Home health RN question

CinDRnyc · Jun 18, 2012

Why don't you just go to your nearest home health agency and ask the 1st RN you see for an interview...just remember to have a Starbucks gift card with you!! I had to interview a director of a funeral home and I did the exact same thing but I also had a digital recorder w/me ! Best of luck

caliotter3 · Jun 18, 2012

Frankly I don't see any questions that an LPN/LVN working in home health could not answer.

1louise1 · Jun 18, 2012

@caliotter: well, when i interviewed her, she had limited examples of nursing routines/activities (she didn't do admissions, assessments, you know, stuff RNs can do), she didn't know the roles of other team members, nor did she take part in coordination of care with the other team members (RN task, she said she deferred those kinds of tasks to the RN). sooooo, that's why i need to speak with an RN who will have a broader scope of practice.

lpncal · Jun 18, 2012

1. describe the setting you worked in/for (no agency names please) i'm currently employed by 4 different home health agencies. my main job, with my primary agency, is "relief rn". i work 20 hrs/wk mainly supervising cna's, making sure the clients like them, etc. i also have a couple clients of my own that i visit to either pour their meds into weekly med boxes, or give insulin shots, or do diabetic foot care (massaging feet and legs, nail care, etc.). on top of that, i do semi-annual re-certifications on our clients, which consists of having them or their poa sign paperwork, doing a quick head-to-toe assessment, vitals, etc., finally i go visit clients when they come back from the hospital or have something unusual happen to them (skin tear, elevated bp, etc.). one of my other agencies has a client that is total-care, i take care of her occasionally, tube feedings, nebs, meds, chest physiotherapy, incontinence care, etc. the other 2 companies use me mainly to open new cases, which consists of a quick head-to-toe, vitals, paperwork, home safety assessment, etc.

2. describe the types of settings you worked in: mainly the office, where i do paperwork, put client paperwork on msword, play on facebook (j/k...not really, i do). other than that, i visit client homes to do supervisor visits, as described above.

3. describe the types of clients you served: many are underprivileged, medicaid recipients. some are va, some private pay. some have money, most don't.

4. daily nursing routines/activities in collaborating and coordinating care for the home health clients: most i described in #1, but sometimes we have to have an interdisciplinary meeting with the medicaid field service coordinator, caregiver(poa), family members, seldomly does the md ever come, but sometimes a nurse practitioner will. in these meetings we discuss an issues that are affecting the care of the client.

5. roles of other team members (i'm thinking md, pt, ot, st, sw, cm): our office doesn't employ pt, ot, st's, but md is usually contacted via fax, and faxes back any order changes we ask for. if there is a medication change, usually the family makes sure the rx gets filled and implemented. sw's let us know how many hours per week we can go into the client's homes, and what they are paying us for. there are 2 categories for cna care: pa1- chores, pa2- hands-on care. if a nurse is necessary, that is a whole different pay scale. rarely do they pay for that, because its expensive.

6. methods of client/family education: we try to educate our clients and family with each supervisor visit, but most of our client's and families are surprisingly well informed as to their conditions and medications. some aren't, and have to be educated little by little in the basics of diabetic lifestyle changes, healthy living, etc. mainly we use verbal teaching with some written handouts for them to read on their own time.

7. what is your opinion of the characteristics of successful planning and coordination? the key is to get the family involved if they aren't already. mainly we are there for respite care, not to care for the client 24/7. mostly the family has been doing the job for several month/years and are just needing help finally, so they call us. therefore, they already know what they are doing. make sure the different cna's going into a home are all on the same page. make sure they don't badmouth each other to the client in order to get more hours, or have the client ask for them only! make sure the client/caregiver knows when you are doing a supervisor visit (i've had more than one family member get miffed at me for not calling ahead before coming).

1louise1 · Jun 21, 2012

hey lpncal...thanks so much! this is an interesting field, so i'm learning. i had a couple more questions, if you have the time.

so mainly your patients are underprivileged, uninsured. are they geriatrics? what is the typical problem (if there is one): diabetes, stroke, trauma, etc...

are they usually male, female?

do you know how many nurses your main agency employs? or how many patients they serve? thanks!

lpncal · Jun 21, 2012

so mainly your patients are underprivileged, uninsured. are they geriatrics? what is the typical problem (if there is one): diabetes, stroke, trauma, etc...

diabetes is rampant on this island, but we only have a few clients that are diabetic. most are elderly, not quite ready for the ltc facility.

are they usually male, female? i'd say its 60/40 female/male.

do you know how many nurses your main agency employs? or how many patients they serve? thanks! our main agency, on honolulu, has 2 or 3 rn's on staff as far as i know. i'm not sure how many clients they have. our office has around 31-35 on any given day, so i'd say they have closer to 80-100 clients.

1louise1 · Jun 21, 2012

so your office only has 2-3 RNs for 80-100 clients? how does that work?

is it because the RNs only do supervisor visits? is there a ratio in place (i don't know about home health ratios in california, but i do know in hospitals we have them)

how many CNAs do you employ then?

sorry for all the questions, this is all new to me!

lpncal · Jun 21, 2012

For 30-35 clients, our local office employs about 20-25 CNA's. I don't know how many CNA's the main office has, but I'm sure its well over 60. There's very little work for the RN's to do, other than supervise, and maybe a few clients need their medication poured for them, or insulin shots given. That takes like 15 minutes? So there is no standard ratio in home health, as far as I know.