Typical Day For A Home Health Nurse | Life of a Nurse

[hoolahan]

Not a bad day today... started back per diem today.

6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like I usually try to do.

8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go.

Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re please give pt RX for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go

Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five RX dated 1-21-03, two are new meds, but PRN types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go

Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

2:15 pm. Back to my township, drop wee wee at quest labs, drop off RX at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

Pretty routine kind of day today.

Anyone else want to share??

A Day in the Life of a Public Health Nurse...

 

[seajulesRN]

hi all, my name is julie and i am moving from nicu to home health......interviews this week.......anyone have suggestions on what questions i should ask? and what is the best way to know if i am picking the right agency for me? i love your posts and i am so glad you are willing to share your experiences...thank you, julie:)

[RyanSofie]

Home health certainly can use your expertise in the NICU.Many children requiring complicated skilled care are at home. The great thing about HH is you facilitate the care provided by families at home. It is overwhelming for them many times and working with them alleviates some of the burden. Teaching is a vital part of HH and being super organized is a definite requirement. Ask what a typical caseload is and about orientation. it is wise to go with a company that provides a good thorough orientation regarding Oasis and Medicare guidelines for HH.It is also good to go out with a preceptor for admissions/discharges/recerts/. The paperwork itself is daunting at first but if you are well organized you develop a method of doing it that makes it much easier. Some HH have computerized the paperwork for Oasis which is great. These HH agencies provide a laptop with a software program for the paperwork. Another question is if your required to be on call after hours. In my agency we rotate on call and cover a week at a time usually. We are then required to do any admits we get after hours, any prn visits etc for all patients on service.

[seajulesRN]

Thank you so much for taking the time to respond. I will certainly add those things to my list.

[ybstressed, LVN]

OMG WHAT A DAY!!!! I need help, support, and advice. I am new LVN as of 1-14-09 and have been working with a awsome HH since the end of Jan. I have been seeing patients for the past two weeks and thought I was doing great......unitl........today!!!!!

9am Started my day with a great patient. No problems and a great daughter taking care of her. The patient is only on 3 meds and she 95! I attempted to do education on a few of her hypertension meds and her daughter cut my off stating "my husband is a doctor so I don't need med education" my reply was " thats great! So, after I finish teaching your mother about her meds, you can answer her questions when I'm gone". JUST LET ME DO MY JOB LADY!

10am Pulled up to a patients house. No one is home! This is the second time I have been to see this patient and no answer. Call the main office to verify the address and I'm at the right place. Called the daughter to see if the patient is at home and just can't come to the door but no answer. So I left to see my next patient.

11am :redbeathe:redbeatheSweet older man who is easy to teach, actually using all my teaching to reduce his bp, and is always happy to see me gets his visit with a thumbs up. BP wnl's, no recent falls, and a healhty diet!! Whoot whoot:yeah:

12am Got to my next patients house and his son (plus three friends) stop in their tracks....sit on the couch....and watch me with their jaws on the ground:eek:. Not only do they watch me but they try to hit on me while I'm attempting to assess the patient. YOUR GROWN MEN ....ACT......YOUR.......AGE!!!!!! SO.....as I'm giving the patient a good look over the caregiver gives me wound care orders with no doctor info....a bag of opened supplies, and told me the wound care nuse instructed them to stop his bp meds until bp is wnls. BP was super low(94/54)....normal pulse.....heart RRR with pacemaker. So....I decided not to change the wound dressing with the opened (no longer sterile dressings) and to call the doctor requesting faxed orders to the office, get supplies for the woundcare, and to take care of the low BP. So I will call the doc after lunch (office was closed) and go from there.

....inbetween the above and the below visits my 10am called me back and stated that I had the wrong address and that she forgot to call the office with the new info. She then begged me to see her mother, which I agreed to do, as long as the caregiver is there (the patient only speaks spanish). OK....ON THE NEXT VISIT.

12am Next patient, at first, did not like me because I look like I'm 15 y/o. But, after the first visit, she just loved me and I love her! She is a great patient and is really trying to improve her health!

1pm I finally get to see the patient that I missed at 10. And low and behold the caregiver ONLY speaks spanish to!!!!! Wow...so how am I supposed to teach her about her condition when all I can say in spanish is pain and hello:uhoh3:

2pm Time to call the home office and check on the order for my wound pateint....get the supplies....go on a interview at 3pm.

230pm Completed a quick interview...got the job......now time to go to the office.

3pm Got to the home office...asked the front desk for the orders for my wound patient....no orders!!! OF COURSE...I then ask the front desk for a few supplies which starts a yelling match between the front and the supply guy! So after 10 minutes I walk in the back myself and grap my own supplies. I then called the my "wound" patients pcp for the wound clinics number that they referred him to and to report the low BP. The docs wife answers the phone and states that she does not know what wound clinic the patient went to and and asked" are you in the home with the patient" I stated no and continued to tell her about the patients low BP. She then says (angry tone) " if you are not in the patients home then why are you calling". I then state "because I'm the HH nurse and I need orders due to the low bp and a few for wound care".

She then states " thats what I asked you the 1st time" and then I said " no....you just asked me if I was in the home and I'm not...I'm at the office" she then states " DO YOU KNOW WHO YOU ARE TALKING TO....I'M THE DOCTORS WIFE".

OH....REALLLY....COME ON! She said to have the daughter call the office and they will deal with it tomorrow.

Wow!!!!!!! I dont even know if I handled the situation right but the day is over and I will start a new one tomorrow!

For for the poor grammer and spelling...Im just to pooped to care!

[RyanSofie]

Take a deeeep breath and blow it out slowly....You have passed the "honey-moon phase of those 1st 2 weeks". Now comes the challenges. First, organize visits before going out to see patients. Prioritize according to acuity and difficulty ( family challenges). See those with highest acutity first, eg: b/p issues, wound care etc. See those with pcg issues last if they take more time. At least that is how I do it. I keep a rubber made storage container in my trunk with wound care supplies, cath kits, extra drain bags, anything I may need for visits and I restock weekly.I also keep folders with extra paper work forms I may need. I also keep a file with basic written teaching materials I can give to patients..I give them a copy and keep one for chart. I then note what I gave and teaching I provided. I find organization is the best way to decrease stress.. Each week I update my frequencies and my five day windows for end of cert periods on my schedule for the week that way I am not caught by surprise. The other neccessity is time for yourself. You need down time...do something for yourself. Rekindle your strength....

[ginab2]

Hi! I'm trying to get the nerve to leave the hospital and go to HH. Could anyone give me some of the pros of going to HH over the hospital setting. I'm looking for a position in nursing that might work better with having kids, didn't know if HH was the way to go?

[caliotter3]

You can find plenty of threads covering this in the home health forum.

[mightymitern]

WOW what a great thread! I am considering HH and am happy to see how the days go. I work in a Hospt. med/surg tele floor, but since starting have never felt so stressed, and have been sick more than I ever have been in my whole life. Are any of the HH agencies unionized, or are they pretty much private? Thanks for all this info it has been a pleasure reading.

[pear8]

Hi,

i was wondering because 5-7 clients are seen per day at their homes and it seems to be maybe 1 an hour. is there enough time to drive to different houses and provide them the care they need in your day? or is it just in, out, quickly, next house? cause i dont know if you can give them adequate care in just less than 1 hour like 30 min? cause then it takes time to drive to the next house. is it under pressure and stress?

[elprup, BSN, RN]

I can't go into details about my daily routines, but I did home health for about 8 years and I really enjoyed it. It has it's negatives but remeber this: your worst day in home health is still 5 times better than your worst day in the hospital setting!

Love that quote! Thanks

[ED_Bound]

Hi! I'm trying to get the nerve to leave the hospital and go to HH. Could anyone give me some of the pros of going to HH over the hospital setting. I'm looking for a position in nursing that might work better with having kids, didn't know if HH was the way to go?

I'm actually looking for the answer to this one as well. I enjoyed it during my one day clinical requirement in school but that of course was just an 8 hour glimpse into the HH world....

[Blackheartednurse]

I read twenty all twenty three pages of this thread.Wow awsome journeys you guys have been on.I was amused,shock and impress by all of your stories.I hope I can join in as well and share some experiences with you too.For now I would like to thank everyone who contributed to this thread,I learned a lot,thanks.