camoflower

We carry a tackle box with lab equipment. (the day a lab is due the supplies are on the cart for pick up, pkg'd with pts name) Kerlix/abd pads/ 4x4 normal saline tape cath kit must be on a barrier, sealed, in date we have to have a contamination package with gloves, shoe covers, clean up supplies, yellow gown, mask.. we use lots of wax paper for our barriers 1 box per week, our nursing bags set on the barrier we have Cavilion wipes/alcohol to decontaminate all our equipment used in home Perell hand sanitizer a small cooler for our blood specimens...in the heat of summer plastic containers with lids/away from dirty box weight scale...for SOCs and CHF patients to be weightd every visit

Its all about safety. Can they safely ambulate without stand by assistance at all times?You can mark the Oasis lower, and they can get better in a couple of days if they will work on their safety awareness- that you TEACH. We can go back as far as 24 hours. WALK WITH ASSISTANCE pays the agency more money. As for as pain, if a patient reads the pain scale and is taught the pain scale, and they still claim it's an 8 (when its probably a 4) we consider an 8 SEVERE PAIN, and really a patient in severe pain, not a patient that can sleep and state or claim an 8. So we will make an order, in on the POC, which will place the pain parameter, at a higher level than norm, to call and report to the physician. Like diabetics we have the parameters, we document, all the readings since last visit, if out of parameters, we call the physician. He in return will up those parameters so that we do not have to call him. (we even chart we taught or observed patient's using their own glucometers and are able to test them to see if they are working properly. Most of our physicians are beginning to refer to a pain specialist when their pain is always ""severe pain at an 8"". We push for those referrals.

Worse case scenario; in a wreck, someone dies, they see your badge......hospital gets drug into a lawsuit. Unless it was before your clock in. Its for the agency you work for.

I love home health. I am single. I can not see myself in this field with children, nor, if I did not have a very supportive husband. I have seen husbands bring in the equipment, bag, computer and phone verbalizing very sternly "she will not be coming back", that's how that one quit. Large turn over, you either like it or hate it. We see 5-7 patients per day, huge paper workload, get paid 8 hours per day, lots of your home time spent charting. Three years ago I could sit and politely chat to the patient and work too, lately I have my head down typing, like a mad squirrel. I feel rude, in their home, we get where we can't visit, because of all the paper work. Physicians orders are received, doc com made, verbal order made, calendar updated, slow computers ..takes time. Oasis knowledgeably takes time, months to learn. Organizational skills is a must. If it only paid more, if I could have some of my home time back. I'd stay forever. But, I've put 30,000 on my car every year, my salary doesn't reflect what I am worth, my files and supplies overrun the car. If you took my salary I probably make 8.00 per hour. I sleep with my phone, I wake up from dreams thinking...got a "BMP" order, did I put that order in, and order the supplies, and enter the date on the calendar...yes, you did. When we discharge, its call the doc get the order, enter the order, doc com the order, do the discharge, don't forget to document you provided a medication sheet, instructed the follow up ..then do the Agency Discharge. I sigh. We are the paper work charting masters. Car, no Friday nite date night, drive lots, charting never ends... I don't know anymore. I am getting so tired of working 60 hours per week.

Although nurses have = precious Limited time. You must address, by calling physicians, any red flags, or issues. Good doctors never let home health nurses wait for answers. I have one that I know who tells his staff to NOT to let us hang up without orders or answers. An hour later we are possibly 25 miles away and in another patients home...in the middle of a wound change or drawing blood when we get the return phone call. Instructions....clear and precise are given to the family. Our facility has the big magnet with our office number with instructions call and ask for a nurse for any questions. (Most patients have just come home from the hospital..and we know all too well some should have been able to stay a couple of more days) Whatever you tell them can and will be repeated several times. Even my age...I look younger than I am by 8-10 years....told a patient my age, told her NOT to tell anyone..she was so surprised..well guess what?..everyone knows now (and she pinky promised never to tell anyone) lol Ask physicians for perimeters ex: for blood pressures that are too low..even when a patient states "ohh all the nurses call and ask the physician the same question" It takes 15 minutes to call, 15 more to document (takes time) I was surprised to dig into the chart and see NOT every nurse will do it, or address it in the charts, but the State Inspectors will. Even if the patient is asymptomatic C.Y.A. put it in writing 80/60 acceptable with the medications patient is currently prescribed stated Dr. Knowit. Gotta paint that picture..every note must stand alone.

I work, finally, with management that shows appreciation every single chance they possibly can. I work with a really good group of nurses in home health...the sweet nurses. There is not a Debbie Downer in the entire bunch...and I love, love, love that. I joined HH in March 2012..from day one they looked me in the eyes, and smiled, when they talked with me. My bosses used to be HH Rns...they understand the sweating like a laundry woman by 11 am, the lethargy that arrives around quitting time, or saving some charting to do at home. Kudos to my bosses. Their Best advise..finish in the home..just make yourself finish. They say 45 minutes you should be done with your assessment, visit and charting D O N E. I have been HH two months, its still taking me over an hour to get it done, then the mileage/lunch/Medicare mileage rules from home blah blah messes me up a little now. The rushing ...is more stressful than driving. But I think I can do it. Rural roads - long drives - forget it. I make prob a 100.00 per day (ARKANSAS)...so being paid hourly is like $20 per visit. 5 patients 200-300 miles daily. I got to sit down and figure out..new VW..or run my vehicle into the ground at 20 mph...till the wheels fall off? or a used VW? hmm? Anyone got it figured out? If they provided a company car - I'd never leave. My boss called me to her desk this month...my heart sunk thinking the worst (thanks to my first boss I always think THE WORSE)...she said to me softly so others could NOT hear her.... "Hey, you are kickin.._ss" You get out get the visits done faster than others that have been here for years, fantastic charting, c y a cya..but call them doctors more and chart it if you do.. - you go girl...doing grrrrrrreat" (now I have heard from other nurses "you are not doing us any favors on not putting in for overtime"..so I have started putting in some overtime, which may bring my first growl from my managers. I think where is the incentive to go faster? (mine is to get it done and get home without work to do- to cool down in the shower!!) I have received two "star" awards from compliments from patients to my management. There is more feedback in HH from patients to management. So it seems like management talks with us more. One of our nurses quit after 5 years she got a 2 hour stop by if you can party, which most did not get to drop in for, of course, but the effort was made, and we got a text to go and join in at a Mexican Rest for a good bye lunch, on our 30 minute lunch)...top notch management. Here is what else I love, I love the music on the radio between patients. I love charting in the rain in my vehicle. I love seeing animals and farms. I love overhangs at Sonic and the half price icy cold drinks. I love people, the horders, the animals and after the 3rd visit they love me and offer me food (no thank you I am fine- so sweet for offering). However, I am not fond of lunch on the road. I am not big on take out foods...so, hospital lunchroom I grab and go sometimes when I take Labs to the Hospital, or make spring rolls with plum peanut sauce, I take along lots of ice water. Bowls of oatmeal and raisins with maple syrup is my thing...when sunflowers or fruit..I can eat it til 2 pm. This is not a job for Moms with children my son is just about grown and thinks I work all the time. I don't cook like I used to when I get home the heat drains. ..I am up at 5 am, taking report from my computer..accessing all info on my patients prior to hitting the pavement, getting prepared for anything, jotting down handy phone numbers. I write an itinerary for the day - giving a little over an hour in-between patients. It never works out the way I planned..but I keep trying. The worse is the 47 cents per mile, hearing "no overtime..no overtime". Hate roaches...fell sorry for pts w/wound care..ohh the germs. Hate heavy smokers worse than 30 kitties. I feel guilty heading out the door of a patient's home and hearing "just one more story, I really hate taking up your time, but you're so nice to talk with, my heart hurts for them", or a nurse putting in wrong directions along with a wrong phone number..lost in the heat of the day, or a snippy nurse returning your call at closing time and because you were lost and in a hurry and left that cell phone in your car because it slipped out of your pocket, silently out of site, inbetween seats, as you grabbed your nursing bag and computer and dashed across the dirt road to hurry to try to get your last PT/INR of the day prior to doctor's offices closing early on Fridays, knowing you were NOT going to beat the time, realizing your phone is NOT in your pocket, having to dash back across the dusty road, and search around in a 100 degree car for a slippery phone. You look down at your phone as your running back across the dusty road..and see you have a message..its The snippy nurse returning a call did not answer the question you left, prob because the receptionista did not bother to ask the nurse your question. Ms Snippy saying 'Well, it looks like YOU'll have to call back on Monday because YOU did not answer your PHONE!"(My brain says ..why not just answer the question!!).and being/feeling responsible you will go home and research for hours if it is normal for a pt with a new illiostomy bag to have a little stool come out of rectum, my thoughts = snippy nurses have snippy bosses..better know before you let this go. (YIPES..my imagination sets in again) The last pts PT/INR was 3.1..and of course the doc's office was closed when I called.....could I live with this all weekend, without any orders, I do believe that patients should NOT have had PT/INRs on Fridays, after noon, of all days, or we should not have 5 PT/INRs do do in a day (you have to call the physician's office and WAIT for an order..which will come as you are driving 60 miles an hour down the hwy 2 miles from home, your brain is fried, you have to pull over for each phone call and KEEP them very straight by being organized)..all weekend my head will have thoughts..will my license be safe?, or will my boss change her perception of me within 24 hours when Murphy's law rears its ugly head and cranking nurse with cranky physician calls our office with complaints?.... sorry, so long. I just love Home Health, love the diversity, most patients are awesome, its just another part of the nursing beast that takes 50,000 things to remember ...so different from floor nursing!

Of course its "norm" to feel nervous about a job you expect to do well at. My imagination makes every patient much worse than they really are prior to seeing them for the 1st time. You know you are going to be pretty much alone in the field. Murphy's Law kicks my derriere..without giving me a break every time. Be prepared for the worse and your day will run smoother. My worse problem is the mileage/lunch thing. I have to squeeze lunch in the time somewhere...hate it, because I eat on the fly. I don't like putting 200-300 miles on my vehicle every day either. 47 cents per mile. However I like being my own boss out there. Good Luck hope you love it.

My "How to land a job within a hospital" story - I spent days sending out applications to anyone and everyone I possibly could:bugeyes:. I put a small photo of me and my kids on one resume :nurse:and was called from five different facilities. Then about a year later I got fired by a jealous ADON..she was told and believed I wanted her job:uhoh3:. On the job search again again:uhoh21: I finally landed a pool position and worked for 6 months in the hospital - and then when a job opened up - in home health - I had several nurses in the hospital recommending me - I was in, like Flynn. :) Usually in a hospital..they hire from within the hospital facility, if possible, to keep you from having to go through general orientation - paying for the most boring days ever:sleep:. These two ideas WOrked for me. So, I'm curious, are you working yet?

Yes, I go back to one of my stories..whereas a doctor yelled at me and I was angered for weeks at him. I thought we got along on the floor. His odd behavior reinforced, to me, the reason why most nurses HATED him. I have a son in pre-med, has NO social skills, I can relate to doctors. (they have no social skills because ...well my son just doesn't understand why anyone wants to converse with anyone other than close friends or family..another story- he is working on it)back to my story.. but one day, this doc and I, happened to BOTH be taking the stairs, he was leaving for home and I was running up the steps to work...He said "haven't seen you in a while"..I said or mumbled something like "yeah I hide from doctors that don't like me..." he stopped long enough to say something along the lines of how he liked me what was up with my comment and "ohh I don't remember yelling at you.." and down the steps he continued. I suppose it goes with everyone that is on the floor with you with things don't go smoothly, we lash out at each other, not purposely. good point nursemarion good point. I enjoy your opinions.

oh hoe hoe! describing my first job. Lesson Learned: if they don't answer your questions...they don't KNOW the answer. So don't ask questions. 1. it makes you look lazy and ignorant 2. puts them on the spot because they are lazy and ignorant and don't have a clue. So they don't say anything that would make them look as stupid as they are...they only look brilliant because you desperately want to learn and grow and you want them to be brilliant. I had no idea that nurses would be so mean, land-sharks still groping for the teachers attention, drama pools of back stabbers, they will run to the manager and lie about you - if your too professional and bright eyed. Just zip it and verbalize every month.. "I like and try to get along with everyone"..be sincere. You have to somehow get and maintain the managers support of you Ms Newby on the floor-and not loose it to the other side, if you do, she'll ignore you and support them. My manager of my first job, how the smoking puffer's voice still haunts..."they will eat you alive little bit". She was telling the truth - the clique - was out there - she knew it. My first week, on my own, got report from a hateful burnt out nurse of 8 years on that floor....words used so fast such as this person had an appy, lappy, coly, gabby..my head was spinning. That hateful wench ran to my manger and said "that newbee doesn't know anything about anything" - I was called to the office..the manager beat her fist on her desk and called me the dumbest..not learned..uneducated! I told her I did not learn those words in school...and may have had a dumb deer in the headlight look on my face no understanding and verbalizing my ignorance of those words she was using. She had my back for a while told me to get back out there. But once the 8 year nurse blabbed to everyone I did not know anything without specifications, because she did not have to, and its like you trying to defend yourself. I had friends like the RN that trained me knew how everyone was. The meth head that turned nurse had the managers support because "our families grew up together", those in the clique had concrete foundations that went back to them "we I was little and my manager knew my momma stories" I was an outsider..from another small town 40 miles away.. I went home crying for weeks.I found medication in rooms and did not write others up, I should have. I should have run to the manager about everything but I thought well she is too busy or I can fix this why bother her. (I ran 6 outlets stores back in the day-I can manage)...I was old enough to be their mom!! Bubbly and perky me went down the toilet for a while. I left that job after a year...to a retirement home..the yelling of co-workers to each other and to the floor supervisor...was like watching prison shows where the yell and call names, CNA told an ADON, after I told her to remove her piercings from her nose and eyebrows, I wanted her job..I knew I was good, but did not want to be an ADON, but could not convience her and she was so insecure I mooooved on again......now I'm in a clinic..wonderful but the clique between hospital staff and corporation staff is so obvious the doctors see it. I have worked many, many jobs but have never seen the hateful ways between co-workers, as I have seen between nurses. Sad but true... I am still looking for a less drama queen induced infectious place to work. ha ha love nursing....do not like the lazy, lying, cheating..oh the CNA's husband killed himself...and then she gets fired (finally) for hitting a resident..Karma will catch up to them, it may take a while. But now looking at my resume..it appears I am a job skipper..ewww.

So funny a co-workers "message received BONG de la BING" went off at work today and the Nurse Manager got on to her pretty heavy reminding her (again) about the cell phone rules (and here we are talking about it). Rules are rules - follow the rules, don't try to bend them to suit yourself. Our cell phones must be turned off. That coworker looked at me as the NM was venting and said "hey, that might have been...was that your phone?". I frowned at her projection and said "you know I don't even bring my phone in the building - if my teens have a problem as in "emergency only" they can call me at work only then. Ages of those involved: Nurse Manager 38, guilty party 62. lol Its the person. The problem I have with being older, as in 55, is listening to the younger nurses talk about how old their parents are *I cringe* esp. when they are younger than myself. Somewhere around the age of 48 I've started becoming invisible the Paula Dean look doesn't work for me. I don't care for the younger nurses calling me "Mom" because it's an insult, when I'm not their mom. Patients whatever ails them bring em on. I have not a preference usually. But I am highly allergic to mean people..I break out in a chapping rash. luv my job.

If you leave on good terms, she may call you back. It happens around here. Stay and take the invisible route. She obviously doesn't need any more input - I'm sure everyone's squawking away in her office. Too many chiefs is right! But you could stay and just keep doing what you've been doing. Just write up errors that inspectors will find and slip them under her door, so that she can read them when she gets a minute. If she knows you have her back it'll go better.

I worked on a floor, where they would not hire another nurse over 60, but had one 59 year old on the floor, that had worked there 8 years, that was "in" with the floor manager and although everyone complained that she did not do her work, ex: amputees not being wrapped, bandages not changed, antibiotics run late, and she is soo quick to point out anyone's shortcomings and dare you to even point out one of hers...that queen bee is still there. 100% of the nurses had one word for her..it was "lazy". There was one more boomer, that was a blonde, 65 year old"ish", that was so nervous of write ups it showed and she was always defensive about the least little thing - her hands shook like pudding. I have worked with new grads that are so dramatic with the "ewws" and "oh that smellsss soo bad" constant comments it makes me wonder what they thought their jobs would be - to look and smell like a magazine scratch and sniff fold out? I have seen young, street smart, wise mouths, get away with not doing the little things that a boomer would be swift kicked out the door for. I believe it's the individual, as in patients, some act way beyond their years and some peter pans will be running 5Ks at 75 years of age. I am 55 with the peter pan syndrome, got moves like Jagger "ain't you a little ray of sunshine?"...too bad the DON/ADON could not see the mess the wound nurse was leaving for you. I'm with you it's not your mess - but she probably lives in that mess at home and is blind to it...just clean it...and keep smiling.

Hear Ye Hear Ye...Once a doctor yelled at me, I yelled back at him...my patient was asked and he refused pain meds over and over..but when the doctor asked of course he was "hurtin really bad" I had another doctor raise his hand and tell me "DO NOT INTERRUPT ME WHEN I AM SPEAKING!" he interrupted me 1st, he wasn't the one trying to keep the gauze replaced that was soaking fluids from a 80 year old intestines that were accidentally nicked by this particular doc for the past 12 hours. He should have been praising me! .....I have learn its not you when folks yell at you - they yell at you to a. impress their patients or b. they are having a crappy day...anyhooo, too many crappy days in that hospital so....I left. I work now with doctors that give gift certificates to me for Christmas, never yell, teach me things and I in return get the patients to write the doctors wonderful letters of appreciation, blow up gloves and write notes to the doc of appreciation. There is always a downside isn't there..my life isn't all rosey. I'm still PRN - not enough hours an my office manager is female...I mark the calendar, from 5 days to 2 days after the FULL MOON, PMS at its worse!! She yells and threatens to fire us, slams her desk, micro manages like a zoombie every thing we do is wrong even when its right.....we hide until we hear her laugh again. VENT VENT VENT....write about it ....let it go..

Case Manager, I worked in "the worst hell whole" said a patient that got to leave. Other patients sang the song Hotel California along with the CNAs whilst I worked there. My experience, and I'm a nurse w/2 years (YaY!!), with hospice...was an eye opener. One the LPNs murmered because of the "lack"of help in our facility, and yes those in hospice care are the dead weight back breakers, belong to hospice. I had to, as wound care nurse and night supervisor, educate LPNs - just because she is hospice...doesn't mean when Hospice Nurse yells for help on getting a change of status for the worst on vital signs that you can walk away from the situation and say "that patient belongs to hospice..not our problemo". Our hospice gals would roll their eyes at meee from the frustration - yes the DON and ADON .."were aware" - and did not care..when hospice went to the office LPNs laughted. Hospice at this facility were called even when I went to the patients bedside and told the LPNs that did not want to answer bedside families questions "Don't call hospice - its not time" they would run and call hospice anyway then hospice would be called in for another round of vital signs and come to me and say "why was I called the patient is dying but it may be another 3 days..?" I'd be wasting my time replying.."duhh because an LPN went behind my back..and nothing will be done or said to the LPN because our turnover was 90% a year". Our CNAs were pathetic but we did not have enough of them, I was a CNA/Wound Care/Supervisor/feeder/admissions clerk and was expected to do wound care, chart, schedule, assign baths, call in CNAs when someone called in, which took up to two hours every day...and cared for my patients, loved them dearly. The ADON thought I was after her job..I would have lived there but liked being the wound nurse. Now my hospice gals would come to me and I'd take them and show them the wound and did the wound dressing change and we'd have the same measurements and full descriptions together. If she was running late I'd have her call and I'd leave a copy for her at the nurses station of my would care. But to get to know one another when I first met hospice I'd go with them, my nurse would also hands on help me put that dressing back on the coccyx on those dead weight..or the ones that had several skin tears. Our hospice gals would have the best smelling patients and other families would come in and ask can my dad get on hospice - look how clean they are and fresh smelling they are. Even when State would come into the building...the hospice who had great shampoo, great care, good smelling deoderant etc...and the nurse kept it with her or the CNA's would steal her products. I believe every hospice nurse should bring her CNA with her, marketing themselves by having the best smelling, best cared for patients...some of our hospice patients could tell others that they were cared for by hospice. The families of our facility stood very firmly behind hospice because our attitude of the DON and ADON -backwoods hillbilly Drank BIG OL SONIC shakes -stuck together - which ran everybody off - were severly lacking. Sorry you have to ever walk into a hell hole prison of a glorious retirement community. The money that the facility makes ...the CEO's are way way way overpaid, the DONs need to get out of the office and onto the floor and be feeders at lunch at least 3x per week. Even the marketing needs to get certified as a CNA and be a feeder at lunch time...and the recreation person too..they treat their little dogs better than granny/grandpa at the nursing home.