annaedRN

I am sorry that you are not receiving any support or orientation from your boss/agency - it makes it much harder to succeed in home health. Anyway - this link is you best bet. You can also call your KCI rep and ask for tips if it is a tricky wound or patient. Good luck V.A.C. Application Videos and Guides | KCI

I would agree that there definitely are the negative factors that RN 1263 listed - however, it is not true every day or with even most patients. On the bad days, or weeks... it is so easy to focus on those. But honestly, if you believe and love what home health nursing does - Susan's list is what keeps you going!! Kate as always was spot on - but I would have to say I only organize my supplies about every 3-4 weeks. If I use something from my car stock, I keep a list and reorder it. If I made a list trying to focus on different things from what the others said it would be... 1. Be organized. Plan ahead as much as possible. Call a few patients the night before It WILL make your day go much more smoothly 2. Learn to be efficient. Chart as you go. Learn to chart and listen at the same time (hard to do and still make your patient feel #1) 3. Keep Lysol wipes and extra clothes in your car...you never know what you will find in a home 4. If at all possible, have an iPhone (smart phone) - use the apps for pill identifiers, meds, lab results, email, map/GPS - has been invaluable to me!! 5. Know that even though you will often want to pull your hair out dealing with noncompliant patients - the rewards of helping patients in their own home - you will have those few that tug at your heart strings and those success stories that keep you going (I had one 375 lb patient that would not leave her home...now 3 years after I showed her some tough love is under 200 lbs and frequently stops in the office to bring us all goodies - she calls me her angel....that keeps me going!!!)

I would not and could not work in those circumstances. How many other nurses are helping you see these patients? I do not understand how you could effectively manage 70 patients - it is a near impossible task!! I have often seen 7 patients in a day (prefer 5-6) but I am only managing 20-30. Personally, I would find something else if at all possible. This job is leaving you wide open for something to come back and bite you in the butt....besides just leading to total burnout!! Good luck to you

Kate- well said as usual. It's what I was thinking but you said it ever so much better than I could have. Use the guidance (manual) for OASIS to answer your OASIS questions, use the head to toe assessment to document your findings. Always think SAFETY!! And like Kate said - do not assume safety. Our agency has recently started giving out OASIS "M" question handouts one "M" at a time - the "M" question, with the most important guidance listed, and tips/tricks to think about accurately answering questions and maybe an example. Giving clinicians time to look at one question at a time lets them think about it a little more - rather than a long inservice. Has people asking questions atleast.

some of the infusion companies have their own infusion nurses that may come out and provide that servcie for you.

switch to an antifungal powder (not cream) then can still apply barrier cream over the antifungal powder. works wonders

In my agency all the fulltime RNs case manage. Of course, the amount varies with the census - but routinely I have 20-25, the most I have had was 32. Once it is over 25, I feel that I personally am not able to case manage as efficiently - it is harder to really get to know my patients at that point. Productivity is 5 a day for us, but that too varies - it is usually 5-6. We are salaried - so that rare day when it is 3-4 patients - we jump for joy. Only once in a blue moon we have 7 to see.

Hello Kelly. I graduated almost 5 years ago from HACC - doing the LPN-RN. I went to Harrisburg for the transition class though. It was a difficult transition initially to go from practicing nurse to student again. The transition class is a mini-version of what a regular semester will be - the 1st half of the class is lecture, computer modules and skills lab the the second half is clinicals. I worked one day a week - and honestly, that was enough. There were a few people that worked more than that...but most people did not work at all. There is ALOT of work that needs to be done independently. The reading, the assignments, the studying. There is alot of paperwork/case studies for clinicals as well. The more you put in, the better you do. I learned more from that clinical paperwork than I ever thought possible. I personally saw as a student, then later as a tutor that the people that complained the most were the people that really werent doing the work...then said that they were picked on or being failed (yet they were the ones that missed class, turned things in late or incomplete, didnt read the texts, etc) Many people complain about HACC being unfair or too hard. I cannot vouch for indivdual instructors---I am sure that there are some not so good ones out there. HACC is tough. But if you get through it - you are VERY well prepared. Most local employers have said that they would rather have HACC grads that most other new grads. It will be your full time job, and then some. But it's worth it. Anyway, good luck to you. If you have any questions, please feel free to send me a message

Most Vanco in the home is administered in elastrometric therapy (Eclipse or Intermate) - atleast most of the time. Or a portable IV pump such as the CADD Prism pump - usually no IV poles required

I am currently in SRU - I'm only taking one class a semester because my BSN is a long term personal goal - and I want plenty of time for family, work and fun too! Anyway - so far, so good. I have taken 3 classes so far, ready to start 4th. Easy to work with, I have had no problems with the blackboard/distance learning technology. Classes are regular semesters - SRU is a brick and mortar school and they follow that schedule - keep that in mind that in between semesters, it is difficult to get answers because there is no school! Professors so far have been helpful, and available when they said they would be and offered quick feedback. Tuition is pretty good. They only require 13 classes - and the 2 that aren't nursing are still "medically minded" - biomedical ethics and professional/medical statistics. Hope that helps.

you call to arrange visit time and your wife says your are out with your buddies, dont know what you are doing or what time you'll be back. your neighbor says that you are out car shopping - hoping to bring home a snappy little mazda miata.

Roaches I am definitely not fond of..but exposing a wound and finding hundreds of maggots...now THAT got to me!!!

Optifoam is great if its a smaller wound and you may be covering with a transparent dressing. Optifoam or other "generic" foam dressings are absolutely acceptable if the purpose is more for insulating the wound or protection. Depends on the wound. I like Allevyn too - but in this day and age of the increasing price of healthcare...saving a few bucks and still getting the job done is often the way to go

Sounds to me like an order for cath flo is needed. Better check your agencies policy on it.

Well said, Kate, well said.

make sure his bag has a charcoal filter built in- that would help keep gas from building up. and, yes, like tewdles said - look into why a colostomy has primarily liquid stool - should definitely be more formed unless there is an underlying GI disease

WOCN/NPUAP have issued guidelines to be used for home health/OASIS that you should be familiar with. In a nutshell, if you have a stage 2 that is OPEN then it is nonhealing - no matter what the measurements. Once it is healed then it is no longer reportable - because stage 2 are partial thickness, they do not heal by granulation - they epithelialize. Once epithelialized they are closed. They do not cause underlying tissue damage so, in essence, once closed up - they are gone. No reverse staging. Either you have a stage 2 or you don't. This is Medicare OASIS guidelines for home health - not talking about hospital/SNF, etc.

yes- you are right. cut to fit into the wound. if the dressing is on intact skin, should not affect it. one thing to consider though - alginate dressings are used to help manage the exudate of a draining wound. if the wound is fairly dry, alginate may not be the best choice of dressing - or, maybe the frequency of dressing changes need to be extended - alginate should be left on until it "gels" up - if it is dry and you have to try to soak it off then it is too soon to be doing the dressing change. it can be left on up to 7 days. sounds like you are critically thinking about it :)

sounds like you have tried most of the tricks. have you tried medical adhesive spray on top of the duoderm before applying the wafer. Using eakins rather than paste. how about some of the cement? making sure that each product you try/apply dried sufficiently so it doesn't work against you. I like to use antifungal powder then nonsting barrier wipes on broken down skin - apply it then let dry and apply it again - then the duoderm. have you looked into him eating foods that constipate for a day or two to "give it a rest"? hopefully you'll find the trick! good luck to you and him!

YIKES!!!! My agency would NEVER tolerate that!!! It is really quite disgusting...and quite disappointing. Hope she is fired!

Most agencies that are part of the Visiting Nurse Association have a good reputation and follow Medicare regs. However, individual agencies are only as good as the leadership allows:)

I too did extended care for quite a while. I loved it at first, but quickly became bored due to above mentioned reasons. I wanted a job that challenged me and that I could use all my skills. I stayed as long as I did because of studying for my RN. I am now thankful that I had that experience but would not go back to extended care if I had a choice - I love being a field nurse/case manager....I am definitely NOT bored and do use a variety of skills all the time and continue to learn on a daily basis. Good luck to you guys!!

even though the wound has little drainage, TAO is probably keeping it too moist. I would silver nitrate it then place foam or something absorbent and wrap it - sometimes the less the better.

Show her this.... http://blog.wcei.net/unnas-boot-application-demonstration/

I put it on the 485 for all patients - as PRN for respiratory assessment. That way it is covered as part of assessment no matter what the circumstance, checked or not.