kparry

Is it safe to say you are new to home health and new to this agency? To tell this agency the truth, as you have told us, "Frankly, I don't think this visit is worth the money" is silly - - - they already know that. That's why they sent you! They new staff always get the cases no one wants. Otherwise they wouldn't have hired you in the first place. And the experienced staff will always tell you, as we have told you, refusing cases is not the way to get more cases or build part-time hours. You have to take the 2 hour visits with the 20 minute visits. So you've pretty much seen the average workday already: seventy minute visits for which you will be paid for an hour. (120 minutes + 20 minutes)/2 visits = 70 Welcome to home health!

Sounds like you got exactly what you requested.

Seriously, Mobile, AL? http://mobiledoctors.com http://www.fbi.gov/chicago/press-releases/2013/mobile-doctors-chicago-ceo-and-doctor-arrested-on-federal-health-care-fraud-charges

Is the use of E-stim within the scope of practice of a Home Health Aide or a CNA working in Home Health? The SCI patient is tetraplegic and unable to apply nor start/stop the units without maximum assist. Although we would like to help, we feel BioNess Handmaster use is best left to family members or PT / OT. Alternatively, we feel documentation and sign-off on HHA training by OTR might be sufficient. Nevertheless, not if E-stim is outside the scope of practice of a Home Health Aide.

The 24 X 7 grid was part of an application for employment to work as an "RN for medication management and caregiver training." I came across it during a work search and wondered if something similar was cropping up elsewhere. But there is no guarantee any hours will be available. They are asking for, let say, 100% of my availability on Tuesdays and Fridays for the next two weeks and beyond. I can't schedule anything else during that time. No dental appointments, no lunch with the girls, no sick kids, broke down cars, nothing. And again there's no guarantee those two days set aside will lead to any income or work. No. In another industry (or most jobs) I will have accepted a schedule THEN if I don't show up they fire me. In this case I am asked to accept the POSSIBILITY of work hours and then expected to work if work materializes. And if something materializes on short notice and I decline it, they can state I voluntarily quit. That's quit without notice BTW. The worst kind if quit. Essentially they want to "own" their at-will emplyees. What the document does is make every call from the office a threat. It just isn't a fruitful way to treat employees, build a reputation, or run a business. I get it, scheduling is hard. Nursing is harder. I didn't sign the document and I wouldn't work for a company that would ask me to sign it.

Seeking work and came across something odd. Preceeding the following paragraph is a grid 24 rows long by 7 columns wide with the instruction to put an x in each box for hours you are commited to work going forward. Hours commited can only be changed with two-weeks notice. And then this: "By signing this document, you are knowingly accepting the hours you have advised you are available and upon receiving a shift within your available hours you decline it will serve as voluntary termination as per this agreement." Would you sign this? I'm thinking if I say I can work Tuesdays 7 AM to 7 PM, they are free to call me at 11:00 AM on Tuesday and "demand" I work Noon to 7 PM or I'm voluntarily terminated. Maybe this is a common agreement. Surely they have some problem they are trying to solve. But it seems threatening their employees is their first best effort at solving it. Of course they can fire me at any time, but this agreement says if I decline a shift, I quit. Worse still, it seems a handy way to implement forced overtime. I'm leaning that given the odd document and general messiness, this is not the place for me.

That's a different topic. This is about what's most needed. The preferred acquisition method was given. as I conceded

Suture Removal Kits are online and contain sterile forceps, scissors, and gauze. Blairex Wound Wash Saline is at Wal-mart Transparent film dressing and steri-strips are at CVS pharmacy I can make a big difference in outcome by having what I need to treat those frequent skin tears when they happen. I replentish as needed from wherever, but have no problem spending $5.00 now and then to keep myself well stocked.

Thank you for a real world answer. You have actually nailed the situation precisely. I see client's families so in need of help, and so thankful they receive it, that they then feel the very natural emotion to give in return. The CNA came to me to ask what to do. The gifts started out small... she donated the clothes... Christmas was the cash gift... she felt like she would offend the family if she didn't accept the invitation to Easter dinner. A good chance no one would ever have known had the CNA not come to me for guidance. As a Companion I was removed from a case and subsequently lost my job because a family fed me and an Alzheimers patient together. The client would eat better if she thought I was a friend and we were sharing a meal. I'm suprised no one suggested notifying the BoN which is probably also appropriate ...sigh... No winners here. CNA has discipline against her license, agency loses a client and staff, client loses a compassionate and proficient caregiver.

Can nursing boundaries be rebuilt after being crossed? Is there any way I can facilitate or encourage boundary re-building between a CNA and a Home Care Client? The CNA has accepted gifts, food, and clothing from the client, several hundred dollars in cash. She has attended Holiday meals with the client and the client's family off the clock. We do have a policy and train that CNA's are never to eat with client's or family members. She's well liked (duh) by the family, and is an otherwise compassionate and technically proficient CNA. I'm considering removing her from the case, educating her on boundaries, and placing her elsewhere. That could leave the next Aide open to the same temptations and perhaps cause the client to leave the agency. Thoughts?

Thank you for the insightful input. Unfortunately, CNA's are allowed by policy to apply ZnO, and Band-Aids. So they combine the liberties and apply both to every cut scrape or skin tear they find. It seems like common sense not to do this. I didn't write the policy manual, don't own the facility, and really have no idea how to fix this. I feel a little bit better knowing most agree that ZnO isn't the best thing for wounds. But I doubt the DoN will accept forum posts as evidence based best practices. There are times when I just plain want to give up.

Any reasons not to put Barrier Cream (20% zinc oxide in petrolatum base) on a skin tear? What I'm hearing is band-aids and diaper creme are within policy for CNA's to apply. So they are using it on everything. (When all you have is a hammer everthing looks like a nail...) I recently had to clean a pretty thick layer of it off a 25mm x 35mm skin tear where the CNA had trimmed away the flap of skin herself because "it wouldn't stretch back over wound." That issue aside, what and when are the negatives of zinc-oxide and petrolatum on wounds?

Yes, the updated PoC are hopefully at the office in the clients home charts. Stop by the office at an appropriate time, not at 8:30 AM on Monday or 4:30 PM on Friday, and ask for a copy to place in the home. If a PoC is not available, ask when is a good time to return to pick one up. If you don't get a copy on your first visit or the return visit, and you are seriously troubled... not just nit-picking, notify the person one step higher in the chain of command. The very first thing you should do is look for another employer. Seriously, most of the time I'm begging my home aides to read and follow the PoC. You are asking for one and can't get one? Run as fast as you can from this agency.