Tuesday, February 25, 2014

A lovely day

As always my day starts with me feeling anxious and questioning whether or not I want to be a home care nurse. I know I want to do it, but the old doubtful tiffany still lives inside me :( anyways stopping in the office is usually a little annoying because the nurses always seem stressed and full of complaints. I like to get my assignment and then leave. I started off with 5 possible patients, but one didn't answer the phone and the other asked if the visit could be postponed until the next day. So this leaves me with 3 patients. Lucky for me the were all within minutes of each other, so my day started at 10 and by 12:20 I was done seeing patients :) since I'm getting much better at revisits, I was able to compete my charting in the car before leaving for the next patient. The only thing I had to do in the office was write a note for one patient because I spoke with her daughter who requested we only see the patient  after 2.

I enjoyed my work day and felt very comfortable in each patients home. At one house I sat on the floor with my legs crossed :) she was hard of hearing and her furniture was too far apart for me to sit close to her. I even enjoyed teaching this time :) I was so pleased that one patients family member asked me about a blood pressure medicine and magnesium and I was able to answer them and help! I always carry my ipad and it came in handy when I had to discuss a surgery with a patient. The office didn't have a printed handout so I just pulled the info up for the patient and we discussed it.

Tomorrow I'm working again and we have the dreaded care conference, lol. I'm also scheduled to do an admission which I am very optimistic about :)

Lastly, my manager mentioned to me last week that a position would be opening up for a per diem case manager.... Not sure if I mentioned it before but if it's the right opportunity I may be able to decrease my hours at the hospital! Cool beans. I'm remaining open and optimistic. Life is good... 

Oh yeah, I finally got my ID lol next they need to get me my phone!

Wednesday, February 19, 2014

Missed visits

I was supposed to see 4 patients today and ended up only seeing 2! One patient had a dr appt and per Medicare rules ( at least that's what I'm told) we aren't allowed to visit patients the same day as dr appts, it makes sense. I couldn't see the other patient because I couldn't reach her to schedule the visit. Initially i was happy, I would have such a short day but then I started thinking about how little $$$ I made and questioned whether it was worth my efforts. Funny thing is, I'm not even doing home care for the $ I just want to explore a different area of nursing. I also want to someday do home are full time and working per diem is a great " trial run".  The patients I did see today were easy, they were just " teaching" visits where I go in assess the patient and teach then about a medication and/ or condition. I enjoyed chatting with my patients and felt very appreciated as both patients seemed happy to have me and asked questions about the topics I presented.

I had a couple days off from my hospital job this week and I am dreading going back Friday. Taking this time off and finally being off orientation in homecare I am really contemplating leaving the hospital. Still my biggest concern is the finances, I would take a huge pay cut, then I also worry about the stress of doing homecare full time. I don't want to be like some of the nurses at the agency who say they are out seeing patients at 8pm, or making phone calls hours after leaving the office for the day. With that said I just have to be patient and continue learn the ropes of homecare.

Thursday, February 13, 2014

My first admission

Yesterday I finally did it! I did my first start of care (SOC). My day started with our required care conferences where we discuss all of our patients, and then we had a staff meeting. I was annoyed because the meeting was almost 2 hrs ! I wanted to see my patient as early as possible because I knew it would take me a couple hours to do the full admission. After the meeting I scheduled my patient who said I could come at 12, this gave me over an hour to make sure I had all the paperwork and enough back ground info on her to do a good job.

I arrive at her house and she and her family were lovely and inviting. Unfortunately, this patient was pretty young and had a recent craniotomy (procedure involving the brain) to remove a mass. She was left with some physical limitations after the procedure which made her home bound. 

I started the admission with making sure she understood what our company offers. Sometimes patients think they are receiving around the clock nursing care, maid services and all kind of crazy stuff. Lucky for me she was well informed and knew exactly what we were offering, so we went ahead and signed consents. After the "business" part was complete I went ahead with collecting her medical history. This conversation tool a good 30-40 minutes and discussing her medications took just as long. Lucky for me, she wasn't on a ton of meds, because I have to document every single med she takes. Once I gathered all my information, I started my assessment which didn't take more than 5 minutes. I Tried my best to  chart as much as I could while I was in her home, but I'm not familiar with the paperwork so it would have taken way too long to do it in the home. The total visit ended up being 1hr 40minutes. We are paid a flat rate and admissions are supposed to only take 1 hr.... Lol

Now the hard part was waiting for me. I had to get all the paperwork completed and be out of the office by 3:30 to meet my daughter at the bus stop. I get back to the office and no one was available to help me because one of the nurses went home sick and my preceptor had to take her patients. My DON (manager or director of nursing) couldn't help because she was in a meeting. I was left to figure it out on my own. Most of the OASIS wasn't bad at all, I just had to simply fill in my assessment. I notice questions were asked over and over, and that was annoying. But I know it's made that way to make sure we are being consistent and honest... I guess that's why.  Finally at 3pm my manager was available to help, so she was able to help me with some of the documenting. But it was now 320 and I had to get ready to leave. Before I left the offic I called the patients DR and made sure she would sign our home care orders. I spoke with the secretary and was told they would call me back with an answer.

I make in home by 340 and just sat in my car until my daughter arrived. I was just about done the chart! After my daughter arrived we went to pick up my son. Once we were all home it was 4pm and I had to take the chart back by 5 for payroll!!!! I was really stressed now, because I knew I had to finish and my kids were being normal kids harassing me lol. I had to keep telling myself to get it done and if something is wrong I can always fix it later ( that's what my manager told me) this eased my anxiety and stress levels . By 440 we were leaving the house to drop off the chart. I made it back In perfect timing and handed the chart in and again my manager assured me that it was my first admission and I shouldn't worry. She said we would go over it together next week :)

Now that I think about it, I had a pretty stressful day but in the end I was able to pick my kids up and take them to the office with me. I still got my work done. I'm pretty sure it gets a little easier too. I spent the whole day working on this admission,but I'm glad I finally got to do one. I'm sure the next time I do one I will be much more comfortable.

I'm so excited to learn to be a proficient home care nurse. Right now I'm in the phase where I don't trust my assessment or anything I do. I think I'm doing an awful job and question whether I am really helping my patients.  I haven't received and negative feedback so I guess I'm doing ok,but I know I have so much to learn. For the first time in my nursing career,I really want to take my own time to invest in educating myself on my new role. I'm thinking of ordering a home care reference book to help with documenting. I may had said it before that this home health company teaches just by doing and doesn't t really rely on polices or written guidelines.  It worries me a little bit,  but I also look at it like there's room for improvement and I would like to help with that :)

Sunday, February 9, 2014

Meant to be?

I'm a big believer of things happening because it's meant to be. This is a random post but last night I was thinking of how I ended up working for the home health agency. I don't remember exactly what pushed me to submit applications but I applied for the home health position, per diem hospital position, and a wellness nurse job. I knew I really wanted the home health position as I wanted to get out the hospital and felt like home health may be my niche. I applied to the other places just as a back up. I didn't even get phone calls from the other two jobs! Ironically, I get a call for the home health interview and they ask when I could come in. It just so happens that week my husband and I were both off Friday so I asked to come in then. This was rare because we normally work opposite schedules to accomadate my daughters school schedule.

It took the agency a few weeks to call me back and offer the position. During that time I questioned if they found someone else or if it just wasn't the right job for me. I decided if I wasn't hired, it probably meant that this extra job in addition to my full time job and graduate school would be too much.

Fast forward to my first day of work, which didn't happen weeks until after the offer. This was perfect because my first graduate class was over. I had time to focus on my graduate class on its own and now I had time to focus on my new position. When time came to enroll for the next semester of school, I reluctantly enrolled but ended up dropping the class. It wasn't an easy decision, but I think I only registered for classes because I was desperate for a change or something new in nursing. As I had time to think in between semesters I realized grad school didn't excite me or inspire me. Instead I was stressed and the class didn't even start! I'm so glad I dropped the class. 

Anyways back to things being meant to be... Another thing that worked out perfectly is child care. When I was working my home health position I had to bring my mom over my house to spend the night and watch my son while I worked. She hated being at my house because she's a city girl so I would have to drive her 30 miles all the was back home after working and driving all day. It was a lot of stress and I got to the point where I thought I would have to stop working for the home health agency. That is until I found an affordable, flexible preschool for my son. Now, I had already inquired at three other schools but they were all way to expensive and only 1/3 offered part time and it was still too expensive! Again I was discouraged and questioned was it all worth it. I had already wanted my son in preschool because he's 4 and is a November baby so he won't go to kindergarten until he's almost 6! Things always work out when it's meant to be because I found a school for my son that's affordable and flexible! Of course it's a good environment too lol. Anyways this school is about a minute down the road from me and they offer before and after care to my daughter school! This is great because I can now really think about full time home care!

My sons first day was Friday and I also worked that day. I was so nervous. I was afraid he'd have an awful day. I had already planned my work day to where I would be able to pick him up early if needed. I called to check on him after a few hours and he was fine! I continued seeing patients, finished my charting and picked my boy up at 3 :)

I feel so blessed because I know things are working out for me because I ask God daily for his direction and blessing. I know things won't go my way, but Gods way.  

When things are meant to be and Gods will, it will be done! There's just no other way

Friday, February 7, 2014

Adventures in Home Care

After almost a week off from homecare , I returned today. My day went exactly as planned which is highly unusual in homecare. My son had his first day of preschool so I was very nervous to work as I expected I would have to pick him up early if he couldn't handle the whole day. I planned on telling my agency I would only take 3 patients as this would give me enough time to see everyone, drive, and chart. My DON told me I'd be receiving 3 patients from our case manager and I was pleased with that. That is until the case manager tried to give me 4 patients, I kindly told her I was only taking 3 and her reply was "well the DON said you'd do 4 let me go check with her" she returns and says exactly what I told her in the first place. Lol anyways I was very proud of myself for sticking up and speaking my mind because the old me would have just took that 4th patient and stressed myself out the whole day worrying that I wouldn't make it home in time to meet my daughter at the bus stop.

On to the field work, my first case was about 16 miles from the office. I arrived there on time as planned. The visit went well, the patient and family were very pleasant and thankful for my care. I did a little education on the patients disease and a new med she was prescribed. I also had to make my first call to an MD and this went smoothly as well, the MD got right back to me, so I was able to let the patient know the update plan of care within hours of seeing her :) I was pretty much done the visit within 20 minutes but a very concerned family member happened to call and wanted to speak with me just as I was about to leave. I spoke with the family and the vist ended up being 50 minutes! But I was still on time to see my next patient. This visit was just an observation/follow up. I just had to go and literally check on the patient. I was in and out in about 20 minutes :) thankfully the patient was doing well.  After seeing my second patient I had a whole hr before I was due to see my last patient. I thought about calling and asking if I could come early, but decided that wasn't necessary. Instead I drove to a parking lot and charted on my first 2 patients, I made it to patient number 3 ten minutes early. This visit went smoothly as well, no issues. This was a teaching visit and the patient seemed to be doing well at home. I did my assessment and teaching and finished within about 20 minutes. My charting wasn't completed in the home because I could tell this lady just wanted me out of her house lol. 

I arrived back to the office around 1330 and finished all my charts, chatted with my DON and got all my questions asked. finally my email acct was live so I was able to email report to the case manager to let her know all was well with the patients I seen today.

I must say I was pleasantly surprised with how well my day went. I still worry that I didn't do a good enough job, even though I'm pretty sure I did ok. I'm not feeling all that confident in documenting goals and writing out why the patient is still home bound, I really love the one on one patient care and I feel like I am really doing nursing care as opposed to the hustle and bustle of hospital nursing. I have time to sit and chat about anything the patient may be concerned about, I get to educate my patients, meet lovely families, see beautiful homes, eat when I want and enjoy the beautiful sunshine. My work day started at 9 am and I was home by 3! I know this isn't typical of home care especially full time, but knowing as a per diem nurse I can pretty much have everyday like this is very enticing. As I get more comfortable I will of course take more patients. I think I can defitenly do 4 now as I am much better with the charting. The hardest part for me so far was planning out my day.