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!

NC29mom, Just for clarification. The flagyl gel would be the primary treatment? Could you just use it for Odor control and then apply( for example) prisma dressing over it? What kind of pouch? If I have a sacral wound, with a large amount of drainage and dressing needs to be changed tid how would I apply the pouch. I'm thinking, your talking about a colostomy pouch.. Thanks I appreciate it!!!!!!

Hiring and firing and insubordination make up about 75% of your job. Like Orca said stick to your principles. Work with the staff who cares about coming to work everyday and caring for the residents. I am very good to my staff and my door is always open to them, but if they're not meeting MY expectations (not theirs) in quality of care I don't want them working on my team. My famous line,when I see staff not working that 100 %, is, "punch out and go home, otherwise get busy." Mind you, I don't say this everyday, but my staff knows when I mean business. I always try to make their days fun, not so routine. I like them to think outside the box and teach me something too!! I also haven't had any call ins in 8 months. I'm very positive in my facility. I have the we can do it attitude and never talk down about anyone (even though I would love too) This took me a long time to make it work. It won't happen overnight, but in the end you'll sit back at your desk and say "what a great day today." One day at a time. Good luck!!

Respect is earned. Show them that you do care by getting your hands dirty. Answer lights, help with the dining room or food trays. I'm not saying this is an everyday thing, but it helps them realize that you're a nurse first and making sure the residents are being taken care of is your # 1 priority. When you get there in morning, walk the halls and see if staff is doing ok. Say good morning to the staff. I had a housekeeper thank me once for saying hello to her. She said in the 10 years she has been working at this facility, not one member of upper management ever said hello to her. Trust me this works!! Showing that you're a team player will open their eyes and also make your job much easier. Hope this helps!

You need to rewrite the order and say contact md if patient pulse ox is below 92%. Patient is on continuous oxygen.

Home health is a very demanding job. Paperwork is endless and no you're not the only one whose doing paperwork, until 11pm at night.. I'm with you, on the daily wound care patients, they drive me nuts!! If I was in your situation ( my kids are older now) I wound take the LTC job. Do your 12 and go home. Granted, you might have to stay over to finish some charting, but at least you'll get paid for it. Home health nurses work 24/7, no matter what anyone says. There's no point in taking a day off, because the follow up needed, on a patient, is there for you to do, the next day. Everything you said in you're post is accurate. Corrections, missed visits, SOC/ROC, transfers etc..Paperwork never ends. I've been doing home health for 6 years. I stay with it because of the flexibility with my kids. Picking them up, activities, helping with school functions etc. I can't believe they won't let you go to part time. You might want to check with human resources or review your employee hand book.. That doesn't sound right to me. Enjoy your kids while their little and spend quality time with your spouse. You'll feel a huge weight off your shoulders!! And ask yourself what are you going to do with all the extra time.. Good luck!!

I disagree. I work for a home health agency that has hired new grads and they're doing great! I work in the field as the RN case manager. Basically, you're making sure all the disciplines are updating you, at least weekly, and following the plan of care. If you're going to be an actual manager, in the office all day, inputing the 485, dealing with staffing issues etc, then I would say not a job for a new grad.. If you have the proper training, experienced preceptor, management team with high standards of care and ask questions, until you're blue in the face, you'll do just fine.. Never set yourself up for failure, until you try it. Who cares if you've never worked in healthcare before.. Obviously, the company that called you, for an interview, doesn't. You stood out from the rest. Good Luck!! If you declined the interview call them back. Say you thought about it and would like to proceed and want to find out what the job entails. We all were a new grad once. We all took the leap, to start something new and out of our comfort zones!!

Would I put the silver nitrate just on the wound edges or on the wound bed as well? Pt only stays up in the chair for a 1-2 hour period and then lays down. Spouse does not reposition Pt at noc, which I could write a book about.. Pt had the roho cushion for about 6 months...also has a Foley catheter.. Thanks

I have a patient with a stage IV pressure ulcer to her coccyx. The patient has had this for over a year and I've been the primary nurse. When I first saw the patient it measured 6.0cm x 6.8cm x 1.3 cm. Now, a year later it's 0.5 x 0.3 x 0.2. It's been this size for months. Pt is bed bound, but gets up in chair throughout the day, has a specialty mattress and a roho cushion for the w/c. Transfers with hoyer lift. Spouse is the primary caregiver. Initially, pt was on a wound vac but wound showed no evidence of healing, did acidic acid wet to dry daily for months and the wound made significant progress. Wound became to small to continue treatment.. In the past 3-4 months I've used: Aquacel AG, honey, and now I'm using prisma dressing. I change it 3x weekly. I've cultured the wound approx 1 month ago and it was + for MRSA. Pt is on juven and ensure bid, appetite is poor. I did a pre-albumin level and it was 19( range is 18-46) Pt is not able to go to a wound clinic, transportation is an issue. Wound bed 100% red, sm-mod serous drainage, no odor, surrounding skin is macerated, but has improved since using an eakin seal.. Any ideas?

No , you can't go for a one time visit.. You have to go through the whole eval process.. My agency has our PTs do pt/iNRs by finger stick, otherwise your case manager will have to order the lab to draw it.