KP RN

What a dilemma, Curly! My husband is a retired podiatrist. He says that E.coli infections like you describe are not that uncommon. Perhaps when you took a shower in your own home, the water ran down your own body and into the ingrown toenail?? It's a lot more palatable when you realize it might be your own E.coli, eh??? Good luck!!

Calcium alginates are quite effective in absorbing tons of drainage and keeping the periwound skin reasonable dry and healthy. Good luck!

Our agency does not require case conferences, per se. However, we do document interdisciplinary communication at least every fourteen days. Our skilled nursing visit notes have a line which is for IDC, we simply write the name and the discipline of the person we communicated and what was discussed.

My best friend's husband and children have severe allergies to pet dander and hair. They have purchased two Shar-Pei's, you know, the wrinkly faced big babies?? I am happy to tell you the family has no problems with allergies or shedding, and these two dogs are so good with children!! Try a shar=pei!!

My spelling pet peeves are the incorrect use of: your and you're to, two, and too there, their, they're, and the use of GOOD instead of WELL. OK, I feel better now...

Hi Brenda. I do private pay home care visits. I advertise in the local newspaper. Sometimes I get referrals right from the doctors themselves. The population which I am targetting are elderly people with chronic conditions who need some help, but aren't yet ready to live in an assistive living facility. Many have children who are either out of town or unavailable. These patients aren't required to be homebound, nor do they need to have a skilled need because they are paying privately. I send bills out monthly. Have not had any problems collecting. My census varies, and I am pursuing my business "on the side" and working for other home care agencies on a regular basis. I do not attempt to "recruit" any of my agency patients for my own business for ethical reasons. Good luck!!

Why is it that US SMART people always wear glasses (or contacts?)

I was not aware that any nursing programs require 20/20 vision. I began wearing glasses at the age of 4 for near sighted vision. I now wear contacts (had been a coke bottle bottom girl til I was 16!!). My vision is only 20/30 or 20/40. Good enough to get a drivers license, good enough to practice as an RN. Good luck to you!!

Oh my, Karbyr, May I assume that you were being paid hourly, as opposed to per visit?? Glad you got out of there!!

WOW!! My daily productivity is 5.7 visits. We do have a policy which requires us to call the pt the evening before our visit to inform them of our appt. time. This has never been a problem. If I get stuck at one patient's house and I get behind, I just call those patients by cell and notify them that I'm running late. I would absolutely REFUSE to do HCA visits on a regular basis. Likle Hoolie says, I've done them every now and again, but I certainly wouldn't be giving showers routinely. I have a question though. Is this really Medicare fraud?? Seems to me that with PPS, the agency is paid one fee for the entire case. I didn't think agencies were still billing for, say, 12 RN visits, 8 PT visits and 18 home care aide visits??? It sounds like your agency is taking advantage of you. Karbyr, I'm shocked that your agency doesn't want you to be in a pts home for more than 25 minutes!! OMG! How can you possibly do everything you need to do in such a short period of time?? My average visit is probably 45-50 minutes--and that's an easy uncomplicated one!! I learn something new every day!!

Ah! The good ol' days!! I used to do 4-10s at a large university hospital. If I remember correctly, days was 7a-530p; evenings were 2p-1230a; and nights was 10p-830a. That was the greatest method of scheduling!! The overlap time gave us the extra hands to be able to finish paperwork, chart, get everyone turned, etc... Boy, did I love that job!!

I'm an RN in home health, and I have the opportunity to speak with many MA's over the phone regarding my patients. As in all fields, there are good MA's and bad MA's. Those who are formally educated can be quite helpful. I think most of the nurses on the BB would agree with me, the biggest problem exists when MA's call themselves "nurses". Only an LPN or an RN can legally address themselves as "nurses". MA's should be proud of their accomplishments, and call themselves medical assistants instead of nurses.

Organic chemistry-- After 20 years as a nurse, I've never had a situation in which I had to explain the clinical significance of benzene rings, valences, or carbon bonds...

OB/GYN, There is a thread in Nursing Entrepreneurs started by "AestheticRN" which may be of interest to you. Aesthetic trains nurses around the country in botox injections among other things. I think the thread in entitled Indepent Nusing. Check it out...

I always wear gloves whenever I might be in contact with blood or body fluids. I remember, back in the early 1980s, getting my a-s reamed at work for wearing gloves when cleaning up a patient's poop. Back then, us nurses were told to NEVER wear gloves when cleaning up someone cause it can hurt their feelings!!

I've been a nurse for 20 years now and have seen a lot as well. Whenever I have a patient die, and because I work home health and many deaths are unexpected, I find I beat myself up a bit. I try to figure out if I missed some subtle change, or if there was something I could have done to prevent the death. I know that I can rationalize unexpected outcomes, but part of me feels somewhat responsible. Do any of you feel that way too??

I married a doctor seventeen years ago. I didn't marry him for his future money making capacity. We married because we were best friends and had a lot in common. It was the best decision I ever made. Seven years ago, he became ill and lost his vision (Stevens-Johnson syndrome) and couldn't practice medicine anymore. Despite multiple corneal transplants, his vision is still too poor to do much of anything. We did the ol' role reversal thing. He cooks, cleans, does the laundry, and raises the kids while I go to work. Y'all are generalizing all the monstrous despicable qualities about doctors . Mine's a gem!!! Am I the only nurse married to a doctor who's happy on the board?????????

My situation is similar to disher's. My husband (a podiatrist) had a rare allergic reaction to an antibiotic which caused him to lose his vision--his corneas were "burned out" of his eyes. Stevens-Johnsons syndrome...and it only occurs in 7 people out of one million. Multiple cornea transplants didn't work...long story.... Anyways, we sold his practice and I knew I'd have to work full time. I let him mope and feel sorry for himself for about a year. Then, I laid down the law!! That was 7 years ago, and now things are great!! We have both adjusted to our new roles. Although he doesn't clean or do laundry as well as I did (he can't see for gosh sakes!), he is the barbecue GURU, and he is able to do many things around the house. It has also been nice for our sons to have Dad around all the time while growing up. Like they say, if you got together with a bunch of friends and everyone put their problems out on the table; you'd be glad to take your own problems back!!

OMG!!!!!!! I could never, ever, ever in a MILLION years wait and do my charting a month after the visit!!!!!!!! I get confused if I wait til the end of the day. (hhmmmm..was the swelling in the right or left foot??)

I'm with a large, hospital based agency. We take call one night every fourteen days. Visits are paid out at a rate of visit and a half, and mileage paid to and from your home. We do every third weekend, but generally, no more than 5-6 visits each weekend day. We do get a day off during the week before and after. I should also state that one of the administrative nurses gets all calls before they come to me. I am only notified if visits actually need to be made. Call offs, and problems with rabies/West Nile virus would not come to me!! This is a new agency for me, and I feel like I'm being totally spoiled and pampered!!! I love it!!

Like the others have written, nursing does hold many different scheduling options. When my boys were little, I worked evenings in a large teaching hospital, 3-11, and my husband would be home before I left for work. Now, I do home health and work Mon-Fri from about 900 am to 300 pm. I have to rotate weekends, but it's every 3rd weekend only. There are a lot of options, and with the worsening of the current shortage, you'll have more choices. Good luck!!

Topaz, I'm not sure I understand what you mean by "summaries on the 485"?? The info included on the 485 have been pretty standard at the different agencies for whom I've worked. What kind of information do you summarize on the 485??

Good question!! Mileage is very confusing, and agencies vary greatly with their interpretation of the rules. At my agency, we get $.36 per mile, beginning at our first pt home, and ending at the last pt home (or office). I always thought that I could claim mileage from my house to the first pt home on weekends or holidays when our office was closed. Recently, I was informed by the powers-that-be that the office "never closes" because they have an answering service and a nurse always on call, even though no one is working in the office which is locked up. Doesn't make sense to me, but no point in arguing.....

Thanks for your post, Hoolahan! My next question is...when the patient asks me why my actual visit schedule doesn't match my initial projection, what would be a good response?? Especially if I believe she needs the visits? CHFer with frequent rehospitalizations?? This is a patient who might call the Medicare hotline and say she's not getting the services she's entitled to? Can my agency get into trouble with MC for altering visit frequencies in the name of cost containment? Am I the only HH who has these problems????? What to do?????

Hi y'all!! I have a few comments, then a couple of questions regarding frequencies on the 485.... At my agency, we are not allowed to range visits (2-3w4, etc). It has to be exact.(2w4). When I open a case, as case manager, I will project my 8-9 weeks worth of visits,(ie:4w1,3w3,2w3,1w2). My projection is discussed with the pt when the case is opened and it is written on the admission/authorization sheet which is signed by me and the pt. A copy of this goes into the chart. For some reason, my office will decrease my frequency when they type up the 485. (3w1,2w1,1w7). Is this common practice in home health? Is it an OK thing??? Just wondering.......