Rant

[KateRN1]

The following is simply my rant in response to the whingers I've had to deal with the last couple of weeks:

If you don't want to travel every day and don't want to fill out a ton of paperwork every day, please go work somewhere else that offers what you want.

If you only want to work PRN and only travel within one zip code, don't get mad when I don't call you to see patients.

If you are upset because I call you to complete your paperwork or to clarify questions that are inconsistent, then please do your work properly from the start and you won't have to deal with my phone calls/emails/texts.

If you don't want to do supervisory visits, don't ask to case manage the patient.

If you didn't want to fill your gas tank three times a week, why did you buy a huge SUV (after you started home care)?

If you don't want to go to homes that are dirty, in the "hood," have hoarders, or dogs, or cats, or ants in the garden, please reconsider home care.

If you only want to see the patients who live in mansions and have hired help to attend to their needs, then consider hiring yourself out as a rent-a-nurse.

If you want a $100/week raise or you'll quit, please don't let the door hit you in the keister on the way out. Our reimbursement was cut by 10% this year and everyone here is lucky they still have a job.

If you don't want to call the office or the nurse or the therapist or the doctor and feel that you shouldn't have to communicate with anyone else, please go somewhere else. My purpose in life is not to transmit your messages when you could've just called that person instead of me.

I'm not bitter, I'm not angry, but I AM so TIRED of the people who say they love home care but in the same breath hate everything that makes home care what it is. I'm tired of the whingers, the moaners, the woe-is-me-ers. I'm tired of the people who don't do their jobs and then complain when they're asked to redo it.

I think I need a vacation.

That is all.

[toniasday7, ADN, BSN, RN]

How about some good old fashioned teamwork and less B***hing people! LOL

[LuLu2008]

What corrections are your nurses having to do? What are they not doing right the first time? I'm just curious.....I will admit I'm meticulous and if I don't do something right it drives me nuts. I don't get asked to make corrections, just to lock/sign my visits/oasis, so I'm wondering what mistakes are your nurses making?..... We will be training 2 new nurses soon, so I'm looking for things they might screw up that I'll have to drill in their heads....

Here is what I keep running across as I approve OASIS's, 485's and re-visit notes that the nurses don't seem to "get"--

1. If a patient is a fall risk, why do you not teach fall prevention, and why do you not refer to P.T.?

2. If a patient is being seen for a medication planner being filled weekly, why can't I find any documentation to support the reason? Gee...his vision is normal, his functionality is fine, no problem with cognition or memory, and no neuropathy -- why are we there? Or... it may be that on the initial paperwork the nurse documents poor STM, but on visit notes it is never again marked as a problem.

3. Patient uses a walker, and nurses do not mark impairment of mobility; I see no assessment addressing balance or LE weakness, no need for assistive devices, no equipment or supplies needed. Really? It is not logical.

4. Questions about vaccines rarely answered (they aren't important?)

5. Morbidly obese patients, with no height or weight given (or even a statement saying patient cannot be weighed), no ongoing assessment of changes in weight at recertification.

6. Pediatric patients with no documentation of height and weight each recertification period. Are they growing?

7. Clients in general marked as having absolutely no psychosocial, neurologic, behavioral or cognitive problems. No signs or symptoms or depression. No coping challenges. No caregiver strain. Really?

8. A plan of care is developed at the onset (because required) and not carried out.

9. No true nursing assessments, no evidence of a nursing process, no evaluation of retention of alleged teaching done.

10. Not enough documentation to support why a nurse should be visiting the patient in home care for a billable service becaue specific procedures and outcomes are not clear. It looks like the nurse is there to hold hands.

11. Pain going as high as 10/10 is not addressed as a problem; no goals to mitigate or alleviate pain, teach about pain management, or communication with the physician that may result in other treatment options.

12. Not addressing lab values in the visit notes or with the doctor/patient.

13. Consistent lack of communication among multidisciplinary team members, when RN is case manager.

14. Supervisory visits of C.N.A.'s mark documentation as "excellent" when in fact the nurse rarely, if ever, reviews their visit notes, which are incomplete, inaccurate, frequencies off. Supervisory visits missing.

I could go on......

[KateRN1]

I also want to make clear that I do not have a problem with those every-now-and-then-forget-somethings. We all do that. What I take issue with is those people who refuse to follow Medicare guidance, no matter how often they've been educated/trained/inserviced and insist that I am trying to "game the system." Ummmm . . . . No. I have solid info from CMS to back up every thing I say or I don't say it. And I take issue with those few who think that HH is an easy job and I'm making it unnecessarily harder than it has to be. They are mistaken. I am trying to avoid having 1/3 of our total revenue taken back in an audit, the company going bankrupt, and all of us losing our jobs. It happens. I don't want it to happen to us.

No one is perfect, everyone has a bad day here and there. I get that. But don't be the cause of your own bad day and then blame everyone else.

Oh, and yeah, whingers = whiners. I got used to the word living overseas and interacting with a bunch of Brits. I still occasionally call the stove a hob, too, and people think I'm crazy. But then again, maybe I am. There are a couple of people on here who know me in person and can vouch for it!

[RN1263]

I see.... I'm sure it's frustrating.

I'm a field nurse so I don't perform reviews of charts, but we switched to a new computer program and UGH.... Just today I did a SN revisit and the prior nurses (2 LPN's) have performed the SN guideline/pathway and not any of the other teaching required on the order for the past "9" SNV's. Also, they have not been using the wound addendum, so the wound number/description is different on every visit note (I went through all 9 notes to check teaching done and wound order, etc.). I think the LPN's don't care about the teaching because they aren't the ones on discharge that will have to teach 5-10 topics if not covered previously. Also, we are suppose to be making a running list on the "plan for next visit" of what teaching has been done by copy/pasting from the past SN note- however that also is not being done. The nurse who discharges will have to look at every single SNV to know what has been taught. I told a manager what I found today, but what she does about it is yet to be seen.

[lou12]

As a nurse new to home health, I understand your frustration with those who don't do their job as well as they should. However, it is upsetting when as a new hire, you are told you need to do a better job but oops..we never gave you any training to assist you in learning the job and the paperwork.

[KateRN1]

I whole heartedly agree with you, lou12. One of the reasons that I am trying to revamp our orientation process.