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sunnysideRN has 1 years experience.

sunnysideRN's Latest Activity

  1. I'm a full-time CM working with the PPV model and my census has been low for months. Generally, my agency keeps me consistently busy but I don't think I can keep waiting for more SOC's. Today I had 3 visits, tomorrow 2. I prefer 5-7 visits per day. I'm thinking of going per diem at another agency to supplement but wanted to hear from someone who has done it. Specifically, how do you track mileage when going from patients of different agencies? How manageable is it having two employers (multiple iPads, phones, case conference meetings, software, policies)? Any insight welcome!
  2. sunnysideRN

    Working on my DNP considering aesthetics.

    Hi DPhilp, I'd private message you but I think there's a required number of posts before that option is available. Anyway, I'm an RN interested in aesthetics nursing and I was drawn to your enthusiasm for the field I posted some questions last week and I'm hoping you'll respond. Mainly would like to hear about what you love about the field and how it was transitioning from acute care to the world of cosmetics. Thanks!
  3. sunnysideRN

    Gaining experience/knowledge in HH

    Thanks Caliotter3! That's a great idea. I'll ask my supervisor about getting some reps in after our case conference meetings once a month. I was just pondering the fact that we have all these inservices on Oasis and billing but literally nothing on improving patient care.
  4. sunnysideRN

    Gaining experience/knowledge in HH

    Thanks Daisy4RN! Sometimes I get suckered into thinking I should have all the answers when they really should be going to their MD's. I like calling the MD in the home, then the patient can see my effort to help them. Even if it's just leaving a message with the medical assistant.
  5. I really hit it off with one of the injector/laser nurses at the dermatology clinic I occasionally go to. She's hoping to retire soon and thinks I might be a good fit down the road. I have zero experience, I'm currently working in home health, but she would prefer to train someone without experience ("not have to undo bad habits" as she said). I feel fortunate to have such a nice opportunity but also want to make sure I go in with eyes wide open. Some questions for those of you already in the field: 1. What do you enjoy most about your work? 2. What are the most stressful aspects? 3. Does it ever get redundant/boring? 3. If you previously worked in a more traditional nursing job (i.e. with sick patients), how was the adjustment to treating cosmetic concerns? Do you get any funny reactions when you tell people what you do? Meaningful work is important to me as is having a work/life balance (something I'm really lacking right now). Playing to my strengths, the psychosocial aspects of nursing is something that comes naturally to me and I imagine that's an important part of the aesthetics field. Please share!
  6. sunnysideRN

    Gaining experience/knowledge in HH

    Thank you for your feedback and perspective. You are absolutely right about setting ourselves up as specialists when we're very much generalists. It'd be impossible to be experts in everything we encounter: wound care, cancer pain, palliative care, nutrition, diabetes educator, cardiology, pharmacology.... That reminds me of another thing I was recently asked in the home. The pts family member asked me to read a copy of their EKG strip. I literally have not done that since nursing school. Maybe it's the demographic I serve because I do feel like I get put on the spot quite often and am expected to be a little doctor. Thank you, thank you for the reminder that we won't be able to fix it all in 45 minutes once a week (or even daily for 9 weeks).
  7. sunnysideRN

    Gaining experience/knowledge in HH

    I've been doing home health for just over a year and for the most part it's been very satisfying. Prior to this I worked as a nurse supervisor in post-acute rehab for a couple years so the pace of home health was a much needed break. The hours work well for my family ( I have three young kids). The charting is extremely tedious. I try to do as much of it as I can in the home or in my car right after the visit. Oasis assessments I tend to do at night after my kids are in bed. I've become very disciplined in performing the charting the same day as my visit and this helps prevent me from getting buried in it. I have a pretty stable caseload and avoid a lot of missed visits by keeping track of all their appointments in a calendar and using that to shape my day. The driving is really pleasant in my area. What's bothering me is my own lack of knowledge of the medications, pathophysiology and sometimes inability to draw a lab, trouble shoot an alarming PCA pump, fix a leaky wound vac, know how to treat a stubborn pressure ulcer, access a port a cath and there's no one there to help.... I know these things come with time and being a supervisor in a SNF really didn't provide a rich nursing experience (to say the least!), but still I'm bothered that I'm not able to give more to my patients. The office is able to provide support to an extent. I do call other nurses but at the end of the day, it very much feels all on me. I had one today who was just readmitted to the hospital after I did her SOC yesterday for side effects from a new medication. In retrospect, it should have been obvious but I missed it. I have one very challenging, hospice appropriate s/p CVA patient who has every diagnosis known to man and his son gets frustrated when I can't give him lengthy explanations to all his numerous questions. He told the MSW that he's unhappy with me because I don't "know enough." I guess he just said what I was already feeling sensitive about. Typically, when I need to know more on a subject I just pick up a book or research on the web. I'd love to watch some Khan academy lectures on body systems as a refresher (nursing school was a decade ago for me), but there is literally no time. I'm either working, sleeping or caring for kids. I'm exhausted and feel like I have nothing more to give. I told my husband today that I'd like go work for Trader Joe's or sell shoes or anything! Sorry for the long monologue... I needed somewhere to vent. Especially after the "She doesn't know enough" comment. I guess the most challenging aspect of HH is being a jack of all trades. Much easier to specialize. Support/advice welcome!
  8. sunnysideRN

    Mobile X-ray Services

    Are any of you field nurses able to carry out orders for mobile xray services? I feel like this could be very handy in the case of a bedbound patient needing an xray to r/o PNA, fecal impaction etc. I received an order for mobile CXR for just that, to r/o PNA but it was shot down instantly at my agency. They said that it would be too hard to get authorization from insurance and simply, "we don't do that." Managers, any insight into why I received such a strong reaction from my agency?
  9. sunnysideRN

    Patient education

    Thank you so much for enlightening me about "stoplight" tools! This is exactly the kind of systematic approach I've wanted to take with my patients but there's no way I could've created all that from scratch. I've registered and begun printing the handouts. So glad there's an organization focused on HH quality. Very cool, thanks again!
  10. sunnysideRN

    RN Home Health

    I'm in Socal where a 3 bedroom apartment rents for approx $3000/mth (just for context) SOC- 100 Recert/ROC/DC- 65 SNV- 55 Non-billable discharge- nothing, not a penny (curious if other agencies reimburse for this)
  11. sunnysideRN

    Patient education

    No, never heard of it. Please share.
  12. sunnysideRN

    Patient education

    Wondering if any of you have a system for what you teach and when you teach it. For instance, I've heard of some nurses teaching safety measures on the first f/u visit after the SOC, then pain mgt, then the medications. Also heard of some nurses teaching on 1 medication and/or disease per visit until they are all covered. I'm trying to be more systematic about it because I feel like I just address things as they come up and I'd like to be more proactive. My agency uses Kinnser and I feel like the pre-populated "progress to goals" don't help matters. It doesn't feel like a real care plan to me as so many of the items aren't relevant and there are many other things I liked to teach which aren't in there (though I could "free text" them if I had all the time in the world). I'd like to print more educational handouts but after all my charting the last thing I have energy for is printing materials, plus I'm trying to be smart about out-of-pocket expenses spent on work. Currently, I use my phone to pull up information in the home (for example, side effects of such and such medication) and then I just discuss it with the patient. Is a discussion the best teaching method for elderly adults, I am not sure. Any thoughts on anything related to how you teach your patients is appreciated :)
  13. sunnysideRN

    Charting in the home

    The prospect of coming home at the end of the day with nothing or very little to chart makes me giddy :) When I'm scheduling patients I've started to allot some time for charting. For example for a follow up I'll allot 30min for the visit and 10 min to finish up charting in my car before moving on. For SOCs I usually spend 1hour in the home doing my assessment, med rec and collecting data for Oasis(I have a cheat sheet). It then takes me about an hour to complete the Oasis plus a comm note for the schedulers. So would you block out two hours before scheduling your next patient so that the bulk is done in the home or somewhere nearby (depending on the pt/environment)? Over time, do you think my SOCs will get faster or is 2hours reasonable? If you have any tips at all about streamlining SOC's I'm all ears :)
  14. sunnysideRN

    Charting in the home

    Hi Libby1987, I'm newish to HH and I've finally begun charting my follow-up visits in the home. It's amazing what a time saver that is at the end of the day. I'm wondering how feasible it is to chart a SOC/ROC/Recert/DC in the home. Any tips for making those lengthier assessments more manageable? I've received a lot of valuable tips and tricks from your replies to various posts!

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