complex or non complex clients

JustBeachyNurse, LPN · Jul 29, 2012

Does the patient require continuous monitoring via apnea or pulse ox? Trach, Vent, CPAP/BiPAP, continuous O2? Jtube, Gtube, GJtube, NG tube? Colostomy,ileostomy, urostomy, nephrostomy? IV medications? continuous IV infusions? Central line, PICC, peripheral IV line? Contininent, Incontinent, catheterization required? Seizure monitoring/precautions? Technology dependent? Assistive communication? DME such as splints, monitors, standers/walkers/wheelchair? Rehabilitative nursing? Complex wound care or simple wound care?

A patient with a trach, vent dependent with a GJ tube (J tube continuous feed via pump, meds via GT), wound vac for sacral ulcer, IV antibiotics via PICC, continuous pulse ox and trach suctioning q1-2hrs, straight cath PRN, VS q2h and PRN change in status, etc. would be a very complex patient.

A stable patient with a Gtube and some PO intake, seizure precautions (no active seizing but risk for, well controlled on antiepileptic medications), insulin pump with AC/HS glucose monitoring, routine vital signs q shift and PRN change in status would be a less complex patient. Or a PO fed, incontinent patient VS q shift or PRN, risk for seizures requiring skilled nursing monitoring and complex medication (PO) schedule would perhaps be non complex.

caliotter3 · Jul 29, 2012

Most patients in long term continuous home care cases require routine care. When an employer bases their compensation on how "complex" the patient case is, usually it will be based on whether or not the patient is on a ventilator or requires multiple interventions or monitoring, such as with IV meds administered in the home, a central line, etc. However, employers also will compensate the nurse based on their reimbursement source: private pay and insurance company versus medicaid. Medicaid wages will be the lowest. I have found that employers will tell a nurse that they base compensation on acuity of the patient care, when in fact, nothing of the sort happens. They will establish as low a base rate of pay for an individual nurse as possible, and leave the nurse at that low pay rate as long as s/he does not challenge it.