thanks for your post. You're right, we don't cut off referrals for low staff. I have at times been able to put off a referral with a doc's permission, usually to the next day. (call the patient and find out how they are, etc, then call doc and get permission). It makes things easier that day (which is great for days we get a ton of referrals or a lot of sick calls or days off).
I know there has been meetings that have included nurses as well as admin that have discussed ways to improve the situation, but honestly I am not sure where that is going-the meetings were weekly and just concluded last Thursday. One of our nurses on my team was going, and was so stressed fitting it in, but I always did all I could to make her day easier and practically begged her to go so she could give admin an idea of what nurses in the field deal with on a daily basis.
To be honest, I'm not sure about recruitment.... I asked my boss if we were getting applicants at all, and she said yes, but that nurses coming from hospitals are making considerably more than we pay, and so far have not wanted to take a pay decrease. I was a little surprised, because 2 years ago there was little difference. But recently, the local hospitals have done a lot to try and lure new nurses/keep the nurses they have, by raising pay rates. In my opinion, homecare has so much to offer, that the pay cut is worth it, but I guess if you need the money, then you need it. So, as far as recruitment, I just don't know.
As for the other things you mentioned....well, lets see, our labs are done by an outside lab (unless if drawn from a line)...I send in the referral to the lab, the lab draws it and faxes the results to the doc and a copy to the nurse. The nurse usually follows up abnormal values, but we get our copies by mail, so the docs usually have already seen the results.....I myself do not even see the results, they come in the mail, go through the secretary into the nurses mailbox. Our opening packs are made up by secretarial staff. All our work is on the computer, and now all our nurses (on our team at least) are up and running with PC's, and only doing paper if their laptop is in overnight for repair. So....for discharge, the only thing paperwork wise is the signed DC form, the rest is all computerized. Same for recerts and ROC's, except they need a "routing slip", which all RN's keep on hand. Most supplies are ordered initially from the hospital. I have been calling in supplies occasionally to help out, it helps save time and cell phone bills. I also do HHA sups by phone when they can be done by phone. I try and field some calls from patients during the day......the secretaries often just page it right out to the nurse, but when I can I try to catch them, and if it's a simple question I can answer I will do so and document as such.
There is so much more, I am sure, we can do. They were talking again about having PT do their own openings (ie on hips and knees), but frankly they've been saying this since I came to the agency, and probably before that, so I am not holding my breath.
I appreciate your advice, it kind of helped me order my thoughts a bit. Hopefully relief is in sight soon. I can't help but think that it won't be long before another nurse leaves.....