How's your staffing compared to census?

[hoolahan, ASN, RN]

We are dying! We can barely manage to see the pt's we all have, yet they keep taking those news!! Today, they made a big to do b/c our quality nurse opened 3 news yesterday, and was helping us today, even the sup's have been doing visits. Me and my big mouth said, loud enough for TPTB to hear, "Fine, they opened 3 more cases, are they going to case manage them?? How can we squeeze in the needed visits? We need to stop taking new pt's!! It seems that with PPS, they count the pt as long gone when they go into hospital. They seem to forget, we have to keep that case opened and resume when necessary.

Anyway, one nurse was told we are "lightening up" on news, while another nurse was told we are not taking any cases that need PT. We are super short-staffed on PT and HHA's right now. Forget OT, we have like one!

One of my pt's called today, she is pi$$ed since she was not seen since last Monday. I had her on my schedule Monday, they pushed her to Tues, tues and wed I was off, they pushed her both days, today she got pushed, now tomorrow b/c she c/o, she will be seen and not pushed to weekend. I have 14 pt's on my schedule tomorrow, I am supposed to see 7. The new supposed to be mine was not opened today, he was not home. Another freaking managed care case to track!!

One good thing they did to help us, was have the other quality nurse do all the pt updates. So she tracked and got our auths, which is a good thing, b/c she can see for herself how lazy intake is!! They are even talking about not doing labs anymore, and telling docs to refer to mobile labs. That will stop alot of bogus referrals.

I'm thinking of going into mobile lab business. What do you think? Do you think people will pay $30 to avoid a 2 hour wait at the local lab their HMO send them to? If I did 8 sticks a day, I'd make more than I do now! But how would I get supplies?? I would accept no insurances. I'm talking about a strictly service for convenience, not even have to be homebound. I may do a few pro bonos if it works out. What do you all think?

[PattiRN]

Hoolahan...got to say I like your style! I am a sup in NY and yes I go out to make visits occasionally to help. Last night I did a SOC . No one else would go at 7pm.

Adm. wants less nurses...seeing a caseload of 25. My nurses are straight out.

Come to NY and we'll all work with you in mobile lab...can you bring up some apnea monitors too...in my county (rural) we have no DME suppliers with monitors!

[hoolahan, ASN, RN]

Patti,

LOL! NOw we have been in a slump! That's always the way isn't it?? I guess this is why they don't like to say no to referrals, b/c then people stop sending referrals. But, after having helped w intake when I was a weekend super, I know that is not always the case, as I used to have CM from insurance co's call me begging to reconsider to take a case. One d/c planner reported me to a insur co b/c I didn't take an IV case. We had only one IV nurse, the other two were on sick leave, and the one nurse was totally burned out from 24/7 call. I patiently explained this to the insur co CM, and she said, get this, "Well, are you advertising??!!" Yes, I said gritting my teeth, check X newspaper's ad the last 3 weekends, but unfortunately, that will not help you at this moment! NO means NO!!! And still they begged us to take cases, so I really think it is just that time of smooth sailing when the weather turns nice.

Now that we are in a heat wave, we will get bombed with elderly people d/c w diagnosis of dehydration from the hospital, no doubt.

I have gone PT for the summer. What a relief!!

Can't help you w the DME, but we have scads of them down here. Not all are good though. I am not going to do the mobile lab thing, but I do have another enterprise under my hat. But, I don't want to say too much about it until I have worked out some more details, but I really need to be my own boss. I am sick of being micromanaged in this PPS environment!!!!

[PattiRN]

Hoolahan...explain what an IV nurse is in your agency? Are they IV certified nurses and how are they trained? How do they get updates? Do they work with a local hospital? Seems up here in the north everyone can teach IV therapy..that's our goal to teach a family member to do that IV! That's PPS!

[hoolahan, ASN, RN]

Patti, not sure what you mean. I was working at another agency as weekend supervisor in my above post. Yes, the nurses were certified, trained by OTJ w nurse educator. THey worked w our agency which was not affiliated w a local hospital. HOw do they get updates? Do you mean CEU's or something like that? Yes, we also teach IV therapy to the pt, that is everyone's goal. What I was talking about was we did not have enough staff available to take any more IV cases b/c two of the three nurses were out for whatever reasons. That left only one nurse to take call.

Having a nurse join the IV team was optional. Most people, including myself, chose not to do it, b/c it meant more call. In fact one of the main reasons I left this position is that the IV nurses rarely answered their pagers, and it left pt's hanging if they had a problem. I was not able to talk them through anything b/c I was unfamiliar w the equipment, and most of our IV cases were not Medicare, but maaged care, and each HMO works w different DME/Pharms, so every pt may not have the same type of IV pump.

Did that answer your questions? We can only teach a pt family IV's if we have been certified ourselves first. How do your nurses get certified in IV therapy?

[dlstovall]

in the agency I work for they have started to priortize pt admits b/c of the very thing you're talking about. Like a referral today b/c pt is constipated. Go to the drug store, for heaven's sake! But we're going to put him off until the weekend b/c of the load. CM do 28-30 cases at a time, but seeing 7 pts a day is a rarity, usually its b/t 5 and 6. They kind of have to take care of the nurses here b/c its a rural area and its tough getting nurses. Of course the per diems see 6-7 a day. They use travelers a lot.

The mobile lab sounds like a very good idea. I bet you could get the supplies from the lab you're dedicated to, you know. The other problem would be hazards. Perhaps the same lab would let you drop off there instead of paying a waste company to take it. Let me know if it really works for you.