CFLA.RN

I agree you should spend some time finding your place in the nursing world before trying to go for an advanced degree. Where you start out in nursing is not always where you'll be happiest. I started in the hospital on a transplant unit. I loved it and thought I would be there forever. Over time I found that while I enjoyed the hospital and transplant unit, my skill set and passion is in wounds and geriatrics - two areas I never thought I would practice in. My advice is to work on your BSN and spend time working to see what you want to do with your career. I don't think every nurse needs to be an NP, it doesn't guarantee a greater paycheck but it does guarantee more responsibility.

Work/life balance is a struggle for the majority of home health nurses that I know. The best days I have are the days where I charted completely in the patient home during the visit, at least everything except the narrative note. Over time you'll learn to get faster with charting and it really makes a difference. My first company used HomeCare HomeBase (HCHB) and in the beginning it took 30 minutes for me to chart a regular visit and about 1 1/2 hours to chart an admit. After a year I was able to chart a regular visit in 6 minutes and an admit in 30-45 minutes. The key that helped me was copy/pasting common teaching guides for the narratives. I had a desktop folder with every medication I ever taught on so that I readily had access to teach the patient and had Medicare approved documentation for charting. I also learned to go into a home and tell my patient that the first thing we were going to do is run down the assessment list so that I could put that in the computer and then we could address everything else. Some patients don't like that but the majority of patients would rather let you spend 5-10 minutes doing your assessment and charting so that you can spend the rest of your 20-30 minutes completely focused on them with your device turned off. As far as points - 27 points shouldn't be too many visits a week. Most home health nurses don't know how to say no and end up picking up more than the requirement. Learn to say no if that's the case. It's important to create healthy boundaries with your employer because they will always work the "yes" people to death. It takes a good year to get into a routine with home health, there will be days that even your best intentions with charting fail and you spend all weekend catching up. But then there will be days when everything works beautifully and you find yourself at at 3 with nothing to do but relax.

There's a difference in acute pain vs chronic pain...I would treat acute pain first then the constipation. Chronic pain and constipation...would have to look at other factors, especially the site of chronic pain and the onset of the constipation.

FNP programs have considerably large application pools, often twice as many (or more) as AG primary or acute care applicants. I looked on nursingCAS at all the schools with applications available and started the process for whichever ones I thought would work out. I had no idea there were so many programs available, some with revolving start dates. It is discouraging to be rejected but you have to remember that it's not personal, there's only so many open seats and an over abundance of applicants. Good luck.

How are BSN nurses trained to prioritize any differently than ASN nurses?

Depends on where you work. I worked a year in the hospital and then went PRN in home health. I don't think any place will let you not work in the summer and then come back in the fall, you would definitely have to keep a minimum of visits or a new PRN person will get preference over you.

Got my acceptance into AGPCNP program today! I'm in Arlington. Glad to see I won't be the only one in this area.

I love home health and the patients, I hate the charting that is never ending. There's an immense satisfaction in teaching people how to manage their disease processes so they can stay out of hospitals and stay home with their families. But there is also frustration when I have families that won't help out or seeing how isolated some of our elderly truly are. I love the autonomy and independence of home health, but it can be lonely at times too. Every time I swear I hate it and am leaving it for good...there's a patient or family that shows so much gratitude that it reminds me not only why I do home health but why I'm a nurse. Charting and lack of family time (due to my own inability to say no to extra visits) led me to leave full time but I still work PRN at two home health companies and one hospice. Its a love/hate relationship for me.

What part of Texas? I know one of the companies I work PRN, they hire LVN's for different shifts so people have some flexibility. I worked home health as a single mom and never had trouble with child care. When she started school I worked from drop off to pick up and then charted after she went to bed. Also a lot of opportunities for on call/weekends in home health or hospice.

HHC is all about the narrative too. It's where you document the skilled service you provided. Check boxes are nice but don't "paint the picture" that Medicare wants to have. I learned to copy/paste teaching guides from NIH to the notes and use those for teaching guides for patients. It cuts charting time in half and gives you consistent teaching info, especially for meds and common chronic illnesses.

I don't know what area you're in milesims but I've never seen a HHC position that offered less than the hospital, at least in my state. I went from making 19.50/hr bedside to 35/routine visit and 75/admit (9 years ago). Current rates in my area are 40-50/routine visit and 100-125/admit. LVN's are making around 35/visit. Salaries can be low but a lot of companies are moving away from straight salary and paying on visit or point system. The lowest paid salaries can be supplemented working PRN with other companies. Its easier to pick up extra visits in HHC than it is to have to pick up an entire shift at the hospital, especially if your visits are grouped together. Companies in this area sometimes pay 1/2 point or visit rate for traveling over a certain amount of miles. Sometimes they offer company cars instead. Benefits are not always as comprehensive as the hospital (insurance is more expensive, very rarely has tuition reimbursement, etc) but that's the trade off for having more flexibility. And I definitely wouldn't say you'll see so many different types of patients - you'll see mostly COPD, CHF, HTN, Ortho, DM, and wound care. You'll talk a lot about medications and managing chronic illness.

How long did it take for you to get your acceptance letter/email after you applied?

Go the ADN route and do RN-BSN online while you're working. You'll be getting the work experience you need and a lot of employers will provide tuition reimbursement for the BSN. It will also give you time to decide which area you want to be in, the field you think you want now may not be were you end up.

Home health can be amazing at the right company. It's important to have the right training because it is very different from floor nursing. You have to remember that it's only going to be you in the home - there is no back up if you can't place a foley or draw a lab. There's a ton of charting, different charting systems make a huge difference. Simple ones, like Kinnser or Axxess are a breeze. HCHB can be frustrating, but if you do as much as you can in the home it won't be so bad. Home health can be extremely flexible if you set boundaries with your company and with your patients. Make sure that your territory is a reasonable area, there is nothing worse than having dead time because you're driving 20-30 minutes between visits and having to complete 6-8 visits a day. You really have to be able to handle constant change because days hardly go as planned, patient schedules don't always line up with your planned route, and there is always calls from the scheduler begging you to pick up "just one more easy visit" that turns into a 3 hour wound VAC. Pros - can be flexible, usually pays much more than hospital, frequently have same patients for months at a time so you build relationships, become strong with clinical assessments and skills because there is no back up Cons - can have the same patients for months (can be very frustrating, emotionally taxing), charting is 110% worse than hospital, patients call after hours, driving (car always loaded down with supplies), charting, charting, charting, always charting. I worked one year in transplant and then moved into home health for the last 8-9 years. While I appreciate the flexibility home health gave me as a single mother, I eventually had to move into a different field because I got so tired of the charting. Everything else I loved.

It really depends on what your home life is like and how often you would have to take call with the m-f. I would have preferred to have the weekend call with terrible hours over the m-f 8-5 with call because after working all week doing regular visits you get to have a weekend with terrible hours or nights during the week where you get no sleep and then end up working all day again. How big the company is makes a huge difference too. How big is the coverage area? Do you have to triage calls and make visits or do you work in an RN/LVN team? If it's a bigger company, is there back up on call in case you get two crisis calls at the same time? I would ask a lot of questions about what their typical weekend calls looks like and also what the weekday visit load is.

Each hospice is definitely different and it's important to find one that will train you correctly. As far as going with a bigger, national company vs a local company that really depends on what benefits you are looking for. The bigger companies often have full time on-call staff and admissions nurses. Smaller companies usually have the full time staff take on-call which can be really slow or really busy. I have also found that national companies pay significantly lower than some of the local companies. I like to work with companies that utilize RN/LVN teams rather than companies that only use RN's but that's a personal preference. As far as trying to see if hospice is a good fit for you - I would sign up as a volunteer and ask to ride out with a hospice nurse one day. Not every company would let you do it but I bet some will. Pay varies per company, position, and experience. I would say a good average - 70-75,000 with extra for on-call days and visits. Expect to have some kind of contact 24/7 but it's manageable if you know how to say no to extra visits and set boundaries with patients (ie I tell patients...here's my number, I'm available from 8-5, after 5 call the on-call number and they will gladly help you. If you call me I won't be able to answer because I will be with my family). Just know that you will always, constantly, and forever be charting! It is the true downside of home hospice care.

I just looked through my old assignments, looks like there was a weekly journal with 3 key points from the module (took about 20 minutes to do once a week) which led to a synthesis paper at the end of the course. There was a capstone PowerPoint project (based on whatever topic you want - I did one on caregiver burnout) that you present to co-workers which also requires creation of evaluation documents (like the survey/test taken after a CEU) and then ties into a capstone project summary paper that wasn't very difficult. Also had a paper about our future goals which is very similar to the synthesis paper and is basically a revision of the personal philosophy of nursing paper we did in the professional nursing course. It seems like a lot but I really only spent 1-2 hours a week doing it, except for the research for the capstone project.

I took co-op and I hated it. I don't mind writing papers but the journal was such an annoyance. On my survey after the course I recommended that they adjust the course to reflect other nursing fields like case management, home health, hospice, etc because the course was really geared towards hospital nursing. I am a care manager working from home and felt like I had to make up journal entries because the topics we had to journal on didn't apply to my position. I would have much preferred the medical terminology class but it wasn't offered during that session. It's definitely not a hard class but was definitely my least favorite.

I took Capstone in the fall, it was really easy. It was a resume review and a few papers, two of the papers were essentially the same. Probably one of the easiest classes in the program.

Axxess and Kinnser are great from a field nurse entry aspect but absolutely horrendous if the nurse is trying to quickly review previous notes or orders before going into a visit. HCHB is tedious at first but awesome to be able to get look at what's going on with a patient...assuming the previous nurses have completed their documentation. The other big downside to HCHB is that you have to access from the device to be able to chart, Axxess and Kinnser can be used from any computer access and not user specific device. HCHB from an administrative side is great because there are so many reports that can be generated. There's no program that both administrative and field nurses will both love though since each side is looking for vastly different things.

Hi - I would suggest calling the number on the UTA academic partnership website. I got absolutely no help from my advisor so I called that number and they transferred me to the department I needed to speak with to get the information that I needed. I'm not able to apply until December so she put me on her list to call in December and walk me through all the steps for the application. She also answered all my questions regarding the program and was very helpful.

I'm not sure about your particular state, but an old friend of mine was able to petition the TX BON for licensure and they approved - he had several drug and theft convictions in his 20's and became and RN in his 40's. Me, personally, would not have allowed him to become a nurse given his history but they did allow it with certain stipulations (mainly that he have proven amount of NA meetings, etc, similar to TPAPN requirements). However, another student from my nursing school was not allowed to sit for the boards because of felony DUI charges 10 years prior. I think the difference in the two situations is that the first student petitioned the board prior to going to nursing school (I saw the letter from the board myself, before he had even been officially accepted into the nursing program) and the second student didn't petition until after he completed the program. Good luck!

It will get better! My clinicals were in a very small rural hospital, I was definitely proficient at administering PO lasix for CHF exacerbation and IV abx for pneumonia...but seriously, nothing else. I didn't give my first suppository until I had been working on the floor as an RN. My first position was on a Transplant floor which was completely different than anything I had seen in clinicals. I was always so nervous when my preceptor was with me but I found that I was more comfortable with my skills once she had left me alone with the patient because I no longer had the pressure of someone watching my every move. My preceptor was nice enough but not very helpful. At the beginning of the shift I reminded the other nurses that I was new and really wanting to help with all procedures to get proficient...they were very accommodating in including me on different things - from central line care to dressing changes to foley changes - so that I learned different techniques from each nurse and was able to become confident in myself. It takes time to find your place as a nurse. I worked on a great floor with physicians that were so helpful and kind and nurses that really worked to help each other so my experience probably wasn't typical - but even then it took a good 3-4 months to really feel like I was doing my job well.

I've worked full time (over 50 hours a week for the first 10 weeks) and taken full semesters, 2 classes at a time, and made all A's except for college algebra. If you have working knowledge of APA format and experience in research and writing papers than this program will be a breeze. Since I thought I had to do college algebra (and therefore remedial algebra) it will take me 1 year to complete the program (took one 5 week session off to do a history class at a local community college). They did accept my wound care certification through NAWCO as an elective so that took one class off. If I didn't take the algebra it would have taken about 10 months to complete. On a side note, my mother works for the same hospital system I work for, and her manager and co-workers are doing their BSN through Aspen and are raving about it. It's a monthly fee and I think you can take up to 3 classes at a time. They do not require statistics to complete the program. I know it is a relatively new program but for someone who is not looking to go into a NP program afterwards it might be worth looking into.

I'm almost finished with the online program. There's been times when I've absolutely loved it and times when I'm ready to quit and give up being a nurse altogether. My biggest complaint with the program is that some of the classes are well organized and some classes (like Management) seem to be thrown together as an afterthought. I've found the majority of nursing classes pretty easy but with pointless busy work, but that's because I was an English major before I went into nursing school so writing papers is not difficult for me. I'm a little irritated right now because I was first told that they would not accept my previous college algebra (from 2001) so I went ahead and did remedial algebra and then algebra. I looked back at my degree plan and found out that someone decided that my previous algebra would be accepted but never thought to notify me that it had been changed. So I basically wasted an entire semester (two 8 week courses) and over $1000 on a class that I previously had an A in. I know that I should have double and triple checked before registering for classes, but I really think the bigger issue is that my advisor is practically non-existent. I'm sure she has too many students to properly advise each of us, but it would be nice to have some kind of response to questions - even if it is a generic "I'm looking into it, will let you know" type of response. I haven't had much need of the Academic Coaches but the one question I did have was not addressed - it was in regards to a quiz that had incorrect answers - but some of the coaches are more interactive than others. If you're looking for a lot of support to get through a program than I wouldn't take this one... but then again I don't think the classes require a lot of support either. I would definitely do the program over again because it is convenient to any work schedule and relatively affordable. Definitely check your degree plan frequently and question any inconsistencies before signing up for non-nursing classes. Rent textbooks from Amazon, they're so much cheaper than the bookstore. Read the syllabus and follow the rubric for every assignment and the assignments will be easy to understand. I've definitely spent more time on the non-nursing classes (mainly algebra) than I did for any of the actual nursing classes. Hope that helps a little! Let me know if you have any specific questions :)