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 :)

HELP!! Like decorating a board for an upcoming skills fair for our field staff is on the very top of my priority list at the moment particularly since I'm behind in everything else dealing with an elderly mother with recent cervical surgery(last week) and her dementia. I'm the only child so guess who is burning the candle at both ends. I'm living on 5 hr Energy shots at this point LOL. But for some reason this "board decoration" is more important then meeting the goals of completing my files and tending to my field staffs needs to the Directors . Therefore I am in dire need of some suggestions as I am completely "brain fried" to the point I sometimes forget my own kids names LOL. Anyway I need to decorate my section as I am responsible for the IV/Venipuncture aspect of the fair. I am entirely clueless at this point as it's at the bottom of my priority list so to speak. But the top of admins LOL. So far for f/c aspect one nurse made her f/c into a heart with a ribbon. God only knows what they will do for the colostomies. If anyone has any ideas that would help me out at this point it would be a godsend!!!! I'm generally pretty creative but I've lost it some where in that brain of mine but at this point cant find it anywhere So while the other CLM are looking at Couch bags and Princess Crystal online I'm beating my brains out trying to get caught up and come up with this "decorative" board for the field staff who honestly dont have time to stick around the office to even look at it. (my team field staff live 35-40miles away one way lol). I'm burning the candle at both ends between work and caring for my mom at the moment and would appreciate any ideas so I can get my section of the board done and move on to the IMPORTANT things like patients lol. It needs completed mid of this week considering I was just told about it Friday - that's home health for ya lol. I had to cancel going into th field this week as I tend to do to help out my field staff over this as it is (I love to go in the field, so disappointed there )

Fulltimes can say no with my office if they hit thier units for the week. They are not required to take on the extra unless they agree to do so. Then I have to find who is short on units on another team to cover and IF they will accept it. If you are short on units and say no then we have an issue. I usually do the call (yeah I know managers dont do them generally) if I can rather than hear all the BS that follows. Sometimes you learn to pick your battles and that's one I dont like to hear too often lol. Our Clinical Director does alot of them herself particularly on the weekends which was a real shocker to me to discover. Not many Directors volunteer thierselves like that almost every weekend to help out the on-call nurse but she does.

If pt out of town we DC. What if he needs care while out of town? Then what. We D/C then readmit on return. Yes sometimes homebound patients will go to family homes for a week or so to tie up loose ends most of the time. But we never put anyone on a "hold" status. If vacation or a cruise definitely DC and we dont readmit unless they are definitely homebound

Consider with lupas there are times it cost more in the long run for the company as by the time they pay the disciplines that did manage to get in the door and the processing, etc that goes with it. They may make a little bit in the end but they still have to pay out. Nurse and pt goes to home makes a visit, pt after 2 visits doesnt want any more care - believe me the company has already paid out more than they will be reimbursed after all the other budgetary cost are considered all the way down to paper cost. Pretty simple - very low profit and most HHC are Profit making companies (heck most health care is now adays)

Ours are required if any paperwork it must be turned in on a daily basis. Case Conference meetings are done with everyone weekly up until this summer then we moved to every 2 weeks and probably staying at that from now on. Fortunately my nurses communicate with me frequently about thier patients anyway. Some of mine have a 40min drive one way so I always tell them try to knock out a visit first then come so they can claim thier mileage at least for to/from office.

Initially we tend to go on auto that the cramps are related to fluid removal which in most cases it is. Also to consider is other issues such as CA+ levels, etc. I'll never forget a pt that one of the techs were loading up on the saline only to find out the SNF didnt give him his insulin and his b/p was off the chain on top of that, but here was this LPN hand squeezing NS into the pt because "he didnt feel good" (ACCCCKKKKK) and I am of the school of thought if it can be prevented do it! Treat the cause not just the symptoms. My last facility utilized hypertonic saline which did help most of the time for those who where really overloaded and we needed to challenge them. Look at the whole picture it isnt always "taking off too much fluid". There is an over the counter leg cramp medication(natural of which my Nephro checked and had no issues with) that has quinine in it many of my patients swore by. I believe they found it at Walmart and Walgreens. Another suggestion I've heard my docs tell pts is to drink the quinine water prior to dialysis if not on a very retrictive fluid intake (most do what they want anyway lol). Sometimes I just shut it down for 10-15 min then restart at a lower UF as it could be as simple as it's just pulling it faster than they can tolerate at the time. Look at the pt as a whole and as an individual. I have seen way too many dialysis nurses and PCT's that get such "tunnel" vision that they think giving saline is the solution to everything and think of nothing else but the dialysis aspect!!! Yes we are giving dialysis but it's generally other health issues that resulted in thier renal failure that placed them on dialysis in the first place. We need to see the patient as a whole not just the kidney.

Well said Deebles, I agree and this is after 30 years of it lol.

earlier I mentioned my oldest son loosing 2 of his dearest friends and he still rides. Like others have mentioned you have just as much chance of losing your life other than a motorcycle. My youngest son hadnt had his drivers license 2 months before a 91 year old woman not using the cross walk on a 6 lane highway darted dead out in front of his car at 9pm in the night. She didnt survive of course. Heck her scalp was still in the windshield when impound let me have the car to bring him (automatically impound anytime severe bodily injury at your own cost also) Nice reminder for my son trying to recover (Thanks DPD). It was ruled pedestrian fault and my son was cleared of all responsiblity thanks to many witnesses at the scene. But that was 3 years ago and to this day if he sees someone facing the street and appears they may dart out or try to cross it puts him in cold sweats. It took my months to get him back into car that I sold the car and we helped him buy another. When it comes to the road you dont have to be on a bike to lose your life. It's something he will have to live with for the rest of his life and he knows he wasnt at fault but still feels "I took a life"...........Little differenct but not much difference in the principle - I wont let fear keep me away from anything I love and enjoy. But of course I surf and bungee jump too lol. Sometimes there are those of us that love the feeling that taking abit of risk gives. I'm one of them I guess.

As others have said a hard lesson learned. But in the future if anything like it should happen again. Believe me it will, it may not be the same exact situation but crap happens. I always immediately called the charge and my immediate sup soon as I discovered my error and made it well known. It may have saved you a lot of headache if you had approached it immediately. I have gone as far as driving right back to the unit to in the middle of the night to return what ever I had forgotten. I long ago had to really work at teaching myself never to put anything to do with meds in my pocket for any reason. Narc keys too lol.

I have always been a staff oriented manager and wouldnt ask anyone to do something I wouldnt do myself. I also have not only the field nurses but manage the PT/OT for my team as we dont have a rehab manager. If they have only one ultrasound or anodyne and it needs to go from one end of the county to the other - I'll take it between them in my vehicle. I also give a small gift (this week it was a bottle of wine) to who I felt did something exceptional or had thier paperwork/DVR's in on time, and a $5.00 gift card to the local 7-11's when on the road to stop and grab a drink or coffee. Something to show I appreciate everything they do also. In turn they go out of thier way to help me when I need it. I dont understand how it can be so painful for some to just say "thank you" now and then at least to the staff. They deserve it. My last job which I quit last year for X-mas I bought all the gals(8) new purses that I thought fit thier personality, a jar of the burt's bee's body butter, lip protector, gold bond hand lotion and a basket of goodies. Believe me I am a great bargain shopper for the good stuff and hit ebay alot too lol. I always looked at it this way "Anyone can be a manager, but not just anybody can be a Leader". I like to be a leader and a good one that retains her staff! Next weekend we've managed to get us all together for me to treat them to dinner with the main rule of "NO WORK TALK" just fun lol. I already volunteered to do take the week call for this X-mas so others could be with thier families. My kids are grown and I'm single (yet happy) so it's not a big deal. I'd rather have New Year's myself off anyway lol.