megsquirrel

Renarian, You'd certainly do better finacially, not to mention physically, if you went back into the field. The 60-70 hour work weeks would probably only drop to 50 hours or so, given the current climate of home health nursing, but I'll bet you'd consider 50 hours a week a "vacation" at this point. If I didn't know better, I'd swear we work for the same company. When our CM's went salary they weren't told in advance....they were told they had "new" time sheets to fill out.....the next week they were salaried. We all know reimbursement is down, home health patient acuity is up, there is a shortage of nurses and that we have to be "flexible." But there is a point, and your agency has gone w-a-y past it with you. I'm currently looking for a new job. Hopefully I'll fnd something at least half-way reasonable. If not, I'll take a much-higher-paying hospital postion.....if I'm going to be driven straight up the wall, I may as while make it worth my while. Meg

At my agency each team has a nurse that does the coding. She also figures out the number of visits that are allowed. I find this really helpful when developing a care plan. I'm not limited to that exact number of visits, if the patient clearly needs the care we deliver, but I do try not to go over the allowed number of visits.

Makes sense! Thanks!

Lately several of my home care patients have orders for magnesium oxide 400 mg BID and in one case, TID. All of these patients have a cardiac dx, mostly CHF. When I asked why the mag oxide supplement, the patients told me it was for their heart. I've been looking around, but I'm finding limited imformation about mag oxide.....mainly that it's a supplement and it's "good" for muscles and nerves. Does anyone have any information for me??? Thanks!

Today I had a really "easy" day....makes me nervous because the FULL MOON is next Tuesday so Monday and Tuesday ought to be doozies! #1 89 y/o LOL with HTN and mild orthostatic changes (I'm talking 10 points systolic with no dizziness). I'm only to call the MD if BP greater than 200/95. She's also been having a "faintly feeling" with slight epigastric pressure when she has been up and around for more than a 1/2 hour or so. Says it lasts only a minute or so. MD is aware and no change in orders. So, today, when I am ready to d/c her because her ortho BPs have been unchanged, her meds are unchanged she has the "fainty feeling" with epigastric pressure while I am there, lasts maybe 2 minutes. No seating, no SOB, no pain in arms or jaws. BP was 200/90. Five minutes later she back to her "normal" 170/70. Call her MD....only change in orders is "continue to monitor her 2x/week and fax me the BPs, oh, and decrease her Megace to QD. " GRRRR. The patient saw the MD yesterday and was told to find an assisted living asap. I'm thinking she needs a new MD to change her meds and consider that anxiety may be an issue. Nothing concrete...just a feeling I have...and you know those "feelings." I feel like I am spinning my wheels in there....I fax my notes to the MD every visit.....I think she thinks of me as a phlebotomist who takes BPs. #2 "Covering" another RN to administer a monthly B-12 injection. The new primary RN has asked me to address this lady's homebound status. Turns out the lady has been on caseload for 2 years for these injections....all the while driving herself all over. Address homebound status and tell the lady we will be arranging for her MD office to administer the injections in the future. Her primary said she'd d/c her. #3 New Admit. 89 y/o lady who had showed up in the ER several times this year with c/o SOB. Got admitted for two days when she added "chest pain" to the complaint. Known to have CHF, I'm to teach her about her disease and meds, monitor her cardiac status and eval for a HHA. During the interview, she starts talking about how nervous she gets, living alone, and fears her heart will fail. Says her MD won't give her meds fdor anxiety "because they are addictive." (SHEESH!!! This is the same MD who, in the past, has told me to "jolly the patient along" whenever I try to address depression.......) I admit her so I can see her a few times to teach her about her CHF, her meds and her diet. She's fine today....no edema, clear lungs, stable VS. #4 90 y/o man with G-tube feeds and a neuro-muscular type disease that no one has put a diagnosis to. I'd been his nurse a while back and just loved him. He's lost a lot of weight and is pretty weak. Oriented the HHA and talk to the PT about her plans for him. His wife is a doll and so devoted! The tube feeds are gravity at this point, but she's trying to talk the doctor into letting him switch to a pump...so maybe they can do more than feedings and exercises during the day? He has a new decub which I gave some samples of calmoseptine for...I love that stuff...clears up superficial decubs like magic! The plan is to get this man strong enough for him to have surgery so he can take po again. Please God he gets there. #5 80 y/o lady I see once a month to administer a B-12 injection. This one truly is homebound, O2 dependent and insists on doing as much for herself as she can. Refuses a HHA because, though it takes her quite a while to shower, she wants to do for herself as long as she can. I refuse to let the per diems do this visit, she's such an love, I think I deserve this visit! Back to the office to fill out all my forms. We are in the process of switching to computer, I'm still doing paper. All our forms look like the ones on the computer...to help us get used to the form, I guess. I have a TON of recerts in my box. All are for next week and the week after...whew! I should have most of these people d/c'd before their recert dates, lets hope! Finish filling in my schedule for next week. I've been a discharging fool lately....so I know I'll be doing a lot of admits next week. Can't believe I had a day with no labs, no disasters, no messages from "quality assurance"! Shut my beeper off and RUN!