carwin

Report it. These actions are the source of billions of dollars in medicare and mdicaid fraud. That nurse is not providing care and is stealing.

Yes have the lab fax to the doctor but you still call to make sure they receive the results and get your orders. if you draw a lab, you are responsible for obtaining and reporting the results to the ordering clinician. Then, CHART it. I always say call the lab yourself because labs drop specimens, they don't pick up specimens and you won't know until you call them. I will leave that nation-wide lab un-named.

RN 1263,well aware of the subject, just sharing a little extra knowledge picked up from CMS surveyors. Whatever is done on ANY computer can be tracked by the IT person and your software vendor. Some software vendors term is a work log which shows who did what on any chart. No one can say they did or didn't. Do something. We have clinicians sign forms at hire giving permission for correcting the OASIS after a phone call (paper or point of care). The corrections are made after a phone call to the clinician. We complete a correction form and place a copy in the clinicians mailbox and personnel file. RN 1263, reviewing those forms allows me to see which questions are a problem (widespread or individual)and I can address that in a staff mtg or 1:1.

I code and I lock the OaSIS. That's a little paranoid. Home care is trust all the way around. Office staff have to trust that visits are really being made on the dates that are stated and that what is being written was actually done. Clinicians have to trust that their work is not being changed. Quite frankly, if I could change anything, it would be the revisit notes. Many people have a difficult time completing those to reflect that skilled care has be delivered. What makes you think your company is doing that and if they are, why not report them, why do you remain? Continuous locking and unlocking can trigger an audit. It's called teamwork. You are throwing the one having to lock and unlock your OASIS under the proverbial bus. I don't change anything because I've not seen the patient. I don't know your situation or your skill level in completing the OASIS but many agencies have not oriented as well as they should as well as having occasional reviews. I have my nurses select their answers by starting with the last answer and working backward. Remember you are selecting the answer by what YOU OBSERVE the patient doing SAFELY!!!!!! Did you see them put on pants, pullover a shirt, can they read and comprehend?! Always let us know about poor vision, HOH, dribbling is INCONTINENCE!!! Some people are incontinent because they can't get out of the chair and walk to the bathroom quickly enough. Writing from phone right now but I will post the link from CMS for the chapter that tells how to answer the OASIS. It also states the intent of each questions. We all need to frequently review this info. I've been in the field and I understand. Home care is a team effort. I first preserve my license and that of my clinicians. I hope things are better than you think they are!

The accrediting bodies charge for their services. Why would they come out and risk not getting paid? Many people do not know that the agencies pay for those surveys. Those surveys are a few thousand dollars even if the census is around 15 patients. Notify your state home health hotline. If you have to report them. It's no crime in being broke. My most timely pay including direct deposit was from an agency that I found was making up visits. I quit. You see the obvious. Why not just stop accepting patients from them? At some point, they won't be able make your check good. I don't know what you keep up with outside of seeing patients as far as the home health industry goes but this industry is undergoing big changes. Many of these changes are some that will close the smaller agencies. The recovery audit contractors' audits can take money back if the documentation from field staff does not follow the care plan. Agencies have shutdown real fast due to those audits. I hope there are other options. By the time payroll is affected, things are bad. That means that there is no line of credit securing the agency. An owner knows people won't work if they aren't paid. Good luck to you. I hope there are several options for you.

I welcome you to the profession. So sorry this happened to you as a new nurse. This is why I like to see new nurses in facilities first before striking out in home health or private duty. I feel you need to be mentored by the nurses you interact with daily. Then in a situation such as this, you know your skills aren't a question. Especially because you're new to nursing, I think your supervisor or DON should give you the reason why this happened. As many have stated, it may be no big deal. I wish you well. Please try to find opportunities to be mentored so that you increase your skill level.

I knew just knew you were in fla or southeastern michigan. These are two areas that are overrun with home health agencies. Cash flow can be a little goofy at times in home care. I've been at well established agencies and had that happen but they been able to move money around to meet payroll or cover you the same day. You really should look for another place because of 1, you are in fla and 2. If they can't get money in a day or so, it's only going to get worse. The economy is bad , lines of credit are hard to come by and these younger agencies are often started by engineers who started the company with their Ford or GM buyout money. Good luck to you

Try calling a family member

Completely agree with txredheadnurse. While many of these workers are not trained along with having limited education, many have some of the biggest hearts. I worked for a home health agency where the owner had 5 group homes. The workers often called needing toilet paper, cleaning supplies and yes food! These workers have pooled money to buy food, deodorant for clients while the owners get GOOD money to care for these residents. THe group home owners skimp on getting qualified help and/or fail to train good-hearted staff. Many wat to know more and the owners won't put out money to orient. As with any job you have some who do the best they know how and want to do better and those who know what to do and are too lazy. The oversight of the homes is sad.

Sooooo true Nurse156. My concern is that you are not separating your work and personal times. Nursing is very demanding physically and emotionally. Work on building a strong, positive personal life so that you won't need to rely on your professional life to fill that need for you. If you lost your job, then what would be your support system? Take care of yourself.

Keep your relationship with your patients professional. Ditto ArwenEvenstar. I heard of a case where nurse is taking care of Grandma. Nurse and Grandson start to date...then comes an ugly breakup! Grandson calls the state board of nursing and tells how Nurse would give GM ibuprofen or an enema, etc. Nurse went through the blues with that. Never confuse the relationship! And I don't friend co-workers. My FB is family and very close friends. Co-worker don't need to know all of you comings and goings.

The legal mess would be creating a visit note or OASIS when no visit was made.

Give it a try. This is a large company that should have an organized orientation process. Contrary to popular belief, home health nursing is not the "easy job" or "in and out". Just because you're sitting in the family room seeing the patient, your professionalism must remain intact. Anything you report to the RN or MD in acute care, you do in homecare. Documentation is everything. You will be teaching meds, disease process, etc. Doc what you taught and patient's response. You will marvel at the impact you'll have on teaching patients and or their families. You must be organized and approach it very business-like as far as setting up visits so you're not wasting time and gas. Call patients the night before and verify the next day. See those patients first thing, and complete that paperwork daily!!! Best of luck!

The "need a paycheck" mind set is one of many reasons we're not a profession. Bottom line, a new nurse requires learning experiences that are interactive and varied before taking on the very independent role as a home health nurse. When you sign up, you're saying "I can handle this". In home care, you ARE the backup. That's why the patient is at home because a competent, confident, professional nurse has been provided. The only back up you need is 911. The doctor's expectation is that you would have assessed a situation and handled it. The doctor expects you to call to say this is what I assessed and this is what I did or planning to do! You are the eyes and ears out there! Please respect your hard-earned licensed. Don't offer it up so easily! And don't get me started on the fraud side of HH that greedy agency owner can pull on the newbies! Home health agency owners love you guys.

It takes about 18-36 months to get a medicare number. You will be paying out of pocket to see patients until you can bill m-care. There are way too many changes that are decreasing payments. Until we see how all these changes come to pass, I would not even think about it. Docs are more apprehensive about referring patients because they don't know if an agency is playing right or not. The bad guys have made it hard for the ones who want to run an agency right. Good luck to you.