Lacie

I currently work FT for Senior Bridge (not under other agency contracts as some others have mentioned) and have for 2 years now. Senior Bridge occasionally contracts with an agency if for some reason we are down on staff. If FT then it is a salaried position. PRN's are paid by visit. I will say my salary is more then I ever made in HHC. Pay is good. Mileage if 51 cents/mile. Senior Bridge is actually owned by Humana whom bought us out June 2012. We only handle Humana clients (PPO and Medicare Advantage programs). We have been in the merging process for abit now. Generally the case load is expected to be a minimum of 25 clients with weekly visits for FT (5 - 6 clients/day). There are many times I have had up to 35 or more dependent on the staffing situation. No on hands, but primarily educating client's on Disease Managment, community resources, med reconcilation. My area does Long Term In Home and 30 day Transitions. I love the Transitions program most of all. I have a great director and have had no issues with the job in my 2 years and actually quite satisfied. Been an RN for over 30 years and probably at my happiest with this job (other then when I was younger and could do the running in the ICU). I will say you must have good time management skills or this isnt the job for you. My office is the center for the entire state. It's not a 9 - 5 and if case load is high then you may spend nights catching up charting. Then there are times when I may be done early afternoon and relax abit. We are provided with a Blackberry and some of us are fortunate to have Ipads supplied as we are entirely computerized. They anticipate everyone to have an Ipad after 1st of year. On-call is also part of the job but I have yet to go out when on call over my 2 years with the company. I will say the on call pay is $225/week just to answer the phone, so don't mind it at all. I have gone without a single call when on call many times. It can be flexible if you have a doctor's appt or other personal things if not excessive without having to use your PTO. Some areas have long drives to clients homes depending on thier area. Fortunately I have localized cases usually within 20 min of each other.

We've already implemented it and so far seems to be doing ok. Some tweaks needed of course. Marketer has one form they must get and if they individual hasnt been seen then we make the appt for them in the home on the SOC with our form. Also ensuring that the physician is going to sign our orders. Both are turned in at SOC and also have been placed on our oasis and 485 software in the office. I'm having more issues getting the doctors to have signed Lab requistions/orders for the labs new requirement with they must have the doctors actual signature on them. This one has finally been postponed for a little while.

My office is all paper also. I place on the facesheet who I am assigning for PT/OT, the CM RN name, along with any other ancillary services they may be getting. I either fax or put in the nurses box copy of the IE from PT/OT. I keep my calenders well documented and expect the nurses and the PT/OT to communicate with each other routinely. Also they each document frequencies and progress in the home folder. That's the first thing that is looked at when they enter the homes. I keep a skeleton file on all patients for important documentation or problems such as lost orders or improper filing. All paperwork/DVR's are brought in 3 times a week (MWF) and logged when recieved. No paperwork, no pay until they do. We also have weekly case conference as a team for at least 1 hour.

Recent Federal Background check for your job maybe? I know mine is coming up 2011. I have never been asked about my military service with exception on a job application if I ever served. Unless there were criminal charges either civilian or military it shouldnt be an issue nor do you need to notifiy boards unless the military now decides to take legal action of some sort (unlikely). I have never had to submit my DD214 except if I was applying for a job that provided Veterans Preference. This is not to say your employer may not look to see if you answered in reference to your service on your initial application for employment and it wasnt disclosed. Then it's your employers decision to keep you or not.

I left dialysis to return to clinical areas and found it was very difficult (at least in my area). Most of the hospitals didnt consider dialysis as "bed-side" experience therefore wouldnt even consider an interview. Although I have almost 30 years experience previously in open-heart, burn ICU, and other critical care areas for over 25 of those years. I ended up securing a position in Home Health Care as a Clinical Manager. In all honest it has turned out to be the best decision in the long run. I love it!! Not that it doesnt have it's issues as with any job but much easier on my body/mental stess. I get to go home at 5 with no nights/weekends, except for a week of call here and there. I work 7.5 hr days M-F :)

My agency pays .41 cents/mile so consider yourself fortunate:rolleyes:

We had a Ledger as you suggested and wrote out daily any abnormalities, changes or specifics related to any pt that was out of just the routine daily "conveyor belt" tradition lol. Problem usually is having time to do it as most chronic dialysis units are on such a tight schedule to get patients in, on and out for the next turn over to go on. Staffing is usually the biggest issue you find primarily retention of experienced RN staff. I finally left working dialysis (was a DON/FA) not long ago for these very reasons. Guess after so many years in critical care I just couldnt get that tunnel vision to just run them through like cattle without looking at the whole picture.

Workers comp case management companies; home health case management, check also as previously mentioned research nursing such as Covance and others in your area.

If it's the first time I have seen a pt I usually inquire who and how they have been doing a particular procedure - first to determine what they already know and if being done properly by the caregiver. If I see teaching is needed then that's where I start off with "there are other ways to do things that are just as appropriate and I can show you and then you decide which way is easier for you and more comfortable for the patient. After all it is the PATIENT that is the priorty not the family members opinion or what's just the quickest or easiest way to do something for thier convenience. Yes you have to be thick skinned and like someone else stated "after 30 years" like me I'd rather remember the good stuff and put the nasty ones way behind me lol. (ewww the thoughts of some of those nasty ones in the past puts chills down my spine lol) After open hearts, trauma and burns and worse of all chronic dialysis think I can handle about anything they throw at me unless it's something out of an adult diaper (this has happened too) I'm fine lol.

Just for the every day stuff I sign my name and RN but with official reports or 485's (medicare stuff lol) I sign with my BSN. I also sign my BSN with any chart or legal reviews I do. I'm old school and did the generic BSN so worked my tail off for it with my son 3 years old when I graduated. I earned it I'll use it but I dont abuse it. They didnt have Online programs when I did mine, I actually had to go to classes, didnt have computers in class, or blackberries to use lol. Just good old handwriting and listening. So yes I use my BSN after official signature. One of my other CLM's is a non practicing ARNP yet signs all her work with her title also. Every where I have worked until my current position always put the BSN after my name, RN, BSN on my name tag also.

Wow, we have a 9-10pm cut off for all visits.......if later than that they go to ER if needed. We dont allow our nurses out after 10pm at latest, even the on-call. If we get a pt who needs it that frequently and it's medicare well it's out of pocket for the meds usually but if the local hospital has an Infusion Unit that's what I arrange for them. We dont accept them for that frequent infusion orders.

And your right. The whole thing is childish and just trivial to me. I got better things to do that repeat kindergarten activities. Actually getting out into the field lowers my stress level. I am fortunate to have a great group for my team and love everyone of them. Most the stuff they as me to fax to them or do is already done as I've gotten to know them that well. I enjoy it! It's the office politics I hate and I've been in management along time. Even when I managed an open heart unit I still scheduled myself 2 paperwork days and the rest on the floor taking patients. Wouldnt ask anyone to do someting I wouldnt do myself all the way to scrubbing a floor if needed. Doesnt bother me. I have one RN who hates venipuncture or IV's so I will drive that 35 miles down to do her start if no one is available. Wouldnt take a second blink if she lets me know she needs me. So thank you. I'm old school so firm believer that you have to help take care of your staff if you want to retain good staff. It wont be me that runs them off lol.

I'm limited on supplies as they dont keep IV tubing or fluids in our supply. I have butterflys with some short tubing and venipuncture supplies such as vacutainers. That's about it. Most my patients have to pay out of pocket for anything IV if given at home since medicare doesnt cover it so when we do give it a local Pharmay delivers all the supplies directly to the home for us. I do have a couple of old Jelco's that I managed to grab before they quit ordering those in my bag since I do help my field staff with home visits when they get slammed. Plus keeps my skills up and I enjoy getting out of the office. I'm very field staff oriented rather than behind a desk so I get out there with them as much as I am permitted. Screwed my knees up pretty bad so had to leave hospital settings which I really miss. Yeah I agree, a f/c into a heart with a red ribbon was a little strange but it works for the purpose I guess. She used what creativity she may have the best she could so I gotta give her that although the rest of the time was on the internet looking at shoes for sale.

Thank you so much!! Ideas for the board is the thing they are pushing on for the moment but I'm just overwhelmed with the "mom" issue at the moment that I cant even think straight .Any ideas for the board would be great. Something quick and to the point just so I can get it out of the way. No fun being woke up 4-5 times in the middle of the night to yell at me for something I did when I was 5 lol. (Demential) She forgets it's not 1960's and lunch time is at 2am. So sleep is someting I'm learning to forget about and I'm sure many here have been in the same shoes to understand where I'm coming from. I dont have brothers/sisters or extended family to help. I'm it lol. Hiring someone I just cant afford right now with her extra bills. I responded on your private message and cant thank you enough that will help a great deal for the inservice aspect. I still may just tape up a jelco and tell them "there's my decoration" LOL. I'm generally not a smartorifice and stay quiet concentrating on my work but think they need to stay out of my way when I go in tomarrow instead of blending into the carpet as usually do lol. Generally I could knock something like this out no problem but.........you know how it goes if you've ever been in this type situation with your child, parent, friend. Again thank you!!!!

Already did that course. Didnt get me too far (reason for this post). Yep definitely have the grey hairs and ulcers on the way lol. After 30 years of being an RN think sometimes people have completely forgotten what "help" means withing the work place unless they hear a pt screaming it lol. (or team work for that matter) It's for the yearly skills checks for the field RN's and LPN's so no changing the date as I can prepare for the seminar but that stupid ******* board is the last of my priorities. Thank you Jolie :)