LaRN

I laughed when I saw the title of this thread...... sometimes I feel like i'm more of a hotel customer satisfaction rep than a nurse. employers try to get everything they can out of you and so do most of the patients and nearly all of the family members. the trick is to find a balance-- satisfy your role and obligations but don't go over the top and be used as a tool. i occasionally find myself drifting off into tool territory....and have to correct myself, otherwise i become resentful.

I could've written this. if there is that much dead skin, it usually means they aren't washing the feet very well or at all even. makes you wonder what else they aren't washing. it's a lot of work but you may have to go back to the drawing board and check off all of your cna's on their bathing skills. still a lot less work than dealing with a tag.

ktrvrn, something is definitely not right there...promoting someone who has no experience in home health to asst admin is crazy. sounds to me like he's just setting you up for the fall. in other words, when the agency gets busted for illegal activity, you will be an automatic suspect, and they will see that you lied about your experience, and it all unravels and goes down hill after that. do NOT change the information on your resume. i have a feeling he will change it without your knowledge. i don't normally tell people to quit their jobs, but you need to get the hell outta dodge young lady

it's possible she does this because the nurse who calls the doc has a lot of influence whether the md sends the patient out or chooses to treat the patient where they are, ie, antibiotics, u/a, portable xray, etc. the manager probably wants to know what is going on and make sure the nurse remembers to remind the md that they are a medical facility and can possibly provide the care that the patient needs. most hospital transports aren't like dramatic scenes from E.R., they are for things that can be handled in the nursing home, however, if your patient codes, surely they don't expect the nurse to waste time by calling supervisors.

There's definitely a negative vibe associated with long term care, for which there are numerous reasons, but I think the main one is: any time you hear about substandard care issues, it's almost always a nursing home/LTC. next in line are mental institutions/ however, I believe that the majority of care givers in these settings strive to give the best care possible. sadly, the funding and resources they need to accomplish this goal are not always in place, and if management isn't really good at operating on a shoestring budget, patients will come up on the short end of the deal. I've seen so many occasions where low paid employees end up bringing things from home, or buying items in order to properly care for their patients, or nurses buying wound care supplies because those things couldn't be found, or were never provided to begin with. In reality, anyone who has worked in ltc and managed to do a decent job should consider themselves head and shoulders above the rest.

my guess being budget is the biggest reason, but another reason is = if mngmt can simply call agency nurses when coverage is needed, then management tends to not have a 100 percent commitment to retaining their nursing staff. by commitment I mean treating them fairly so they don't run them off and have to work in their place. . also they tend to keep their expectations more reasonable when they occasionally have to meet the goals they set for others. its a slap of reality when one cant jump through their own hoops. to thine own self be true and it must follow... as the night the day

Curious as to how most agencies manage their full time staff. do you have to return to the office before and/or after seeing your patients, or do you go home when finished with your daily route? if your employer expects you to come to the office at the end of the day, are you expected to answer phones and handle other issues not related to your daily visits? and do they expect this of hourly staff only, or per visit also?

That amount has varied over the years. when I first started, patients were seen more frequently, which made things much easier, I would see approx 6-7 revisits /day. now that frequencies are very conservative, there is so much to be packed into each visit, which extends time spent with each one.....so. i don't really care to see more than 4 or 5 re-visits per day. i also have to push myself to be less personal and chatty so that im able to get the job done and still have enough time left in the day to keep myself sane. hourly rate approx $25 hour / or 25 per revisit/ 60 recert/ post hosp 75 admit 5 extra for aide supervisions or blood draws with lab drop off

I'm not sure what others are talking about when they say home health requires assessment skills , etc that aren't covered in nursing school or clinicals. of course good assessments skills are required, just as it is in all areas of nursing. .....report abnormals according to given parameters, but home health patients should be fairly stable... its not icu. however, a very thorough medication review is necessary, always look at the bottles and ask them to show you exactly how they take meds. that may seem a bit exhaustive, but quite often there is a big difference in what they say they take and what they actually take. such as "i take my blood pressure pills twice a day".....but when you ask them to show you the bottle, its a diabetic med, or something else. I had a patient tell me that he wanted a new sleeping pill b/c the old one was no longer working. ... he had actually been taking flomax. a lot of reading between the lines is needed with most patients. and if you don't do anything else, get a gps. life is so much easier with one of those.

around here the assisted living homes have had great difficulty finding and keeping management ....nursing director of wellness and admin /ceo ....mostly because they are expected to be on call and available nearly all of the time....and held accountable for what goes on there 24 hours a day. they have become so absorbed with making a profit that they squeeze every little bit they can out of their employees, beyond the point of ridiculousness

i could have written this very same thing. i went through an ordeal like this a while back.....its like bad luck was on my side...i think i was trying too damn hard....in addition, those jerks gave me all of their WORST patients . the ones that their regular nurses had grown sick of....and somehow expected ME to satisfy them....well guess what, that didnt happen.......not that they were ever happy with the other nurses..b/c they complained about them too......but they didnt care about that....because the managers KNEW those nurses and trusted them.........they didnt know me, i was new......and 75 % of my patients were nutjobs......and with 3 or 4 of them calling and complaining, it looked bad to someone who was too ignorant to realize the predicament that they put me it contributed greatly to this problem.....and i didnt do a damned thing wrong.....i went by the book........not good enough though.

been there, done that. employers arent very tolerant these days, ...we are a disposable society, nursing. at least a third of the nurses i know who have been nurses for any real length of time have been fired from at least one job. a profession dominated by women....go figure

by doing what?

oh no.....in the words of Fred Sanford "You big dummy!". She must have felt like a complete idiot when she realized what she had done.

the only time you may have to start earlier is if you have a fasting blood work on a patient who insists on having their blood drawn early, or perhaps a diabetic who isn't able to fast through their normal breakfast time. but in my experience, that rarely ever happens about going to the office: depends on what your employer requires of you. I don't like going to the office before starting my day because a lot of time can be wasted there. If necessary, I go after i see my patients. If you leave your house for 8 a.m. you are doing better than 50% of the home health nurses that I know. including myself

most of the LTC in this area have a treatment nurse instead of the med nurse doing them.

a nurse loses her license based on HER actions. if they tell you to do something that is harmful to a patient and you do it, then of course you could lose your license. other than that, NO. almost anywhere you go, there are going to be problems. Most likely it won't be the kind you are having with this place, but trust and believe there will be problems. They are probably just doing and saying whatever they have to in order to get you to continue working there, and I don't blame them. I've been through a similar situation, and it was very difficult but it turned out okay and nobody got shut down or lost their licenses, however a great deal of change, WORK, and improvements were made, and I learned a lot. Unless they are treating you horribly, I think you should hang in there where you are needed.

The ideal solution is to request more training, but that may not be possible. The only other alternative I can think of is to watch nursing education and instruction videos for the nursing task that you need to learn. there are several on youtube, but try to make sure that it is a reliable source. medcom and some universities, and medical supply companies or supply brands are a few. There's probably 200 instructional videos for each nursing skill. This has helped me tremendously.

not making sure that nurses are properly oriented before turning them loose, then writing them up when they fail to do something according to some quirky company policy. and when the nurse complains about not having the policy or protocol available to them , supervisor replies "you should have asked, any nurse here knows".

seems as though nurses are getting fired at a higher rate than fast food employees these days. many times its warranted, but other times its just a personality conflict or unknowingly hacking off the wrong person. I have noticed that nurses who don't say much to anyone and just roll with whatever comes their way tend to stay employed longer, and are forgiven more readily when they do screw up.

As far as filing a complaint on you........pft for what? the wrong cath size? its an error, but as far as errors go, its very very low on the totem pole. i've done it before, and realized it afterwards , and just simply notified the doc......and he just gave orders for the size that I had inserted and revert to the previous size next cath change. and besides, it sounds as though the company you worked for has enough of their own big "errors" to worry about. I'm not sure why some companies threaten nurses they've fired with reporting them to boards when they really have nothing to report...perhaps its just a way of shutting the nurse up in case she wants to cause trouble for the company.

One of my first nursing jobs I was told not to share to others what my hourly pay was because I was making more than several other nurses. I did that for a while, but then overheard some others talking about their pay and realized I was NOT getting paid more than anyone there, I was the least paid, and it wasn't by just a little bit either.

have you watched any Media lately? you ought to see how they're portraying nurses there.

. if you dont want to share the info, just say you can't remember, or change the subject. I dont think its an issue of being nosy, b/c most nurses like to make sure they're getting a fair deal , and sometimes the only way to gauge that is to find out how much others are getting. It's not about you, its about the money.

make your schedule and map your pts out in the order you will travel. then call and be direct... tell them an approx time you will be in their area (with a 1-2 hr window) and that they are scheduled for a visit. most will grumble about any time you give them, but don't budge (unless they have md appt). Occasionally I will have a pt give me a hard time, and I tell them very kindly, sorry thats the only time i will be in that area. worse case scenario, they don't get a visit that week. text worke best for most. had a supervisor who used to fill out slips on anything the nurse failed to communicate and gave them to us. at one point, communication sucked so bad, we were required to call the office after every visit and give a report to the cm or supervisor. that got old really fast.