Home Infusion Per Diem

Carolbknits · Mar 28, 2009

Did you ever get a reply to this? I too am intersted. thanks

Carol

iluvivt, BSN, RN · Mar 28, 2009

This is what I do...... I work 60-70 hours per pay period on a hospital based IV/PICC team. The other days I work for a Home Infusion Company in Ca. I have done the IV home care part for about 13 yrs now and have seen a lot of changes for the better. I hope the job pays by the hour and not the visit. My company does a lot of IVIG so many days I just have 1 or 2 pts and a lot of these for 5 days in a row q mo or q 6 weeks so you see the same pts over and over again as chronics. These are the other things I do.....Administer and then teach how to administer the following therapies....antibiotics...TPN...steroids.....Remicade.....Blood products....IVIG....neupogen and epogen administration and other sq.....+ others....also do a lot of CVC care...port access....IV starts....dressing changes....PCA...cassette and bag changes...blood draws and lab runs......alos can use fed-x on some lab pick ups...lots of teaching and charting....lots of people complain about the charting.....does not bother me AT ALL...I can whip it really fast......next week this will be my day.....drive 45 min to first pt..call pt remind him to take his pre-meds and IVIG out of refridge......get there....access port and do a pre-infusion asessment...administer IVIG over 3 hrs...monitor pt..flush port and de-access...drive to pt 2...and do the same thing.......chart inbetween doing vital signs.....A lot of nurses start at the office and go from there..I like to go straight to the pt.....opens take longer...more paperwork and sometimes pt or caregivers feel overwhemled and you have to stay calm and support them...especially TPN pts. You have a lot of freedom and the pts seem to be more welcoming than some hopital pts....always give the pt a time range when you will be there b/c if you give them an exact time..some get upset if you are not there...i usually give them a 45 min range and if I get stuck somewhere I call..anything else you would like to know???

Carolbknits · Mar 28, 2009

Hi,

Thank you very much for the informative reply! What parts do you like/dislike about your job? What kind of support do you have during you day? How long did it take you to get comfortable with being independent doing this? I have been off the floors for 11 years and definitely lack confidence :-( Feel free to write! Thanks

Carol

iluvivt, BSN, RN · Mar 29, 2009

1 .I was really comfortable right away b/c I had an extensive backgroung in IV therapy.....so for me...show me the ropes for charting...appointment making....pharmacy delivery....paperwork turn in.....on call issues and how to deal with them....and i was ready to go........they will give you an orientation of course

2.You will be very independent.....but you will have a clinical coordinator that should be an RN in the office as well as a pharamacist.....a director and your policies to refer to

3 Some chronics have ports...but some do not and you must be good at IV starts...as well as providing all types of CVC that meet the current standards of care. Most acute antibiotics will have a PICC line

4. You will need to be able to teach pts and caregivers how to safely and aseptically administer the prescribed therapies......YES that will seem strange at first after you have been used to doing it all....DO not do it all...you will need to show them if they will be admiistering it...this requires a great deal of patience and you must encourage the pt and caregiver and support them....you will not be able to do a visit every 12 hrs to administer that Vancomycin...so teach well

5 Sometimes you may miss other people being around like in the hospital setting...that is why i just do perdiem

6..Set up a little office in your car and have any stuff you need to amke your time in the car enjoyable....stuff like water..chapstick...mints....energy bars..kleenex....you get the idea...of course do not leave home withot your cell phone and GPS

I say go for it and try it...if you do not like it...you can quit.....I love infusion of course :yeah:

Carolbknits · Mar 29, 2009

I don't know of any agencies in my area. My dad is receiving daily home infusion right now and unfortunately I am not able to help much since I live out of state. I haven't even been there when the home infusion nurse comes but it is an area of nursing I hadn't thought about. I would like to find someone in my area to shadow and get to see "the ropes". I have also thought about wound and ostomy care (since my dad, brother and niece all have ostomies) but again haven't shadowed anyone in that area either. I am taking a refresher course to reenter the hosptial but not sure if I want to do that forever. I am a high energy person but older and more tired with 2 preschoolers and a teenager (LOL as well as a husband).

I think you said you stay for some of the more critical infusions, what do you do while waiting? Have you had many people with severe reactions to their infusions that you have not been able to deal with? What if you can't access someone? My dad dehydrates severely and they haven't been able to get access on him (prior to his port) even in the large city hosptial at times. How broad is your area for travel? On average how many patients do you see? I think you said you are on call for weekends? How does that work? Sorry for so many questions. You are the first person I've actually gotten to pick their brain in the field :-) Thanks!

SecuredFloorNurse · Apr 6, 2009

Iluvivt has given you a great run down of home infusions. Everything she has said was exactly the same for my last job. I also did per diem, the hours were always there whenever I wanted to work. I'll try to answer your questions from your last post.

While I waited for infusions to be completed I would take my laptop in and get my charting done and chat with the patient. If I knew it was a long infusion then I would change the PICC drsg after starting the infusion. You just learn time management. Get the infusion going first and then do the other things, drsg changes, wound care, etc.

As far as severe reactions, I never had to deal with that. We did have an emergency bag that stayed at the patients house with Benadryl and Epi and we typically taped it to the patients fridge so it would always stay in the same spot in case of an emergency.

If I couldn't access someone then I called the agency and they would send another nurse. It didn't happen often because you get pretty darn good at it. At my company you were allowed 2 sticks and thats it. The hardest were the MS patients who were getting a 5 day course of steroids, they typically had no veins. BP cuffs worked great with hard sticks though, so much better than a tourniquet.

On average I would see about 4-5 patients a day. I would get my daughter on the bus every morning, leave home about 8am and I would make it home by 3:30 to get her off the bus.

At the company I worked for, as a per diem nurse you had to sign up for one weekend a month. I hope this helps you some.

I'm planning to go back to home health after the summer because I miss it so much. I'm not challenged enough where I am now.

I highly reccommend checking things out!

munieca · Feb 18, 2011

How much do Rn get paidper visit or per hour for home infusion ?