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RN told she will now get LPN wages

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by Blackcat99 Blackcat99 (Member)

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24,727 Visitors; 2,819 Posts

Update: The RN was suppose to be leaving this job at the end of October. Mom told me today that the RN has decided to not leave after all.:eek: Mom said that the RN has now agreed to stay and that she will accept the LPN wages. Unbelievable!!!!

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3 Followers; 95,926 Visitors; 36,544 Posts

Very believable. The RN decided that the possibility of not being employed outweighed the insult to her self respect.

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Luv2care0907 has 10 years experience.

2,981 Visitors; 154 Posts

Blackcat directed my attention to this thread. I thought I would share my story, but also, I am specifically looking to how to resolve this issue. I want to make the money that I deserve. I have worked hard regaining my license . . . again. In May of 2009, I retook the NCLEX. After much money was invested, I passed with flying colors. I was ecstatic. I immediately went out to apply for a job to recoup the money I had just invested and to start making money for my family. Like many others here in South Florida, I found that the hospitals refused to hire me. You talk about discouraging. Even some of the hospitals here that promised me a job if I ever wanted to come back had become impersonal due to these companies that are hired to filter through the applications. I have so many glowing recommendations and references as well including people on their board of directors. I have a whistle clean record.

After a year of pursuing a hospital job and getting turned down over and over, guess what door was opened to me? Home health. At first, I was going to do trach patients. But my forte is babies. So I easily fell into a few cases with those and I have thrived working those clients. I love my job! I love these children and it is encouraging to see them recover so well.

So naturally, you would think that the agency, seeing how well I am doing, would give me a raise. (not) Within a few months, I got a notification from the agency telling me that Medicaid no longer pays for an RN unless the client has a trach, a GT, or other criteria and that I would have to take a pay cut to LPN status. I love my job. I am good at it. I guess somewhere out there, there is an LPN that can handle a preemie with an O2 NC on various meds weighing 5 pounds and do her job as well as I can. I would like to meet this person if they exist. I have a friend whose son ended up with a hypoxic episode during his home care. These children are not as easy as they look. On several occasions, I have had to act to prevent them from aspiration etc.

Anywho, I took the pay cut. I had no other choice. I would have loved to have said, "Take your job. I can make more money over here." But you see, there was nothing like that for me. I am making WAY less than $20/hour right now.

Even as we speak, I can see on one of the hospital web sites that there is a job opening for the nursery at this hospital that holds a monopoly in our area. If I submit an application, I am sure to get a computer letter stating that there are other candidates more qualified. How do you fight something like this? I know I am more qualified than anybody they could possibly have but how do I get them to see that? Do you take someone from the EEOC to the hospital to make them reconsider? Then what? I feel like I would be cutting off my nose to spite my face in that case. How hard would it be for them to find something to fire me over at the end of the day? I want them to welcome me with open arms not feel pressured to hire me. . . or I want the agency I work for to pay me for the work I do. My other question is that after a year of working with the HHA, will the hospital reconsider hiring me?

If Medicaid is truly paying $35/hour for my services, is it possible to force the agency to compensate me for the work I do? Are they really getting LPN wages for my time? I think one thing to consider is the fact that each case has a case manager that does the paperwork. So that may be where the agency is having to direct some of this money or are they compensated for that as well? Plus, like you said there is office staff, equipment, office rental and many other expenses to running a business. I am sure some of that money goes toward that. Still, I would like to make the kind of money an RN is supposed to make. From what I can see on this board, there are plenty of RNs in home health that are making that kind of money. I am all ears. :cry:

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3 Followers; 95,926 Visitors; 36,544 Posts

I have almost 20 years experience in nursing and my employers think that is good reason to pay me $5 less an hour than I was previously getting, while maintaining employees at $1 an hour more than me that they hired right out of school. I am actively looking elsewhere for employment. I am certain the present employer won't notice I am gone because they don't notice me enough to keep me working at even the low rate.

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24,727 Visitors; 2,819 Posts

Caliotter3- I am sorry to hear that your employer is treating you so badly.:crying2: It's bad enough that they give you a low pay rate but they don't even give you enough hours either. I hope you will find a better job soon.

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systoly has 23 years experience and specializes in LTC, Memory loss, PDN.

12,081 Visitors; 1,756 Posts

Below I've copied and pasted a post I made on Medicaid reimbursement a while back. While no company can afford to pay the entire reimbursement they get because there of office overhead, state mandated supervisory and reassessment visits, Start of Cares etc., you can see that there is still plenty to cover that without cutting the employee wages. My agency would never ask a RN to accept LPN wages or a LPN to accept HHA wages. I'd find another agency to work for! Sometimes these things are a sign that it's time for a change. Don't short change yourself!

Kyasi

I would say the biggest money maker for a Medicaid agency is Prior Authorizations where the per hour reimbursement is $18.34/hr for a HHA, $25.01/hr for a LPN, and $37.36/hr for a RN. I'm sure this varies from state to state. The biggest reimbursement is the 'overhead' where they pay $34.30/day of service. So if the agency is paying roughly $9.50 - $10.00/hr for a HHA, $17.00 - $18.00/hr for a LPN, and $22.00 - $23.00/hr for a RN, you can see the profit.

So an example would be: let's say we provide a HHA 10h/day, 7 days per week. Reimbursement will be is $1,283.80 + overhead $240.10 = $1,523.90/week. If the average HHA pay is 9.75/hr, the pay out is $614.50/week. Toss in there minimal benefits and a very small travel reimbursement and you can see in a years time that there is a big profit. But then you do have to take into account the nursing staff who does the paperwork to obtain this funding and who do the needed start of care and follow-up visits with the clients. That's what the overhead pays for. But obviously, there is profit or the company would fold.

Your numbers are spot on for my area.

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Luv2care0907 has 10 years experience.

2,981 Visitors; 154 Posts

Your numbers are spot on for my area.

I would be thrilled, at this point, with $22-23/hour.

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nursel56 has 25+ years experience and specializes in peds//ambulatory care/HH-private duty.

1 Follower; 43,281 Visitors; 6,653 Posts

Blackcat directed my attention to this thread. I thought I would share my story, but also, I am specifically looking to how to resolve this issue. I want to make the money that I deserve. I have worked hard regaining my license . . . again. In May of 2009, I retook the NCLEX. After much money was invested, I passed with flying colors. I was ecstatic. I immediately went out to apply for a job to recoup the money I had just invested and to start making money for my family. Like many others here in South Florida, I found that the hospitals refused to hire me. You talk about discouraging. Even some of the hospitals here that promised me a job if I ever wanted to come back had become impersonal due to these companies that are hired to filter through the applications. I have so many glowing recommendations and references as well including people on their board of directors. I have a whistle clean record.

I was very surprised to return to nursing and find things drastically different from what I expected they would be, too. The market is just so horrible now for everyone. New grads have the worst of it, but it certainly isn't confined to them. It's as if any time elapsed before you want to re-enter the workforce, even if you had lots of acute care experience prior to taking time away, they treat you as a nurse with no experience.

After a year of pursuing a hospital job and getting turned down over and over, guess what door was opened to me? Home health. At first, I was going to do trach patients. But my forte is babies. So I easily fell into a few cases with those and I have thrived working those clients. I love my job! I love these children and it is encouraging to see them recover so well.

So naturally, you would think that the agency, seeing how well I am doing, would give me a raise. (not) Within a few months, I got a notification from the agency telling me that Medicaid no longer pays for an RN unless the client has a trach, a GT, or other criteria and that I would have to take a pay cut to LPN status.

You are going to find that raises in home health are few and far between right now. I am at this point thankful my pay has not been cut as I'm pretty sure new hires are making quite a bit less than I am at the moment, but I don't talk about my wages with anyone. I'm an LVN and I take care of trach/vent patients. Lots of babies have trachs and vents, too. Is your agency large enough that you could ask to be paid the RN rate for those?

As an RN you may also be able to transition into a case manager role in the same company. Or do "visits" in home health that are paid per visit instead of an hourly rate.

I love my job. I am good at it. I guess somewhere out there, there is an LPN that can handle a preemie with an O2 NC on various meds weighing 5 pounds and do her job as well as I can. I would like to meet this person if they exist. I have a friend whose son ended up with a hypoxic episode during his home care. These children are not as easy as they look. On several occasions, I have had to act to prevent them from aspiration etc.

I've worked in peds ICU stepdown and in the NICU - only mention so you won't have to keep looking. :)

Anywho, I took the pay cut. I had no other choice. I would have loved to have said, "Take your job. I can make more money over here." But you see, there was nothing like that for me. I am making WAY less than $20/hour right now.

Even as we speak, I can see on one of the hospital web sites that there is a job opening for the nursery at this hospital that holds a monopoly in our area. If I submit an application, I am sure to get a computer letter stating that there are other candidates more qualified. How do you fight something like this? I know I am more qualified than anybody they could possibly have but how do I get them to see that? Do you take someone from the EEOC to the hospital to make them reconsider? Then what?

I'm not familiar with the EEOC regulations regarding the hiring process. Do they get involved in the issue of qualifications for individual jobs? I always thought you had to prove they had an established pattern of only hiring one ethnicity or age group or physical attribute - things like that. It's incredibly frustrating to see so many obviously qualified people unable to get a foot in the door! What a waste of talent! I only hope the situation starts to improve very soon. I hope you finally make it into the job of your dreams. In the meantime - it sounds like you've really bonded with the super little tykes and found a niche you love. That in itself is such a good thing as we're bombarded so much with stories from nurses who don't seem to like anything about the job anywhere. I hope everything will work out for you!

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Luv2care0907 has 10 years experience.

2,981 Visitors; 154 Posts

Lots of babies have trachs and vents, too. Is your agency large enough that you could ask to be paid the RN rate for those?

As an RN you may also be able to transition into a case manager role in the same company. Or do "visits" in home health that are paid per visit instead of an hourly rate.

Thank you for your kind reply. Actually, Medicaid does pay RN wages for clients with IVs and trachs. I am not being critical at all here. I appreciate that you are experienced and are well versed on those things. However, the older school LPNs can handle the tougher situations. I doubt a new grad LPN is the same. Yet, no doubt because of folks such as yourself who are great nurses and others like you, Medicaid states that an LPN is all that is necessary for home care. I would like to see an LPN do what I do or even what you are saying you do.

I may be able later on to be a case manager. Yes.

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nursel56 has 25+ years experience and specializes in peds//ambulatory care/HH-private duty.

1 Follower; 43,281 Visitors; 6,653 Posts

You're right. I probably wouldn't be hired as an LVN at the places I've worked at in the past, say from 1975-85, and I feel fortunate indeed that I was able to work in those specialty units. If I was starting today I would probably go for the RN right away because of the broader choice (assuming the job market ever picks up anyway!)

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3,651 Visitors; 202 Posts

Interesting... I am the Nursing Supervisor of a Medicaid only agency in the Midwest and I have seen none of this. We provide care to children with Prior Authorizations and Medicaid Waivers for Respite Care. RN's are reimbursed with RN rates and LPN's with LPN rates. No criteria exists in my state regarding trachs, vents, etc. Is this something others are seeing also?

Kyasi

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Luv2care0907 has 10 years experience.

2,981 Visitors; 154 Posts

Interesting... I am the Nursing Supervisor of a Medicaid only agency in the Midwest and I have seen none of this. We provide care to children with Prior Authorizations and Medicaid Waivers for Respite Care. RN's are reimbursed with RN rates and LPN's with LPN rates. No criteria exists in my state regarding trachs, vents, etc. Is this something others are seeing also?

Kyasi

This is one of the reasons that I have been posting here. I want to hear if this is a truth. I want to hear what is happening to other people. For example, do other RNs have this same experience? Does Medicaid work from state to state differently? Is that a possible reason?

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