Assessment is finished, now what?

[Farmorethanrubies88]

I just recently started working at a small HH agency, I had orientation with one nurse who was fairly new to Home Health herself, we saw maybe 6 pt's. Her visits consisted of a quick assessment of the pt and asking if the pt needed anything, a sign-in to the interdisciplinary sheet and off she went.

I know teaching is a BIG thing for home health... but what else? I am used to going into a pt's room knowing and clearly seeing what this pt needs, not in this situation.

The money is terrible. I am putting tons of miles on my car, and I only get paid per visit and IF I go over 30 miles, 10 cents a mile.

Maybe I am just used to having IV's beeping and call lights going off even in my dreams. Oh and to make it worse everything is on paper... Aren't we in 2012? It is a little less stressful...BUT Does it get better?

[merlee]

You are not having a good orientation. Each visit should have a purpose beyond the assessment. A task, or specific teaching. And you should be getting mileage from the first patient's house until you leave the last patient's house. Are you not riding together?

And mileage reimbursement should be based on Federal guidelines. Small agencies may not be able to afford electronic charting, but they will have to, at some point.

You need much more instruction/orientation, and so does she. We had wonderful booklets for a wide variety of illnesses/situations. We taught one or 2 chapters at a time, and documented what we taught and the pt's response.

Are you doing wound care? Blood work? Why are you making these visits???

Best wishes.

[caliotter3]

My intermittent visit agency has a wonderful documentation note that almost spoon feeds a visit. It incorporates a full assessment and interventions on the front side and the reverse lists teaching points for each body system. I was given a copy of the 485 before even making my first visit and it is 'extremely' complete also. I didn't even need to waste any time wondering what I needed to do on my first visit (mine was the first and subsequent follow-up visits) and afterwards. And my boss was very willing to provide input and answer questions over the phone. You are being shortchanged. You should speak up and get some help with this.

[KateRN1]

Where is your 485 Plan of Care? That is your treatment plan and tells you exactly what needs to be taught, what skills need to be performed (eg wound care, IV, etc), and when patient is ready for discharge. Above advice is great, but start with the 485--that's your physician's orders, just as the MAR, TAR, or Care Pathway is in the hospital/facility. If you don't have a 485, ask where the physician orders are.

[Shimmer580]

It sounds like you are doing skilled nursing visits vs shifts of 6+ hours... If so, they are typically something like that. You go in, do your assessment, address whatever their health concern is and see if there's anything else you can help with before going to the next visit. Def check your 485 and before seeing a new patient, always speak to the clinical manager so they can give you a better introduction to the clients history and clinical needs. It does get better but it's certainly less hectic than a hospital.

Home health is more one on one and you get to do extra little things for your patients that you wouldn't necessarily have time to do in a facility with 4-25+ patients per nurse.. Just my personal experience though. I love home health! I do shift work though but used to do visits too.