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...

 

[renerian, BSN, RN]

Hoolhan hubby and I have had lots of talks about our health care should something happen. I would want to die too and he says he would want to live. Big difference of opinion.

Your thread is living a long time LOL.

renerian

[NancyB,LPN]

My sentiments are the same, once I am unable to care for myself, let me go. I was put on this good earth to care for others, not vice-versa. (although I do like the occasional pampering but let me do the personal stuff)

I do have a great deal of respect for this person with ALS, she has an iron will, and, I'll admit, she's taught me alot. I had never dealt with a ventilator patient before, so I have some skills there now, and I have become more tolerant of other people's idiosyncracies. I guess I just needed to vent that day. (don't we all?)

Have a wonderful day!

[hoolahan, ASN, RN]

Yeah, {{{Nancy}}} you can respect her all you want, but it still isn't easy to deal with for a 10 hr shift. God bless you!!

[hoolahan, ASN, RN]

My agency started carepaths this week. It essentially involved takiung away one 3-page form, and adding 3 more 2-page or more forms in it's place. Now for each visit we have to document on a minimum of 2 forms, maybe 2 more if there are co-pathways, more if a wound, etc...

People were so freaking grouchy this weekend, it was kind of funny. They did lower our productivity requirements for a bit.

Everyone is B&Ming like never before! I heard one nurse say if this process isn't smoother in 2 months, she is leaving, and she has a ton of seniority!

Anyway, my day started out w a pt w a trach and new enteral feeds. I got to his home, in a really bad neighborhood. Like I would not walk the streets of this hood, not w/o a gun or mace or something. He has a note already written out for me asking if I would go to the store to buy him a battery for his caller ID.

Now I am sorry, but this does not qualify as an emergency for me! I said no, it is not an emergency, and I have other pt's on my schedule who are waiting for me to show up in a timely fashion.

He got PO'd and would not cooperate , look at me, listen to me or acknowledge me. He did let me get his VS, but that was about it.

What the heck?? Next person needed RX's dropped off at a pharmacy. New type of insulin. This I did, b/c it was a better & safer hood, and it was vital to care!

Have we become personal shoppers now as well??

It was such a crummy day, and tomorrow will be as bad, and as hot, it is my last scheduled weekend w this agency...and I have to tel you, I cannot wait!!!!! to start my new job!

Thanks for listening. I needed a mini vent!

I can hardly wait to see what will become of Medicare and I am hearing big changes are to be expected for Medicaid as well!

[seasonedlpn]

Started late today. (12:30)

#1: Four year old Home Health little red-headed girl @ day care, neurogenic bladder. Straight cath.Cute as a button, but can be cantankerous. Always a very time specific visit.

#2:Elderly Home Hospice Female with lung CA, multiple skin tears.Changed dressings on legs and arms. Spent a lot of time discussing God and "The final Judgement".Told her I thought God would judge people not so much on What they did, but Why they did it. A concept she had never considered. Answered her questions as best I could, but who am I to know the mind of God?She seemed relieved to think that God might actually listen to an explaination! I think I was able to give her a bit of peace.

#3:Home Hospice male with lung CA. Needed a protime drawn. Had to go to a Kaiser lab (drat), so drove 22 miles to the outpatient lab near my next patient rather than park at the Kaiser hospital near his home, walk 2 blocks from the parking structure to the lab,then wait in line for the lab secretary.Easy stick.

#4:Home Hospice Male:(different agency),enlarged prostate, & other problems, needed foley cath for retention. (coude) Unplanned visit, called because I'm "the plumber!" Expected a difficult cath.....turned out to be easy. Bladder full, 500+cc amber urine. Will sleep comfortably tonight.

#5: Home Health, male, paraplegic, right BKA, colostomy, urostomy, s/p closure of decubitus ulcer. Lives alone. Paged me to stop by SUBWAY and pick up a Turkey sub with everything but peppers.(I did). Changed dressing, looking good, nearly healed. Now if he can only avoid tearing it open while transferring from bed to chair............!Bought myself a sandwich, too. Ate dinner with him, and got home about 7PM.

Now I'll figure out mileage, finish charts, and go to bed. Tomorrow I have 6 visits to make. Will start around 10AM, get the local patients seen before my 1:00 straight cath,(little girl), then head over to the next county to see Home Hospice patients for another agency. (whew! tired just thinking about it!)

My car is full of fast food wrappers, bits of paper with little notes, and pre-printed pages from Map-Quest. Gotta clean out that car!

Laugh and the world laughs with you............cry, and you look like hell!

[adaptation]

Hi, everyone,

I'm new around here and am I ever glad I found you!!! I really need some help and I hope you will indulge me.

I'm a MSN prepared psych hh RN in a suburb of a large Canadian city. I get paid per visit and since things are slow (the agency just starting taking psych pts.), I can organize my own schedule. It's supposed to be one hour per patient, not including travel time (and I've only been working since April-can't imagine what that will be like with snow.).

However, I get paid the same amount for an admission as I do for a regular visit. Paperwork takes at least an hour and a half extra (unpaid). Then I have to call and give an initial report to the case managing agency (oversees the one I work for). If I have to call the family or doctor after the visit, that's unpaid, too. So, I am being paid one hours salary for at least three and a half hours of work. Regular (no admission) visits are a little better...maybe only a half an hour extra past my alloted hour. But no overtime for anything. And you know that you can't rush "in and out" with a psych pt., even if you set clear limits about how long you can stay!

I asked about increasing the visit time for an admission to one and a half hours pay since it is at least an hour and half work...and was told that if they did that for me, they'd have to do that for everyone. (As soon as I hear that progressive style of management, I'm already half out the door!)

Right now, I figure I'm making a little less than $ 10/hr. Mileage, travel time, and cell phone are unpaid. There are no other benefits.

And this will sound nitpicking (forgive me), but it just adds insult to injury. Discharged patients' charts go back to the office, one hour away (round trip). I have no other reason to go to the office, and I figured it was cheaper to mail the (usually only one) chart than the gas and my time would be. ($ stamp cost=1.00-not reimbursed!) We keep psych charts on us vs. leaving them in the home.

I'm like a teacher, doing my charting and paperwork and calling families at night and on weekends! Is it that I'm too compulsive and thorough??? Should I settle for the bare minimum? But that's not me.

I don't know what to do. I love the patient care, and the hours, (I can't work nights-health reasons, and have not been hired for 2 jobs because of it) but I do NOT like being abused.

I also think I am "beating a dead horse" when it comes to trying to negotiate with my manager, who is obviously not willing to budge, even though I've been told that they haven't been able to find anyone else to hire. Duh! Wonder why? (I better watch it, maybe that's why they're keeping me!)

I don't want to keep whining about these issues (especially to my boss), but I am FED UP! I don't want to quit because I need a job and like the other aspects of it, but will if something doesn't "give".

Any ideas? Maybe not so much how to handle my agency, but how to handle my workload in a more "time efficient manner" (their advice, even though I think it is them, not me). I'd really appreciate any of your comments or suggestions.

Thanks...and looking forward to getting to know you.

[hoolahan, ASN, RN]

You are being so taken advantage of!! Unfortunately your peers have set the precedent by accepting this same situation.

I don't know much about Canada, but can you deduct the mileage from your taxes? We can do that in the USA if you are required to travel and are nor reimbursed for it, at a rate of 36 cents a mile. Of course, you have to wait a year to claim it. Unless you file quarterly, which usualy involves an accountant fee 4 x a year.

I do not think you are overly compulsive. You are an good, efficient, and caring case manager.

Are you compariing med-surg nurses to a psych nurse, or are the other nurses also psych nurses with the same productivity?

If you are comparing med-surg nurses, there IS no comparison. Our visits are not nearly as time comsuming as yours would be.

Exactly what is your role? Are you the psych nurse consultant? NP? If either of those, you need a lower productivity and higher pay. IN other words one less visit a day.

Example, if I have a freq flyer CHFer, who I readmit q 4 months or so, I can finish a recert or a ROC in the same time it takes for a revisit pretty much. I know them, and usually in that kind of exampple maybe the lasix dose will change, but that may be the only change.

You cannot compare that to re-assessing a psych pt who has just come back out of the hospital for a psych admit, even if you know them very well.

I can hardly blame you for all the hard work and $$ of getting your Masters too, and then to be paid the = of 10/hr...well that's just shameful!

If I told you I make $30/hr and $36/hr on the weekend plus get mileage and have my BSN, would that tell you something?I'm in NJ. I just started a second job, and this agency pays $80 per admit and $60 per revisit.

Welcome to the forum BTW!!! :)

[seasonedlpn]

Another Day in Home Health!

I am known as the catheter queen...as well as the "disimpactor".

I suppose it could be worse,(?), but to tell the truth, I'm pretty good at what I do.

I was sent to re-insert a foley that had been removed two days before. Unfortunately, I was the one that put it in, but bladder spasms, and generalized ignorance about the workings of a foley caused the patient to request removal. We ordered an antispasmotic, and a size 22fr from Home Depot, lol,and I performed a miracle.(again)

The patient could not lie flat; and the first catheterization was a nightmare. She sat on the edge of the bed, lying slightly on her side, with her legs resting on her wheel chair. Difficult, yes, but I got it done.

This time she decided to remain standing, leaning over the foot of the bed. A bit of a challenge, wouldn't you agree? She was obese, and weak. Her husband refused to become involved. He has been reported to APS more than once.

The scenario: I am nearly lying on the floor, sterile field between her legs, mini-maglight in my teeth, working from behind. She has had marsupilizations of the Bartholin glands, leaving blind openings, and is unable to reach around to hold the buttocks apart...................I got the foley in, got a clear return of urine, inflated the balloon............but it took me longer than usual!

Another miracle!

The next patient was an easy male cath,even the enlarged prostate was no obstacle. Then.......................................The surprise ,the kind which can only happen in home care. The last patient lived in a rural area, on a large piece of land. Pleasant folks, caring for aged parents.Quick visit, and ,as I was walking to the gate, I glanced back........A GIRRAFFE was in the back yard!

It just couldn't get any more interesting than that.

Neither rain, nor sleet, nor snow shall deter the HH nurse from her appointed rounds. Out here in California, even the sudden, rapid movement of the earth (earthquake),only adds to the variety of daily life. I've spent post-quake days picking up televisions, resetting clocks and finding flashlight batteries...then, and only then, can I perform my nursing duties.You don't get that kind of variety in the hospital setting!

Life: A sexually transmitted, terminal condition.

[hoolahan, ASN, RN]

All I can say is......WOW!!! What a contrast of sights you had the day from flappy perineal areas to giraffes! I can never top that!!! That even beats the horse in the house!!!! LOL! Thanks for sharing that!

[passing thru]

Who took care of these kinds of patients 30 years ago before they had home health nurses?

[hoolahan, ASN, RN]

Well, this was just a little haha that brightened my day while working as the weekend supervisor Sunday.

I had a dozen pages back to back, and trying to get back to everyone in a timely way, I turfed a few to the secretary. I asked her to call back the HHA who couldn't get in to the bldg to drop off her time sheets.

The secretary, who of course is non-clinical, called the number given to the service, and spoke w a woman answering the phone who said, "Oh, she's in the shower with my husband." The sec said it took a minute for her to figure this out, and she said, I was just thinking to myself, "Wow lady, you are really in an open relationship!" Then I explained to her HHA's give baths and showers to pt's, and we both busted out into hysterical laughter.

The day before, I got a page from a family member who was having such terrible chills and thought she had a urine infection. I advised her to go to the ER, b/c I figured the chills were onset of septicemia. She cried and said how she didn't want to go back b/c no one keeps track of her bowels and she got so "compacted" there before. I advised her to be sure her doctor orders her a laxative and a stool softner in that case, but she needed to go. She puts her son on the line, and he proceeds to tell me the details of the compaction problems. They two of them were on extensions and if they used the word compaction 20 times they used it 1000, it was all I could do not to burst out laughing, not at her distress of course, but the word compaction for impaction, and they way they kept repeating it. She didn't go, and I found out from her primary nurse she does not ever f/u w doc or go to er when advised.

[renerian, BSN, RN]

That is so funny! renerian:chuckle