yayanurse

I am working with a start up agency and the average numbers of our visits are much higher than the national average. We had 55 visits on one pt in a cert period. Is there any guidelines I could refer to so this does not happen again?

Take away that the nurse also works in a doctor's office....if the patient is still eligible for the services then I do not see a problem. It's a small world in the medical community and nurses frequently work for more than one employer. It's good that the doctor thinks highly of the care that your agency provides that you get repeat business.

Could anyone give me some guidance on where to dispose of sharps in the home? If I draw labs do I carry a sharps container in my bag to dispose of used sharps and then carry sharps from pt to pt? We are a new agency and do not have a clear policy on this. Thanks for any help.

My thought is if you don't speak up, you are doing a great injustice to yourself and those who follow you. Is your time worth more that 10 bucks an hour? Agencies are able to negotiate when it is an exception. Speak up...LOUD AND CLEAR. You ARE worth more than 10 bucks.

Sometimes we have to learn by doing....is your agency new?

Good luck to you. I am also new to home health care in an administrative position. I often wonder what ever possessed me to take on such a challenging job but I have to admit I love it most of the time. If there is anything I can help you with please contact me. There is a LOT of information on line. I think it's very important to have a reliable backup source for information because there is just so much too learn.

Can anyone point me to where I might find what incont supplies are supposed to be supplied to home pts. Is the agency responsible for supplying unlimited supply of briefs to pts?

I just left a hospice position because of the unreasonable workload with a census of 23, on call 10-12 days/month, if I was on call w/e it was guaranteed I'd be out 10-12 hrs each day. We were also doing all our admissions, no triage for phone calls, and we covered multiple counties in PA. It was not unusual to drive 300mi+ on weekends. We were also told they were trying to hire, but it just seemed to me that were hiring more administration than practicing nurses. I found out that they LAID OFF our on call nurse in March 2006 and were not actively looking for a replacement because the rest of us could pick up call. This company laid off LPN's as our census was exploding. I felt used and disrespected by this company. The RN's were salaried so it didn't matter to them if we worked 60,70,80 hrs/wk. We actually made less per hour than the LPN's and some of the CNA's. Also no comp time, and if you were off sick you can be sure they used you vacation time. This is the 3rd largest hospice in the US owned by a major nursing home corporation and they posted a very nice profit for the 3rd quarter of 2006. You would think that a corporation that depends on its nurses for it's livihood would treat them better. Instead they spend their money on fancy seminars for administrators, and stupid bright green buttons for employees to wear to advertise their service. We need to speak up about these unreasonable workloads. It is not fair for the patient and their love ones to get the kind of minimal care that is provided when the nurse has a heavy caseload. It is not fair to the nurse to have to give up family life for a heavy caseload. I am not talking about the occasional spike in patient census. I put up with an increasing case load for 8 months until I said ENOUGH! There are other hopsices out there that care about the patinets and nurses. I would pursue a position with them. Good Luck!

Does anyone ever have missed visits and what do you do about them? Do you know the Medicare regs for snv frequency?

Some questions to ask are : would you be surprised if this person was dead in 6 months without curative treatment? If the answer is no, then this person is probably eligble for hospice benefit. Also what is the underlying reason she needs amputation? The main criteria for hospice eligble is the pt must have a prognosis of 6 months or less to live if the disease runs its normal course AND the pt/family wants hospice care vs curative care. Also if this person is having pain, I would not wait until a meeting next week. That would mean she would suffer that much longer. Can you place her on hospice inpatient or continuous level of care until her pain is managed? Also get IDT members involved, sometimes it takes a call from the hospice medical director to the PCP to get things moving. Remember pain is what the pt says it is and she is the one living and dying right now. I have a pt that takes methadone 145mg q6h and Roxanol 180mg q1h for breakthrough pain. This pt has been such as education for me for pain management and I have really had to advocate for his PCP to increase his pain meds.

This person may just not want to suffer any longer. I have ALS pts who choose not to be vented even though that could prolong their life. Maybe this person does not want to live life less than whole in their eyes. If the docs won't increase pump, do you have a med director who can order increases? I think, as hospice nurses, we have a duty to provide comfort for those entrusted in our care and the biggest thing is pain management. You need to advocate for this poor soul.

Go for it. I became an LPN at 43 and RN at 53 (May 2004). Sometimes life gets in the way of our plans but it is never too late to pursue your dreams. If we don't have goals in life, we might as well be dead.

I work in a small 25 bed facility. We do team nursing so we are fortunate to have an aide do our vs. But it requires good communication between all of us on the team to know when the vitals are out of norm, when it's the machine, what is normal for that particular patient. etc. I think I would rather do my own vitals with assessments, but i'ts a time thing too. The docs want the vitals before rounds and if BP and cardiac meds have parameters that affects the dose, you need to know the vs before administration.