New nurse / new to HH / tons of questions - page 2

by tinyRN72 7,816 Views | 37 Comments

Hi all, I just graduated and got my license. My first job is home health. My first week is over and I have found that I have a ton of questions if anyone doesn't mind taking the time to give me some input. 1) Where do you... Read More


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    I have asked and I was told that everything I need would either be at the patient's house, I would order, or the lab would supply. Of course, though, I can't seem to get a supply list to order anything.

    L.O.L.
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    This is ridiculous. You've been given no training at all, sent out and expected to track down your own patient supplies on wild goose chases?

    I know jobs aren't easy to find right now, but if I were you, I'd leave this agency and find one that provides some mentoring. At the very least, you should be taught about OASIS, exactly how to get supplies the patients need, and be able to shadow an experienced nurse for a few weeks. Even that is not nearly enough, imho.
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    I am actively looking for a new agency / internship / or just about any job.... and I am studying OASIS on my own - thanks to this site I found out that I really need to know it. It is ridiculous. I just keep thinking that if I can just stick it out for 6 months (if nothing else comes along) then I can change to a better agency. It is really a shame because I greatly enjoy the actual work. I didn't expect to go into HH, but I really like it a lot and I can see that I would love it if I were working for company that isn't such a joke.

    Thanks all --- at least I now know that it isn't just me who thinks this is crazy.
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    You should NOT be paying for any supplies out of your own pocket. I get lab supplies from the lab- one lab that I use has a program where they supply (free of charge) lab supplies for specimens that are coming back to them. We order the vast majority of our supplies from them even though the vast majority of our labs don't go back to them. There is one specific tube that that lab doesn't use but the one at the hospital that most of our patients come from do use.... I just try to ask for a bunch of them every time I go to drop off labs.

    Doctors/the hospital frequently tell patients "oh just have the home care nurse do that" without ever checking to see if it's something the agency/nurses actually can do in the home. The most glaring example I can come up with is... a patient had a clotted PICC line. His mother brought him to the ER- they did an XRay and confirmed its placement and then changed the cap. They sent the mother home and said "tell the VNA to tPA the line." When she ever told me this, I couldn't have been more mad... they had kept her waiting in the ER for 4 hours to not actually do anything which was more than enough time to tPA the line. We don't carry tPA, the MD never sent an order for tPA, it would have had to be delivered by the infusion company and then it would have required 2 visits within 2 hours of each other to instill and withdraw it. Not a practical thing to do at home when the patient was there in the ER where they easily could have done it.

    Another one that was annoying as could be... a patient (who is followed for every other week IM injections and we do his labs monthly since we're already in there) was at a major hospital for a Renal appointment. Instead of just doing the labs that the patient needed done on that same day, the MD called the agency and requested us to draw a slew of labs (including one that had to be delivered on ice on a day in August where it was 90+ degrees out) on a week when the patient wasn't even due for labs. Why would you just not hand the patient a lab slip at the appointment and say "stop at the lab on your way out"? This patient is not homebound and is fully able to wait at the lab to have his labs drawn. Why ask that we go out and do them on a SATURDAY when they will be A) brought to a lab outside of your hospital's system and B) the results will not be available to you for a week after the appointment... you could have had the results THAT SAME DAY and made treatment decisions before we even got in there!
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    Hi KelRN215,

    Thanks for the stories. Wow. Here is what I got today:

    You must got to this patient TODAY, no matter what, must get there today to change her PICC dressing. Ok, it was on my way home anyway, no big. I called the house, and guess what? No supplies for changing the dressing. My supervisor told me to have them go to CVS for the supplies. I relay this to the patient's husband. He insists that he doesn't know what to buy and asks if I can just stop and get them on my way, and he would pay me back when I got there. Ok, NO! I told him to meet me at CVS and I would show him what to buy. I waited there for him for about 40 minutes before he finally showed up.
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    CVS sells PICC line dressing kits? If that happened in my agency, I would instruct the patient to call their DME company and to call me when they had the supplies. If a PICC dressing is changed a day late, it's not the end of the world.
    SE_BSN_RN and LaRN like this.
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    CVS doesn't have biopatches, but they do have tegaderm. Thankfully the patient did have 1 biopatch left.
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    I would tell you to quit, but this is getting pretty interesting.
    SE_BSN_RN, Kitty Gatita, RN, HMAmara, and 1 other like this.
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    Quote from missyg1972
    CVS doesn't have biopatches, but they do have tegaderm. Thankfully the patient did have 1 biopatch left.
    You need more than tegaderm to change a PICC line dressing properly though. We don't use biopatches but the vast majority of PICCs that I deal with have Stat-locks that also need to be changed weekly and you need everything else that's in the PICC line dressing kit- especially sterile gloves and chloraprep. I would not change a PICC line dressing without the full kit in the home.
    LaRN likes this.
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    Quote from KelRN215
    I would not change a PICC line dressing without the full kit in the home.
    exactly....the end of the cath goes all the way to the sup vena cava. if the patient develops any kind of infection or complications, that substandard bandage will be the culprit.


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