Davidaugustyn

I flip houses and am starting to hold and rent soon. Other than that, I am trying to delve into freelance nurse writing, but it's been tough.

Hey Overtonis! If there are others like me, there have got to be a lot looking for a way out. I have been flipping houses on the side to get out. I'm looking now into nurse writing to get out of the hourly grind. There will always be a need for direct care nursing, but there has got to be a huge demand for something that will unite people that want out.

I started a wound consultation business from home and saw a few clients before giving it up. The biggest things that slowed me down was that it was a lot of work for the same amount of money as a an hourly job. I learned a lot from building the website, like hidden fees. Wanna open an email account? Costs more than the website itself. Make sure before you commit to one that you know each cost of everything you'll need. If I did it again, I would start more mom and pop. I put a lot of effort in making my business look professional before starting, to give the right image. Ultimately though, it was through word of mouth and referrals that I got business. I don't believe to this day that the website was any help to anyone in my small town. I would make the website when business started coming in. I would have probably not started my business, only because it is hard to break into a higher income bracket as a nurse consultant driving to peoples homes. You can only charge so much for that. So I suggest having a business plan that actually shows profit to be made for you, while affordable rates for the client.

Fistulas are the hardest things to deal with. I shutter when I hear of a new admit coming with a fistula...I wish I could give you better advice...Supplies are drained to quickly with them...

Hello everyone and thank you for having me here. I have enjoyed this forum. First a little background... I have worked in long term care for 10 years, wound care certified for 4. Last year I started working in an LTAC with a wound care team and then was promoted to a wound prevention supervisor. We effectively reduced in nosocomial pressure ulcers from an average of 6 a month to an average of 1 a month over a 9 month period. (5 months high and 4 months low after implementation) I have recently moved on from that the the Director of Nursing position in the SAU adjacent to the hospital. It is an independently run facility but that was sharing the wound care team. As of the new year, we are pulling back wound care strictly to our department. The department does have some issues handling wounds and prevention. My plan is to have floor nurses pick the daily dressing changes back up, where they before never had to do this. We will have a wound nurse that does strictly weeklys, admits, declines, issues, etc. My question is, -Has anyone ever done this and how did they meet the resistance? -Does anyone have any good suggestions? -Turning, as everywhere, is a problem. How have you effectively turned around a non-turning unit? I mostly wanted to start a thread to share a wealth of knowledge. If you have something good, let's here it! Also please let's try to link what we know to best practice and evidenced based effectiveness. Here we go!

That may be true, and I may be speaking from my LTC experience. Of course we would not skip documenting on it; it is there. But if the origin is unknown, there becomes the opportunity to defend allegations of abuse, depending on the wound. That's all I meant. Not that we wouldn't chart, but that we need to find the origin first or at least have a realistic idea of the cause when oversight comes around.

yeah hollister does have alcohol. I mostly use it for a weeping peristoma. If truly is the key for a a good seal. Ask anyone with a long term difficult stoma. It's just how it's used. Like you said, its not glue. the idea is for the o-ring like seal.

I passed my LPN with 85 in 2004

Too bad. You failed.

How many days old is it? Is it appropriate redness in the inflammatory stage? Lots of times it's just a hope that it doesn't dehisce. I wouldn't use topical antibiotic, not best practice. Really I have not seen much help from the outside on an approximated wound.

I have 3 LPN wound care nurses working in the wound care department that I supervised. They were not certified and the company was hesitant to have them certified because of their degrees. The reason they fell into wound care is because the hospital doesn't like to hire LPNs for the floor. Kindred Healthcare based in Louisville KY has facilities all over the country which greatly hires LPNs. I have worked at 4 different Kindred facilities and each has hired LPNs. One facility had an LPN as a Clinical Manager in fact, overseen by the DON. In our wound care dept, we just make sure an LPN does measurements at least every other week. If I were you, I would see how I could position myself to fall into being needed for a wound care position as the certification is expensive.

That's true. Tough situation. I would suggest to him a mattress if he doesn't have one, (something he can't be noncompliant with) and let him be. Those are tough....

Well said mommy.19

I would stick with what I said than. Maybe not silvadene, but a good moisture correct environment and diaper it up.

I'm sorry I was in a mindset when I wrote that. What I should have more clearly stated was that topical antibiotics were useless, and oral antibiotics, unless broad spectrum, have little efficacy due to the way we culture a wound. I do agree with punch biopsy, but only as a means to diagnosing infection. (which I believe can be done with a look and a temp) On that note, Dakins is not best practice either. I have a tendency to speak on the results I see along with the knowledge I've gained. I can see the results with Dakins. (for short periods only) Here is the link to article that sums it up well. http://www.o-wm.com/content/bacterial-swabs-and-chronic-wound-when-how-and-what-do-they-mean I would encourage you to stay minimal with the culturing purulent wounds. It's not a good indicator or the bacterial bioburden. Also purulent drainage is not always an indicator of infection.