Sterlink

our agency considers 6 SNVs a full load...of course, nurses do get days of 7 or 8. a SOC and 4 is also supposed to be manageable. problems come with the mix of acuities you may get, and amount of driving.

now...that all does make sense, but in practice, many nurses, myself included go in with good intentions...meaning i'm gonna be fast and efficient, and before you know it, one hour and 45 minutes have gone... I want to find a way (or ways) to teach myself (and my staff) how to be efficient more times than not. I think it's both a mindset, and tools (like you say: care maps, etc.). But it's easier said than done...

persistence. and we're told to follow SBAR when communicating with MDs: Situation/Background/Assessment/RECOMMENDATION!!!!!!!!!!

when we still documented on paper, oncall nurses would get a print out, at the end of the day, before they took call....

in my agency, meds reconciliation is constantly emphasized....you should never let your guard done on meds....never assume...often the MDs have a different list than what's going on in the home....HC nurses must VIEW meds and discuss each one, and how used with either the pt, or the caregiver responsible for administration....and don't let someone's title trump doing your own assessment...i had a dtr-in-law once who was an RN and the primary cg for my patient...she gave me the most trouble because she would frequently make her own decisions with the patient's meds...NO GOOD.

listen to you pts...in homecare you may have more time to do that...you'll learn a lot

when in doubt document EXACTLY what you see...like "pt continues to nod off during assessment interview" i had a pt once who was on methadone for chronic pain, was doubling up on doses, and had fallen with injury...these are tricky....just always document what you SEE.

oasis questions should be supported by your documentation/narratives. if they are changing the pain level answer, ask them why. it's good practice to teach the pain scale to a pt before you ask them their pain level...then support their response with your narrative. changing adl answers is common...but usually there is a logic to the change...our qa staff won't change anything without getting agreement from the clinician first...this gives the clinician an opportunity to support their choice or elaborate further with narratives to support a different oasis choice recommended by qa

I am trying to chart later...stubbornly trying to jot paper notes and catch up with the laptop later. I'm thinking I have got to stop this and work that machine into the visit.

I was given a laptop about 6 months ago. I charted on paper before that. Charting is my least favorite part of the job. But now with the computer it's killing my career. I am always behind in my computer charting. I do believe that our software is cumbersome. But it is all that we have, so I have to learn to use it intelligently. I'm looking for advice on how to integrate the laptop into my time in the home so that I can get my charting done and save my homecare nursing career. I'm looking for advice on everything from how to word things succinctly, briefly, yet completely, as well as advice on where to put the darn machine when I'm in the home. I sure hope someone's got some stuff I can pick up and run with. Thanks.

I will look into OT. And I am wondering how to select a better leg bag that doesn't come apart between its nozzle and tubing so easily.

Yes, you should have hospital experience before hc. life experience helps a lot too. The human element is way more acute is hc. You are right in the middle of people's lives.... Being able to relate to people from the emotional to the physical and more has been important. I went to nursing school at 42. Spent 2 yrs in a hospital before finding a hc job

Patient could not get leg bag nozzle out of Foley catheter without assistance. Leg bag tube also came apart too easily from its nozzle. Basically I'm having trouble getting this gentleman independent with changing between bags so he can leave the house again and go fishing.

We answer oasis as not what they are doing but rather what they can do safely. So what would I teach and document on a 97 y/o who lives alone, won't accept an aide but is observed to be unsteady on her feet.

I'm wondering how other clinicians teach and document activities and safety on a start or care when there will be a gap in care. For example, a little 97 y/o lady who refuses an aide but accepted p.t. for muscle weakness r/t extended hospital stay.

Chart in home, or immediately afterwards in your car. Call MDs immediately! Don't put off anything you don't have to. You will be busy....that's for sure. If you think it's slower than hospital, you'll be on the wrong track. Be super organized. Be in control. Know what you're asking the MDs for. Think SBAR: give the Situation/Background/Assessment /then Recommendations. Be like an ICU nurse. Only way to survive.

You shouldn't ever make a decision on that. You need an MD's order. If an order is for so many units of an insulin, that's what the pt should get. If you're concerned about the pt becoming hypoglycemic in the night, assess the situation and contact your RN or MD. If this pt isn't eating at night, maybe he should get long acting insulins in morning only.

My advise is plan your visit ahead of time. Follow your script. Eventually you'll develop your own flow, but at first follow a script.

Got it. Yeah, good to have something to look at quickly. I know what you mean about having to go back to the computer for something simple...

"front of the right side, back of the left side..." please explain that again...not sure what you mean...

How about how much time it takes to know what's really going on? I had a daughter call me back and say she could NOT get her mom to a doctor's appt. Seemed to be saying "it's her problem." I was surprised. But the next day, the daughter called me back....she has issues with her mom, but after sleeping on it, she wanted to call me back...and I learned a lot more about these particular family dynamics.

That's a good list. Think I'll bookmark it. Of course, you need a good MSW.

I have a 29 year old patient status post incision and drainage of an abscess (MRSA cellulitis) at her right groin with one margin at her labiocrural fold. I am packing the wound and then covering with a DSD. I am looking for suggestions/advise on how to secure without putting too much tape (if indeed any) on her right labia majora. This is an early intervention, still presenting with moderate sanguineous drainage. Thanks. Sterlink

Was d/c from snf c/ garment, but too difficult to use. No f/c. Wears depends for minor incontinence, able to void on toilet. Looking for comfort measures.