Home health nurse need to report minor cold symptoms to MD?

[DinoY, RN]

Hi, I recently became a home health nurse. I learned that you have to report any changes in patient's status to a doctor from their normal. However, if I visit a patient at home and they have a minor cough and they are congested does this need to be reported to the MD? Even if vitals are normal, mental status is normal. Lungs sound clear. No fever, no chills. No sob.

[Davey Do]

Such calls were made when I worked in HH, just leaving a message at the office or exchange.

A slight change in condition can be a point of reference should the condition worsen.

[Concerned C]

As a retired professional, I am now in a position where my 83 year old husband is in need of home health. Nursing and CNA services. The nurses have been amazing, but we have had constant problems with the CNAs . They either try to run over me and treat us  disrespectful , don't want to do their job, call in and don't show up. The company has a big problem getting dependable employees. I have been yelled at,  my husband has been left alone because the CNA left early without permission and he has dementia. He's been ignored by his assistant. I have been preached at daily! The aid would sit at our table for half an hour on her phone or in my room sitting on the bed preaching to me instead of working. When I tried to talk to her about leaving early while I was at my doctor's appointment and leaving my husband alone, she got angry, threw her arms up ,yelled at me and walked out of the room. I fired her on the spot. I use to take care of my older sister and constantly had problems with her home health workers. I don't know what is going on in these home health companies but something needs to change. 

[Davey Do]

I am truly empathetic toward your situation and having to deal with the variety of Healthcare workers with which you've come into contact, Concerned C.

It seems the sweetest days were the days that used to be. Working in the area of HH from 1992 to '96 as a field nurse and NS, the nursing staff who were drawn there seemed to be the cream of the crop. However, while discussing the quality of Healthcare givers a decade later with a nurse I had worked with who was still I HH, she relayed that it had gone downhill.

The seasoned HH nurse believed the cause for the decline was due to reimbursement rate of the paying entities. For example, hourly SNV were about twice the salary that an RN would make in a hospital setting, and a case opening nearly three times the rate.

Having been out that area of nursing for nearly 30 years, I have no idea of staff's wages, but the nurse I spoke with 20 years ago said the pay was not nearly that of the past.