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paradiseboundRN

paradiseboundRN

Home Health Nurse
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Content by paradiseboundRN

  1. I read a lot of posts asking for help with a narrative so here is an example for a SOC PATIENT IS 78 Y/O FEMALE POST HOSPITALIZATION FOR EXAC OF COPD. INDEPENDENT PRIOR TO HOSPITAL PMH: COPD, CAD, HTN, ANEMIA, NIDDM. CURRENTLY, A&OX3, VITALS WNL. USES 2L/NC OXYGEN CONTINUOUSLY. DYSPNEA WITH MINIMAL EXERTION. LUNGS SOUNDS DIMINISHED BILAT. NEW NEBULIZER AND RX FOR ALBUTEROL. ADMITS TO STRESS BLADDER INCONTINENCE. POSITIVE BS X4. SHE HAS A 0.5 X 0.5 X 0.2 CM WOUND (SKIN TEAR) ON HER RIGHT ANTERIOR FOREARM. POSSIBLE TAPE BURN. WOUND BED IS BRIGHT PINK WITH NO DRAINAGE. BANDAID APPLIED. FBS 110 TODAY AND COMPLIANT WITH GLUCOMETER AND 1800 ADA DIET .EDEMA: 2+ PEDAL BILATERAL, LEFT INSTEP 28CM, RIGHT INSTEP 26CM. RATES PAIN 2/10 IN BACK DUE TO ARTHRITIS. UNSTEADY GAIT, USES WALKER. INDEPENDENT WITH ADL'S EXCEPT BATHING. LIVES WITH BROTHER WHO IS MAIN CAREGIVER. PLAN TO TEACH COPD DISEASE PROCESS AND MANAGEMENT; TEACH MEDICATIONS, SAFETY, NEBULIZER, HOW TO DECREASE EDEMA. MONITOR WOUND. Basically you need to write the story. What were they in the hospital for? Medical HX? and then go through this list. I usually chart by exception, meaning that if I didn't mention it, it does not pertain or is normal. I added normals to this example so you could see how its done. All of this assessment data is in the OASIS anyway but most agencies want you to write a narrative. I might have missed something but this is the basics. Hope it helps. orientation vitals lungs oxygen exertion level bladder/bowel wounds pain edema FBS if diabetic diet ambulation assistive devices ADLS support system/CG new meds (coumadin, insulin) new DME or equipment
  2. This is the new reality. Medicare wants patients out of the hospital as soon as possible and does not want them readmitted (at least within 30 days). So one of the specialties with the most jobs for the near future is home health care. Home Health keeps patients out of the hospital. I want to bring this to the board members attention because I see a lot of posts from new grads about starting in home care. No, home health it not a good place to start your nursing career because you need the experience of the hospital. However, the problem is that many cannot find a job in a hospital to gain that experience. I get it! You want to work! You want to be a nurse! You want to make money and use the knowledge that you worked so hard for! Ideally, after about 2-3 years working in the hospital you would be ready for a job as a home health nurse. But unfortunately times have changed and they are not adding hospital nursing jobs. So unless some of the hospital nurses retire or leave there are no jobs there. So how do we solve this problem? The only answer I can think of is to lower our expectations of experience to 1 year of hospital or long term care nursing. Also to have new grads work with an experienced preceptor for the first 3 months or more when starting in home health. What do you think? How do we solve the problem of --How do new grads to get their experience to be home health nurses?
  3. I'm thinking about quitting my Home Care intake job (45 hrs/week, salary blah,blah, blah...) and doing an intensive online RN-BSN program with WGU. The problem is that I can't start the program until April 1st. So, I want to do some home care agency work for just a few months. Does anyone know of a company in Detroit area that staffs home care companies?
  4. paradiseboundRN

    WGU RN-BSN in 1 1/2 years??

    I started WGU RN-BSN on 4/1/13. I spoke with my mentor last night to set up my courses for my first term and she said that it will be nearly impossible for me to graduate in 6 months and 1 1/2 years is most likely. She said that more courses have been added recently which makes the program longer. I explained to her that I will be working only 1 day per week (if they call me in) and plan to devote 40-50+ hours weekly to studying. I have no children at home and my husband is also working on a degree with WSU. I have some pre-reqs to take--micro, statistics, bio-chem, and behavorial psych. But, I have been a nurse for 14 years: med/surg, case management and home health for 11 yrs. I have already taken 2 RN-BSN classes plus nutrition that didn't transfer. Furthermore, I had a 4.0 in college! She listened to me but said she really doesn't like to accelerate students that much. Needless to say, I was very surprised. I was hoping to finish in 6 months but 9 months at the most. Am I being unrealistic? Do I have a lot more courses to take then others do? I was so motivated and excited to start but now... Any advice is appreciated.
  5. They called me for a phone interview and I just wanted to get the scoop on them. Thanks in advance.
  6. Here is a quote from the BSN community site mentor: "Hi everyone! I know that there have been some rumors about finishing the RN-BSN program in 6 months, and I wanted to clear up those rumors. A 6 month finish is highly unlikely due to the fact that certain courses can't be taken in the same term;please speak to your mentor about this. However we encourage and support students to accelerate through courses at their own pace It IS possible to finish the program in two terms (12 months) - and I have actually heard of students completing it in as little as 10 months - but 6 months is definitely very difficult. I know this may be disappointing to those of you who may have been hoping to finish it in 6 months, and I do apologize for that."
  7. I started the RN-BSN program 4/1/13. One of the reasons that I chose WGU was reading the posts about how fast the program could be completed. Well, I want to clarify that for those of you that are considering WGU for the same reason. What the posts fail to tell you is: 1. The students that have completed the program in record time ALREADY have a bachelors degree in another subject. So most of their prerequists are already done. 2. They completed the program before WGU added additional mandatory classes. They seem to add more each semester but after you start you are grandfathered in. Don't get me wrong, you can still accelerate. I've finished 8 classes this semester but I still have 9 to go due to pre-requisites. Be careful what you are reading. I've noticed that posters leave out the "I already have a degree part"
  8. paradiseboundRN

    Beware of what you read about how much time to complete RN-BSN

    Congrats! But you have to agree that many posts are from students that already have a bachelors degree or took the program over a year ago.
  9. paradiseboundRN

    WGU won't accept per diem nurses

    That sucks, I have also worked most of my career per diem for the same reasons. I'm a current RN/BSN student. I wasn't asked much about my employment except that I needed to send a resume. Don't ask/Don't tell :)
  10. paradiseboundRN

    Health Assessment Class

    First of all, the pre-assessment is much worse than the objective assessment, so don't get discouraged by that. The preassement was written by the school? and the objective test was written by the NLN so there are no multiple choice answers. The questions are refreshingly concise, and not misleading. Many of the questions were easy and about 15 I had to guess at. I had no anatomy questions. Most of the questions require you to know the abnormals and normals but not what the abnormals mean. Don't waste time memorizing all the diseases. I did have at least 20 infant questions. I would spend time reading each chapters examination techniques, as there are a lot of questions about positioning. Also, concentrate on the infant and I had a number of questions about heart sounds which I thought were hard. Hope this helps.
  11. paradiseboundRN

    WGU's New MSN curriculum

    Here is some info if you are currently in the RN-BSN program and may want to switch. I'm currently in the RN-BSN program and was considering the MSN education track before these changes. I called my mentor about the changes and she said that students can change tracks in between semesters. My semester ends in September 30th and the new MSN programs may or may not launch in September. If I finish the semester before they launch than I can change to RN-MSN and be grandfathered into the old RN-MSN program. I'm not going to be heartbroken if I'm not able to do the old program, but if I can, I'll take advantageous of it. The person to call at WGU regarding changing your bridge program is Mary Pugmire.
  12. I think what you are really asking is why are there no HOSPITAL jobs available? When I started nursing school in 1997, they best information they gave us was "when you graduate, there will not be jobs in the hospital, the jobs will be in the community" and for the most part this has been true. The problem is the nursing profession still wants all the new grads to work and learn for the first 2 years in the hospital. Great idea, but how is that supposed to happen with no jobs? Even if the older nurses retire, the new model of care is away from the hospital. We need to be thinking how these new nurses can get experience outside the hospital. For example. home care agencies have many job openings and the patient acuity is growing rapidly. The nurses in home care do everything a med-surg hospital nurse does except give blood. We need to provide new grads preceptors and educational experiences outside the hospital so they can get their experience and a job. The jobs are out there, but you're not looking in the right places!
  13. paradiseboundRN

    Advice on HH Books, Gadgets, and More!!!

    Here is some of the stuff I used, if your agency does not supply them: 1. pill boxes at the dollar store to use in a pinch 2. a fast electronic thermometer at the drug store or a tympanic one if your agency allows 3. a hand mirror for looking at back of legs/feet easier 4. a couple of pencil case size bags (Walmart used to carry sturdy ones), Ziploc bags, or small plastic containers to use to separate supplies in your bag 5. a notebook for your car for mileage, notes, etc. 6. a GPS 7. Either carry a drug book or if you have a smart phone download "Epocrates". Its free and its the best drug resource book around. 8. a flashlight. That's all I can think of for now. Good luck!
  14. paradiseboundRN

    Wondering about books

    I really don't like reading extensively on a computer. Therefore, before I start the class, I go online to Amazon.com and look for a used version of the textbook for the class. So far, I have been able to get them very cheaply. This way I can highlight, etc and I don't have to be on the computer all the time. And as a bonus, students get Amazon Prime free shipping!
  15. paradiseboundRN

    So confused about SOC?

    If you are working a weekend, call on Monday morning to get orders. Call the doctor that is going to sign the 485, which is either the doctor that signed the original order from the hospital or the patients family doctor. Ask him if you can add PT/OT and give the reason. You should be calling him/her anyway to let him know that the patient has been opened and what the plan of care is (this is a Medicare regulation). If you can't speak to the doctor directly, leave a message with his staff, but be sure to get the staff's name so you can put it in your charting. Request a call back from the staff member that he said the additional services were ok to add. Regarding the lab work, the home care office should get a copy of all the labs. You're going to ask about that. The other option is the call the lab yourself, they might give you a verbal or will fax a copy to the office. A lot of questions are going to come up as you move along in this new position. You will need to find someone at the agency to ask these questions to. If you don't feel comfortable with your manager, maybe one of the other nurses will help you. These questions are normal for a new home care nurse, you shouldn't be embarrassed to ask them. Hope this helps.
  16. paradiseboundRN

    Iphone Apps for Home Health

    Epocrates is the best drug app around. Its so good I can't believe its free!
  17. paradiseboundRN

    Help I have a HH interview this Friday

    There are many HH agencies out there. You need to decide if this is the one you want to work for. Here are some questions that you should ask. Try to remember, you are interviewing them too! Is this agency non-profit or profit? Affiliated with any hospital? How long has the company been in business? Where do you get your referrals? How many referrals per week? What is your usual census? What territories does your agency cover? Which territory has the greatest need? Which territory do you want me to cover? Do you pay mileage? What is the current rate? How will I get paid? Hourly? Salary? Per visit? If per visit, how much for a SOC?, ROC? D/C? If salary, is their a minimum amount of patients I need to see per week? Point structure? Will there be extra pay if I exceed my quota? How does your on-call work? extra pay? Will I be working weekends? How often? extra pay? What is your turnover rate? How much seniority does your employees have? How long will my orientation last? Will I have a preceptor?
  18. paradiseboundRN

    Are all home care agencies a disorganized mess??

    oh yes, many HHA's are a mess! But thank goodness there are so many agencies out there to choice from. There is no reason to stay with a bad one. I do know changing jobs frequently takes a toll on the nurses' psyche, but its better than being used and abused. The caseload number can be deceiving, as some of those patients may be 1/month catheter changes, so the important number is visits per week. A full time nurse in home care is expected to see 5-6 patients a day. Many agencies use a point system and a FT nurse must have between 28-30 points a week. RV=1 point, SOC= 2, Re-cert=1.5, Resume=1.5, D/c=1. It is very common to have a scheduler. Their job is to assign new patients to the nurses and other disciplines. I do know of some agencies that try to actually schedule what day and time the nurse will see the patient, but it never works!
  19. paradiseboundRN

    CHF and weights

    You can measure calves/ankles/feet as long as the nurses all agree on how to measure. For example, if you are going to measure calves, how many centimeters from the knee or the foot? If you can agree on it, then all the nurses can compare measurements and monitor the edema correctly. CMS (Medicare) likes to see measurements for edema.
  20. paradiseboundRN

    Baylor Opinion

    What is a Baylor position? I've been 11 yrs in home care and have not heard of it.
  21. paradiseboundRN

    New grad & home health?!

    This topic has been talked about a lot. Check the searches.
  22. paradiseboundRN

    What do you do if a patient needs to go to the hospital?

    If they absolutely refused to go now, then I would call the doctor to let him know about the refusal and the possibility of the patient going later. ALWAYS call the doctor in these situations! Then, I would chart my butt off about it. In my note, I would use the exact wording that the patient and/or family said in quotes. I would chart that I notified the dr and my manager (if appropriate). I would chart that I explained to the patient and family the possible outcome if he does not go to the hospital and they verbalized that they understood.
  23. paradiseboundRN

    WGU transcript evaluation appeal

    Both my husband and I tried to appeal, no luck!
  24. paradiseboundRN

    WGU RN-BSN in 1 1/2 years??

    I don't know anything about that. I think you messaged the wrong person.
  25. First of all, if your interested in a flexible RN-BSN program with affordable tuition, check out Western Governors University. I have been in home care for 11+ years. There was only a handful of times that I felt unsafe and it was because of the neighborhood, not the patient. I wouldn't let safety get in the way if you want to do home care. As far as the paperwork, home care requires a lot more than other specialties. Thankfully, most nurses have laptops now and that makes it easier. You get faster with the paperwork, the more you do it. You're right that you won't have "time off" like the school job, but if you want to be challenged and really use your nursing skills, do home care. Hopefully, most employers realize that home care nurses are doing almost all the skills that hospital nurses do. I don't think an employer really understands what school nurses do. So I'd have to say home care looks better on a resume. Nursing in the community, such as home care, is where the jobs are going to be in the future. The specialty of home care is growing rapidly and will continue to do so. It is getting harder and harder for nurses to break into the specialty without having experience. If you have a job offer, that's great. Since school nursing is your only experience, if you continue with it, you may find it hard to move into another kind of nursing.
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