Do you rotate patients? HELP

caliotter3 · Mar 18, 2015

To address in simple terms: I would cease dealing with the fiasco agency. That is not the way to do business, unless there is an underlying reason for promoting lack of organization. You can hide a lot of offenses when you have no one able to do proper follow through. Who would want to try to track things through that mess?

Libby1987 · Mar 18, 2015

My agency doesn't operate like that at all. We're primarily case managers with some part time nurses. We try for continuity as much as possible. And no one can provide quality care consistently seeing 9 patients/day, especially with no continuity in staff.

KelRN215, BSN, RN · Mar 20, 2015

No, that's asinine. Everyone gets a primary nurse- in the majority of cases the nurse who admitted them- and that nurse does all visits and follows them until discharge. If there are some visits the primary nurse cannot do, others fill in. For the most part we self schedule.

JustKeepSmiling, ADN, BSN, RN · Mar 20, 2015

I don't work in that type of nursing and that sounds ridiculous! How can that come close to providing quality consistent care??

pnkgirl25 · Mar 25, 2015

This is my thoughts exactly. It's a MESS. Since I am an LVN the RN typicall opens the case and then the LVN's float to different patients. 80% of the patients are wound care but it makes it hard not really knowing whats going on with a case before you see them. Sure you can read H&P's but I still often feel like I'm going in blind. Another annoying thing is you will see a patient one week then 2 weeks later you get assigned that same patient and think...GREAT I know this one....then you get there and the supplies are different, the orders are different and they might have a new wound all together lol. I only stuck it out this long because the pay was good and the patient load was great but I'm at the point now where no amount of money is worth my sanity.

Libby1987 · Mar 25, 2015

You don't have access to their records?

toomuchbaloney · Mar 25, 2015

meh

I worked for an agency that had central scheduling.

I would have a schedule for my case load and would regularly discover in the AM that the scheduler had completely changed my day.

It was ridiculous and I only worked for them for a year. It was not tolerable.

JustMeRN · Mar 26, 2015

I work per diem for an agency that schedules similarly. Everyone has a primary nurse, but the full timers have pretty heavy caseloads. That's where I come in. I pick up the cases the full timers can't see that day. I get my schedule emailed the evening before. I might look through my charts, I might not. I don't call anyone until the morning. I usually open my laptop around 8. I might spend a half hour looking through orders etc, then I plan out who I'm seeing when, and call to let them know what time to expect me. I'm usually on the road at 9, and manage to see usually 5 visits (4 if one is an admit or a long drive), and be home by 1-2. I usually need another hour or two to finish charting, then I transfer data in and I'm done.

I also keep keep supplies in my car. I have a small drawer stack, keeps it organized.

I think if you are not full time and / or are not case managing you really have to be good at going with the flow. Have you asked about being assigned to case manage? Or, have you asked if you could be assigned as a partner on cases so you can have some continuity?

pnkgirl25 · Mar 28, 2015

I work per diem for an agency that schedules similarly. Everyone has a primary nurse, but the full timers have pretty heavy caseloads. That's where I come in. I pick up the cases the full timers can't see that day. I get my schedule emailed the evening before. I might look through my charts, I might not. I don't call anyone until the morning. I usually open my laptop around 8. I might spend a half hour looking through orders etc, then I plan out who I'm seeing when, and call to let them know what time to expect me. I'm usually on the road at 9, and manage to see usually 5 visits (4 if one is an admit or a long drive), and be home by 1-2. I usually need another hour or two to finish charting, then I transfer data in and I'm done.
I also keep keep supplies in my car. I have a small drawer stack, keeps it organized.
I think if you are not full time and / or are not case managing you really have to be good at going with the flow. Have you asked about being assigned to case manage? Or, have you asked if you could be assigned as a partner on cases so you can have some continuity?

You have luck with same day appointments? Lucky. If I called my pts same day 1/2 of them would not answer the phone, the other half would want to tell me when THEY want to be seen. I typically see 7-9 pts per day so same day scheduling does not always work. Plus I cover a large area....All of North and South Orange County

pnkgirl25 · Mar 28, 2015

I have access to every patients electronic records but when we have hundreds of patients and I dont get mine assigned until the night before its pretty useless. Now when I do get assigned im up for 2 hours reading charts and order, going over med lists, treatment orders then I stat calling and scheduling.

JustMeRN · Mar 28, 2015

You have luck with same day appointments? Lucky. If I called my pts same day 1/2 of them would not answer the phone, the other half would want to tell me when THEY want to be seen. I typically see 7-9 pts per day so same day scheduling does not always work. Plus I cover a large area....All of North and South Orange County

Honestly, I dont give them an option. My phone calls go something like this "hi this is C with the visiting nurses. I'm coming to see you today, I will be there between 12-1. See you then". Very occasionally I will have someone refuse, and even then I can usually gently convince them. If the absolutely will not than the visit gets bumped, and either I see them if I'm working, or someone else picks them up if im not, or the visit gets cancelled. The thing is, if you are seeing medicare clients they need to be home bound. The only valid reason for refusal is doctors office or church. My agency is pretty strict with this. If someone refuses you because they are going to have their hair done they are reminded that according to medicare (and most private insurances) they must be home bound and available when we come. Period. If they are capable of leaving the home for hair, lunch, shopping etc they are discharged from care and set up as outpatient for their needs. As far as I know the vast majority of nurses in the agency call the day of visit and tell, not ask, the client when they are coming. It seems odd to me that your clients dictate their visit schedual. You are the nurse.

eta: when they don't answer the phone I leave a message stating " this is C from the visiting nurses. I will be there to see you between 12-1. If this is a problem please call me at 555-5555. If I do not hear from you I will be there between 12-1". If there is no one home when I get there it gets charted as a missed visit. Aha, medicare requires home bound and the vast majority of our clients are medicare.