spectral_ev

Don't underestimate the value of your experience. When you have handled the skill and responsibility of nursing you are very competent to do something else, either for a change or for a new direction. It took me about 30 years to end up in an office cubicle doing nurse case management, but this is a good fit for me and I'm grateful to have found work that lets me help people in a different way. There are many ways to apply your abilities, good luck.

Good luck. You are right about this. If the employee has carpal tunnel they need a doctor, and if they don't it's a waste of a splint. If the company considers a splint protective equipment for the job they have to write it into policy. How about the employees take a half hour break when their wrist hurts? That would do more good.

I've had patients with MS who had extremely difficult personalities. These patients were not demented, but I thought that the disease was affecting them, beyond the stress of having such a condition in the first place. I think your patient's doctor should consider a psych consult, or some meds for depression, agitation, pain, or get him counseling. He must be miserable, and his behavior will interfere with the care of the other patients.

thanks for all the responses. one thing I'm trying to figure out is-- how weird is this situation? I don't have any support right now in trying to make sure all the nursing bases are covered, or support in covering my own base. but it seems like there are a lot of agencies that are not well-organized. I'm shocked, shocked to find out that money trumps patient care.

right now there is no one at the office to follow-up. one of the doctors is not willing to answer questions on the phone and won't answer faxes. I like the patients, and I like the job, but I feel out on a limb.

Right now the path is a fax to the doctor which is not answered and no one to back me up. I'm wondering how to protect myself, and whether this job is going to be possible.

LuLu, I never had to work in the field with no one to help when doctor's orders are needed and the doctor does not get back. It sounds like that's what you're dealing with. Can anyone tell me how common this is? Without case management or a supervisor present to go to bat, I'm running around doing visits and case coordination as well, with no date of return for the supervisor. It's extra work, and kind of lonely when I am the only one who knows what is up with the patient. I have a difficult doctor who sees most of my patients and doesn't answer calls or faxes. But I formerly worked at a large agency, and they were more organized, so maybe I have to adjust my expectations of how things work in a smaller one.

I always thought that the assumption is that patients are homebound-- that's the justification for sending a nurse to the home. I try to accommodate my patients but if it messes up my schedule I tell them it's not possible. I don't think the nurse should have to backtrack, keeping the driving down is a priority too.

yes, it's the lack of help with case management. it's tough to do all of it when you are on the road, any office time I put in is unpaid extra. I wonder how much case management is assumed when you are a per diem making home visits. Am I expecting too much?

A lot of home care nursing is not that acute. You have great skills and you are way ahead of a lot of nurses in that. In my agency we don't even do the IV's, another agency handles that. You sound very well qualified, most patients and families are really nice, it should average out to be good. As far as parking, I work in 'the neighborhoods' and no one ever gives me a hard time. I find 'the burbs' to be scary.

In my previous job when the doctor didn't call back I would just note it in my report and the supervisor would take it from there. I worked weekends so the supervisor would call the doctor's office during the week. I'm starting to think I took that for granted, because now it's very hard to keep things safe and get the orders.

Working as a per-diem nurse in the field in a home health agency where the nurse supervisor is on sick leave. It's a strain if one of my patients is sick and their doctor is not accessible--if he does not answer requests for orders or clarifications. There is no back-up right now, all I can do is document and inform the patient and family. I haven't been in this situation before. Is this common? Other agencies I worked in had more than one supervisor and they covered for each other. How long is it reasonable to wait?

thank you, Hmarie. I'll print this out.

Thank you. I think it is pretty shaky to have a nurse putting diagnoses into the record when we don't diagnose. Our office staff used to be better about getting the diagnoses and putting them into the program. Now I'm getting pressure about the coding, which is a whole area I don't know well and don't want to unless I am paid for the office time. It's hard enough to wedge in some actual nursing care on admission, when there's all this information to chase. I heard that in France they have a card that every patient carries and practitioners can use it to access their medical records. Lost information is one costly problem in the USA.

I've asked for a 'cheat sheet'. I've never yet found COPD in the program. When I started at this agency it was all on paper. I love computers, and being able to see other nurse's notes makes it almost worth the extra time. But we are being asked to collect more information, about half of it for insurance purposes, and admissions are tough enough already. Not only is it a task for the nurse, often the patient is just out of the hospital and not in the mood for a thousand questions. All these computers, yet the patient often comes to us with no information, just a med list. I'm doing tasks that used to be done in the office, and my pay has not gone up.