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BORI-BSNRN 8,069 Views

Joined: Mar 18, '04; Posts: 470 (8% Liked) ; Likes: 48

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  • Oct 15 '14

    I think many home care nurses quit because they don't understand the nature of home care. They think that it will be an easy job and no one is looking over their shoulders. I think that home care draws a lot of "loner" -type nurses who balk at authority and don't always have the personality to maintain relationships. When they discover that home care is heavily regulated and relies on massive volumes of documentation and that they are required to meet a certain productivity standard, they move on to another agency where they think it might be easier or they stay PRN to avoid requirements. I've seen quite a few hired without so much as a reference check. As long as they have a warm body, a license, and pass the background screen, they're in.

    I also think that many agencies don't treat field staff well. They do not get a thorough orientation and are often surprised by standards they weren't told they had to meet. I think many agencies have unrealistic expectations of what field staff can do in a day. I have seen managers in the office get upset that clinicians are home by 3 while the manager is stuck in the office until 5 (or later), only to forget those days of doing paperwork and returning calls after hours. I have also had managers with the attitude of "I own you until 5 pm" but the reality of it is that there are really no set hours for home care. Some days may finish at 3, some may finish at 7, but it all evens out in the wash.

    And hospitals often do a poor job of discharge planning with the attitude that "home care will take care of it." Discharge planners without experience with home care give patients unreasonable expectations of what homecare can/will do which disappoints the patients. Patients and families also have the idea that Medicare will cover everything they need, only to find that there are huge gaps in the coverage.

    There is no one reason that nurses leave home care. Those that understand the nature of the beast and love it do well. Those who don't understand it and want it to flex around them will be perpetually disappointed. If you want regular hours with a job that doesn't follow you home, home care is not for you.

  • Sep 15 '14

    Quote from BORI-BSNRN
    My Mom passed away in 2011 at 62 

    I'm so sorry Bori. (((HUG)))

  • Sep 14 '14

    I don't think anyone would say that about your husband. Sex is a very important part of marriage, although certainly not the only part, and yes, marriage is complicated. No need to be defensive about your decision to keep your ovaries, it's an individual decision that only the woman involved gets to make.

  • Sep 14 '14

    I talked to my doctor at my last annual visit, and she asked if I had considered just having them taken out. I'm only 39, and even though I'm done having kids, I still consider myself to be "using" my ovaries because, frankly, I have a great sex life and I know the hormonal activity of my ovaries contributes to that. I'm not ready to give that up. When I'm in the week right before my period, I have almost no desire for sex. I could be a nun and be totally fine with it. If I get my ovaries removed and feel that way all the time, I'm afraid of how that will affect my marriage. I don't want to be stupid, but these choices are hard. I have not had any genetic testing.

    Do NOT respond with any form of comment about how my husband must be a selfish d'bag or I wouldn't have to worry about this. If you've been married any length of time, you know how complicated it is. My husband is amazing and has proven over and over his willingness to sacrifice for his family.

  • Sep 14 '14

    Quote from LadyFree28
    My paternal aunt died of ovarian cancer in her 30s.

    I think that ovarian cancer doesn't get the research that is needed and more aggressive ways to help detect it because it's "chick cancer"; even men get Breast CA, and I'm suspicious that was a main reason (along with aggressive campaigning after decades) that it get's the attention that it does.

    In my mind all cancers need to have the same funding to help detect it and ensure early treatment.

    You have my support.

    I agree, to a certain extent. Breast cancer is still considered a women's cancer, however, the Komen Foundation helped to turn it into a marketing juggernaut. Pretty soon, corporate America learned that "if it's pink, it sells."

    I agree that there needs to be parity with research funding and support. Unfortunately, it's almost impossible for other voices to be heard against the roar of breast cancer activists. Really, who pays attention to pancreatic cancer patients? How about gall bladder patients? A while ago I took care of a patient with CA of the appendix. I don't think we're going to see any "Race for the Cure" for those cancers.

    I'm glad patients with breast CA have so much support out there, but now we need to start caring for other cancer patients.

  • Sep 14 '14

    On Sept. 4th, President Obama signed a proclamation declaring September "Ovarian Cancer Awareness Month." He urged women to get regular check ups to increase the possibility of early detection, and touted the Affordable Care Act as a means to protect women with this disease from being treated unfairly in the workplace and from discrimination by medical insurers. He assured women with ovarian cancer that the Administration was doing all it could to find a cure.

    Don't get me wrong: his sentiments are appreciated. I just have to wonder if what he says is really true, or if it was just one of those "feel-good" efforts that a president does, then checks off on his "To Do" lists.

    Next month, the White House will be awash in pink for "Pinktober." You won't see the White House turn teal for Ovarian Cancer Awareness Month (or for any color of other cancers, for that matter), even though ovarian cancer is the fifth leading cause of cancer death in women and the most lethal of all gynecologic cancers.

    Why is there such a lack of interest in a cancer that affects 22,000 women each year and kills more than half of them? In 2009, the National Cancer Institute's funding for ovarian cancer was $110.1 million dollars, along with $16.2 million dollars allocated for research from the American Recovery and Reinvestment Act. By comparison, the National Institutes of Health spent $800 million dollars on breast cancer research. In that same fiscal year, they spent $147 million dollars on ovarian cancer research. Since 1992, the Department of Defense, which has a breast cancer research program, has added an additional $2.5 billion (yes, billion) dollars in peer-reviewed research. By comparison, they allocated $20 million dollars in ovarian cancer research. It's easy to see why women battling ovarian cancer feel like the proverbial red headed stepchild next to all that money.

    Unlike breast cancer, there is no diagnostic test to detect ovarian cancer. Many women believe (wrongly) that if they go to their gynecologist regularly for an annual exam and PAP test, the doctor will be able to tell if they have ovarian cancer. The truth of the matter is that it is very hard to discover growths from ovarian cancer on a bimanual exam, and the PAP test does nothing to diagnose ovarian cancer. Even the trans-vaginal ultrasound is unreliable in finding growths. The sad fact is that most ovarian cancers go undetected until the disease is at an advanced stage, making the likelihood of survival poor.

    As nurses, we can improve awareness by taking any and every opportunity to teach our female patients about the signs and symptoms of ovarian cancer:

    This month, take a moment to educate someone you love about ovarian cancer. Teach your patients, your co-workers. If you have symptoms like the ones noted in the picture, see your doctor. Wear something teal to show your support for women who have been affected by this cancer. Write to your Congressional representatives and ask for more research dollars for ovarian cancer. Write letters to the editor. Speak up at every opportunity. As nurses, we are well positioned to make our voices heard when it comes to advocating for the health of our fellow citizens. Working together, we can help give women a fighting chance against ovarian cancer.

  • Sep 14 '14

    I wouldn't be surprised if we see increased funding since the Komen Foundation has teamed up with the Triple Negative Breast Cancer Foundation.

    I watched an interesting documentary a while ago called "Pink Ribbons, Inc." which went into great detail about many of the aspects surrounding the marketing behind organizations like Komen. What started out in the 80s as social activism demanding increased research for breast cancer has turned into something entirely different years later.

    Women are still far less likely to survive ovarian cancer than a diagnosis of breast cancer. While there are some promising new treatments on the horizon, ovarian cancer has not seen the breakthroughs in treatment that other cancers have. Let's face it: ovaries, pancreas livers...not sexy.

    All that aside, September is the month we focus on ovarian cancer. We still have a little over two weeks to use this month to educate our patients and our loved ones about a disease that kills far too many women every year.

  • Sep 14 '14

    It just amazes me that despite all that money going towards breast cancer there is still no cure. Yes, survival for some types of breast cancer has increased a lot and that is GREAT, but I think the focus needs to shift to "race for a cause" instead of "race for a cure." Let's face it cancer treatments are rough and without significant risks. I think breast cancer has received all the attention due to creative, persistent, and aggressive marketing. I do wish all cancers got all the same funding because they are all devastating.

    As I get older cancer is a very real fear for me. I just want to know what the heck is causing all this cancer. It's just scary! It's a shame that we have hospitals just for cancer. Something is very wrong!

  • Sep 14 '14

    Quote from OCNRN63
    I wouldn't be surprised if we see increased funding since the Komen Foundation has teamed up with the Triple Negative Breast Cancer Foundation.

    Triple Negative Breast Cancer Foundation®
    Wonderful news!

    All that aside, September is the month we focus on ovarian cancer. We still have a little over two weeks to use this month to educate our patients and our loved ones about a disease that kills far too many women every year.

    YES INDEED! Let's save some lives!

  • Jul 26 '14

    I work for an agency in IL and we are paid PPV. SOC 75.00, RV 50.00 with mileage reimbursement for every mile past first destination. The hours are long. I am always behind on charting and work 7 days a week, charting on weekends. I drive long distances, incurring a lot of wear and tear on my vehicle. I worked like a slave last year for a gross of 40k. Worst money of my nursing career. You have to be creative, non-judgemental, independent, well rounded with skills and brave. It is most rewarding on a personal level, but most disappointing because of inadequate pay and lack of benefits. I feel undervalued, therefore it's hard to be proud of my job. I live rural and my patients are spread all over. It is not uncommon for the agency to pressure me to commit to jobs that are farther than I'm willing to travel. You have to be strong and say no when it isn't in your best interest. The agency will run you ragged if you let them.

  • Jul 26 '14

    Quote from ratgirl63
    I am going with the see a patient, chart a patient way of case management. This includes OASIS documentation. My charting is done in a timely manner by doing it this way. I can’t see as many patients but “oh well”! I don’t want to take home work if I can avoid it and management keeps telling us to submit our documentation same day. So there you go, see a patient, chart a patient. Then move on to the next.
    This is a sensible approach.

  • Jul 26 '14

    I love when they say, " take the day off and get your paperwork done." haha! some day off. I do love my job, so what is the answer to avoid staying up late doing paperwork.

  • Jul 26 '14

    Yes! I try to finish SNV charting in the home. I only take home OASIS visits. When my agency made the rule that snv needs to be completed in home it really helped me.

  • Jul 26 '14

    The following are some tips I have learned from experience and my peers:

    1. Have a good sense of humor.

    You have to learn to laugh at yourself. This is a good practice for most aspects of your life. But if you take yourself too seriously, no career will be enjoyable.

    2. Be open minded.

    Toto, we are not in the hospital anymore. In the patient's home, you are no longer in a controlled environment like a hospital or doctor office. You still have to follow your agency's policies, safety rules and perform procedures correctly, but if the patient requests you enter their home and take your shoes off because of religious reasons, you do. The beautiful woman that presents as your patient, turns out to be a man. (You learn this without warning when they drop their drawers for the dressing change you came to perform. The scheduler thought it would be funny if you were surprised.) Diversity is one of the wonderful aspects of home care, you learn how other people really live. Learn to appreciate different cultures.

    3. Learn to modify.

    You have to hang an IV. It's after hours and the pharmacy forgot to send the IV pole. The hanger over the door may work, or the broom handle strapped on the upright vacuum suddenly creates a wheeled IV pole. But always make sure that your modifications are safe and appropriate, otherwise it will come back to bite you in the ....

    4. Be flexible.

    The day you planned will change, guaranteed. There is an accident on the freeway, now you are late. The patient has a doctor's appointment they forgot to tell you about and now they aren't home. Someone called in sick so now you have 5 extra visits. If you can't be flexible, home care may not be your bag.

    5. Be prepared.

    Sure enough, the dog ate the patient's box of dressings, or the patient has a bed sore that did not show up on the hospital discharge information. Your car trunk should look like a supply closet.

    6. Be organized.

    For those home health nurses that drive a car between patient visits, your car is your office. It should contain supplies, paperwork, computer and cell phone battery chargers, pens, marketing flyers, etc., etc., etc. Learn to plot your visit route. With the cost of gas now-a-days, you don't want to have to drive needless miles.

    7. Have basic computer skills.

    If you don't have them, learn them. Many home health agencies have already gone to field staff carrying lap top computers into the patient's homes. It is the way of the future.

    8. Be alert and be safe.

    You may be presented with many new dangers that you won't see in the hospital. Take a self defense class. Learn what areas are the "unsafe neighborhoods" in your territory. Visit those places early in the morning. Always be alert to your surroundings. Don't talk on your cell phone while driving. Follow safety rules.

    9. Don't be afraid of paperwork.

    If you work for a home health agency that performs Medicare visits, YIKES, what paperwork (thanks in part to the Medicare Paperwork Reduction Act?)!! An OASIS is not a desert paradise. Those agencies that have laptops for their field staff have part of this licked. However the questions still need to be asked and documented. Practice does help speed up the documentation process.

    10. Keep your skills up.

    Take continuing education classes on-line. Attend seminars. Read articles. Knowledge is power. You are very autonomous in the patient's home and good skills and quick thinking are mandatory to survive.

    In closing, home health is a wonderful way to care for patient's. You are able to interact with the family and really do one-to-one education. Whether it be with a Medicare agency, Hospice, private duty or other home care venue, it is an enjoyable and full-filling division of nursing. Remember, many home health nurses believe:

    A bad day in home health is better than a good day in the hospital.

  • Mar 12 '13

    Yeah I keep telling myself don't be afraid of the changes just be prepared!!! Yes goodluck to us both! I just keep praying and praying that it's all in God's plan. I will be an RN and I will beat this test this comes April!!!