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Nurse on the Go

Nurse on the Go

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  1. Nurse on the Go

    individual emergency plan-home health

    We have a separate page that accompanies our admission orientation materials. It has blanks for emergency contact information, equipment needed, level of assistance/caregiving support needed, etc. We complete the form with the patient at SOC and transcribe the info into our EMR. We encourage patients to hang the forms on their refrigerator.
  2. ^^^ This! I'll also add that the orientation program for even the best home health agencies won't focus on teaching you how to function as a nurse. Home health orientation teaches you the basics of how to organize your day, the mountain of regulatory requirements you will need to know and follow, and the basics of case management (if you're lucky), but it is designed with the expectation that you have already mastered the basics of nursing. Clinical competence is typically validated, but is not the focus of the training program. Home health is an amazing field and a great goal to work towards. Focus on getting some solid med-surg experience (and any wound care experience you can get will be a huge plus) and you'll be in a good position to make the leap in a year or two.
  3. Home health is really not an appropriate setting for a new grad and you'll find that reputable agencies won't consider nurses without at least 1-2 years of experience. There is good reason for this: the assessment skills, critical thinking, ability to direct a care plan, and autonomy necessary to succeed in home health are gained with real-world experience, not learned in nursing school. As the above poster mentioned, I would recommend you get some basic foundational experience and set yourself up for success. Home Health will still be there once you're experienced, and you'll be a far more effective clinician for it. Oh, and the multitasking piece is certainly not unique to the hospital. Home Health is incredibly busy as well and you'll find that effective time management is very much required.
  4. Nurse on the Go

    Good program for certification

    I just wanted to say hi to you, Trina4362! I will be starting the Webwoc program in August as well. I can't wait to get started. Good luck!!
  5. Nurse on the Go

    Home health

    In my experience it's been a transfer OASIS and transfer summary, but I agree this is something you should ask your employer.
  6. Nurse on the Go

    COS-C certification

    Check out OASIS Answers. Everyone I know who is COS-C certified has used them- they're good. Event landing | OASIS ANSWERS
  7. Nurse on the Go

    Not cut out for home health?

    First, I am so sorry you are going through this! Second, I don't agree at all that you're not cut out for home health! The charting is often what trips up new hires because it is difficult/intense and usually involves a steep learning curve. 6 months isn't a particularly long time to fully integrate into home health, especially working part time. I think it's reasonable that you would still have a lot of questions and need support with OASIS! From my experience, most new hires need between 6 months and 1 year to really get their feet under them and feel comfortable with the job. It seems like you're right on track... How long is your average visit? Are you able to get any of your charting done during the visit? One of the biggest things that helped my productivity was when I started charting in the home (or at least in my car right after the visit.) I'm not sure what you mean by charting a frequency but if you want to give more detail I'll try to help. As far as OASIS, there are classes to teach you how and why to answer the questions a particular way. If you're interested, you might check out this organization: Event landing | OASIS ANSWERS The class is pricey, but you could purchase just the Oasis Answers book if you're looking for additional information. I found it to be really helpful.
  8. Nurse on the Go

    Medication Review

    Hello all! I am in need of recommendations for pharmacology CEU courses, preferably online. I am orienting a new nurse who would like to brush up her knowledge of common medications, and I can't seem to find a good course to recommend to her. I've looked through all of my favorite CEU sources and done some googling without much luck. Even my organization doesn't seem to have what I'm looking for. For now, I've recommended that she review the 10 most common medications prescribed for older adults and the most common medications used to treat the top diagnoses we serve. Does anyone know of a good pharmacology review course or other resources I can share with her? Thanks so much!
  9. Nurse on the Go

    RN Case Manager? What does this mean in Home Health?

    Hi! Home Health Case Managers do indeed provide direct patient care. They oversee all aspects of the patient's home health services. That includes things like creating and updating the patient's plan of care, determining an appropriate visit frequency, communicating with the MD, ordering/obtaining necessary supplies, tracking all the OASIS timepoints and completing assessments, facilitating referrals within the interdisciplinary team (PT, OT, MSW, etc.) The number of patients you will be expected to case manage may vary by agency, but from what I've seen it's typically between 25-30 for a full time RN. Patients are usually seen between 1 and 3 times per week (it will vary based on what the patient needs, some may be seen less frequently if you're just doing catheter changes for instance.) You will generally do their OASIS visits like you mentioned above and delegate the follow up visits to your LPN. The LPN will communicate any changes in the patient's condition or new needs the patient may have, and you'll work with the MD or the interdisciplinary team to figure out how to solve the problem. In the agency's where I've worked, all RNs are considered Case Managers, except when we've had nurses who only worked a few days a week and primarily did SOCs to hand off to a Case Manager. As far as challenges, there is a fairly significant administrative/paperwork component, and that piece is not for everyone. Home Health is heavily regulated by CMS and that comes with it's share of challenges- it's a steep learning curve. The things I see new nurses struggle with the most are staying on top of documentation and effectively managing their time to get everything done within an 8-hour day. Strong organizational skills, time management and prioritization, and critical thinking skills are an absolute must. It also helps if you have a strong office-based support system (manager, triage nurse, scheduler, etc.) who have your back and can help you with questions and some of your admin tasks when needed. Is it worth it? In my opinion, absolutely! I love home health and don't see myself working in any other setting for the foreseeable future. I love the autonomy, the 1:1 time with patients, the ability to see the same patients and watch them progress and heal over time. You can definitely advance your career in Home Health if you're so inclined. Here's my story from a previous post: I started out as a field clinician/case manager in a small agency and later worked my way up into an office-based nursing position. Over time, I cross trained to do several different types of roles: intake/transitional care, utilization management, triage, even a little bit of billing. I really got to learn home health inside and out! I found it was always just a matter of putting myself out there and volunteering to learn and do more. Now I'm a manager for a large hospital-based home health agency. I can attest that there is definitely opportunity if you stay hungry! If management is not your ultimate goal, there are plenty of ways to advance clinically as well. I know several nurses who have gone on to become certified in wound care, nurses who have moved into education-focused roles, and I even have a nurse right now who is working on an ARNP degree. Hopefully this was helpful to you. I wish you all the best in making your decision!
  10. Nurse on the Go

    New to Home Health and Confused

    I'm so sorry you're not receiving a more thorough orientation! Yes, you would definitely want to call the MD right away for that blood pressure. I found that when I would use the words "I'm in the home with the patient and I need to speak with someone urgently" my call would often get higher priority and I would get to actually speak with someone in the MD's office vs. being sent to voicemail. Your agency should have standard parameters for vital signs and when to contact the MD- this becomes part of the patients plan of care/485. That is good advice from artsmom above about verifying INR and dosing orders with the MD, not the patient. Some MD offices and anticoag clinics will work directly with you and some will take care of contacting the patient for you (be sure you ask!) but always make sure you receive the results first-hand and make sure you document who followed up with the patient. Regarding labs in general, the MD will likely see the results before you do. I always liked to ask the lab to send a copy of the results to the MD and a copy to my office so I knew what was going on. That way I could clarify if anything was abnormal or I had questions. If you're not feeling comfortable with lab draws, can you ask to spend a day just doing labs with another nurse who is very comfortable with that skill? Or, if you work for a hospital-affiliated agency, can you spend some time with the staff from the hospital lab? Just a few suggestions. Hope that helps. Good luck on your new adventure!
  11. Nurse on the Go

    Buy your own laptop?

    I have never worked for an agency that required me to purchase my own laptop. I have worked for one that had us use our personal cell phone with a monthly reimbursement, but even that is rare in my area. I agree with previous posters, it seems like a red flag. You may be able to do better with another agency. Good luck!
  12. Nurse on the Go

    Noncompliant and hostile patient- where is the line drawn?!

    I really hope your agency will support you- that's a difficult situation. We don't serve patients who are active drug users due to the staff safety aspect. We will sometimes draw up a contract with "challenging" patients outlining terms they must follow if they want to stay on service with us (including maintaining a safe environment in which we can provide care)- is that something you could try?
  13. Nurse on the Go

    Home Health Nursing Pay

    Yes, I agree with caliotter3. It's much more important to look at the local standard vs. industry-wide, since rates will vary significantly based on location. Not all companies have moved to the pay per visit model, but it has definitely gained popularity over the recent past. Some of the agencies in my area have created a "modified" approach to this model by paying the staff a base salary and offering incentives/bonuses for visits completed beyond the minimum expectation. There are pros and cons to both methods.
  14. Nurse on the Go

    changing positions - need words of wisdom

    Home Health is most definitely not a waste of talent! On the contrary, it takes quite a bit of special talent to excel as a home health nurse! I'm pretty biased, but I consider home health to be one of the best areas of healthcare. í ½í¸Š As far as opportunity for advancement, I can share my story with you. I started out as a field clinician/case manager in a small agency and later worked my way up into an office-based nursing position. Over time, I cross trained to do several different types of roles: intake/transitional care, utilization management, triage, even a little bit of billing. I really got to learn home health inside and out! I found it was always just a matter of putting myself out there and volunteering to learn and do more. Now I'm a manager for a large hospital-based home health agency. I can attest that there is definitely opportunity if you stay hungry! If management is not your ultimate goal, there are plenty of ways to advance clinically as well. I know several nurses who have gone on to become certified in wound care, nurses who have moved into education-focused roles, and I even have a nurse right now who is working on an ARNP degree. I wish you all the best in your new role. I hope you come to love home health as much as I do!
  15. Nurse on the Go

    Chart Auditing and education

    In regards to the chart reviews, I think it would depend on the type and extent of reviews being done. An LPN could review documentation to ensure quality elements were addressed, all the required boxes were checked, etc., but should not provide direction on the care plan itself. And I would think only an OASIS-qualified clinician should review OASIS documentation. The education and orientation piece is more tricky- I don't feel good about that because of the differences in scope of practice. I suppose it would be okay for an LPN to sign off an RN on certain skills that both disciplines would perform, but not all aspects of the RN's orientation. My state board's guidance was vague, so this is just my opinion.
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