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CooperNurseRN

CooperNurseRN

HH, ER, Primary Care, QI, Risk Mgmt,
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CooperNurseRN has 15 years experience and specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

A true nurse at heart...always looking for a way to make a positive impact in the world we live in.

CooperNurseRN's Latest Activity

  1. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    UPDATE: I have hired 4 new RNs so I'm only one RN down at this point. They are in training. I have hired a mixture of RNs- a couple with previous home health experience and a couple without. So far, everything is working out well. They are eager to learn and excited about a new career path. The clinical supervisor and I work with the scheduler to ensure that the visit load isn't overwhelming. She and I are both case managing about 70 pts each to keep other nurses from getting overloaded as we train the new ones. We've both been on call for over a month now. However, there is light at the end of the tunnel and I'm confident it's not a train. :-) I think the existing staff can see that we do genuinely care and want to help them maintain that happy life-work balance. I have to say that I've gleaned a lot of insightful information from this site...from how I might be perceived to ideas on how to develop a more cohesive team. I'm always open to idea, suggestions, etc. So thanks to everyone who has commented.
  2. CooperNurseRN

    Admissions/corrections for other nurses...who is responsible

    Since it was an admission visit, I can see where she might want you to make the corrections. She hasn't seen the patient so she might not be able to answer the questions. She should have made the corrections when she did visits for you, though. If it's just the coding piece and calculating the frequency, then she should have no problem answering the questions. At my agency, we try to have the RNs do their own starts but sometimes it's impossible. So, when an RN does any visit, she's responsible for completing all components....coding...corrections...hha care plans..calendars..etc. Then she is suppose to give the RN assigned to the case a report and let her know of anything that is still pending so the bal doesn't get dropped. Any corrections go to the person who did the visit. If I were you, the burning issue for me would be the fact that she did not do her own corrections when she did an admission for you. I think I would remind her of that situation and tell her that you're really overwhelmed with your own workload. Ask her if she could complete the rest of the paperwork for you since you did this for her. Surely, she will. I would talk to your supervisor if this approach did not work. In the end, your supervisor may still have you make the corrections. Consider it a lesson learned. I'm sure you're very frustrated because you feel like you were taken advantage of. Good luck!!
  3. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    DKS3132: A neutral party from our HR department conducts the exit interview. HR gives me the feedback. I try to make improvements based on that feedback. The subject of micromanaging is a valid one and something that I'm doing some soul searching on as well. I don't like to think of myself as being a micro manager so I work at that one. It's a difficult balance because the issues that my own job performance is evalated on is often directly linked to that of my staff. So~ I try to offer feedback in a coaching style so we can all reach our goals. Honestly, I'm not perfect in that micromanagement issue. Gosh~ I do try though because I completely hate being micromanaged. I am probably more guilty of micromanaging issues when they arise. I have lots of projects and other tasks that I'm accountable for so I really do have a whole lot of time to micromanage anything. Especially now that we're short staffed. Your point is well taken though! Thank you. My primary reason to be on this site was to investigate if our caseload/ visits per day is too high and if our internal processes were not supportive enough for our RNs. Someone had commented on a start of care being more time consuming than a recert. They take about 3 hrs to do We realize this and give it 3 points. I can do a recert in about 2 hrs. But we go ahead allow 3 points for a recert too so the RN will have plenty of time for proper coordination of care, chart reviews, etc. I've actually been able to gleen several outsider perspectives and a few good ideas from this website and I'm very appreciative.
  4. CooperNurseRN

    Need Advice....

    Don't be offended by what I wrote. I've never worked in the OR but I have quite of bit experience as a trauma RN in the ER. So I understand what you mean. When I said controlled environment....I mean that we don't have everything we need right there at the time that we need it. I understand that the OR requires constant prioritization. The OR nurses that I've hired really dislike the fact that they are never really "finished" with that patient until the end of the cert period and they don't like the feeling that their work day never ends. As you know, with home health, you prioritize and do what you can get completed in your day. You shift everything else to the next day and it starts all over. Some people just don't like that type of feeling. I've hired 2 OR nurses in the past year. Neither have worked out. My comments come from the issues that they struggled with. Both were very sharp nurses. Home Health just wasn't for them.
  5. CooperNurseRN

    Anyone do VA Home Based Primary Care?

    I think the VA Home Based Primary Care is a relatively new program. My agency also sees VA patients that are on a contract basis with the VA. The VA's program is probably an hourly position and is going to be regional. They are going to outsource those patients who live in areas that are outside their coverage area to other home health agencies. I think it will be interesting to see how successful they are. I know they have Health Buddy telehealth which is also what my agency uses. They have all modules, I think..which are DM, COPD, and CHF. Recently, I spoke to a social worker about the VA and told that they deal with quite a bit of psych issues in the home based program. I know that the VA is big on following the standards of care and working with clinical guidelines so I would be those things would be incorporated into their delivery of care. The vets I've dealt with in my own agency have been pretty high acuity patients, ie wound care, DM. We tend to have a some difficulty getting things like home PT, OT, ST approved and I'm sure it's due to the expense.
  6. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    We have a neutral party conduct the exit interviews in order to get the most accurate info so I do believe their opinions that they are working too much are valid to them. I'm struggling with how to make effective changes for a happy medium and still have a financially healthy company. I believe our computer system is a huge part of the problem. We use Misys which is a powerful system. But it takes longer than paper. The IT staff and I have priortized updating Misys and streamlining it to reduce the duplication of documentation. For us, a start of care averages about 3 hrs- maybe more if there are lots of meds to be entered or care to be coordinated. One bit of info we received from the exit interview from one of the RNs was that that a start of care took her about 7 hrs and we expected her to do 2 of them a day. I wasn't sure how to comment to that. Once again, I questioned how I might have failed her in her orientation process. A start of care should not take anyone 7 hrs. AnnemRN posed the question about whether they are effectively case managing their patients. Some are and some aren't. Our QI department is finding all sorts of things we need to improve upon. And that's OK... I'm tickled we have a QI department. We have office support for them to send faxes, write orders, note orders, make schedule changes. We scan and email the faxes to the RNs so they will be informed. Yet we've still had some incidents where the Case Manager didn't read an email and missed an order. We're all human and that's bound to happen on occasion. Our outcomes need some improvement. We really manage our type of visits using productivity points. A nurse for our agency should never have 3 starts and a recert. That's way too much. She could have 2 recerts and 2 supervisory (routine) visits. However, that's recently been changed. Our nurses are not suppose to be scheduled more than 6 productivity points per day. A start is 3 points, a recert is 3 points, sup is 1 point, and discharge is 1 point. Our nurses have spaced out their sup visits so they never have more than a couple a day. So they have 6 productivity points for 4 days per week with one office day where they don't see any patients. I really appreciate the feedback about the discharges. I think I might have offended a couple of nurses by asking questions or by conducting reviews. That was not my intention at all. Whereas I can see how they might feel their judgment was being questions; I'm very careful how I word that conversation because I know how I would feel. I really do view the process as havng another set of eyes looking for something I could have missed. When I was a case manager and I was struggling for a reason to recert, I had no qualms about asking someone to take a look to see if they could find something i'd overlooked. I suppose I assume others are that open. I also realize how all case managers (including me) are prone to manage their own case load when they are understaffed and overwhelmed. I've done it. I've been there so I definitiely understand. My stance has been to really work to be in a proactive staffing position so the RNs don't feel the need to self manage their case load. I've not always gotten approval from my exec admin team. But I've been able to mostly keep the patient load around 30-35. We have a couple of RNs who have occasionally crept up to 40. I try to get a few of their patients reassigned as soon as possible. Ironically, those RNs are still with us. Another point of dissastifaction is that RNs who resigned really did not like to make visits for other nurses. We really try to make sure this doesn't happen. However, there will always be times when it's unavoidable. They mostly see their own patients though. Vacations, call ins..or even those days when it'sa Friday and the RN has 4 or 5 recerts to be done may result in another RN making some of her visits. It's not optimal...it does interfere with continuity of care but it can not be helped. The built in office day may also cause an RN to have to see someone else's patient so an RN can have that office day. Bottom line is that the office days are dispersed evenly so they all get one...they all take vacations.. and we're all on the same team. We do not employ part time RN case managers at this time. We're not opposed to it. It's sometimes difficult to find that seasoned RN who only wants to do part time and it's really difficult to train a part time nurse to do home health. Thanks again everyone for the feedback. Keep 'em coming. Everyone's comments really force me to think about things from others viewpoint and is very helpful.
  7. CooperNurseRN

    ICU Nurse with a HH Interview Soon, What to Ask?

    *How may patients you are required to manage? *How many visits per day will you have? *How many miles per day will you average in driving? *What is the mileage reimbursement? *Does anyone assist with coordination of care..ie office staff? *What kind of QI programs do they have? *What is their philosophy about using home health aides? *What is the on-call like? *How large of an area will you be covering on a routine basis? What about when you are on call? Do you have anyone to help you on your call times..ie LPNs? *Do you have scheduled office time? *What is the expected turnaround time for your documenation?
  8. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    KatyRN~ the staff definitely know that we offer a flexible scheduling. That part of the office culture has been present prior to my arrival and it's a huge perk. You may be on to something with my communication style. In this forum, I could see where it might come across as being cold, rigid, and formal. That's not my personality at all. Live and in person, I'm warm, fun, and open-minded but always fair and consistent. That's how I perceive myself. (Hopefully, I'm not looking in the funhouse mirror..haha) The nurses actually seem to be comfortable talking to me and their direct supervisor. A couple of the nurses who left actually were the ones who told me that they felt like I was questioning their nursing judgment when I offered to help them look for a reason to recert by doing a chart review. That's how I learned that bit of info. I respect them for telling me. It's not easy to give your boss that kind of feedback. They weren't being mean or catty when they said it. I believe they were being honest. We have a neutral party from another department conduct all of our exit interviews. We also do anonymous exit surveys to try to ascertain even more information. More on that discharge issue.. Our exec admin really scrutizes our number of discharges so I do reviews to make sure they're goals are met and well documented, that they are truly homebound, etc. And I can totally understand how some nurses could view this as being micro- managed. So I go into great detail to explain that sometimes, a fresh set of eyes can pick out something that they might have overlooked. I had suggested letting them do peer reviews but that idea went over like a lead balloon. lol. I am directly involved with the QI department so we are always conducting chart reviews on wound care patients, patients who were hospitalized, etc. Our approach is to provide QI feedback to the group as a whole without divulging the patient name or the nurses involved. Occasionally, we will have to meet with a nurse individually and coach her on what was missed, etc. I'll be honest, we've had a bit of a learning curve with some of our nurses both the new ones and the seasoned ones. As we have really revamped our QI department, our nurses are getting more feedback than ever. It's never derogatory or demeaning. I don't believe in that style of leadership. However, some nurses are receptive to feedback and some aren't. My position as the Administrator is unique in that I'm actually middle management. I have an exec admin team above me and one clinical supervisor below me. I have to tell you~ middle management is tough. But I accepted the position so I accept all that goes along with it. I always make the exec team aware of the staff concerns. Both the clinical supervisor and I are solid advocates for our staff. But we also have to carry out the instructions of the exec admin team and try to meet the goals they establish for us. Sometimes, the goals are negotiable but often they are not. So we work diligently to come up with solutions that are win- win for both. Perhaps it's the nature of a for-profit organization that is causing unhappiness. Our patients receive the services that they need. The staff members, clinical supervisor, and I are unwavering in that aspect. However, with all of these Medicare changes, we really have to plan ahead and really be smart how we spend their healthcare dollars. I'm not sure of any agency that can send a home health aide out 3 days a week anymore. One of the nurses told me that she didn't really think she should have to worry about any of the financial aspects of patient care. This made me really question if I had failed her in some way by not properly defining the role of a case manager when she was in her orientation phase. I love the idea of improving the socialization aspect. I'm already thinking of things to do. I'm not in any way trying to say that my company runs a perfect organization. We wouldn't have had the staff turnover of late. I definitely get that. But so far, I'm hearing the workload isn't completely unreasonable.. and that we seem to fair in what we expect of the nurses in the coordination of care aspect. A communication mishap? Perhaps. I'm doing some soul searching on that one. I've worked for employers who were cold, demeaning, and even derogatory. I sure hope I don't come across that way. It's definitely not my intention. I'm thinking my frustration with the situation is pretty evident. I'm working through that..... it's another reason I'm here....seeking info, suggestions, and tips.
  9. CooperNurseRN

    VA's

    I've had experience in the VA system. One was superfantastic and the other was a nightmare. I began moonlighting in an ER at a rural VA Medical Center. At the same time, I was also working in the regional trauma center. I was accustomed to working with the ENA protocols and standards. The rural VA had great nursing staff- all very bright, eager, and excited about taking care of our vets. What amazed me was the times when I've had to pull a near dying patient from the vehicle when I had suggested they call 911 a few hours prior to their arrival. Their rationale was that they could not afford to go to their closest ER. I would educate them that the local ER would stabilize them and transport them to the ER. It didn't matter. These vets have been trained throughout their years with the VA to "hurry up and wait" and that "everything closes down at 4:30pm-even if you're dying." Of course, I'm exaggerating a bit but if you all have experience with the VA system, I'm sure you've heard those quotes. I do believe the culture is changing and I am so happy about that. For the most part, the vets I cared for were always so appreciative of everything I did for them. I felt very honored and rewarded during my tenure in the VA system. I can recall my first day at the VA..I was standing in line to get my name badge. I had to go to the intake clinic to do this. The intake clinic was where vets went to get signed up for the first time...but it was also the check in for the ER. While I was in line, I met a gentleman who was having chest pain. He was standng about 2 or 3 people behind me in line. I noticed he was diaphoretic and ashen looking. I was trying to get him to the head of the line but he was ever so polite and kept saying that he'd wait. I finally grabbed a wheelchair and just wheeled him over to the nurses station so he could get prompt treatment. He was in fact having an MI. During my first few weeks, I encountered situations where patients who were in the ER to rule out an MI had to walk over to the radiology department to get their xray. These examples were common place. I'm really proud to say that my co-workers and I were able to change the culture of that VA- to follow the standard of care so our patients received safe and timely health care. I have fond memories of my experience there. However, I later transferred to a large tertiary VA Hospital in Florida and worked in their ER. They did not have enough exam rooms to take care of the sheer volume of patients. That set up was destined to be disasterous. The nursing staff had little to no trauma experience. They had no set triage processes- it was first come first serve. We had all kinds of things happen in the waiting room that would just give you nightmares. Most ERs have an element of chaos to them. It's that uncontrollable chaos that kept me from sleeping during my time off. I had grown fearful of losing my nursing license because of something I couldn't control. During my last month in that emergency department, we had 3 sentinel events. Thankfully, my name wasn't anywhere near those charts. I made suggestions to the Medical Director and the Nurse Manager about possible protocols and processes to develop. They loved what I had to say. In the end, I felt as though that battle was more than what I wanted to tackle at that point in my life. I chose to leave in order to protect my career. I don't think their issues were due to people not caring. I think the overhaul that was required for that ER was so massive and overwhelming that no one really knew how to begin. I bet their were issues with the funding of such a project as well. I've thought about that place a few times and wonder if improvements have been made. My father goes to the VA Hospital in Oklahoma. I have to say that he has received nothing but top knotch care. I'm highly critical of healthcare when it comes to my family members. But I've got to say I've been impressed. Not only has his care been exceptional...it's been timely. Kudos to the Oklahoma VA system!! Bottom line~ every facility is unique. They all have their own culture as well.
  10. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    Once again, I genuinely appreciate the feedback. It's great to hear someone else's perspective. Yes, I agree that communication styles can really morph the intended meaning of a statement so your point is well taken. You had some interesting comments about the loneliness factor. Perhaps that is why they have felt unappreciated. I never considered that. With regards to the staffing model, as previously mentioned-our RNs never drive more than 1 to 2 hr per day- unless they are on call. And a typical day would be 2 -3 visits/day for 4 days of the week and a built in office day once per week. If the nurses need to pick up their children or attend a school function, we have no problem working with them on those things. I'm also a single mother so I understand the need for flexible scheduling. Thanks again!
  11. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    All of the nurses had exit interviews and all have said that they just worked too long. They stated that they did not have any issues with their clinical supervisor or me, the Administrator. We had one who felt underappreciated. Our scheduler is the best I've had the pleasure of working with. A couple of the nurses who left recently were ones who were quick to judge and tell others that they could do it better. However, when I consulted with them to allow them to make their suggestions for the good of the whole, they had zero suggestions to contribute. I believe that they did partially taint the newer nurses which is a shame. I was very impressed with the hospital nurses. They actually made fantastic case managers. They really seemed to resent my questions about discharges and seemed to think that I mistrusted them. My company is working diligently to grow our census. However, we do not color outside the lines or ask/do anything that is fraudulent. I have a high standard of ethics and will not work for an organization that does not. There are lessons to be learned from any conflict. I'm committed to gathering as much information and learning from this experience.
  12. CooperNurseRN

    Considering Home Health but not buying their story . . .

    I have to tell you that I think you are not getting a competitive offer. I realize that rates of pay do vary depending on the region. However, your offer seems really low. My advice would be to conduct a salary survey. Go to salary.com and find out the rate of pay for your area. That websight isn't always correct but it will let you know if they are even close to what you should be paid.
  13. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    Ladies~ come on out to Oklahoma....where the wind comes sweepin' down the plain. And the wavin' wheat can sure smell sweet. When the wind comes right behind the rain. :wink2: If anyone is seriously interested..send me a PM..I'll give you the sweet details.
  14. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    Out of the nurses who left our agency, we had some who were new to home health but coming from the hospital and some were seasoned home health nurses. The hospital nurses went back to the hospital. The other nurses went to another agency for less pay, more frequent call, and no company car. No feedback on whether they have regrets.
  15. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    My agency is in Oklahoma. We reimburse for mileage. I can't imagine not reimbursing for mileage. We have some nurses who cover the Oklahoma City area and we reimburse mileage. However, for our high mileage drivers, we have company cars which have a fuel card and maintenance card so they don't have any out of pocket expenses.
  16. CooperNurseRN

    HH Administrator Seeking Feedback About Productivity

    I haven't heard of anyone in my area decreasing rates of pay yet. There have been layoffs and hiring freezes at the hospitals though.