like that going on over in Ireland, that's just great! I'll have to keep a look out for them here. Thanks for the cultural education Jenny P.

Hi Sue, Some hospitals are more concerned with trying to promote agenda's such as therapeutic touch and bringing prayer to the bedside, not that there isn't a place for alternative therapies, BUT, I think they should spend time/effort/money on meeting the basics of care FIRST, that are substantially lacking ie.. having enough staff to make sure the patients call light gets answered timely and patients get bathed, rather than who can perform TT and pray with the patient. I think they use this stuff to be impressive for JCAHO visits, and somehow hide the real issues. I can't tell you how many home care patients have complained that no one helped them do anything in the hospital, but they did get a tape recorder, headphones, and music tapes to help them relax. This patient came home with crusted betadine all over his back, because no one helped him bathe, and he was in the hospital over a week. Unbelieveable eh?

Hello Ullis, Thanks for the input, now we know its not just a problem here, Nurses need to unite globally for improvements to be made across the country and world. With forums for communication like this board that will make it possible.

Eric55, I think nursing pins will be difficult to collect since most nurses wear thier pins and they become a personal hierloom, I know all three of my pins, LPN, ADN, and BSN pins will be passed on to my daughter, your best bet might be estate jewelry sales, you might be better off collecting Disney pins which I have noticed are quite popular, especially in the north, because Disneyworld is so far from us. NN

Hi Mijourney, Does your agency use a point system for productivity, I just recieved a copy today of the plan that my agency is implementing with a salary model, frankly, I am appalled with it, the more hours you work the less points you get, I can't believe that nurses in other agencies would put up with this blatant attempt to prevent overtime pay. It's really quite disgusting the ways they continue to try to not pay nurses for what they do. And if you can believe this, a memo said they want us to do our paperwork in our cars in the patients driveway as much as we can. So as not to give more points and overpay us for doing paperwork at the office, YES its true! I for one am not sticking around to find out how they will "Tweak it" for our needs as one manager told me. I think I would rather do 3 12's and be done in the hospital, then put up with this disrespect anymore. NN

To LenoraRN and others, I have been in home care for the last 11 years and seen the paperwork multiply like rabbits, I also see the nurses notes that sometimes come from referring hospitals, and quite frankly, most of them are checkoff notes, not much of anything written, even the admissions are checkoffs and 1 page to boot, I am seriously considering a position change to a major medical ICU/CVU, and would like some input of paperwork in these units, I do believe most of the insurance and orders are all done by clerks or unit secretaries, a little information regarding would be appreciated. Thanks NN

Dear SubQ, Just had to write, and say if more nurses would stick to their convictions and really advocate for patients like you did, we wouldn't be in the mess we are in now!! YOU GO GIRL, Don't give up on nursing, not all of us are cannibals. And we need outspoken, in your face leaders, so step up!

Hi LenoraRN, Many Home Health agencies, have incorporated oasis into there own assessment forms and computer forms, for instance where I work the OASIS assessment is 16 pages long, also include ER plan, payment agreement, med profile,standing orders, carepaths,485, directions, significant clinical findings, HHA care plan and coordination of service with whatever therapies, were talking 20 or more papers to fill out, 2 hours in home and 2 hours out at office just to get all that together, its unreal! Now the problem isn't doing it, its not getting paid to do it, $40.00 for an admit where I work, thats $10 an hour, no thanks, Even contigent nurses won't do admits because "Its not worth my time" to quote a few, I agree that home care can be the most fufilling place to work for a nurse, but the fact is you are never done. Its a 24/7 job, even when your on vacation, you get called about a patient! OASIS Maybe isn't a big deal to those who are paid hourly, and or salary, if they don't force you to work overtime without compensation, but where I work, the full time nurses work 10-12 hours a day, just to make a fair living, and every other weekend. I have heard of some great Home Health agencies to work for, but I think they went out of business, last year.

Amen, Amen, Amen, Lets get the word out! Nurses have power, let us use it effectively!To create the type of career we can stay in, and recruit others to.

The cause is quite blatant, poor pay, high risks, laughable benefits, terrible hours, and schedules. Not to mention its very mentally and physically stressful. Any other questions??

Dear Candyvna, PPS has made home care nursing so oppressive and unfufilling that many of my co-workers have left, we are tired of filling out hundreds of duplicated forms, OASIS, Resumptions, discharges, Recerts, all which are way to subjective to give the bean counters in Washington any clue as to the outcomes results, to which they are basing payment. Not to mention being paid per visit doesn't add up when you are doing hours and hours of unpaid paperwork, There has to be a better option than this, any one out there has ideas, pass them along. Thanks NN with