Typical day for a HH nurse... - page 2

by hoolahan 187,581 Views | 254 Comments

Hi guys, I thought it would be nice to start an ongoing thread to just post/vent about your usual day. With a lot of entries, it can sort of serve to show nurses who are thinking about getting into HH what it is really like on... Read More


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    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
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    Thanks for the diff perspective sphinx!

    Here was yesterday & today, along w some venting.

    Yesterday, get kids to school, arrive in office 8:30, get handed a chart and told pt needs a foley change, and HHA leaves at 9:30, so I have to leave NOW to get there on time. (Yes, I was pi$$ed!) I also have 2 news, and literally did not have time to call them to confirm. Now I will have to call them from the road, and if they don't work out (ie still in hosp, or pt has a MD appt or something else going on) I will have to play find more visits, which really sucks. The supervisors all greddily home in on you, trying to pawn off the worst visits possible. AND I hate getting visits in bad areas after 2pm. I plan my day so I am in the city in the am, and the burbs in the pm. This way the drug dealers are still alseep when I am in the city, and the drunks are still somewhat coherent before they start drinking, and the safer visist I leave to the afternoon.

    So, I rush out to the first pt home, change the foley, do a HHA sup and all is well, I am done and out of the way of the HHA by 9:20, so she now has 10 min to get pt OOB for the day. Thing that irritates the heck out of me is a family mbr is sitting in the living room watching cartoons, couldn't even get his lazy arse up to answer the door. God bless the aides, some people really treat them like servants, and it bugs me!

    Back to the car. Called my new admits, they are a go, thank goodness, and off I go, first vist in city, woman is a doozy. No she doesn't have a problem w etoh, she just parties too hard sometimes. She honestly tells me she went on a binge, and fell two times, second time she couldn't get up. She says, that is IT, I am not gonna drink non more...uh huh. What is your plan to not drink anymore. Oh I don't have no plan, I'm just not going to do it. What about if you get depressed, or stressed, how will how handle it, what will keep you from reaching for a drink? I just won't....uh huh.....Drink du jour 2 cans of beer (they must be the 32 oz cans) and a pint of ginger brandy. She prefers scotch but can't afford it. She needs help getting a new bed. She is HUGE, and can't get in and out of bed easily b/c she only has a mattress on the floor. Uh, we are not a furniture service...turf to MSW for referral. NO new RX in home, she can't find d/c instructions, can't find the rx, and one of the new ones is a "water pill" and she has +2 edema BLE...can you say readmit w CHF w/in a week?? LOL. Called the son, told him to get over on weekend, help her find RX and I am giving doc his number to f/u with. Call doc and explain, they will do what they can a f/u w call to son. I would love to say, listen, when you are serious about your health, and concerned enough to not lose your rx, call us, but until you are...adios!!

    Next admit, elderly woman w compression fx in SEVERE intractable pain. Doc asked us out b/c he has no idea what to do w her. I suggest duragesic patch or oxycontin, he said he would call something in and let me know what it was. I like to give them a choice, so ultimately they make the decision. Nice woamn, nice family, but PT arrived in the middle of my admit and starts butting in, interrupting my questions. VERY irritating. Nice thing tho I did watch her physical eval, so that was helpful, did ask those questions on oasis, just observed her.

    back to office to collect local new admits, in case of heavy snow. Got two, not too far, but in desolate areas = bad roads.

    The one thing that irks the heck out of me, is our agency will do no triage of visits. They usa Saturday as an extra day to turf visits to. Case managers put pt they don't like to see themselves to the w/e schedule. and so many times in bad weather I risk my life to see someone who lives w multiple educated family mbrs, and I have to ask myself *****? Why waste our resources like this?? And in snow, forget it. Supervisors should call the pt's and see if visits are really needed. I did that when I was super. One Christmas I had it down to only two new admits who needed to be seen. Just irks me!!!!

    Today, light snow, so I proceed to make my first vs, a sad woman w stg 4 lung ca, wants chemo and rad, AMA, they told her to go home and enjoy the rest of her life, she wants to fight. Will probably need o2 in near future. HHA placed.

    Next vs, eldergy gent w early dementia, lives w wife, she can't do it all, I am thinking all they really want is a HHA. I am sending MSW to counsel for long-term planning, HHA, PT eval and PT eval need for the ordered OT which I do not think is necessary. He is slightly debilitated and had turp for bladder obs. I do educate the wife that if he eventually ended up w foley or SP tube, she could get hha ongoing. Hhhhmmm, food for thought. She gets my underlying drift and says, yes I will have to discuss whether he needs that w the urologist.

    Back to the office, pick up two re-visits.

    One bogus turf to w/e b/c it is in a BAD neighborhood, now it's afternoon too, but snow is keeping the creeps indoors I guess. This guy doesn't need a nurse today and really doesn't need one ever!! He will be d/c next vs I tell him.

    Next vs, strange woman. She has more medically going on than on her chart diagnosis that is for sure, starting w moon face, and bulging eyes, but of course, a complete assessment was not done, and I can't get a sense of it from her meds. Despite her strange affect, she seems to have a good handle on her meds, and her diabetes. This little dingy apt had a fecal smell soooooo strong like sour sewage, I almost gagged when I walked in. her bathtub has water just pouring non-stop. She was trying to get a landlord to address it, but no luck. And probably won't have any luck. She is stable, weight is down, sugares are wnl, and I am on my way.

    Hojme at 2:30, w mountain of paperwork, and here I am on the puter, so I will be doing it later. I just want a nap, but I refuse to lay down til it's done. I am procrastinating and I will pay for it later. While at office earlier, I picked up 3 new admit for tomorrow, and confirmed they are all home, so I will get charts ready and start a wee bit later tomorrow, first vs for between 9 & 9:30. Sounds like a winner, I always love it when there is no phone!
  3. 1
    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...
    mullen831 likes this.
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    Awww sunny, you are a nice doggie nurse!! See, in homecare we really do holistic care of the whole family!! Furbabies too!
    mullen831 likes this.
  5. 3
    Originally posted by hoolahan
    Awww sunny, you are a nice doggie nurse!! See, in homecare we really do holistic care of the whole family!! Furbabies too!
    one of the best parts of home care, imo, is knowing their families, esp knowing their pets by name....hell, i have some pts that i like their dogs better then i like them....
    mullen831, OkieeRN, and annaedRN like this.
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    Today I had a really "easy" day....makes me nervous because the FULL MOON is next Tuesday so Monday and Tuesday ought to be doozies!

    #1 89 y/o LOL with HTN and mild orthostatic changes (I'm talking 10 points systolic with no dizziness). I'm only to call the MD if BP greater than 200/95. She's also been having a "faintly feeling" with slight epigastric pressure when she has been up and around for more than a 1/2 hour or so. Says it lasts only a minute or so. MD is aware and no change in orders. So, today, when I am ready to d/c her because her ortho BPs have been unchanged, her meds are unchanged she has the "fainty feeling" with epigastric pressure while I am there, lasts maybe 2 minutes. No seating, no SOB, no pain in arms or jaws. BP was 200/90. Five minutes later she back to her "normal" 170/70. Call her MD....only change in orders is "continue to monitor her 2x/week and fax me the BPs, oh, and decrease her Megace to QD. " GRRRR. The patient saw the MD yesterday and was told to find an assisted living asap. I'm thinking she needs a new MD to change her meds and consider that anxiety may be an issue. Nothing concrete...just a feeling I have...and you know those "feelings." I feel like I am spinning my wheels in there....I fax my notes to the MD every visit.....I think she thinks of me as a phlebotomist who takes BPs.

    #2 "Covering" another RN to administer a monthly B-12 injection. The new primary RN has asked me to address this lady's homebound status. Turns out the lady has been on caseload for 2 years for these injections....all the while driving herself all over. Address homebound status and tell the lady we will be arranging for her MD office to administer the injections in the future. Her primary said she'd d/c her.

    #3 New Admit. 89 y/o lady who had showed up in the ER several times this year with c/o SOB. Got admitted for two days when she added "chest pain" to the complaint. Known to have CHF, I'm to teach her about her disease and meds, monitor her cardiac status and eval for a HHA. During the interview, she starts talking about how nervous she gets, living alone, and fears her heart will fail. Says her MD won't give her meds fdor anxiety "because they are addictive." (SHEESH!!! This is the same MD who, in the past, has told me to "jolly the patient along" whenever I try to address depression.......) I admit her so I can see her a few times to teach her about her CHF, her meds and her diet. She's fine today....no edema, clear lungs, stable VS.

    #4 90 y/o man with G-tube feeds and a neuro-muscular type disease that no one has put a diagnosis to. I'd been his nurse a while back and just loved him. He's lost a lot of weight and is pretty weak. Oriented the HHA and talk to the PT about her plans for him. His wife is a doll and so devoted! The tube feeds are gravity at this point, but she's trying to talk the doctor into letting him switch to a pump...so maybe they can do more than feedings and exercises during the day? He has a new decub which I gave some samples of calmoseptine for...I love that stuff...clears up superficial decubs like magic! The plan is to get this man strong enough for him to have surgery so he can take po again. Please God he gets there.

    #5 80 y/o lady I see once a month to administer a B-12 injection. This one truly is homebound, O2 dependent and insists on doing as much for herself as she can. Refuses a HHA because, though it takes her quite a while to shower, she wants to do for herself as long as she can. I refuse to let the per diems do this visit, she's such an love, I think I deserve this visit!

    Back to the office to fill out all my forms. We are in the process of switching to computer, I'm still doing paper. All our forms look like the ones on the computer...to help us get used to the form, I guess.

    I have a TON of recerts in my box. All are for next week and the week after...whew! I should have most of these people d/c'd before their recert dates, lets hope!

    Finish filling in my schedule for next week. I've been a discharging fool lately....so I know I'll be doing a lot of admits next week.

    Can't believe I had a day with no labs, no disasters, no messages from "quality assurance"! Shut my beeper off and RUN!
  7. 0
    Hi everybody....I like this thread. It has helped prepare me for what I will be seeing/doing. I have just started HH this Monday, after working a med-surg floor. I used to work Hospice and had done a touch of HH, so I sorta knew what I was in for. I wanted a position that would let me work a little slower pace physically, since I have a bad ankle and need to have surgery on it soon.

    I spent Monday doing office junk....you know: read the updated Policy & Procedure book, update paperwork for my file, get my beeper, cell phone, get my nurses' bag and stuff it full of supplies. I was not nervous at all about my day...I have known nearly all the nurses for over 3 years. We do have a new Manager tho, but EVERYONE says what a sweetheart she is. My impression so far is the same.

    Tues thro Fri I went on call with one of two different nurses who are precepting me. Yesterday & Thurs I did some of the visit care while the other RN helped, just to get my feet wet. I did a triple line lab draw on a 21 year ol female who has lung CA and a newborn baby (4 weeks old!) She is also getting ATB Vanco IV that we have to stary until it is run thro. So on one of these daily visits, I held the baby and fed him!

    I started a peripheral IV line for a different female who will self-admin IV steroids x 4 days for an exacerbation of MS. We will see her once a month for 6 months to restart the IV...then she will self-admin x 4 days and then d/c her IV. Nice young lady 26 yrs old, married w 2 kiddos.

    I have been w the nurse three occasions to see a man who is so very sweet, had a baby toe amputation d/t DM, to change dressing and eval wound. He is also "legally blind" and scheduled for retinal surg in 2 wks, hopeful to regain some eyesight. He is in his 60's...when he found out my Hubby & I ride Harleys, made me promise to drive over someday when the weather clears up just so he can "see" the bike and hear it! Says there is NOTHING like the sound of a Harley engine! RUMBLE RUMBLE.....I agree w him! The other RN & I agree this man is starved for male attention & conversation, since all he has around him is women. I need to see if Hubby might just drive by his home someday....

    Saw a LOL in a senior housing complex who has HTN, CHF. There to assess BP, ck meds. She has a little Pomeranian named Walker who has NO TEETH and tried to gum me before an aide picked him up & held him during the visit! hahaha He growled like a little tiger everytime we touched his lady!

    On three days saw a 64 yo lady who had bowel resection w an abdom wound dressing, not healing well d/t DM. She is perhaps mildly retarded (very very...but you still get the impression she may be IQ in 80's?) Has a mildly retarded daughter who lives with her and does the dressing changes and cares for the colostomy, cooks, cleans, etc. Theses two are the cutest pair...they tease and pick on each other, and the RN is just sweet w them...you can see the love here...That dtr is doing a WONDERFUL job, writes down the BS, writes down BP, the wound is healing great...used to be (per the RN) "big enough to put your two fists in it", and is now maybe 8cm by 3 cm! Dtr is a great cook and promises me a pineapple-upside-down cake!

    Yesterday saw a 17 yr old male, autistic w retardation, who lives w 24 hr caregivers thro a group home type of organization. He attends our local MRDD school which will move him to their workshop for employment after HS grad at age 18. We just give allergy shot q month and stary to assess for any rxn. Obviously NOT a homebound case, but the county MRDD pays for our visits. He is a sweetie. Active, but not real verbal...beautiful eyes. And he is a bit of a flirt!

    That is just a few of my visits for the week. I have been in a home on the "wrong side of the tracks" that was maybe a $8,000 home all the way up to a home maybe $250,000. But w/o exception, I have been met warmly, the ppl are interesting, and I am excited about this job!

    Yesterday morning, I got my laptop and had computer class. We are going to all be "live" by the end of the year. Right now, two RN's are total computer, the rest of us do limited stuff...OASIS and time logs, mainly. It was not bad...will be glad to go "live" if they want me to. It is a Toshiba w 17 gig HD...not bad! Had to sign my life away for this baby...

    Well, next week I am going to do revisits and opens w my preceptor Mon & Tues, and I will do the cases while the RN is my back-up. Then the plan is Wed I will be out on my own for some revisits! YAY! My job is full-time Case Mgr. so some of my work will be office stuff, paperwork. That will come later, altho one of the RN's who is primarily a Case Mgr and does PI work for HH, has a new case she is ready to hand over to me already! hahaha I am so happy to be here.....they have all made me feel so welcome and are glad to have me.... It is quite a change from working the floor! I had to go to my floor to pick-up my paycheck and some mail....it sure didn't break my heart to leave that day after seeing everyone racing around like always! I have had 4 or 5 MD's tell me they will miss me on the floor b/c (as one said to me) "I always knew if you had my patients they were being taken care of". Another MD, (who is my fave!) grabbed his chest and told me I had broken his heart, because he valued my nursing skills and always liked seeing my "smiling face" . That was really sweet.

    I have not said this, but the HH I work for (obviously) is with the same hospital I worked floor on. I work mainly this county and will be assigned to one particular part of the county/city. All the RNs have an area they are primarilly given. Cuts down the driving. We do get paid mileage (32.8 cents) and get paid by the hour. I will make the same hourly pay I made on the floor. Our cell phone, pager, laptop is supplied as well as nurse bag and supplies for it (blood sugar monitor, BP cuff w scope if you need one, etc.) I will see between 4 to 6 patients a day and also case manage. On-call rotates...we have an evening RN who works 6 days a week so on-call starts at 8 PM til 8 AM. THen weekend call is Sat 8 AM til Mon 8 AM. Right now, I will be on-call one week night every 8 or 9 days, and weekend every 8 weeks or so. That is of course after I am full thro training. We also just hired a contingent RN and she will take some on-call too. So what do you guys think??? Not too bad, huh? I feel blessed to have gotten the job. They interviewed me 4 weeks ago and w/in the same day, told me I had the job if I wanted it. At the interview, 4 people were there: the manager, a case mgr, and two of the RNs I will be working with. The Mgr told me they wee all unanimous that they wanted me to come there! It is so nice to be wanted!!!

    Thanks for "listening"....I know I am in the "honeymoon" period, but I truly feel it will be a great place to work.

    Debby
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    Oh, forgot to tell ya....the big thing at this hospital right now is we are scheduled for JCAHO in April. So, of course, all the managers are trying to get us prepared. I asked about what I could wxpect...I think I will get off easy b/c I am a new employees to the HH...bt I might get picked out to answer questions regarding orientation stuff. We have been given a booklet of info to know in prep for inspection. The nurses told me that the HH Mgr made a game out of it w few weeks ago....had a meeting where they played "Family Feud" and asked questions...one person was the "Richard Dawson" character, dressed in s uit and tie etc...she said she did the role except for NO KISSES, lol....the winning team got prizes of little plastic bird feeders filled with jellybeans for their desks. How cute!
  9. 0
    reg... I can read the excitement in your posts. So glad you are liking what you do. And never fear, you will form bonds w the docs, esp the docs in the clinics, and get to know who to ask for in the md office who can get things done for you.

    There is a cardiologist in this area I have spoken w so many times, yet I have never met him, and when I call, he knows it is important enough for him to come to the phone, tho I must say his office nurses are fabulous, and I rarely need to speak to him personally. He told one of my pt's he was "lucky to have me as his nurse" and this from a doc hwo has never worked side by side w me, so you will form new bonds, and if you are a good nurse, that will show thru whether you are on the floor, of on the phone w the docs.

    Keep posting, it is nice to see how others' assigments are. My day was kind of draining, so I don't want to re-lice it by writing about it tonight, maybe tomorrow??
  10. 0
    Reg, it is wonderful to "hear" the ffresh excitement in your posts!!! Keep it up, you'll keep the rest of us feeling fresh!!!



    this is my w/e off...but i did do one visit earlier....client with a VAC...only 2 of us are oriented to it...the other nurse is his case manager, but she's getting burned out on him...he's a grouchy soul....can be a likeable grouch at times, but he is frustrated with it taking so lon gto heal his wound...but it is doing well with the VAC....but he is inssiting it is not working, cuz as it is healing and as the infection has cleared, the amount of drainage had drastically dropped....he refuses to comprehend this, insists that the VAC unit is faulty...the rep finally gave in and got him a new one, just to shut him up...no such luck....she won't even return his calls now. (in one way i can't blame her, but i really don't think highly of this girl, for various adn sundry reasons... )


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