Calling all HH Nurses, roll call - page 43

Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field. I have been a nurse 20 years, 17 in critical care,... Read More

  1. by   RyanSofie
    The focus is on the goals set in the POC. Each visit note should reflect your teaching,the patients response and the progress towards goals.Three weeks before end of cert period your patient should have met at least 80% or more of goals and your documentation should reflect that.If the goals have not been met then consider recerting if patient has proven to be competent in meeting goals and have not met functional potential according to your assessment. When writing your summary refer to your IDT plan and address the goals met . Also address any goals not met and why. Include in your final summary the followup plan and any materials you provided with teaching ( logging blood sugars,blood pressures ,diet etc) regarding pt management of disease process in the future. If wound care was your focus then document your teaching of wound care either to patient or caregivers, wound measurements and status of wounds throughout cert. In HH the teaching is the vital key to include in documentation.
  2. by   lamazeteacher
    I agree with the previous synopsis of charting by Ryan Sophie!

    Whatever you do, don't use previous notes in the chart as your guide, unless by some miracle they reflect that post.....
  3. by   RyanSofie
    [quote=lamazeteacher;4519844]I agree with the previous synopsis of charting by Ryan Sophie!

    "Whatever you do, don't use previous notes in the chart as your guide, unless by some miracle they reflect that post".....Now ,why would you do something like that? Use your visit as a basis for your clinical notes and as I said the course of the patient's care for your summary. Medicare has specific requirements for HH skilled nursing and if your notes do not reflect skilled services your visits will be considered non -billable .
  4. by   Natasha1978
    Hello, everyone! I graduated in June with ADN and started to work in HH in the end of August with no experience at all. That was the only job offer I got. I actually have nothing to compare it with, so it’s all right for me. Most of all I like to draw blood, insert Foleys and perform wound care. I learned some of that since September. Sorry if it sounds silly We have a great wond care nurse who teaches me basics I have 16 patients per week right now and the pay is per visit, depending if it’s regular visit or SOC sort of thing. We are paid for mileage too. I tend to
    teach patients to expect me at specific day and time, so I have cancellations very infrequently, luckily. I like the hours because I have a small child at home; this aspect of the job attracts me a lot.

    I was just wondering it HH often requires Med-Surg or ICU experience is there the other way around? I apologize if somebody already asked that, but I am just curious how do hospitals look at HH experience? Will I have troubles if I let’s say, I would want to switch to hospital job in a couple of years when the child grows up a little? Thank you for your time.
  5. by   nursemissy8
    Hi, I'm a new home health nurse. I started off in critical care right out of nursing school, and they was displaced to case management in the hospital (which was calling the insurance company and d/c planning) I tried out a nursing home but did not like it ( I was working every weekend, which I thought would work for my school schedule which it didn't) so now I started home care. I worked as a social worker for aging which I did in the home and really liked it, so I do think I will like home care. I really like it so far. I like that I can focus on one patient at a time and I'm doing teaching with the patient and family.
  6. by   nrsdolphin
    I've been in HH for over 4 yrs now. I've been casemanager, field nurse. Now I'm QA and do a lot of the admits. I audit admits and discharges, help with nursing ed as well as find new info for pt ed. Will be taking the certification test for Oasis and for Chronic Care Specialist. I've worked VA, prisons, NH, and hospitals. I LOVE HH!
  7. by   toniasday7
    Pretty new to HH and I love it! I am only working PRN but get plenty of work best job ever!
  8. by   morningmom
    I just had orientation for HH! I was in SNF prior. It has taken me 3 months to finally get a break, but I got it!
  9. by   Roozeyk
    God Bless Home Health Nurses...and all other nurses as well.
    I wish home health nurses could have a scribe....would make the job so much nicer
    If we could just go in the home and do the nurse stuff and leave the monotonous charting up to someone else

    I feel kind of bad, b/c I feel kind of complacent in my job right now. maybe it's b/c I've been in the medical field for 30 years, the last 6 years in ER/Trauma, and the past few months in Home Health again, and am a little burnt out so I'm finding it harder to be content with my job.

    I know no job is perfect, but wish I could find a job that piqued my interest again.

    Meanwhile...back at the OASIS....
  10. by   lamazeteacher
    I worked in Home Health in between doing Infection Control, Education and administrative jobs wherein I could use more innovation. In the five or more Home Health agencies for which I worked after the compuyer era occurred, I'd suggest that software for our charting would save time for doing real nursing nd communication with other team members.

    Most of the other areas in nursing have developed appropriate (or not) software, yet Home Health remains married to the same old OASIS forms, writing names, dates, case #s, etc. over and over again. I've heard every excuse for not having a necessry charting tool, from the cost of buying one, to the uniqueness of Home Health situations and the rigidity of the decision makers at Medicare.

    Please!! There is absolutely no reason why those forms can't be accessible online (if they're not already), with a secretary type person inputting the non nursing info, any changes in personnel, case manager, location, etc. at the office. Then a handheld device can be used by nurses or other healthcare workers, for values obtained such as vitals, BS, etc. The assessments following the initial updated /current changes would need to be entered, along with choices given from the care plan, to reflect what has been accomplished, added and then outdated material removed from the plan.

    Doctors need to have that info availble to them, and they can place changes in orders that automatically go onto the med sheet and care plan (written in red, until acknowledged by the nurse on the med sheet, etc.). Then, of course the care plan would need alteration to reflect teaching/understanding about expected results, possible side effects, and availability of the product for the patient. Supervisors could check charting, get information about cases, etc. online which would forever end the search for elusive charts.....

    Accomplishing computerized, nurse friendly software needs nursing input, and that would be a good challenge for those feeling burnt out. To get those in positions "on high" in your agency involved, time the present charting procedure and then estimate time saved, and accuracy of charting gained, as well as increased productivity, and increased amount of money (in dollars and cents) the agency could have as well as being more attractive to new nurses, PTs, OTs, Nutritionists, etc......

    The patients and their families will realize that their care is reflected as "state of the art"; and appreciate having more time to talk to their nurse and gain more understanding of their illness and how their needs are being met, as well as knowing that their doctor is part of the information sharing loop. Results of tests should also be shared online by labs, to avoid the process of calling the doctors' offices, waiting for calls back, and then inputting the results ourselves for our information.....

    Of course it will still be necessary when aberrant test results are known for a few days, without any necessarry change in regime, what the doctor plans to do about them. (I can't tell you how many years went by without shared /interchangeble software with labs) so you may still need to call the office to jog the doctors on those things.

    Have any of you with computer aptitudes felt encouraged or challenged by these ideas?
    Last edit by lamazeteacher on Oct 24, '11 : Reason: additions
  11. by   Antonia RN
    Quote from hoolahan
    Welcome sasjp. Holy Smokes!! What an experience!! How scary!!! Sounds like the man needs inpt facility!!

    I don't know if you guys have heard yet, 2 days ago a home health aide was murdered in the home of her elderly client. The client was upstairs in the 2-story home, and very HOH, so she heard nothing. The poor woman wasn't discovered until the client's dtr came over b/c no one was answering the phone,and discovered the body. No word yet as to any suspects or how this happened. In NY.

    As far as getting referrals like that, our agency does takes any referral, and puts us at risk regularly, all b/c we have an escort, who many times has been know to escort us to the door and leave to get coffee, one nurse had to page the sup from her cell phone to find him, was stranded in a BAD neighborhood while he was getting his freaking coffee. Numerous c/o, no change. Sigh!

    What I hate the most is when they instruct me to enter a home from the back, and I have to walk between an alley, or in multi-apt homes, going in the fornt door, close it, and there is absolutely no night,try the switch, nothing. Very scary. No street signs, I have to count the streets on the map and hope a little alley didn't count. Broken glass all over the streets. Having to park far from a home in a bad neighborhood.

    On the plus side, the elderly are usually well-connected in their areas. I drove up to one bad neighborhood, and I mean BAD, and on the corner, guess I stuck out like a sore thumb, a man said, "You the nurse for Mr J?" Yes, "He's down there, just go straight until you get to the next guy." Next guy point to where they saved a place for me to park, and escorts me to the door. This was a good thing, b/c not one house on the street had numbers on it!!!! Home Health is always interesting!!!!!

    I work in 2 northern California valley cities well known for high rates of murders and drive-by shootings. I have questioned many nurses who have worked Home Health for many years, and have not heard of any assaults, rapes, or even robberies of any nurses in our area for over 30 years! I have visited patients in some very scary neighborhoods, but with my stethoscope around my neck, I just act as though everything is fine and walk on in - even though the hair on the back of my neck is standing at attention. Actually, I was assaulted once, by an obnoxious chihuahua! After that I wore cords on those visit days for "protection." One time recently, a late model car with tinted windows and its motor running (because of the air conditioning while they listened to music) was parked in the lot and as I approached, one of the windows slid down and I was asked if I was "...Thomas' nurse?" I said I was, and I was told "oh, okay nursey - have a nice day." (Lord knows what would have happened if I had said no.) Probably by Hippa standards I shouldn't have acknowledged that. I have found some of the nicest, most pleasant people in "those neighborhoods." And they are amazingly compliant as much as they are capable of being. The biggest fear I and my fellow nurses have is cockroaches. One of our nurses said if one opened the door for her to escort her in, she wouldn't be surprised, but his wiggly antennae would cause her to run off screaming.
  12. by   lamazeteacher
    It's heartwarming to see that a similar respectful condition exists now, regarding personal attacks on nurses at work, in seriously high crime neighborhoods. The "escorts" that were hired by HH agencies when I worked in that field used to be referred as "security guards", and they were armed louts. Most of us felt safer without them, as Antonia described was the case in N.CA.

    I worked in HH in S. CA, when the only means of communication outside of the office was an infrequent street phonebox (yes, I'm a dinasaor). The places most feared then, were in the "projects". It was earily quiet whenever I went there, and minimal fear was expressed by clients (who were beyond scared to "rat" on anyone).

    In the early '80s, I was stopped by a police car with its lights whirling, in a mainly African American middle class community in Baldwin Hills in the center of Los Angeles. I was in my soon to be ex-husband's sporty red late model BMW (which may have given the appearance of being a drug dealer...) The exaspirated white Peace Officer asked if I hadn't seen the gangs lying in wait for each other (I wouldn't have known one if I'd tripped over them). To my negative reply, he said "Doesn't that agency like you?"

    He drove ahead of me to the address of my pediatric client, which he said would be the scene of a "bloodbath" soon to happen. As he left me there, he warned, "You be sure a family member takes you right to your car, and don't come back". When I repeated that exchange at the office, I was told that I should have asked for a security guard before going there. Who knew?

    Now that I think of it, nurses with the expectation that they would go into dangerous situations, deserve "hazard pay"! Not to mention a session in self defense..... I've taken those, and the first step in self defense is to stay out of dangerous situations.

    So what does a nurse do, when given a case that she/he knows will involve possible danger to themselves? Even though our society accepts the fact that nurses do whatever task they're given, (even the impossible) I believe that we deserve consideration when going into embattled areas.

    Short term nursing care can be given at a treatment center. Obviously that's how doctors see their patients, why do we keep facing permanent injury and dissability, not to mention our own demise? I ws amazed to read the story about the doctor going to investigate an unanswered telephone call. Unheard of!!

    Finally the county where I live, has a new program for recently hospitalized homeless people. They are discharged to a hotel or motel wherein meals are brought in for them, and nursing care, PT, etc. rehabilitation occurs there, thanks to the Reform of Health Care Act!

    Similar accommodation needs to take place in safe areas for those recuperating from similar hospitalizations, for HH treatments, where nurses can visit them without fearing for their lives!

    I have noticed that gang warfare is on the increase now, here in the middle coastal area of CA where I live now, especially with the drug cartels that shoot anyone on sight. It's not only a city neighborhood issue.....Let's not act in bravado, but set an example for safe as well as healthy modeling behavior, and respect ourselves!!

    The American Red Cross saw the need for housing those who haven't an appropriate residence, in motels and hotels, and to a limited extent, they meet the need for housing in massive shelters after natural disasters occur. I'm not suggesting that they take HH needs on, rather I'm pointing to a safety need for ourselves, that must be confronted. The only way to accomplish that, is for nurses to refuse (across the "board") to visit areas wherein their lives are threatened.
    Last edit by lamazeteacher on Oct 30, '11 : Reason: multiple improvements
  13. by   sadie1000
    Hi all, I am a HHN-been doing it for about 4 years now. I specialize in wound care and in seeing the patients no one else wants to. Ive kind of made a game for myself out of taking on the pts that are "difficult" and seeing how I can best make a difference for them and hopefully eventually enlist them in being proactive, or at least a willing participant, in their care. I absolutely love home care!