Beeda

I completed the WebWoc program several years ago. 4 of my certified wound care colleagues also completed the program and are doing well. One colleague went to Emory and got a lot out of that one. It is what you make of it. I think where you do your precepting work is every. It as important as where you go to school. If you want to discuss WebWoc, please PM me. lisa, CWOCN

My son used to make fun of my “q-word” phobia until he became a paid emt during college. Now he gets it! Even now I don’t use the q word at home. I say “not noisy” or calm or pleasant

I tend to have a lot of tolerance for bad behavior. I’ve been an RN for 28 years. My last job I stayed in the same role for 7 years, the last 3 of which involved throwing up every work day from stress. I enjoyed the independence and the work, but not the conditions. I finally left that position because I realized that there was nothing I could do to make things work out with management (and because my husband finally got it through my thick head that there were better options available). I am in a job now where I make a difference and where I’m well thought of. My previous job lasted 8 years. When management told me float to another hospital without orientation (I believe the phrase was “get your *** over there”) I went to senior management and my manager was disciplined, when they said we were to be inserviced in how to mix the chemicals to wash the floors, we said “we are willing to pitch in, but if this is an essential part of our job description, we will seek employment elsewhere” and they rethought their position. The last straw was when they closed the hospital and basically said “you can drive to work and sit in the parking lot, but we won’t pay you and you can’t come in...” well, it was time to go. Sometimes I feel that I stay until the pleasure exceeds the pain. Recently I have come to realize that I am worth more than being miserable, and that it is up to me to make it happen... suffering doesn’t make me a better person, it just makes me miserable.

WOW!, this comment seems unnecessary and hurtful.

I work in a large hospital within a larger system. I am part of the wound care team and a CWOCN. I am critical care credentialed and have been an RN for 27+ Years. In my current job My team and I are pulled to swab employees and patients, take temperatures, care for patients and staff, answer the covid hotline as well as manage traditional CWOCN responsibilities. I am happy to be versatile. Our APN is also sometimes pulled to cover alternate assignments too. It is not beneath me, it is all part of being a team. Sure, there are some assignments that don’t work my brain the same way as others. I have learned to embrace the versatility and flexibility that makes me a good team member. Bottom line, it does not change my paycheck, is not morally uncomfortable, and does not violate my state board of nursing responsibilities, and my employer is willing to pay me to do it. I’d be quiet and do it gracefully unless and until I chose to find another job.

So remind your nurses that there is often no relationship between what a patient does and what they SHOULD do. On initial evaluation you should make your evaluation based on the situation before any teaching is done. For example, Ms Total Hip is 79. She greets you at the door dragging her walker (which is too low) through the hall because it is too wide to fit past the grandfather clock and the pile of mail. Her dog is yapping at her feet and she is wearing untied shoes (because she can't bend to tie them.). Just based on this at minimum she requires assist with dressing because she SHOULD have someone to lay out her clothes. She can't safely get them, clearly can't dress her lower body While observing hip precautions, has a major trip hazard (dog) Incorrect use of the walker, and environmental hazards. Additionally, she should have assist with lower body dressing to observe hip precautions. She later takes you into the bedroom where she shows you how she gets her shirt on (while standing up - an automatic safety fail) I would score her as totally depend for safety. Ok, she lives alone and does it daily, but it is not SAFE. By the end of the vs you have moved the clutter, fixed the walker, and moved the wheels to the inside of the walker. She sits in a chair to get dressed, and she found the dressing aids she got from rehab. Score her a dependent on soc BEFORE teaching and by the end of the visit you have improved her to clothing must be laid out for upper body and assist for lower body. BINGO! You have also improved your outcomes and made her safer Tell your staff that low oasis scores help with risk adjusting and with reflecting accurate patient conditions that can often be improved with pt/ot/sn instruction and justify additional visits. If someone is a 0 on start of care they are probably not homebound and should not need any therapy! if that fails, remind your staff that people are not safe if they are texting while driving...just because they don't have someone else in the car to text for them doesn't make it any safer.

The first visit I make I am already planning for discharge. Your care plans are there to help. As you reach a goad...med teaching, instructing s/s of disease, when to call the doctor, etc, end those care plans. When they are ended, you are done. For example: new diabetic teaching. Goal: indep with FSBS, knowledgeable of oral hypoglycemic/insulin (major effects, side effects, how/when to take), diabetic foot care, s/s to report to md, management of sick days, s/s hypo/hyperglycemia, nutritional education, meal planning, carb balancing and how to read packaging... you are looking for basic proficiency and 2 weeks stability (stable blood sugars and no significant med changes). for other chronic diseases like CHF/COPD you are looking that they understand disease process, meds, and s/ to report or when to go to the doctor. Again also look for 2 weeks stability which means stable VS, no major med changes, stable activity tolerance. If they are not capable of understanding or learning after 2 weeks or you are not making any progress with instruction, identify who is the caregiver you will teach. Don't forget, Medicare does not cover chronic management of most homebound patients (exceptions of foleys, etc). When the patient is no longer truly home bound, they must also be discharged and referred for further management (md, heart care clinics, pulmonologist, cardiac rehab). I tell my patients from the beginning that my care is a short term, intermittent bridge between hospital or rehab and their return to (relative) health. Please also remember to discuss your care plans/ patients with your supervisor who can help you when deciding to keep or discharge. Sometimes I will just ask myself if there is anything I am adding to the equation, is there something I am missing, or if they are just ready to graduate. It is very rare that I will keep someone with a chronic disease on service for more than one cert period good luck

I've been a Visiting Nurse for Medicare Certified home care for 10+ years. I use the sticky pads on my laptop for my schedule and clinical notes. I have a binder for papers and an enclosed clip board for papers that need to go back to the office (in international orange!). I put the mileage right into the schedule when I get to the patients home and reset the odometer before I get out of the car for the visit. I use google on my phone when patients have questions during the visit...suppliers, generic vs brand name terms, who won the "game last night"... you tube is a great source for procedure videos for patients (and nurses) to refresh your recollections...especially if it's been a while. (Just make sure to preview them privately before using them for families...). I have doctors numbers in the resources section of my lap top. I also have switched to using a backpack for carrying my stuff - there are lots of pockets for organization of computer, cell phone, wifi, pens, forms, visit supplies, basic equipment (like BP cuff, thermometer, stethoscope, pulse ox) and infection control stuff. My GPS makes life much easier and can help find a bathroom when you are in a less familiar territory! In my car I have bins for supplies and carry bags for holding admit packets, my binder, scale, surplus infection prevention supplies, etc. I also keep an insulated tote for lab draws with an ice pack for hot summer months - until I can drop them off. A trash bag is helpful for corralling the inevitable trash that comes with spending so much time in your car. When planning out out my day first review any reports/new admissions, listen to voice mail and check e-mail. I then look an my day and write out patient names on the sticky notes in my computer. Next, I cut and paste the patient addresses onto my sticky notes. I then use a mapping software to lay out locations (if I am not sure how the addresses relate to each other) and then order the visits based on geographic proximity and any special needs (time specific visits, CHHA supervisions, fasting labs, etc). I review the last visit plan for each patient and any new clinical notes from other clinicians. If there are any new admits for the day, I review the intake notes and look up anything I'm not sure of...Then I call the patients and schedule. I always give a window of time for my arrival which reflects the expected time I will spend with the previous patient plus travel and then the "fudge" factor...e.g.: patient one: I expect to arrive between 830 and 930. Patient two: I expect to arrive between 930-1030, patient 3: I expect to arrive between 1115-1215. And so on. good luck, and you will get the hang of it.

Is this a Medicare certified agency? If you are being hired to supervise CHHAs then you will need to arrange your day so you are present when the aide is there. It is Very unlikely that you will be able to flex your visits to consolidate your week. I have been a HH RN for 10 years for 2 Medicare certified agencies and was a critical care nurse for 16 years before that. Most visits can take from 30 minutes to 1 hour depending on whether it is a skilled visit or a CHHA supervision only. If you are covering pts in Manhattan and the Bronx be aware that this is a big territory and you will need to go back and forth to see the patients when the aides are there. If the agency is not providing Medicare certified services but is only providing companions/certified aids you may be able to group your visits a little better but I still doubt you will be able to work a consolidated week. More likely they will give you visits to make for that day. In my agency our productivity is 6 units/revisits a day. Non-billable aide supervision visits count as 0.5 units