twokidsmom,rn

I have a pt that knows that he has to be homebound for care. Has stasis ulcers. But has no family and needs to go to supermarket for food and goes to MD and WCC appts weekly. He does try to do MD and supermarket stops at the same time and supermarket is not far away. Uses a walker and it is taxing for him to leave the house takes hours to do the short trips that he does do. I consider him homebound.

But the nurse who did the SOC which the 485 is taken from should know what is on that 485. Lately we have not received a copy of the 485 for weeks. We usually see our own cases but sometimes if going on vacation or might see a pt for someone if they are too busy.

Most BSN programs I have looked into are at least 10K. My nurse friends that are in classes have to take things like statistics and are always doing research papers. I do not think they have to do any public/community health class. That would be a good thing if they did. At this time in my life I can not fit school in with home life and work not to mention tuition.

When I see a pt for another nurse I get report from her before I see them. They tell me everything that I need to know and I can ask questions.

Many specialties require a BSN in order to sit for there test. I am a home health nurse and I do not have a BSN. Many of my fellow classmates are going for there BSN when asked why they do not have an answer. Too rich for my blood. I will stay a low ADN nurse.

Thanks. Was talking to another nurse she said that if the staples are not inserted straight that no matter what they will hurt coming out.

I live outside of Philly I get $35/visit, $65/SOC and $22/hr for office work. Lately have been seeing 5/6 pts a day. Our census is low right now. With Medicare cuts do not see any increases for a long time.

I feel horrible. Have a pt with a total hip replacement removed 46 staples on day 15 (Wednesday). Site looked fine, some pink in middle of incision but no drainage and she has been doing alot of walking. Also on coumadin INR is 2.5. Had her take pain med before I came. As I was removing staples some were very easy to come out others I had to wiggle out. She grabbed the bed rail and yelled that hurts. I feel so bad, never had staple removal hurt that much. After it was all done she said the pain is back down to 2/10. No drainage, covered with DSD, used a few steri strips in middle of incision and end of incision. Will see her friday to remove DSD plan on leaving it OTA. But concerned about how much pain she was in during removal. Has anyone had this problem? Called her later in the day she said she is fine and no pain.

I know exactly how you feel. I was seeing 40pts a week and working every weekend all summer. I found a company that promised me 6visits a day. So I changed companies. BUT I am going back to the other company. The new company is also a hospice and when your on call one night a week you can be called to hospice pt anywhere and any time and when your oncall one weekend every 7 weeks the same thing. Also they have you leave report and you have to depend on the other nurses that see your pts to leave you report. I am a case manager and have to decide to DC pts that I have never seen? My old company hired 3 nurses after I left. My old boss called me and asked me if I wanted to come back if not she would give my territory to someone else. I decided to go back as long as we will have help. So I do not have an answer for you. The grass is not always greener. Good luck on your decision.

When you are oncall you have to answer the phone. No matter who it is a home health or hospice pt. All case managers have to be on call at night once a week and one weekend every 7 weeks. Not an option.

If you work for a company that has both Home Health and Hospice. Are you ever on call for both? The company which I am leaving has the RN case managers on call one night a week and every 7th weekend. When your on call you can see home health and hospice pts. Of course if your on call and a hospice pt has past or if family wants a nurse there you have to go it does not matter where they live too it can be over an hour away. Recently nurses have had a few 2am deaths and had to be at work seeing there own pts the same day? You get paid time a half for the visit time but not for just being around. Also we were told if there is a hospice question or a problem your not allowed to call a hospice nurse you have to call the administrator that is oncall which is not a hospice nurse. Glad I am getting out before that happened to me.

I was bit on the ankle by a parrot. Was doing wound care on a patient when her parrot came up behind me and grabbed my ankle. Broke the skin. I cleaned it applied neosporin and a bandaide. Next day feel lousy, red around wound but no pain, no drainage. Has anyone had this experience.

It is a skin tear on his elbow and forearm. Not a stasis ulcer, he bumped into the doorway and tore his skin.

Should I use telfa instead of adaptic? Or will that dry it out too much?

A non approximated skin tear. Caretaker applied adaptic and tegaderm. It now has white area in center.

Make $35/visit and $65/SOC. Live in Philly suburbs. Went to a $33/hr job but did way more driving since territory was 20-40 min from home and office was 30min from home. Thought I would like it better but feel like I truly live in my car. So going back to the close to home company and paid per visit just hope they don't run be ragged again. WILL LEARN TO SAY NO!!!!

My boss from the company I left 2 weeks ago called me. She wanted the phone back and wanted to check with if I am sure I did not want to come back she had a nurse that she would hire if I did not want to come back. She has hired 3 nurses in the last 2 weeks. She wants to pair up a part time nurse with full time to help with visits. And I would not have to work every weekend with the new help. The area would be close to home and would not have to travel 40 min from home anymore. So I decided to go back. I have found out that the company I work for you have to be on call as a home health and hospice one night a week and many have been called out to pronounce in the middle of the night. The company I work for now territory is 20min-40min from home and I have been leaving my house at 730 and getting home after 5 every night. So I decided to go back. Told my new company and they want me to stay for 2 weeks. So no more complaining just have to deal with it things are not always greener so if things get bad again I will just have to deal with it.

I am starting to think it is me. I worked for a per visit company and was seeing pts 6 days a week sometimes 7, 35-45 pts a week. Now working for a company that I am a case manager and see 6 pts a day no more than 7. They have many PRN nurses do many visits and SOC too. ANd on call once every 7 weeks and one night a week. Still not happy, maybe I am not cut out to be a nurse. I have much less paperwork at home since I have time to go to the office daily and do my paperwork while being paid. But many nurses do not follow up with things. Any change of condition I call the PCP. Two weeks ago when I just started with this company there was a missed visit on a weekly pt. No one put in a visit the next day just missed the one visit that week. Well I saw him last friday, I did not have the INR machine with me and did not have an order so I called PCP before my visit to see if he wanted an INR. No one in the office till 2pm. I would not consider this an emergency and the MD would not have his chart if not in the office. Pt was going to see the PCP later that day on Friday afternoon. When I called to tell him I was coming today son told me he was in the hospital since Mon. I asked if he went to the PCP that day. Son said no he refused to go. Over the weekend his gum started bleeding, he refused to go to the ER. Monday the son called 911 and then he went. Well INR was 11 and needed to be transfused. What do you do with this? Who ever missed the visit should have told the scheduler to have someone see him the next day not just drop it. THat is what I would have done. THese are the things that bother me. I either am too busy and putting my pts before my family OR worry when someone else see's my pts and do not do what I would do. AHHHHH.

WOW! I would LOVE that too. I get $33/hr on call one weekend every 8 weeks. BUT on call one night a week. Have not been oncall yet for this company.Have been going into office daily and it is 30min from home. Hope to cut that down to 3x/wk. CONGRATS!!!!!!!!!!

We have a on call but I have worked holidays. If a wound needs to be changed it does not matter what day of the week or if it is a holiday. Also IF a patient gets discharged from the hospital the day before a holiday then a SOC needs to be done. But we all take turns on working a holiday. Fourth of July was horrible for me.

Congradulations. I like home health but trying to find a company that is more flexible and allows me to have a life. Right now I see 6 pts mon-fri but I have decided to stay PRN for my previous company just in case this new one does not work out. I still have 3pts with the old company and they all live 5 min from my home so it is not too bad but still work a few hours each weekend. Will have to choose a company soon, I am working at least a little every day. But it is great to hear that some people love there jobs. Congrats!

I have found that case management is not a 9-5 no matter what agency. I am still doing charting at 9pm after working all day too. Thinking about going back to a hospital so I can leave it at work. I guess case management is a 24/7 type job

What do you do when discharge med list was different than what pt was on. I called PCP no answer left message will fax ROC list with meds from hospital in the AM. Also faxing verbal order for PT since he is SP fall. Nothing too bad lasix decreased, no colace listed, toprol was discontinued last month but is on dc list, and no KDur listed but K was WNL.

KateRN what is your average freq? With this new agency MANY pts are 1wk visits.

I became a nurse at age 40 graduated 2008. Worked as a CNA all during school. Worked on a med surg floor for 2 yrs before going into home health. Worked for a company for over a year. I did everything from CM to all the visits. The last 3 months which was all summer I was seeing between 36-45 pts a week and saw pts every weekend. Summer was over and I did not spend much time with my kids. Only went on 2 long weekends for vacation. So I decided to try another company. I just started there 2 weeks ago. I am a CM full time. Was told would be on call one weekend every other month since they have 7 CM. THey have 8 PRN nurses who do visits. I am to see 6 pts a day. I also kept 3 pts from my other company to keep my foot in the door incase this new company did not work out. My issue is I worry about my pts ALL the time. I thought by working for a company where other nurses will help with visits and I don't have to do all the visits that would help. But I can not turn it off. I worried all weekend about a pt I saw Tues S/P hip replacement and she has CA. On Tues incision had small opening temp 99. Called ortho, set up appt for the next day. Another RN went to see her THurs. THe RN told me the pt was coming home from a Cardiology appt and had a echo done. Incision still had small open area and was draining, temp 100. She put on a DSD. That was it. I did not get a chance to call the ortho on Friday was too busy. Called the pt over the weekend to check on her and to set up a visit time for Monday. SHe did not answer and did not call me back. BUT I WORRIED ALL WEEKEND AND CAN NOT TURN IT OFF. I am thinking I am not not cut out to be a nurse. THings were so much eaiser when I was a CNA. Just helped people and no issues to deal with. But of course made no money. Do not need health benefits. ANy advise would be greatly appreciated.