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! :)

We are also a very small agency with a "new" director (she was a field nurse before w/the same agency) who just found out she has cancer. We typically take call once every three weeks from Friday evening until the next Friday morning and the director is backup for the LPN when she is on call. Lately with her being ill though we have been trying to help cover hers as well. We have another nurse who just started today that isn't looking very promising either..... PT for us doesn't take call and they don't do admissions but we are told that is soon to change too.... I would rather do the paperwork than have to be on call all the freaking time!

Anyone out there use this system? What are your thoughts on it, any advice or tips? Our agency just installed it with the plan to "go live" on July 1 (the day I started) but there were so many flaws we had to go back to the "old" system for a few weeks there in between. Now we were told we had to "go live" again as of Aug 1 but many of the problems are still not fixed. We have visits sitting around for days we are not able to get put in the system because no one knows how to operate the system. We are a very small agency with few resources so any input would be greatly appriciated! :)

I feel you pain! I worked at what sounds like a very similer facility until recently and we went through this very same struggle with the management. The way our facility was set up we had one building on each side of a main highway that runs through town and had more than one occurance where lower functioning individuals left their areas and crossed this road unsupervised. Thank God nothing ever happened to one of them (yet) but after what I felt were some very poor decisons on the part of the managers and another incident were we "lost" a deaf autistic man for about 10 minutes and found him alone outside...I finally decided that it was in my best interest to leave the facility. I loved my job and the individuals that I cared for, but the people making the important decisions about their care at this particular facility do not have medical training and there was too much happening that I felt was jeopardizing my licence for me to be able to stay. As far as where you are now, you can only do the best you can do. Teach you staff and stress how extremely important it is that they know where their individuals are at all times. Maybe as for the garbage disposals they could cover the switches somehow? In one of our buildings all of our light switches were only able to be turned on or off with a key and we got away with that so it's a thought at least. Our facility kept a seperate kitchen and the individuals only had a "cooking class" every so often so no knives or food were kept on the areas where they lived and I can see how this would be a concern....I don't really know what other advice to give but keep us posted on how it goes.

I work in an MRDD long term care facility that is operated by the state and we have an individual who is somewhat MR but also has numerous other issues. He had been on Clozaril but had to be taken off due to agranulocytosis. We went through months and months of decreasing the dosage and trying to find a "happy medium" with it but his WBC finally got too low and he was removed from it all together. Currently he is on Haldol (both oral and IM), phenobarb (seizures), topamax....I can't remember what all else. He has been on Mellaril in the past as well as Thorazine, Abilify, and Risperdal that I can think of. We had a recent brief stint on Valium but NOTHING is working. Right now, he won't take any pills that are white (he thinks we are poisoning him) and half the time he won't eat and is already underweight. His behaviors have never been "good" but he was much more controlled on the Clozaril. The Dr. is going to wean him off the Haldol and try Prolixin next; but after that no one knows what else to do for him. Sometimes when I am giving meds and he is upset and starts with the "I'm not taking any of those **** white pills" I can talk to him before I punch them out and explain *sort of* what each one is for... this one is for your blood pressure, this one is for your heart.... and sometimes he will take them, and sometimes he won't. Today, he hasn't taken any meds all day.... Any ideas about newer meds that may help this poor guy?

Took NCLEX-RN today, and for all those people who told me that the LPN test was harder....you lied! I had the min questions for the PN test 4 years ago and passed, left the test feeling ok; this time I had close to 160 q and felt like there were a LOT of things I didn't know. This wait is going to kill me it feels like...

That is perfect! Thanks so much!

Anyone got any ideas? Thanks in advance!

I have to come up with an assessment for my on-line transitions class and I am having some difficulty following some of it. 1. what is pupil consensuality, and pupil convergence (on a neurological assessment form) and what do I put in the blank. Then it says "Gaze: (presence of nystagmus)" what would you put there? Or Attention span/ Calcualtion:___ I hate that they give us these forms that no one has seen before and expect us to figure it out on our own and it is due by MN tomorrow! I will be sooo glad when this class is over!

That makes sense, thanks!

Working on an assignment that states, formulate a nursing diagnosis for each of the following: Problem: Boredom, etiology: isolation Anxiety, hospitilization Unable to sleep fear of surgery These are the three that I am having the most trouble with, input of any kind would be appriciated! More questions later I am sure! Thanks in advance for any advise!