Cindy5

Are you still working for this agency? If so, how is the work load now? I've been involved with the staff nurses at my agency and have been working with getting paid for the work we actually do. It has been very interesting for me - nurses tend to work very hard and really try to please the employers. That is why it is so easy to take advantage of us. So, how is it going for you now?

There is a lot of stuff you have to look at when you are treating a non healing wound. First, is the origin of the wound venous or arterial? Can you feel her pedal pulses? Is there any edema? Does she keep her legs dependent much of the time? Does she have any pain with the ulcer? Are there any co-morbities such as diabetes or hypertension or peripheral vascular disease? This will affect the wound healing process and all this must be managed. How is her nutrition? Do you have access to lab values such as albumin or pre-albumin - this will give you an idea how good her nutritional status is. Have you recently cultured the wound? Sometimes people can have an infection, but not present with the classical symptoms of an infection. What does the wound bed look like? Is it red or pink? Is there slough or eschar in it? That will determine if the area needs to be debrided or not. Are the borders well defined or ill defined? That will help with diagnosis of type of ulcer. I am not a wound specialist, but I do work with a few of them. If you can answer atleast some of these questions, I'll ask them what they recommend. You really need to look at the entire picture of the patient - just looking at the wound itself won't give you all the information you need to determine best treatment. Even in spite of that, sometimes some things just work for one person and not for another. I've used a lot of trial and error in my practice.

Why don't you take self defense courses such as karate, judo, akido? Not only could it potentially protect you in all sorts of situations, but it is good for your physical health and your soul.

In my agency, we just started a "Care Level System" that gives points to each patient - each point represents one hour work - basic revisits are 1.25 points - that includes follow up calls, 30 minutes for travel time and the charting. Many of our patients are very ill and complex - they can be given 1.5 to 2 points/ visit. This is for the revisit. Admits can be anywhere from 2 to 4 points. We are assigned up to 7.5 points/day. That represents 7.5 hours work/eight hour day. We have two paid breaks per full day worked. There is no time allowed for going into the office or picking up supplies. Therefore the scheduler usually gives less than 7.5 points/day if possible. Our charting and follow up is very extensive. We are responsible for knowing everything about the patient. Our system allows us to follow up directly with the physicians, we can access all testing that has been done on each patient. We just started this system and there will be follow up audits on it. All of our "easy" patients are given to in house LVNs or are supped out to registry agencies for visits. Case managers usually see the "easier" patients once a week.

The time it takes for you to do a basic revisit and the paperwork is about the same for me. We have to hand write everything and have numerous forms to fill out. Changing wound care orders generates a two page nurses note, a wound assessment form, physician order sheet and a wound care instruction sheet for the patient's home. We are switching to computers within two months. I thought this would speed things up. Has computer use helped you spped up your documentation?