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Discussion

need advice

Hi all,

I am a new grad. home care nurse. I have a patient who did a lab test, Now there is some abnormal data from his lab. The agent called me and asked me to follow up. What can I do? Call the MD and discuss with him/her about the treatment? or just teach the patient about meds? Why does the agent call me rather than the MD? I need some advice. Thanks.:redpinkhe:redpinkhe

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    • Expert

    The nursing supervisor should have called the doctor. I would call the doctor and seek new orders, if he wants to change anything. And keep in mind that this agency is expecting you to do follow up in the future. The agency called you instead of the doctor because the nursing supervisor or case manager is not doing their job.

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    This is really not to bash the OP, but honestly, this is the reason that new grads shouldn't be doing home health care. I know that most new grads don't choose to go into home health, most would much rather gain hospital experience, but if agencies are going to hire new grads, they really need to do a better job of training them and not just throw them to the wolves.

    Clearly, the doctor needs to be notified of the labs and the best thing to do is to fax a copy of the labs. Then call and notify the office that labs were sent and ask if there are any new orders, meds, or treatments.

    The ability of the nurse to counsel the patient depends a lot on what the lab is, but there is a lot of room for diet teaching, med education, etc., with abnormal labs. Look for meds that could cause elevation in certain labs, too, like liver enzymes, kidney function, etc.

    Don't assume that someone in the office isn't doing their job. If the nurse's job is to case manage, then it's the nurse's job to contact the physician and follow up on all abnormal labs and other tests.

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    • Author

    Thanks so much for both of you, KateRN1 and Caliotter3.

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    • Expert

    Were you informed that you would be the case manager when you were hired? All of my home health agencies have instructed me to call the nursing supervisor with important information regarding the patient. Lab reports are typically transmitted to the agency. I have only had two patients who had their own fax machines and used them to communicate with their doctors, etc., outside of the agency communication loop.

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    At our agency, its the nurse's responsibilty to take care of everything r/t the patient. We do "case managing" and if there is an abnormal lab come in, they call me and its up to me to take care of it. I call the doc and notify them and obtain orders, if any new ones.

    Case managing is the only style I know. If you are not case managing, then I would assume the agency would have to call?

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    • Guides

    . . . and all of this points out that again, one agency is from Mars and the other one is from Venus when it comes to just about everything. At my agency now, the Case Manager never calls the doctor. If I had to wait to get a response from her, I'd be completely hamstrung. One day, I decided to call the Case Manager and the doctor at the same time about an issue I was having. I was talking to the doctor within 20 minutes, and the "case manager" never called back.

    We had an issue 5 months ago, when a few of the nurses wrote orders she found lacking in some detail or another, but she had faxed the orders without looking them over first, the doctor signed them, and then she flipped out at the nurses who didn't add, like an ending date on a once daily maintenance BP med. Sigh. . .

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    • Author

    Hi all,

    wow, it seems that there are still a lot of things I have to learn in the future. Thanks so much all of you. All your responses inspire me so much. I only take up this job for a week and I didnt know too much about my nursing role. Please tell me more about your experiences and suggestions that I can do my job well and I can protect my patient well under my caring. Thanks. Love to talk with you all.

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    • Expert

    It sounds to me that, although your employer knew you are new, they failed to orient you to important aspects of your job. You need to be proactive and seek out guidance from your supervisors at the workplace. You can gain all sorts of ideas and insight from this site, however, some agencies do things the exact opposite from others, so you need to find out what your employer expects from you at your present job. Since we don't work there, we can't be specific with you.

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