Supervision of GN at Camp

merilynRN · Apr 15, 2014

Continuous ONSITE presence vs. daily supervisory presence with continuous access by phone and availability of RN come down as needed.

Alex Egan, LPN, EMT-B · Apr 16, 2014

Per the PA code.

21.27. Unlicensed candidate.

The candidate may practice as a graduate nurse until the licensing examination is passed subject to the following:

(1) Unless licensed, the candidate may be employed as a graduate nurse for 1 year only from the date of completion of a nursing program except in the case where special permission is granted by the Board due to extenuating circumstances. In such a case the candidate shall present validating documentation.

(2) The candidate shall practice under the supervision of an experienced registered nurse. ''Supervision,'' as used in this paragraph, means that the registered nurse is physically present in the area or unit where the unlicensed candidate is practicing.

You may consider expanding your search to experienced LPNs as they can function with off sight supervision.

21.45 (f) Paragraph (2) allows an LPN to be under either physical presence supervision or electronic communication when the patient's condition is stable and predictable.

Hiring a new grad is a challenge in the best circumstances. Having a GN seems like a bad bad idea.

merilynRN · Apr 16, 2014

Thanks Al,

I'll share this info at the meeting tomorrow. Really, an experienced RN or LPN is what is needed. Appreciate your response. Do you have a link to the code? I'd like to print out that section for the camp.

Meri

Alex Egan, LPN, EMT-B · Apr 16, 2014

http://www.pacode.com/secure/data/049/chapter21/chap21toc.html

Alex Egan, LPN, EMT-B · Apr 25, 2014

How did your meeting go? Any luck finding a candidate? Hiring seems tough this year.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

merilynRN · May 3, 2014

Hi big al,

I had a meeting with the assistant to the director as there is currently no director either, as of this time. This places the assistant in charge of finding an RN. He said they had an interested GN candidate that he was hopeful would take the position. I gave him the run down on legalities and such as we discussed in previous posts above. He said she was planning on taking her boards in May and thought she could be registered by late June (when camp starts).

I have never heard of anyone getting it done that expiditiously--usually boards in June or July and results in Sept--but thought maybe things have changed with computerized systems now. I also told him he may need to put ads in local papers so they can attract PA licensed nurses who don't need to obtain the out of state permit.

Well, I just contacted him again earlier this week--apparently the GN candidate backed out (maybe she couldn't realistically be registered in time, or maybe something else came up--he didn't say). He seemed a little defensive saying he's had other projects going on and hasn't really had time to devote to finding a nurse.

He already knows, per my offer during the first meeting, that I will set up the health center, help orient health staff, and be present to help train and oversee the first couple of opening days, and closing days as well.

However they will not be able to fall back on me for the rest of it, should they not come up with other nurses. If camp has to close, so be it. Maybe they need to learn this. I tried my best but apparently health center planning is still an 'afterthought'.

How soon does your camp begin health center / infirmary planning?

Alex Egan, LPN, EMT-B · May 5, 2014

A lot of camps come dangerously close to having no nurses. It amazes me how down to the wire the directors let things go. The other thing is in PA a nurse is not required to run a camp. The administrators or a designated person can handle med administration. The camp regulations in PA are quite loose compared to other states such as NY.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

lawrencenurse · May 9, 2014

Per New Hampshire law - it has to be direct supervision of a new grad nurse. They can't do anything without an RN right there. Thanks to computerized nursing boards, you get your results in 2-4 days and can be immediately licensed depending on the states that you pick to do your boards through. In New Hampshire, you have to do all your fingerprints and stuff before you get your authorization to test from the state so your license is immediate once you pass. I'd be surprised if they would be able to get a test date in May since you can't test until final grades are posted. My last New Grad nurse (didn't pass her boards - bad situation) couldn't get a date to test until 4th of July at the earliest. When she failed that left us completely without a second nurse for more than 2 weeks. We did eventually get nurses through a temp agency but it was a very difficult summer.

Lucky for us New Hampshire is a compact nursing license state so its easier to recruit nurses from out of state. PA isn't which makes it harder. We've recruited from non-compact states and have struggled to remind nurses that AT BEST its 8-10 weeks for the board to issue you a NH license and there is no "temporary licensure" in our state. I've had to send nurses home before because they thought that they could just walk in and be licensed in NH.

Good luck and I hope it works out!!!

CampNurse1 · May 23, 2014

Merilyn, I wonder if your camp is professional enough to want to mess with. With their staff turnover, who knows what kind of atmosphere you will get. Ideally, a new Camp Director should be hired in the fall. One coming in this late will spend most of the summer just learning the job and the personnel. I would guess healthcare would be a low priority.

I worked at a camp one summer with a non-professional administration and a dysfunctional, squabbling board of directors. The year-round staff had dabbled the winter away. One of them came to me, in tears, the day before orientation, telling me she was not ready for camp. That summer was spent flying by the seats of their pants. I found the health center to be un-maintained over the winter, with moles under the floor, and the floor in my bathroom collapsed. I found the records from last year in a hodge-podge, with many records missing, or never created. Many of the supplies had rotted over the winter. It had never been given any thought. They were due for ACA accreditation that year, as well. I arrived one week before camp. It took a day or so to figure out this camp was not well run, but I decided to stay because the staff was so darn well meaning. They served inner city kids, and I figured they needed all the help they could get.

I remember grinding my teeth at the check-in table, being presented with campers with no health history, no consents, etc., because these things had not been addressed during the winter. I told the boss these were ACA violations. He told me to sign them in anyway. I wrote in the nurse's notes on the check-in sheet over and over, "Admitted per the Camp Director's instruction." It was they only way I could think of to protect myself. Mom or dad would tell me they would be sure to fax the forms in first thing tomorrow. Of course, the forms never arrived. I thought it was interesting how many inner city homes in Philadelphia had fax machines, lol. I lucked out, and kept my license somehow that summer. You should have seen the med passes. I had to insist on identifiers. I think the lay people around me thought I could pass pills with a pea-shooter. I did my best, and, looking back, I believe the staff did their best, also. They just were not up to the job, and had less than the best leadership.

The staff I work with now are career camp professionals. They are not moving on in the fall to finish school or to follow other pursuits. My current Camp Director has been here for 15 years. Our Administrator has been here for 20 years. Our year-round staff has been here for 8 - 12 years and are in there 30s. I am the new kid still with only 4 years out here. My colleagues and I are owners, not renters.

Recruiting nurses can be a challenge, but it is not impossible. Camp nurses are hard to find, but thousands of camps find them every year. I hired three this winter, while interviewing about 20. Merilyn, I suspect your assistant director spent the winter goofing off. The best he could do in the whole region was find a possible GN? I don't buy it.

Big Al, I think Alabama copied the PA nurse practice act, or vice versa, since the wording is almost identical. I have a license in GA, also, and they do not allow for GNs, so it depends on the state. As always you are bang on. In the states that allow GNs to practice, an RN has to be at least on the premises. I'd stay closer than that, for it is the RN's license at stake. A solo GN is a terrible idea. For one thing, if there is no RN, you are committing a criminal act. ACA doesn't allow it. And what if he/she doesn't pass boards? Better to hire a strong LPN, paramedic, or even an EMT.

That being said, I like to hire one new grad every year. They are so darn bubbly! They bring enthusiasm and current knowledge to the table. They make me a better nurse because I want to set a good example for them. Camping gives a new grad a chance to "come down" from nursing school, and there is opportunity for networking with her veteran colleagues before moving on to that real job in the fall. Some of them even make a career of camp nursing. Nowadays, you can sit for NCLEX in 4 - 6 weeks after graduation, just in time for camp.

Boy, did I meander around in this post, as usual! Bottom line: Hopefully, Merilyn, by now they have hired a nurse and you are golden. If not, I would not even set up the health center for them. At best, it will be thankless, and, at worst, you will be getting mixed up in something you do not want to be. Good luck!

merilynRN · May 23, 2014

Thank you, very helpful info. As of this time, we have 3 RNs who've worked the camp before willing to help out with a session or 2, but they still had not recruited any new nurses. This is 'scrape by' staffing. It is distressing to see year after year what a low priority they give to the health program and its staff. Thanks for your response.

meri

merilynRN · May 23, 2014

Thank you for your response - no meandering I appreciated hearing your experience. Last year I had told them at the onset that I had another full time job and would not be available but would help train new health staff in the system etc. The nurse they ended up hiring did not want to hear anything from me so I bowed out. It turned out to be a disaster of a summer in the health center for them and she was fired. (No one had checked her creds and she was not an RN!!!) I came in later in the summer and it took a week to straighten out the mess (junk and food all over, no system) she had called 911 for things that were not 911 calls. Huge expense to the camp. So this year I was trying to save them from another such mess.

Yet, there have been no more meetings (as there usually was with previous camp director) to discuss the health program and ongoing process of setting up the health center so I gave them a list of what I have done so far and what I will need to do. It is very frustrating that there is such poor communication. It's like pulling teeth to get things done, or like an 'intrusion' upon this assistant's day each time I try to get something done that will necessarily involve them (for funds for example). New director arrived last weekend but apparently still have to deal with the assistant as no meetings with the director yet. You are so right about 'thankless'.

meri