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.

My home health agency wants me to collect diagnoses on admission and put them into the OASIS form using a program that is supposed to bring up the ICD-9 code. It doesn't work too good. And isn't this better done by office staff? Based on interagencies that should have been faxed to the office? And should nurses be doing this at all? Diagnosis is a practitioner responsibility. And now I'm supposed to do all this coding stuff. Why can't I just take care of my patient? I never went to secretarial school. Am I being unreasonable? Should I just suck it up and accept that computerization increases my workload? If I didn't love computers, I wouldn't be playing with the net all evening and posting on this site. But my job is hands-on nursing. What should I expect to be responsible for in the way of paperwork?

If you went back to the 19th century, when women actually wore those 'victoria's secret' camisoles and petticoats, most of the body was not considered available for public viewing and judgment. as it became acceptable to uncover the body, prudery took another form-- declaring that the natural woman's body is obscene unless it's shaved, liposuctioned, whatever. now it is such a radical thing to say that i think i'm fine just as nature made me, that I hardly dare to say it-- fearing I'll be called ugly and perverse. but there's only one man I allow to get that close to me, and as long as we are happy I don't need to please anyone else. and of course, I keep my clothes on when in public. Absolutely women should do as they please, and shave if they like. but in our culture, to not shave is an offense to the current standard of femininity.

Well, I'm a child of the sixties (meaning I'm kind of old now). In my day they said that facial hair on men was disgusting and unhygienic, but I like it when my husband grows a beard. It looks good on him. I never wasted time with guys like the 'dude' who is so disgusted with a natural woman's body. If body hair turns you off, then do avoid getting close to people who forget to shave it or pull it out. But try to be tolerant of people who let well enough alone.

Personal style is not trivial, it's how we present ourselves to the world, and small things can matter a lot. I don't like the shaved mons style, but how would I ever know in a normal acquaintance? Too much perfume, or wearing plaids with polka dots gets into the public space. However, if you decide not to shave you are going against the current feminine ideal that says you are ugly unless you shave, deodorize, starve and paint yourself. One commenter here said 'a dude' would jump out of bed if the woman had a 'jungle'. I worry that our concept of female beauty is narrow, prudish and overly influenced by Barbie. Men are starting to get kind of weird too. We're nurses and we see a lot of people. If we can see the beauty in ourselves and others, without prejudice, and have the freedom to like ourselves as we are then it won't matter what we shave. So if women are doing this for personal expression that's fine, but if they feel like their natural body is ugly that's very draining to self-esteem. But it will sell a lot of razors.

I'm going to be very counter-culture and say that we are beautiful just as nature made us. But then, I'm an old hippie. I work in geriatrics, and losing your hair is a symptom of aging. I'm not happy about aging but you have to consider the alternative. I think this fear of secondary sex characteristics is more about prudishness than fashion-- on the other hand, I'll defend anyone's right to do whatever they want with their body hair, I'm not the hair police.

A local writer described it this way-- men have a unit, women have an area.

Of course it's their business, but I'd never want a razor near my personal area.

i just used mesalt for the first time on a patient and she says it stings very much. that makes sense since it's salt. she's going to make sure to take pain med before the next dsg change, but i would like to hear if anyone has a way to make it less painful.

loved it. i've been doing home health for two years and you confirm a lot of what i've found. especially the part about keeping flexible.

I had a patient in long-term care who had a rash that wouldn't go away. It turned out that she had undiagnosed diabetes, and when she was treated for that the rash cleared up. They should have checked for that in the hospital, but is there any chance that your patient has high blood sugar?