spejsa

I am working as a utilization management nurse for an insurance company and took over the job of some patients who have been in LTAC's in Arkansas and Oklahoma for an extended amount of time. The LTAC's are now wanting to DC the patients but there seems to be no facility in the area that will accommodate these patients. I have been told that the only facilities that can take these patients are in Illinois and Texas. Am I right? Does anybody know anything different on this?

Great idea! GIve me the info on where you can get it for $90. I think it is well worth the money.

I don't think my agency has pipettes... Do you think a lab at a hospital might give them to me?

I seem to have so much trouble using these machines. I get the blood and get it on the strip but I have a lot of problem getting the test to actually run. It always says there is not enough blood... Any ideas?

This will be my 2nd week in orientation at my current home health agency. I will be on my own this week seeing patients (although I was doing that last week) and a nurse will just be with me, signing me off... I just wanted to ask everybody for ideas on what things should I make sure the office or nurses out in the field with me go over while I am still orienting... Before I am on my own and clueless again...

I have had problems with that before but when I use a blue tube it has been ok? You are getting blood right into the tube and not drawing into a syringe and then transferring, right? I was told in the lab once when mine did that it was cuz it clotted quick enough in the syringe. She said I should never draw and then transfer to teh tube, cuz it would clot immediately...

Thanks!!!

Well, we got into an argument last night and that nurse hung up on me. I told her that I was legally done Friday and she said "legally it is your responsibility to give report". I told her that I told the office the week before I left that I needed to know who was taking my patients and they didn't know. I told the office last Monday that I would meet with the clinical supervisor Friday afternoon (my last day) to do report... they ended up giving me 2 admits that I should not have taken but did... So, the office called Wednesday and said "you can arrange to give report to so and so, she will be taking your area"... So, she said "I am off Thursday but we can meet". So, I went to her house, out of the way, and really not a part of my day seeing patients on Thursday and was going to give report. She said she had to leave at 10:30 and I arrived at her house at 10:15... It was not my fault that she had to leave... I got from A-H and she did NOT EVEN SO MUCH AS WRITE ANYTHING ON PAPER... So, my feeling was, "she doesn't care".. So, when Friday came I turned all my paperwork in with my bag and sent a spreadsheet to the boss via email... She worked the weekend but did not even call all weekend (even though she had daily visits for my patients on the weekend...???).. But, then she calls Monday night after 5PM to get a report??? Please!!! So, last night she called me on my way home and I said "I really don't have info on the patients as my last day was Friday." We got into an argument and she hung up on me. She did send me her email in a text message before we talked and she hung up on me. So, I went home and sent the spreadsheet to her.. and I also sent an email with a written report on patients with last names H-Z... So, I am done. Oh yeah, I made sure I blind cc'd my boss on the emails as well.. I hope I am covered. And I hope the boss doesn't give a bad reference.. She said she wouldn't, but I know how that goes.

I left an agency that I was working for last week. I gave them 2 weeks notice and last week, my last week, I told the nursing supervisor that I would give her report on Friday (my last day).. I got a call Wednesday from the office stating that Friday would not be good and that the nurse that would be taking my patients wanted to meet with me to get report... So, I called the office and spoke with that nurse (she was in the office at that time) and she said she was off Thursday but could meet. Remind you, I would take time out of my schedule that day to meet with her... I had quite a few patients to see that day. I called her that AM cuz I had a person with a PEG tube that needed a lot of help and I was at their house for an hour and a half. WHen I called the nurse it was aorund 10 and she said I could come to her home and we could go over patients, but she had to leave at 10:30... I went over there. When I did go there I gave report on patients with last names A-H and she had no paper, wrote nothing down, and then after 15 minutes said "I have to leave to meet a loan guy" and she left. SHe never called me Friday and that was my last day. I did send a spreadsheet to my administrator and brought copies of this week's schedule for her (which would have been mine), the nursing supervisor, and the scheduler... So, her work was cut out for this week.. The spreadsheet has all my patient's last visit date, next visit date, frequencies... What else do you need? Now, she calls yesterday and today saying she wants report and I Legally have to give it... I told her my last day was Friday... Anyways.... I need advice on this situation...

Willow, your experience sounds a lot like mine. I mean, exactly. ARe you at my agency? It is crazy the way these agencies seem to work. I am on to new things and just want to get out.

Thanks for the info! I really want to attend one of these seminars. I asked my agency if they would pay, but they would not. They said our corporate was doing training sessions once per week and I could come in at 8:30 AM on Wednesdays for the training... WHat I heard from staff that did come in, it was worthless...

I know!! I don't know why the dressings would be BID either. All I can think of is this man hadn't been to the wound clinic this whole time since yesterday. So, it was the first time they saw the wound and they are starting at the bottom... Then, they will increase, etc. The orders also said 'TEACHING FAMILY DRESSING CHANGES'.

Kate, So, the patient finally got to the surgeon for a follow up and now the LPN says that the dressings are BID???? Stacey

I totally agree here! I hope that I can figure this stuff out soon. I start a new agency soon. this one is really a mess, hoping the next one is a little better. Sounds like it's bad everywhere though

The problem is... My hubby doesn't understand but nursing really SUCKS here. There are 4 hospitals and 2 are owned by one corporation, so not much to change to in the hospital setting... Only 2 other HH agencies in the area so if I leave and go to another I only have one left. In 4 years I have already burned all my bridges hospital wise in this area. My boss at the agency I am leaving said she will be my reference and has heard great things about me. Thinks I am a great nurse!!! Then, why can I not find a good fit?

I would love to... But, I live in Arkansas...

Today I did a resumption of care and 5 visits. One of the visits was a PRN cuz my pt called me with his catheter "not working". I had to go out and put in a new one.. which didn't work after putting in, so had to do another... Spent way too long there... Another visit was doing labwork and then add 20 minutes+ for trip to and from lab to drop of the blood.

KateRN1, I quit today. And, this time I am not changing my mind. This same nurse called me today on a patient that was admitted by another nurse a few weeks ago. It was for a patient that had a total knee arthroscopy. The nurse gave me report saying she didn't think I needed to schedule but the one visit to see the patient a few days after she admitted her. I went out and thought maybe I would keep seeing to teach, etc. but the patient and PTA (showed up while I was there) were like "oh, she said she would be DC'd this Saturday so she can go to outpatient therapy)." So, I talked to the PT that Friday and she said she would discharge. Now, it is end of month and this nurse at the office called and asked why I wasn't seeing the patient. That I needed to get the five visits in.. That i need to teach SOMETHING... I told her that the other nurse had told her I would not come but once and it made it difficult, plus the patient had been doing dressing changes 4-5 days at that point and really had no skilled need as far as I could see... So, she told me today "You have to go back out there and do more visits. We need 5 visits". I told her that I missed now cuz I never went last week. She said "just do a missed visit" and I said "no. I never called and what am I going to say?? YOu have to say you attempted the visit, which I did not"... Nevertheless, I quit last week and went back on it and I sent my resignation over to the boss tonight. My last day is next Friday.

She said we need to go out and see patients that the Dr. refers so we keep the relationship good...

The reason I wish to discharge is the drug issue. I have not seen anybody do a drug deal but I know there are drugs in there. There are multiple red flags.. and it worries me being in the home at all. And, the patient saying people are taking his pain meds, etc...

It is an abscess on the buttocks from a "spider bite". I think we can go with less than daily dressings but the LPN disagrees. I am waiting for the MD to evaluate the wound to give orders. The LPN is quick to say "well, we have to do daily until the Dr. tells us differently". But, I am the one that wrote the daily order 2 weeks ago on SOC? And, it is doing well and has healed very well, but we are still packing. I don't think we need to but she thinks we do?

Well, this particular patient is not a wound care patient. She has a dx of cholecystitis (or possible, which they think was all better when she was DC'd from the hospital). I live in Arkansas and I am unsure about teaching the staff. My LPN said she taught staff there before and insists I need to go and told my nursing supervisor in the office. The nursing supervisor has never done home health (which is the reason I think I need to get out and will do so. I was going to see if they could work it out but I do not think that it will happen). And the woman has Alzheimer's and really no other chronic problems such as CHF, COPD, DM, PVD, HTN.... Otherwise, she is in pretty good health except the Dementia...

A social worker is in order. Remember, KateRN1, I am new to home health. This particular patient has a history of drug abuse. He told the LPN last week that he has had no pain meds since DC from hospital as his family took his pain pills. I thought that we had to have somebody in the home to teach and that was the basis of home health. So, we can go eternally on daily visits? The problem with my agency is... We can make daily but the weekends are a problem b/c all of us are in different areas.

I have a similar situation... I received a referral from my office for the following: A woman who was recently discharged from the hospital with a DX of possible cholecystitis. The MD wants labs (CBC, CMP, Amylase, Lipase) drawn prior to appt this Friday. She lives in an ALF and teh family says "all of her needs are met there. We don't think she needs a nurse on an ongoing basis." But, the office when I asked about it says we can't just go out for a blood draw but she is 80 and "Surely you can find reasons to go out". I went to see her and she has Alzheimers'. The staff was all in a meeting when I was there so I was not able to ask any questions about anything else and don't know what else I can do with her... I have been to this place in teh past and the staff did not want to be trained or taught anything. They are busy doing their jobs, etc... The LPN I work with told the agency that she went there in the past and did teaching, blah blah... I don't see a need for us to bill and really think the dr just sent us to do labs.. I could make something up but really... Should we just go out to chat with the pt and waste their time? Do we expect that the staff will learn? What to dO? I didn't get the blood draw so I will have to go back to get it so I guess I will find something I have to teach...

Then today I had a conversation with the LPN I work with and she said that we have to go out to do a wound dressing change daily on a patient because the family REFUSES to do the dressing. This patient also doesn't go to dr appts (missed last week appt with wound doctor)... also didn't have Cipro filled since 2 weeks ago... she says we cannot discharge and she sees him so what do I do? I have to dc but she sees the patient...