Typical day for a Home Health nurse... - page 17

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like... Read More

  1. by   Diva Nurse Dani
    Wow...this has been helpful!!
    I am considering moving from a Med-Surg floor (with almost 4 years experience) to HH. My fear is I am also working on my Masters with the intent to teach, and afraid of another change. But if I don't get off my floor soon I will scream!!!

    I have been called for an interview, so I guess one foot in front of the other...

    Any suggestions??
  2. by   msslim
    Quote from kayekayrn45
    i've worked in hh as a staff relief nurse. i see patients when a nurse is sick or on vacation, or just when the office is booming... needless to say this is a fulltime job with all the benefits. about the oasis... thank goodness we have coders at our office who fill in the oasis code stuff.. we tell them what we think is the primary diagnosis and so on, and they fill in the code #'s for us (thank god...we just dont have time for this). also, when it comes to the insurance, medicare, medicaid stuff... do like i do... ask which oasis to use. after 4 years of hh nursing, this gets my goat. fortunately, i work at a company who has staff that calls the insurance co's and medicaid so they can tell us how many visits we can make. i used to work for an agency that the hh nurse had to do all of this...i got burned out and quit. with my co. we have wonderful lpn's who have desk jobs to help out the rn's in the field. if we need to contact a doctor, we call the pcc (lpn), give them all our info on the pt, they contact the md and get orders for us and let us know. this is great because we can make our call to the pcc, leave and go see another pt.....no waiting around on hold for an md's nurse to run down the md and get orders....our pcc's do that for us.... it is awesome and it saves us hh nurses so much time. i am spoiled. since i don't have my own case load... i usually have no info on the pt except diagnosis and meds... the lpn's are up to speed with the pt's and really help me out quite a lot. i must say that i actually like my job, and that's a first for me after 11 years of nursing.

    about the oasis... people make it out to be harder than it really is. just read the question and go with what mostly fits the patient. if there is a gray area i usually pick the "most worse" answer and hope that on discharge or recert that the same question would show some improvement.

    on a last note... with the oasis, just do the best you can and if you have a good qa person, they will help you correct any mistakes... don't take offense at qa... they have taught me so much just by all the mistakes i've made on hh paperwork. your qa person is a good resource along with your clinical supervisor.

    home health is very rewarding and most patients are greatful for what you do for them.
    gosh i would like to know what company you work for!!! seriously if you don't mind telling
  3. by   RyanSofie
    Quote from sunnygirl272
    thought i'd bump this thread...i'll chat about yesterday and today...
    yesterday
    saw:
    #1 & 6: a quad w/4 pressure ulcers (3 stage IV, one stage II) for bid dressings changes.
    #2 an elderly gent in one of the ritzy senior living buildings, for dressing change to a nearly healed skin tear.
    #3lovely lady who lives in a rather rustic cabin with her hubby...had to do pin care to her arm, Fx wrist, slipped on ice.
    #4 another lovely lady, French-Canadian, speaks english, but i have been practicing my french with her also.. had a CABG, then had an abcess from the donor site in her thigh...we have her open for dressing changes...we are in there 2x/week... nearly entirely healed...d/c planned for next week...(personally think she coulda been d/c'd last week...)
    #5 pia. young joint replacement. wants to become part of her armchair. no motivation at all.

    today
    #1 &#6 saw my quad again for BID dressign changes..
    #2 gent with skin tear again..also yesterday adn today he showed me his photo albums...lots of OLD pix,...
    #3gent w/ s/p hip replacement, assessed his healing stage II pressure ulcer on his nonsurgical side, no doubt partially shearage from pushing himself up in bed...wife doing well with his care...probably d/c next week...
    #4 pleasant lady with s/p fem pop...doing well...general assessment, no wound care
    #5 Hepc....call to md re: 10 pound weight gain in less than 24 hours..also new rhonchi since last nursing visit 2 days ago.


    oh...and i forgot...yesterday i did a suture removal...on a boxer...(dog)..my quad's roommmate's dog had a mass removed, benign, but couldn't get back to see the vet...i had offered to take them out, he was gonna find a ride...couldn't..asked me yesterday if the offer was still open...he was a good boy...
    Love it!!!
  4. by   maddie45
    I am considering going into Home Health. Most job positings have 'previous Home health experience preferred.' Not required but preferred. I have a BSN and 2 years experience as a tele nurse.
    What is everyone's experiences with first applying for HH?
    Also, I am wondering if some could share 'emergency situation' experiences.
    From previous post "It is best to have some hospital experience as you are very autonomous in home health and have to make many decisions sometimes in emergency situations. You need good critical thinking ability,the hospital experience is very valuable."... examples?
    Thank you!
  5. by   RyanSofie
    I am a "novice" in HH and was doing quite well till yesterday ( or so I thought). The new Oasis C was introduced to me a few days ago..what I find daunting is the amount of paperwork involved and the high turn around of patients resulting in more paperwork. You do an Oasis for admission, one for transfers ( if pt goes to hospital), one for recerts if goals were not met during initial cert period. Another Oasis for discharge.Then there is the scheduling of visits, supervision of HHA's and packing up your supplies for use in the event you are in need on a visit which includes enough forms to fill a city library. Keeping track of frequencies and making appointments to do visits when pts go AWOL and do not ansewer phones. I am overwhelmed at this point to say the least..is this the usual learning curve associated with the transition to HH? In addition the patients recieving HH now have multiple chronic health issues and are in need of intensive attention to details, teaching and interventions. Critical thinking, organization and a strong sense of confidence in ones' skill is an absolute neccessity in this area of nursing. I wonder if I have what it takes..I am certainly giving it my best shot...(no pun intended) ...
  6. by   caliotter3
    Quote from RyanSofie
    I am a "novice" in HH and was doing quite well till yesterday ( or so I thought). The new Oasis C was introduced to me a few days ago..what I find daunting is the amount of paperwork involved and the high turn around of patients resulting in more paperwork. You do an Oasis for admission, one for transfers ( if pt goes to hospital), one for recerts if goals were not met during initial cert period. Another Oasis for discharge.Then there is the scheduling of visits, supervision of HHA's and packing up your supplies for use in the event you are in need on a visit which includes enough forms to fill a city library. Keeping track of frequencies and making appointments to do visits when pts go AWOL and do not ansewer phones. I am overwhelmed at this point to say the least..is this the usual learning curve associated with the transition to HH? In addition the patients recieving HH now have multiple chronic health issues and are in need of intensive attention to details, teaching and interventions. Critical thinking, organization and a strong sense of confidence in ones' skill is an absolute neccessity in this area of nursing. I wonder if I have what it takes..I am certainly giving it my best shot...(no pun intended) ...
    You can avoid all of this by asking for a patient care job instead. Just do your extended care shifts and turn in your nurse's note for the shift and that is it. No Oasis anything. No charting a gazillion stuff on your own time. You can relax on the way home from your shift knowing that you don't have a mountain of charting to do on the kitchen table.
  7. by   RyanSofie
    Quote from caliotter3
    You can avoid all of this by asking for a patient care job instead. Just do your extended care shifts and turn in your nurse's note for the shift and that is it. No Oasis anything. No charting a gazillion stuff on your own time. You can relax on the way home from your shift knowing that you don't have a mountain of charting to do on the kitchen table.
    I do both one to one and case management. I have a full time one to one in peds. The HH case management is per diem and supplements my income as a private duty nurse for a child . I posted to get some responses and point of view from other novice HH nurses regarding their experience at this stage of learning the ropes. I do enjoy the one to one...just does not pay enough...:redpinkhe
  8. by   seajulesRN
    [font="comic sans ms"]hi all, my name is julie and i am moving from nicu to home health......interviews this week.......anyone have suggestions on what questions i should ask? and what is the best way to know if i am picking the right agency for me? i love your posts and i am so glad you are willing to share your experiences...thank you, julie
  9. by   RyanSofie
    Home health certainly can use your expertise in the NICU.Many children requiring complicated skilled care are at home. The great thing about HH is you facilitate the care provided by families at home. It is overwhelming for them many times and working with them alleviates some of the burden. Teaching is a vital part of HH and being super organized is a definite requirement. Ask what a typical caseload is and about orientation. it is wise to go with a company that provides a good thorough orientation regarding Oasis and Medicare guidelines for HH.It is also good to go out with a preceptor for admissions/discharges/recerts/. The paperwork itself is daunting at first but if you are well organized you develop a method of doing it that makes it much easier. Some HH have computerized the paperwork for Oasis which is great. These HH agencies provide a laptop with a software program for the paperwork. Another question is if your required to be on call after hours. In my agency we rotate on call and cover a week at a time usually. We are then required to do any admits we get after hours, any prn visits etc for all patients on service.
  10. by   seajulesRN
    Thank you so much for taking the time to respond. I will certainly add those things to my list.
  11. by   ybstressed
    OMG WHAT A DAY!!!! I need help, support, and advice. I am new LVN as of 1-14-09 and have been working with a awsome HH since the end of Jan. I have been seeing patients for the past two weeks and thought I was doing great......unitl........today!!!!!

    9am Started my day with a great patient. No problems and a great daughter taking care of her. The patient is only on 3 meds and she 95! I attempted to do education on a few of her hypertension meds and her daughter cut my off stating "my husband is a doctor so I don't need med education" my reply was " thats great! So, after I finish teaching your mother about her meds, you can answer her questions when I'm gone". JUST LET ME DO MY JOB LADY!

    10am Pulled up to a patients house. No one is home! This is the second time I have been to see this patient and no answer. Call the main office to verify the address and I'm at the right place. Called the daughter to see if the patient is at home and just can't come to the door but no answer. So I left to see my next patient.

    11am Sweet older man who is easy to teach, actually using all my teaching to reduce his bp, and is always happy to see me gets his visit with a thumbs up. BP wnl's, no recent falls, and a healhty diet!! Whoot whoot

    12am Got to my next patients house and his son (plus three friends) stop in their tracks....sit on the couch....and watch me with their jaws on the ground. Not only do they watch me but they try to hit on me while I'm attempting to assess the patient. YOUR GROWN MEN ....ACT......YOUR.......AGE!!!!!! SO.....as I'm giving the patient a good look over the caregiver gives me wound care orders with no doctor info....a bag of opened supplies, and told me the wound care nuse instructed them to stop his bp meds until bp is wnls. BP was super low(94/54)....normal pulse.....heart RRR with pacemaker. So....I decided not to change the wound dressing with the opened (no longer sterile dressings) and to call the doctor requesting faxed orders to the office, get supplies for the woundcare, and to take care of the low BP. So I will call the doc after lunch (office was closed) and go from there.

    ....inbetween the above and the below visits my 10am called me back and stated that I had the wrong address and that she forgot to call the office with the new info. She then begged me to see her mother, which I agreed to do, as long as the caregiver is there (the patient only speaks spanish). OK....ON THE NEXT VISIT.

    12am Next patient, at first, did not like me because I look like I'm 15 y/o. But, after the first visit, she just loved me and I love her! She is a great patient and is really trying to improve her health!

    1pm I finally get to see the patient that I missed at 10. And low and behold the caregiver ONLY speaks spanish to!!!!! Wow...so how am I supposed to teach her about her condition when all I can say in spanish is pain and hello

    2pm Time to call the home office and check on the order for my wound pateint....get the supplies....go on a interview at 3pm.

    230pm Completed a quick interview...got the job......now time to go to the office.

    3pm Got to the home office...asked the front desk for the orders for my wound patient....no orders!!! OF COURSE...I then ask the front desk for a few supplies which starts a yelling match between the front and the supply guy! So after 10 minutes I walk in the back myself and grap my own supplies. I then called the my "wound" patients pcp for the wound clinics number that they referred him to and to report the low BP. The docs wife answers the phone and states that she does not know what wound clinic the patient went to and and asked" are you in the home with the patient" I stated no and continued to tell her about the patients low BP. She then says (angry tone) " if you are not in the patients home then why are you calling". I then state "because I'm the HH nurse and I need orders due to the low bp and a few for wound care".
    She then states " thats what I asked you the 1st time" and then I said " no....you just asked me if I was in the home and I'm not...I'm at the office" she then states " DO YOU KNOW WHO YOU ARE TALKING TO....I'M THE DOCTORS WIFE".
    OH....REALLLY....COME ON! She said to have the daughter call the office and they will deal with it tomorrow.


    Wow!!!!!!! I dont even know if I handled the situation right but the day is over and I will start a new one tomorrow!


    For for the poor grammer and spelling...Im just to pooped to care!
  12. by   RyanSofie
    Take a deeeep breath and blow it out slowly....You have passed the "honey-moon phase of those 1st 2 weeks". Now comes the challenges. First, organize visits before going out to see patients. Prioritize according to acuity and difficulty ( family challenges). See those with highest acutity first, eg: b/p issues, wound care etc. See those with pcg issues last if they take more time. At least that is how I do it. I keep a rubber made storage container in my trunk with wound care supplies, cath kits, extra drain bags, anything I may need for visits and I restock weekly.I also keep folders with extra paper work forms I may need. I also keep a file with basic written teaching materials I can give to patients..I give them a copy and keep one for chart. I then note what I gave and teaching I provided. I find organization is the best way to decrease stress.. Each week I update my frequencies and my five day windows for end of cert periods on my schedule for the week that way I am not caught by surprise. The other neccessity is time for yourself. You need down time...do something for yourself. Rekindle your strength....
  13. by   ginab2
    Hi! I'm trying to get the nerve to leave the hospital and go to HH. Could anyone give me some of the pros of going to HH over the hospital setting. I'm looking for a position in nursing that might work better with having kids, didn't know if HH was the way to go?

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