Typical Day For A Home Health Nurse - page 20

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line... Read More

  1. by   OkieeRN
    Quote from hoolahan

    Just wated to share this one b/c of the ethical dilemma. What would you guys have done in my place?
    I think I would have called APS the same day. I agree with you that they could have done no more on that day but it covers your hiney and your agency's hiney. And lets face it, the woman really needs some help here.
  2. by   Nursecathy123ca
    You only know by asking, in detail, what their policies are. This would occur during an interview. Remember, this is not just them interviewing you. You should interview them. If they pay a salary, what is their productivity points requirement? Do they pay points for mandatory meetings? (I found this one out the hard way.) How often do you have to be on call? And insist on a minimum salary. I assure you, the managers interviewing you have a salary!
  3. by   nurseemily87
    I really appreciated the posts here regarding what a HH Nurse's day looks like! Tomorrow I start a new adventure in home health with a well known company in my area. My last job was subacute nursing, caring for 9-11 vent patients per day........I'm used to daily surprises so, I feel like I'm up for the HH challenge
  4. by   hhnintn
    Yesterday; I drove to the office 730 am. then first pt 29miles away. wound care have to teach personal care hygiene. on to second pt 12 miles away new to diabetes oh boy get to teach. Nope dtr RN. A/E and review knowledge. onward into a rain storm and more miles. Lovely pt who is terminal and not aware. unna boots. next more miles lots more miles into the middle of nowhere. Beautiful drive cool and sunny now. Farmers and cows. oh dear no stores no fast food no nothing. discharge planning on pt i have never seen before. That takes a little longer. B-12. moving right along next 8miles wound care. next 16 more miles. DM non compliant.CVA dysphagia choking on water, using two straws and leaning over to his side to drink arrggh. HOw did the speech therapist instruct you on eating and drinking " shes been doing pretty good but I had to cancel last two visits cause i have trouble sleeping. I beg please dont do that anymore we only have limited time to help on to the next one for wound care. single wide with 6 dogs. Need I say more? It was clean just crowded. Oh another wound care, after visit I got to admire the garden, 4 dogs and 17 chickens. more miles no food in site no bathroom in site. finally last visit of the day total of 132 miles and 9 pts lovely couple healed wound discharge planning. Day off exhausted chart remining notes
  5. by   jennrn52
    I love this thread! I got started in home health April of last year per diem, then in September went full time. The office was 1 1/2 hours away from my house but I had a "hook-up" with getting an interview because I knew one of the supervisors (PCC). When I went full time I went from per visit to salary with "compensation." That is, I get a set salary, plus car allowance and cell phone allowance. I am required to get 35 points a week, and anything over that I get the per diem visit rate for each point over 35. Boy did I blow up the bank on that one! I was averaging 45-50 points a week. However the strain on my car, time and family was too much, and a few months ago discovered that another branch of the company had a full time position open for a section of the county I lived in that was 15 minutes away from my house. Woot! So I transferred. Big mistake. Can't stand the supervisor, she is an IDIOT and can't ever get things done in a timely manner. Not really a fan of my fellow field nurses, the two I work with in my area are per diem LPNs and they used to get tons of visits but since me and another FT nurse started they get squat now and they are very vocal about it.
    Anyway I've been reading other posts and I saw one that she covers 27 counties??????? Whaaaa???? Not sure how everyone else does it but my company generally has a branch in whatever county they are covering here in Florida. The exception is my current branch. Their office wasn't getting alot of visits so they took the southern end of the county just north to them (my current territory) because the area is SO BIG. We are paid by Medicare so I see nothing but little old people and the younger ones on it for disability. Just a little back story. On to my day!

    I had to move some patients off tomorrow because they are making me take the day off because I'm on call this weekend. Yes, MAKING me. I would rather work, it would just make my life easier. I've had to give away visits because I've had almost 14 regular visits every day. So today I originally had I believe 10 regular visits, no admissions (thank goodness). Making my phone calls last night and one of my pts had an MD appointment today to get the wound below her stoma looked at. So I told her we would skip the weekly check up this week (she does her own wound care, long story, unable to d/c due to open wound and the surgeon doesn't know what to do so we help determine WC). Down to nine visits. Doable!

    Had to get to the office early this morning to drop off paperwork (yes we are still on paper in this day and age!) and of course get held up by my supervisor yammering *yawn*. Finally get out of the office (which BTW is 30 minutes from my area I cover) around 900. Which is great since I was due to be at my first patient at 900. Show up at 930, he isn't there. Greeeeat, will try again later.
    On to #2. He has a wound on his foot that everyone thinks is a diabetic ulcer....except he's not diabetic.....anyway he goes to the wound care center weekly, they send new orders, yadda yadda. They decided to totally change up his wound care, using something I had to Google. It's called Tritec by Milliken. Interesting. Will have to see how this goes. He then informs me that even though his orders from the center say F/U in 1 week that would be Memorial Day, so it's 2 weeks. Will have to call and clarify since our orders will end next Monday. Pretty lengthy wound care, but shuffle through then it's off to my next one who is about 20 minutes away.
    #3 is the sweetest little man. He's a quad x 7 years since neck surgery gone awry. He gets weekly foley changes and currently has a massive heat rash to back and booty and has a wound on his arm he got at the hospital that is healing up nicely. He lives with his little old wife who takes care of him and has hired help bathe him 4x week. I change the bandage, his wife tells me she had to change the foley sunday because he had so much sediment it clogged the cather (again). Suggested he drink more fluids and start running on the treadmill to decrease the sediment. That got a laugh out of both of them. Off to the next, another 20 minute drive back to the area I was at this morning.
    #4 He had back surgery, they left a sponge in, now he has a huge wound on his back. Daily wound care, luckily his cute little wife can do it sometimes too. Whip through that visit, smell that their son got a pizza for lunch and hear my stomach growl. Realize it's now 1200. Off to the next patient!
    #5 zip over to him right quick about 5-10 minutes down the road. He also has a chronic ulcer on his foot that IS complicated by Diabetes. And he's mildly overweight. And he smokes. He has a cute little doggy though. He goes to the same clinic as #2, same doctor, ALMOST the same wound care. He also tells me his next appointment is in two weeks, and his order says F/U 5/29. Hmm.....something is fishy.....will have to call and clarify this....but it's 1230 so they are at lunch......mmmmm food.....
    Stop at McD's and eat since the Big Mac is on sale for $2
    Head over to #5, little old man with a skin cancer removal from his head we have been treating for a few months. I almost had the joker healed 3 weeks ago and the flipping dermatologist thought it would be a great idea to put silver nitrate over the WHOLE THING. So I feel like we are back at square one again. Play with their collie for a few minutes, I think they want me to take him, they keep commenting how my little boys would love him. Lemme get out of here before they ask!
    Head over to an ALF memory care to see #6, 7, and 8. They all live in the same unit (how convenient!) and two of them are husband and wife (how cute! they're demented together!) Do the husbands wound care (this is a joke, flush his toe with saline, apply TAO, and literally put a band aid on it. but the alf can't do it.) Go to do the wife's skin tears and man! Is she crotchety today or what!!! Come to find out from the staff she went to the doctor today. So I don't have to see her after all. Which was fine by be because she was all mad because she thought her husband was flirting with the cup of popcorn in front of him. So I decide to see #8 (who is now number 7). She had fallen out of bed and broke her arm. Went in to check on her and guess what. She's taking a nap. So I'll just move her visit to Friday since she's 1x week anyway.
    My #9 was supposed to receive IV potassium and mag, however she is in the next city with her dad who is dying of lung cancer, so she decided to delay the medicine (this would be her first dose x 3 doses) until this is all done.
    Back to see my original #1. He's home, so I get to do his wound care. He has a traumatic wound on his leg I've been treating for a few months. It was sooooo sloooow to heal, and I had to recert him last week. It has shrunk down so much in the past week I think I may be able to discharge him in a week or two. Woot!
    So saw a total of six people today, finished visits by 3pm. Headed over to the satellite office we have up here so I don't have to drive back down to the main office, call and confirm my visits with my scheduler, and make a few phone calls. Had to clarify those follow up appts with the wound care center. Yes both patients were right. So guess who gets to write the new order and tell the scheduler two of her 3x week wound cares are now daily x 14 days? Yeah boy! Me! Notified the doctor's office of the lady with the dying dad that she will not get her medication until she gets back from that and we will delay the post med lab work until after the med is done. All in all was home around 415 today, had most of my charting done in the patients homes for a change so just need to document one or two items!
  6. by   jennrn52
    Wow just realized how long that was, so sorry!
  7. by   kkremer77
    You are one organized individual!
  8. by   thenightnurse456
    Was loving reading this thread before realising it was created when I was a child... Crazy to think that I wouldn't have understood a word of the posts back then, now I'm really enjoying reading the typical day of a HH nurse!

    It's sounds incredibly challenging and rewarding!
  9. by   stella789
    I've been thinking about a career move to another field of nursing and HH has been on my interest list. But I must say that I found this thread so interesting I read every single post and have decided HH is exactly what I should be doing. I work very well with a team but there's nothing I enjoy more than autonomy and my independence. Thanks for all the insight
  10. by   Nursecathy123ca
    So glad this column helped you make that decision. I did home health nursing for 8 years and have no regrets!
  11. by   Yosemite, RN
    0300 hours: alarm went off, got up an turned on computer, brewed coffee.
    0320 hours: plotted out my visits for the day, driving times, expected visit times, ect.
    0415 hours: reviewed the care plans, printed teaching materials for presentation to clients.
    0530 hours: began documenting previous days visits
    0630 hours: breakfast
    0700 hours: wrote and printed Faxes, orders, etc. for physicians
    0745 hours: personal time
    0815 hours: shower, etc., prior to leaving for office
    0900 hours: arrived office, emptied in-box. Dealt with that crud.
    0930 hours: began calling and negotiating with clients for visit schedules. Most didn't answer their phones.
    1000 hours: office politics, gathering supplies, etc.
    1030 hours: avoiding highway patrol speeding towards 1st visit.
    1050 hours to something like 1130 hours: 1st visit, got my dressing change urinated on by the client. Had to re-set up my gig.
    1130 to 1150 hours: driving through bad part of town to get to next client; hard time finding a place to park. Glad that my battered ol' truck will not stand out for thievery.
    1150 to 1205 hours: attempted to see client, had to wait and enter through security gates. Pt. was smoking in apartment, I had asthma attack, had to bail from the scenario, almost calling 911 (for me). Almost overdosed on albuterol. Patient not "seen," little pay for this encounter.
    1205 to 1330 hours: traveling to and seeing next client. No problemo! Go figure, eh?!
    1330 to 1430 hours: traveling to next client; traffic jams. Detours.
    1430 hours to 1530: Foley catheter malfunction; replaced. C-PAP mask misunderstanding; fixed.
    1530 to 1645 hours: Drive home, long distance without reimbursement, stop and go traffic, some 39 miles or so.
    1645: grocery store for diner supplies.
    1700: Home. Blowing off charting. May blow off diner. 1/2 bottle of merlot, then bed by 1930 hours. Wondering where my personal life went.
    0300 hours: rinse, repeat.
  12. by   ED_Bound
    Can totally relate to Yosemite, RN. I gave it 10 months. Just quit 2 weeks ago with no other job even lined up.
    Time invested divided by pay equals not even close to worth it.
  13. by   Libby1987
    It's a rare day I see 9 patients but when I do I would make $585, more if any were IV/vac/discharge. Plus OT.

    I've worked for a total of 4 different HHA employers, I haven't had such negative experiences as I read here.