nurse955

Everything! Over the years, my responsibilities as a LD nurse during a delivery has not changed but it does vary slightly depending on the hospital. For example, I've worked in LD units where a nursery nurse comes to every delivery and other units where nursery is called if there is a problem or one anticipates a problem. If nursery staff is not present, my responsibilities include ensuring fetal tones are audible during the delivery, coaching pt with pushing efforts, ensuring sterility of the delivery table(family members don't touch), crowd control, supplies are within reach of the OB/GYN, administration of medication such as pitocin after delivery of the placenta, fundal massage, applying suprapubic or McRoberts manuever if directed by the OB/GYN. Once baby is delivered, newborn care such as maintaining body temperature, apgar score; measurements such as weight/height, head circumference, length(depending on the facility) and promoting breastfeeding if pt desires. The responsibilities is different if it is a cesarean section .

lindaw, I feel your pain. My husband and I started a home health agency about a year ago and I still feel overwhelmed. Although I have 17years of nursing experience as both a staff nurse and management, home health is completely different. Getting the initial license from the state is fairly easy, hardest part has been finding patients and all the paperwork that goes along with the admission. I'm still waiting for the initial survey from the state and medicare. I'm unsure of any specific DON home health training but as the administrator, I had to complete initial administrator training online, i believe it was 18hrs and has to be renewed annually. I think number of hours is dependent on your state. If you google "home health administrator training", several online training schools will come up. My past management experience has been helpful with regards to organization but I need assistance with starting a QAPI binder and have questions I would love to ask someone with DON/Administrator experience. I also have to give a big thankup to Allnurses "home health forum", I have learned lots of information about bag technique, 485(plan of care), narrative nursing notes, CMS PPS, etc by reading current & past posts.

ksreuter, I'm in texas and still waiting any day now for a surveyor from the state. Is there anything I usually be doing in preparation for the visit. I've read, re-read the CMS condition of participations and Texas regulations. But I still feel extremely anxious and scare considering some of the horror stories I've heard about home health surveyors. Does your agency provide homemaker services? If so, is the hha or cnt required to obtain vital signs (every visit) on a patient that's only recieving homemaker(light housekeeping, laundry, cooking, etc). Is a treatment plan, plan of care, or 485 required on a patient that is not getting skilled services? Lastly, any information on Quality Assurance Performance Improvement(QAPI) such as document format, indicators, worksheet tools. I've done research on QAPI, have a list of possible indicators but I've clueless as to the next step. Because we are a new, start-up agency, cash flow including revenue is tight:mad:. I've been providing free care to patients for the past 6 months. Any tips, suggestions, documents or sample you want to share are truly appreciated. Thanks

Do nurses in your unit insert IUPC? is it within scope of practice for a nurse to insert IUPC or FSE. If anyone has supporting documentation or link from licensing board, please post. Thanks.

I've worked for two hospital systems(HCA, MEMORIAL HERMANN) that require these screening within 30days of employment and especially if you are planning on signing up for their insurance plans.

This is my situation. I have a patient who no longer meets homebound criteria. Two weeks ago(Friday), I informed the patient by phone that he will be discharged. During the phone conversation, I explained the reason and he expressed understanding. I also informed the physician and she was in agreement. The following week(Tuesday), I called the patient because discharge paperwork required his signature and acknowledgement. He did not answer, so I left a message. I was able to reach pt 2 days later and we were to meet last Saturday. Prior to leaving home, I called pt about an hour before the scheduled visit time and no answer. The message after 1 ring says "this subscriber does not accept incoming calls". I waited 30 minutes, call again and recieved same message. I called an hour later and several times on Sunday and kept recieving same messgae. This past Monday, I mailed the discharge papers(highlighted the required signature area) via certified mail and return receipt. Thus far, no reply from the post office. Anyone had a situation like this? If so, how was it handled? Any suggestion on what I should do? Thank you in advance

I work for a big hospital system and all direct care staff are required to take the flu vaccine. If you refuse, one must wear the blue face mask while on duty(entire 8 or 12hr shift). It is immediate termination for anyone caught without the face mask

Thank you so much for the responses

Recently bought a 2001 Toyota Avalon that is used for making visits. The car is very roomy and the trunk is large. The vehicle had (1) previous owner, runs great and had 8200 miles when it was purchased.

I'm also new to home health and I have found books written by Tina Marrelli to be very helpful. I would recommend getting the fourth edition of of her book titled: Handbook of home health standards & documentation guidelines for reimbursement.

Congratulations. I would recommend submitting a memo stating you would like to stay on a PRN or per diem status.

Thank you all for your replies

It varies by hospital. For example, OB nurses in my current place of employment must wear a combination of black and pink. Another hospital where I worked, OB nurses worn same color scrub as other nurses but the ID badge had a red background with a giraffe. patients are instructed upon admission that only nurses with the red ID badge are allowed to take their babies.

the daughter residence is within the agency's service area and the patient has no problem with visits conducted at her daughter home. Patient's visit to her daughter is strictly for relaxation and to spend time with her grandchildren; does this mean she is not homebound? The agency owner really wants to keep this patient but she says her insurance policy only covers care provided at the patient's residence. KateRN 1- do you have a link for OASIS Q&As quarterly

the patient is been seen 1x/wk for disease teaching relating to diabetes and hypertension. During past visits, lot of time is spent on disease process, dietary choices, and complications. I forgot to mention this is a non-pay case as the agency is trying to build a caseload for the 7 active patients required for initial medicare certification. Do I need to inform pt that she is going to be discharged? If so, do I send a letter or document the conversation on a progress note?