nurseinmo

jeannepaul what is the census of the hospice you work for? I just interviewed for a job that sounds a lot like what you are doing. I was told they would pay an hourly/salaried rate for the time and a per visit "bonus". The current census is 47. With that, can I expect to be pretty busy?

I have seen this happen as well. I think sometimes when those "other" hospice agencies are trying to build in a new area they go above and beyond what they would normally provide to try to boost their reputation if you know what I mean. I am currently working LTC but trying to get into hospice within the same corporation and I see it all the time.

That's what we have been trying to tell her!! I thought maybe something had changed as far as the 485 was concerned; I think she is just mis understanding what the surveyor meant. There is no talking to this woman, I have tried and it has just gotten me in trouble. I asked her today about a new policy she had written and a couple of places were wrong, just minor things and she got very defensive, pulled the papers from me then shoved them at my arm, essentially shoving me in the process and tole me to "write the policy then, you be the director". I said I thought she was being hateful and she said "well I said it nicely"... I am soooo ready to get out of that department with everything that has been going on! As far as the "standard" question goes; I was trying to explain to her today that this is...well standard on every patient. She asked how I teach it...really?? I said, well, I go over it at every admission, this is why we put a barrier down for our bag, clean hands before getting into bag, wear gloves, clean hands, clean equipment...etc. She really is tough to deal with!

I have worked for the same HH agency (hospital based) for 2 years now. In that time we have had 6 directors... we recently had a survey that apparently didn't go like they thought it should. One of the issues that was brought up was our 485's. Now the director is telling us that we have to teach EVERYTHING on the 485 with EVERY visit. Prior to this our 485 would say something like Teach: Disease process - Diabetes (foot care, self assessment, when to call, diet...) so then our computer based charting system would give you a drop down with the things in () to select from to teach a different one each visit. She gave me back 3 485s today to change. Some things were duplicated because of the system and did need to be taken out; but she also told me I can't put "standard precautions" in because there is no definition??? Excuse me? That's why it's STANDARD!! I learn more and more every day that most of what she tells us is not right but I just wondered on this issue how everyone else does it? TIA for any input.

My situation was a little different. As a new grad, I did about 3 months of med surg nights and then I worked in a long term care facility for the developmentally disabled, the same facility I had worked at as an aide and an LPN. With about one year under my belt total, I applied for a HH job and was hired. I have been there for 2 years now and I have never felt like I was not capable of taking good care of my patients.

Until recently our LPN was on call as well, with an RN back up in case of something outside of her scope. She is the only one of us who doesn't live in town and several times would call whoever her backup was and have them make the visit so she didn't have to drive over because it was "faster for the patient". Partly because of that, the discontinued her being on call. She is the only LPN in our agency with 3 RN's....we are all paid hourly.

Yes the ones I am thinking of are Medicaid only patients. we only do initial, 60 day, and d/c summaries for the Medicare patients. Apparently the story goes that it was sort of a "billing" thing that they weren't paying so the agency would send along with the paper bill a summary of everything that had been done and that "fixed" the problem of getting them to pay. Now they are doing e-billing though and it hasn't been a problem so I am thinking that it is probably just an agency specific thing and that we don't need it anymore.

Thank you so much! I have looked everywhere and have yet to find anything that says this is required but wanted to see if it was something I was missing.

Does anyone know anything about doing 30 day summaries for medicaid? I am fairly new to HH and was recently told I need to go back and do 30 day summaries on all my mcd patients....billing says that we don't need them anymore but I want to be sure. Thanks for any input!

Here is one with several useful things on Diabetes.... Diabetes Education and Research Center - Teaching Materials

We are allowed to wear either scrubs or street clothes but no jeans. I do know of another agency that does allow denim but not blue...they are allowed to wear scrubs if they wish as well. I do genearally wear scrubs unless I go out after hours or I'm on call or something then I have work street clothes.

THANK YOU!! That does help quite a bit actually. I wish they would let us use the paper forms for ours, esp since we don't do OASIS on infants and we usually don't see the moms as patients. The last time the people from this software company was here they sat with us and helped us "build" a peds assessment but it still isn't right, things are missing and some of it is totally off the mark as far as what we are looking for so I'm hoping that now that I'm starting to figure the system out I can go back and revamp it to make it what we really need it to be! :)

We have just gone through some software changes and we are a very small agency and none of us are really "baby nurses" if ya know what I mean.. anyway, my question is, what are "must chart" things for a well baby visit? I am going to have to rebuild our assessment and need some expert input! :) thanks!

Wanna move to "middle of nowhere" MO? We have a good agency as well. Just filled the open position but I don't look for this one to last long based on a lot of what she said today. :) The good ones are out there! :)