Silverblitzen

Nope, no scorching from me, only a hearty agreement. It's why I just left nursing. Our central agency was offering our company everything that came down the pike and our company accepted EVERYTHING in order to keep the contract, even if there wasn't staff to deal with it all. Money is the bottom line. Consequently my teammates regularly have 10-15 clients a day, are constantly sick, and work till the wee hours of the morning doing paperwork and faxing. I refused. I asked a friend on the team how many she's usually assigned and she said from 12 to 15 clients a day. That's starting at 7 in the morning and not finishing with the clients until 9 or 10 at night. That is not including the following paperwork. She's just handed in her resignation and has accepted a position at LTC where she'll work her shift and be able to interact with her family and not be called to do visits on her days off. She's done this schedule for the last 3 years, as are some of the other team members. One just came back from an extended leave, with a doc's note that she not have over 4 patients a day. She's regularly being assigned 10 "because there's no one else to do it". This is unacceptable and if nurses continue to put up with these conditions, not being paid for all the work you do, it will continue. Most of you are not unionized in HH and it's showing. You NEED representation! Me? I've gone back to school, yes, at my age and I'm following my bliss. I've started in an enology and viticulture program (wines and vines) and dream of owning a vinyard of my own someday. I may be broke now, but I'm much, much happier. :yeah:All the best to you all. Sue

"It is too bad that agencies "give up" on these patients and will not allow nurses to continue to try and educate their patients." Hi Anna, You can only do so much with the time you have. For every one of the non-compliant clients, there are so many more that will love to see you, listen to what you say and care about their health. I'd say a safe measure would be the 3 strike rule - 3 teaching/reinforcement sessions and if they still don't follow the med regimen, they're discharged. Save your energy for those that care enough about themselves to follow what you're saying.:selfbonk: If there are other obstacles to their understanding, then other agencies may have to be called in, but you, as HH nurse, only have so much energy to give. Give it to those that are trying to help themselves because you'll soon find yourself burned out trying to force someone to be compliant who just doesn't give a rat's patootie. And you'll resent them which is counterproductive to that therapeutic relationship we're all supposed to have. So, rule of three and set them free! Yah! Best, Sue

Arwen, Well said. I couldn't add any more than what you stated. Sue

Hi Cookie, You have to be careful and really watch for burnout. I didn't catch your age, but those kinds of days can wreak a toll on your body. I did the same till I came down with pneumonia and was out of work for a month. I had to drop to part time and it's better, but those days I work only remind me of why I did it. Please be careful. Best, Sue

Uh, I think you're right about the CG not wanting to leave the little cabin in the woods! The body could be days old and she'd still be saying the poor thing was just sleeping! OMG! Let us know what happens? Sue

Ya know, I tried to pick just a paragraph to quote in order to save space, but that whole situation was just too much! I couldn't pare it down anymore:eek: What a horror story! Is she still with us? The CG sounds like a trip. And she knew nothing of how to take a pulse? How does one get a position as CG and not know how to take a pulse??? Sue

I've got to check in on this topic. Since I'm not a spring chicken anymore, I have to pay a bit more attention to the tootsies so..... I paid a visit to the orthotics store next to the hospital. While there I was directed to a brand called Naot. I bought a pair of black oxfords, not the most stylish shoes, but like wearing slippers with support! They have a removable cork insole and I can walk all day in them. Love 'em! Sue

Hi, I always take my shoes off in my house, and therefore, I take them off in client's houses. It's a long standing habit from when I had horses and also had a mud room outside the kitchen in which to take them off. So, I carry a pair of hard soled slippers to wear in client's homes. They seem to really appreciate it, and it's such a small thing to do. And it gives a good impression right from the start. JMHO Sue

I never thought I'd wax poetic about a PBJ, but with Fieldberry jam (Smuckers), and the crunchy style PB, OH MY! Sooo good. I try to make it a bit more nutritious by making it with flax/sunflower seed bread. Ummm. Sue

Yes, Ontario. I do think home health is the way to go, but there has to be some consideration to the amount of work one can do in one day. I'm past wanting to do 60 hour weeks anymore and that is what full time (anything over 22 hours a week!) had turned into. They'd continue taking cases, wanting to get to 100% acceptance (i.e., take any cases given to our group). That's a fine concept in principle, but if you don't have the field staff with which to do it, it's insanity! :heartbeat Sue

Hi Os, Nope, not prn. Regular part time. Our company doesn't offer benefits. We were promised a new contract by July 1 that offered 8 hour shifts, comparable pay to hospital nurses and paid benefits. Guess what. We got a 3% raise. Nuff said. I can start off the day with 6 patients and end up with those and 2 admissions thrown at me at midday. It's 2230 and I just got home and now have to do my calls and faxes. I have a nice glass of Cab sauv in front of me however, and the paper stuff may have to wait till the AM. Thank you for the kind suggestions. I need to think some more about all of this. Sue

Hi, If you figure on 8 visits a day at $21 a visit, that's $168. Adding the $48 in mileage for the 100 miles (hypothetically) gives you the $216. Of course if you live in your area and only do 20 miles a day, that would change the outcome. Still, you're getting compensated for whatever mileage you put on, and have the opportunity to make more money by doing more visits. If they pile the work on and give you more than 8 visits a day, it's even better. Of course, it'll depend on your client preference in the end because you have to be happy with the decision. Best, Sue

Hi all, I've been in HH for 4 months, started full time and am now part time. Even at only 3 days a week it's burning me out more than anything else ever has and the kicker is that I love this kind of nursing! I took an $11 an hour pay cut to do this, but my main complaint is that it takes over my life! The day off before I work, I'm doing admission paperwork, schedule adjustments, faxes, phone calls to schedule appointments and the list goes on. We have no benefits, no paid days off, no paid vacation time and we're all afraid to call in sick because our team members would have to pick up the slack. All my team members are physically sick and I don't know how much longer they'll last, but I can only change MY situation, right? What to do? Hospitals are crazy. :hdvwl:LTC, unless you get into a supervisory position are extended med passes and kill my legs. I have an ADN degree (AAS nursing) and I'm 58. I wish I could retire, but that's not an option. Any suggestions out there? Sorry this is such a whine, but it's good to vent now and then. I hope with all the accumulated wisdom out there, someone may have an idea of where else I could turn..... Many thanks, Sue

Well, I think it comes down to what you'd enjoy doing. Company 1 will probably offer more diversity but longer, fewer visits. Number 2 offers a more stable roster of patients, but less time on each and so more you can fit in per day. Lets figure on you driving 100 miles a day (it's possible!). That's going to take, what, 2 hours+ drive time with town traffic, stop lights, etc. Company 1 gives you 6 clients for the day so you have 180.00 so far in visits. Figuring each visit averages 1 hour, that's your 8 hour day. Period. Now look at company 2. Driving 100 miles will give you $48 more towards your day. With half hour visits, you may be doing 8 or more (our RPNs regularly do 16 visits a day! ) and that comes to $168 just in visits. Time-wise, driving the same mileage as #1, you've put in close to 4 hours in visits with the same 2 hours driving time and you have $216 with fewer hours. With easier paperwork, a more stable case load and more money, you're way ahead with company 2. Just my most humble Sue, who is about ready to jump in the shower and go do my 8+ hour day as road warrior!

In this case, no, I wouldn't call 911 but you now have a baseline with which to compare. He has edema and crackles so you know the heart isn't working at its maximum capacity. If he's up and feeling great, just continue to keep an eye on him as you know that he functions at this level. Beware of any changes, however, and if things start to go pearshaped and he's in danger of crashing, and you know a call to the MD isn't going to help the immediate problem, then call 911.:redbeathe Sue

Hi Anticoagulationnurse, And welcome to the crazy world of HH nursing. I've only been in the field since April, and it's a steep learning curve. You basically have to forget what you learned about hierarchy in hospital settings and consider yourself Social worker, Nurse and Ward clerk. You do the assessing, but the family is actually the unit of care. You wear many hats as there is usually differences of opinion within the family unit as to how Dad should be treated; at home vs. in hospital, should we keep Mom informed or not, and the list goes on. Your assessment skills not only take in the physical, but all aspects; holistically, if you will, of the client's health. You are the liaison between the client and the MD and your duties may include faxing your assessment to the doc after hours to see if further orders are needed. If others are seeing your pt on your days off, you need to update them on their condition and, likewise, they'll do the same for you when they see your patients. Now to your question. I'm now part time, as full time just sucked the life out of me and I got sick. I'm recovering from pneumonia and at home. My hours were supposed to be 8-4 but they were more like 8-8 or even later with all the paperwork involved. When you are considered 'case manager' you manage everything concerning this client. My day typically had 5-7 visits, on occasion 10 or 11 (OMG!) Then you get home and do all the paperwork. We don't have computers yet, so all is done on paper. It takes a LOT of organizational ability to keep it all, well, organized. The funny thing is, I like this kind of nursing. It's the way it should be, but there is a terrible risk of quick burnout and you must be vigilant of that. It's good that you're salaried (our organization is also looking into that, but it won't happen soon, I'm told) and have a set amount of clients to see. My bit of advice would be to keep the home office area clean and have a place for everything. I'm one that can't cook in a messy kitchen so why I expect to make sense of this mess of a desk is a big question for myself! Ask questions if you don't understand something - and communicate! Communicate to the MD, your teammates, home office and whoever else is involved in care for your clients. Whenever there is a change in condition, it should be reported to whoever else has contact with that patient. This is something I'm also struggling with - keeping everyone else informed. It can be overwhelming at times and I've been told it'll take me a year, at least, to get the hang of it. Be kind to yourself and watch the overload which will inevitably come. You have to be number one on your care list, so check all your systems before the start of the day. Stick to your guns as to the number of clients seen in a day. You'll be happier, your clients will be happier - and you won't be missing work because you're sick! Happy trails, Sue

Hi, more from me. To monitor a client is to use your assessment skills. The symptoms you see allow you to make decisions regarding your client. Symptoms of extreme hypotension are: urine output less than 30mls per hour, altered state of consciousness, dizziness, weak/thready pulse, but you'll also see tachycardia as the heart tries to compensate. If there's no muscle left in the heart, it will be unable to do so for extended amounts of time. You may also see some SOB if there's a lack of CO2 leaving the brain. If the situation has been allowed to go this long, however, giving him something PO isn't going to stop the cascade of events that this has triggered. In ICU there are usually standard orders for IV boluses or IV meds in this situation. If I see symptoms like this in the field, I send the client to the ER unless there is a DNR in place. Hopefully, by this time, I've talked to the family about this situation and it's expected. If those are the only orders you received, I think I'd be prepared to call 911. Then call the doc. In that order. Sorry, not meaning to lecture. :sofahider Best, Sue

Whew, first I had to convert from Kilometres. Taking 1Km to equal 0.63 miles, my .36 a Km comes to .57 a mile roughly. I think I did that right! :smackingf Ontario, Canada not-for-profit HH agency. Sue

Hi, I'd just continue to monitor, and notify doc if BP falls below stated parameters, and/or pt becomes symptomatic. Some people seem to live in these ranges, but I'm sure glad I don't! Best, Sue

Hi Jessica! Back in 2000, I lived in Tucson and took a summer contract at the Casa Grande Regional in the ICU. Great pay for a summer's work! Anyway, will your company be associated with the Regional hospital, or something completely separate? (I'm thinking if associated with the Regional, you may be able to take a tutorial at the hospital with the IT people. )There are a few threads here that deal with starting a HH agency, as well as some that deal with the associated comp systems. You might find some information there. Best, Sue

Sorry I can't give you any advice right now, but I'm a HH nurse with a Canadian not-for-profit company. We're looking into ways to circumvent the gas situation, as is everybody I'm sure. Our manager let slip that they are looking into ways to incorporate telehealth technology into our practice as one way to do it. I'll be plying his brain to find out more when I get up to the office. We have a wound care nurse that's pretty finely spread throughout the area and with this kind of technology, we could get instant wound care advice while on the road. I see a real use for this in the very near future. More and more people are being discharged to home, earlier and much sicker than before and I think HH will be used more frequently as a way to avoid hospital overloads. The telehealth systems will only aid that goal. I'll be glad to pass on more when I find out something! In the mean time, best of luck. Just think, you're on the forefront of an opportunity here! Best, Sue

I've been working full time and my day usually started around 8 AM. With faxing, travel to, from and in between clients, chart work (paper) and at home processing of admits for the next day, my days ran about 12 hours at least. I've done this full time for 3 months and my body finally said "Enough!" :sfxpld: I was healthy for 2 weeks, and off sick for 2 weeks - a never ending cycle and something had to give. I like my clients and I like this kind of nursing so......I've dropped back to 3 days a week. I'll do my every other weekend, but then I only have 2 days during the week. I haven't had time to try this as I'm home, again, with a chest infection, on two kinds of inhalation treatment, Clarithromycin and Hydrocodone cough syrup. It must be my body's way of dealing with an untenable situation. Is anyone else full time having this problem, or is it just me? Hackingly, Sue

I've always tried to do the 'circle' route. :rollI start with a few nearer to me, then plan on driving out to the farther ones, working my way back. That way, you're paid mileage from a distance closer to you, including the trip out to the farthest appointment, and including the route home to finish up the ones nearer to you. You're still driving the same distance, but being paid for a majority of it. Your way has the psychological edge to it as you're always working your way home, :specs:but you're not being paid for that long trek out to the farthest client. JMHO Best, Sue

Man, oh man, oh man.........! No advice to give, per se, but I'll relate my own experience. I'm 58, have had 21 years of hospital and clinic nursing in a lot of specialties such as OR, ICU, Telemetry, Med/surg, rehab, LTC, and palliative. I thought that I'd be able to sail into HH with no problems but I'm finding it's a whole different kettle of fish! In hospital I found that sometimes if I offered suggestions to certain docs, I was put down for even having an opinion, much less offering one. You get to the point that you wait for instructions from the MD and follow the orders. Yes, I know, we're supposed to have autonomy, BUT......in institutional situations docs are still God. I'm coming on 3 months in the field after what seemed like a decent orientation and I find that I'm second guessing myself constantly. In HH you are the unofficial doc, nurse, ward clerk, social worker. In other words, the family and patient look to you for all the answers, whether you know them or not. You learn to develop a good poker face, and search your brain like crazy until you can come up with something like an intelligent response to the constant questions while you're trying to chart. It takes an extraordinary ability to organize, and wear many hats at the same time. Even 21 years of experience is being taxed with this HH newbie! Best of luck in your decision, wherever it may lead! Sue Just me and Nuvi (GPS) beating the country roads of the Niagara peninsula!

Hi Jeff, I noticed that you posted this awhile ago, but in case you haven't had an answer, I'll comment. We moved from Vancouver because I wanted to be nearer family in Ontario and the price of just living there was too costly. Don't get me wrong, I loved the city, views, ocean, mountains, etc, etc. We lived in a second floor walk up apartment in the west end; the upper floor of a house. It had 2 bedrooms, was on a noisy street and had a druggie living in the basement apartment that used to do "yard work" at 2 am. Thought he was helping out the owner! This apartment which did not include utilities, cost us $1700 a month. The experience of living in Vancouver was something I'll never forget, but the cost of living, ...... Best, Sue