There’s nothing like a busy Monday! I have a note on my desk from a weekend per-diem nurse. She saw Mrs. Patterson, one of my patient’s with dementia and a wobbly gait. She fell and broke her hip and is the hospital. I stop to look at the assignment board for today. I have six patients to see. One is a new admission. The new admission is a 84 year old woman with a leg wound. My supervisor tells me that she is going to need daily dressings. Home Health Aides come, get their assignment, and go. I turn on my laptop. While I am waiting for the home care program to open up, I grab a few of the sheets in my “in” basket. I take a quick look at some signed orders that came in from a doctor. I place them in the “to be filed” basket. Even though we use electronic charting, there is still lots of paper floating around. I set up my schedule for today. A couple of the patient’s I’ll see today live in the next town. The rest of them are local. I’ll probably drive about 30 miles today. That’s a good day. There have been days that I’ve driven as many as 60 miles. Very draining! I’ll start the day with a “med pour”. Get that out of the way. I’ll fill Mrs. Doniello’s pill box with her weekly pills. She used to do it herself but I can’t count her doing it right anymore. From her house, I’ll head out of town to see Mr. Wohleski. He’s a tough guy. He’s been in and out of the hospital alot this year with emphysema. He now uses continuous oxygen. I’ll be checking his lungs today and seeing how his oxygen level is. I’m worried about him. He’s going downhill so quick! Down the street from Mr. Wohleski, is Miss Peters, a retired school teacher. She’s a sweetie. After years of teaching kindergarteners, she now finds pleasure in feeding her birds. We’ll talk about the antics of her backyard birds before I check her blood sugar. As much as she tries to watch her diet, it always is a struggle to keep her blood sugar in target range. I’m afraid the doctor is going to increase her insulin dose again. Hopefully, she really watched her diet this weekend. Before lunch, I see one more patient. This is a hard one. Racheal is a 40 year old with advanced breast cancer. She has two young children. They’ll be in school when I visit her today. I’ll be putting a “DNR” bracelet on her. This is something she really wants to do. She’s realistic about her illness and knows things don’t look good. The bracelet will prevent her from getting rescusitated if she should have a cardiac arrest at home. I’ll need a break after I see her. I usually take a working lunch break. That means I’ll grab something to eat on the run while I start my electronic charting. I’ll sit with the lap top entering vital signs and my physical assessment while eating a sandwich. I try to see new admissions right after lunch. I get my second wind and am then ready to meet a new patient. Seeing a new patient for the first time takes about 1-2 hours depending on the complexity of the case. I’ll review the medications the patient is on. Check to see if the patient can manage taking the pills on her own. I’ll obtain a history of the present illness as well as a past medical and surgical history. I’ll want to know if the patient is homebound since Medicare requires a patient to be homebound in order to cover the services. I’ll do a safety check of their home and see how they manage to take care of themselves. I’ll meet with family members and hear their concerns. I’ll do a complete physical assessment including listening to the heart and lungs and checking the legs for edema. Before I finish, I will draw up a plan of care with the patient so she will know just want to expect in terms of nurse visits. I’ll coordinate with other services such as occupational and physical therapies. And before the day is done, I’ll need to write this all up….electronically, of course. My last patient for the day doesn’t live far from the agency. It’s Bill, a retired policeman. He is a favorite of mine. Bill is terribly lonely. His wife died three years ago and his children are all out of state. I like to give him a little extra time when I visit him because he enjoys our visits so much. If I can get him to laugh at least once, I know it has been a good visit. I’m betting I’ll get back to the office about 3 o’clock. My shift ends at 4 pm but I never seem to make it out the door then. Medicare has very strict rules about what has to be documented on each patient. I’ll have alot of “paper work” to do before I leave for the day. I’ll also have to call doctors for new orders or to update them on their patient’s condition. I talk to caseworkers with social agencies arranging for equipment or services the patient can not get in any other way. I conference with my supervisor over clinical issues such as wound care or diabetic management. I’ll fill out a mileage sheet, a time sheet, a fall sheet, a new plan of care. Physical therapists stop at my desk to let me know how my patient is progressing. A dietician calls me to ask me if my patient is keeping a food diary. No doubt it will be close to 5:30 pm before I’ll leave for home. My calendar shows seven patients on my schedule for tomorrow. Did I think Monday was going to be the only busy day!!
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