bshaw96

I'm sorry but none of this story makes a bit of sense to me. In what world would anyone think it was possible to do 26 visits a day? I don't care who you are you know that's not possible. The story would be more believable if the nurse was claiming 12 or 13 visits a day. I could be wrong but I just don't believe any of this. JMO.

I would think that would depend on your assigned area and your time mgmt skills. I am usually off by 3pm, but as you said, that leaves lots of paperwork at night, which can also start to cause problems. But yes, hh is about the closest thing to school hours I've worked. Keep in mind there will be on call too so have a plan for that as well as days you can't be off at 3, because there are definitely many of those days. While flexible, home health is never predictable.

I have been in home health 8 years as a case manager as well as admissions nurse. I know hh inside and out. We recently adopted a child and I have applied for a Baylor position with my company. It's a salaried position (32 hours, paid for 40) with the expectation of 24 points. I've been given the option of splitting my hours over 4 days (fri-mon) or 3 days (sat-mon). I could also do a half day Friday and Monday along with Sat and Sunday. It's really flexible as long as I get close to 24 points. I want off as many weekdays as possible but also am not trying to do too much in a short time. We only get 2 points for soc ( changing soon) so that's a lot of starts in a 3 day span. Anyone experienced Baylor home health? Opinions? Oh, and no on call. Basically, I'm a weekend soc nurse.

I know. Orientation is great. And I've got the sense to stay off her bad side That's why I vent here and not to her. But honestly with 5 years hh experience all the orientation is annoying LOL. I just wanna work already!

I'm 3 weeks into orientation and annoyed. My preceptor refused to check me off on wound care BC I forgot to change my gloves 4 times during simple dressing change. Company policy. Fine. I'm not too prideful for criticism. However in same visit I watched her change a piccline dressing with no gloves touching it at the entry site and all. Yet she tells me I could have caused the lady to get an infection???????!!!!!!!!!!!

OK, maybe I misunderstood your question? I thought you were asking if diabetes made a patient automatically at risk for pressure ulcers. Not necessarily, depending on the other factors mentioned. I have admitted many patients who have diabetes as a comorbidity but that is not their chief problem, and it is well managed. We do education as needed on monitoring feet and legs daily for discolorations or open areas, etc. But if they are up and mobile and continent with good nutrition I do not consider them at risk for pressure ulcers even with diabetes. But if I admit a patient without diabetes who has suffered a CVA and is wc bound and incontinent, they are gonna be much more at risk for pressure ulcers and will need education on repositioning, incontinence care, offloading, nutrition, skin monitoring by themselves/family, etc. Most of the skin problems I have seen with my diabetics has been diabetic or stasis ulcers with poor healing. I've also had several trauma wounds because the patients had injured their feet and never felt it. One guy walked around with a nail in his foot for a week! Ouch! I hope you enjoy your new job, it can be very rewarding once you get the work/home balance worked out

I would say your diabetic patients are more at risk for diabetic ulcers, or infected/trauma type wounds, but not necessarily pressure. (Although depending on other factors, they could very well also develop pressure areas) Also, being recently hospitalized does not necessarily make you at risk for pressure ulcers. It's more about mobility, and nutritional status. Do they require alot of assist to move or shift position? Or they in one position frequently? Or they incontinent? Does their equipment properly fit (wheelchairs/casts/etc.). There are so many factors, and congrats on getting comfortable with the admits. I just left a job where i was the oasis/admissions nurse. Tough and lots of paperwork, uggghhhh!!!

The first time I sent her to the ER it was supposed to be for a flow study. They never did it, and the IV nurse just accessed it and sent her back. I was in the process (today actually) of calling to get the orders to have her set up for outpatient q Friday when I got the notorious email. Pretty much trying to tell me I had to keep trying. That's alright, because I know my patient, and she's gonna request to have it done at the hospital and that will be that. I just hate seeing the greedy side of healthcare although I Know it exists.

I have only been in HH since February, and genuinely love it. Although recently, I'm starting to see things I don't like. Here's the problem. I have posted before about trouble accessing one of my patient's ports. It has tilted and migrated. She is on IV's at home and the needle is changed weekly. Anyway, I attempted x 2 on admit, and couldn't get it. Sent her to ER, and IV team got it. The next week, I tried x 2 again, same problem. The next day, they sent another nurse to try, one who had worked IV's for 12 years. He couldn't get it either. Back to ER she goes. I had discussed this with my clinical manager and we'd decided to simply have her scheduled to go to outpatient every week t o have it changed as it was not fair to patient to keep trying when we clearly couldn't get it. No problem. Well, today I get an email from the same manager stating she spoke with her manager and we need to at least try every week. States if no success, send to ER. Why? So the visit will be billable! Now this just ticks me off. We've already established we cannot access it in the home for whatever reason. Not just me, also the most skilled IV nurse we have. But there's no budging on this with them. Every week, for the next month, I have to needlessly stick this lady. Unless of course, she refuses and requests it be done at hospital :wink2: She was quite OK with the idea of a weekly trip to the hospital vs. having us all attempt without success when I first told her those were the plans. I'm just so peeved! And we're supposedly a not for profit agency. What would you do?????????

Wow, thanks so much for all of that information and taking the time to write it!! That helps alot! I had heard of the chambers, but that's about it. Now when he starts talking about it, I don't feel quite as lost! Oh, about the fire thing, I didn't say anything, but then I didn't know alot. But the clinic had already told him that b/c that's mostly what he kept talking about, catching on fire, when I saw him Friday. But he seemed pretty open to the idea and I think with some education will do fine. Again, thanks so much!!!!!!!!!!!!!!!!!!!!!!!

Need some opinions. I am a HH nurse who has a patient with an open surgical wound to lower back midline. We have been doing VAC therapy for about 6 weeks now and have only seen minimal improvement. I know he has MRSA, for which he's receiving BID Vanc at home. There is actually some bone exposure at the base of the wound. His surgeon and primary MD as well as the staff at the infectious disease clinic he visits weekly have been telling him/us it looks good, just healing slow due to presence of infection. No obvious S/S of infection other than slow healing. Well last week he went to a wound clinic. They were not pleased at all and said in addition to MRSA, he has 2 other organisms (have not yet seen or confirmed which ones) Patient states Friday they want him to do VAC tx for 6 more weeks and then do hyperbaric treatment for 2 hours a day, 5 days a week, for several weeks. I know very little about this tx. Can someone share any experiences or knowledge they have in this area? Thanks so much!

See, this is why I'm so glad my agency is not a for profit business. The last job I had was with a hospice agency that was for profit, which I think just sounds bad, much less how it actually was! It was horrible!!!!!! Much like you described. Tried to get me to document stuff I knew was not right! Like a FTT diagnosis on an elderly lady who was losing weight. Well, what she needed was a care aide who would see that she was eating regularly and financial assistance to get food. Not hospice!!!!! I held in for over a year before I couldn't do it anymore. The HH agency I'm with now is not for profit, and it's like night and day. I can truly say my clinical manager works very hard, she's an old field nurse herself, and they've been turning away patients due to lack of staff so much that now that we're fully staffed, we're having to get back in good with the hospital dc planners just to get referrals. Look a new job!

Hi there. I have a question about port access. I am a home health nurse and this has been a week for things I've never seen before. First a male foley problem, and now a port problem. 12 years of nursing, you think you've seen it all, guess not. Anyway, I went to do an admit yesterday for IV ABT thru the patient's port. The woman was not a heavy lady, but her port was not easily palpated and was in no way visible. And when I tried to palpate it, it almost felt "turned on it's side". And it seemed to be moving around. But I was eventually able to palpate the septum and access the device, but no blood return. I have had patient's that don't always get blood return, but she says she always does. Attempted to flush, and she complained of pain. So I deaccessed and repositioned the needle. Same scenario. I called her doc and he said to send her to hospital to have it checked out. The patient states it took them all of 5 minutes to access the port! Now I'm not new to ports, and have accessed plenty. She says the IV team nurse "told her to tell me" the port was tilted and there was a certain way to access it. It actually appears she accessed it upside down, as if she came from over the patient's shoulder if that makes sense. My poor patient couldn't remember the instructions nor the nurse's name for me to call, but I'll see what I can find out next week before the needle is to be changed. But I thought I'd see if anyone here had worked with a port like this, and suggestions. I'm actually just plain nervous about the whole thing now. And I've never had a problem with pacs.

For Medicare, no, for Medicaid, yes. Most of my medicaid monthly patients are what we call CAP assessments. They have CAP in, but they contract us out to do the monthly assessment that keeps the CAP aide in the home. And most of my CAP patients are not very sick, and their assessment takes very little time unless something new is going on. Same meds, same routines, etc. My other medicaid assessments are incontinence assessments. We simply provide their incontinence supplies and do an assessment every 2 months. That takes a little longer bc I do a full skin assessment, but still can be done rather quickly.

Yes, that is what we were using the last few times. The leaking doesn't concern me as much as why it was suddenly difficult (no, impossible) to get another in. I guess the urethra could be swollen/irritated from all the reinsertions, but it literally felt as if I was hitting a brick wall. I've had them do that with me before at the point of the sphincter, but usually it will eventually relax and allow you to continue advancing the foley. But this one was not budging, and he was clearly in a lot of pain.