Letisha Hamilton

You visit times must never overlap even being different companies. Would be considered fraud if audited. Where I live, there have been fraud cases with billing for more visits than humanly possible. So, it is monitored. If you live in a right to work state, don’t think they can stop you, contract or not. They can stop giving you assignments. Getting RNs to do home health start of cares if difficult for most agencies. A lot of work for the pay. So, they value nurses who will! Many perdiem home health nurses work for multiple agencies. One gets slow and you have another source for income. Just never mention to patients or families that you work elsewhere, be careful not to wear the badge of another company when you visit.

We all have an occasional complaint, especially when it comes to demanding patients. The only problem there could be for you is if the Morphine was ordered around the clock, not as needed. Sometimes, pain meds are changed without taking the opioid equivalence into consideration. For example, Tramadol 50mg po is equal to about 5 Oral morphine. oxycodone po 5mg is equivalent to around morphine po 7.5mg. It’s different for IV Morphine. These are all IR dosages and amounts vary per facility policy and patient response. I’ve had to remind doctors of prior dosages and ask they believe the dosage will be enough. Be prepared with total dosage for day of all pain meds given. It’s not your role to calculate the dose, but you can be prepared with number of dosages and strengths given. Help the on call make an informed decision. Now, dealing with an patient who has been abusing their drug of choice, there are going to be problems. But we are responsible for attempting to assess their pain level. Document to cover your actions and decisions. Keep in mind the onset, peak and duration of the meds in patients with pain. Allowing meds to totally wear off can then take longer to get patient relief. Patients do not want to hear excuses, they want the problem fixed. If he wants Md called, be proactive and ask right if he wants to be woke up and informed. Telling the truth that the Md refused the order is appropriate, you tried, offer a solution for now, even an apology that they are not satisfied. Inform you will pass on report that there is a complaint and offer what you can do. Sir, I cannot give you that Med without an order. I can check on you when medication is due. I agree, offer to wake him. If his pain is real, he knows the med will wear off and appreciate the offer. Have a complaint, pass it on to your direct supervisor, left them be proactive in addressing his threats and a dreaded bad review to survey. I rather deal with it right away, not weeks from now when no one remembers and his complaint is exaggerated. try not to take this home with you. Not the last difficult patient you will face.