tktjRN

I've changed a trach about 5 times and I'm still not comfortable doing it alone and don't know if I will ever be comfortable doing it by myself. I have made everyone, I work with, aware of this fear. You're not incompetent. You're looking out for yourself and most importantly the patient. Just be honest to your employer and I'm sure they'll understand. Don't ever do anything your not 100% comfortable with.

Unfortunately, every job description that I've had stated "and duties as assigned." Yes, bruises are part of skin care, but I do agree that it should be separate charting from wound care. Bruises of known or unknown origin should be monitored by staff nurses, not wound care. This can be documented, to assess area daily, in the treatment book, until resolved. Skin tears should be monitored by wound care on a weekly basis. Good Luck!

Nurse4wounds I totally agree with you A lot of people are obsessed with letters behind their names, thinking that will get them to the top. I'm not saying continuing education and degrees are not required for advancement, but you are where you are because of the quality care you give and the reputation you have in the community. You go girl!

DavidDudley was very well said and 100% accurate.

Oh yes.

A pre albumin level is not usually ordered unless nutrition is an issue. A nutritional assessment should be conducted first. Any weight loss, how much is the patient eating at meals are they on nutritional supplements. Is the wound chronic, look at the patients comorbities and try to figure out the etiology of the wound first, before ordering labs. Wound cultures are usually only performed when there's s/s of infection or a chronic wound that's not healing. The etiology, of the wound, is the key to develop the plan of care Hope this helped

Look at the tread "Can you have a life in HH."

I would get her a speciality mattress and a roho cushion if she doesn't already have them. Ask yourself, is it really necessary to send a pt in there 90's to a wound clinic for sharp debridement?? Please start with santyl, hydrofera blue or medihoney.

Date of last visit is the last time you saw patient. Date of discharge is the day you found out about it. Example: I saw patient on 11/5 for wound care. I called patient on 11/12 and pt stated he does not want to continue services.. My discharge date is 11/12.

I recommend staying in the hospital for a few years and get comfortable with your nursing skills. Acute care is the best place to learn.

We use paper scale liner towels from Medline.

We use paper scale liner towels from Medline

We have about 150 clients and we have 8 RN's, 1 LPN, 4 OT, 8 PT, and 1 HHA. I think 20 HHA's is way to much. Our HHA is steady, but not overly busy. We also have to many nurses with not enough nursing cases. It also depends on the time of year. Summer is very busy and winter is very slow. Weird I know, but every year this happens line clock work. I sometimes only have 11 visits, for the week, during winter Months. Good luck!!

1. DON should be doing DON duties, not case managing patients. 2. Our LPN's do none of that, but it would be nice if they did. RN must co-sign all MD orders for a LPN. 3. That's called Medicare fraud for unnecessary visits. No need for nursing, the pt should be discharged. Holding paycheck!! What the hell is that about. All notes should be handed in within a certain time frame, but if corrections are needed they can't withhold your pay check. I would contact human resources about that one 4. Your absolutely correct about home bound status. I could have no car, but if I'm going out to eat every day with my friends, I'm not home bound. OMG!! They have part time jobs?? That is Medicare fraud for sure. What's wrong with your company? Is it privately owned? Home bound status should be documented for that scheduled visit. Your home bound status can change with every visit. You shouldn't be writing what's on the 485. 5. It should be the case managers decision if they want the LPN to write or put their input on the case conference sheet 6. Get out of there!!! That's not only shady their not following Medicare guidelines for home health care... I would report them to the state after you quit!! Good Luck!!!

All the nurses, at my agency, carry a bin of supplies in our trunks. Our supply room is locked at all times so if we need something after hours or on weekends we're out of luck. We leave enough supplies for at least 2 dressing changes, then we order the rest. My agency prefers that we take basic supplies like gauze, Betadine and skin prep, from supply closet, to give to patients because of shipping fees. But the other responses are correct about the supplies in the trunk. I do have to empty the trunk every time I go shopping!