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Concierge Nursing for the Entrepreneurial RN


These days, it’s not uncommon for patients to wait days or even weeks to see a doctor. When they finally do get an appointment, they will often endure hours of sitting around a crowded waiting room with other sick patients, only to spend a scant few minutes with an overworked physician.

Also known as boutique healthcare, concierge medicine refers to an arrangement in which patients pay a monthly fee in exchange for enhanced services such as home visits, email consultations, and same-day appointments. While the typical GP sees thousands of patients a year, a concierge physician’s roster tops out at around 500. As patients grow increasingly frustrated with managed care, more individuals are turning to concierge medicine, and concierge nursing, for a higher standard of treatment.

Concierge Nursing Versus Concierge Medicine

While doctors have traditionally been the ones to offer concierge care, today nurses are jumping on the boutique bandwagon as well. Although they can’t legally perform the same functions as doctors, such as prescribing medication and diagnosing conditions, nurses can and do offer a number of valuable services to patients in needs. Here are just a few of the many services that concierge nurses perform in their patients’ homes:

Post-surgical recovery – which involves assisting patients who have undergone a traditional or plastic surgery procedure. Concierge nurses often change dressings, prepare meals, help with hygiene, and provide transport to and from doctors’ offices and physical therapy appointments.

Illness and injury support – from repositioning bed-ridden clients to helping them perform activities to enhance range of motion, concierge nurses provide necessary assistance following an illness or injury.

Help at doctor visits – as a concierge nurse, you may accompany patients to their doctors’ offices, helping them relay symptoms, understand diagnoses and medication instructions, and ask the right questions of physicians. Additionally concierge nurses offer patient advocacy services, ensuring clients have access to the care they need from GPs and specialists.

Travel nursing care – concierge nurses may accompany patients on business and personal trips to help manage their care and treatment while away from home.

Medication assistance – concierge nurses help ensure medications are taken in the correct quantities and at the designated times.

Blood draw services – ideal for homebound patients and seniors who would prefer not to visit a clinic for their phlebotomy needs.

Benefits of Concierge Nursing

If you’re an RN with entrepreneurial sprit and an interest in providing more personalized care, concierge nursing may be a great option. While nurses in doctors’ offices and hospitals are often overworked, rushing through basic tasks and patient consultations, concierge nurses have the luxury of spending as much time as necessary with their charges. They can feel confident knowing every patient is receiving the most personalized and specific care in the comfort of her own home.

Additionally, concierge nursing can be incredibly lucrative. According to one source, the average concierge care nurse earns $55,000 a year, though RNs and nurse practitioners in higher-income cities and towns may earn almost twice this amount.

If you’re an experienced RN with the urge to strike out on your own, concierge nursing may be the way to go.

The Problem with Pain


Pain management is a vital, but tricky part of nursing.

Pain management is a vital part of nursing care. It can be tricky to measure, since there is no definitive test or scale to measure pain with complete accuracy and a completely objective interpretation of pain is usually not accurate.  As a nurse, you will rely on helpful tools, the patient’s report, your senses, intuition and the patient’s history.  Pain is nothing to brush off. It is the body’s way of communicating that something is wrong. You have the power to get your patient on the road to relief and comfort, with a little detective work.

In So Many Words

When you are doing a pain assessment, your patient will be verbal, cooperative, and oriented. This is in a perfect world, of course! If your patient is able to communicate with you, document where the pain is located, when it began, if there was an incident the patient remembers that instigated the pain, what makes the pain worse, and what makes it better. Then, it is helpful to ask the patient to describe what the pain is like. There are so many words to describe pain; pounding, aching, sore, tender, gnawing, cramping, etc. Sometimes the patient will say the pain feels like something, such as a vice, a tight band, or like a needle, to name a few. Accurate documentation of exactly how patients describe their pain can be vital to the treatment and pain management.

A Painful Puzzle

I remember an elderly patient who was cognitively impaired, who had fallen and broken a hip, and his arm in two places. He could communicate with phrases sometimes, and drifted in and out of reality. By the time my shift with him began, he had gone 12 hours without any medication for pain. He was grimacing, moaning, and shifting about in his bed. But when the nurse before me had asked him if he was having pain, he whispered “No, no, no.” Because she took his verbal report only, and did not take his non-verbal cues into consideration, she missed an opportunity to bring this gentleman relief from the discomfort he was obviously in. So how does a nurse assess pain in a patient who can’t answer back, such as a baby, a small child, or a person with dementia?  The first thing to consider is the history. If they just had an injury, a surgery, or a raging ear infection, it’s a safe bet that they are probably in some pain. Non-verbal cues that might indicate pain can be crying that can’t be soothed with ordinary methods, guarding a body part, grimacing, sleep disturbances, restlessness, reluctance to be touched, withdrawal, or poor appetite. A small child might be able to point to a sad face on a Faces Scale, indicating how severe their pain is.  Children and the elderly are sometimes wrongly viewed as making up or exaggerating their pain, which is something to consider when doing your own evaluation.

Putting the Pieces Together

With a detailed history, the patient’s report, your own observations, and use of the many pain evaluation tools and scales available, you will have the clues you need to effectively comfort your patient. The most important thing to keep in mind is that pain is whatever the patient says it is. Different people react to pain in different ways. Some may break down in tears, some may be stoic. Patients may even be reluctant to say anything, because they are concerned about being “a bother.” Assess pain regularly, listen and note cues,  and follow an appropriate pain management plan.  Your patient will experience comfort and the peace of mind of knowing they are in capable, caring hands.

Four Moving Tips for Busy Travel Nurses


Travel nurses have a lot to worry about on the road.

Travel nursing is an exciting career that affords talented RNs the opportunity to do what they love while meeting new people and seeing the world. However, the profession can also be a stressful one, as travel nurses must uproot their lives whenever a new assignment comes along. Here are four moving tips designed to smooth the relocation process for busy travel nurses:

1. Ask About Relocation Assistance

It’s no secret that moving costs can take a serious toll on your bank account. If you’re thinking of accepting a new travel nursing post, consider requesting that your employer pay all or a portion of your relocation expenses. While many companies budget for employee relocation, they won’t necessarily offer these funds to workers unless they ask. Don’t be afraid to negotiate for moving expenses along with your salary and benefits after receiving that employment offer. After all, skilled nurses are in high demand right now, and you shouldn’t hesitate to take advantage of that fact when applying for travel posts.

2. Review Your Contract

As thrilled as you are to receive that travel nursing offer, it’s important to review the contract carefully before signing on the dotted line. Unlike those in traditional nursing positions, travel nurses may be required to “float” among different departments, regardless of their areas of expertise. Additionally, these positions may not guarantee you a set number of working hours per week. Before accepting a travel nursing job, make sure the position really does fit your needs and that you will be comfortable performing all the tasks required of you for the length of the assignment.

3. Inquire About Amenities

Once you’ve accepted your new travel nursing post, you will likely begin wondering what to pack. Before you start stuffing all your belongings into suitcases, call and ask what supplies will be provided at your new accommodations. In most cases, the recruiter or employer provides basic furnishings, while nurses are responsible for items like sheets, towels, and cookware. Find out what you do and don’t need to bring ahead of time so there won’t be any unpleasant surprises upon arrival.

4. Collect Crucial Documents

These days, travel can be more complex—and stressful—than ever. Before leaving on that new nursing assignment, take the time to get all your paperwork in order. Along with your contract and services agreement, you should gather your licensing and identification documents including:

  • Driver’s license

  • Passport

  • Birth certificate

  • BLS card

After all, it’s better to be over-prepared for an assignment than find yourself in another state or country without the proper documentation.

If you’re considering a career as a travel nurse, the idea of uprooting your life every few months may be stressful enough to dissuade you. However, the truth is that travel nursing can be a great career for those with a strong sense of adventure and a passionate desire to help those in need, provided they can stay organized. By following the above tips, you can make the relocation process as easy and painless as possible, leaving you free to focus on what matters: choosing your next destination!

Be the Nurse that Everyone Requests


As a nurse, you will have important encounters with many people.  They will be patients and their families, endowed with a mind-boggling array of character traits, communication styles, and personal beliefs. Often, they have endured a lot of hardship before they meet you. Illness, pain, uncertainty, and long wait times can make the encounter fraught with tension and frustration. Luckily, there are tried and true techniques to transform a challenging situation into a win-win for everyone.

The First Ten Seconds

Nurses are among the most trusted professionals. Your patients will rely on you to set the tone in the room.  Your demeanor has the power to help reassure, calm, and provide hope.

The first few moments are a good time to convey your message, and make a great impression.  The method is simple, effective, and easy. Approach each person with the understanding that they only want to feel better, and be understood. Good eye contact and a smile may seem clichéd, but are powerful non-verbal cues that you value your patient.

If a patient says something, listen non-judgmentally, and avoid correcting if possible.  If you enjoy humor, try to feel around and see if the patient would appreciate a light-hearted joke. If you can get a patient laughing, there’s no better medicine.

You Expect me to do What?

Painful and unpleasant procedures are sometimes a necessary evil in the workflow of a nurse. The age of the patient can have a profound impact on the level of cooperation, and ability to handle discomfort.

Children often make mental leaps to the most frightening conclusions, and may not fully comprehend your instructions. A little boy receiving kindergarten vaccinations once asked me if the needle would go all the way through his arm, and if he was being punished for being naughty. All patients do well knowing what to expect, in clear terms, on a level that they can understand, before the procedure is done. An opportunity for them to ask questions in advance, and explain the procedure in their own words can help assuage any fears.

If you are called upon to perform painful procedures regularly, become really, really good at them. Practice as often as you can, and learn distraction techniques, such as coughing or counting backwards during a shot. Soon, you’ll have people requesting you and only you to come poke them!

The Little Things

Being a great nurse can be as simple as bringing another warm blanket to the patient who is shivering under the air conditioner. If you know what your patient likes, and can have a certain kind of snack, and sneak one into their room without being asked. If a worried family member apologizes for asking so many questions, invite them to ask a hundred more, any time they want.

Some computer charting programs will allow nurses to put a note on the chart that will pop up only for you, every time you open that particular chart. If you learn that your patient has a new grandson, or is planning on running a marathon, make a note of it, and remember to ask them about it the next time you see them.

These techniques may seem like too much to take on, with your overflowing list of tasks to be done. You will be amazed at how practicing them will end up saving time, and decreasing stress. Your patients will be happier, and you will too, knowing that you have contributed to healing their body and spirit.

Five Causes of Our Nation’s Nursing Shortage


As you may have heard, the U.S. is on the verge of a serious nursing shortage. In fact, if the problem persists, the number of qualified registered nurses will not be able to meet healthcare demands over the next decade. Here are five reasons for the impending crisis:

1. Aging Populace In Need of Care

America’s largest generation is getting older. The Baby Boomers, or people born between 1946 and 1964, account for almost a third of the U.S. population, and they’re currently reaching retirement age. As older individuals tend to require more medical care, additional healthcare workers are needed to fill the void. Without an increase in the number of qualified RNs, patient care is bound to suffer.

2. Rise in Number of Insured Patients

One of the provisions of the Affordable Care Act is universally mandated health insurance. As more individuals join the healthcare rolls, the number of patients visiting their doctors for routine check-ups and other treatments is expected to rise as well. Because there aren’t enough physicians to cover this increase in patients, many practices are looking to nurse practitioners and nurse-managed health centers to help pick up the slack. As a result, more RNs are needed to meet the increased demand.

3. Lack of Skilled Nursing Instructors

Combatting our nation’s nursing shortage requires that we graduate more qualified RNs. However, according to the American Association of Colleges of Nursing, U.S. nursing schools rejected more than 75,000 applicants from graduate and baccalaureate nursing programs in 2011 due to a lack of teachers. Nursing programs are struggling to find experienced faculty members who are willing to relocate to schools in need of instructors. Additionally, many nurses hesitate to leave jobs in hospitals and doctors’ offices to accept lower-paying positions in academia. Whatever the reason, there simply aren’t enough qualified instructors to teach the next generation of nurses.

4. Lack of Interest in the Nursing Profession

Along with faculty shortages, many nursing schools are struggling to attract top talent. In the past, nursing was one of the few career options open to female students. However, as opportunities for women increased, the number of young people entering the nursing industry declined. As a result, the current nursing population is aging rapidly. With the Health Resources and Services Administration projecting that over a million RNs will hit retirement age in the next 10 to 15 years, the nursing shortage is only expected to worsen.

5. High Turnover Due to Poor Working Conditions

While experienced nurses may enjoy greater flexibility in the workplace, employment opportunities for new nurses are hardly glamorous. Along with regular overtime shifts, younger nurses are often expected to work nights, weekends and holidays. Many new nurses opt to leave the business in favor of a career with more flexibility. Additionally, lack of staffing may lead to an increase in medical error and patient infection. The stress of working at understaffed hospitals and offices leads many nurses to exit the field early.

Despite the many challenges of working in the nursing field, the shortage is going to result in an unprecedented demand for skilled registered nurses. In fact, the Bureau of Labor Statistics is anticipating over half a million new nursing jobs between 2012 and 2022. Whether you’re currently attending college or on the verge of enrolling, you may want to consider a career in this growing field.