Taking a trach/vent pt to school

HopefulRN7 · Apr 14, 2016

Can you try a rolling cart to carry everything else"' It is like a milk crate on wheels and it will carry the o2 and all kinds of other stuff, I got mine at Staples for about $30

This is a brilliant idea, one I wish I would have had at the time. Great investment

smartnurse1982 · Apr 14, 2016

Very few companies pay more for trach vent. There is no longer additional reimbursement for high tech cases in many states like NJ. You take the cases because you have the skills.

I believe the school district is paying to send the child to school. The school is private.

My agency does pay more for high tech cases if the child has private insurance.

They do tell us if a client has private insurance before starting a case.

My agency does not make all high tech nurses take high tech cases.

It's all strange,so much that a basic case with private insurance pays more than a high tech Medicaid case.

smartnurse1982 · Apr 14, 2016

Some school situations would allow you to store certain items at the classroom area so you would not have to transport a lot of stuff every day. The school where I went required that we keep our "supply" of O2 tanks in a special area at the school. Still needed to take an E tank back and forth but I knew that there was a backup at the school. I've often felt akin to a pack mule every time I had to transport my patient here and there. At least if you work in the home, you can limit these outings to occasional appointments outside of the home. Often, the parents don't even want the nurse tagging along, but then there is no work for that day.

I only work 2 day shifts but now i am going back to an all-nights schedule.

My agency has more trouble filling day shifts more than evening and night shifts.

Many nurses do not like going to school with clients.

JustBeachyNurse, LPN · Apr 14, 2016

I believe the school district is paying to send the child to school. The school is private.
My agency does pay more for high tech cases if the child has private insurance.
They do tell us if a client has private insurance before starting a case.
My agency does not make all high tech nurses take high tech cases.
It's all strange,so much that a basic case with private insurance pays more than a high tech Medicaid case.

You posted your state before.

It doesn't matter if private or public school the public school pays the nursing agency. Then Medicaid reimburses the school district: $20.07 per day for AM RN. Not per hour. School districts have fixed contracts unlike private insurance. Even high tech the Medicaid rate is less than $20/hr closer to $15 for one Medicaid HMO. .

caliotter3 · Apr 14, 2016

I've always preferred night shift over day shift anyway, primarily for the peace of mind of having the family in bed instead of hovering over my shoulder. As many times as I've been thrown to the trash after working my rear off in case managing a client during day shifts, I now shy away from day shift and all the extra work. I can do most administrative tasks while working at night anyway, so don't need the added potential drama. Some day shift nurses only want to work cases where the parents are absent and they can spend most of the shift watching TV or on their cell phone. That is not for me. I did not mind going to school with my patient, but that was an easy case. Most of them are not necessarily that easy.

The agencies that I've worked for that said they "paid more" for high tech cases never explained why those rates were the same as what other agencies paid anyway. One even told me that their rate of pay was competitive when I had seen via the internet that they had just lowered their range by $4 an hour! Four dollars an hour may not seem like much when you are salaried management, but for those of us at the bottom of the wage totem pole, it is a very substantial loss.

HopefulRN7 · Apr 15, 2016

I've always preferred night shift over day shift anyway, primarily for the peace of mind of having the family in bed instead of hovering over my shoulder. As many times as I've been thrown to the trash after working my rear off in case managing a client during day shifts, I now shy away from day shift and all the extra work. I can do most administrative tasks while working at night anyway, so don't need the added potential drama. Some day shift nurses only want to work cases where the parents are absent and they can spend most of the shift watching TV or on their cell phone. That is not for me. I did not mind going to school with my patient, but that was an easy case. Most of them are not necessarily that easy.
The agencies that I've worked for that said they "paid more" for high tech cases never explained why those rates were the same as what other agencies paid anyway. One even told me that their rate of pay was competitive when I had seen via the internet that they had just lowered their range by $4 an hour! Four dollars an hour may not seem like much when you are salaried management, but for those of us at the bottom of the wage totem pole, it is a very substantial loss.

Nothing like busting your rear and going the extra mile everyday to have families basically **** on you and act like they're owed something. Also the ones who hover as you mentioned- and plan out every minute of your day with what to work on with the patient despite your nursing judgement (ex: Please PO feed "so and so", I know they're falling asleep and vomiting through their trach but they need to learn to eat!")

Catcar1963 · Apr 22, 2016

Exactly what I was going to say. See what supplies you can store at the school so you only have to lug the DME with you.

smartnurse1982 · Apr 24, 2016

Exactly what I was going to say. See what supplies you can store at the school so you only have to lug the DME with you.

You cannot store O2 tanks and BMV's at the school because you still have to bring it on the bus with you just in case you actually need to use it while on the bus.

The family only gets 1 feeding pump,neb machine,only has 1 extra vent circuit,and 1 pulse ox machine.

Kitiger, RN · Apr 24, 2016

You cannot store O2 tanks and BMV's at the school because you still have to bring it on the bus with you just in case you actually need to use it while on the bus.
The family only gets 1 feeding pump, neb machine, only has 1 extra vent circuit, and 1 pulse ox machine.

Exactly, and the spare vent circuit goes in the go-bag, too, as it has to stay with the patient.

Schools will store extra oxygen tanks for a patient who uses a lot on the bus. The DME supply company can supply an extra oxygen concentrator to be kept at school.

Some families buy nebulizers on eBay. Some supplies can also be purchased there; Medicaid doesn't always supply enough. There isn't much you can do about getting an extra feeding pump and pulse ox, other than to order a second one when it's allowed. Medicaid usually will pay for a new one after 5 years.

I have worked in homes where the DME supply company allowed 2 vents in the home, one for stationary and one to travel. These usually were homes that were a good distance from the supply company. All trach homes have 2 suction machines. one to travel and one stationary.

I would suggest that the parents delay replacing the vent circuit a few times, say go a week and a half before replacing, just so they can have 2 back-ups (one spare in the go-bag and a back-up at home.) It's better to have 2 back-ups for critical supplies (circuits, boxes of suction caths, trachs, etc.) that can't be bought in a store.

Trachs can be cleaned and sanitized, for example, and suction caths can be stored in a vinegar solution and reused.