BrianLee73

I have been an RN for over 20 years now. I have done a variety of things in the nursing fields from medsurg, to orthopedics, to ER. About 7 years ago in started with a Home Health agency. When I started my agency was non-profit, but last year we became for profit, and even though we were told it would he business as usual, it is NOT. Not only that, but our pay was cut. I'm not kidding, it was cut. The boss doesnt see it that way but my paycheck does. I can explain later or some other time, but..... Needless to say, anyone that is an RN wants to truly help people. Formerly being in the hospital setting Inwas used to treating either acute injuries or illnesses, or exacerbations of chronic ones. Make no mistakes it's not that I thought Home Health would be easy, or easier per se. But some of the most shocking things I have found are the levels of expectations that patients and families have, about what we do, and will do, along with the level of non-complaince, and the amount of patients and family members that are defendant upon, and have no intentions of NOT being dependent upon the services of Hone Health agencies, and health care in general. It's a staggering number of people, and although the reasons and backgrounds vary, its rich people and poor people alike. Our job is to try to promote independence. A liberal politically as I am, I cannot help but be in utter shock at the amount of people that have absolutely no intentions of being independent. None whatsoever. There are a staggering number of people who will not even do a simple thing, no matter the amount of education, like take thier medications, or skin care, etc. They want someone else to do it family members too. How many Home Health RN's can tell me they haven't seen lazy family members that will not do simple things for thier loved knees they live with that will help to promote thier health. I had a patient rehospitilaized a few weeks ago for infection in a stage 4 sacral wound. Each visit (3xweekly) his diaper and bed were soaked in urine and feces. I mean, the bed, head to toe. They wouldn't turn him. No dressing changes. Wanted US to do it all. WE should be healing him. I've had patients I have seen for wound care, flat out tell me they didnt want to hear about what they should be eating, or having there blood sugars under control, "JUST DO THE DAMNED DRESSING CHANGE". I would calmly try to explain that doing dressing changes IS part of the plan of care but it isnt what Medicare pays for, it's the assessment, teaching and education. I went to do a wound vac last night because I was on call. After already having a VERY long day of seeing 8 patients in 2 different states, I was told the patient was discharging around 3 or 4 PM, and that the actual SOC and IV antibiotics would he done the next day by knee of the weekend nurses, I was to go and place the wound Vac. Depending on the wound and other factors, I can usually do such a visit within an hour. Less maybe. I'm pretty good with wound vacs, I was trained by someone who used to work at KCI. The patient was sitting in an electric wheelchair in the living room and had to be transferred via hoyer to the bed. The wife did absolutely nothing. Refused to. Said I am the healthcare worker, I am to do it. He had feces in his diaper, so after being transferred had to be cleaned. Large scaral stage 4, approximately 10cmx9cmx5cm. HUGE. Looked good as far as it was beefy red. So, while the wound was being soaked with Dakins for 30 mins (wife insisted, although that was a previous order I could see the new wound vac orders, I felt, superseded those), I went over the consent forms, etc, and what services were to be offered. SN, PT, and OT. She asked how many visits for PT and OT were ordered. I told her only one is ordered, they evals, they will come do an evaluation with him and you and go fro. There. She then goes on to explain how he got them daily in the rehab facility and that's what she expects to continue. I told her that is not realistic, and that thier job, and ours is to promote independence, not to do FOR him or you, but OT will instruct how to safely transfer him in the home. No, no, no. She said. They should be coming and doing it . I also exained that tomorrow (Saturday) an RN will come out to do the actual SOC and instruct her on how to do the IV antibiotic meds (one push, and two by gravity I believe, via a PICC in Left arm). I'm not a nurse. YOU guys are supposed to be giving his meds DAILY. It's YOUR job, and the Dr said he would send someone out to do it. 2 hours later I finally left. I will get ONE unit, or approximately $36, and I still have to chart everything. People complaining wanting a $15 minimum wage, and I will get less than $13 per hour for this visit with this patient, who unfortunately has to move with a spouse who refuses to do what is needed (she was very upset when I recommend a coccyx cushion in his wheelchair to help offload pressure). Just heal the wound. Put the wound vac on. Lovley. Wants a wound to heal, but doesnt want to relieve pressure. What are the chances of that, considering he will likley be kn the wheelchair all day. Anyhow, that's just one story, of HUNDREDS I could tell you. Maybe more. People want free services, free things. Expect me to bring the chic, diapers, etc. Otherwise capable people that refuse to set up thier own pillboxes. I discharged a patient Thursday who refused to check her own blood sugars, despite being on Insulin. Said it's just something she doesnt do, and has no intention of doing. She can walk, but has had multiple toes amputated, due to diabetes. I had had enough. I DC her from SN. She will still get PT for another week or 2, but I think it's a waste. She sits around watching TV most of the day. Her and her fiance actually wanted me to make her Dr appointments FOR her. I'm a grown adult, I have not had another person make my Dr appointments for me since I was a child. Ibwas on hold 3 separate times for almost 2 hours to get her a Dr appointment, despite the fact that her and fiance were told to this by the SOC nurse. I'm pretty sure I have patients who keep themselves from getting better or wounds healing, simlmy because they want me to come see them. Its just getting tougher and tougher and OASIS isnt getting any better, Dr offices. Hospitals, and clinics wont return calls. I truly enjoy helping peo ppl, but SO many dont want us to help them become independent. They want US to do FOR them. Not ALL, to be sure. Some do cooparate, are appreciative of the help and education, and assistance in returning to or becoming more independent. But enough are like this, that I feel like it's a real problem in our society. I don't know how we survive as a country. I may be close to the end of my rope on the Home Health gig, fed up with an agency that runs on the cheap and I have to use my own band aids on patients and I'm not likley to get a raise (havent had one for over 3 years), but our health care crisis in America has multiple reasons. Peoples lack of willingness to do anything for themselves is one of them.. Having recently lost a friend who had a neurological disease, and couldnt move or feed himself for the last year, and just died a few weeks ago, I'm amazed at the amount of people that CAN do all of these things but wont. I thought it was silly, when I was in the hospital and I'd walk an able bodied patient to the bathroom and they would lean against the wall and want me to wipe thier ass. Some people cant, I get it. But far too many simply wont.

So,min just wanted to chime in before I go to my next patient. I've been working for the HH agency I work for for almost 5 years now. It will be 5 years this October. I've been an RN for 18 years. I've done a wide variety of things in the hospital that I believe helped prepare me for this job, but anyone that says Home Health is easy is lying to you. It has it's good and it's bad. My agency when we started we were charting on big clunky laptops. A couple years ago we went to iPads that have 4G LTE. Along with this came the fact that documentation was wanted almost immediately, although that ain't always the case. Recently I have been going through something on my personal life that I need more money for. That and the fact that we just switched to a new software for charting in June meant that I had to sink or swim. I had to buckle down, get organized and compete my charting and not be on the bad-boy list of people with incomplete documentation. Documentation is a HUGE part of healthcare unfortunately and I hate it. Whomever created OASIS should be water boarded. LoL. It helps to communicate with my manager and the person who assigns new patients. I keep in constant contact although most of our contact is through text messages or emails. My agency is pretty family oriented. So they are pretty understanding if something comes up, they just want communication. They have been there for me in times of need. Our agency does a lot of Medicare and Medicare replacement plan patients, so all care HAS to have a skilled need. Often times patients believe that home health will be permanent, or that we should stay in the home longer or be there 24/7. People have a misguided picture of what home health actually IS. I have had many ask me when someone was going to come clean thier house, or apartment. Like we are a maid service or something. I've had some tell me I need to come give them thier pills 4 times a day. I've had family members walk out and tell me I have to stay with the patient 24/7. I thought I was going to go nuts a few weeks ago when I heard about the 5th patient say "I can't do that". I very much dislike the words I can't. I also dislike that most of my patients want to be seen from about 12-1pm. When I have a day with 8-10 visits there is no way that I can get it done without stating at a bare minimum of 8am. I get "THaTS to early, when I say I well be there between 9 and 10 about 20'times a week. I drive a company car now. About $120 twice a month comes out of my paycheck but I never have to pay for gas or maintaining it. That's nice. To always have a reliable vehicle. I also hate the fact that FAR too many patients are discharged from the hospital far too early, and far too often when people need a Skilled Nursing Facility or a rehab but either refuse to go to one, or cannot afford it, Home Health is ordered and seen as a viable alternative to 24hr care. It's also sad when so many family members simply refuse to help the patient or do anything, but want to collect mom or dads or grandmas monthly check to pay their rent. It CAN be very rewarding. It is a,so very challenging. It took me years to get to this point, honestly. Your job is NEVER done. Always more tomorrow. LoL. But, that's the way it is. My best advice is to be as organized as possible, remain somewhat flexible, try to tackle challenges, and do the best your can and always try to do what's right. I still get flustered when I plan out my whole day for the next day and then I'm given a SOC or something to throw in the mix. It's tough. I love my patients that let me come early, cherish them. I try to schedule my visits for 8-4pm. Sometimes I'm a little later. I try to get OASIS done IN the home, as well as meds entered. Our new software this can be done pretty quickly. Sometimes getting calls back from Dr offices can be impossible. I simply chart whom I left a messege with. Google "Dr office not returning calls" or something like that. It's a challenge. poor VA patients seem to be left in the dust still. Things are only slightly better for them. We have very good PT and OT and Speech therapists and I love them all. Our a bath aids work hard too. It's tough. But so is ANY nursing. Being an RN or LPN, I've never had or seen an EASY job or one without stress. This one you need to be able to be autonomous and get things done and treat it like a business in a way. In the moment with the patient, be a nurse, but always thinking ahead.