KaeliF

sometimes I'll see up to 8/9 a day but thats only on occasion

right now I'm usually seeing somewhere between 6-7 pts a day, 5-6 if I have a SOC or something. ​

I've been a HH nurse for a little over a year now. My old office was not well organized at all and as a result I usually worked from the time I got up to the time I went to bed 7 days a week. I was on the verge of quitting, then moved to a new area (transferred to a different office within the same company) this office is MUCH better organized and I starting thinking I finally got a point I could see myself sticking with home health. However, last couple weeks have been especially busy (as it tends to get) and I've started working more and more hours again. Nowhere near as bad as it was before, but still I'm determined to get down to a 40 hour week. What are some of your time saving tips? Here's what I already do I try to do as much charting in the home as possible (unless the patient is SUPER chatty, in which case I just get what I need and try to get out ASAP) I try to schedule my next visit while still in the home to prevent from having to call up patient and schedule visits (just started this plan last week so it hasn't yielded all the benefits it will yet) I wake up at about 5am and chart (I'm a morning person and can focus much better this way then when I try to chart after a long day) which usually allows for about 2.5 hours of charting before i have to get ready and go I keep a notebook with all my patients info and goals and try to cross off goals as i meet them to keep up with it (even though I usually forget to do this and end up having to go back through my notes and cross things off that way) any additional ideas? it would be incredibly helpful!

thanks I'll have to look into that!

I have been a HH RN for a few months now and I have been working on average 75 hours a week. I am also a single mom (which is why I started in HH in the first place, a schedule that matched up with my daughters school schedule better) so I can't work that much! I have been neglecting my responsibilities at home and I feel like I never spend time with my daughter anymore. I like my job and I don't want to quit and I like the flexibility of the schedule but if I can't cut down on how many hours I have to work then I can't keep going like this. Please, does anyone have any tips?

I would say it's not a great idea for a new grad. I started HH nursing about a year out and I wish I would have stayed in the hospital for another year or so. I dunno about you but when I was new I had to ask questions CONSTANTLY and in home health there is no one to run and ask, no charge nurse, no one to say "Hey I'm not entirely sure if I need to call the MD over this (fill in the blank) can you come take a look for me?" I'v been home health nursing for a few months now and I don't feel entirely out of my element but still I think if I had stayed in the hospital a little longer I would have been way better prepared cause you learn the basics in school but you REALLY learn how to be a nurse on the job

oh yea we use a cheat sheet when we have to do paper in the home too. I would suggest going through the oasis and typing up your own cheat sheet though, the ones they provided me are missing some things and if your new to oasis you wont know to ask.

I just started home health, I've only done 3 SOC's and each one I've had to do on paper because I live in a very rural area and alot of my patient's don't have internet or cell signal to connect the iPad through. It's taken me about 1.5hrs each visit in the home, however it should take less, each visit seemed to have some complication or another. Buuut, then getting onto the oasis and charting takes another 2 hours or so. But I think this will get quicker with practice.

Hey! I've been an rn for a little over a year on med surg and pcu, now I'm going to be transitioning into home health! Any advice on things to brush up on before i start? Thanks!

Any advice on how to get started in this field? I live in a fairly rural area and there aren't any agencies that specifically deal with developmental disabilities, so I'm not really sure how to get going.

So I have been a med/surg RN for about a year now, and during this time I have been living with my grandparents because my daughter is not yet in school and there is no child care service on the planet that can cover the crazy hours I need (from 0445 AM to anywhere from 1930-2130 pm depending on how crazy the day was.) This has been a great situation, but the problem is I REALLY hate the area I am having to live in. Plus some family dynamics are starting to be problematic. So with my daughter starting school in the fall, I am trying to find an RN job with school or very close to school hours. My question to you home health RN's out there is what kind of hours do you generally work? Is it a realistic option to expect meetings/visits to be confined to 0800-1430, then be able to chart at home?

Thanks that makes me feel better! The med never actually made it to the patient, it got caught, and I made sure to keep my composure and thank the nurse that caught it before coming home and freaking out. Also, since then I've had a pharmacist tell me that diluting an IM med wont change the absorption rate? Which is really the only problem I could imagine with it (other than if it ended up being >2ml) I mean I guess there's never really a situation where you need to dilute it, I was just acting out of habit and grabbed a 5ml syringe (the size I used for most pushes) and wasting what I needed to was easier if I diluted the med first that way. I could have just as easily grabbed a 3ml and avoided that whole situation *sigh* but I digress... I guess you could dilute an IM med if you for some reason had to at some point?

Well tonight I did something REALLY dumb. I have been working night shifts now and have never really adjusted. I still just feel like I'm at work in the middle of the night when I SHOULD be sleeping! Anyway last night I was particularly exhausted (for no apparent reason, I had slept that day, my body simply will not adjust) And in order to make it easier to waste an IM medications I DILUTED IT and then wasted part. Fortunately, this was for a psych patient and I needed an extra nurse to help make sure I didn't get hit while trying to administer it and he pointed out my mistake. However, the fact that I forgot something as BASIC as "dont dilute IM meds" Is really scary to me. My charge nurse just said she would like me to show her my IM meds before I give them for a while, but I'm expecting I'll get a call from my director about it. Any advice on how I should handle that call? Ugh this is the first thing I've done that's really made me question whether or not I'm in the right career.

I typed my brain sheet up on word, so I can just print a couple out on the day of my shift. I divided sheet into 5 patients, I left an open square big enough to place a patient sticker, and I have areas to put patient's Diagnosis, diet, ambulation (assist x1-2, walker, self, etc), fluids, allergies, history, orders, and labs/diagnostics. I also have a little corner over to the side where I've typed "foley, telly, 02, accucheck" and if the patient has any of these I highlight it. Then I divide the back of the sheet so I can write anything extra on the back. I've also found it really helpful to make up kind of a grid, where I have patient room numbers across the top and times down the side (for example I work nights so box 1 is 1800, box 2 1900, etc) and that way I can write in my to do list for the night in a way thats very easy to reference, and it gives you an organized place to jot notes to document later. Best time management tips I've learned so far is bring a bag of fluids with you into the room and just hang it up with your first round, even if the current fluids still have a while yet to run, that way rather than running to the supply room all night when your infusion is complete you just go switch it over. Also try to fit as much as you can into each trip to the patient's room. DO NOT BE AFRAID TO DELEGATE! I hate telling people what to do, so I end up doing a lot of tasks that a CNA COULD do and it costs me a huge amount of time. This is a personal problem I'm working on :/ hope that helps!

Hi there! I'm a new grad, a few months out, currently working on a med/surg floor, and I'm trying to decide on a specialty to go into. It seems like there are a lot of job listings for case management nurses and I like the idea of creating continuity of care, rather than the 'treat em and street em' mentality that seems to prevail on the floor. I was wondering how you guys feel about being in case management? Can you give me some pros/cons?

I'm a new nurse, been working for about 2 months and I am finding that I really don't like my job. I've been starting to look into what I want to specialize in and honestly nothing sounds good to me, nothing about nursing interests me anymore. I understand there is an adjustment period to be expected and I'm probably just feeling a little exhausted from the 'newness' of it all, I was just wondering how long it took you guys out there to start enjoying nursing?

I'm a new grad that started working in july so I am right there with you! Trust me, if this is the worst thing that has happened to you thus far you are doing fine. There was one morning in particular a couple weeks ago I got so upset because it felt like each pt I reported on, the oncoming nurse would ask a ton of questions that I could not answer, I felt so stupid. But the thing was, I gave them everything I had gotten in report at the beginning of my shift, so really I had received poor reports as well. Now I just make sure I do really thorough chart checks because I've found that even the most experienced of nurses leave stuff out. However, I have found this puts me behind at the beginning of the night so I still have to find some kind of balance there. I've just kind of accepted the idea that the more experienced nurses probably make fun of me. They at least have the courtesy to do it behind my back (well most of them anyway, there was one guy last night that doesn't usually work on our floor who was very condescending) But I'm sure when I've been a nurse 20+ years I'll find new grads kind of funny too. Just remember it's not that you're not incapable, just inexperienced. I keep on hearing that it takes about a year to really start getting comfortable, so only 10 months to go!

All I can say is that if you are on a psych unit be sure to dress VERY conservatively! A lot of the people on your unit will be middle aged men with very poor impulse control, so you are definitely not dressing to impress here. Also, when I did my psych rotation our instructor told us to be sure to avoid wearing scarves or anything else that could be used to choke you. I know it sounds outlandish but better safe than sorry.

oh my God that is horrible! She didn't have anything else going on? Like a congenital heart defect or something? It just doesn't seem like that could happen to a young healthy person just from drinking too many Monsters!

Just call ahead next time! There are some days that people literally do NOT have the 2 minutes it would take to say hi and be cordial and get your resume and all that. Not to be rude or discourage you from trying again, just make sure to call and set something up ahead of time so that way whoever you're meeting can plan accordingly, otherwise it comes across that you are self absorbed and have no courtesy (even though I'm sure that's not the case) it reflects poorly on you and gives the employer a bad taste before they even get to look at your resume.

I do NOT understand it! You would think everyone would be on NS or LR but no, the majority of my patients are on D5 0.45%ns with 20mEq of K. Does anyone else notice this trend or is it just at my hospital? Are the physicians just trying to keep their glucose up (I work on a post surgical floor, a lot of people are NPO after midnight or on clear liquids) and trying to replace K+ cause they are putting out more than they usually do at home due to the fluids going? This is my best guess.

Nurses probably look like it's something trivial when you tell them about patients in pain because those are probably the same patients who have been incessantly complaining of pain all day, to be honest we just get tired of hearing it. That's not to say it's not important or necessary that you relay pain levels to the nurse. Trust me it's not that they think you are telling them something petty, they are just thinking "omg I have to go medicate them AGAIN???" As for the blood sugars, the night shift NA told you wrong. I've never seen someone clean the first blood away before. And actually, you are not supposed to sit there and squeeze the finger after you've pricked it to get blood as that can give you an incorrect reading, and if you've already cleaned the first blood away then milking it out is the only way I can imagine you'd get enough for the strip. So go on doing it the way you were taught the first time, you had it right.

I took the ACLS course online and it said you were allowed to retake the test if you needed. I can't remember if there was a fee for taking it an extra time, but you could retake it.

It depends on your facility's policy. Our policy is that intermittent infusions need tubing changes q24h.

I think after learning the different abnormals and what they sound like it's just a matter of experience. I'm a new nurse and I still have sometimes have trouble differentiating between really coorifice crackles and rhonchi, but I have a lot less trouble than I did in school, so I think its something that comes to you fairly quickly.