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Living and Working as a Nurse in Houston

Posted in Nursing Jobs

The University of Texas M. D. Anderson Cancer Center (Photographer: Wikimedia Commons/Zereshk)

The University of Texas M. D. Anderson Cancer Center (Photographer: Zereshk)

Home of NASA’s Mission Control Center, Houston is also home to some of the best hospitals in the country. Some of the best nursing jobs in Houston can be found at the Methodist Hospital, St. Luke’s Episcopal Hospital, University of Texas M. D. Anderson Cancer Center, Memorial-Hermann Texas Medical Center and TIRR Memorial Hermann, which are all well-rated by  US News and World Report, and all have high-ranking specialties.

Many Houston nursing jobs are in hospitals located on Portsmouth Street, including Bayou Medical Center, or Fannin Street, where the Women’s Hospital of Texas is located. The Shriners’ Hospital for Children and Kindred Hospital Medical Center are also located on Fannin.

Nurses working in the Houston area have salaries that are moderate as the cost of living is also somewhat middle of the road.  Staff RNs average about $66,000 per annum. Licensed practical nurses average just under $42,000 per year, with CNAs averaging just under $29,000 in annual pay. All figures are from Salary.Com for 2012.

For travel nurses visiting the city, there are all sorts of places of interest to see and experience, from the Johnson Space Center to the Houston Museum of Natural Science to the Theater District and the Aquarium. Plus, there’s the Mahatma Gandhi District, the Houston Zoo and the Houston Arboretum. Sports enthusiasts will surely enjoy watching the Astros, the Rockets, and the Texans, and a pilgrimage to the Astrodome is also in order. History buffs will have fun checking out the Clayton Library and the Sam Houston Hotel, or strolling around the Fifth Ward’s Frenchtown – or taking a trip west to see the San Jacinto Battleground in La Porte, which is about a half an hour away.

Houston night skyline (Photographer: eflon on Flickr)

Houston night skyline (Photographer: eflon)

Whether residing in Houston or visiting as a travel nurse, getting around is not too bad, as the center of the city is laid out in a grid. Interstate 45 (also known as the Gulf Freeway) cuts through and then skirts the city to the west, and then it arcs around to the north. Route 610 makes a ring around the city and then another ring, Route 8 (Beltway 8), goes around that. Route 59 proceeds from the southwest to the northeast. It eventually intersects with Interstate 10.

Houston travel nursing jobs are often in the Fannin Street area, which is to the southwest. That area is near Route 59 and Route 288.

Another popular transportation option in Houston is the comprehensive public transportation system. METRO (the Metropolitan Transit Authority of Harris County) consists of buses and regional rail. The Red Line travels from Fannin Street South to the University of Houston Downtown stop.

Housing is more expensive the closer you get to the center of things. Prices can be very high in affluent bedroom areas such as Washington Avenue and the Allen Parkway area. Prices are a bit lower outside of the city, in areas such as Tomball and Jersey Village. According to Trulia, the market is on the rise, but overall sales seem to be decreasing in early 2013. Apartment living can be in modern townhouses or developments.

Educational opportunities are plentiful, as Houston is home to a concentration of great colleges and universities. Nursing programs are available at (among others) the Houston Baptist University, Prairie View A & M and Texas Women’s University. All of these schools can improve the experience of nursing in Texas.

Houston – it’s an impressive global city. Got any more insights into living and working in Houston? Let us know in the comments section!

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Living and Working as a Nurse in Indianapolis

Posted in Nursing Jobs

One of the most recently revitalized cities in the United States, Indianapolis is home to some great Midwestern hospitals. Some of the best nursing jobs in Indianapolis can be found at the St. Vincent Hospital and Clarian Health Partners, which are all well-rated by  US News and World Report, and have high-ranking specialties.

Many Indianapolis nursing jobs are in hospitals located on various numbered streets, including the Richard Roudebush VA Medical Center and Wishard Health Services.
Nurses working in the Indianapolis area command salaries that are moderate as the cost of living is about average compared to the rest of the country.  Staff RNs average about $67,000 per annum. Licensed practical nurses average about $40,000 per year, with CNAs averaging just under $28,000 in annual pay. All figures are from Salary.Com for 2012.

For travel nurses visiting the city, there are all sorts of places of interest to see and experience, from the Children’s Museum to the Museum of Art. Plus, there’s the Indiana Repertory Theatre, and the Kurt Vonnegut Memorial Library. Sports enthusiasts will surely enjoy watching the Pacers and the Colts, and a pilgrimage to the Motor Speedway and Hall of Fame Museum is a must. History buffs will have fun checking out the President Benjamin Harrison House, or strolling around the Colonel Eli Lilly Civil War Museum – or spend time at the Indiana State Fair in November.

Whether residing in Indianapolis or visiting as a travel nurse, getting around is not too bad, as the center of the city is laid out in a grid. Interstate 465 rings around the city and intersects Interstate 74. The White River runs to the west of the city and is crossed at Maryland Street.

Indianapolis travel nursing jobs are often in the downtown area, which is where a lot of the numbered streets are. Other downtown cities are named after presidents or states, with New York Street cutting all the way across from east to west, and Pennsylvania Street traversing north and south.

Another popular transportation option in Indianapolis is the comprehensive public transportation system. IndyGo (the Indianapolis Public Transportation Corporation) consists of buses with connections to CIRTA (Central Indiana Regional Transportation Authority), a regional rail service. Several of the bus lines service area hospitals, particularly the #10 and the #28.

Housing is generally more expensive the closer you get to the center of things. Prices can be higher in affluent areas such as Forest Hills, Herrin-Morton and Windsor Park. Prices are lower in the Warren Park and Devington areas, and are rather low in comparison to other parts of the United States. According to Trulia, the market is in flux, with many listings rising but sale prices falling in early 2013. Apartment living can be in modern townhouses or sometimes in developments.

Educational opportunities are plentiful, as Indianapolis is home to a concentration of great colleges and universities. Nursing programs are available at (among others) Indiana University, Purdue University, Marian University and the University of Indianapolis. The experience of nursing in Indiana can be greatly improved by attending any of these schools.

Indianapolis – it’s not just the Speedway. Got more great ideas about living and working in Indianapolis? Feel free to add them in the Comments section!

Care Coordination: Opportunities for Nursing

Posted in Nursing

Coordination of care is not a new role for nurses, but it has never been fully appreciated. As nurses, we coordinate patient care and ease the transition from hospital to home, often preventing readmission to hospital and improving the quality of patients’ lives. Finally, this vital role is being seen as a valuable one, not just in terms of patient care, but in financial terms for nurses who perform this essential service.

The Medicare fee schedule is set to change in January of 2013. It contains new codes that will have a great impact on care coordination, which is typically performed by nurses in a physician-supervised setting. Currently, reimbursement for non-face-to-face visits is lumped under payment for face-to-face visits. Both physicians and nurses have argued that the current codes are insufficient, as they do not account for communication with persons other than the patient, home visits or conveyance of patient information over the phone, common practices which are not adequately addressed under the current codes.

“Specifically, this HCPCS G code would describe all non-face-to-face services related to the TCM furnished by the community physician or qualified nonphysician practitioner within 30 calendar days following the date of discharge… The post-discharge TCM service includes non-face-to-face care management services furnished by clinical staff member(s) or office-based case manager(s) under the supervision of the community physician or qualified nonphysician practitioner” (Centers for Medicare and Medicaid Services, 2012).

Required elements for post-discharge transitional care management include:

  • communication with the patient/caregiver within two (business) days of discharge (communication by phone, electronically or face-to-face)
  • medical decision-making of moderate to high complexity
  • to be eligible to bill for the service, there must be a face-to-face visit with the patient within 30 days of the transition in care or within 14 (business) days following the transition in care

What does this mean for nurses? Nurses provide an essential service and should be reimbursed for this service, according to the American Nurses Association. Care coordination activities are often performed by RNs and have been shown to reduce patient costs, improve outcomes, prevent readmission to hospital and increase patient satisfaction. This move by the CMS increases the likelihood that nurses may soon be able to directly reimburse for these services. This may create the need for new nursing jobs to fill the growing need for nurses skilled in this area, particularly as the population is aging rapidly and more elderly individuals are living in the community.

As physicians will be able to bill for services performed by nurses who provide transition services, this will encourage the growth in jobs in this area. “Although the rule does not allow separate billing for care coordination, some private insurers likely will use the codes to reimburse providers directly for the service…[reimbursement policy] could expand the RN job market and raise recognition for nurses” (Nurse.com, 2012).

Sources:

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DMEFace-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013. Centers for Medicare and Medicaid Services, 2012.

CMS rule creates reimbursement opportunities for RNs. Nurse.com, November 15, 2012.

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