Home health nursing and case managers?

[mzsuccess]

Hey!

I work as a homecare nurse. I love it! I have a great rapport with my patients and family.

My only issue is-the nagging from management about updating the patient’s plan of care. Calling Drs for orders and receiving orders for the infusion team.

Now I’m an lpn so infusions is not in my scope in my state. So I asked the case manager why should I be calling a provider for medication that has to be given via ports ( by an infusion RN). Also, the infusion nurse comes before me. If an issue with the pt’s port she will tell the pt to tell me to call the Dr.

Another issue I work with one patient twice a week. I’m constantly getting harassed to update the POC. Any changes of new orders I receive. I update the pt and family. MAR and agency. But it seems like they want me to sit and call different Drs all day and med reconciliation. Which I do but it’s taking from my patients care. The case manager tells me she knows the pt is sleep so I can make phone calls.

Also, she will text me on my first day back. Call the Dr about this, that and get an order for this. It makes me uncomfortable. Maybe because as a case manager I feel like it’s her job.

I don’t mind helping and I’m a team player but where do I draw the line. How can I focus on my job without doing much of hers? Or is this my job? What does a case manager entail?

[Silverdragon102, BSN]

Moved to the Home Health forum

[caliotter3]

If you are the nurse on duty, it really is your responsibility to update orders with the MD, although in some agencies (and more so in the past), the case manager (or clinical supervisor) takes on more of this role. In the case of the IV infusion, no, the infusion nurse should be doing it. S/he is more qualified to discuss specifics of an IV order with a doctor and they are responsible for carrying out that order. However, if there are other nurses on the case, the nurse on duty when everything transpired is supposed to handle the nuts and bolts of the paperwork. The manager is looking to you to do it, because the other nurses can’t be relied upon, and she does not have the time to do this herself. Nevertheless, the last part of your post indicates that the case manager is dumping too much on you. Sleeping patient is no excuse for her not to manage the case.

[mzsuccess]

10 hours ago, caliotter3 said:

If you are the nurse on duty, it really is your responsibility to update orders with the MD, although in some agencies (and more so in the past), the case manager (or clinical supervisor) takes on more of this role. In the case of the IV infusion, no, the infusion nurse should be doing it. S/he is more qualified to discuss specifics of an IV order with a doctor and they are responsible for carrying out that order. However, if there are other nurses on the case, the nurse on duty when everything transpired is supposed to handle the nuts and bolts of the paperwork. The manager is looking to you to do it, because the other nurses can’t be relied upon, and she does not have the time to do this herself. Nevertheless, the last part of your post indicates that the case manager is dumping too much on you. Sleeping patient is no excuse for her not to manage the case.

I agree,

However, i work the end of the week and like everything is waiting on me to complete. Whenever, the POC expires. I’m expected to call the Drs to clarify or verify orders ( my pt is on a lot of medications). I understand my part as stated above. But I can not spend all day chasing Drs- when it’s a bunch of kids in the home when I can barely hear.

I feel like the case manager is dumping a lot of things she should be doing on me. I’m ok calling the dr if it’s a change in my pt’s status, talking orders. But as far as the POC goes. I don’t feel comfortable revising it. I wasn’t trained to do or amend a POC.

[caliotter3]

If I were you I would seriously think about finding a new agency where you would not have to work under this woman. She has targeted you as her work goat. If she could put you on all of her cases with the same requirements to do her job, she would do so.