JustMeRN

In my opinion clinical experience is important and outpatient experience helps. With the experience you listed you might get some bites depending how competitive the specialty is in your area. And yes, more than half your time is spent in office tasks (phone calls, chart review, chart audit, charting). Though case management is a pretty broad description, some jobs offer more active roles than others.

Write them for month frequencies. So instead of 1w8 write 4m2. So in your case, if you want to see them once a week but don't need another visit this week do 3m1 followed by 4m1 and adjust your visit dates accordingly. Writing for visits in a monthly fashion when you are seeing a patient less frequently allows a lot more flexibility without creating frequency violations as well.

You are allowed opinions sure. However, vaccines and the question of vaccination is not an opinion based argument. It is a fact based argument, and the facts are clear, vaccines are oberwhelmingly safe and effective. There is no evidence to the contrary after decades of research. Anyone who believes that health care should be based on opinions instead of facts doesn't belong in a position to influence its outcome.

I read up a lot on cosleeping when my littles were little, we had a side car sleeper, best thing ever. I'm not saying cosleeping can't be done safely, just pointing out that bed sharing is frequently encouraged for easy night nursing even though bed sharing (not cosleeping) cancels out the benefit of breastfeeding in terms of SIDS risk reduction. In other words, why do lactivist organizations encourage bed sharing when it's known to be unsafe? Why do they rely on the scientific evidence on breastfeeding that isn't rock solid to aggressively encourage EBF, but then refuse the epidemiological evidence on the risk of bed sharing. The AAP guidelines/ opinions are used to support breastfeeding, but their opinion and guidelines on bed sharing are ignored. Why? SIDS and Other Sleep-Related Infant Deaths: Updated 2

im a firm supporter of cosleeping, but bed sharing is considered one of the highest risk factors for SIDS, a blog I read said that the risk of bed sharing basically cancelled out any benefits from breast feeding in terms of SIDS risk. Also, pacifier use was shown To have nearly the same effect on reducing SIDS as exclusive breastfeeding, but breastfeeding women are frequently encouraged not to use a pacifier. Why?

im not saying that breastfeeding shouldn't be encouraged, my point is the evidence is not inconclusive enough to warrant the aggressiveness that has become the breast is best movement. Woman are literally so scared of giving their infants formula they are starving them. And there really is not any evidence to support that fear.

Have you seen this one? Breast-feeding Benefits Appear to be Overstated, According to Study of Siblings

But what you are not doing is providing evidence beyond your opinion that formula carries enough health risks that infants should be given pasteurized donated breastmilk above formula. And I'm not going to yell, because quite frankly I'm not sure what your yelling about. I asked you to support your obviously strong feelings about the dangers of formula with something other than your opinion, that makes you angry?

Can you specify where you are getting your information from? Everything that I have read recently published is coming to the conclusion that the benefits of breastfeeding have been overstated, the benefits over formula are small, and when taken into context things like mental health of the mother, socioeconomic status, cultural factors etc breastfeeding is not always best. Overstating risks is guilt tripping. Vaccines have vast amounts of evidence on safety and large margin of benefit vs risk. saying that choosing not to vaccinate places a child at higher risk of death is not overstating in the same way. Vaccines work in all socioeconomic conditions, all living conditions, under all variables. As far as contamination, that has been covered. And breast feeding is not without risk. This article is a really good example of why "breast is best" is so misleading and worth a read. Breastfeed At Your Own Risk - Contexts " Political scientist Joan Wolf, in the Journal of Health Politics, Policy, and Law, argues that the benefits of breastfeeding have been vastly overstated. Perhaps the largest problem is that it's impossible to conduct a controlled experiment—by asking some mothers to breastfeed and others to formula-feed—so all studies are observational. In other words, researchers have to tease out the characteristics of those who decide to breastfeed from the benefits of breastmilk itself. Mothers who choose to breastfeed may also promote a host of other health-protective and IQ-promoting behaviors in their children that go unmeasured in observational studies. The problem becomes even more pronounced when trying to examine the long-term health benefits of breastfeeding because there are even more potential unmeasured factors between infancy and adolescence that contribute to overall health"

Nearly 12 years ago I had my healthy, full term son with every intention to breastfeed exclusively. I was ready. When he was just a few hours old he had a low blood sugar, over the next 12 hours I would nurse, then the wonderful on nurses would cup feed, and on and on. No matter what we did he couldn't keep his blood sugar or temperature up and off to the nice he went. He spent 5 days, in that time I never had any engorgement etc. I kept nursing on demand, and topping off with a bottle. For the next 2 months at home I was a wreck. We made several visits to an LC. I took reglan, I would nurse for 15-20 minutes each side, top him off with formula in an SMS system then pump for 20 minutes each side. By the time I was done the process it would be time to start again. I was a mess, and finally decided in hysterical tears that I couldn't do it anymore and switched to bottles exclusively. 8 years ago baby number 2 was coming. I convinced myself that my problems with baby number one were due to the stress of his nicu stay, this time I was going to exclusively breastfeed. I spent hours researching breastfeeding, bought herbs, supplements and teas, I was ready. She came along, healthy, latched beautifully, we were home 24 hours after she was born. All seemed ok, except she nursed constantly, and fussed whenever she wasn't. I reached out to LC''s and support groups they all strongly encouraged breastfeeding, formula is evil, don't cave just persist! Finally my husband gave her some formula one night since she just never seemed ok, she sucked it down and I was worried. I made an appointment with an LC the next day, she wanted to do weighted feeding. At nearly 2 weeks old my girl was still under her birth weight. Weighted feeds showed she was getting about an ounce total from me. The LC was so concerned she handed me a bottle and didn't let us leave until my girl had eaten, and strongly suggested supplementing. Her evaluation of all factors was no matter what I did my breasts were not going to produce enough milk to feed a baby, ever. I cried, a lot. I had been starving my baby, and for what? Because I had let other people convince me that to be a good mom I must never give my child formula? So with my second child I continued to breastfeed and formula feed until she was 7 months (I had some medical issues and the medication I was taking wasn't compatable). She nursed for comfort a lot, she was a clingy needy baby and what she needed was me. I stopped feeing guilty that she always needed a bottle to top off. She was healthy, happy, and growing. So, I almost starved my baby. I spent months with my first baby stressed and crying. I was the recipient of dirty looks and snide comments when I gave my babies a bottle out in public. I was a failure to many. And for what? Having a body that didn't do what it was supposed to? I think breastfeeding is great, but the aggressive push at all costs has got to stop. Formula is a safe and healthy alternative for parents who can't or don't want to breastfeed. I am an intelligent woman, a nurse for goodness sake and the preassure to breastfeed led me to starve my second child and miss out on so much with my first. It's out of control!

To the part I bolded, can you back this up with anything? What risk does formula carry? Do you also realize that you have gone ahead and continued to guilt trip moms who can't, or choose not to breastfed? You are perpetuating the guilt heaped on woman who don't breastfeed, and for what?

I do admits exclusively, and when I'm training someone new I always tell them adl questions should not be about what the person can currently do, but what is the ideal situation that would result in the best care of the patient. Regardless of wether or not someone is there to help what is the safest way for someone to do adl's. So grandma joe might be bathing and dressing independently, but is that safe and manageable? Very rarely should someone needing homehealth be rated 0 on adl questions. So, if grandma joe is able to get her clothes from the closet or dresser, but walking to get there, managing balance while reaching and pulling drawers makes her unsteady, she's a 1 (at least). Even though she can do it, it is not the safest situation. If she is showering independently, but it's so exhausting she only does it once a week then needs a nap after she's not a zero. If I feel the need to guard her as she walks she's not independent. If she has a walker that is necessary for ambulation she needs meal set up (you can't hold a walker and carry your plates). I think we hate to feel like we are judging patients. If I answer grandma jo needs help with everything, but there's no one to help her, is answering accurately going to get her taken out of her house, or me in trouble if I say she needs help and then something happens to her I couldn't prevent? Those are the resistance I hear. But, oasis is not judgemental, in many questions we are not judging intent, just collecting data. I think that's the disconnect many people have with oasis.

nope, nope, and nope. In my opinion home health is not the place for new grads, and that scenario sounds terrifying. Keep looking, and good luck!

Yes, a new medication for pain, the pain would be the treated condition (or the identified cause of the pain ie arthritis, fall, fracture). You should always have a change in treatment, this is your skill. New meds (the condition treated is the diagnosis), need for monitoring (maybe nothing was changed post fall but the doctor is concerned and asked you to monitor BP for example). If there is not some sort of condition change you can't justify the need to be there.

Initially yes, now no. I make my notes as thourough as possible so reviewers have very little questions at this point. Initially it felt like I just couldn't get it right! What really helped is when they requested I change or fixed stuff I asked for an explanation why. It became a learning tool, now I don't make the same mistakes repeatedly, making my reviewers life easier and reducing corrections for me. In addition to what was said above, homecare, and especially oasis, have a language all their own. It's not like most other charting and getting it right is crucial. It can certainly be frustrating though!

Goodness no way. Find new employment and report them. Agencies like that are what makes it so difficult for the ones doing it the right way!

As an LPN you should be getting pretty basic stuff, daily wound care, follow up visits for Chf, copd etc. the most difficult paperwork is oasis, which you will not be doing. 6 revisits a day is very reasonable, as long as you don't have crazy drive times. Get in the habit right away of doing your paperwork at the visit, or just after the visit in the car. The biggest issue with paperwork is that people put it off and Rush off to the next visit, then need to play catch up for 6 visits of charting once they get home. If you do all / most of the paperwork at the visit (or in the car just after the visit) it is much, much, much more efficient. Also, don't get sucked in. That's not to say don't interact with your patients, but set your boundaries early. Don't be the nurse who spends half an hour listening to the clients jabbering about holidays, or families etc etc etc before you even do your assessment. Go in with an air of "I mean business". And understand if you have a client with true social issues the best course of action is to involve social work, or ask the pcp office to intervene if you don't have social work. Trying to fix everything is another time management pitfall. You can't do it alone! Good luck!

Holistic nursing practice is not naturopathy. When adding the term holistic to nursing practice you are encompassing the whole patient, not the disease. Naturopathy is a whole lot of nonsense quite frankly. There's a whole blog from a young woman who is a former naturopath, here is her response to people asking if they should Perdue naturopathy: Should I go to naturopathic school? - Naturopathic Diaries And just FYI chronic Lyme disease is not a recognized medical condition "The term chronic Lyme disease” (CLD) has been used to describe people with different illnesses. While the term is sometimes used to describe illness in patients with Lyme disease, in many occasions it has been used to describe symptoms in people who have no evidence of a current or past infection with B. burgdorferi (Infect Dis Clin N Am 22:341-60, 2008). Because of the confusion in how the term CLD is employed, experts in this field do not support its use (New Engl J Med357:1422-30, 2008)." And is a perfect example of why naturopaths are not safe medical providers.

Yes, you can take term breaks,up to three months I believe. During term break you pr student portal sort of locks down so you don't have any access to course content. Once you have a student mentor just let her/ him know about your plan and they can wal you through the paperwork etc.

Now that I have read the whole thread I'm changing my advice a bit. You are being exceptionally childish and ridiculous. Working as a nurses aid in the hospital does not give you some super special skill set that make you amazing. You are delusional. If you can't lower yourself enough to start on the bottom rung of the ladder (in SNF) you have some serious issues, and should probably consider if nursing is the right fit for you. No one starts at the top, no one gets there dream job out of the gate (and especially note with an ADN in the age of nursing surplus). I think you have some delusions of grandeur regarding your place in your current hospital and how much they need you. magnet hospitals don't need 100% bsn, did it ever cross your mind that if they wanted you as much as you think they do they would find a place for you as an RN? You come on here very aggressively and shoot down every reasonable option suggested to you. You bad mouth a school and a program many of us proudly graduated from, then say you already decided your not going to this awful school anyway. So what's your point?

Several of the nursing classes require you to use your current position as an RN to complete tasks, so, no, you can't do the program if you aren't working as an RN. That said, lower your expectations while job hunting. Take a job at a SNF of LTC or assisted living facility etc. you have your sights set on a hospital job, but you can't get one until you have a bsn, so take a job you can get (even just part time) and move on. You're wasting you effort and time on fighting a policy that is a good policy, makes sense, and is pretty standard across the board for RN to BSN programs. Move forward and let it go. It's not worth the fight and you won't win it (because it's a good policy).

I called in sick once on Christmas, because I had a temp of 103. It wouldn't even cross my mind to call in sick on a holiday just because I didn't want to work it. Your question honestly is disgraceful and embarrassing. You knew what you signed up for when you took the job. Did you somehow think you were so special the need to work holidays would not apply to you? You had Christmas off last year, suck it up and adjust your plans. Act like an adult.

Some days/ patients you make a difference, some you don't. The differences are not always as dramatic as you probably saw in oncology. Sometimes the wins are very small (your Chf patient threw away the salt shaker, or weighed himself every single day since your last visit). Home care is much more long term in most cases, so the benefit you are providing is sometimes more gradual. And you will make not a bit of difference for some people because they won't / can't change or take care of themselves. With those clients it's really about helping control the damage as much as you can. Sometimes just support is all you can do, change and making a difference are not always an option, be ok with that. Someone else mentioned what a difference the first visit makes for some, and I have to agree. I switched to a position doing complex care admissions only and find it very rewarding. When doing an admit try to take your time, provide lots of education and reassurance, and do a thourough med rec. I can't even tell you how many times someone claims to have a good handle on meds, we look through bottles and compare lists and it's a complete disaster.

For me I stumbled in. I was an excellent student in highschool, top of my class. Came from a poor area, my parents barely finished highschool. I was accepted into a 4 year school to study education, but we were not able to figure out how to navigate the world of financial aid and so I didn't go. I took a job as a daycare worker and 2 part time jobs on the side, all making minimum wage. When I was 19 I wanted desperately to move out on my own, but couldn't afford it. I had a friend working as an cna making almost double what I was making. So I called the local community college to enroll in the CNA class. The very nice lady told me the class was cancelled due to low enrollment, but she was going to send me the info for the RN program, maybe I might consider that. So I did. I applied, aced my NLN, and started 6 months later. I finished in 2 years, and off I went. Crazy how that one random admissions office person changed the course of my life. Its now been 16 years. I havnt enjoyed every second, but I don't think I would change it. The good pay and flexibility make up for the stress and physical demands. When my kids were babies I was able to work per diem hours off shifts so we didn't need sitters. I have continued per diem in various positions which means I work as much or as little as I want, I don't have to request vacations or days off for field trips, I just don't schedule myself. I recently finished my bsn and now have the option of deciding where I go next, there are so many options, so many different paths I could take. What other degree has so many different career areas?

I saw this on Facebook today, thought this was a good place for it.