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Discussion

No Nurse Supervisor

Working as a per-diem nurse in the field in a home health agency where the nurse supervisor is on sick leave. It's a strain if one of my patients is sick and their doctor is not accessible--if he does not answer requests for orders or clarifications. There is no back-up right now, all I can do is document and inform the patient and family.

I haven't been in this situation before. Is this common? Other agencies I worked in had more than one supervisor and they covered for each other. How long is it reasonable to wait?

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    Even with a supervisor, we never get answers back. I just do the best I can under the circumstances.

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    In my previous job when the doctor didn't call back I would just note it in my report and the supervisor would take it from there. I worked weekends so the supervisor would call the doctor's office during the week. I'm starting to think I took that for granted, because now it's very hard to keep things safe and get the orders.

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    I too, have no supervisor right now, and I am LOVING it. However, at my agency the supervisor is not responsible for following up on any MD phone calls and things of the such. We have Case Managers for that. Sometimes I don't even bother calling certain doctor's offices (unless of course, it's an urgent matter, then I will call... urgently). Instead I send a fax to those certain docs and they can just get back at some later time when it's convenient for them and then I in turn can follow up when convenient for me.

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    yes, it's the lack of help with case management. it's tough to do all of it when you are on the road, any office time I put in is unpaid extra. I wonder how much case management is assumed when you are a per diem making home visits. Am I expecting too much?

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    • Experts

    I was just told the other day by a new nurse supervisor at my present employer that they can not change the plan of care until the 60 day recert mark. Strange, one of my previous DOCSs used to send copies of signed orders to the home religiously. She was the only person who ever saw to it that we got up to date orders. If I refused to follow through on what I know to be new prescriptions, changes to prescriptions, new treatment orders, etc., I know for a fact I would catch hell. I think that was said to explain away the fact that the office never bothers with keeping up with any of this. If you explain away shortcomings, they are not shortcomings.

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    Uh oh, Caliotter, that is just plain wrong! What is this person thinking that the POC cannot be changed? If the patient dies, are you supposed to keep administering meds until the 60 day mark when you can change their status to "dead, no further nursing intervention required?" Craaaaaaazy.

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    • Experts
    Uh oh, Caliotter, that is just plain wrong! What is this person thinking that the POC cannot be changed? If the patient dies, are you supposed to keep administering meds until the 60 day mark when you can change their status to "dead, no further nursing intervention required?" Craaaaaaazy.

    That's what I say. Because technically, she was telling me that we are only supposed to implement changes every 60 days, because I had also been told from day one that you have to follow the signed 485. Since they don't bother to send out a copy of the latest signed 485, who knows when the changes will, if ever, be implemented? I just got home from a case that has a 485 (unsigned) from more than a year ago in the field chart and partially filled out MARs and TARs; but I thinned the binder out and am taking in TWO YEARS worth of old documentation and MARs, TARs. Nobody has looked at the main chart in the office for more than two years?

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    The agency I work for will call the nurses with lab results and answers to faxes. However, the responsibility of communicating with the doctor and following through to make sure a response is received rests with the nurses. This is sometimes done multiple times with no response to the same question. Of course, none of that time in the office counts as "paid" time. But it is cheaper to have the nurses track responses than it is to hire a supervisor to keep tabs on these issues.

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    • Guides
    I was just told the other day by a new nurse supervisor at my present employer that they can not change the plan of care until the 60 day recert mark. Strange, one of my previous DOCSs used to send copies of signed orders to the home religiously. She was the only person who ever saw to it that we got up to date orders. If I refused to follow through on what I know to be new prescriptions, changes to prescriptions, new treatment orders, etc., I know for a fact I would catch hell. I think that was said to explain away the fact that the office never bothers with keeping up with any of this. If you explain away shortcomings, they are not shortcomings.

    Your new nurse supervisor thinks you can't implement new orders until the 60 day recert is due?!? :confused: So if a patient gets a new order for something like discontinue propanolol due to hypotension, she expects you to continue giving it for the next 59 days? That's nuts.

    Our orders go in a sequence like this most of the time. Patient or Doctor to--->nurse at the home who writes the order for signature and implements the order that day (eg D/C propanolol)then--->home nurse puts yellow copy in the chart, then mails or faxes the white copy to the office attn: Case Manager who--->hopefully reads it before she faxes her white copy to the doctor who--->signs it and faxes it back to the office---who files it in the patient's office chart and sends that signed order to the home then--->nurse files it in the home chart and discards the unsigned yellow copy, ta-daaahh!!

    It sounds way more complicated than it is, and makes sure the new orders get started ASAP. What path do your orders follow?

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    • Author

    LuLu, I never had to work in the field with no one to help when doctor's orders are needed and the doctor does not get back. It sounds like that's what you're dealing with.

    Can anyone tell me how common this is? Without case management or a supervisor present to go to bat, I'm running around doing visits and case coordination as well, with no date of return for the supervisor. It's extra work, and kind of lonely when I am the only one who knows what is up with the patient.

    I have a difficult doctor who sees most of my patients and doesn't answer calls or faxes.

    But I formerly worked at a large agency, and they were more organized, so maybe I have to adjust my expectations of how things work in a smaller one.

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    • Experts
    Your new nurse supervisor thinks you can't implement new orders until the 60 day recert is due?!? :confused: So if a patient gets a new order for something like discontinue propanolol due to hypotension, she expects you to continue giving it for the next 59 days? That's nuts.

    Our orders go in a sequence like this most of the time. Patient or Doctor to--->nurse at the home who writes the order for signature and implements the order that day (eg D/C propanolol)then--->home nurse puts yellow copy in the chart, then mails or faxes the white copy to the office attn: Case Manager who--->hopefully reads it before she faxes her white copy to the doctor who--->signs it and faxes it back to the office---who files it in the patient's office chart and sends that signed order to the home then--->nurse files it in the home chart and discards the unsigned yellow copy, ta-daaahh!!

    It sounds way more complicated than it is, and makes sure the new orders get started ASAP. What path do your orders follow?

    This is the way things went when I had the DOPCS who took care of things and is the way it should happen with all agencies. For some reason or other, though, the other agencies I have ever worked for just do not have someone in the office who bothers with anything. The yellow suspense copies of orders for changes collect in the field chart, and I get more and more disgusted.

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    • Author

    Right now the path is a fax to the doctor which is not answered and no one to back me up. I'm wondering how to protect myself, and whether this job is going to be possible.

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