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...

 

[hoolahan, ASN, RN]

Hi Kristi, not quite sure I am getting your question, but, I can tell you that most of the psych nurses in home health, that I have worked with, are also responsible for the med-surg component of the visit, like assessing vitals, doing wound care, etc...

You should get checked off on this prior to finishing orientation, and you can always call the sup for advice from the field.

Since you are not a new nurse, I am sure you will be fine. I don't know of too many agencies that are strictly psych nurse.

Welcome to the board.

[KRITSI]

Hi Kristi, not quite sure I am getting your question, but, I can tell you that most of the psych nurses in home health, that I have worked with, are also responsible for the med-surg component of the visit, like assessing vitals, doing wound care, etc...

You should get checked off on this prior to finishing orientation, and you can always call the sup for advice from the field.

Since you are not a new nurse, I am sure you will be fine. I don't know of too many agencies that are strictly psych nurse.

Welcome to the board.

Hoolahan/Scavenger with the furry mend, don't know this site well enough to know to whom I am speaking, hope Scavenger is back to work, probably cast and boredom so long gone this is appropriately obsolete..

Hoolahan, if I may be so bold to speak, you appear to be the Mother of this thread I just discovered. Your attention to detail and committment to work, time to articulate your day-to-day with hubby somewhere close, two almost-grown kids, and stuff either growing in the kitchen or planted sincerely in your mind, you are indeed inspiring.

I have so enjoyed following your accounts of weather, can't tell you how greatfull I am to know rain, floods, mud-slides, catastrophic summer fires, and the trial-and-tribulations of celebrity news like Michael Jackson keep me just distracted enough to realize my sisters on the east coast are still doing the do, sometimes in the snow.

You answered a post from a MSN in Canada who thought she was being abused. You were kind not to address the socialized system of medicine she works under. You were personal and reassuring. Now I have a question for you.

I am a psych RN. Have been for 15 years. We know that Behavioral Health is going bye-bye in this country, PPS to impose itself soon. I know that to remain solvent I have to transition out from under psych. I am a RN since 1978, but I can't get anyone to notice me because I haven't had one year of recent acute care experience.

I applied to a HHA to implement my community-based talent, but my clinical bed-side skills are more impotent than the acute skills I read in your thread. You have taught me a great deal, mostly about organization and time management. Psych discharge follow-up can be critical and timely, as you validated with Canadian RN. I know now there is a productivity profile. This thread has made me nervous, but excited about the challenge. How marketable am I? I have the desire to transition but cannot afford to go back to acute med-surg at new-grad pay.

I know I have special gifts; we all do. I do not consider myself at square one after 25 years; any advice for me? Is there a special something to say to the folks at HH? Is there a grin-and-bear it somewhere in here I can't afford?

Thank you Hoolahan, or Scavenger, wherever this goes.

[hoolahan, ASN, RN]

I don't see any reason why you should expect new grad pay. You have 25 years experience. You only need to be honest and say it's been X years since I have inserted a foley, and they will send you out with a nurse to watch one, then again to see you do one, at a minimum.

I am not sure where you live, but my agency covers only one county, so, on a rare occassion, we could call each other for support. Since I had the cardiac experience, a nurse called me one day because she couldn't get a BP on a pt. He was AA&O, she just had a problem because he had a dialysis fistula in the left arm, and a PICC line in the other, and she could get anything in his one leg, the other amputated above the knee. I wasn't too far away, so I met her at the place and showed her how to palpate a BP in the forarm below the PICC line.

Just be up front and ask to see a procedure done before trying it yourself. If you don't get everything on orientation, don't worry, you can find your oppotunities afterwards. I imagine you would have the most trouble with wound care and ostomies. It is hard to teach pt's about that when you don't feel knowledgable about it yourself. Ask to spend time with the wound/ostomy nurse, or the first time you have an ostomy change for someone to come with you. That was my weakest area, my bags would fall off, but I just kept reading about it, practcing on dummies, going to inservices, and then I was like an expert.

It will come together if you are motivated. Your agency will also have to be motivated to invest the time to get you up to speed.

Good luck.

[CardioTrans, BSN, RN]

Hi guys and gals..... Whew is it just me or is the cenus booming lately?? Seems like I have done about 20 OASIS visits in the last 5 days. I went out with our hospice nurse Friday night for a hospice admit who came home with IV antibiotic, had a PICC line, but she wasnt comfortable with them, so I went with her to help her out. Son watched me Fri night, he did it all Sat AM and Sat PM. I just stood there and watched. Amazing how some people are willing to help their parent, while others absolutely refuse to have anything to do with them. I have driven no less than 130 miles/day in the last month. whewwwwwwww, guess thats life in home care.

[NRSKarenRN, BSN, RN]

Ok who said that "BOOM" word outloud...as bad as the "Q" (quiet) word in the hospital.

Since last Monday we have DOUBLED the amount of referrals through my office to the point we are unable to staff about 30 therapy cases at each office = 120 patients not able to receive therapy yet this week. VP of nursing informed me to turn down all referral sources except for our own facilities on Friday and we needed to tell our own facilites that a therapy delay of 3-5 days may occur. Yesterday we had 17 Mom-Baby referrals in one day--usual is 5-8.

Of course, one hospital emailed the agency admin team that Intake informing them of therapy delay so giving business to competitor. Email was forwarded to me in AM by my boss, the Chief Financial Officer "Are your staff REALLY saying this and who said they could". Thankfully, my staff keeping me updated re all branches inudated 48 hrs for new starts of care. I reviewed intake stats, called and confirmed with therapy Mgrs outstanding cases, jotted info down re unstaffed cases, that VP of nursing aware and discussed with me etc.

3PM today, I spoke with CFO who was number crunching to see if they could raise therapy salaries as unable to recruit new staff.....

Yep, 500 referrals in one week will do that to you!

[hoolahan, ASN, RN]

OMG Karen!! 500 referrals!!!!

You know what, let them go ahead and refer to a competitor, when one agency is like this, they all are, and I bet they will also have a delay, but they may not have the courtesy of being told so up front.

I have seen this happen several times at different agencies, that occassional PT overload, or OT. Of course all cases then get triaged, with post-op hips and knees at the top of the list.

Have you considered using another contractor to help you out when it is so overloaded? We had a PT vendor we could refer to when that happened, but like I said, they could get just as backed up, and it is usually all agencies at the same time.

I used to laugh when they would threaten to call another agency, nine times out of ten, they called me back eating a slice of humble pie.

[hoolahan, ASN, RN]

I thought I would give you my typical day as a home health aide. Which I think is quite interesting.

Anyways, that is my typical day. I hope I didn't break any confidentiality rules, I didn't name any names and I didn't say the town or state so hopefully I am okay.

Thanks for listening. CS

Thanks CurlySue, your day is indeed very intersting. I look forward to more of your posts. I don't think you broke any confidentiality any more than any of us have. One thing I do often, is change the sex of the pt too, unless you are talking about a prostate or mastectomy concern. Just so long as no one can read this and identify a person, but w/o names or locales, that is pretty hard to do. I have seen a few nurses be identified by their employers though, so if you want to rant about them, do it, but carefully. :)

[Noelle_RN]

Hoolahan,

A jersey girl myself I wanted to thank you for posting this. It was very helpful for me since i am considering going into HHC from the NICU. IF you see this or anyone else does and has advice for an interview I have Monday with a Peds home health care I would greatly appreciate it!

Thank You!

[Cmyst]

Yeah, this is a great thread and thanks for starting it, Hoolihan. :)

I was supposed to go in for orientation to paperwork/forms today, but it was moved to tomorrow. Hopefully, I'll buddy up with a former colleague the day after tomorrow, THEN hopefully I'll be set to go and actually leap back in to HHC after 5 years away from the field. I already had an agency orientation last week.

This thread has been instrumental in my decision to return to HHC, because really -- it sounds like things haven't changed that much since I left, and I always loved it. Hopefully, it will pay the bills! I left NOT because of paperwork, but because I did not care to work for hourly pay at a hospital-based agency and those were the only ones that had a steady stream of referrals after OASIS came in. I'm returning to the field per diem, to maintain a comfort level of control over my scheduling, but I am hoping to work full-time visits for the most part.

Again, thanks for this thread!

[Daysleeper]

Wow--when I started visiting this site, I was still a "daysleeper"--working night shift on the Oncology Floor. Part of my decision to transfer to Home Health was because of the posts here! Anyway . . . about my day today.

9:30 Called my first patient (who is a long time friend of my in-laws) and she agreed to me visiting at 10 today.

10:00 Saw first patient, drew Protime/INR, then ended up sitting and chatting with her and her (very talkative) husband for a half an hour about "the good old days." (Good thing I'm not busy today!!)

11:00 On to patient #2. I love this little fella. Since I opened him for care back in November, he has had an MI, has been diagnosed with CHF and now has a MRSA+ wound on his leg. Took photos and measurements of wound today, wound care, etc.

12:00 To the office. The hospital my agency is through treated everyone to pizza today for lunch. I was happy--I was starving and didn't want to take a break to go out for lunch.

1:00-4:00 Charting, phone calls, etc. Also reviewed charts for every patient in my caseload (10). (Guess what happens next week? JCAHO survey! Woo hoo!)

4:30 Home at last. A few more phone calls and I am done for the day. I like "easy" days like today! I love this job and have never been able to say that about any job before!

[Hairstylingnurse]

I thought I would give you my typical day as a home health aide. Which I think is quite interesting.

7am-8:30am

-Get up, shower, drink my hot cocoa, look at my schedule and out the door I go

8:30-2pm

-First client, 27 years old, 3 years ago involved in a DUII MVA. Resulting in fractured back, crushed pelvis and closed head injury. Was in a coma for 2 months. Currently is ambulatory, can do many things on her own however cannot stand or sit for long periods of time. So she cannot hold a job. She is in the process of getting SSDI.

-I get her up in the morning, shower, help her dress, medications, cook breakfast. Then I start cleaning. THe house is trashed everytime I come there. THe day before I am there I leave the house spotless but the next day it is trashed. Her husband is the laziest person in the world. Will not even do a dish, take the trash out, pick up his clothes, I could go on and on. They also have a child so that adds to the mess. I just take a deep breath and begin my 4 hour cleaning routine. Make beds, do dishes, wash clothes, scrub bathroom and kitchen floors, vacuum, pick up toys (client cannot bend over to pick things up), scrub toilet and so on. I love cleaning, its something I have always like to do I guess I am weird like that. So I really don't mind cleaning. What bugs me is how incredibly lazy her husband is. He NEVER does anything! I was told I was only supposed to do my clients laundry, dishes and pick up after her, no one else. WEll, I cannot really do that easily. I guess if it gets really bad I can go on strike and make him do something. He is really immature and spends what little money they have on video games. Lovely, huh? In fact I had to buy my own cleaning supplies.

-And besides cleaning I have to make sure my client has everything she needs, assist her with her shoes and socks and other things. WHen I first started working there their house was awful, black mold everywhere, just terrible. Now with me there we are starting to organize things so its not so bad.

2pm-6pm

-My second client, 50 some year old lady with COPD, Fibromyalgia, diabetes, and on oxygen. I do the same for her as I do with my other client except she is more of a hoarder, stuff everywhere. She has a problem with sugar, eats a lot of junk. Sometimes she has me make a cake or a batch of cookies and eats all or most of it! WOW. THe one thing that really scares me is that she smokes while she is on oxygen.

Anyways, I cannot emphasize how much I love my job. Although its not really reliable, your never really guarenteed hours or would if someone dies or gets their hours reduced. I get health insurance through them which I really need so I hope I don't have a problem with that.

Anyways, that is my typical day. I hope I didn't break any confidentiality rules, I didn't name any names and I didn't say the town or state so hopefully I am okay.

Thanks for listening. CS

Curlysue, please don't think me rude but your post sounds like it should be on a "merry maids" website. I'm sorry but I refuse to bake cakes, wash toilets, and most of the other things you do. I guess maybe your a housekeeper on a cna salary. As long as your happy that is all that matters. I really don't mean to seem rude,so please don't take it that way.:)

[NRSKarenRN, BSN, RN]

Curleysue is provding a different type of home health aide care for clients who are longterm disabled, most likely under a medical asistance wavier program.

Wavier program is designed as "nursing home diverson program" to provide skilled and custodial care aide services to help a client live at home rather than be placed in a nursing home. They ususally receive several hours per day of mix of home health aide and homemaker services to maintain a client in their own home. HHA hours range from 2 to 8/hrs per day, 5-7 times a week.

Clients care plan includes personal care, meal preperation and daily kitchen cleaning of sink/table/meal prep area, sometimes weekly food shopping, weekly cleaning of bathroom, laundry 2-3x week along with time for "Companionship" i.e. socilaizing with client to keep them stimulted. Weekly vacumming and straghtening-up of living room and bedroom along with monthy refrigerator cleaning is included. Some programs even have social workers/business staff that mange patients bills.

These programs are cost effective and improve longevity of client IF adequate HHA supervision provided, often every two weeks or at least monthly HHA while HHA present in the home. Monthly skilled SN visit may be provided for home safety assessment, VS, instruction in diease managment along with evaluating med compliance and possibly prefilling mediplanners.

Not all home health aides are cut out for this work. I managed 200+ clients on this type program (had staff that made SN visits). After much education, our aides called me immediately if they found their client sick or went to the hospital cause they wanted them back PRONTO upon discharge as they were so concerned for their welfare and it was steady work in the same homes daily.