bloomicy

Thank you all for your help! I suppose it's better to be covered, but sheesh. caliotter3, I'm with you in wondering about the MDs. We never get feedback on the 485s -- they just sign, probably 'cause it's just too long and nitpicky to bother going through in detail. It'd be interesting to poll them and see what they think.

Thanks so much - that's really helpful!!! To follow up -- for aide service, do you have to specify everything that the aide is to do on the 485? And what about who is to do meds (caregiver to fill med box; pt to take pills independently from med box)? Or who assists with which ADLs/IADLs??? Thanks again!

Our agency is working with a QI consultant who is totally gung-ho on the 485 POC, and is having us put down every single intervention we do for a pt -- to the point where "assess lung sounds qv", "assess GU and GI status qv", "assess pain level... qv", "notify MD for HR >100 or 36 or you get the idea. Basically, our 485s are now 4-7 pages with every possible goal and intervention for a pt. It's getting SO out of hand, and the nurses are going crazy!!!!!! We've got the disciplines and frequencies... but what else NEEDS to go in there? Do you have all the basic interventions in there at all, do you put them elsewhere, or does your agency just leave that stuff off? How specific (or nonspecific) are your 485s? For a pt with >1 diagnosis, for example (like most HH pts are!), what do you put for #21 (Orders for Disciplines and Treatments)? Thanks in advance!

Hi, all, I'm a new HH nurse, trying to figure out my own "system" to keep myself organized on the road. We have laptops, so I won't really need to bring too much paperwork... but I'm looking for handy tips on how to organize my stuff on the road. Folks with laptops -- do you do most of your documentation in the home or in the car? If you do it in the car, do you have any kind of "desk?" Can you recommend a supply company for organizing an office in your car? Do you keep your computer together with your nursing bag? When you eat on the road, how do you keep your car (and computer, and cell, and papers) clean and safe? Any tips would be helpful! Thanks!

I feel your pain... I started a new job (as a brand new nurse) with a small agency about a month ago -- they were in the "rebuilding" phase. Turns out there has been a turnover of staff so much I only recognize one name from January's list. And two of the three current nurses are constantly complaining and talking about leaving. Great. I'm still only on orientation, but am determined to stick it out, 'cause especially with a first job I REALLY need the experience. Just try and stay positive -- you're in it for the patients, right? They need you. Don't worry about getting fired -- sounds like the agency needs you, too, and they need you more than they need a bunch of complainers dragging the morale down. My own personal approach is that I'd prefer to try and pull the morale up than get dragged down with everyone else... we'll see how long that lasts. I can't imagine the work is as bad as everyone is saying! A positive attitude really goes a long way sometimes -- I'm hoping this is one of those times.

crazystudent, I'm totally with you... I had one placed yesterday (around 2pm); by 8pm I had a definite induration, at least 10mm. Today the area is red and itchy, with the center area warm and darker, but no induration any more. I've had this before, and they've said that it only counts as positive if the induration is there after 48 hours, but I don't really understand why I would have such a definite induration so early that would just go away. It just stays red and irritated up through the reading and for a day or two afterward. Anybody else? Would an early induration count as positive?

For those who have worked on salary in HH, how much is a starting full-time salary in your area? If you get paid per visit, what does that work out to for a year's salary? I've been offered a position, and we need to start negotiating, but I haven't much of a clue what a reasonable starting salary is for a newbie. Anybody?

I'm almost in the same boat, except that I don't even have the 4months' experience! I know I really want to do HH, and I've been an aide with an agency that is now interested in hiring me as a "visit nurse" -- as opposed to a case manager, I guess. I have a great rapport with the staff and with several of the patients, so they're willing to train me for HH. I'm very excited, but also nervous... is it a career-killer to not work in the hospital a while first??? I don't like floor nursing at all -- I'm ADHD and easily distracted, so I get stressed when I have to juggle call bells and the myriad of things competing for my attention. I'm SO much better one-on-one... but I worry whether or not it's a bad idea to not have hospital experience (other than as an aide or student). What do you folks think? Can I make a good career of HH without ever having worked as a floor nurse?

Thanks, BBN... I'm surprised. I guess I thought med/surg would be a bit easier on a student due to lower acuity, but I guess ICU would allow more focus. Isn't ICU more stressful, or is it the other way around?

Anybody?????????

We're on a trimester system; our third term in the spring we do an intensive senior practical experience working 200 hours or more alongside an RN who is our preceptor.

I'm a senior BSN student -- nontraditional (age 43), high GPA, self-motivated and all that stuff... but I'm very ADD and am absolutely TERRIFIED of having to juggle more than 2 patients at a time. I know I don't want to do med/surg, that being one of the top reasons. I think I eventually want to do either primary care, Peace Corps-type clinic work in other countries, or community health -- situations where I'm more likely to be able to focus (hopefully one patient at a time?) and work with less stress. I know my limits, and I make mistakes when I can't focus. My nursing program finishes up with 200 hours of practicum -- usually in either med/surg or ICU -- but sometimes they'll allow good students to work in other units if we can arrange it. Three questions (somewhat related): 1. If I DON'T do either med/surg or ICU and find something else, am I knocking myself out of the running for a lot of jobs? 2. What other areas should I look at that will allow me to focus on one patient at a time? Will the lack of med/surg experience be tremendously detrimental in those areas? 3. Are there any other hospital units that are good for practicing skills but have lower acuity/stress/patient loads? Thanks for any advice!

I don't know about the actual courses they give -- I've taken two exams through them (ethics and A&P) to get credit at my college. I've got a high GPA and am a good self-study type, so they OK'd it to fulfill requirements. I took the exams at a local Pearson testing center. I can't remember the cost, but it's right online. Like I said, I don't know what they do for courses... I think it's all self-study with guides. Sorry I'm not more help.