mharrah

Do any of you aesthetic nurses do sclerotherapy? Do you do it under a physician's supervision? Are RN's able to order hypertonic saline solution for sclerotherapy, or does it require a physician to order it? I do chemical peels and microdermabrasion, but I need to add other services. I was thinking I could do sclerotherapy since I'm already familiar with it. Does anyone have any other ideas for services I would learn/add to my menu?

please share!

I hate my job in LTC. I have an anxiety problem, and it gets worse each day with my job. I want to go back to ambulatory care. I managed my anxiety much better with that kind fo work. I worked for a dermatologist and loved it, but I had to quit, because I couldn't survive on just the $13/hr she was paying me. The problem is, I've been looking through the ads for weeks and don't see any openings for ambulatory care. I originally got my foot in the door at the derm office by making cold calls. Wondering if I should try that again? Just call up different offices and see if they need an RN? Or should I go out and deliver resumes in person? I'm feeling down and depressed that there is nothing out there for me. Bottom line...is it rude to do cold calls or show up in person?

I've been an RN for 5 years but only worked in LTC for two months. I really like this new place, and I can see there are many opportunities for advancement. Currently I know of openings for unit manager and nurse practice educator. How soon is too soon to apply or express interest in advancing? I don't want to be laughed at for applying too soon or not taken seriously. But my mom is DON at a different facility, and she recently told me she had worked her way up to ADON within two years of becoming an RN.

So I've been off orientation for about a week. The other night, I experienced seeing someone dead for the first time. She wasn't my resident, but I wanted to go in and look just so I could get use to this kind of thing. She was a DNR. For about a day after that, I thought maybe LTC wasn't for me. I couldn't get her face out of my head. But I'm feeling better about it now. I don't really have any questions about this experience...I just kind of wanted to talk about it/get support. Even though I just got off orientation, sometimes I'm technically the nightshift supervisor since I'm the only RN in the building. I have to run the midnight census, start an antibiotic for a resident on the other unit that has a port, and some other little stuff. And then I'm assigned about 20 residents of my own. My question is, what is the normal case load for the nightshift supervisor. If something comes up, it would be hard to do this and care for 20 residents too. The thing I like about LTC is that it seems there are a lot of opportunities for promotion-unit manager, restorative, clinical reimbursement coordinator, etc. How soon is too soon to apply for these positions?

Are you suppose to check for residual prior to administering tube feedings or giving meds through the tube? I'm new to LTC, and I'm not seeing my mentors check for residual. I'm trying to get my hands on the facility's protocol. But until then, can someone give me some direction or a sample protocol?

I just started a new nursing job at a LTC facility. I'm on the transitional care unit. I have 21-25 patients with three trachs and two enteral tubes. I work three 12 hours shifts per week. Last night was my 2nd night on the TCU. Was supposed to be with a mentor, but she was pulled away to help with other things, so I did the 9pm med pass alone. I started at 8pm and ended at nearly midnight. I really need to speed things up. Any suggestions?

Earlier, I posted that I was going to an interview for LTC. Well, I had that interview today. They asked a few questions that I hope I answered well. They asked "If Mr. Smith falls on his head, what would you do?" I said I would immediately go assess Mr. Smith. I would contact the doctor and fill out an incident report and any other paperwork required by their policy. They said "if this happened at 3am, would you still call the doctor?" I said that, yes, I would call the doctor and added that the doctor would probably want to know. Now, I don't know if this is the right answer, because my experience is not LTC. My experience is hospital, and you would definitely call the on call doctor when working at the hospital. Mr. Smith would also need to go to the ER probably to have a head CT and some other testing done, but I did not think to say that during the interview. So give me your own feedback about Mr. Smith, please. They said that some nights, I would be the only RN in the building, and this is a 130 bed facility. But there are LPN's there, and I wouldn't be alone til orientation is over. Is that normal to be only RN? That sounds scary. How do you give report at LTC since there are so many patients? Forgot to ask that question. They said they would need me most in the transitional care unit. They said turnover is big there. Should I be concerned about that? When I worked in the hospital, I got down to an unhealthy weight, because I did not have time to eat during my 12 hr shift. Would this be a problem in LTC as well? I would love to hear your opinion about working at a hospital vs. working in LTC. Would like to hear your pros and cons. Thanks.

I would think it would be a problem. When you take orders, aren't you suppose to write your credentials after your name? And I don't think you can legally use "RN" if your license is suspended.

I have an interview at a LTC facility. They also have short stay residents. I'd appreciate any helpful info. I have a few questions: At a LTC facility, do the RN's have to start IV's or insert NG tubes much? I'm not very experienced with those skills. In your opinion, is the stress level/chaos better or worse than working as a floor nurse in a big teaching hospital? I worked in a teaching hospital for 7 months and did not like it. The medical residents were either on the floor asking a million questions (instead of reading the chart) or calling on the phone, writing/calling in orders then changing their minds after their meetings with the attending doctor, taking the charts for hours at a time to their meetings, etc. Do you have to deal with residents and med students much at a LTC facility? I have not done direct patient care for over two years. Do most LTC facilities have the resources to orient me back to this? (they do know that I currently don't provide direct patient care and that I want to get back to it) I have been told this is one of the newer, better, cleaner LTC facilities in the area. That makes me even more interested in the job, so I want the interview to go well. So fill me in on anything I need to know. Thanks!

I'm looking for a new job because I have an 8 week old son and want to spend more time with him during the day. With my current job, I spend all day at the office away from him. So here are some questions I have: Is home health flexible? Would I be able to do some of my work during the day but save some such as documentation for evening? Would a home health agency consider me for employment since I have only done a llittle clinical work over the last two years? With my current job, it is mostly educating over the phone. But before that, I worked in a hospital and a doctor's office. Do home health agencies have different shifts? I would assume all home visits would have to be during the day? Your input would be very much appreciated!

I have been working for a wellness company for one year. My title is RN phone coach. I work with high risk clients over the phone. I really love this job, and it is very low stress in my opinion compared to other nursing positions. I love the concept as well. Disease management and prevention provided by wellness companies will hopefully prove to decrease hospital admissions and decrease workload of already overworked floor nurses. There wasn't much training for this position as I am the only RN here and the only one that deals with the high risk clients. I had to sort of teach myself and find techniques for getting these people to open up and talk about their health. It is still challenging at times, so I think training for this specific position is needed. I also love the people I work with. I would say 95% of us at the company strive to be healthy and we all have a positive influence on each other. I have thought about doing wellness on my own. But I have a stable job and good money, so it would be a huge risk to try to go out on my own. And I'm trying to figure out if I could combine a wellness clinic with my experience in skin care (peels, microderm, cosmeceuticals which I do on the side)....a health and beauty spa maybe, but I don't know if those two things combined would fly. It's nice to hear from others in the wellness area! Feel free to send me a message if you would like. Marlene

caligirl2, I have worked for a dermatologist in the past. In my area, dermatologists do some cosmetic procedures but not a full range of them. For example, the one I worked for likes to do a lot sclerotherapy but does not offer dermal fillers. Most of her time is spent treating skin cancers, warts, moles, etc rather than aesthetic procedures. But working for a derm, you really gain a more in depth knowledge about skin conditions. I learned so much more about melasma, acne, rosacea, etc. The pay there was not so good, but that may differ from place to place. I hope that helps, and good luck! Marlene

healthyhere, My post did not include my training, background, etc. I am personally offended that you would make the assumptions that you did, lacking information about me....stating that I have not spent time, money, or effort learning about aesthetics!! Of course I have. Lots of us that post here have, and that's why we post....don't be so quick to give us all a slap in the face after all the effort we put into this. I worked under a dermatologist at that time and took independent training on my own. At that time, I was wanting to branch out on my own and needing advice. That post was nearly two years ago and I've done well since then. Your "advice" as you call it is not needed.

Interesting topic. When I was in nursing school (in 2005), the instructors and nursing students called them patients. The same went for when I began working at the hospital. I never heard the word client. Now that I'm working for a wellness company, they are always client NEVER the patient. But this is a unique type of nursing where I provide coaching and education over the phone to employees of companies that have paid for our wellness program services. So I think it is appropriate to call them clients. It's just my opinion, but I think that in the hospital setting, patient is the appropriate term. If I was admitted to a hospital, I would want to be called a patient. What are they going to do next....change it to "inclient" instead of "inpatient" ??haha.

I agree with Blee. I thought I was the only one who would get grossed out watching blood and guts on TV but then handle like it's no big deal in real life. I guess it's because when you see it for real, it's just not really that bad. Anyway, back to the original question....I've worked some nursing jobs that may give you some ideas. Right now I work for a company that develops and implements wellness programs. I review lab results for high risk patients, explain them to the patient, and then develop a plan with him/her to improve their health. I've also worked for a dermatologist where there is little blood, but then again, if you do a little skin biopsy on someone who denied that they were on a blood thinner, then woooooooooooo there comes the blood gushing out of that little incision. And then I had a job where all I had to do was a fingerstick to get cholesterol readings and talk to the client their results. If you work at a nursing home, there is not that much body fluids to deal with...at least not as much as the hospital. But I think the important thing is to realize that although there are many jobs where contact with blood is minimal, you never know what may come up on the job, and you have to be prepared to deal with some unpleasant things as a nurse. Once you have gotten experience, you could consider case management, claims review, QA, school nurse, etc.

I have not given the flu vaccine for two years but will be giving them again soon. It seems that safety devices are constantly changing, so I wanted to get feedback on what type of device is most commonly used now for administering a flu vaccine (or any type of IM injection for that matter). When I administered them two years ago, the needle was manually pulled out after injection slowly, and the needle was disposed of without recapping. Now I hear talk of retractable needles where you push the button, and it instantly pulls the needle out of the skin for you. I would think this would be inappropriate for IM as it would pull out of the muscle too quickly. From what I am familiar with, self retracting needles are only appropriate for insulin and other types of subcutaneous injections. I would think the protocol would be the same. Please advise as I have been out of the injection loop for two years.

I worked for a dermatologist for 1 1/2 years. Things I did included assisting with in office surgeries like ellipses, punch biopsies, shave biopsies, and reexcisions; treating precancerous lesions and warts with liquid nitrogen; electrodesiccation and curettage for basal cell and squamous cell carcinomas; scrapings and preparing slides to check for scabies; assisting with vein sclerosing. In all of these things, I only assisted the doctor. The few things that I did independently included removing sutures, dressing changes, pregnancy testing, preparing surgery fields, preparing syringes, and giving pathology results to patients. We did not do Mohs in this office. Instead we referred to a Mohs specialist and then saw them in follow up for post care of the surgery site. I did not remove Mohs sutures as they were too intricate, and the doctor wanted to take those out herself. Good luck with your new job! I found derm very interesting.

First off, it's wonderful that you're doing so well after such a poor prognosis. I attended AEI. I thought the instruction was wonderful while I was there. There was excellent hands on training with real people and plenty of time to ask questions. I was disappointed, however, at their lack of response to my emails after I got back home and had some questions especially since they claim to be there for you for life. I still feel that their training is probably the best though. So if you go, try to think of all the questions while you're there. The way I started out is this: I took the facial aesthetic courses, went home and ordered the chemical peels, practiced on myself several times then my family and friends and moved on from there gradually increasing. I opened up a little office and soon after bought a microdermabrasion unit (which I'm still making payments on and have not profitted from yet :-( ) I really enjoy doing the procedures. However, this summer, my clientele dropped off the face of the earth. My business has not recovered yet, and I am in the red and had to get a full time nursing job with a wellness company to pay for my aesthetic business debt (but I like the new job). So this means no time to spend at my own office, which makes it look like a closed business and lowers clientele interest even more. So I may have to close soon. I'm not trying to be pessimistic. I guess I'm just suggesting to really consider the cost of your business and if you can afford it. Even if you don't have your own business, the cost of training, insurance, etc, is still a lot. I wish you the best of luck. I would love to see individual nurses succeed in this area, because I think nurses do it best!!

I have to agree with Patti. I went to a facial aesthetics training for nurses. The training was great while I was there. But they do not meet their promise of being there to answer your questions afterwards. They gave us order forms while at training so that we could order the chemical peeling agents from them later. Well my first order was fine, but then when I needed to place another order, they said that they do not offer those products and that I needed to order it from the manufacturer. They did not bother to tell me this until two weeks after I faxed my order. So I emailed them and said I was totally confused as to why they filled my order the first time but not the second time especially since it was their name, address, and phone number on the order sheet and not the manufacturer. I never got a response from them. So I contacted the manufacturer of the peeling agents and had to go through a big registration process and waiting period before placing my order. My point is I got my products late, thus put a damper on my business, because of this school that claimed I could order everything I needed directly through them. On their website, they now claim that their students can become certified aesthetic nurse specialists. I emailed them and said that I was a previous student and wanted to know how I could be certified. Again I never heard from them.

Wow that is amazing and encouraging that so many nurses have become doctors. Good for them! I'm curious though, did they drop the RN and just use the DO or MD after their name? I think I would want to keep the RN though some might think that's silly. I'm darn proud of that RN after my name. :-)

RN from Charleston here. Graduated with my AD from UC in 2005. Started out at a hospital, now working for a wellness company and trying to keep my own aesthetic skin care business going.

Hello fellow aesthetic nurses! I am considering my options for adding a skin care line in addition to the services I perform. Your feedback would be greatly appreciated. 1) Do you sell a skin care line? what line do you sell? 2) What types of skin care products do you sell? (fading cream, etc.?) 3) Do you sell the products for double the price you bought them? I may go with IMAGE. I purchase the actual chemical peels from them. I Just hope their home skin care line works well also.

Tiffany, FL seems like such a difficult state to deal with when it comes to this practice. I don't have any words of wisdom. But I hope things work out for you someway, somehow. I think the reality is that we are all going to eventually have this problem...one state at a time. I'm In WV, and we are not up to date on things like FL is. but I'll probably have the same issue several years down the road. Tanya, Great to hear that you're doing well! What percentage do you get to keep? Is the doctor there when you do your procedures? Reading your post makes me want to go take the dermal fillers course at AEI (where I learned peels, micro) BUT READ BELOW Everbody, here is my current issue. I want to learn Botox and Restylane now. BUT I currently don't have a physician for what I'm doing (peels, micro) because I don't have to have one here. But with dermal fillers, I would have to? right? because no matter what state you live in, only a doctor can order those injectables. right? correct me if I'm wrong. SO could a resident be my ordering physician? I've met a few very competent residents here. One in particular who has become a good friend, is finishing up his general surgery residency and starting plastic surgery residency. I would love it if he could be my medical director. I am finding a recurrent problem. Prospective clients ask "do you do botox", "do you do permanent makeup" etc. And I have to say No. And basically they walk away, and I don't get any business from them. So that's why I feel the need to add more procedures to my practice.

Thank you, periwinkle, for your support and encouragement. I do hope to break away from that environment soon. I would like to get advice from you all about making my clinic (the one I own, not the derm office) look more attractive without spending a fortune. My clinic is located in an old strip mall type of building. It has it's good and bad features. The good is that it is close to the road with visible access and has a place to put a nice sign when I get the money to buy a sign. right now I have a hand made sign there since I couldn't afford one. It also has a nice large window that is almost the length of the front of the clinic, and people can see inside. the bad part is that the building is old and run down in general. I have found that covering things up is the best thing to do right now. Like using large rugs on the floors. The bathroom is the worst part. The sink is old and nasty, and I don't know if there is any way to make it look better. The floor in the bathroom is uneven. Any ideas on how to fix up and old place for cheap? I'm there for now because my dad owns the place, and rent is free. Had to start somewhere. I was thinking maybe a thick rug in the bathroom may hide the uneven floor? and how about a lacy curtain or something to cover the exit door that is sooo ugly that we never use? I'm still lost about what to do with the sink. I don't know of any type of covering you can put over a sink. lol.