hoolahan

Does anyone in case management or in particular disease management have to meet productivity "numbers?" As in how many assessments per week, contact with members per week, etc... My manager is completed focused on numbers and doesn't give a hoot about quality in the least. As a nurse, I feel like my focus has shifted to a factory type job, having to produce so many license plates a day. I was just wondering if I am just being naive, and these numbers are so particularly important, or is HEDIS outcomes and quality of the contact more important?

I don't know of anything like what you are asking for. I can only offer that titration should be based on the half-life of the drug, and the effect it has within that time frame. In the CT unit I worked in, docs ordered titration, or weaning, of inotropes as 1 drop per hour for Cardiac index > 2.5. We generally did not have free range to increase inotropes, though at a different hospital I worked at we did, but there was no protocol and it was haphazard. But that's another story.

40.5 cents a mile. It went up 3 cents and gas went up 60 cents a gallon! Not much left over for wear and tear!

Just do what many of my patients do, they get a notebook, and just write in it. Some family's leave me notes in there, or questions, and I answer them, usually only things like "Please order more 4x4's and gloves" and I write "OK", and they usually want me to write down the BP and blood sugar, so they can take the notebook to the doctor with them. Nothing fancy needed. :)

I find this to be a very accurate portrayal of the attitudes I have encountered. Is it right? Of course not! But why fault the program or writers for doing an honest job? To sugarcoat it is to do a disservice to the struggles of nurses. If you ask me, it just shows what a perfect orifice those two docs are!

Ah, rub it in why don't ya! Just kidding, that sounds cool. Are you finding the diabetes and HTN measures very time consuming? I am assuming you are doing these, but I know the commercial MCO's do less measures than the Medicaid MCO's, which is where I work. Looking for eye exams in a 2 year time frame is totally disorganized sloppy charts...ugh!

She means Rustyhammer, one of the admin's on this forum, used to do home care. We have several male nurses at the agency I work for. It has never been a problem. It really isn't any different than the same issues you would face in a hospital. In some cases, a female prefers a female, and those wishes are respected, just as a male prefers a male in some cases.

Well, we got our assignments the end of the second week of March, and I got most of the appointments scheduled the following week. I have 4 counties in NJ, a total of 700 charts and over 250 sites. I have been on the road for 2 weeks, and the weather has been terrible, rainy, gloomy. Geez, I thought I'd be cruising abound in sunshine. At least I got some great new CD's to listen to on my new CD player in the car. I got a lighter assignment, probably because it's my first year, so I'll help everyone else finish.

I empathize with the situation. I agree that he should be let go. Your staff needs to know that you will follow up with your expectations, and it will give them faith in you, that you will not allow one self-important person to infringe on everyone else's free time by covering for his absences and lateness. It sounds like he thinks he's got you over a barrel, and since you are short, and he is a good nurse, he can pull his passive-aggressive power into play. If you could try suspending him for 3 days w/o pay, and then the very first time he is even 5 min late, he is out, not at the end of the shift, but right that minute. If you have already followed all the steps in your P&P, and there is no such option as suspension, he needs to be terminated. Good luck Melissa. I hope you are able to manitain your enthusiasm for many more years. Good managers are needed.

OMG, your agency is just like mine, except that we only covered one county, and we never had to cover the whole county except for rarely on the weekend. That kind of traveling is too much. I would go to them and say no way. Let the supervisor's do the re-visits, make them take away the revisits at least. You have 2 news, a resumption, and a recert? So four Oases?? That is crazy! Demand OT or a day off in exchange. I'd be out of there if they did that to be on a regular basis, no wonder you were sick! I put 197 miles on my car today, doing Hedis auditing. But I was home by 4pm!

I plead the 5th.

I did! Good to see you here. Well, you know, doo-doo happens. We can't all be saints 100% of the time. If they complained to management, I suggest you give them an apology and move on. A simple, I just wanted to say I am sorry I was short with you the other evening. Don't get too deep into it, but you obviously fo feel badly, or you wouldn't have mentioned it. Some family's are no bed of roses to work with either. I am sure your manager knows that as well. Maybe you can set some limits with them like you will give them 15 minutes of uminterputed question time while you ask a coworker to cover your people for that time. Ask them to write down all their questions. I know it sounds crazy, but sometimes these folks just want to know they are being heard. Good luck hon!

I used LOL = Little Old Lady, way before the days of lol on the internet. Just ask, and we'll explain them.

I never had to worry about this much, since I work the suburbs and city and am never too far from a hospital. So I will try to shed a little bit of light, but I am by no means an expert. 1. We had to use 3 labs, depending on if it was Medicare, or HMO. Each lab uses their own tubes, this can be extremely important when it comes to the PT/INR. So, as far as how much to put into each tube, you need to check with their policies, the lab whose tubes you use. I know there is a line on the label of most of the tubes I use, and a teeny tiny writing that says how many cc's are needed. If they give you baloney when you ask, ask if they have a package insert from the box the tubes come in, or ask for a policy on that test. Other than that I don't know what to say. 2. For bmp/cmp they have to be spun within 2 hours. If not, I believe it can become hemolyzed which will falsely elevate the potassium, and perhaps other components. So, I would imagine if you drive 45 min, someone better address that sample in the next hour, spin it at least. 3. I have always been taught to keep labs on ice, or in a cooler with a cool pack, but I am not sure if it is a must. On cold days, I use the cooler no ice, but hot scorching summer days, I am sure to use the ice pack. 4. I used to plan my labs to be first thing in the am or last in the day. So, if I had fasting labs, I went to that pt home first, got the labs, dropped off, then went into the office. We are lucky, we had a daily pick-up from the 2 HMO labs by 10am, and the Medicare by 11am. So, If I did it that way, I wouldn't need to go to the lab, just repport back into the office. Since my manager knew I preferred this, she usually gave me a call the day before, so I could get it together. She also lived down the street and dropped off charts and lab supplies for special labs she needed covered, like when another nurse was off, so I was just all-around lucky that way! Other days, best laid plans go to heck! Those days you just figure your day will be disorganized no matter what and you just do the best you can. Are there any satellite offices for the labs? We have a satellite in every township for the HMO labs.

Thanks for the plug Karen. Melissa, feel free to quote me, or print out anything from my site. I PM'd you too.