PCUSheryl

Thanks for your replies! I didn't mean to whine, just really curious how my workload compares to others'. I just remembered a few more of my responsibilities: *intake on some patients, approx 1/3 of all new referrals, this means entering all demographic info on new referrals prior to admit/scheduling, including looking up physician addresses, phone numbers, NPI, license and UPIN numbers and entering this info into the computer. *insurance pre-authorization prior to admit and recert or when we need more visits authorized for whatever reason(we have a lot of patients with private insurance). *writing all orders for my patient load (this is standard for all home health nurses, tho, right>) Thanks again--Sheryl

The agency I work for now requires a discharge summary for every discharged patient, even tho every 485 states we will send discharge summary upon request. The agency I worked for previously didn't require a dc summary unless requested by the Dr, which was extremely rare.

I'm an RN who has been working in home health for more than 3 years. I started out in the field, then moved to QA, then DON. I excelled at my job in the past, was always praised for good productivity, good patient care, good relationships with coworkers, good leadership skills. I needed to changed jobs d/t a change in my husband's schedule and needing to pick my son up from school. So, I recently (in September) moved to a smaller agency after a nurse friend gave it a very high recommendation, and after interviewing with the administrator who assured me she would be flexible to allow me to pick up my son, and attend school functions or family needs when necessary. I was told the software they used was extremely easy to learn and use, and cuts down on workload. Well, for about a month, everything was going great. I was able to finish all my work within 24 hrs without much stress. But then the DON left to have surgery on her neck. My workload suddenly got bigger, and it seems even a small change in workload meant a large difference in my ability to keep up. I got a little bit behind, then a lot behind. Here is a list of the responsibilities I have with this new agency: 1. seeing all Oasis visits for my patient caseload, which is approximately 20 pts 2. I also do approximately 95% of routine visits, and all aid sup visits--for my patient caseload 3. I do all scheduling for all patients in my caseload, rescheduling, changes in schedule, scheduling aide visits 4. I do all follow-up phone calls to physicians, DMEs, and any and all coordination of care communication for my patients 5. fax labwork to physicians for my patients 6. do chart audits on every patient every 60 days when i recert 7. send and make all referrals for my patient caseload, such as MSW, PT, OT, ST, etc 8. backup receptionist duty when in the office, and the usual receptionist doesn't arrive until after 9 am every morning, often after 10, so i am not able to catch up on documentation or focus on my own work in the morning before leaving office to see patients d/t answering the calls and following up on them 9. Attending case conference weekly, for approx an hour. I'm sure there is more that I can't think of at the moment. But I am not used to doing all of this. At the previous agency, I only did Oasis and aide sup visits, no routine visits and did my documentation, coordination of care, referrals. And I was plenty busy of course. It just seems that all the extra duties overwhelm me since my workload increased after the DON took leave for surgery. I am getting some gentle pressure from the administrator to catch up, but was told that if I work more than 40 hrs a week, I will only be paid straight time (no OT), UNLESS I am oncall on the weekend, they only pay OT when you are oncall. I am paid hourly, not salary. So I do not want to work late every evening, not see my family, etc for straight time. It's not worth it. I don't even think it's legal. I have refused to work OT hours so far because of this, but plan to work alot over the new year's holiday weekend, because I am oncall and will be paid OT. None of the other RNs seem to be as far behind as me, but they are willing to work late for straight pay or take their work home with them. I've said all this to ask all of you these questions: 1. Is this workload comparable to other agencies? And if so, how well are you all keeping up with it? 2. Does anyone else have similar amount of responsibilities? (scheduling, audits, etc) 3. Does anyone else work for an agency that won't pay OT when you are paid hourly? (I could understand if I was salaried, but I'm not) I appreciate any comments, and thanks for listening. Sheryl

From what I've read and heard, HCG increases fat loss, making it a useful adjunct to diet and exercise programs. I've known many women who've done the injections with good results, and none have described any side-effects at all. The dosage may be higher for fertility purposes, perhaps? http://www.hcgobesity.org/hcg_obesity_opinions.htm http://hcgobesity.org/hcg1.htm There is lots of info on the net about hcg-- some positive, but mostly negative it seems.

Hi! Has anyone had HCG/B12 injections for weight loss? And if so, have you had any complications from it? One of the adverse reactions is hyperstimulation of the ovaries, ovarian cyst, and rupture of a cyst. Or have you taken care of a patient who's had any of these type complications from HCG injections?? I'm considering having them, as I've heard several people say their weight loss was significantly faster than dieting alone. Any comments are appreciated. Thanks in advance! Sheryl

I remember thinking the same things about nurses when I was in clinicals. At lunch all the student nurses would gather and talk about each of their preceptors. There were lots of negative things said. And I actually remember feeling that way about certain nurses my first year as a new nurse. But the longer you're a nurse, the more you will realize that generally when a nurse is acting in a manner not so friendly or not as patient as is desired, then either A) They're not a friendly or patient person, or B) They are overwhelmed with things to do and not enough time to do it. Usually B. is the case. I have more compassion and patience for nurses now than when I was a new nurse. One day, you'll be that nurse who is juggling 20 things in her head (and hands), dealing with disgruntled patients and families, trying to please them, dealing with doctors that can be demanding on good days and downright mean and cruel on others, critically thinking about the pathophysiology of all of your patients, answering call lights, trying to check off that checklist of things that must be done before 2pm (or whenever) like checking blood sugars, giving all meds at correct times, doing chart audits, carrying out all orders written on your shift, etc. I could go on and on. And you will understand what it feels like when that bright and well-meaning student asks for your help politely and you are all the while wanting to be able to teach them, monitor and supervise them, and feeling helpless, because you have 5 other things that REALLY ARE more of a priority at that moment. You will one day understand that the ability to complete all those tasks and and maintain a positive and pleasant attitude at least 90% of the time is a learned skill, but it's only for the ones who are determined to rise above and be that strong and confident nurse that is so in need! Before you become that nurse, you most certainly will fail at times. Hopefully you'll learn from your mistakes. Who knows, that nurse or nurses who, (I won't repeat that horrid phrase) were not pleased to have you on their unit, may have been on their 3rd or 4th 12-hr shift and having a terrible day. Or who knows what may be going on at home? To encourage you, I think generally most nurses know how badly we need more nurses and desire to be good preceptors and mentor and teach new nurses. We want to encourage you, prepare you, because we need you. If you come across a nurse with a bad attitude every now and then, don't take it personally. Don't let it discourage you, and determine that you're not going to act like that when you're in their position. I hope this helps.

Has anyone heard of or experienced a patient dying after being turned on their left side? Some more experienced nurses were joking once about it, swearing it was true. And actually it happened to me once, a patient who was very ill, in the dying process, and I was turning her q 2 hrs, she died shortly after I turned her to her left side. I've heard it's harder for the heart to work in that position, and one that's very weak and on it's way out can't hold up to it sometimes. Anyone every experienced this?

Sometimes hyperthyroidism can cause ventricular arrhythmias, too. Maybe other hormones can play a part as well.

Could be potassium or magnesium imbalance; something is causing irritability of the heart muscle, could be CHF, cardiomyopathy, diseased heart valve. To treat, find the root cause and fix it if possible; If not symptomatic, no cause of alarm, just fix the problem. If symptomatic, apply O2, examine rhythm, rate, etc. If rate is too fast, give beta-blockers, and continue to dx root cause and reverse it.

I forgot some things: During the weekdays, I usually am scheduled to see anywhere from 2-5 pts per day. Although if it's 5, they're usually maybe only a recert and the rest routine/aide sup visits. On days when it's 2 visits, usually both are Oasis, but not necessarily, sometimes it's 1 Oasis and an aid sup. It's not too bad in my opinion. The area we cover is within a 50-60 mi radius of the office. Those days when I have to see someone 50 miles away, the scheduler gives us fewer visits. My daily mileage is anywhere from 30-140 miles (a heavy day). Although usually around 60-80 miles. A typical day is I call my patients for the day, then finish up Oasis/charts until around noon. Eat a quick lunch at my desk, then go see pts. Usually finish up between 4:00 and 5:30. All in all, I am feeling good about my job most of the time.

From reading the posts in this thread, I can see there are so many differences in home health agencies! Just thought I'd log in how it's done where I work. Full-time RN's are paid salaried, depending on experience, and according to a grid. I had been a nurse for 2.5 years when I came to work here, so relatively new nurse with no HH experience, my pay was the same as in the hospital. I am satisfied with that. Although, actually took a large cut in vacation time. The hospital paid over 4 weeks per yr in PTO that accrued every pay period. Here, it's a little more than 2 weeks PTO. I'm on call every 5-6 wks on weekends only. There's an RN who takes call every weeknight for us (LOVE it!). So we're paid $50 per day when on call, plus per visit for any visits. Any Oasis visit is $65, that includes DC and RC! Routine visits are $35. And then mileage is $0.395/mi. On weekends, there's an RN and LVN on call. LVN's do all the routine visits unless she can't for some reason, then the RN does it. It's only happened to me 1x in 7 months. The only thing is when you're on call, you can just expect to be working. I have 4 Oasis to do this weekend. I can do them all today or spread them out over 2 days. Also, one of the visits is a "pre-assessment", not even an Oasis, just someone who is not happy with their current HH and wanting to talk to an RN about our agency, and be assessed. I am paid $65 for this visit, which probably won't take an hour to do. Right now, we are one RN short, and so we're working pretty hard, it's a challenging pace, although, it's not anything close to the stress and fast pace of the hospital. The agency is flexible with the nurse to a certain degree, as much as they can afford to be. I am pretty happy where I'm at. I hope it stays this way! Well, I hope that my post shows you that there are some good agencies out there, just keep looking.

The Oasis is not just a typical assessment, some of the questions are easy to misunderstand if you're in a hurry. And it is very important for the SOC nurse to assess accurately for several reasons. We are eventually going to be paid by our outcomes, and if SOC assessment is off, then it messes up the outcomes at discharge/recert. I can definitely see a need for the QA nurse to be "anal" about how the Oasis is filled out, but the policy should be that she also signs the 485 if we are not given a chance to review it before it's locked. I think I'll have a talk with the Director about this.

The Oasis is not just a typical assessment, some of the questions are easy to misunderstand if you're in a hurry. And it is very important for the SOC nurse to assess accurately for several reasons. We are eventually going to be paid by our outcomes, and if SOC assessment is off, then it messes up the outcomes at discharge/recert. I can definitely see a need for the QA nurse to be "anal" about how the Oasis is filled out, but the policy should be that she also signs the 485 if we are not given a chance to review it before it's locked. I think I'll have a talk with the Director about this.

Thanks for all the replies! I think the thing that makes me feel uncomfortable is that the QA nurse is not asking me to change my answers, but she changes them herself, and then I don't get to see the 485 again until after it's been sent to the MD and to Medicare. So I am signing something that is not completely "mine". Another nurse has changed my answers and her name isn't on the 485. So if there ever was a problem from MEdicare's viewpoint, who will be held responsible? Me--I'm sure the agency will be, as well. Would that make ANYONE else uncomfortable? Or am I just worrying for nothing? I completely understand needing to change answers sometimes to get the best reimbursement that we can get. I have been educated about the Oasis, and we are educated on an ongoing basis at my agency. My knowledge of how to fill out complete the Oasis is not the issue.

NRSKarenRN- Thanks for the good info and the links. That helps me alot. The agency I work for is really pushing for PT and OT right now. They want EVERYBODY to have one or the other, preferably both. We have to document why the pt did not get one of them if their scores say they qualify, I mean give a detailed description of why they aren't getting it. And it's not because they want to help the pt. They want to help the corporate pocketbooks. I can understand to a certain extent. Everyone likes getting paid, and getting bonuses -- from the least in the company to the greatest. But it makes me feel like a used car salesman....they've given us a script to help us talk the pt's into therapy. They don't want us to take 1 "no" as an answer, tjhey want us to apply a little pressure. At this point, I no longer feel like a nurse, I am no longer an advocate for the pt. I just don't like it. Thanks everyone for your responses....I had a feeling I wasn't the only one facing these kinds of issues.

I'm wondering if I will be covered if Medicare decides to audit and finds a discrepancy on one of "my" 485's? Our computer system will show who put what data in and when, etc. But will Medicare give a darn about what's in our computer system, or simply what is on the 485? Is that a legitimate concern, or am I worrying for nothing?

Hi, I've only been doing HH for 5 months now, and no one else at my agency seems to have a problem with this... The field RN's complete the oasis, but cannot lock it, (we're almost completely computerized now). The QA nurse changes the answers as she sees fit, mainly MO questions, in order to get more $$$. In the computer system, the changes are automatically signed by her, because of her login, etc... and computer signature is required. However, when the 485 is sent, it has the field RN's name on it and she is required to sign it. The QA nurse does not sign it, and her name is not on it anywhere. Changes are not sent to the field RN to review and authorize. Does this sound right? I feel very uneasy about this, but the fact that none of the other RN's mention it at all surprises me. Is there something I don't know? Anyone have any comments or suggestions?

I have been in HH for only 5 months now. The agency supposedly requires RN's to have 24 points per week. 3points for SOC's, 2 points for recerts and F/U's, 1 point for routine visits. Most of the RN's only make that the quota 1-2 weeks out of the month. We keep hearing: "i can't believe they're (corporate) not making us get rid of an RN, because ya'll are not working enough." I see anywhere from 12-18 pts a week, sometimes more, sometimes less, depending on whether i'm on call. I feel like it's pretty sweet-- although there are times when we can't keep up with the pace. Although, I've found that for every SOC, I need a minimum of 45min in the office to complete the care plan, referrals, MD calls, etc. How does that compare to other agencies/nurses? Please reply.

After reading these posts, I'm feeling a little worried, because I have been crushing KDur for one of my patients recently who is on aspiration precautions, can swallow smaller pills, but cannot swallow the KDur, even broken in half. The form we have for 20meq is a large white oval shaped pill, scored down the middle, easily broken, very easily crushed. When I crush it, I cannot see any "microcapsules" - the pill seems to crushe completely, I mix it with applesauce. I have never been told not to crush this particular pill. We never see the package inserts for most of the meds we dispense. If there is uncertainty, we look it up in our nurse drug guides or call pharmacy. Does this pill I've been crushing sound like the same ones you all are saying should not be crushed? We also give a 10meq that is a capsule with obvious microcapsules, this med is well known as extended release. I am so concerned about this patient now, he's been doing this for awhile now. I am not the only nurse administering it this way, all of his nurses do it. Could we all be so ignorant? I was never taught not to crush "potassium" in nursing school. I was taught not to crush enteric coated or extended release pills. I didn't know that this form of potassium was extended release, because it doesn't have a coating or in a capsule. In response to the previous poster who wrote "how do these idiots make it through nursing school?": I thought this was a forum for open discussion and support, not a place to be ridiculed. And I'm glad that you're so perfect, you've never made a mistake.

Clarification: I only stick the patient 2 times most of the time, 3 times when there is a shortage of nurses who are available to try. I have never stuck any patient 6-9 times. I meant that the patient ends up being stuck that many times, although even that many times is rare. But it DOES happen, and it's terrible for the patient. I think there should be a policy that if a patient is stuck more than "X" number of times, we should seek a consult for PICC or central placement. That's something I can suggest at our next practice council meeting. Thanks for all the good advice, keep it coming! Sheryl

I have been a nurse for 2 years and work in a stepdown unit. Most of my patients are elderly, have chronic diseases like CHF, CAD, DM, COPD. Many of them have had numerous hospitalizations for exacerbations of these diseases. They are usually what we call a "hard stick" and several IV start attempts are necessary. Sometimes 6-9 attempts! I feel so sorry for these people, and I feel sorry for the nurses too. It seems that nearly half the time I try to start an IV, I fail, and I wonder sometimes if it's me or their bad veins. I take into consideration their age, the condition of their veins (most of the time they are small, rolling, or hard, or they have so much edema on their arms, it's difficult to see the veins or reach them), etc. I guess it's another issue that we deal with all the time, this one causes my stress level to rise, because I feel bad for the patient, don't want to hurt them, and inevitably do because they've been stuck too many times, and they feel bad anyway! It's also a confidence-stealer for me. I like to walk out of their room feeling confident because I have skillfully and professionally started the IV after only one attempt, with minimal pain. But 75% of the time, that's not the way it turns out. I guess I'm wondering if anyone else working with similar patients is having similar problems with IV starts. Do I need some more education or training on IV's? (My gosh, I have done so many, and I've watched probably hundreds) Any and all honest suggestions are welcome. Thanks, PCUSheryl

It is so GOOD to see that I'm not the only nurse who's having a tough time dealing with these family members. Why do they so many times assume that we are hellbent on neglecting, abusing or at least determined to give poor care to their family member, the patient? I don't understand this. Why not just as easily assume that we're going to give good care? This happens so many times, I don't understand it. I meet the family member for the first time (who has been in the pt's room all of 5 minutes), and they have an attitude with me, they are on the defensive, they are on the offensive, and the whole time I'm wondering "why are they behaving this way towards me....", I'm then trying my best not to be offended and to respond in such a way that they will not be able to tell that i'm offended. It takes so much mental energy to deal with these situations all day long. And has anyone noticed a recent increase in the number of uneducated, unlicensed, but EXPERT nurses, and even physicians out there? These family members think they know so much more than you, they need to tell you what to do, when and how. I'm really tired of putting up with them. It's so hard not to tell them off sometimes. I want to ask them how they could be so arrogant as to think that they know more about nursing/healthcare than someone who has sacrificed 5 yrs of her life to study, and then has been immersed in patient care, nursing, studying on a regular basis, always seeking to improve skills and build knowledge. I'm not talking about the family member who has genuine concerns. I'm talking about the family members who are complete and total control freaks and think that things need to line up with their perception of how things should be. Their perception not actually having anything to do with REALITY. Nursing is a sacrifice, I cannot believe that some people actually do it for money. We don't make enough money to do what we do! Now that I've vented a little.....now i'd like to know if anyone else can give me some advice on how to deal with people like this without becoming upset. I work on a very busy stepdown unit and most of our patients are very acutely ill with one foot in ICU (so to speak), yet we have 4-6 patients who are all telemetry, many are on cardiac drips. When I encounter a family member who gives me attitude for no good reason, I have recently found it harder for me to control my feelings, although I have controlled my actions just fine. AFter the negative interactions, I have usually either gone to the bathroom and cried or prayed, usually both. I have been feeling like I want to leave nursing, or maybe just go to a different type of nursing, such as recovery, surgery or something where the family members are not around. Any suggestions?