GmaC13

Wow when I get on here an read these stories I realize how good I have it. I am paid hourly. We currently are not required to see a set number of pts. I do work a lot of over time but am paid handsomely for it. We usually see 3-5 pt a day but we have to do everything in the office from answering phones, getting insurance authorizations, faxing , meetings, supplies etc. I often can not get my paper work done. We are on computer but they do not work well. Just this week my computer quit on me in the middle of a SOC of a very complex wound ostomy pt. That was Tuesday and I just finished his admit today. I hate always being behind but we can come in after hours or on the weekend on the clock to catch up occasionally.

I can relate to the dog story. We have been caring for this elderly couple for about a year and working hard to get them into assisted living. I am not the case manager so I only see them occasionally. The case manager had arranged for them to visit a few local assisted living facilities to see what might work for them. I went out to do a routine catheter change and asked how the visits went. The wife (who needs a walker to get around their single wide trailer) responds " oh those places where just too expensive so we decided to stay here and get some puppies" She proceeded to show me her 2, 8 week old pups. I nearly busted up laughing and knew the case manager would blow a gasket after all of her hard work trying to get them place. The pups where so cute it was hard to be mad. I love my job but at times it is so frustrating.

Teresa You are correct in that the pt is not expected to live more than 6 months as a matter of fact she passed last weekend. My concern was nursing practice in general. All of the guidelines that govern how nurses handle medications say that meds need to stay in the original bottle. I really didn't think it would harm the pt but is it leagal? Still not sure my self. If I had been the nurse finding this I would have advised the family to use the oldest meds first and put the other bottles away until the oldest was used up. I wish the legal aspects were more clear. thanks for your input

I work in a small rural HH/hospice agency. Recently one of my co-workers did a visit with a hospice pt. She found that this pt had multiple bottles of medications. She apparently is on some type of automatic refill plan. The problem is she would open a new bottle each time she got a delivery resulting in many bottles of the same drug with different expiration dates. The nurse decided to combine the meds into one bottle (like meds of course but different dates) 5 out of 6 nurses in our office were concerned that this is a violation, Poor practice at least and expressed our concern to our director. We were told there is no problem with mixing these together as long as they are the same strength. I still disagree but am not sure how to find some guideline that says this is wrong. Anyone have similar experience or input.

I once had a hospice pt whose wife was at rimes difficult to deal with. Her name was Drucilla and around the office we some how started referring to her as Cruella. I was in her home one day near halloween and had on a scrb top with Cruella on it. Her little granddaughter pointed to Cruella on my top and asked "Who is that?" I blurted out "oh that is Drucilla" Then quickly tried to correct myself and say Cruella. The pts wife was not amused. My face was beet red.

Hospice is the best nursing I have ever done. What other job allows you to go out and help people with thier dying wish. Recently I had the honor to help one of my pt get married. We actually performed a marriage ceremony in thier home. Our hospice chaplin did the service. My sister (she is an RN working in the same office) and I were the witnesses. Our secratary took pictures. This wasn't really nursing but it surely contributed to this pts emotional and spiritial well being. It was so wonderful to push to get this done and be a part of it. We hospice nurses are truely privaliged to share in the pt's most intamate moments. PS I get the best of both worlds because I work in a small agency that does both HH and Hospice. Great balance and satisfaction. I love the work I do.

Where I work we do get paid what the hospital nurses do and yes I think you all should. It is a shame that HH/Hospice nurses are treated like the red headed step child. I work for a hospital that requires membership to the union and it sure helps with pay. We get $4.50/hour to carry the pager and 1.5 our regular hourly wage if we are called out. We are garunteed 2 hrs and get milage. I'll bet none of the hospital nurses are expected to get up at 2am, drive 40 miles, take care of the pt and then work a full shift the next day. We desrerve that pay!

You are right there actually shouldn't be "excess" sponge. The sponge should be cut to fit. I am currently caring for 3 pts with wound vacs. I was trained to cut the sponge to fit the wound as close as possible and when in doubt slightly small is better than sightly big. There are other factors that affect your healing. Are you eating enogh protien? You need 1.5 gm per kg of body wt. I always encourage my pt to increase thier protien intake to assist with granulation and have seen great results. Best of luck.

I am trying to get an idea of how other agencies handle getting the ICD9 codes and insurance authorizations. I our small agency we have to depend on a coder at the hospital that really has no idea how to code for HH. She does not understand that we need supporting codes if we have a V code. She has not been trained for HH coding. Nice lady and all but not effective for what we need. Also insurnce authorizations are done by the admitting nurse. Sometimes it is impossible to get moving to see the patient because you are waiting for the insurance to call or fax. I worked for a different agency where we had an intake nurse. She did all of this and much more. Are there actually other nurses out there required to get insurance auths and figure out your own coding before you can go on and be a nurse?? Thanks for any input.

We did have a social worker for hospice but she was very part time. She had her own pratice and was not redily availble. She saw our hospic pts (the ones that would let her come) about every 2 weeks. She recently quit to get married. They ahve hired someone new that will actually be 20 hrs per week but only for hospice pts not home health. She won't be starting for a few weeks. I have thought many times of getting out but this is a very rural area and there is not much available without a major move or a long drive. Thanks for your input.

Where I work we share call. We each take call at least once weekly (5pm-8am) after working a full shift and expected to work a full shift the next day. We are paid $4.50/hour to be on call and 1.5 our hourly wage if called out. We are garunteed 2 hrs if called. If we don't have a consecutive 10 hr break our following shift is paid at 1.5. We do a full weekend every 4th weekend. This is from Friday at 5 to Monday at 8. We do have scheduled pts, admits, resumtions you name it and handle every call that comes into the office. For the 8 hrs seeing scheduled pts we are paid our regular hourly rate then the $4.50 per hour to be on call. Some weekends are great, getting paid to lounge around the house or shop. Others are killers. The pager never stops and you get so tired you are usless. We genrally hate our call policy and would love to have something new but change is very hard in our little agency.

We are currently recieving multple complaints about the same subject. Realisticly our nurses are currently seeing 3-4 pt in 8hrs. Administration coninuously reports that we are well below the standard and that other agency see far more pts. Unfortunately we are expected to be secrataries, intake nurses, insurance billers, phone answerers, supply runners etc,etc. Dispite our repeated complaints that we do not have any support staff we are just told its always been that way, deal with it and see more pts. We have a census of about 50 pts, combination of HH and Hospice. We have 2 full time nurses, 2 part time and 2 per diem. We do not have a pt care coordinator, only a partime secratry, no intake nurse, no social worker etc,etc. My frustration has gotten so high at this rediculous use of nursing hours I could scream. Anyone else have similar experiences?