Abbies

I forgot to add, that when I worked at a facility with computerized systems, the nurse could go into the orders and make time changes there.

A nurse can change med times if they are not ordered at a specific time. I draw a line through the time and initial and date & note "time changed," write in the new time/s and make a copy for medical records so they can print out the correct times the following month. For example if the order is for a BP med BID it can be given at: 0700 & 1900, or 0800 & 2000 or 0900 & 2100. You can move daily supplements , bowel care, etc. to different times as well. Ideally your patient care manager should be able to go through their patients' MARs & and spread the med passes out better. Just saying... sometimes you have to be the one to make the change. The grass may look greener on the other side but often it is only the distance from where you are viewing it that makes it appear so. (Loose quote, something like that.) I haven't worked anywhere yet where I could get my work done, take breaks, eat, drink and empty my bladder all in the confines of my 8 hours shift.

5 routine or 2 starts on a good day

edit: it could also be because there are a lot of cna's who run around whining all day about nurses and how cna's work harder and yadda yadda. i've seen that. cna's bouncing between rooms while the lpn is working at the nurses station and the cna is convinced the nurse is just a lazy sob and she should be fired! that cna clearly has no idea what it is to be a nurse. i think people are just focusing on that and assuming that is the case instead of giving me facts based on the information i gave. it's kinda like nclex- they need to answer based on the information given. instead, everyones just been adding to the scenerio because i must be wrong because i must have no clue. lol. if they don't feel comfortable with admiting to the fact that there could be a lazy nurse out there taking advantage of an alzheimers unit then they should answer the question hypothetically instead of just telling me how i probably have no clue. :eek:hypothetically or not, from either perspective you should not remove a dressing or unna boot from a patient. you could cause harm and you would not want that. report what you see to your nurse. if nothing has been done by the end of the shift, be sure to mention it in your report to the oncoming shift so the patient will get the needed care. it is about the patient. it is your job to keep the nurse informed about the patient. if you feel the nurse is ignoring your reports and you have serious concerns then you should give your reports to her in writing. put the date, time, and the problem and sign it and give copies to her supervisor. i would suggest discussing the situation with the nurse first before coming to any conclusions. there may be a very good reason why the dressing or unna boot was not removed in the first place. you may feel you know better but unless you have that conversation with the nurse, you really don't know for sure... and yes, i have seen many lazy employees.

Our office staff sends out continuation orders the same day they received the signed referral for eval. and treat. We usually have revisit orders back within 1 to 2 days. If we need to revisit on day 2 we must have a VO from the doctor. We cannot touch a client with saline or even a band aid without a verbal order. If I can't talk to an RN or don't get a response back after calling, my office staff will fax (or re-fax). I let the person on the other end of the phone know I can't take care of the patient until we get an order and if the doctor is occupied, they will usually stick a fax under his nose for sig and fax it back to us. Otherwise......the patient has to wait. Most docs & their staff respond quickly, it's the surgeons that I have the most trouble with because they are usually only in 1-2 days a week or must be paged during surgery for urgent matters.)

You certainly called that one. I wish the doctor had placed pt. in the hospital to begin with. Have a great weekend!

WOW, what ever happened about this? I'm pretty sure my administrator would not feel this client was appropriate for home health if that was his only treatment option.

We use a laptop with a medication validation program installed and have always had to do that and fax MD. It will be interesting to see how we elicit required response from MD. Fortunately my first client had no medication issues.

Yes, 2 SOC would be a full day but rarely are 2 starts assigned to one nurse in a day. They have always asked me first and given me the option of saying no. I know our expectations seem reasonable but when adding travel time, doctor calls, coordinating between team members, patient families/caregivers, documentation required when visiting facilities (and now our added marketing duties while in those facilities), ordering and tracking supplies, faxing, scheduling, or whatever it can be challenging. (and not to forget to keep track and code every second under the proper charge for payroll as well as keep the master schedule updated) I would have to cut way back on patient time if required to meet expectations I see from these other agencies. Or... they could always buy me a faster laptop.

We do all documentation in the home on the laptop. The clients are understanding. We are discouraged from working without documenting the actual time spent because it is important that Medicare have an accurate account of the time required for each patient. We can never hope to receive adequate compensation for our work if we under-report. It really helps to be realistic about what I can accomplish in one visit. I tend to front-load heavily and focus on priority issues, later I complete less urgent goals. It is the scheduler's duty to fit any new assignments into my schedule without overloading me or causing me to go into overtime. They really have to be aware of this now that the focus has shifted more to outcomes. I have to hustle to meet expectations: start of care 3.5 hours (which I cannot do and it has never been an issue), routine 1.5, routine with lab 2.5, evaluations 2.25, DC 2 hours. All associated tasks including travel need to be included in these time frames. No reasonable time spent outside of these expectations are questioned. We would be questioned if we did not document and record time spent on a patient.

I completed an OASIS-C discharge today and it was not hard. Tomorrow will be my first OASIS-C start of care. We were well prepared but I'm a little worried about completing it in a timely manner. Any impressions from those of you that completed one today? Do you feel you received adequate training? Abbie

The elderly patient that suffered an acute MI and was not expected to make it through the night might have wanted to say to you, if she could: "Before you and your partner :angel::angel: came into my room my old bones and joints were getting very painful from being in the same position for so long, my skin was wet and burning, and I was beginning to feel ill from the smell of urine and feces. Thank you so much for making my last hour comfortable and peaceful!....."

If you find a way discourage back biting, please let me know. It seems to be on the rise!! Abbies

I had the shot, I didn't even feel it, no SE

sounds perfectly reasonable and well organized. these basic pathways could easily be personalized for each situation.

when i don't feel like jumping up and down on mine for it's slowness or not letting me be in 4 places at once, i love it! i do most of the documentation in the home except for care planning updates and doctor's orders because they take more concentration. i like to keep a post-it note next to the scroll bar for making quick notes. if i have time between clients i'll finish up in the car. if not, i try to get it done before i leave the office that day. it isn't perfect but it is encouraging to know that our it and support staff are always working to find easier ways for us folks out in the field. it has really pulled our team together. communication, scheduling, accessing other disciplines' notes, and all the resource material at my fingertips is unbelievable. of course you must be working with a good program or it will be more frustrating than beneficial.

cmarm, thanks for sharing. I have many of the same complaints. This is the 2nd HH agency I have worked with and although their approaches are different, they have similar problems. 1. Schedules - we get payed per hour, not per patient as at your agency yet with the same result that some nurses spend minimal time with pt. and max. time with "charting/office" hours. Or, these "speedier" nurses are often assigned heavier patient loads and receive pats on the back from Admin. for doing such an "efficient" job. Ever follow a nurse that made the patient/nurse-interventions look great on paper and when you follow you find a totally different picture because you actually take the time for proper assessment and teaching? 2. Qualifying patients - Yes to your post, I have seen the same. Do the words Medicare fraud ever cross your mind? Personally, I always chart what I see and let Admin. know if I find evidence that pt. is not home bound. I would advise you to keep a personal journal to CYB. Recertification??? Did we not just spend x amount of weeks seeing client that is now stabilized in her/his condition and technically not homebound, yet Admin. instructs you to re-certify and list same problems and goals as before, or they allow personal acquaintances to remain on services, taking advantage of the system because they have the power to? What do you say or do in these situations? I'm afraid to be a whistle blower and get fired. I really love my job, it pays well, provides good benefits and is relatively low on the stress meter. 3. Poor referral information/coordination - This seems to be an inherent systems problem. Everyone is so overwhelmed and the cracks have turned to crevasses. I keep names and phone numbers handy of those contacts that get me the results I need. I am always courteous, pleasant and grateful to the people I am extracting this information from. I try not to show my frustrations but to focus on building a professional friendship with them. It doesn't solve the big problem but does make it easier to deal with. Some HH agencies will not agree to take patients until all information has been faxed to them, i.e. orders, med lists, therapy notes, chart notes for the last 24 hrs, etc. Our agency, on the other hand, says yes to all and worries about the rest later. (They compete with other smaller agencies.} 4. Office/clinical - Alas, the poor office staff, the hub center, the glue that holds it all together. Our person wears many hats, stuck at the desk all day answering the phone that never stops ringing, doing the bills, processing faxes coming in, copying and faxing the insurance companies the endless amounts of documentation they hound her about before they will consider reimbursing us, filing, maintaining the records, tracking the computer updates and troubleshooting computers and the copy machine, doing the payroll, coordinating schedules, taking referrals, ordering supplies. Oh, and did I mention: bath aide duties when one calls off sick? The "go to" person everyone filters their problems through. Our person does not even get to go out for lunch and if she does she has the phones transferred over to her cell phone so she can continue to take calls while she is out. Usually she just eats at her desk while working and tries not to spill or dribble on the records or her keyboard. She always arrives an hour early for work so she can keep up (time that she does not claim). When she indicates to me that I'm on my own, I remind myself that I do not do her job for low wages. I do call her often and she will check for orders, etc. without being rude. I think she needs a raise.

Please hold

ditto this one

so sad but all so true. when i was in management a wide sweep was made downsizing staff and when i refused to work under their new job description i was blackballed from moving to a floor position. the administrator told me that it is usually better if all of the old employees leave because the new ones won't complain about something they never knew existed. yep, my jaw hit the floor on that note. i do enjoy a change of scenery. it's true that my wages have increased much faster than other nurses but i'm tired of playing this game.

I am not your personal secretary, I am your nurse. I am not your doctor, I am your nurse. We have documented the thousand and one times you have used your call light as well as what the caregivers did for you each time and we are going to show it to your daughter so she will know what a liar you are. Your wife will be in to visit you just as soon as she finishes listening to the taped recording we made of all of the lewd remarks you have directed at the female caregivers during your stay.

Most of my employers have had a contract with occupational health and mandate that the employee receive a medical assessment for all on-the-job injuries. If minor, a non-emergency paramedic/EMT is called to the job site to assess and provide follow-up recommendations.

One of my instructors had no patience and in her irritation she would verbally put down students in front of the whole clinical group. At the end of each term it was the practice at our school for each student to meet privately with the instructor to receive a final student evaluation. At that time the students were asked to evaluate the instructor (by filling out a written form and leaving it in their in box, no need to identify who it was from) Although I was never a target for this instructor, I went out on a limb and gave her an honest evaluation of her performance face to face. I did not make any assumptions...just the facts. I presented her strengths, (she had many and had never put me down) and then the areas where I felt she could improve. She complimented me on the way I gave the feedback and said she would think about what I had said. I left feeling like I had just experienced how civilized people tell each other when they are being jerks. Fortunately, I didn't draw her again as my clinical instructor or I may have experienced how she could politely fail me if she were so inclined. :grad:

""i calmly told her that i didn't appreciate the condescending tone in which she used when speaking to me. i would appreciate it if when addressing a problem or situation with me, that she would treat me with the same respect that she wishes to be treated with. and furthermore, there is no such thing as just a cna. i resent that you would think that we are the mat under your feet, you are no better than us, you just have a nursing license. oh and by the way nurse peggy (not her real name) compassion isn't learned with an education, if it were, you would have failed."" i wish i had your gift for coming up with a good response in the moment. i usually think of something great to say after it's too late. misslo, you gave that nurse a lot to think about. there may be hope for her yet. abbie

My kid decided long ago never to become a nurse. To each his own. I can't imagine myself doing anything else.