deefizzle

At this point I am dreading it. I'm in a very rural area so my patients are 30 minutes apart. Half the time they don't call me back or agree to the time I suggest, so I'm spending a lot of time driving aimlessly. Today for instance I have a SOC and 2 revisits. I called all 3 last night, with plans to start at 9am. No one has confirmed. I live 40 min away from the first visit. Then the next one is 30 minutes further. Close to an hour from me. Then the next is 40 minutes away. They are so spread out its making it really hard to plan my day. I'm sitting here in my kitchen now just waiting to hear from someone. When I send the visits back to the office due to non response they will send me someone else in the opposite direction! I agreed to this position but I did not realize they would be sending me all over a large county where the patients are so spread out. I assumed I'd have some kind of territory. IF I see all 3 today, IF they call me back, I will have driven a total of 2.5 hours.

Probably a little of both. I am and have always been a people pleaser and don't like to be a bother. I sent out an email earlier to my team and asked for tips for scheduling patients and manipulating the schedule as needed. Everyone has been nice. I'm just not used to being so independent and not having coworkers around to bounce things off of. I feel like I am emailing and calling my manager constantly.she always says that it's no bother but I feel like her tone says otherwise. Then again I am sure that she is completely swamped with work and just trying to get a quick answer to me.thank you for the feedback, I really appreciate it.

I am new to home health and I'm doing full-time case managing. I'm only a month in and I am seeing up to five patients a day. I have also done a few starts of care which take me hours to complete. I want it to work and home health partially due to the flexibility of the hours, but I am still out of the house until about five each day and then coming home and starting until 8 PM. I have no time to clean or spend with my children.I'm extremely overwhelmed and have tried reaching out to my office and don't feel like I'm getting much support. Everyone just keeps telling me it takes timeand I will eventually get it.However I am struggling with getting my patients scheduled when they don't live near one another, are never happy with the timeframe I give them, and don't always answer calls. I am working in a county 30 minutes away from my home which doesn't help. If I send a visit back to the office due to no response from patience, sometimes they will send me another visit to do and that one can be up to 40 minutes away. I don't know how I'm expected to see all of these people and get them scheduled in a way that works for The patient as well as myself. I am seriously considering going back to my old full-time job. They still have a position open for me. has anyone else had problems like this? Did you stick it out and end up being successful? If I do decide to leave, would I be expected to give a notice being that I'm still in my 90 day probation. And have only been working independently for about 2 to 3 weeks? I know that overall it will get easier with time but I'm just not sure if I'm willing to stick it out if I'm so unhappy.

I am brand new to HH and just finished week 3 of orientation with my preceptor. I started seeing patients last week with her shadowing, so on Monday I am going to see 2 patients completely on my own, with the plan to case manage them going forward. I'm nervous. My preceptor, while very nice and great with her patients, was not the best educator and I feel like there is a lot I still don't understand, in terms of how HH works. Whenever something unusual would come up, she would pretty much take over and handle it without really explaining much to me. I've been a nurse for 6 years (acute in-patient rehab and urgent care background) so I'm comfortable with the actual nursing aspect, but just feel very unsure about the HH aspect. My manager told me to expect 6 months to a year before I feel completely comfortable, and that the office is always there to support me and answer any questions I have. I just don't want to look like an idiot in front of my patients. Some examples in particular. On Monday I'm drawing labs on a patient (which BTW is NOT my strong suit) so I'm already feeling stressed about that. The results get sent to the PCP. I'm used to seeing those results and reporting them to the doctor. In this case I won't actually see them. Then the doc is going to adjust the patient's coumadin based off the INR results. I'm assuming they communicate that directly with the patient? Then I find out from the patient what the adjustment is? We also saw a patient who was new CHF. We are monitoring cardiac status. His BP was 200/110. No chest pain or SOB, lungs clear, trace edema. My preceptor said we will see you next week to recheck BP. In my opinion that is something that should be reported to MD. I'm used to: if BP is that high, we at least do an EKG. Obviously I'm not doing that in home health. But at least we should call the doctor right? See if they want him to come in? EKG in office? Labs? Or get an order to monitor? Just looking for some thoughts, tips, words of wisdom...thanks

I have a phone interview tomorrow with a home care company, and am really excited. From what I understand, I would see approx 30 patients per week and get paid per visit. For those of you who do home health, how long do you usually spend in each patient's home? Do you get your charting done while in the home? What kind of duties do you perform? Also, is home care different than private duty? From what I have researched, private duty is more of a long shift spent in one patient's home, while home care is more of a "visit". Is this correct?

Thank you all. You have been very helpful. And I will be sure to look into purchasing my own malpractice insurance for the future.

So should I wait for Risk Management to contact me? Or should I contact them first? Should I speak with them prior to contacting the attorney? And since I am not named in the lawsuit, do I HAVE to speak with the attorney? The letter I received on Saturday was the first I had heard about any of this. Thanks again for all of your input.

Oohhh ok. thanks!

What does that mean?

Thank you so much RiskManager. You have set my mind at ease quite a bit! It's a scary situation when you receive a letter from an attorney, esp when it pertains to my job. Its something I've always dreaded but hoped it would never happen to me. I appreciate your feedback.

Thank you for the info. I actually do NOT have my own malpractice insurance. But I will be sure to find my own attorney.

Got it. Thank you Rose_Queen.

I left my previous job approximately 6 months ago. It was an acute rehab hospital setting, and the patient acuity was getting higher, patient load heavier, and staffing shortage was just out of control. I no longer felt like it was a safe environment for either my patients or for myself. Today I received a letter from an attorney who is apparently representing my old employer in a case of patient negligence. The letter says the lawsuit does not name me directly, but that I was employed at the time of the patient's hospital stay. His name does look vaguely familiar so I am pretty sure I did take care of him at some point. The attorney asks that I call his office for discussion. I am freaking out. Has anyone had this happen? I'm assuming I have no choice but to contact the attorney. I was considering calling the Risk Mgt manager at the hospital prior to speaking with any attorney. If anyone could give me some feedback or speak about your experience with lawsuits involving hospitals I would greatly appreciate it. Thanks.

vspaniel I live in S Jersey. I wouldn't say its a BAD idea. I will say that most LPNs make between $18 to $23 an hour and most full-time nursing jobs are less than 40 hours a week (anywhere from 32 to 36 hours usually). Agency and per diem nurses make more but depending on if you need health insurance that may not be an option for you. I worked at an acute rehab hospital and half of our nurses were LPNs. We were basically a mini-med surg floor. There are also doctor's offices, LTC, homecare, wound centers, etc that still hire LPNs. Most hospitals are looking to hire Bachelor level RNs at this point.

This is something that really bothers me. It really is becoming more important to satisfy the "customer" than it is to treat the "patient". I had a patient recently who called our office DEMANDING (in her words) to be rx'd a certain medication because another doctor suggested it previously and she apparently declined it. There's no record that the initial doctor offered to rx it, but now she wants the doctor on duty (I work in urgent care and we have doctors rotate through) to prescribe. He does not feel it's an appropriate med for the diagnosis. After MUCH drama, my supervisor encouraged me to go back to the doctor and basically beg him, because "this is becoming a customer service issue and we want the patient to be happy so they come back." On one hand I get it, because we need to "bring patients in" but on the other hand, we are allowing the patient to dictate her own care at the opposition of the physician. Does anyone else experience this?

dawnall, I just want to say that your concern for your patients and your commitment to ethical nursing practice is commendable. I don't know why so many people are making this seem like a negative thing and are assuming it's some kind of reflection on YOU, but I feel you are doing the right thing by reporting any type of med error that has potential for injury. Good for you.

I should clarify just so I'm not making him sound worse than he is...he does wear gloves, just not sterile ones.

Thank you for your response (and reassurance). This doctor has some very questionable judgment at times. I will definitely educate him.

I work for an urgent care facility and cannot locate an exact policy on this scenario. Patient comes in with cyst, doctor performs I&D for culture. I&D tray is set up using sterile technique. Sterile field, all instruments are sterile from autoclaver. Doc says he does not need sterile gloves because "this isn't a sterile procedure." I'm a little skeptical of this practice. Can someone with more experience please give me their opinion? Thanks

Today we had a situation at our urgent care center where we had to send a possible NSTEMI out to the ER. We have a very limited staff (one doc, one RN, one MA, one xray tech and one lab tech) so we need to work together very quickly. While I was preparing meds, the lab tech was initiating the IV. They allow this at my center as long as the tech does not flush the line or push meds. When I went to apply the extension tubing, I primed it as I always do. The lab tech (in front of the patient and family) says "You're not supposed to do that until its connected to the patient". I very quickly said "I needed to prime the line" and went about my business. I'm very upset that he undermined me in front of the patient. He is the lab supervisor so he knows his stuff and is very knowledgeable in his field. But I feel he overstepped his boundaries when it came to nursing practice. The worst part is I think he feels he was right and I was wrong. I know I should talk to him about it, at the very least for educational purposes, but I'm hesitant. Advice please?

I did end up calling out. I just told them my dad was in the hospital and I needed to be with him. Honestly all day today I feel like a weight has been lifted off my chest. I'm still scheduled for 2 more shifts next weekend but I've made the decision to email my boss this week and thank her for everything, but effective immediately I am resigning from my per-diem position. A small part of me feels like I should suck it up for my last few shifts, but a bigger part of me knows I just can't do it. I may be wrong, but it feels right. Thank you for your responses.

Thank you so much, and I'm very sorry for your loss.

I need some non-biased advice. A month ago I left my full time job for another full- time job that I absolutely love. I stayed on perdiem at my previous job but haven't picked up any shifts until today...a month later. It was absolutely horrendous. I knew it was bad when I left, but it was worse than I remembered. So understaffed and just terrifying in terms of patient safety and management issues. Now that I have a better, safer, cleaner and more positive environment to work in, I realized how bad it really was. I left there today in tears with a splitting headache, frustrated and feeling emotionally and physically drained. On top of that my Dad was just hospitalized 2 days ago due to a possible heart attack. I'm supposed to work another shift with them tomorrow but I just know I won't be able to handle it and may snap. I originally have them 2 weeks notice and left on good terms. Would it completely reprehensible to just call out tomorrow and then this week tell my boss I need to fully resign my per diem position? I honestly don't know if I can suck it up for even one shift. Esp in light of the situation with my Dad's health.