New nurse / new to HH / tons of questions - page 4
by tinyRN72 7,869 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
- 0Feb 24, '13 by LaRNQuote from mother1strn2ndI keep a few supplies on hand, every nurse should. Not a stock pile, but one of everything you will likely need. catheter kit, cath irrigation kit, sterile gloves....central line or picc line dsg. I wouldn't mind going to a medical supply store and picking up items that are charged to the home health's account.Many of our nurses live on average an hour away from the office. Many times they do not want to drive to the office to pick up supplies and may be inconvenient for them, especially if they have accepted a
Case and Soc is the next day.
- 0Feb 24, '13 by joy&caringQuote from paradiseboundRNMedicare pays the agency about $48 per patient for the cost of supplies. While a patient is under service, your agency is obligated to pay for all of their supplies. That includes any dressings, ostomy wafer and bags, catheters, suture and staple removers etc. The agency should also have basic supplies to be used by the nurses such as alcohol, band-aids, tape, thermometers, non-sterile dressings, cotton tip applicators, etc. Many agencies stock the basic stuff and drop ship supplies that are specific to a patient. If the patient doesn't have Medicare, they still need to pay for a staple remover and have a DME supply the other stuff. Lab supplies are usually supplied by the lab that you drop off your specimens on a regular basis. They are ordered in bulk. I'm not sure if there is a charge for them. Do not pay for any of these things out of your pocket!
A flat rate per patient is pretty common but they should be paying you mileage. This should be close to .0.50 per mile. If they don't want to pay mileage than you should be getting a higher per visit rate. In Michigan, the average per visit is $50 for a revisit and $85 for a SOC.
I recommend that all new home care nurses read this book cover to cover. It explains home care documentation, Medicare regulations, the OASIS and much more! I know I suggest this book a lot but I learned so much about home care after reading it. You can find it on Amazon or the authors web site.
The Handbook of Home Health Standards: Quality, Documentation and Reimbursement, author: Tina Marelli
Welcome to Home care!
Thank you for posting this resource!
Do you have any suggestions for other resources for new home health nurses?
- 0Mar 3, '13 by KarenJordanI am a DON of a small mom and pop agency and we are not much of hand-holding when it comes to orientation because we lack the time and resources most of the time. But sheesh! I would never put a new grad in the position you are in!! But I also confess that I do not hire new grads in home care. You need to be in a hospital to learn get your skills down pat before you start in home care. I would go to your DON or administrator and tell them that you need some orientation. If they aren't willing, go somewhere else.
Also, our agency doesn't pay milage either. We have a higher per visit rate to compensate.
- 0Mar 3, '13 by tinyRN72I actually found everything -- choraprep, sterile gloves, tegaderm -- at CVS. Just not the biopatch, which no everyone uses. Her stat-lock was outside of the dressing anyway. Maybe I made a mistake, but I cleaned it the best that I could and I know that everything under the tegaderm was sterile.
I have 2 other PICC patients, and they have had supplies... I am hoping that this was just an isolated mess-up.
- 0Mar 4, '13 by tinyRN72Yes, thank you VERY much!
I started this post on my first week there... I was VERY over-whelmed by everything. Since then, I have sort of "learned the ropes." I know, now, to call as soon as I get a case and find out if I need to order supplies. The lab has realized that I will bring the specimens back to them, and they are more helpful.
Things have definitely gotten better. It is a small company. I like reporting directly to the owner. There is no chain of command. I like working directly with the actual person in charge. Believe it or not, tomorrow is the first day of my 6th week... and I am the main RN. There are 3 others, but they only work part-time.
I feel much better now. I don't know what the deal was with the lady with no PICC supplies. I think another agency dropped them, and we took them. I sort of panicked, but it turned out OK.
- 2Mar 4, '13 by tinyRN72Well, you have obviously read this post.
Since I started it, I have learned that I really like HH nursing. I don't have a charge nurse looking over my shoulder, there is no gaggle of experienced nurses gossiping about how long I will last or how stupid I look trying to do something for the first time, etc..
I can spend as much time with my patients as I want. I make my schedule. You do have to be flexible because SOC can be today or tomorrow... or whenever they get out of the hospital. Sometimes you have to sort of chase them down.
Over-all I like it. I am not sure if I will ever seek a hospital job.. besides they wont hire me for at least another 10 - 12 months after I get some experience.