Typical Day For A Home Health Nurse | Life of a Nurse

[hoolahan]

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 I usually try to do.

8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go.

Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re please give pt RX for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go

Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five RX dated 1-21-03, two are new meds, but PRN types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go

Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

2:15 pm. Back to my township, drop wee wee at quest labs, drop off RX at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

Pretty routine kind of day today.

Anyone else want to share??

A Day in the Life of a Public Health Nurse...

 

[prisca]

that was a really cute story. someone should make a book with all thes cute stories

[Hairstylingnurse]

Hi everyone, I was hoping to hear and share some suggestions to avoid weight gain like I did when I first started in homehealth. When I first started in HH, it was soooooooo easy to pull through Macky D's or KFC, and get a delicious, quick lunch while on the way to a pts. house. All those wonderful large coca-cola's to get a quick, refreshing caffine fix. I went from running around like a mad woman at the hosp. and LTC centers to riding around in the car and not sweating too much(physically anyway). My metabolism went into shock. I have hypothyroidism, so that didn't help. I have since lost all the extra weight by packing tuna fish sandwiches, carrot or celery sticks and a large thermos cup of ice H2o. My problem with drinking all that h2o is that I get sooooooo tired of stopping at convient stores that look new and/or very clean and having to go to those nasty restrooms. I once had to use the restroom at a pts. home out of sheer, desperation(THIS OFCOURSE IS A MAJOR NO-NO AT OUR AGENGY:p ). So it would be great to hear what some other nurses do for lunch, snack, and bathroom breaks and anything else you do between visits. I rarely see pts. close to my home( I stop at home when I'm in the neighborhood.) Also it would be awesome to hear from some more HH nurses about thier typical day. I LOVE reading some of the challenges that we go through and learn alot from the posts. Thanx and have a great day:p

[hoolahan, ASN, RN]

Your agency actually has a policy about not using the patient's bathrooms???

I don't know about anyone else, but we don't have any policy like that, it's just that I would choose to not use anyone's bathroom most of the time. Sometimes the old timers don't make it and have a bit of a mess, and I certaily don't want to sit on their raised seats! lol

Anyway, I have used many a bathroom in nice homes. I don't see what the problem is, you're a nurse, and a human being, not a servant too lowly to use the gentry loo!

About the food. It is tough on the road. I am lucky in that I am in one county, so I used to come home for lunch, do a few charts, then same 2 or 3 visits for the afternoon.

I am on the road now, driving really long distances, and I am sick of McD's. I picked up a nice thermos from walmart, and I keep decaf iced tea, it stays cold all day. I also just make up a sandwich, chicken salad from leftover chicken, or eggsald, ot turkey meat, of course it can't be hot, and use an insulated lunch box and one of those frozen block things. I may also put in a small cup of fresh fruit cut up inside of a rubbermaid container and put it on top of the ice.

However, on cold days, I may stop into a supermarket and get a cup of soup and eat it in the car, or find a restaurant or pizza place that also has soups and eat insode, I always take in a chart or two to do while I break, making sure I don't let anyone see names or anything, I pick a table far away and keep only what I am working on face up.

In summer, I may go to a nice air conditioned library, and do a few charts, use the bathroom, whatever. Can't eat in there, though I confess to sneaking in a sandwich and sitting in the back, sneaking bites as I worked. And a water bottle. Also in summer, I freeze water bottles. I have an insulated bottle carrier, which doesn't allow it to melt too fast, so I may leave it on the seat in the sun for a visit, so I can get a bit more to drink, then slip it back into the carrier.

So, what does your agency expect you to do? They should perhaps compile a list of restaurants in every county, gas stations, and places you can use the bathroom and give it to you on orientation. But frankly, that is the stupidest rule I have ever heard. I have never in all these years had anyone act like it was a burden to them for me to use their bathroom! In fact many people offer me food, coffee, I always refuse that, but I am not even shy about asking to use the bathroom. Everybody pees!

[Hairstylingnurse]

Your agency actually has a policy about not using the patient's bathrooms???

I don't know about anyone else, but we don't have any policy like that, it's just that I would choose to not use anyone's bathroom most of the time. Sometimes the old timers don't make it and have a bit of a mess, and I certaily don't want to sit on their raised seats! lol

Anyway, I have used many a bathroom in nice homes. I don't see what the problem is, you're a nurse, and a human being, not a servant too lowly to use the gentry loo!

About the food. It is tough on the road. I am lucky in that I am in one county, so I used to come home for lunch, do a few charts, then same 2 or 3 visits for the afternoon.

I am on the road now, driving really long distances, and I am sick of McD's. I picked up a nice thermos from walmart, and I keep decaf iced tea, it stays cold all day. I also just make up a sandwich, chicken salad from leftover chicken, or eggsald, ot turkey meat, of course it can't be hot, and use an insulated lunch box and one of those frozen block things. I may also put in a small cup of fresh fruit cut up inside of a rubbermaid container and put it on top of the ice.

However, on cold days, I may stop into a supermarket and get a cup of soup and eat it in the car, or find a restaurant or pizza place that also has soups and eat insode, I always take in a chart or two to do while I break, making sure I don't let anyone see names or anything, I pick a table far away and keep only what I am working on face up.

In summer, I may go to a nice air conditioned library, and do a few charts, use the bathroom, whatever. Can't eat in there, though I confess to sneaking in a sandwich and sitting in the back, sneaking bites as I worked. And a water bottle. Also in summer, I freeze water bottles. I have an insulated bottle carrier, which doesn't allow it to melt too fast, so I may leave it on the seat in the sun for a visit, so I can get a bit more to drink, then slip it back into the carrier.

So, what does your agency expect you to do? They should perhaps compile a list of restaurants in every county, gas stations, and places you can use the bathroom and give it to you on orientation. But frankly, that is the stupidest rule I have ever heard. I have never in all these years had anyone act like it was a burden to them for me to use their bathroom! In fact many people offer me food, coffee, I always refuse that, but I am not even shy about asking to use the bathroom. Everybody pees!

:) Hi Hoolahan, I thought thier policy regarding bathrooms was standard. My agency wants us to make sure you use the bathroom on the way to and from the pts. house. We also shouldn't use the pts. phone unless it is an absolute emergency. Ofcourse they provide us with cell phones so that isn't usually a problem. We do call 911 from the pts. phone if necessary. Our goal is not to inconvience the pt. in any way, shape, or form in their home so I'm told. I'm really shocked that that is not the norm. I will defiantly bring this up at our next meeting. Sometimes, there just isn't a restroom available, and I hate to lose that extra 5 min. several times a day when I could (in the words of Nike)"just do it" while at the pts. house. Do you do this several times a day or once at best. But on the other hand some of the pts. homes look way worse than a nasty old gas station. We have some pts. that we won't even sit while we are in the house:crying2: . But I'm sure that just goes with the field of nursing we are in(I absolutely love this field). I don't know if you've seen a new little gadget that you plug into your ciggarete lighter and it warms your lunch in about 30 minutes. It is pretty popular among truck drivers.

[hoolahan, ASN, RN]

How often?? Well, in all honesty, I don't drink much after I leave the office, or my house wherever I am starting from, so hardly ever really. I don't drink much specifically so I won't have to pee much! lol I am usually parched by the end of the day! I guzzle water once I am home.

Plus, I am usually in one county, and can usually plan to get home for those kind of stops. There are 5 senior building within 5 miles of my home, so if many of my visits are there, I just drive home for a pitstop, and let the dog have one too!

If I have to drive far, like I do now, dunkin donuts, little restaurants, or librabries.

BUT, we have even had a few patients who are on and off service and they tell us to stop in if we ever need a bathroom break! Some of the nurses have regular stops like that.

As far as the phone, of course we wouldn't use theirs, however, since our agencies cell phone bill was soooo high, we were told to make calls from the home whenever possible, if not a toll call, like to the pt's doctors, pharmacy, etc... Of course not personal use, but we also call the office from their phones sometimes, if it isn't long distance or a toll call. I prefer to use my cell phone in many cases, have you seen how gross some of those phone peices look sometimes? One phone had little roaches in it, after that,unless it is a very clean place, I use the cell, I don't care how high the bill is. At one point our agency was threatening to bill us if we used over 100 min a month. That's

I hoonestly don'y see that you reliveing yourself, if there is no other option close by, or using the phone to call their doctor, is inconveniencing the pt!!

[Hairstylingnurse]

:uhoh21: Hello ladys and gentalmen.My name is Hunter and im 10 years old.Is it hard to be a nurse.It sure looks hard on all the medical shows that my mom watches.Have any of u had to help with any operations before?I know i haven't:rotfl: :chuckle :rotfl: :chuckle !Well Ill see u later'

Hunter.

[hoolahan, ASN, RN]

And No, I haven't seen that gadget to warm food. I would love that. I much prefer to have leftovers for lunch, saves a lot of money, but leftovers usually need to be heated. What is it called, do you know?

[Hairstylingnurse]

And No, I haven't seen that gadget to warm food. I would love that. I much prefer to have leftovers for lunch, saves a lot of money, but leftovers usually need to be heated. What is it called, do you know?

Sorry, I don't know what it is called. I saw it on a show called "I lost it". It is a weight loss show on discovery channels in the daytime. Atruck driver had it. It looks similar to the old lunch boxes and it plugged into your ciggarette lighter. I'm looking for one, if I find one I'll let you know. If you find one please let me know.

[nurseneesy]

:uhoh21: Hello ladys and gentalmen.My name is Hunter and im 10 years old.Is it hard to be a nurse.It sure looks hard on all the medical shows that my mom watches.Have any of u had to help with any operations before?I know i haven't:rotfl: :chuckle :rotfl: :chuckle !Well Ill see u later'

Hunter.

Hi Hunter, glad to have u stop in to say hello. Yes it is hard and wonderful to be a nurse.:) I have never helped with operations, I saw an operation in nursing school and got totally sick. But there are alot of nurses there that love it. Are you going to be a nurse or doctor when you grow up? Well have a great day. :balloons: :biggringi

[nurseneesy]

:uhoh21: Hello ladys and gentalmen.My name is Hunter and im 10 years old.Is it hard to be a nurse.It sure looks hard on all the medical shows that my mom watches.Have any of u had to help with any operations before?I know i haven't:rotfl: :chuckle :rotfl: :chuckle !Well Ill see u later'

Hunter.

Hi Hunter, glad to have u stop in to say hello. Yes it is hard and wonderful to be a nurse.:) I have never helped with operations, I saw an operation in nursing school and got totally sick. But there are alot of nurses there that love it. Are you going to be a nurse or doctor when you grow up? Well have a great day. :balloons: :biggringi

[Wgbem]

Congrats on your new job. I loved home health. I would love to be up where Karen is and I would go work with her. Our agency was not very good to the nurses plus our service area was 7 counties. Way to big. Mostly rural and I spent a minimum of 20 to 25 hours per week just driving which I did not get paid anything for since I was per visit. I think if your employer pays you well you will love it!

renerian

I was having that problem with being sent all over. I solved that by going per diem. That was the best move I ever made. Now I let them know where I will go and I have found my niche. Home care can be great (as jobs go).

Have a great day, all.

[mollie]

wow, it is interesting to hear about hh days. I live in a place where it does not snow much, but I was raised in snow country and I miss it. (some parts of it anyway) :) I guess I shoudn't complain about the rainy hh days, huh?

I work prn for hh and most days I love it. One negative would be seeing the same patients over and over again. It can get a little boring sometimes, but it is a nice change from the hectic pace of hospital work and I just keep reminding myself of that.

A typical day? : "ring, ring" Hey, can you come in? two nurses called in sick and another just quit. Sure, I'll be right there! Get there, transfer my stuff to whatever company car they assign me that day. Get my list of patients. Usually 6 or 7. Then fill up the gas tank, record my miles, and try to figure out a reasonable route. It is fun really, figuring out where to go and who to see in what order. And it is wonderful to not have someone breathing down your back all day. I pop in a cd, swing by dunkin doughnuts (for coffee only, of course :)). Then it is usually a 20 or so mile drive to my first visit. I read the directions and follow them as good as I can, but why don't they realize that signs get blown down, trees get cut down, houses get painted different colors?? It makes it quite difficult at times for us prners. But I just pull out my cell and call the office and usually get where I'm going o.k. The last line of my first visit says "chickens won't bother you" and I see why. There are about a hundred chickens every where and all the little gifts they love to leave are everywhere, too. As I pull up to the front of the mobile home, there sits a huge huge pitbull. In the yard a man is working on an old truck. I roll down my window a bit and ask "excuse me sir, does your dog bite"? He slowly (and I mean slowly spits a wad of tabacco on the ground and says "wallll, sometimes he does and sometimes he don't, with no sign of a smile, but plenty of signs of tabacco juice dripping down his chin. I kind of sit there and say well, sir is today a day he will or won't? He says I guess you'll just haveta see mam. So I search for my dog biscuits, throw a couple out the window as far as I can and grab my bag and run for the trailer. I make it...this time! Inside the trailer is a middle aged lady laying on the couch under a worn dirty blanket. Although she is very ill looking, I can see that she is a beauiful lady who has lived a hard life. Even in the mdst of squallor and filth, her smile is lovely. Her couch is very low and there is no chair that is not filled with newspaper, food, cig. butts, ect, so I kneel on the floor to get her vs. My knees become soaked and I say something like oh my! (not what I really want to say):) She looks at me and says Honey, I don't know if that pee is from me or my dogs. My cath is leakin again. All of a sudden I hear little whimpering sounds coming from under the blanket and I gently reach to lower the blanket as 4 little doggies start growling, barking yelping and of course peeing! She has an open sx wound from an abdominal hernia repair, as well as a supra pubic cath leaking like crazy. Her wounds are all gross and infected. ( I wonder why). She is on vanc iv, rocephin Im, wonder why they are not getting better???? As I change her abd drsg, the dogs stay right where they are. I ask if they can be moved till we finish, but she becomes very hostile at the suggestion and I don't push it. I wish I could've had a report before I started this day, if you know what I mean! Well this visit takes quite a while , but there is a definite sense of satisfaction as I finish putting the nice clean drsg on, finish the meds and clean up a bit. As I start to leave I ask her if the pit bull will bite. She says he does bite but gives me a certain name to call him and says if I will call him this name in a certain tone of voice, he won't bite, but I throw my biscuits anyway! As I get in the car my first thought is to get to a store to get some baby wipes so I can clean up my smelly pants, and I only have 6 more patients to go!! But I love it. HH is adventerous, fun, exciting most days and fufilling!