charelleRN

This year I started working for a home health agency that does not reimburse for mileage and pays per visit. My accountant said to keep track of mileage. In previous positions that reimbursed, the mileage started from the office to the first patient even if you did not go to the office. Is this appropriate to document this way even if you are not going to the office for tax purposes? Or should you track exactly how you travel (from first patient to second, etc). TIA!!

I am a new graduate RN and have 2years LPN experience. I was hired in August to a skilled nursing facility with a floor dedicated to "Post Acute Rehab". Today my beds were full with 19 patients. NO unit manage, an LPN med nurse taking over as charge nurse, and a new hire on the other side. These 19 patients include about 12 recent orthos along with strokes, COPD, nephrostomies, gtubes, urostomies, ileostomies, IV antibiotics etc. I am responsible for 7-3 meds, treatments, and a skilled check off and notes on EVERY patient along with any admission assessments or discharges. I don't start my am med pass until 9-30 because it takes a half an hour to count the narcs that have not been emptied in months. The scripts and narc kit do not even fit inside the narc box. On top of that almost every patient is looking for pain meds the moment I get onto the floor or physical therapy is chasing me to give someone pain meds so they can take them to the gym. Even with help with some treatments from the charge nurse I am not leaving until at least 5pm. I have already addressed my concerns with the DON and ADON with them saying that they can hire another nurse but will take away the charge nurse. I feel that every day I will either make a med error, screw up the narc count, or have a patient upset because their pain is not managed immediately. Im forced to clock out for a lunch break and I spend it either medicating, doing treatments, or writing notes. I don't know how to go about doing anything else? Who do I tell? Can i call the BRN? Is this patient load safe?