Typical day for a Home Health nurse... - page 3
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
0May 7, '03 by hoolahanHhhhmmm....it's been a non-eventful week.
I did have one challenge though. A swet lady w breast CA, had a lumpectomy in the past, had chemo & rad, then a year later found a spot on the underside of her breast, it would have been very hard for her to see it.
Anyway, it was necrotic by the time she got to the doc, he cut out the dead tissue and orgered granulex spray (I hate that stuff) a spray wound debrider, b/c there was a lot of slough inside, and that sucker was deep too! Then we were to pack w iodophor packing and cover w 4x4.
I didn't like this wound care the first time I saw her about 1 1/2 weeks p admit, then I saw her again this past Sunday and mentioned it to our wound care "expert" not certified, but she is the be all end all of wound knowledge, and she suggested having her sit inn a shower chair and really irrigate it in the shower, then pack w hydrogel-impregnanted gauze and a covaderm. We were thinking she may be able to do that herself for a day in between visits, we are seeing her daily.
So, not wanting to step on her CM toes, I had left her a VM saying it's been 3 weeks, and although the wound measures the same, it looks worse. Her CM agreed and spoke w surgoen Friday, who arranged for a stat wound care center consult (stat = next day) and she went today. I am curious to know how they changed it.
The other lady above that I talked about, had her sternotomy opened by the surgeon, I knew that sucker wasn't healing beneath that pinpoint hole. It's not too deep and fortunately very healthy-looking and will probably heal well now. She has an attitude tho, man! Like everyone else needs to take care of her and she is completely unwilling to help herself do anything. She met w MSW and she is on the list for a senior living center now.
I was extremely aggravated today by scheduling issues, but I am too tired to type all that out, maybe another day!
The good part is the patients, the rest of it, the paperwork and my particular agency....no comment!
0May 8, '03 by Jay-JayGotta vent!! GRRR!! Teenager with pilonidal sinus and an attitude! She screamed her bloody head off as I was trying to pack it. I backed off...shouldn't have done so....she decided she didn't want me touching her again. It was a VERY small opening, but the sinus was fairly deep, judging by the amount of ribbon I removed.
She wanted ANOTHER nurse to come in, claimed i was incompetent, inexperienced, didn't know what i was doing, yadda, yadda.... She asked for 2 of our nurses who weren't on duty tonight. Worst part of it is, when I spoke to management, THEY called up one of the nurses she wanted, and persuaded her to go and do a visit, even though she was off duty!
(Sigh!) Boy, not looking forward to trying to explain THIS to CCAC when I ask to get an extra visit approved!
After that, which took over an hour for a call that SHOULD have taken 15-20 min, I had to drive to the far east end of our territory to give a 1 mo. old baby a needle. She cried for about 5 seconds when I gave her the shot. Glad she's not a whiney teenager....
In 5 years of community nursing have NEVER had anyone carry on the way that girl did, and believe me, I've done a ton of pilonidals/ abcesses/fistulas. One day, I admitted THREE in the same day!
0May 9, '03 by hoolahanI feel your pain sistah!! I had a 21 year old w a syndrome, I forget the name of it but, it caused his sweat glands to become abcessed and, he had skin grafts on both groins and axilla. Talk about a sissy!! He screamed w dressing changes, but I gave him a verbal spanking, and he got over it. Yeah, I can be a mean nurse! Seriously, I said Holy smokes, your neighbors are gonna think I'm over here beating a child, stop screaming huh? hehe
Today 10 hrs + 71 miles
Jnette, this is your kinda day. I decided to work 10 hours. I had 1 admit and 6 re-visits. One of our nurses is out, and she covers the far corners of the counties, so I played her today.
I had 2 pt's who needed labs, one was medicare, so labs had to go to hospital, the other managed care, had to go to Labcorp. Both of these pt's were far from each other and each were far from the hospital, one was 20 miles away. I had a HHA supervision to do before 10 in another township, another pt who could not be seen til after 1pm close to one of the labs, and 2 visits close to my home.
First to the HHA sup, young man w CP, sup'd the aide, got vitals, checked status of stg 1 on sacrum, no change, did the peg tube drsg chg to observe that, everything is cool, HHA new to me was sweet and seemed to love ct & he her. Cool!
Next vs in the city. This guy was just d/c s/p UGI bleed, is on O2, he has it at 5 lpm! I ask him why, he says I feel better that way He does not have his meds yet, from last week, can't afford them, but won't accept vs from MSW b/c he has a Penn. Benefit, and he wants to see if he can renew that, if they will not accept that, he will have to re-apply in NJ then he will agree to see MSW. After so long in this field, I simply say, OK, well you let us know (when you stroke out!) I place a call to md and let him know he is using his O2 at 5lpm, got a VM, did not leave my number, left pt number. Some people you will never get thru to, this guy (the pt) is one of them!
Next visit, near my house and close to the last. Noticed there was no auth for this visit, called to ask about it to intake and found out we no longer have to fill out a seperate form for req more visits YAY!!!!! THIS is what I'm talking about for a nurses day gift, OK?? Woohoo!! So, I req auth for this vs and one more.
Drop lab 2 townships over to Labcorp.
Back to my town, a dressing change, looks good, drsg done, home was 2 blocks from mine, so I stop home to get a quick bite and write up first 4 visits.
Nuke leftovers, turn on soaps, write my charts so far, start time sheet, and quickly peel 4 potatoes and stick a chicken to roast w veggies in the fridge so hubby can stick it in oven when he comes home, and it will be ready when I get home.
Next off to the really nice section of town, more rural. I was assigned to a home, to my surprise, that I have driven past and admired all my life. This HUGE monstrosity of a house has a scenic little stone "house" beside it, and a stone wall extends from this house and water falls over the stone wall, and onto a little water wheel. What I have never seen from the road is that above this is a huge pond, and that the house is even more unbelieveable as a big florida room looks out onto the pond, with a glass walkway to a pool house. WOW!!
My pt rented the little stone house. I was there to check VS and prepare for D/C next week. Doc comes to her home next tues if no changes in meds and BP stays stable, we will d/c her next week. This was such a thrill to make this visit!
Then, I realize I am going back to the "castle" another 11 miles down the road. As I drove by, I think of the newspaper story this am that reported a black bear has been in the area slaughtering sheep on a nearby farm. I realize this is where I am going. I think COOL! I hope the bear crosses the road while I'm here! (that happened to us in Virginia once in the blue ridge mountains) But, bears in NJ??!! I hardly seems possible, yet it's true!
This house is the be all end all. I mean, if it had a moat, it would be a castle. The first time I was there, I had to call from my cell phone to see how to access the house from the private road, which fork in the road do I take? I had taken the wrong route first and ended up by the poolside. The pool house could comfortably house me and hubby. There were multi-level decks and stone walls, it is a fortress!
This lady has been very unstable. So I am there to check labs & VS. VS are stable. Hgb turned out to be 7.3, up from 7.1 2 days ago. She refuses to go to the hospital and will likely be placed on hospice soon.
I have to take these labs to the city hospital, 19 miles away. Fortunately my last visit is around the corner.
Drop off labs and enjoy the beautiful drive back. Got a spot in the parking garage, that is a first, of course it is 3:30 now, I usually am doing labs much earlier in the am.
Last visit 2 miles away, a nice lady s/p THR. Her BP is 200/80, but she had not taken BP meds yet today, and has not gotten scripts filled yet. Thinks she has some pills leftover upstairs but wouldn't let me go get them for her So, I counseled her on s&s CVA/TIA, risks of unrx HTN and smoking, Instructed her to fill and take BP meds asap, did rest of admit assess and teaching, and left.
Back to office to pick up tomorrows assignment. Got 4 confirmed vs, and one who did not answer and still hasn't but hosp confirmed d/c, so I went w it.
Walked into my house at 5:45, worked on charts til 7:45. I am whipped! But all in all a good even if hectic day.
I hate when my visits are all over, I couldn't find the charts anywhere this am, and all that, but I also knew the sup had tried her best to not make me go all over, but had no choice today. On days like that, I just have to surrender any idea of having an orderly route and throw it all to chance, and hope I will get to all the HHA sup's before the aides leave, and hope that I get everywhere by the times I guesstimated to the pt's I said I would be. And even tho it was wild today, I worked hard, and got it all done. So, not a bad day in my book.
0May 12, '03 by Scavenger'sWifeYour day sounded pretty good to me, hoolahan. I actually am kinda jealous becuz I am bored and ready to get back to my patients!
I am going in to work at one of the QA nurse's office this week and help her out with auditing some charts. As I will be doing some work like that with HH anyway, it's OK with me to help Becky out. I'm gonna review some hospital re-admit charts that were orig TKR, THR and see if the reason for readmit had anything to do w their hip or knee surg (like osteo or infected wound, etc). And look at some pneumonia charts. Woo Hoo! But it'll get me out of the house for awhile !
1May 30, '03 by CseMgr1I worked in Home Health for 18 years.....loved it in the beginning, for I was like everyone else: sick of hospital nursing and working weekends and holidays. But as the years passed, I grew weary of going into nasty houses, the increasing, mindless paperwork (Oasis was the icing on the cake) and having to trade in cars every three years. But there were good times, too. I once cared for a guy who had a complicated GSW to the abdomen. When it was suggested (by his insurance co's case manager) that he start doing his own wound care, he started acting out and was verbally abusive, etc. I wasn't exactly having the best of days myself, loaded down with 8 heavy visits over a 100-mile radius, and I got into his face and told him: "You are perfectly capable of participating in your care, and if you don't get rid of this s--t attitide, you're never going to get better". I left his house, not giving a damn if he reported me or not. But after that confrontation, his whole attitude changed...and he began to assist with his dressing changes. By the time my assignment had ended, I had grown very close to him and his wife...and they presented me with a "Precious Moments" Nurse figurine.
And now, six years later, I have that figurine sitting atop my computer at work...and am constantly reminded of why I became a nurse to begin with. :wink2:
0Jun 3, '03 by NancyB,LPNHullo all...
My days can get interesting, I do primarily private duty with visits lasting from 1 to 10 hours. One of my patients is an ALS patient who is on a ventilator and uses an in-exsufflator for cough assistance. She was diagnosed 8 years ago and her goal was to see her kids graduate from high school (she has 2, with the youngest starting high school next year) This lady is extremly anal, has to have her face rinsed 3 times in a specific order, her range of motion has to be done in a specific order and 20 reps each (that's doing each finger and toe individually as well), we're not allowed to joke with her kids, we can't say the workd "butt', (but her 14 year old can say "crap") The bowel program is SO time consuming!! she needs digital stim, but you must change gloves each time and wipe it all off of the inside of the bedpan before proceding.
She mouths her words most of the time (despite the continuous hook up to the DynaVox) and she get's irate if you don't understand her. There are only 3 LPN's and 2 HHA's who are willing to go out there! We have all left in tears at one time or another and the other staff refuse to go out there!
Until recently, the LPN's were staying with her for 10 hours on a daily basis (now we are doing 2 shifts of 5 hours)
Does anybody have problem patients like this?
0Jun 3, '03 by hoolahanYes. There are times I can hardly face a 30-45 minute visit with them. I have seen this behavior a lot w pt who have progressive neurological diseases.
I try to put myself in their place. I would want some modicum of control, and if they do not speak out about how they want things done, it will be done in as many diff ways as there are caregivers. So, as much as it irks me, I cannot fault them for it. Howvere, this is why I do intermittent visits and not shifts too. And that is the truth.
I think it disturbs me so much b/c in all honesty, if I got a dignosis like this, I wouod not want to live bedbound, or even wheel-chair bound. When I can no longer wipe my own arse, I want to die. I do not want to burden my family like that. And I don't want to live like that. I think if my kids were younger I would not be so easy to give in, but at least now, I feel like they are becoming young adults that I am proud of, and I know my spirit and words and lessons would be with them no matter what.
Wow, that's a lot of sharing there, huh? Oh well. I already informed my hubby he can kiss the insurance money goodbye if this happens to me b/c I will not stick around long enough to not be able to swallow a bottle of pills. He was not happy with that kind of talk, but said he would understand.
1Jun 5, '03 by NancyB,LPNMy sentiments are the same, once I am unable to care for myself, let me go. I was put on this good earth to care for others, not vice-versa. (although I do like the occasional pampering but let me do the personal stuff)
I do have a great deal of respect for this person with ALS, she has an iron will, and, I'll admit, she's taught me alot. I had never dealt with a ventilator patient before, so I have some skills there now, and I have become more tolerant of other people's idiosyncracies. I guess I just needed to vent that day. (don't we all?)
Have a wonderful day!