Hi,

I just started at a home health agency that requires ME to open cases, recert, and discharge Medicare patients. The home care agency I worked at before was private duty nursing and my nurse supervisor would do all of the above. I would follow the plan of care, educate my patients, and alert my nurse supervisor about any changes to my patients status.

I am very nervous and feel I am not competent in my nursing career to open cases, recert, and discharge patients. I told my new agency that I never done any of this before, but they said I will get the hang of it. I have only been a nurse for 2 years and I have never worked in a hospital.

I was trained for 1 week by the nurse I am taking over but it was not very thorough and the LPN that works at the retirement center I will be providing care at is not helpful at all.

How do I know when to recert patient? For example is educating the patient about their disease and medication enough to recert?

My DON works out of the corporate office which is 30 miles away. She said I could call her with questions anytime, which I will but I do not want to appear incompetent.

Are there any online resources about this or can anyone give me some pointers.

Is there a list of skilled nursing cares I can use to justify the need for an RN visits?

Thank you!

Teaching is always a justified reason to make a skilled nursing visit.

Why are you selling yourself short? You are a nurse and you know when a patient has an exacerbation don't you? If a patient has had a recent med change, it exacerbates a disease process. Were they started on a new HTN medication, was a dose changed or lowered for example would exacerbate them. Have they continued to have a knowledge deficit regarding a disease process? Have they been started on an antibiotic? Have they had a new wound? Are they in need of therapy? There are so many reasons to recertify a patient. I mean with an elderly person it is pretty easy to find a reason to keep them on services.

You recert a patient every 60 days. You are following the patient and assessing their progress. If they are on service for something very specific (i.e. wound care) and it completely resolves, you discharge them once all their goals have been met.

I guess I am really nervous about working independently and not having any support with me. I used to rely on my nurse supervisor to make the final decisions, but now the tables have turned.

I also have not worked in 5 months because we moved to a new city, traveled for a month before settling in, and I had to wait for my license to transfer.

I feel like a new grad sometimes. It's an awful feeling.