nrsjen

I am also super vigilant about where I walk, so as to not track mud or anything into a patients home and will offer to vaccuum up any mess made...and I have also carried extra shoes with me on muddy icky days...

I have a mild form of Cerebral Palsy, and I walk on my toes. As a result, I trip and fall often. I once tripped over a patients wheelchair footrest and did a faceplant right there in his room on my first visit. I also tripped and fell outside a patients condo on the way in to do a wound vac, I chipped my tooth and my lip was all bruised up and bleeding. A colleague of mine joked that I should ask mr. so and so if I could put the wound vac on my face..hee hee I get used to the falls, but it is still a bit embarrassing..esp when you hit your face on the ground and get gravel in your face!! And the patients pity you, which sucks but they don't really know better...Ugh..if I couldn't laugh about it I would just cry..so better to laugh!

I would also like to add to this post that I must wear orthotics in my shoes that make it necessary for me to safely walk, and to have to remove my shoes would place me at risk for not only occupational injury but for further problems with safely walking, not to mention having to have my patients see these orthotics. This can also be embarrassing and can make your patients question your ablities, which is an awful experience(if they see your orthotice). I have also learned, due to the these difficulties with my feet that our feet are precious, we only get 2 of them and they keep us up and moving and able to do what we do, so we should protect them!! We do not really know what is on the floors of our patients homes. We all took microbiology, and thus should know better than to reference a "clean looking" home or carpet. With all of this having been said, I do mostly visit nursing where I see multiple patients in a day and I am in and out of several homes daily. But in the past I did work with clients as an LPN where I stayed with pediatric patients for most of the day, and would have to sit with the patients in a play area on the floor, so I would bring an extra pair of slippers for homes like those, to wear when I was walking around the childs play area, and t I would make sure that my employer was aware of this and of the reasoning behind it, ie infection control for the patient. Most of these clients were pediatric and a more relaxed environment was allowed anyway. So this worked for this particular type of nursing. But as far as adult patients who are being seen by the nurse,. you can offer to vaccuum the carpet if you track in dirt, but be professional and love your feet, keep the shoes on!! PS. I just did break my toe and had to have an ORIF (hahaha) and have been out of work for about 2 months, so sorry about the "love your feet" rant, but really, we need to love our feet. When they are not well, it is not good!!

I used to live and work in the Florida Panhandle. and we had a vent patient in a trailer in the area of town that usually floods real bad..and so I had to go out into that during a hurricane...

I think that 25 an hour is not at all too much to ask. I agree with the previous poster, with your skills and experience you would be an awesome asset to home care. Many of the skills and areas of experience you mention are those that are dealt with quite a bit in home care. I have been a home care nurse since 2001 and it is the best decision I have ever made. In talking with nurses that are looking into home care, the most common reasons for trepidation are 1. That you are out there in a patient's home "alone" and what if this or that happens, yaddah, yaddah, yaddah. Well, nothing could be further from the truth. You always have someone to call upon, be it the DON, another RN in an emergency or difficult situation, and if the situation is THAT bad, you just call 911 or send them to the hospital. The second reason for trepidation is the erroneous notion that home care nursing is not "real" nursing. I had a patient's son the other day ask me if I was a "real" nurse before I did this:angryfire Well, I have learned the majority of my technical skills while doing home care. We do TPN, vents, IVs, trach care, wound care, wound vacs, you name it. Not only that, but I think I have more of an opportunity to do some really good quality teaching, compared to when I worked in the hospital. In the hospital, it was more like,"here is some paperwork on diabetes, hope you don't die, have a great life" Because acute care is so stressful and crazy. With homecare, I can admit a patient that can hardly move around in bed without being SOB, and then 3 weeks or a month later they are up walking about, telling you not to come because they have a hair appointment. And you get to watch that whole recovery process happen. It is so rewarding. Acute care definitely has it's place in the world without a doubt, but home care is the best thing that ever happened to me. As for our agency, If a patient cancels on me, I will either get a new patient, or see if I can see one from the next days schedule, or just take a bit of office time (I get paid by visit, but I am allowed a certain number of hours per week for case management). I was salaried at another job, but that was the biggest mistake I ever made! As for call, I alternate weekday call with the other case mgr M-TH. We have 2 nurses who take weekend call I will help on weekends if it is needed. And as far as being on call, I have never had to make a middle of the night visit yet (knock on wood I am on call this week) If they are bad enough to call in the middle of the night, they are usually gonna take an ambulance ride. Well, I could ramble on forever, I just love home health so much. But the choice is yours. I think you would be great, I just wish you lived here in Fla (we are short a case mgr) Good luck in whatever you decide!

Thank you so much for posting this info. I JUST got stuck the other day de-accessing a lifeport, and had to go thru 5 of the worst days of my life, workers comp, labs, bloodwork, booster immunizations and the worst being the meds. Protease inhibitors and antiretrovirals. UGH. :bluecry1:And it's not over. But thank God we got the source sample back and the patient was negative! :monkeydance:YAY!!!! But just to know that this is something that has happened to others (the rebound stick) and that there are devices in existence to prevent this from happenning. All I was thinking for this whole week is "there are all kinds of safety needles and devices, but I have never seen a safety huber" well, now I have. I think I will take this to the attention of the infusion providers that I usually work with. Thanks again!

I have a question about a patient in regards to MO 680 toileting. If you have a patient who wears diapers due to occasional bowel incontinence related to diarrhea, (because she is unable to make it to the toilet on time) but who is physically able to be assisted on and off the toilet and is able to tell when she has to use the restroom, would you classify the patient as answer 1 or answer 4 on this (MO680). I am having a battle of "wits" :rotfl: with a therapist, who thinks that because a patient is occasionally incontinent, that renders her completely dependent, even though her family can transfer her to the toilet. Thanks!

A little back story and then I will vent. I was asked in May if I would like to train for the Assistant DON position, which I accepted. Well, one week later, the DON left. We didn't hire another until 2 weeks ago, and she quit last week. I have had very little training, mostly picking up what info I could along the way. Fly by the seat of your pants thing, really. Well, I was on call this weekend, rained and rained and rained. Had to drive to timbuktu to admit patients all weekend. No one could or would help. What could go wrong did go wrong. Patients called, trouble breathing, major stuff, it couldn't be anything minor. UGH. So fast forward to monday, I am feeling under the weather, so I am gonna go in, finish my paperwork, and go home. WELL....... TWO WORDS.........MEDICARE AUDITORS! UGH!!!!!

In respose to the previous entry, our consultant has also said that the majority of patients will have a skin lesion, and that a skin lesion is defined as any alteration in the color, texture or integrity of the skin, to paraphrase. Also, another tip that we have our patients do to answer the majority of the functional assessment questions is to walk to the bathroom, and step in and out of the tub, if able. This gets ambulation, transferring etc. out of the way. Also, it makes the patients think we are crazy! Also, for the questions regarding dressing oneself, you have to take into consideration whether or not the patient is able to dress himself in what he would usually wear. I.E. if a patient always wore lace up shoes, but now has to wear slip ons due to inablility to tie them or to reach down far enough, that would be considered a functional deficit.

I would like to expound on this subject some more, if I may. Would it also be okay for the RN to come in, begin the infusion and leave the patient in the care of the LPN, to return several hours later to discontinue the infusion. I am not sure if this scenario changes the rules or not. Like I said, I am just trying to get to the bottom of this. The infusion is monthly and I have about 25 more days to go!!!! Thank you all for the great information above!

I have a question that hopefully someone who practices in Florida can help me with, or maybe anyone can point me in the right direction. I am very frustrated. First, some background info. I have just been promoted to the position of Assistant Director of Nursing, and one week later my DON jumped ship. We have a patient who recieves monthly IVIG infusions. What I am reading in Florida law is that an LPN cannot administer blood products to a patient. And I am also under the understanding that IVIG is a blood product. I have scheduled this patient with an RN, but the problem is that the patient followed an LPN from another agency, and this nurse has been administering his infusions the whole time. He was scheduled with the RN, who called and tried to set up the appointment, and the patient got very irate and manipulative and threatened to go to another agency BLAH BLAH BLAH. SOOO.... My administrator/owner, instructed the LPN to go out and do the infusion, stating that his expert says this is perfectly fine. Problem is, neither the owner of the agency or the expert's name is on MY nursing license. I have asked for someone to just show me in the law where this is okay, and I will leave it alone, and noone is able to. I have voiced my disagreement, but apparently my opinion doesn't matter. Anyway my question is, 1. Does anyone feel it is legal for an LPN to administer blood products in the home and 2. If the answer is no, who will be held responsible if the agency is allowing this to happen. I am the one who is supposed to be upholding the Nurse Practice Act, but I have been trumped. Maybe I am being too stubborn about this, but it bothers me, and once I get some straight answers, I think I will be fine. I could be wrong, and I hope I am, but I just would like to see it in black and white. Thanks!