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Archive for January, 2009

Is Nursing Really Recession-Proof?

People will always get sick and need care, but will this make nursing a recession-proof career? The answer is as complex as the recession. Yes, people will always get sick and need care despite the economic status. Yes, the population is aging, more obese and, in general, demands better care.

But can people afford healthcare in a recession? With nearly 50 million Americans presently without any health insurance, it’s more likely they will opt to make the mortgage payment and not seek medical care unless it’s absolutely essential. So while this can mean a cutback in the number of patients being seen or cared for, it also means that those who are seeking care are often sicker than usual.

For those who are insured, the new calendar year has most likely brought higher co-pays, higher deductibles and out-of-pocket expenses as well as other changes in coverage for beneficiaries. These changes will affect the level of care Americans seek. And given a choice between paying the medical bills, buying food, or paying the mortgage; medical bills will more than likely be put on the bottom of the pile. This will impact the providers.

A leading indicator of a recession to health care industry professionals is the rise in the number of knee replacements and gum surgeries according to an article in the March 28, 2008, issue of Business Week. As Americans face possible layoffs and loss of health insurance, they often rush to have elective procedures done. On the other hand, many will forgo even necessary care for fear of losing their jobs for taking time off from work.

As hospitals, clinics, and other providers face financial losses associated with these factors, nurses and other staff will be affected. Some hospitals and other facilities have already instituted hiring freezes and a few have laid off staff. The nursing shortage isn’t going to go away because we are in a terrible economic crisis. Between 2006 and 2016, the BLS estimates that we will need 23% more RNs.

The really bad news is that economic situation is not expected to get better until it actually gets worse first. It is estimated that an additional 4.2 million Americans are likely to lose their health insurance coverage before the economy recovers.

Illness doesn’t take economic factors into account. The population today is older, more obese and more prone to chronic diseases. Those who face cancer, heart disease and emergency medical situations will need care whether they can afford it or not. Many will be sicker because they have put off seeking care until absolutely necessary which will tax the system even more. Should there be an epidemic or medical crisis during this recession, it could turn into a real medical mess!

Nurses are likely to find themselves placed in a precarious situation of being leveraged with the heavy hand of administrators threatening them to take on increased patient ratios or face layoffs themselves. This is going to be a time when nurses need to unite and stand strong in the face of adversity to not lose the small amounts of ground we have gained in this fight so far.

As the economy recovers, history has shown with past recessions that patients will rush the health care industry and it can be difficult to build back staff quickly enough to keep up with the demand. Because of the growing shortage of nurses, it is important for more people to continue to become nurses. There may be a shortage of jobs for new nurses for awhile, but as the economy recovers, this situation will improve and new nurses will once again find multiple options.

The nursing profession is not entirely recession-proof, but nurses are certainly positioned to be less likely to be laid off than many others. Will they be affected by the recession? Without a doubt.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of TheNursingSite.com.

Tax Time

Posted in Nursing, Travel Nursing

Tax Time

In an economy where every penny is highly valued, filing for an income tax refund can be high on the To Do list. So it’s time to dig out all those receipts and make a list of possible deductions.

Nurses have the potential for many different outright deductions as well as properties to depreciate, but these should be discussed with a tax advisor as they may not apply in all instances. Tax laws change almost yearly and what was once allowed may no longer be applicable so be sure to check each item.

Some of the items that should be considered include uniforms and cleaning costs. For example, some facilities require nurses to wear scrubs that they provide and they charge a periodic rental/cleaning fee. This cost may be deductible. The outright purchase of uniforms and any special shoes may be deductible as well. But if you wear those tennis shoes all the time, they may not be eligible.

Fees for continuing education courses (ceus) for license renewal, as well as any courses taken to improve your job skills or to allow you to advance your career may qualify as well. Some related expenses such as travel and meals may also qualify, but there are a lot of restrictions and you will really need professional advice on this one.

In the past, nurses could earn ceus while on a cruise and then these deductions came under strict scrutiny of the IRS. Travel excursions to foreign hospitals and clinics also got put under the microscope and the IRS clamped down, so beware if you have this kind of deduction to apply.

While it can be difficult to carve out the personal vacation experiences from the educational/business side, with careful record keeping, it can be done. Some expenses are considered too lavish and extravagant to be business deductions. Your tax advisor can help you.

Moving expenses and the costs related to looking for a new job can be considered deductions if they meet certain criteria. If your spouse took a new job in another state and you had to pay for a new nursing license and perhaps had to make a trip to the new area to interview for a job before you moved, these expenses could be deductible.

A professional library of books and trade journals may also qualify for deduction. The type of deduction may vary with the useful life of the items. Drug books for example need to be replaced every year due to updated information and so they wouldn’t be something to depreciate over time.

Equipment such as stethoscopes, PDAs, and all of the little items in your pocket like scissors and clamps can qualify for deduction, so if you purchased any in the past year, dig out those receipts. Other items such as digital cameras and cell phones may also qualify for deduction if used in the course of your business. The monthly fees for a telephone may be deductible as nurses have to take call or be available to be called in to work.

Home health nurses who use their digital camera or cell phone camera to photograph patients’ wounds and decubs could deduct a portion of the cost. You will need to be able to document how much of these items are used for business and how much for personal use. For example, if you have taken 1000 pictures with your new camera and 100 of them are business related, then the business usage would be 10%.

Travel nurses will have a variety of other deductions depending on their situations. The travel nurse agency may be able to advise you on some of the basics, but consulting a tax advisor is highly recommended. Accurate record keeping is an essential part of travel nursing right down to the tips you pay a porter to assist with your bags.

Organization is an essential tool for nurses, and keeping track of business expenses is just another aspect which needs organization. Your tax advisor may cringe when you come in carrying a shoebox full of receipts, but if that’s the best way you can keep track of these items, then at least have that. There are a number of software programs available to help keep track of expenses, mileage, and daily use of items such as cameras and cell phones for business purposes.

Don’t overlook all of the possible expenses you can deduct and set up an appointment with a tax advisor early on in tax season.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and author/owner of TheNursingSite.com

Home Health Nursing

Posted in Featured, Independent Contractor, Nursing, Nursing Jobs, Per Diem, Permanent Placement, Travel Nursing

Home Health Nursing

Have you ever considered home health nursing? Like any other nursing specialty, it’s not for everyone, but it can be a challenging and rewarding career option for the right candidate.

Not to be confused with private duty assignments in the home, home health nursing involves making several visits each work day to a variety of (at least temporarily) homebound patients.

These visits entail a complete head-to-toe assessment which can be brief or complex depending on the patient, the findings, or the physician’s orders. The visit will also include patent and caregiver teaching. Again the extent and complexity depends on the specifics of the situation. Each visit should build on the previous teachings and may involve some sort of return demonstration or pop quiz, if you will.

There may be a task to perform such as assessment and wound care, incision care, IV administration and/or site change, Foley catheter change, G-tube change, etc. The patient and/or caregivers may need specific instruction in the care of these as well.

Or the patient and caregiver may need in-depth instruction for a new diagnosis such as diabetes which would include such things as blood glucose monitoring, insulin or other medication administration, and how to identify and treat the signs and symptoms of hypo or hyperglycemia.

Patients and caregivers may also need instruction in medications including dose, administration, possible side effects, purpose and desired results. Other areas of common patient/caregiver education include specific dietary and nutritional needs or restrictions, and home safety issues.

Teaching caregivers how to safely assist patients with hygiene care (bathing, showering or a bed bath), transfers and ambulation may require the assistance of a PT or OT, but the home health nurse also needs to know how to perform and instruct in these as well.

Home health care is most often ordered by the physician following discharge from the hospital, or it may be ordered in lieu of hospitalization. In most instances it is not expected to be long term, but rather to help the patient and/or caregivers become independent in the necessary care.

For reimbursement purposes, Medicare and insurance companies have specific guidelines and criteria that patients must meet to be eligible for home health care. The home health nurse is responsible for reviewing this and documenting accurately. One of the worst parts of home health nursing is the paperwork! Much of it can now be done using a laptop or hand held computer, but there is still a lot of documentation to be done.

The nurse is the eyes and ears of the physician in the home. Many times home health referrals are made because the physician suspects that the patient needs more assistance or instruction in order to improve his/her outcomes. Or perhaps a higher level of care is needed.

The home health nurse learns to assess a home situation and to make recommendations for durable medical equipment (DME) and other disciplines to participate in the care such as a PT, OT or ST. A home health aide may be added to assist with hygiene care and to teach the patient and/or caregivers how to safely bathe and groom the patient.

If necessary, a medical social worker (MSW) may be called in to assist the patient and family in making more complex short term or long term plans for care, or help them to cope with life changing circumstances.

The beauty of home health care is being able to spend quality time with patients and caregivers one-on-one. But home health care is a team approach and the nurse is not expected to do it all.

It can be scary at times because there isn’t another nurse just down the hall to call for assistance or consultation. But there is backup a phone call away, and with cameras in cell phones, it can be even easier to get that consultation.

The autonomy and the ability to utilize skills that sometimes seem wasted in the fast pace of a hospital setting often draw nurses into the home health arena. Call a home health agency and ask to make a ride-along visit with a home health nurse to consider if this might be something you’d like to explore further.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of TheNursingSite.com

Archive for January, 2009

Is Nursing Really Recession-Proof?

Tax Time

Home Health Nursing

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