84RN

Thank you! I've been helping with the screenings (hearing, vision, BMI, scoliosis) for a few years, and she told me there are a lot of district compliance stuff that is required. Documentation just comes with nursing, no matter what area, lol. But it's a LOT better than having hours of computer work at home in the evening for home health.

I'm considering a part-time job-sharing position with the school nurse at my kids' charter school. The school has grades 6-12. My experience has been most recently: 6 years of home health (adult, medicare patients), and years ago: hospital in ICU and L&D. Do you know of any online courses or CEU's specifically for school nursing? Even an overview of First Aid would be helpful, I think. I have personal experience with type 1 diabetes, have 2 kids with it and managed pumps, MDI, everything for almost 13 years. But anything else, not much.

For a ROC (resumption of care after hospital dc during a 60 day episode), we do a new SOC/ROC OASIS form --same form for both events. In addition, we have a Resumption of Care Orders sheet that you put in the hospitalization info, dates of admission, dc, diagnosis, and then spaces to note any changes in the skilled nursing orders, teaching and new goals. We also do new med profiles, noting any changes in meds, dosages, frequency. Less paperwork than SOC, but still quite a bit.

Any experience/tips for working with a hh patient that has an ActiVAC wound care pump? My patient is getting one, ordered by the wound care center. It's being delivered this week and I'll be setting it up for her. YouTube has been informative, but would also like btdt advice and tips. My clinical supervisor will be coming with me for the first visit to apply, since she has more vac experience than I do.

Thanks for your input. I did suggest getting a wound care center consult and also mentioned the possibility that her surgeon may eventually want to use a wound vac. She went to the wcc Friday, and is getting a wound vac :) She'll continue with her surgeon for occasional appts, and weekly with the wcc. I'll go twice a week to change the dressing on the vac.

I have a home health patient that's getting daily wet-to-dry dressing changes: Iodoform 2" packed into the wound, topped with 4x4s, abd pad and tape. The wound is 4.2 x 2.4 x 4.0 and has a couple of small pockets at 1 o'clock and 6 o'clock. She's post-op bowel resection that went back to OR to clean out a pocket of infection. 10 days after the 2nd surgery, still has a lot of drainage and today saw slough over about 20% of the wound bed. I have a call in to the surgeon's office to let them know, but wondering if keeping up with the wet-to-dry is best, or if I should suggest something else? She's going back to see surgeon in a week, and he's on vacation now--she doesn't want to see his partner if she can avoid it. I think she should go to wound care center, but she's happy with the physician. Thoughts?

Still nursing, but a different career path. In retrospect, I should have gotten my CRNA after a few years of working in ICU. Instead, I went to L&D, then took years off to be home. When I returned to work, went into Home Health because of the schedule being more family-friendly for us. I enjoy Home Health, but think I'd also have enjoyed the challenge of being a CRNA, and the salary would be much higher. At this stage of my life, going back to school isn't feasible or worth the financial cost, plus I don't have the recent hospital/ICU experience required.

I've been perdiem with an agency for over 3 years---paid per visit. No increase in wages at all, despite performance reviews that are always positive and getting praise for my work. I'm wondering if I should ask for an increase, but have a feeling I know what the response would be

I work in home health and have a long-time dialysis patient that is considering hospice. He's in his 90's and has multiple comorbities, is just frail and tired at this point. How long would he live if he stopped dialysis? What would the course of his last days/weeks be like?

I'm so sorry for the loss of your little one. I have miscarried 4 times, and had varied experiences with what I experienced physically, and also the medical care. As medical professionals we all need to be more aware of how our words and actions impact our patients.

That's what the focus of my visit tomorrow will be. Will be doing all we can do keep him dry and watching skin closely. He really does have a very good aide, wish all my patients were as fortunate. This poor man has been through so much. A few weeks ago we got the referral to start him for "foley care", nurse went out and found him with 103 fever, pus coming out of his member, pressure sores. Instead of starting him, sent him immediately to hospital, adult protective services got involved, and during his hospitalization they found another agency to manage his care (his only relative lives very far away). Now, he's immaculately clean, pressure sores all healed, and very well taken care of, thankfully.

Yes, he definitely has a say in his poc, which is why I asked for the order to remove the foley in the first place. Now it's obvious he doesn't want the condom cath, so readjusting the plan accordingly. I AM advocating for him, thanks for the benefit of the doubt.

I'm trying to advocate for him, and at the same time make sure his skin is given the best chance at staying intact. His aide is good, but I worry about the constant wetness on his skin. I saw him yesterday and she told me even with changing him several times during the night, he was still completely soaked through to his sheets. I've talked to his care manager who coordinates the aide (hh was brought in when he was first dc home from hospital a couple of weeks ago) and she's working with the aide to use the best briefs they can find, protective cream for his buttocks, and changing the briefs as often as possible. I'm open to suggestions on this---not my usual patient, but I want to do what's best for him. Right now that means the foley is out, no condom cath and instructing the aide on pressure sore prevention, etc.

He's in his own home (condo) and has a private home health aide 24/7. The reason for the foley was because he's incontinent (urinates a LOT), has advanced parkinsons and dementia, and is essentially bedbound. He can be out of bed using a hoyer, but is so active that leaving him in a chair is a huge fall risk and isn't really safe. I'm just trying to find the best solution to keep him comfortable, and also reduce the risk of skin breakdown from the urine.

Give me your best tips for getting condom caths to stay put. I work in home health and have a patient that had a foley, but kept pulling it out. The physician said ok to try a condom cath, but after putting it on this morning, the caregiver called to say it already came off. I made sure the member was dry (difficult because he urinates frequently), and used skin prep before applying the catheter. He has advanced Parkinson's plus dementia and is very active in his bed, so this is going to be a challenge---but I really want to try because he hates the foley so much. When the caregiver told him I was removing the foley this morning, he looked at me and said "God bless you!"

Well, I've never used computerized charting (they say it's coming....one of these days), but have a wicked case of writer's cramp after having 2 starts, one recert, 2 discharges and a few other regular visits over the last 2 days. Between the OASIS and all of the other required paperwork, my arm and hand are fatigued. I know every system has downsides, but I'm ready for the change.

I work per diem, mainly because I need the flexibility to set my own hours around my family's needs. Just started with a new agency that seems to think that per diem means you are available 24/7 unless you've put in a written request for a day off. Huh? For me, when my visit schedule is as full as I can manage during a week, and I've maybe committed to help in the classroom or whatever else I need/want to do during an afternoon where I don't have any patients, then as per diem staff, it's perfectly fine to say No Thanks to a soc when they call. I was actually told last week that if I'd wanted a day/afternoon off, then I should have submitted a time-off request to hr----2 weeks in advance! Is anyone else experiencing this, where their agency is using per diem staff like we're fulltime? This agency is no longer hiring fulltime staff, probably in order to avoid paying benefits, and I know many per diems want fulltime hours, but some of us don't and this is frustrating.

I had one patient that I did a soc on and did not feel safe in her neighborhood/home. I completed the visit, did the OASIS, made all calls necessary to set things up, and then told my supervisor that I would not go back to the home because of safety issues. Honestly, I know everyone is deserving of medical care, but it's not worth the paycheck to risk my life.

I work in home health, so carry a bag and don't need a lot in my pockets. Rt pocket of scrubs: 2 pens, alcohol wipes and scissors Left pocket: my cell phone and large paper clips (we're still paper, not electronic)

I work per diem and have been able to mostly fit patient visits into school hours. In my agency, I'm not required to do a minimum number of visits, so if I don't want to work one day, I don't schedule anyone for that day and can always say no thanks to a start of care for new patient. The only problem you'd run into is if you get someone that needs daily visits, but that's usually only for a short period of time. Recently I had a patient that needed daily IV meds for over a month and I did miss a few days but was able to find a coworker to do those visits, or my clinical manager would have found someone for me if needed. For skills, good assessment skills are the most important thing. You need to be able to recognize problems early in order to keep your patients out of the hospital (doesn't always work when dealing with an elderly population because so much can happen), and be proactive in calling the physician to get orders for wound care, a UA/C&S if you suspect a uti, or you're picking up on any med problems. Basic nursing skills like catheters, wound care, post-op drains, IVs (usually PICCs, some ports too), using glucometers and INR home machines and being able to teach those skills to the patient or caregiver, and more. I've really enjoyed home health and think it's a good fit for family life. Sometimes there is a lot of paperwork to finish at night if you do many OASIS's, but that's really the only drawback I've found.

When doing a SOC, I start with the paperwork, first explaining and getting admission consent signed, then we have 3 other places that need a pt signature, so do those at this time: emergency form, another medicare/financial form and the soc OASIS, explaining each form during this time. For the OASIS, I tell the pt that everything I do at this visit will be on this form and it goes to Medicare. Then I go through a medical history and meds. During this time I learn a lot about the pts memory, and even their ambulation and balance when they get up to get meds. Then I do a physical assessment, whatever specific the pt needs (wound care, PICC meds, etc), some basic teaching and explaining what the poc will be and how home health works in general. Then I usually do the TUG, and ask to see their bathroom set up, asking about safety and ADL issues. Just by doing this, you can learn a lot about mental and physical status, check for dyspnea, a lot of other things. I also include explaining our home folder and the information inside, and making sure the pt knows when and how to call us if needed.

I'm looking for a new home health bag and trying to decide which to get. There are several in the Hopkins catalog that look good. What do you think is important in a bag? If your agency is computerized (mine isn't yet, but it's coming eventually), then is it good to have a bag that includes a compartment for your laptop/tablet? I don't want anything too huge/heavy because I'm a small person, and don't want a rolling bag. Ideas/experiences?

I delivered in the hospital where I worked, and I was in L&D at the time. First two kids were in small hospital and I was treated like a queen :) My third was in a different state after we'd moved, and I was still working in L&D. It was a much larger hospital, and I knew all of the L&D staff, but didn't know the pp nurses. I loved my OB's, and actually picked them because I saw what good practitioners they were and also had good relationships with their patients.

in our agency, per diem staff are not required to work any minimum, no on-call, and can turn down any new patient offered---but if you say no very often, you run the risk of not being asked, too. Some weeks I have less visits than I'd like, and some weeks I work more than I'd like, but overall it's a good fit for what I need at this point in my life.

I don't think it would be a HIPAA violation, unless letting people know that someone in a particular house having a home health nurse visit is considered "protected health information." But I do agree with the other posters that it's a bad idea overall, separately from HIPAA. I know the company loves the advertisement, but it's not worth the risk to the patients and nurses.