SWRN84

Agree with everyone else. Definitely not homebound and no skill. We would not admit this patient.

I graduated from Mo Bapt in 1984. I have been in home care since 1987 and have often thought of taking the refresher course the institue offers, to try to get back into hospital nursing. Glad to hear you are doing so well. Do you think the refresher at the nursing institute will prepare you adequately to work back on a unit?

mrob.....where are you taking your refresher course? How long have you been away from acute care nursing?

I have been working in home health for 20 years now. Over the years, I have seen the pay scale/type change back and forth. I worked 5 years for a hospital based agency, but the remainder has been with an independent privately owned for-profit agency. Prior to PPS, the nurses were all paid hourly. When PPS came into existence, our agency made a total change and all visiting staff were made per visit....mileage was cut. This lasted a few years. Now we no longer have per visit case managers....the only staff who are per visit are the contract staff, or prn staff. We have some nurses who are paid hourly, and some who are salary....just depends on their situation, hours worked, etc. The home health industry is ever changing and some agencies have to make changes in order to stay in business. I don't think you can generalize where every agency is headed, but I do think every agency is different.....much depends on owner status, independent vs. hospital-based, for profit, or not. Your best bet would be to investigate fully in each agency you are interested in. What are their expectations in relation to the type of pay they offer, etc. I have worked salary, per visit, and hourly....benefits and problems are associated with each type of pay. It all depends on what you need, what you are willing to do, and what you want to get out of your position, not only with pay, but with job satisfaction associated with it. I have not worked in the acute setting in a very long time, so I don't have anything to compare it to as far as money.....just from what I have read, home care pay is lower than acute care. But the rewards are many! And I live in the midwest, so our pay scale would be different than Florida I'm sure. Hopefully, someone from the Florida area can give you some advice on what the average pay scale for home care is in your area. Good luck.

As of March 16, approx 4700 home care agencies registered to participate in this initiative. I am responsible for some of the QI implementation in our agency, including outcomes. I registered the first day. The first implementation package was sent in March....it has to do with hospital risk assessments. We already have in place many of the best practices they will be dealing with, but I am hopeful we may gain an increase knowledge, or maybe just be able to tweak our processes a bit. Our goal is to make our outcomes for ACH even better. We shall see.....it surely can't hurt and doesn't cost a thing.

We have always flushed ports once monthly if they aren't being used. They may last longer than that without flushing, but in the 20 years I have been doing home health, both agencies' policies have been monthly flushes for those ports that aren't being accessed on a routine basis.

I worked for Intellicare in the disease management division.....I trained in the St. Louis call center. I worked for 2 weeks in the call center then went remote at home. At the time I was told the triage nurses stayed working in the call center until they met the time metrics. So not sure if I can help you with the triage part of it.

23 years ago I started as an RN at $7.77/hr in a small rural ICU in Missouri.

What state do you have your license in?

Yep Christine, I do know exactly where you are. I was over in Warrenton just the other day. I was doing home health visits and worked my schedule to end up there so I could make a visit to the outlet mall. Didn't find what I was looking for, but I still like going there once in awhile!

I have been working in home care for 19 years....staff nurse, case manager, supervisor, now am working prn 4 days per week. Home health is a great place for a nurse to really develop different skills and is truly what nursing is all about. Your patients generally love you and rely on your visits and teaching. The pros are as mentioned: one on one care, developing close relationships with your patients and families, feeling like you really do make a difference. Cons: on call...weekends can be hairy depending on the size of your agency and how many nurses take call at one time; paperwork....very much paperwork which can be overwhelming to learn and incorporate into your daily care of patients. You have to be able to utilize your thinking skills, have great assessment skills, and also be able to perform independently. Many patients come home sicker....we see everything.....you will have post surgery patients requiring dressing changes/staple/suture removal.....blood draws, port/central line access, tube feedings, vent patients, iv infusions/pca infusions....just about anything you can think of and have to learn to manage those independently. There is much teaching involved in home care and you have to involve caregivers as much as possible to try and get these patients back as independent as possible. It's a whole different type of nursing, and I do believe you either love it or hate it....there's usually not a whole lot of in between, but like any other nursing position, it takes a good year to feel comfortable.

We use INRatio fingerstick machines for most of our patients in home health. We started using them a few months ago. Prior to that, though, I have occasionally had a patient where the blood would not entirely fill the tube to the line it was supposed to. In that case, the lab told us we could use pediatric blue top tubes for those INR's. Do you have access to a fingerstick protime machine in your agency? If so, I would definitely get an okay from the physician to go ahead and do it that way. It would save you a lot of hassle and the pt a lot of sticks. So far we have had very few problems with inaccurate results. The physicians we work with have basically said use one or the other...either fingerstick or venipuncture...but do not alternate between the two.

I live in Lincoln County....approx 1 hour north of St. Louis. RN since 1984.....most of my time has been spent in home care....now I'm at the "I don't know what I want to be when I grow up" stage....still in home care and needing a change I think. Born and raised in Missouri.....have never lived in another state. I've always thought it would be nice to live somewhere else for awhile....but I do love the change of seasons here. The weather this week is heavenly!

I think it depends on how your assessment skills are....what type of nursing you did prior to leaving to raise your kids. If you are confident in your nursing assessment skills, that's half of it. You have to be autonomous, use critical thinking skills.....good nursing judgement. If you have all that, plus a lengthy orientation, you should do okay. You cannot learn home care quickly in my opinion. I would say it takes about 6 months of steady working to feel somewhat comfortable in home care, and at least a year before you start to feel confident. As far as flexibility...it all depends on the agency you work for...and if you are a case manager or prn nurse. I worked as a case manager throughout the entire time my kids were babies and small children. It's flexible but you still have to take call, work some weekends, and some holidays, but it's totally different than working in a hospital environment. The flexibility all depends on the agency and how they work.

We also use the machines where you collect in capillary tubes after the fingerstick. We use a machine called INRatio. I have been lucky this week....2 days in a row I was able to get orders right at the patient's home.....that doesn't happen too often. I know what you mean about nurses fighting over machines! We only have 2 in our agency so far and it's a circus sometimes. They say whenever the time comes for us to order new strips we will also get another machine. Can't wait for that!

We've been using the machines now for several weeks. At first we had a couple results that didn't seem right, so we went ahead and did a venipuncture protime to verify accuracy. So far they have all been close in results. We had an extensive inservice and they aren't as simple as glucometers, that's for sure. The machine has to be at room temp; it has to be on a hard level surface; once you place the strip in the machine you cannot bump or touch the machine as it may affect the results. As far as having to stick people more than once...I've not had to do that, except for in those early cases when the results didn't quite go with what the patient had been running with inr's in the past. I'm getting more confident and comfortable with them.

Just wondering how many of you use fingerstick protime machines? Our agency just started using them. Today was my first time in a patient's home with one. It was so great having that INR result right there in a matter of minutes. When we first started we had one fingerstick that was very out of range for this particular patient, so went ahead and drew a venipuncture specimen to verify the results. I actually don't know what that showed, but I know of several physician's practices who use these on a regular basis. It sure will come in handy with patients who have difficult venous access. Any thoughts on using these....as far as results not accurate, etc?

Intellicare offers a work from home environment after going through orientation. They have 2 divisions....disease management and triage nursing.

The home care agency I work for hired a prn nurse....no home care experience, but ER and med surg experience. She oriented full time for a couple of weeks, then went down to working one 1-2 days per week. She seemed to do fine with it. I had always been of the mindset that it would be difficult to learn home care doing it prn if you've never done it before. I still think that it's more difficult that way.....only because of the regulations, OASIS paperwork, but I have seen that it can be done.

If you're looking to use your nursing skills, Intellicare offers work from home. They do disease management (which is what I did for them), and triage. Almost all of their nurses work from home.

I have been working in home care for 19 years. It was a position that sort of "fell into place" and I wasn't sure if I would like it or not. Luckily, I loved it and have basically stayed with it all this time. While my kids were young (babies/toddlers), I worked as a case manager in home care. It was a full time position, day hours. We rotated through on call one night per week and one weekend every 5-6 weeks. It was a great schedule while having a family, even though when you are on call there's a possibility of going out at odd hours, but it didn't happen too often. I moved on and worked as a home care supervisor for about 10 years. I'm now working back at the agency I started with in the first place years ago. I work prn....set my days and schedule. It has it's perks and drawbacks. As a case manager you really get to know the patients on a whole different level. It's a very rewarding career and it's been great for me with a family. It really all depends on the agency you work for as far as flexibility and scheduling, on call, hours worked. The best part about it is, no matter which agency I have worked for, if something came up like a sick child, a doctor appt, etc....you can work that around your schedule most of the time. It's been a great fit for me. Good luck.

I agree.....talk with your supervisor, let her know what has happened with your home schedule. Many times, they will be willing to work out something....it may end up not being the optimal position for you, but they may be able to work with you on the hours. They have invested time and money in orientation for you, and probably will be willing to work with you if there is anything at all available. Good luck. I know what a stress it is when you're a mom, trying to "fit" all the work away from home, plus kids. It's a tough time in your life, but you will get through it. I've been there and know how stressed you must be. I hope it all works out!

Tweety!....you're flame proof! I loved that! After I read your post, I thought "oh boy, he's asking for it!"....but the flame proof comment....too funny!! I am in agreement with you. I don't expect much for Nurses Week. I've been a nurse too long to expect much more than a coffee mug, or a beach towel. But I agree, we should celebrate it ourselves.....pride in what we do each day. We had donuts delivered by the hospital this morning. I work in a hospital based home care agency. But better than that....all of the support staff in our agency brought in a wonderful carry in breakfast! It was great! All the best things to eat for breakfast...a good way to start the day. We had to sit through a JCAHO prep inservice while we were eating, but it was worth it! One year, my hubby surprised me at work for Nurse's Week. He sent me flowers at work....the card said..."Happy Nurses Week....come home and let's play doctor!" I will never forget that one! Happy Nurses Week to all of my fellow nurses.....I'm very proud of what I do, even when it feels thankless.....it's a great place to be!

We just received notice at work for those of us who were born after 1957, we have to give proof of 2 mumps vaccinations, or have a titer drawn. I did find my immunization record and it looks like I only had one dose in 1971. I will have to have a titer drawn.....hospital will pay for it....if I am not immune, I will have to receive the vaccine. I live in one of the states where the outbreak has spread....I think I read there have been 4 cases here.

Most things have already been suggested....but I would try going through the division of family services office in your county....sometimes they have referrals for sitters. Do you have a Parents As Teachers organization in your area? They could possibly assist with babysitter referrals.....I had thought about your church.....if you belong to a church, you could try and put something in the weekly bulletin noting that you are looking for a sitter. What about any friends you have with children.....word of mouth is a great resource if you are looking for a private sitter. I don't know if you can afford actual daycare....we went from private sitters to daycare when my kids were really young. It did cost quite a bit more, but you could take part of it off on your taxes, plus you wouldn't have to worry about this happening again. We chose that route just because of the same situation you are in. It actually became a blessing for us. Even for the short term, if you could swing the cost of a daycare, at least you wouldn't have to worry. Iwould say as a last resort, you could look in the ads in your local paper. We have people advertising all the time that they do sitting, but I would definitely want to check the references, etc. Good luck. I do know exactly how stressed you are right now.....been there myself. My kids are older now....oldest is 15, so I don't need sitters anymore, but I know that was the biggest stress on me as a working mom.....worrying about my kids and making sure they were okay. I hope it works out for you.