AmPmRnoncall

Maintaining professional boundaries is very hard but very important to protect yourself and your license. I'm sorry this happened to you but for the sack of you livelihood..stay away... Sometimes the worst professionals are the worst reporters the the state boards of nursing. Again i am sorry this is happening too you.

I worked 12 years for a children's hospital based home health agency. i was a case manager for 8 of those years and did alot of driving(covering 11 counties) and absolutely loved it. the agency put alot of money into my training and certified all of us rn's in peds oncology/chem, general peds, case management and i have specialty certs in all areas. a new manager came in and got rid of all of us. I now work for a adult home care agency and will be doing peds in about 6 months.. i miss peds home health and feel by skills are being under utilzied. best of luck.

LPN's can always make out. they just had a big shift where I use to work. Past tense. I quit. They hired another nurse with no home care experience and I was in charge of training her. She told me what she starting making an hour (4 dollars an hour more than me) and I had been there 11 years. I was livid. I spoke with my manager about this and she said her hands were tied and that if I didn't like it, I could go elsewhere... which I happily did.

I have administered blood, cerezyme, IVIG, IV steroids, Remacaid, in the home. Sometimes the closest hospital was 40 minutes away with a rural volunteer fire ems. Clients should always have had there first dose in the hospital and not be a high canidate for reaction. Always have benadryl, epi and normal saline and a very patent IV line.

Can anyone cite the CMS's requirment on pedicatric certification and also clarifying missed cert periods....

2 things to ask on your interview. "how long is orientation?" (which should be no shorter that 4 weeks) and up to a year with a mentor. #2 "what is the service area I am expected to cover?" (you sould only be expected to do 4-5 visits per day. EXPECT LOTS OF PAPERWORK.. and don't get frustrated to easily. takes time.

I know what you are going thru. I won't bore you with my own account. BUT, what comes around goes around. My old supervisor who kept putting all the pressure to do visits on me was terminated after I made an anonomys call to our compliance officer and our state board of nurseing. My ex boss is now working for our competitor and of course what I hear, messing up big time also. Hang in there kid. I've been in home care for 11 years now. Email me if I can be of help.

My agency payes all of us nurses by the hour. I make 25.00/ hour with a 0.43$/mile. I am responsible for up to 3 counties but if I am oncall, I'm responsible for up to 10 counties. I get 25$/ night week night for carrying pager and get my hourly rate if I get called out. I get 50$/ day on the weekend for carrying pager plus my hourly rate if I need to go out. If I take charge nurse, I get 50$/weekday night and 75$/ weekend. I can really rack up the bucks with call. I work 32 hours per week and expected to do about 20 visits/ week. I also get paided for all my paperwork time. I try to organized myself, so I'm not spending all my time on my paperwork.

My home care only does admissions up to 9 o'clock at night. Anything after that needs to have a good reason why we are sending a nurse out. I am the charge nurse every other week and I won't go out if I can handle it over the phone. I can't say that for all the charge nurses I work with. I am organizing inservices with our security dept to inservice the nurses I work with on safety and personal awareness.

Can anyone tell me how their agency handles missed cert visits. Right now, our director is mandating that if our cert visits are missed, we have to discharge then re-admit that patient into our agency. It is creating way to much work if we are too early or too late on our cert visit. Is it legal for me to only contact the physcian to let know I have missed the cert visit then remain to continue with care without having to go thru all the discharge and re-admit. PLEASE HELP :monkeydance:

Can anyone help me. I have worked for my pediatric home care agency for 7 year now. We had a medicare auditor do an onsite visit for our medicare licensure. She is telling my director that even long term pedicatric patients need to be recerted every 60 days. Is this true..? Most of our patients are medicaid, not medicare. Do the same standards apply for recerts and OASIS patients. :trout: Does anyone have literature to support this. I have reviewed all of the CMS guidelines and I can't find anything for pedicatrics, it's all oasis. Thanks for your time.

Our PRN's do case management (which I think is a joke). And they get paid more than me and I have a much larger case load. Anyway... Just venting.. I wish you the best on your interview and it will be the best job you ever had.:chuckle :caduceus:

Hey everyone.... Who hates those long hours of on call... Tell me what oncall is like at your agency.. Where I work, the PRN's pick up as little as possible and get away with it... It's up to us 1 full time and 1 half-timer(ME) to pick up at least 4-5 days to cover... What do ya think... Let me hear your story..:trout:

Hang in there.... It takes a long time. I worked for a small hh agency once that bragged about being all computerized. WHAT A JOKE... I was constantly going back and reentering and reprinting... And I had 6 years of home care experience to boot.. The person at that small hh agency had the gaul to ruddly tell me..."I thought you knew oasis.. you would never know it by your documentation"... This was coming from a nurse who had only been a nurse for less time than I had been in home care. ( I had been a nurse for 13 years prior to that). I gently reminded her that I was a practicing nurse when she was still driving her kids around to soccer games. Her pressure on me got really worse after that and I quit soon after. HANG IN THERE... IT GETS BETTER... Just think... your manager could start hiring managers that have no home care experience... :angryfire teeheee...... thats another story for another time...... HANG IN THERE..It's worth it....:monkeydance:

To all you experienced home care nurses. We just started something new. Our 485's are entered into our data system by a data processer, then reviewed by one of our RN coordinators for accuracy, then signed by the coordinator. As an example:: J.Smith RN for L. Jones RN.... IS THIS LEGAL. I DON'T EVEN GET A CHANCE TO REVIEW THE 485 BEFORE IT IS SENT TO THE PHYSICIAN. I have 10+ years of home care experience and have never done this before. It is a new policy that we just started. And I am now noticing many errors on my filed 485's that the physican has already signed.:gandalf:

I do both after-hour visits and triage. Gets a little hairy sometimes. But most of the clients are peds and answering questions. If I am unable to triage a complications, I'll then go out. If it is in an area that I know is not safe after my assessment, I won't send a nurse or myself into that situation. I'll usually try and problem solve with them about transportation to get them to the local ER.

Don't give up... It gets better.... Just call if you need more help.. I know how frustrating it can be... Just keep going.. It's worth it! Lois RN:balloons:

Do you have a pallative care MD on staff.. I work at a children's hospital that has a pallative care MD and She is the BEST. I do homecare and she came out at 2:30 AM to help me with a 1 year old dying at home. Sounds like with your patient, the MD's aren't being really aggressive with the parents about the reality of the situation. best of luck and you are in my prayers Lois RN:balloons:

One of the biggest problems I run into is running into the office for a sec and get suckered into and hour-long problem solving issue with my co-workers, who are RN's but haven't done any clinical nursing for many many years. Organize the best you can and always have adequate paperwork and supplies. I went as far and to purchase a copier and I keep it in my car..... Lois RN:balloons:

Boy... Have you opened a hornets nest with me.. This is one of my BIGGEST pet peeves... I try my best to call all my clients either the day or night before. I get better compliance with calling the night before. When admitting them, I even try to set up specific days I will be there, following MD frequency. At my agency, we usually write a "VARIENCE" to the MD and fax it to him/her. If I know it is going to be a compliance visit problem, I end up usually calling the MD and telling about the issue's I'm having and generally I discharge. My time is too valuable to be tracking these people down. I have about 7 pediatric clients a day to see within an hour radius of the children's hospital I work for. I don't have time or the energy to play their games. I put on about 200 miles a day on my car. I try to really tell the patients or their families if I am running late or whatever. Free healthcare is a privladge and some people could care less wether or not you come or not. Best of luck and BTW... Are they really eligible to recieve homecare? Remember, it's your name going on the 485 and FRAUD is a big issue with medicaid. Lois RN:balloons:

Hi Everyone, In regards to cell phones: My agency provides a company cell phone with the stipulation that it only be used for patient calls. Which sometimes my bill is well over 70$. I usually get called on the rug and have to justify the calls. I have a data-base of all patient phone numbers and MD #'s all I have to do is print out the names and numbers and justified. I don't have first-names in my database. Only last names and phone numbers for patients. I started doing this after my one supervisor tried to say I was using the cell phone for personal calls to my husband. I had to then go thru all my referals along with the bill and cross reference each name and number. There was egg on my bosses face and she never apoligized:angryfire . Anyway.... The things we do for our jobs that we love. Lois... RN:balloons:

Could anyone please tell me how to get my IP number. I've called the medicaid line and all I get is an answering voice mail. I've been in home care for 8 years with 4 of that as a high-skilled RN. I'd like to go back into private duty but as a IP, and making for than only 16.00 per hour... Thanks... Lois:)

Hello again everyone.. My census is usually about 25-30 visits per week with putting about 150 miles on my car aday....

Hi everyone. Glad to find a venue for information. I'm the only FT home health intermittent RN for a Children's Hospital in Akron, Ohio. I have a number of PRN's that fill in, but sometimes there availability isn't enough. The area I cover is about an hour radius from Akron. I can but as little as 60 miles to over 200 miles a day on my car. I make an hourly wage(which my travel time is covered in that) Money isn't to bad. It's all the charting in the evening that get to me. I've been in Pediatrics for 8 years (4 with intermittent and 4 doing private duty). I wouldn't change what I do. I love it. I'd like to hear from other pediatric home health nurses out there... Lois RN:balloons: