artsmom

CCM, and thank you!

I would like to get certified as a case manager. I have reached out to a few programs I found in a Google search but no one responded to my inquiries. Can anyone recommend a program that I can go through or at least some direction? Thanks in advance.

Tough situation. Under who's orders are you currently practicing? If his prior MD is signing order's you should be covered there but it sounds like you (because of the way the patient is behaving) are not able to provide the care that is needed. If there are current issues with his health and he has no active PCP he needs to go to the ER. I personally would refuse to see him- how can you care for/treat someone that manipulates all of his caregivers. If your manager feels he can be seen/followed by your agency, she/he can go see him then. I just got out of a situation like this and it was a nightmare but I had a great manager that worked with me closely to get me out of it. You say you don't have enough experience to go somewhere else but I bet you do. My current job holds us to high standards but we hire new grads/new to home care all the time. They are trained properly and supported appropriately in these nightmares. Best of luck.

Thanks for the reply. I don't typically ask people what they expect from me, normally I think it Is obvious to them & us. I was just really thrown off having 2 people tell me how useless I was. I really try to do what's best for my patients so it upset me. You're right though- they didn't even really know me to tell me that and I just let it get to me too much. Thanks again.

I had two patients in one day tell me how useless I was and VNA in general. I generally like my job, a lot, but it got me thinking- except in the very obvious cases, am I useless? I educate a lot, but most people are on/off service and don't listen, they just like the security of my visit and checking on them. I am sensitive so it didn't help to have 2 different people in one day say it. In my 9 ish years of home care I've only had 1 other patient say this to me.

My immediate response would be to r/o a stroke, check kidney functions, check for any tick-borne illness since he works with animals outside.

Everything about it is totally different from the hospital setting. Give yourself at least 6 months to determine if you like it or not, at first it's like being a new nurse, everything is new and it's easy to get overwhelmed. Hopefully you're working for a decent company, don't let them work you into the ground, don't let them shorten your orientation, don't let them tell you to Youtube a procedure you've never done before. In HH you are alone and need to be sure of your skills because there is no one else to guide you and you don't want to harm a patient. Ask lots of questions.

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.

I don't believe that is true. I work in home health but the CNA's are under my license.

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.

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.

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.

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.

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!

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.

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.

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.

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.

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.

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.

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.

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.

I worked for a poorly run home health agency w/no regards for the nurses- no raise in 2 years. I then switched to a highly reputable VNA that cares very much about the staff & their reputation, I've have 3 raises in 2 years. Try looking around for a better VNA. The one I work with now is directly affiliated w/ a large hospital and I think this makes a big difference than the stand alone ones.

Yup, what Libby said. I've been doing this for 3 years now but only feel like I have helped people in the past year or so. The biggest area is when they first come home and are very anxious, just the presence of the nurse seems to really help people relax. Of course there will always be patients that you're not really sure why you are there or they really don't want you there but thats not often. Ive been a nurse 10+ years in different settings and this is by far my favorite. I love seeing people in their home environment.

As a home health nurse I frequently ask the SW's to see my patients/families. Some are great and try to offer up as many resources as they can, others are lackluster. What I see most often is that families can't accept the answers given. One particular family was set on finding free in home care- around the clock. This is impossible and the family did not want any help from the SW if she could not provide resources for free care. Unrealistic expectations. In terms of not answering you about which are the best care facilities- do your own research. There are websites for you to determine who you think will be the best for your loved ones, go to facilities, ask questions. I never recommend a facility because everyone has different experiences and expectations.