Scheduling visits

I<3H2O, BSN, RN · Jul 24, 2013

I work with adults only and the vast majority of them are homebound. The ones that do "disappear" during a scheduled visit hack me off to no end! I sat in a patient's driveway for 50 minutes the other day because they weren't home at the time THEY suggested. Grrrr

anothergrumpyoldRN · Jul 25, 2013

I trust you were still paid for your time?

HH_RN13, ASN, RN · Jul 25, 2013

Ahh so far I've only had it once when the patient wasn't home for my visit and god, was that annoying! So I absolutely understand. I drove out of my way to see the patient and the next day I find out that they decided to go to movies after dialysis instead of going home where I was supposed to meet them!!

On another note, yes a 3 year old kid probably wouldn't be sleeping at 10 am (I have an almost 3 year old, and she wakes up at 6.30!)

I always try to accommodate my patients schedule, but sometimes they are just not understanding that they are not the only ones I'm seeing that day. Sorry for the vent!! Just had a patient yesterday complain that I came at 3pm (we had agreed I will be coming between 3 and 4). Ughhh!!! Homebound means they are home, not at the movies or dinners or god knows where else...

ctrn3478 · Jul 25, 2013

I try to think of visits like drs appts... you have choice between these times no reaon needed nothing else is available. if they have legitamate reasons i can schedule around them or if theyre being particularly difficult, but only if its doable either by me or another nurse (some pts will only be seen between 8-9 so fine no other AM pts theyll go first). But if they arent available for the choices the pick its hard to accomodate and its unfair to any other patients that wait! i always say a one hour range for when theyshould be awaiting a nurse to arrive ( bc who wants to feel badly about being 10 min late when who knows what happened with any previous pts). i try to get them to think of visits as appts bc really theyre similar, if they miss one i mark it missed visit. just bc we can chase them around doesnt mean we should. its hard bc we need to work with them to ensure compliance but if someone is noncompliant with MD visits they are most likely non compliant with other aspects of care.

KelRN215, BSN, RN · Jul 25, 2013

I try to think of visits like drs appts... you have choice between these times no reaon needed nothing else is available. if they have legitamate reasons i can schedule around them or if theyre being particularly difficult, but only if its doable either by me or another nurse (some pts will only be seen between 8-9 so fine no other AM pts theyll go first). But if they arent available for the choices the pick its hard to accomodate and its unfair to any other patients that wait! i always say a one hour range for when theyshould be awaiting a nurse to arrive ( bc who wants to feel badly about being 10 min late when who knows what happened with any previous pts). i try to get them to think of visits as appts bc really theyre similar, if they miss one i mark it missed visit. just bc we can chase them around doesnt mean we should. its hard bc we need to work with them to ensure compliance but if someone is noncompliant with MD visits they are most likely non compliant with other aspects of care.

This is a good point; however, explaining it this way to the patients I have this issue with likely wouldn't help because many of them see nothing wrong with showing up to a 10 am clinic appointment at 2pm. The last time the child in my OP had to be seen in the oncology clinic to begin a new phase of treatment, they had to send a cab out to the home to pick her up because Mom just decided it wasn't important enough to show up for.

One of my co-workers used to say "if these people were waiting for the cable guy they'd take the time they were given so why do they expect us to bend over backwards to accommodate them?"

KelRN215, BSN, RN · Jul 27, 2013

Here's another question... if you get to a house and no one is answering the door, how long are you willing to wait? I typically knock or ring the doorbell (depending on what they have) and if I don't get an answer in 2-3 minutes, I knock or ring the bell again. If I ring a bell twice with no answer, I'll knock in case the doorbell is broken. After that, I'll start calling the patient. If they don't answer, I'll leave them a message saying that I'm at their house and will wait for a few more minutes and that they should either call me back right away or answer the door. If I get nothing after that, I'll call again and leave another message saying "I came to see you as we discussed, I rang the bell and knocked 3 times. Unfortunately I have to move on, please call me if you would like to reschedule." Generally, I feel like 10-15 minutes of doing this is more than enough. I don't have all day to wait for someone who knew I was coming at this scheduled time and agreed to it. This morning I was at a home for 15 minutes, knocked twice, rang the bell twice, called twice, left two messages. I feel like I made the effort and that's that. If the client decides to call me back, I'll go Monday but she blew her chance to be seen this weekend.

HH_RN13, ASN, RN · Jul 27, 2013

Here's another question... if you get to a house and no one is answering the door how long are you willing to wait? I typically knock or ring the doorbell (depending on what they have) and if I don't get an answer in 2-3 minutes, I knock or ring the bell again. If I ring a bell twice with no answer, I'll knock in case the doorbell is broken. After that, I'll start calling the patient. If they don't answer, I'll leave them a message saying that I'm at their house and will wait for a few more minutes and that they should either call me back right away or answer the door. If I get nothing after that, I'll call again and leave another message saying "I came to see you as we discussed, I rang the bell and knocked 3 times. Unfortunately I have to move on, please call me if you would like to reschedule." Generally, I feel like 10-15 minutes of doing this is more than enough. I don't have all day to wait for someone who knew I was coming at this scheduled time and agreed to it. This morning I was at a home for 15 minutes, knocked twice, rang the bell twice, called twice, left two messages. I feel like I made the effort and that's that. If the client decides to call me back, I'll go Monday but she blew her chance to be seen this weekend.[/quote']
I think that is more than enough! They know you are coming and should be there waiting for you. Thankfully, I've only had 1 missed visit so far, and I did wait for about 15 like you did.

KittyLovinRN · Jul 28, 2013

Here's another question... if you get to a house and no one is answering the door, how long are you willing to wait? I typically knock or ring the doorbell (depending on what they have) and if I don't get an answer in 2-3 minutes, I knock or ring the bell again. If I ring a bell twice with no answer, I'll knock in case the doorbell is broken. After that, I'll start calling the patient. If they don't answer, I'll leave them a message saying that I'm at their house and will wait for a few more minutes and that they should either call me back right away or answer the door. If I get nothing after that, I'll call again and leave another message saying "I came to see you as we discussed, I rang the bell and knocked 3 times. Unfortunately I have to move on, please call me if you would like to reschedule." Generally, I feel like 10-15 minutes of doing this is more than enough. I don't have all day to wait for someone who knew I was coming at this scheduled time and agreed to it. This morning I was at a home for 15 minutes, knocked twice, rang the bell twice, called twice, left two messages. I feel like I made the effort and that's that. If the client decides to call me back, I'll go Monday but she blew her chance to be seen this weekend.

Agreed, that's PLENTY of time to wait.

I have a patient who I'll call, leave a message and she'll call me back three days later asking for me to come that day. It's a disaster. There's been many times I've shown up at a time SHE picked and she's nowhere to be found. I d/c her after two weeks of her either not answering my calls or not being home when I go there, she goes to the ER to get home care resumed! UGH!!! :mad:

anothergrumpyoldRN · Jul 30, 2013

When I first see my patient I tell them what the plan is as described by the MD order.

I tell them how many times or how often I plan to see them to accomplish their goals.

I let them know when I am available for those visits, we then collaborate on a schedule and create it.

I try not to let difficult patients get me too upset, I am honest and firm.

If they are not ever available (they are supposed to be home bound) then they are not likely qualified for the care anyway.

KelRN215, BSN, RN · Jul 31, 2013

When I first see my patient I tell them what the plan is as described by the MD order.
I tell them how many times or how often I plan to see them to accomplish their goals.
I let them know when I am available for those visits, we then collaborate on a schedule and create it.
I try not to let difficult patients get me too upset, I am honest and firm.
If they are not ever available (they are supposed to be home bound) then they are not likely qualified for the care anyway.

My patients are children, they are not required to be homebound. Most of my patients are nowhere near homebound and most of them go to school, unless they are babies.

And, I finally reached the patient in question today. I left her two messages on Saturday and one yesterday. She is not available until Thursday. These are my typical frustrations... and then our QI people will be chasing me asking why we didn't see this patient within 48 hours of discharge. (They'll still ask even though it will be documented in multiple places.)

anothergrumpyoldRN · Jul 31, 2013

My patients are children, they are not required to be homebound. Most of my patients are nowhere near homebound and most of them go to school, unless they are babies.
And, I finally reached the patient in question today. I left her two messages on Saturday and one yesterday. She is not available until Thursday. These are my typical frustrations... and then our QI people will be chasing me asking why we didn't see this patient within 48 hours of discharge. (They'll still ask even though it will be documented in multiple places.)

I hate when QI people waste their time and ours asking stupid questions instead of reviewing the documents...WHICH IS WHERE THE NOTATION NEEDS TO BE, a verbal report to them serves to boost their ego. I have previously asked for a staff/QI/management meeting to settle some of that turf battle. Those nurses review and recommend. They need to review FIRST and ask questions later and management needs to support the field nurses in that process.

Field nurses do not have the time to cater to those too lazy to investigate.

I didn't realize you were speaking about a pedi case...different guidelines for sure.

Still, we can't own the schedule of the patients/parents and I refuse to make life difficult for myself because a family is not compliant.

Good luck.