Typical Day For A Home Health Nurse - page 4

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   hoolahan
    My agency started carepaths this week. It essentially involved takiung away one 3-page form, and adding 3 more 2-page or more forms in it's place. Now for each visit we have to document on a minimum of 2 forms, maybe 2 more if there are co-pathways, more if a wound, etc...

    People were so freaking grouchy this weekend, it was kind of funny. They did lower our productivity requirements for a bit.

    Everyone is B&Ming like never before! I heard one nurse say if this process isn't smoother in 2 months, she is leaving, and she has a ton of seniority!

    Anyway, my day started out w a pt w a trach and new enteral feeds. I got to his home, in a really bad neighborhood. Like I would not walk the streets of this hood, not w/o a gun or mace or something. He has a note already written out for me asking if I would go to the store to buy him a battery for his caller ID.

    Now I am sorry, but this does not qualify as an emergency for me! I said no, it is not an emergency, and I have other pt's on my schedule who are waiting for me to show up in a timely fashion.

    He got PO'd and would not cooperate , look at me, listen to me or acknowledge me. He did let me get his VS, but that was about it.

    What the heck?? Next person needed RX's dropped off at a pharmacy. New type of insulin. This I did, b/c it was a better & safer hood, and it was vital to care!

    Have we become personal shoppers now as well??

    It was such a crummy day, and tomorrow will be as bad, and as hot, it is my last scheduled weekend w this agency...and I have to tel you, I cannot wait!!!!! to start my new job!

    Thanks for listening. I needed a mini vent!

    I can hardly wait to see what will become of Medicare and I am hearing big changes are to be expected for Medicaid as well!
  2. by   seasonedlpn
    Started late today. (12:30)
    #1: Four year old Home Health little red-headed girl @ day care, neurogenic bladder. Straight cath.Cute as a button, but can be cantankerous. Always a very time specific visit.

    #2:Elderly Home Hospice Female with lung CA, multiple skin tears.Changed dressings on legs and arms. Spent a lot of time discussing God and "The final Judgement".Told her I thought God would judge people not so much on What they did, but Why they did it. A concept she had never considered. Answered her questions as best I could, but who am I to know the mind of God?She seemed relieved to think that God might actually listen to an explaination! I think I was able to give her a bit of peace.

    #3:Home Hospice male with lung CA. Needed a protime drawn. Had to go to a Kaiser lab (drat), so drove 22 miles to the outpatient lab near my next patient rather than park at the Kaiser hospital near his home, walk 2 blocks from the parking structure to the lab,then wait in line for the lab secretary.Easy stick.

    #4:Home Hospice Maledifferent agency),enlarged prostate, & other problems, needed foley cath for retention. (coude) Unplanned visit, called because I'm "the plumber!" Expected a difficult cath.....turned out to be easy. Bladder full, 500+cc amber urine. Will sleep comfortably tonight.

    #5: Home Health, male, paraplegic, right BKA, colostomy, urostomy, s/p closure of decubitus ulcer. Lives alone. Paged me to stop by SUBWAY and pick up a Turkey sub with everything but peppers.(I did). Changed dressing, looking good, nearly healed. Now if he can only avoid tearing it open while transferring from bed to chair............!Bought myself a sandwich, too. Ate dinner with him, and got home about 7PM.

    Now I'll figure out mileage, finish charts, and go to bed. Tomorrow I have 6 visits to make. Will start around 10AM, get the local patients seen before my 1:00 straight cath,(little girl), then head over to the next county to see Home Hospice patients for another agency. (whew! tired just thinking about it!)

    My car is full of fast food wrappers, bits of paper with little notes, and pre-printed pages from Map-Quest. Gotta clean out that car!

    Laugh and the world laughs with you............cry, and you look like hell!
  3. by   adaptation
    Hi, everyone,

    I'm new around here and am I ever glad I found you!!! I really need some help and I hope you will indulge me.

    I'm a MSN prepared psych hh RN in a suburb of a large Canadian city. I get paid per visit and since things are slow (the agency just starting taking psych pts.), I can organize my own schedule. It's supposed to be one hour per patient, not including travel time (and I've only been working since April-can't imagine what that will be like with snow.).

    However, I get paid the same amount for an admission as I do for a regular visit. Paperwork takes at least an hour and a half extra (unpaid). Then I have to call and give an initial report to the case managing agency (oversees the one I work for). If I have to call the family or doctor after the visit, that's unpaid, too. So, I am being paid one hours salary for at least three and a half hours of work. Regular (no admission) visits are a little better...maybe only a half an hour extra past my alloted hour. But no overtime for anything. And you know that you can't rush "in and out" with a psych pt., even if you set clear limits about how long you can stay!

    I asked about increasing the visit time for an admission to one and a half hours pay since it is at least an hour and half work...and was told that if they did that for me, they'd have to do that for everyone. (As soon as I hear that progressive style of management, I'm already half out the door!)

    Right now, I figure I'm making a little less than $ 10/hr. Mileage, travel time, and cell phone are unpaid. There are no other benefits.

    And this will sound nitpicking (forgive me), but it just adds insult to injury. Discharged patients' charts go back to the office, one hour away (round trip). I have no other reason to go to the office, and I figured it was cheaper to mail the (usually only one) chart than the gas and my time would be. ($ stamp cost=1.00-not reimbursed!) We keep psych charts on us vs. leaving them in the home.

    I'm like a teacher, doing my charting and paperwork and calling families at night and on weekends! Is it that I'm too compulsive and thorough??? Should I settle for the bare minimum? But that's not me.

    I don't know what to do. I love the patient care, and the hours, (I can't work nights-health reasons, and have not been hired for 2 jobs because of it) but I do NOT like being abused.

    I also think I am "beating a dead horse" when it comes to trying to negotiate with my manager, who is obviously not willing to budge, even though I've been told that they haven't been able to find anyone else to hire. Duh! Wonder why? (I better watch it, maybe that's why they're keeping me!)

    I don't want to keep whining about these issues (especially to my boss), but I am FED UP! I don't want to quit because I need a job and like the other aspects of it, but will if something doesn't "give".

    Any ideas? Maybe not so much how to handle my agency, but how to handle my workload in a more "time efficient manner" (their advice, even though I think it is them, not me). I'd really appreciate any of your comments or suggestions.

    Thanks...and looking forward to getting to know you.
    Last edit by adaptation on Aug 17, '03
  4. by   hoolahan
    You are being so taken advantage of!! Unfortunately your peers have set the precedent by accepting this same situation.

    I don't know much about Canada, but can you deduct the mileage from your taxes? We can do that in the USA if you are required to travel and are nor reimbursed for it, at a rate of 36 cents a mile. Of course, you have to wait a year to claim it. Unless you file quarterly, which usualy involves an accountant fee 4 x a year.

    I do not think you are overly compulsive. You are an good, efficient, and caring case manager.

    Are you compariing med-surg nurses to a psych nurse, or are the other nurses also psych nurses with the same productivity?

    If you are comparing med-surg nurses, there IS no comparison. Our visits are not nearly as time comsuming as yours would be.

    Exactly what is your role? Are you the psych nurse consultant? NP? If either of those, you need a lower productivity and higher pay. IN other words one less visit a day.

    Example, if I have a freq flyer CHFer, who I readmit q 4 months or so, I can finish a recert or a ROC in the same time it takes for a revisit pretty much. I know them, and usually in that kind of exampple maybe the lasix dose will change, but that may be the only change.

    You cannot compare that to re-assessing a psych pt who has just come back out of the hospital for a psych admit, even if you know them very well.

    I can hardly blame you for all the hard work and $$ of getting your Masters too, and then to be paid the = of 10/hr...well that's just shameful!

    If I told you I make $30/hr and $36/hr on the weekend plus get mileage and have my BSN, would that tell you something?I'm in NJ. I just started a second job, and this agency pays $80 per admit and $60 per revisit.

    Welcome to the forum BTW!!!
  5. by   seasonedlpn
    Another Day in Home Health!
    I am known as the catheter queen...as well as the "disimpactor".
    I suppose it could be worse,(?), but to tell the truth, I'm pretty good at what I do.
    I was sent to re-insert a foley that had been removed two days before. Unfortunately, I was the one that put it in, but bladder spasms, and generalized ignorance about the workings of a foley caused the patient to request removal. We ordered an antispasmotic, and a size 22fr from Home Depot, lol,and I performed a miracle.(again)
    The patient could not lie flat; and the first catheterization was a nightmare. She sat on the edge of the bed, lying slightly on her side, with her legs resting on her wheel chair. Difficult, yes, but I got it done.
    This time she decided to remain standing, leaning over the foot of the bed. A bit of a challenge, wouldn't you agree? She was obese, and weak. Her husband refused to become involved. He has been reported to APS more than once.
    The scenario: I am nearly lying on the floor, sterile field between her legs, mini-maglight in my teeth, working from behind. She has had marsupilizations of the Bartholin glands, leaving blind openings, and is unable to reach around to hold the buttocks apart...................I got the foley in, got a clear return of urine, inflated the balloon............but it took me longer than usual!
    Another miracle!
    The next patient was an easy male cath,even the enlarged prostate was no obstacle. Then.......................................The surprise ,the kind which can only happen in home care. The last patient lived in a rural area, on a large piece of land. Pleasant folks, caring for aged parents.Quick visit, and ,as I was walking to the gate, I glanced back........A GIRRAFFE was in the back yard!
    It just couldn't get any more interesting than that.

    Neither rain, nor sleet, nor snow shall deter the HH nurse from her appointed rounds. Out here in California, even the sudden, rapid movement of the earth (earthquake),only adds to the variety of daily life. I've spent post-quake days picking up televisions, resetting clocks and finding flashlight batteries...then, and only then, can I perform my nursing duties.You don't get that kind of variety in the hospital setting!

    Life: A sexually transmitted, terminal condition.
  6. by   hoolahan
    All I can say is......WOW!!! What a contrast of sights you had the day from flappy perineal areas to giraffes! I can never top that!!! That even beats the horse in the house!!!! LOL! Thanks for sharing that!
  7. by   passing thru
    Who took care of these kinds of patients 30 years ago before they had home health nurses?
  8. by   hoolahan
    Well, this was just a little haha that brightened my day while working as the weekend supervisor Sunday.

    I had a dozen pages back to back, and trying to get back to everyone in a timely way, I turfed a few to the secretary. I asked her to call back the HHA who couldn't get in to the bldg to drop off her time sheets.

    The secretary, who of course is non-clinical, called the number given to the service, and spoke w a woman answering the phone who said, "Oh, she's in the shower with my husband." The sec said it took a minute for her to figure this out, and she said, I was just thinking to myself, "Wow lady, you are really in an open relationship!" Then I explained to her HHA's give baths and showers to pt's, and we both busted out into hysterical laughter.

    The day before, I got a page from a family member who was having such terrible chills and thought she had a urine infection. I advised her to go to the ER, b/c I figured the chills were onset of septicemia. She cried and said how she didn't want to go back b/c no one keeps track of her bowels and she got so "compacted" there before. I advised her to be sure her doctor orders her a laxative and a stool softner in that case, but she needed to go. She puts her son on the line, and he proceeds to tell me the details of the compaction problems. They two of them were on extensions and if they used the word compaction 20 times they used it 1000, it was all I could do not to burst out laughing, not at her distress of course, but the word compaction for impaction, and they way they kept repeating it. She didn't go, and I found out from her primary nurse she does not ever f/u w doc or go to er when advised.
  9. by   renerian
    That is so funny! renerian:chuckle
  10. by   homenursingrj
    This thread is fascinating! I'm glad to have found this forum!
  11. by   lioneliz
    Just another typical day in home health. I drove 20 miles to my first patient, a crabby old gent with CAD A-fib S/P 3 vessel CABG has had numerous med changes recently. Called his home before I left the office, but when I got there he went to the bathroom for the first 5 mins of the visit. Then told me to hurry up he had to go to the bank. Sooo 12 mins after my arrival Mr Crabby hops in his car and speeds down the road leaving me and his wife standing there . I had to explain to the poor wife that Mr Crabby nolonger qualified for servies. I wish he had just told me not to come and saved me some time and wear and tear on my car.
    -NEXT- An admission for a frail eldery female with a stinking pressure ulcer on her heel. O2 sat's in the low 80's, w/c bound can't get out of the house (no w/c ramp) lives with her brain injured son (sweet but clueless). Got an order for O2, got the ball rolling on a w/c ramp then left hoping her home doesn't catch on fire .
    -NEXT- Drove another 30 mile to dress an open foot wound (at least this one didn't smell)
    My next pt went to the doctor so it was back to the office for my favorite thing PAPER WORK!
  12. by   hoolahan
    Today was fun! I got in early, thank goodness, b/c I found out I had an inservice at 9:30. I had a lighter load as a result, one admit and 3RV. The first pt had labs and a routine foley changes. I figured I could get there, do visit and get back in time for the inservice if I left lickety split, so I call dtr, she says, "Dad, is not doing so good, he had tarry stools last night, and isn't drinking or eating, and his urine output was only 900 all day yesterday." (she empties foey at HS, then again in am. "I haven't looked in on him yet this morning, I hope he's still with us..."

    WTH??? Go look!! I sweetly ask her to just peek and see if he's breathing if she is really concerned this may be a problem, she confirmed he was. Whew! So, I say I'll be there in twenty minutes. Got there, and he was drowsy, but certainly not comatose. Sking turgor was good, urine amber, not very concentrated, and veins plump for the stickin. I concluded she is a nervous nellie. Got back to office just in time for inservice with the KCI wound vac rep.

    I have had this inservice twice now, but never had the chance to do it. Well, this time, she brought models and we all got a leg and a kit, and actually did the dressing instead of watching, very cool. I learn stuff like that hands on, and it is so much nicer to practice on a model first.

    After that was done, almost 2 hours, I got a message one of my RV was in the hospital. That left me w my ROC and a RV. The ROC was out in a more rural area, and as I am driving down the wonding snow-dusted road, 4 deer leaped accross the road, far enough away to be pituresque, and not scary like I would be hitting them. The Delaware river is frozen, and it looks like little waces are frozen, and now there is about 3 " os snow over that. I haven't seen that river frozen like that sine 1994!! That is how cold it has been.

    Forgot to mention, d/t the cold, I was wearing a super-fuzzy long, fleece cowel neck. One of my co-workers remarked how warm and cozy it looked, and it was. BIG mistake! I forgot how the older folks like to crank up the heat. The first home, w the foley and labs, well you know how you get nervous/sweat a tad when a new family member is watching you, well, this house was set to 75!! The dtr even got a paper towel to blot my head like a surgeon. I left the house w/o my coat on, my shirt was wet. And those senior bldg's, the halls are soooooooooooooo hot. I don't know how they don't pass out! Have to remeber to do layers.
  13. by   Nursecathy123ca
    Thanks, Hoolahan, for the picture of a day in the life of a HHN. I'm currently a staff nurse in postpartum/gyn. The hospital routine is wearing me out, plus I can't get a day shift, so still working evenings. Hubby doesn't care for that much!

    One concern: my IV skills are nil, and my blood draw skills aren't much better. Would this be an impediment in a HH job?