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...

 

[homenursingrj]

This thread is fascinating! I'm glad to have found this forum!:)

[lioneliz]

Just another typical day in home health. I drove 20 miles to my first patient, a crabby old gent with CAD A-fib S/P 3 vessel CABG has had numerous med changes recently. Called his home before I left the office, but when I got there he went to the bathroom for the first 5 mins of the visit. Then told me to hurry up he had to go to the bank. Sooo 12 mins after my arrival Mr Crabby hops in his car and speeds down the road leaving me and his wife standing there . I had to explain to the poor wife that Mr Crabby nolonger qualified for servies. I wish he had just told me not to come and saved me some time and wear and tear on my car.

-NEXT- An admission for a frail eldery female with a stinking pressure ulcer on her heel. O2 sat's in the low 80's, w/c bound can't get out of the house (no w/c ramp) lives with her brain injured son (sweet but clueless). Got an order for O2, got the ball rolling on a w/c ramp then left hoping her home doesn't catch on fire .

-NEXT- Drove another 30 mile to dress an open foot wound (at least this one didn't smell)

My next pt went to the doctor so it was back to the office for my favorite thing PAPER WORK!

[hoolahan, ASN, RN]

Today was fun! I got in early, thank goodness, b/c I found out I had an inservice at 9:30. I had a lighter load as a result, one admit and 3RV. The first pt had labs and a routine foley changes. I figured I could get there, do visit and get back in time for the inservice if I left lickety split, so I call dtr, she says, "Dad, is not doing so good, he had tarry stools last night, and isn't drinking or eating, and his urine output was only 900 all day yesterday." (she empties foey at HS, then again in am. "I haven't looked in on him yet this morning, I hope he's still with us..."

WTH??? Go look!! I sweetly ask her to just peek and see if he's breathing if she is really concerned this may be a problem, she confirmed he was. Whew! So, I say I'll be there in twenty minutes. Got there, and he was drowsy, but certainly not comatose. Sking turgor was good, urine amber, not very concentrated, and veins plump for the stickin. I concluded she is a nervous nellie. Got back to office just in time for inservice with the KCI wound vac rep.

I have had this inservice twice now, but never had the chance to do it. Well, this time, she brought models and we all got a leg and a kit, and actually did the dressing instead of watching, very cool. I learn stuff like that hands on, and it is so much nicer to practice on a model first.

After that was done, almost 2 hours, I got a message one of my RV was in the hospital. That left me w my ROC and a RV. The ROC was out in a more rural area, and as I am driving down the wonding snow-dusted road, 4 deer leaped accross the road, far enough away to be pituresque, and not scary like I would be hitting them. The Delaware river is frozen, and it looks like little waces are frozen, and now there is about 3 " os snow over that. I haven't seen that river frozen like that sine 1994!! That is how cold it has been.

Forgot to mention, d/t the cold, I was wearing a super-fuzzy long, fleece cowel neck. One of my co-workers remarked how warm and cozy it looked, and it was. BIG mistake! I forgot how the older folks like to crank up the heat. The first home, w the foley and labs, well you know how you get nervous/sweat a tad when a new family member is watching you, well, this house was set to 75!! The dtr even got a paper towel to blot my head like a surgeon. I left the house w/o my coat on, my shirt was wet. And those senior bldg's, the halls are soooooooooooooo hot. I don't know how they don't pass out! Have to remeber to do layers.

[Nursecathy123ca]

Thanks, Hoolahan, for the picture of a day in the life of a HHN. I'm currently a staff nurse in postpartum/gyn. The hospital routine is wearing me out, plus I can't get a day shift, so still working evenings. Hubby doesn't care for that much!

One concern: my IV skills are nil, and my blood draw skills aren't much better. Would this be an impediment in a HH job?

[hoolahan, ASN, RN]

I wouldn't worry too much about the IV skills. Many agencies subcontract with an IV homecare agency, or have a team of IV nurses. And, even if they don't, they have to ensure your competency, so they will train you.

You will have to be able to draw labs. Though if you are going to do well mom-baby type visits, there may not be too much call for labs, but I am not an OB nurse so I really can't say. Just be upfront in your interview, I am sure they will be able to train you in lab draws as well. You could go in for a day into your hospital lab or outpt dept to learn this. I am fairly good at labs, and rarely miss with a butterfly needle. The worst thing that could happen is you stick the pt and aren't able to get the lab, and they send another nurse out the next day or same day if not too late. Or, they just tell the pt to go to the lab or doc's office. For those who are truly homebound, the mobile lab can be arranged to come out, but that takes a few days to set up, so we usually do the first round of labs.

I am sure the agency would work with you b/c maternal child homecare nurses are in demand.

[nursegeorge]

Thanks for posting so much about your days as HHN. I am interviewing for a HHN position. I have 20 years of Med/Surg hospital experience, 4 years of OR, 1 year of private duty in the home and for some reason considering going in to HHN scares the wee out of me! I think reading through your posts has been a wonderful education and humbling experience for me. You all sound so dedicated and right on the ball with all of your patients. Your humor has really touched my heart too!

Someone said they needed to get out of the hospital atmosphere....I agree with that. I've been there for 20 years and the pace is killer!! I can still run circles around the girls half my age, but for how much longer. After reading through what all of you do...ya'all aint no slackers, that's for sure!! I'm not afraid of hard work, nor long days. I guess, just the learning curve!

As far as pay goes, I'm being offered $42/visit and $60/admission plus mileage if I do the per diem. They are trying to match my hospital salary of $30/hr basepay plus premium on weekends. (I can only work weekends...2 small daughters and a workweek husband.)

I really can't affor to drop my pay much from the hospital, but if I don't do something, I'll drop from the stress at the hospital, (as well as the 18 hour shifts without a wee-wee break or food!)

God Bless all of you here. You are truly an inspiration to me and I love reading your posts in this thread!! Your honesty, devotion and professionalism really shines through your words, and as I think Hoolahan said a doctor said: "Your patients are really lucky to have you for nurses!"

Thanks, Nurse G. :)

[NRSKarenRN, BSN, RN]

Welcome Nursegeorge!

Go the perdiem visit route for weekends. Be mindful that all paperwork willl be required in the office Monday 8AM so keep sunday evening open for hours of paperwork until you become proficient--3 to 6 months to master.

Your level of experience should be a plus to this agency. I'd request a ride along with an agency nurse to fin out more this agency's clientelle.

Good Luck and welcome to HH and allnurses.:)

[nursegeorge]

I am currently negotiating with the HHAgency which is affiliated with the local catholic hospital. They (the hospital) has consistantly been rated in the top 100 places to work for working mothers.

They are trying to match my hospital salary and I was told by the HHDirector that they really, really want me, so we shall see...

Thanks again for your welcome. I hope it works out.

G:nurse:

[lioneliz]

This was not really a typical event in a typical day in HH, but I just had to vent a little. A man came by the office the other day and asked about hiring someone to help bathe his mother. He told me his brother and he had been assisting mom to bathe because she couldn't do it by herself since she had recently had a stroke and had just come home from the hospital. I thought hey this lady sounds like she needs a home health eval and proceeded to discribe what services we offer. But, the man quickly held up his hands and said we don't need home health services we already have that through *****HH agency. They are sending out a PT and a ST all we need is someone to bathe mom. I encouraged him to talk to mom's HHA and ask for aide assistance. He told me the agency couldn't send out an aide due to the distance from ***** town where the agency is located. At this point I saw red, but explained that if an agency accepts someone as a patient the agency is obligated to provide for that patient's care. I gave him the number of some sitters in the community and the DHS number to look into provider assist. We are a small rural hosp based agency hanging on by the skin of our teeth and *****agency is a large hosp based agency at a regional medical center in a town approx 75 miles away. They have a branch office in a neighboring town approx 30 miles away and in numerous communities in this part of the state. *****agency is not known for being overly ethical in their business dealings or in the way they obtain patient's. Many small rural towns send patient's into this regional medical center for care that can not be provided in the smaller hospital's. I have heard from countless other rural HHA similar stories. I really wanted to tell this poor man he should call the state and report *****agency but since I didn't know all the details about how mom was functioning I really couldn't. I felt sorry for this guy and his brother having to try to bathe mom just cause ******agency worships money and doesn't care a whit about their patients.

[luzababy]

Hi!

Please help! I'm thinking about entering HH and have hospital experience only. I have an interview tomorrow with a local HHA and don't know what to ask. Any advise?

thank you!

[lioneliz]

Funny thing happened today...I was just wrapping up a visit (pt assessment caregive teaching wound care & dressing for a patient with a tunneling abdominal wound) when she told me that her husband couldn't understand why the HH staff always checked her bp and temp. She seemed rather amused by her husbands lack of knowledge about what we do and proudly said "I told him you all are sort of like nurses only you're not in a or hospital." Now it was my turn to be amused. I let her ramble on for a moment and the said you are right we are nurses that work outside of a hospital. I'm sure that little bit of information was like water running off of a ducks back.

[CardioTrans, BSN, RN]

Another shower thing...lol One of my home care aides came in the other day and we were talking about a pt who has recently passed away. He was a precious man, but a man of few words. He was always the quiet type, would answer your direct questions, but nothing more, he would never "cut up" with the nurses or HCAs. He was a serious man. She was telling me one day that she had put him in the shower and was standing in the shower behind him, his wife came in the bathroom to leave a towel for him, the wife leaves the room, and the patient out of the blue with the most serious tone said "well, its official" The aide was curious and asked what was.... he said "we've been caught by the missus" She started laughing and said "well, what do we do now?" In his serious manner again, he said "not much now, she knows our secret"