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Joined Apr 10, '07. Posts: 1,043 (50% Liked) Likes: 1,411

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  • Sep 4

    I never tell the family. I work for the agency, not the family. And if you tell the family why, they may retaliate.

    Just recently a nurse left a case I'm on. She told me it just wasn't a good fit. The agency told the parents that the nurse wanted more hours. Of course that wasn't a good lie and the parents saw through it. Its best if the agency leaves it as confidential if the parent asks. Then nobody has to lie and it won't hurt the family as much.

  • Aug 24

    That behavior is common. Nobody tells these parents how things should work because the agencies are scared if running the parents off to another agency. Right now I'm lucky that I have a parent that is involved without being over the top. But she is home all day, sleeps til 2p. Then watches tv the rest of the day. She whines about how hard the work is to take care of the patient. But acknowledges the hard work we do. She complains about how hard 4 hours is with the patient while we do 12 hour shifts. But I've seen worse. We enable these parents to avoid being parents sometimes. We do need to be there so they can go out at times. A babysitter wouldn't be able to do what we do and give the parents peace of mind. However, so many take advantage that it ruins our view of things. I have some parents that refuse to change a diaper. They walk in and tell the nurse to do it. But then they don't change the kids diaper and wait for the next nurse to arrive hours later. We are there to be nurses and give the parents a chance to work our take a break. But so many get greedy and take advantage. Then they go through nurses quickly and complain they can't keep nurses. The good families keep nurses for years. Sometimes I wonder if these parents with special needs kids weren't meant to be parents but our medical technology saved the kid. I had another case where the parents flipped out if they didn't get a nurse on Fri nights so they could go out. They both were home all day living off the system. But they couldn't be flexible to choose a night when they had nurses and be appreciative of that. They act like its owed to them. Luckily not all parents are like that. Its just hard to find the good ones. But yes, it can be extremely frustrating dealing with that day in and day out. It may be time to find a new case or float for a while so you can find greener grass!

  • Jul 16

    Quote from Elle23
    Just because you don't see a camera doesn't mean there isn't one.

    I'm not sure why a nurse would purposely block a camera. What do you have to hide? At the very least it makes you look like you have something to hide.

    There is a video monitor in my patient's home, but I always assume I am being watched even if that monitor is not trained on me. Who knows whether there are hidden monitors?

    I can't say I blame any parent or family member for having monitors. I absolutely would do the same thing if it were my child. I have seen and heard too many horror stories about the bad things people do when they think no one is looking.
    I don't think its about hiding something. Its the creepy feeling of being watched. I have nothing to hide. But cameras make me uncomfortable, even in public places like a store or on the highway.

  • Mar 6

    I started in home health. I wish I could have started differently, but the hospitals in the area don't hire LPN's. I was lucky though. The agency that I started with had a daycare for medically fragile kids that I was able to learn needed skills at. But I only got a week there to learn trach changes, replacing Mic-key buttons, etc. Then I was on my own. But again I got lucky. The daycare for medically fragile kids was inside a regular daycare. They child I was assigned to was in the regular part of the daycare. So even though I was on my own, I could go to the other daycare if I had questions.

    Looking back, I see all the things that still could have gone wrong. The agency wasn't supposed to hire me. But they lied to who they needed to and told them I had a year of experience. I didn't find that out until after a year with that agency. At that point it didn't matter. I also never took a case that I wasn't comfortable with. But with the lack of experience I had, how did I know enough to know if it was an "easier case" or if there was something underlying that I wouldn't realize that I didn't know how to deal with.

    As time went on, I took some classes on ventilators. Unfortunately in doing private duty, you don't get much time with another experienced nurse with a real patient on a vent. Taking a class and working with a patient are 2 different things. Again, I was lucky. My first couple of vent patients weren't vent dependent. I was able to use what I learned in the classes to apply to working with a real patient without as much danger as a patient that was vent dependent. As I became more familiar with vents and how to handle situations with patients on vents I moved on to vent dependent patients. During that time I was also exposed to all sorts of feeding tubes, types of trachs, types of vents, TPN, IV/ports, etc.

    All I can say is that I was lucky considering how much I didn't know. I had no idea what I had gotten in to until I gained experience. In the little bit of time I had with more experienced nurses on the cases I worked, I'd try to learn as much as I could. I would read their notes to learn interventions that I may not have known.

    The agencies don't care about their nurses. Most (not all) just want a warm body with a license. The agencies want to make as much as a they can and some of the nurses don't care about the risk because they want to make as much as they can. Its a bad mix. They agencies will try to pressure you in to taking cases you aren't ready for. Its unsafe, but happens all the time.

    If you still decide to go with an agency. Ask questions. Don't let them pressure you in to taking a case you aren't comfortable with. Learn as much as you can from whoever you can. If you do peds, quickly figure out if the parent has a clue or not. Some parents are wonderful and very knowledgable. That can be good or bad. If you come across as incompetent those parents will let you go. If you can learn from the parent or have a parent that is a nurse/doctor it will help. If the parent is one who basically stops caring for their child and leaves the child for the nurses then be careful. Sometimes the challenge isn't the nursing skills needed on the case. Sometimes its the skills in dealing with the family. Some family members want you to do things that are against what you are trained to do or request that things are done in a way that is different from what you know. Then there is the drama in the family. All families have drama. If you do choose to do home health, get to know some nurses who have been with the agency for a while or float quite a bit. They will be able to tell you which cases are better for you and which ones to run from. Don't trust the agency to tell you the truth. The agencies will look out for themselves and do everything they can to get you to work the bad cases or fill in for shifts on cases you aren't ready to do. Good luck!

  • Oct 9 '16

    Quote from shardtke
    I am new to PD. I work a pediatric case. The agency that I work for pays all LPN's $18/hr. No shift diff. They do add a few hours each week PTO that is suppose to make up for holidays through out the year. There are benefits offered. I have been lurking around and learning a lot from you all. Thanks!
    Don't be so sure they are all paid the same rate. I've heard that a few times and found out they were lying.

  • Oct 7 '16

    Quote from smartnurse1982
    Are you guys using assessment sheets also?I keep getting told there isn't a reason to write all that when there are checkboxes.As a matter of fact,the supervisor said its really not neccessary to write beyond the 5 lines they give us on the combined assessment sheet/nursing notes.
    Wow. I had an agency tell us to fill out the assessment and in the notes just put "uneventful, routine shift"....I never did it. Agency was shut down and nurses were charged with fraud for multiple reasons.

    You should be charting in detail, that doesn't mean double charting though. Medicaid/medicare have requirements for charting. That's the minimum standard. If your agency is accredited by CHAP, JCAHO, etc, you may have further requirements...but that is *if*.

    I hate charting and make it an art to write as little as I can. But I put a lot of info in few words and use as many approved abbreviations as I can. But there is no way 5 lines is enough for 8 hours on even a sleeping child.

  • Oct 7 '16

    Quote from chickengirl1977
    Hi! I am currently working for a HH agency that deals with pediatric patients. I have worked for them for 8 months. I consider myself to be a "new" nurse as I have only been practicing since November 2011. I am with the same patient on a full time basis. My patient is medically stable, but at risk. His primary caregivers are wonderful but are his grandparents so there is the mom and dad that are divorced involved as well. I'm needing advice on my charting, etc. My patient is 7 and has state and federal agencies that are involved in his care who are stating they want more charting. I chart every 2 hours as required, but also when we do walks etc. I do not chart his every move, and he is an active little boy. But apparently they feel that all he does is sit around watching TV and playing games. Any advice I can get on charting would be appreciated!!! Thanks in advance!
    Without seeing the 485 or other details its hard to be specific. But every two hours is the least amt of charting allowed by medicare/medicaid. You would benefit from a documentation class...better if the class is specific to PDN.

    My notes always start with received report from.... Then I document what I observe walking in. That includes what is/isn't connected to the pt. I document that the emergency equipment is checked and functioning properly. After that, I do my assessment. The assessment is supposed to be done in the first 30 min according to medicare/medicaid. Then that is documented. I document meds/feeds given and if the tube flushes easily (to document patency and placement checked). Any diaper changes and if it is urine or BM. I include color, odor, quantity, etc as it applies. I document that the skin is intact or whatever applies. AM care is documented. I document activities throughout the day. My favorite note that always sounds great is "developmental play encouraged" and insert therapy "____ therapy exercises reinforced per therapist instruction". I document changes. If the pt requires sxn, its required to document each sxn. My sxn note (change words as it applies to pt) sxn x2 for lrg amt of thin, white secretions from trach. O2 sat ^ to 99% after sxn. I document transfer to wherever the pt goes or moves to. The nursing hours are decided on based on the number of skills done in a time period plus the pts diagnosis/condition. At the end of my shift I document to cover myself. I write NAD. VSS. Trach midline, patent, ties secure per agency policy. Resp even, unlabored. O2 sat 100% (or whatever it is). Pox probe on left foot. GT patent. Diaper dry. Denies pain. End of shift tasks completed. Equip plugged in, charged, and working properly. Emergency equip at bedside. O2 tank full. Report given to...., who assumed care.

    You can also ask your boss for an example so you can see how it should be done. National agencies usually give you am example when you have orientation. Look at the other nurses notes and compare. The other nurses may or may not be charting correctly, but you will get the idea. I hope that helps! :-)

  • Oct 7 '16

    Oh yeah, I will add that I document when the parents are attentive to the patient. Great for cases where there are questions about the parents involvement or if something comes up in the future. You can remind the parents that you are also documenting to help them.

  • Oct 7 '16

    Quote from Texan56
    I have had some parents who think nurses chart too much, including me. Two have said so, and another made it as difficult as she could. (No table, no time. Here, fold these clothes instead....! )

    It was ludicrous, and I ignored their "preference" in this matter. LOL
    I remind those parents that our charting is how they get their hours. Usually those parents are the ones that are sue happy and know the less you chart, the easier it is to burn you. But I avoid those parents if I can.

  • Oct 5 '16

    Quote from Texan56
    I have had some parents who think nurses chart too much, including me. Two have said so, and another made it as difficult as she could. (No table, no time. Here, fold these clothes instead....! )

    It was ludicrous, and I ignored their "preference" in this matter. LOL
    I remind those parents that our charting is how they get their hours. Usually those parents are the ones that are sue happy and know the less you chart, the easier it is to burn you. But I avoid those parents if I can.

  • Sep 28 '16

    Please post if you are an LPN doing a job that isn't the typical clinic, hospital, LTC, PDN type job.

    I'm thinking of changing my area of nursing. I have no interest in the typical jobs. I'm getting burned out with PDN. I prefer working alone or with a few people. I don't want the risk and pressure of LTC. I don't want to work in a clinic doing vital signs all day. And I'm sick of the nutty families in PDN...dealing with them in short bursts instead of constantly is fine and I'm tired of them having control over my hours. I prefer a job where I can wear scrubs. I hate dressing up for work.

    So far I have applied to 2 plasma centers as I'd enjoy doing assessments all day. And I have applied to an assisted living facility for management experience.

    So what do you do that is different from the typical LPN job? What is your day like? If you are comfortable discussing it, what is the pay like? Any other job suggestions? I'm in NC if that makes a difference. Thanks!