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artsmom

artsmom

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artsmom's Latest Activity

  1. artsmom

    Pleurx drains

    Yes, perhaps she did confuse the abd/LLL, though she pointed to her mid abdomen when I asked her to show me where it hurt. I had taken off ~450ml when she screamed out and yes, it was the 1st time it was done (aside from the initial insertion where they took off 500ml but I think she was under conscious sedation). I'm going again tomorrow and just hate not understanding why I am causing someone so much pain. Thanks for your thoughts though, I appreciate any rationale.
  2. I don't believe that is true. I work in home health but the CNA's are under my license.
  3. artsmom

    Pleurx drains

    Hi- just wondering if anyone can help/enlighten me. I am a HH nurse and have taken care of many patients with pleurx drains, so I am very comfortable with the use of them as well as possible side effects/complications/expectations for the patients during. So, one of my patients had the drain placed in the LLL earlier this week, Friday was our first time draining in the home. Towards the end of the draining she suddenly screamed out in severe pain, abdominal cramping. Coughing, chest pain, etc is what I've seen, never abdominal cramping. I clamped her and we waited for it to subside, restarted very slowly but it came back immediately and as severe so we ended it. I called the surgeon to inform and sought out a rationale, the NP said it was normal but was brushing over it when I asked why that would happen. Can anyone enlighten me? Has anyone else seen this occur? My patient was in agony.
  4. artsmom

    Complete SOC if patient does not qualify?

    First- clarify the VNA role in care of the pt- which is not indefinite 7 days per week care. This patient is bed bound and has a stage 3 so they qualify for services. Ensure, especially if they are elderly or disabled, that there is no abuse/neglect going on, if even suspected, report it. Stage 3's mean some very serious teaching is needed at a minimum. Getting all disciplines involved is actually a good idea, this patient needs help and the family needs a lot of training.
  5. artsmom

    New to Home Health and Confused

    That's a lousy preceptor! Bp that high you definitely call the MD, and if I couldn't reach them I would send the pt to the ED. In the home you're the eyes, you are the only one doing the assessment and need to cover your behind. As for the INR- draw the labs in the am, call the MD office in the afternoon to f/u on the results and new orders. In my job anyways, and especially with coumadin, you need to verify orders with the MD office, not just the pt. This job is A LOT of phone calls. Never assume someone else made the call to the pt either, things get missed all the time and you're there to close those gaps. Your manager is correct, HH takes awhile, I'd say I was truly proficient around the 2 year mark.
  6. I agree with this as a possibility. Someone used me as a reference without checking first so when I got a call about them, I was honest. Nothing slanderous, but definitely truthful. Had they asked me I would have asked them to use a different source.
  7. artsmom

    DESPERATELY seeking for an advice!

    I've been a visiting nurse x4 years, my best advice? Run fast & far. There is so much to home care that you are setting yourself for some major problems. The pay structure is also atrocious. I am pretty sure mileage has too be paid for this position but that could also vary state to state. Without proper OASIS training you run the risk of accidentally creating Medicare fraud and would be liable since you're doing the work. Run! Work a VNA with a big hospital that offers adequate training. Mine does 6 weeks for seasoned VNA and 12 weeks for newbie's to VNA. Best of luck!
  8. artsmom

    Do you have a territory?

    I have a designated territory and am automatically the case manager of all patients in my 2 towns. However our bigger towns typically have 2 primary nurses and the new patients are assigned to whomever has the lowest census at the moment. If my census is low or there is no admission there that day you are expected to travel to neighboring towns and help out. I think our system works well.
  9. A recert visit alone without any clinical need does not count as a skill. It seems like the company is just lucky at this time. I worked for a company that got bagged for massive Medicare fraud, your company's time will come if this is a common practice. Also, as Amarillo mentioned, the nurse/therapist needs to go in every 14 days for a supervisory visit. I have one patient that only has a skilled need q6 weeks (FC change) but since there is an aide I do a non bill visit as needed to meet the requirements.
  10. artsmom

    Offered a job in HH but I'm not sure about this one.

    This does not sound good at all. How are you expected to chart without a laptop? The territory may not be so bad if you can schedule everyone in a row but there are so many other red flags. A lot of VNA's throw the nurses out there with a sink or swim, I'd run. There are better ones out there.
  11. artsmom

    How often do you do med reconciliation?

    Our policy is each visit. This is not practical but I try my best. Cardiac/high acuity patients I do the rec each time, things change often and I don't want them confused about anything. Daily wound care that I am the primary nurse for? I will do it weekly unless there's been an MD appt. As another poster suggested this policy was changed to daily after the state brought it up we weren't addressing meds enough.
  12. You cannot do an oasis recert just for an aide, you are correct that it needs to be skilled. As for your 2nd question, it sounds sketchy but I am unsure the legality behind it.
  13. artsmom

    Is home health that bad?

    The documentation in home health is what drives many people away. Learn to use your time effectively- schedule enough time in between appointments to finish up as much as you can, don't push it off until you've cooked dinner and helped the kids to bed. If I see 4 revisits and 1 admit in a day it is rare that I work more than 8 hours, often times it is less than that because i maximize my time.
  14. artsmom

    Is home health that bad?

    Yup, it's all about working for the right agency too. I always tell nurses in orientation- give it at least 6 months before you decide if you like it or not and 2 years before you know enough to feel confident.
  15. artsmom

    Confused

    Our LPN's set their own schedule, it would be really hard in home health for another nurse to dictate the time of your visit unless it's for a med admin or something that would be timed for anyone. My assumption is that you'll contact your own patients and work out a time that accommodates you both. Good luck.
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