starcandy

I am new to home care and the agency that I work for is a disorganized mess. I got very little orientation. I was just thrown out there after 4 days. My problems are I do not understand "home bound" per medicare rules. There are some patients that I have that I will not consider home bound. I feel pressured to accept everyone. I will discharge a patient and a week or two receive another referral for the same patient. I am finding out tidbits of information that should have been received in orientation. Which is very frustrating. How many patients should a case manager have? I am responsible for SOC and revisits the first week or so, then the LPNS continue visits. Is it common to have a scheduler or you schedule your own visits??

I just started last week in home health. I did my first SOC with preceptor last friday. Monday, I was given 10 more start of cares , with the addition of 14 new patients that need recerts, discharges and regular visits. I am new to oasis-c and overwhelmed. My manager says I should progress and be able to do 5 SOC a day.

How many are can you complete in one day?? How many for one week?? I am new and feeling very overwhelmed. It takes me 2 hours just to finish the interview

I think case studies are a good idea. Drawing electrolytes and CBC with diff would be a good start too.

I was a LPN since 1986 and worked the first year in a nursing home. After that, I started to work agency private duty and nursing homes part time for a while. I had four small children at the time and decided to be a stay at home mom for 6-7 yrs. I returned to nursing in 2001 working midnights in a LTC. I bought a Clinical Procedures manual and a drug book for Amazon.com and went from there. I learned a lot, but I felt I needed more to have a more thorough clinical picture of my patient. Because of the lack of retraining for LPNS in my area, I decided that is was best for me to pursue my RN. I think working in LTC is a good idea and I am sure you will do fine.

I am a 2004 grad of HFCC, Congrats to all:yeah::yeah:

I would have done the same as you and tried to get more IV access. No, I did not catch the contraindication, but we learn something everyday. :chuckle

I understand you needed more IV access for your patient, but why was the Dr. upset??

Kati2005, I hear HFH has great orientation program also. Did you feel they did a good job with orientation to SICU?

I know they still use contract nurses at the DMC. I would like to do agency nursing for a change of scenery also.

I will keep my regular job and use the agency for supplemental income only. I know nurses who contract with agencies and have full benefits. This is a good way to go because the nurses will contract with a hospital for a certain number of days and the hospital has to use them or they are cancelled with pay. A con is that you will not be able to get the continuing education that a regular job will offer you such BLS ACLS or telemetry classes.

There is an agency Critical Resource Inc. that pays 42.00 /hr. They are located in Brighton but you can fax all your info to them. I am thinking of going per diem with them to make extra money. I am in the process of looking for other agencies also.

I have never been able to get a handle on "Nursing Time Management" I have searched books that specifically address this subject and have not found one yet , or I have very generic information . To be brutally honest after 3 yrs of being a Rn, I am still overwhelmed at times. If I can begin a shift where everyone is fine and I can finish assessments , vitals signs and charting in a timely matter it would be great. Most days this does not happen.

I agree with you. :lol2:They don't pay me enough for this job:lol2:

This is what I did I gave the morphine and pt was sedated resps decreased from 30's to low 20's. It was ordered q 1 hr prn. I know the goal is to maintain comfort but I did not want to be the one to speed up her impending death. I assume terminal weaning wwill be discussed very soon.

70 year old pt CHF, ESRD on a vent with dyspnea , b/p 70/30 currently on comfort care only. Dr ordered ativan 4mg/ morphine 4 mg IVP . Due to the difficulty in breathing I gave the morphine dose but was leery of giving the high dose of ativan also. I as afraid of pushing him over the edge with such a low bp. I realize the vent would breath for him but was nervous giving both meds at the same time. Was I wrong in feeling this way? Is this a normal practice with comfort care only pts?

My first job was horrible with gossip and rudeness to new grads. I was having a hard time staying a year. The shift wars were crazy. I remember I worked dayshift and had a pt with a GIB. Dr wrote order for a stat CBC and a type and cross. I sent the blood to lab and notified next shift to look for results. THe results were Hgb was 6.5 and afternoon nurse had a busy shift and did not call the Dr. He reported to midnights and she did not report it because afternoons should have done it. I could not believe what I was hearing. I come back on dayshift and hgb 6.2 now and ended up tranfusing the patient.

:balloons::balloons:Congratulations Tweety:balloons::balloons:

I have pt with a fairly new spinal cord injury fx C 3-4 . Pt is a quad and vented and has chronic fevers. I just learned that the elevated temp originate from his neuro condtion. Medicating with Tylenol I find is largely ineffective in decreasing the temp. I applied a cooling blanket before I left this morning. Any tidbits would be helpful and where can I find additional info?

I am sorry this happened to you. Unfortunately their are many people out here that should not be a preceptor. It sounds like you were paired with someone who either did not want the responsibilites or just basically mean. The next place that you are employed let the nurse manager know you will need someone with patience and supportive of new grads and that they enjoy precepting. You can periodically update how your preceptoship is going. If it is going badly request a new preceptor. Unfortunately the person that is chosen to be preceptor is a lot of times the person that has been employed the longest and not on skill/personality or even wanting to do the job. Getting a good preceptor will help build your confidence. You learn from this experience to not allow anyone to disrespect you.

Isn't the Rapid Response team used to prevent codes??I think you did the right thing considering the pt condition was worsening

I consider it a good day if I could go home and I not think about what I could have done better. It just seems that I am not progressing fast enough and it is so frustrating.

It was a mn shift and where I work the residents are pretty nice at night, but I thought it was something that could have waited until days. The creatinine level was normal.

A patient with an order of IVF of 0.9 ns with 20 meq of kcl. The k level was 4.4 decided to give the IV thinking it was only 20 meq in a one liter bag. It could be addressed on day shift if the Dr wants to change the order. Do you think I made the wrong decision and should have had the IV fluids changed or dc'd to prevent potassium excess?? Even after 3 yrs, I am just trying to increase my critical thinking skills, but there are very few days I leave work and agonize over a decision I made. Scenario B Pt unable to take po meds. Lasix IV not given due to not being able to administer K po. K level 4.5 would you have held the Lasix??? I would have pushed the lasix due k was well within normal limits.

I would love to see a forum like this. This is the main reason I come to the site is looking for ways to strenghthen my critical thinking skills. I think med surg scenarios would also be good. I am just trying to be a better nurse.