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.

Sounds pretty good to me Kathy!! I think the $65 for admit is low, (Between 75 and 85 by me) BUT, if you don't have to complete OASIS for peds, and well mom and baby, then your paperwork may not be too bad, so that is a good rate. The $60 per re-visit is nice. Only, there aren't too many re-visit for well mom/baby, just usually for sick babies, and maybe for poorly healing C-section wounds. The thing about pay per visit is, if you aren't working closer to your home, your travel time is on you. I assume you will be paid for travel miles, and I hope your rate went up to the gov't standard of $0.405 per mile. Good luck with it Kathy, and here I thought you were guy named Tom!

My agency supplies everything, and I won't repeat what is said above. I also do like my own tympanic thermometer, but I also have a digital oral thermometer in case I run out of covers, or I want a double check of a temp. My agency supplies the tympanic, but I had a lot of problems with it, so I found one that used the same covers at Walmart, so I don't need to buy covers. I do buy the plastic covers for the oral one though, bt they aren't expensive. I used to buy a drug book, but now the agency supplies that too. The reason is, they wanted everyone to use only thier book to teach about meds consistently. I also have a small Englis/spanish medical terminology book. The books weight you down! So, for that reason, I use a backpack from L.L.Bean. It has tons of little pockets. I keep alcohol packets in one pocket, hand cleanser in anout outer pocket, and it even has a larger pocket in the front that can hold my sharps container. I also bought 2x2 sized band aids for those people who are post cath or have a large dressing S/P CVP line placement that needs to be replaced with something smaller. In my car, in the trunk I have another box of bigger supplies like the foleys, irrigation sets, etc. I also have pt ed materials in there. Esp Lovenox injection directions, insulin inject directions and lots of diabetic instructions. Someone mentioned insulin syringes. Don't leave home without them. If I had a dollar for everytime a pt got D/C with insulin but no syringes...ugh. But worse is the insulin pens w/o the required needles to attach, since we don't have those, but at least you may be able to draw up insulin for a few days for the pt until they can get the needles. This will only happen on weekends when pharmacies are closed and you can't get the doc on the phone. Tom, I do believe you MUST be supplied with personal protective equipment, that is OSHA law.

I am looking in my Estes Assessment book, maybe erythema nodosum, but that name makes me think it is very red, but if you are talking about what I am picturing, it is not red.

I don't think you are doing anything wrong at all. I think you must be in a tough area. If you were in NJ, they would eat you right up with maternal/child experience, maybe the areas they will send you to are rough, and they know from experience they have a high turnover?? If I were you, and you really want to make a go of it, I would make friends with the hospital Case manager/discharge planner/ social worker/ Home care Liaison (whoever/whatever the title, the person who arranges homecare for your pt's after discharge) on your unit, and ask their advice. After all, it is these folks who send the referrals to the home care agencies for PP visits, or well mom/baby visits. Ask them which agency they like best, and also consider the county health department, they love Maternal/Child nurses (in NJ anyway.) I see ads for health dept or Public health nurses all the time, and they always say Maternal/Child health exp preferred.

What is the accountability of the shift super? It seems to me like it is easier to call you than to work at the staffing herself. My friend did what you are doing, and was terribly abused for a year until she said uncle. She went in and threatened to quit unless they were able to get an agency in. She was excellent at her job, so lucky for her, she was given free rein to use her judgement in offering all kinds of deals to staff and agency as needed, double time if need be so she could get enough sleep. I know it was very frustrating for her as almost her entire day was consumed with staffing issues on our very understaffed unit.

Has anyone gotten their assignments yet? On the road yet? Are you using laptops or paper tools? This is my first year. Everytime we hear the data is ready, it has to be re-run, so we continue to wait for our assignments, getting more anxious as the available days to get it accomplished in tick by.

I only think it would be wrong if he didn't know them. He obviously doen't do this to a new resident he doesn't know, right? What is the harm here? We are talking about one human being brightening another human being's day, in a facility where they are living until their end comes? I for one am glad your co-worker makes these folks feel special. I hardly think it is sexual in any way!

You have gotten great advice above. I can't add to that. What I would suggest is that, if the above measures don't work, see if you can get a Leave of Absence from the program for a few months. In that time, work as an aide in the hospital. You will gain a lot of experience in just being in the environment, interacting with pt's, other nurses, docs, and you will absorb info by osmosis, but not have the clinical pressure. yes, you will have your own pressures as an aide, but not the same level of fear as nurses I think. If, by working as an aide, you are still feeling very nervous, and hate the experience, you can save yourself the additional grief. Good luck to you. Let us know how it works out.

I have no sympathy for you whatsoever. Those patient's are being treated based on your falsifications. What if someone had a stroke because you didn't find out their BP was sky high, but you charted a normal one??!! I would have canned you the second I found out you made up a pulse ox of 96% when it was actually 80%. Shame on you. Get out of healthcare, you are scary!! I see things like this and Thank God my own doctor doesn't "trust" anyone to check his pt's vitals and does it himself!!! And this is a power trip to you? You need help! Please get some counseling. It is OK to be human, to not be able to complete all tasks safely if you don't have the time. It is OK to admit you need help, or you couldn't get something done in the alotted time frame. That is acceptable. What you did is completely morally, and ethically unacceptable. There is never a time that what you did would be acceptable under any circumstances!! Take an Ethics course for God's sake!!!

I guess it does depend on the person. I am usually pretty sensitive to meds, tylenol wipes me out. (Cheap date.) I guess it is more the surgery than the CS. That has to be gone by now. I need to eat some spinach or something!