Tag Archives: talk


Nursing Talk

Dear Cassandra,

Why is American Home Health so hung up on little things like clinical notes? Almost every week someone from the office contacts me about my clinical notes. I go to work and take care of my client. Sometimes I don’t have time to write the nursing notes. Sometimes the supervisor says she can’t read them. Once I spilled coffee on the clinical notes. Once the client’s dog ate them. What am I supposed to do?

Perplexed in Palos Hills

Dear Perplexed:

What are you supposed to do? What kind of question is that? You know that you are supposed to write clear, legible nursing notes every two hours. You know the times and dates on the nursing notes have to match the times and dates you Clock In/Clock Out. You know that the nurse working the last shift of the week is to mail the nursing notes to the office. You know one week’s worth of notes is to remain in the home for reference.

Frankly, I’m surprised you haven’t been fired by now. Your excuses sound like the excuses of a high school student. The dog ate the nursing notes. Please! Every teacher has heard that excuse. So you spilled coffee on the notes. Well, rewrite them. So you have poor handwriting. Well, print.

Maybe you think good handwriting is not important. A man recently tried to rob a bank. His handwriting was so poor that the teller could not read the note. She asked him to write the note over again. Instead, he fled. The teller, of course, had activated the silent alarm. The robber was arrested by police waiting outside the bank.

Why is it critical to send the notes to the office in a timely manner? In some cases, American Home Health cannot bill for services without a copy of the clinical notes to accompany the invoice. In addition, in the event of an audit by the Department of Specialized Care for Children (DSCC) or the Illinois Department of Public Health (IDPH), the auditors review the clinical notes to determine the quality of care. The auditors also compare the times recorded on the notes to time billed. Discrepancies can mean paybacks to the funding body. If nursing care is not documented, it is as if it did not happen. That brings questions of possible fraud. Do you want to be accused of fraud? If, God forbid, a child should die under unusual circumstances, the nursing notes would be reviewed by the authorities.

Always proofread your clinical notes. If you work for multiple clients, check to be sure you wrote the correct client’s name on the clinical notes. Did you sign and date the notes? Did you sign the notes using the name which appears on your license even if you have a different legal name?

Do your clinical notes contain medical bloopers? Below are actual statements found in clinical notes of other medical providers:

“Patient was unresponsive and in no distress.”

“Patient is non-verbal, non-communicative, and offers no complaints.”

“Patient was apprehended and guarded.”

Do your notes contain a malapropism? That is an unintentionally humorous misuse or distortion of a word or phrase especially the use of a word sounding somewhat like the one intended. Did you write, “We had to use the fire distinguisher.” Did you say, “The client had an expensive pendulum around his neck, and it got caught in the Hoyer lift.”

What else can you do to correct the situation? Get a Palmer method handwriting manual and start practicing to improve your handwriting. Talk with your supervisor about time management skills. Keep liquids away from the clinical notes. Keep the notes in a safe place so dogs and children can’t get them. If you are responsible for sending in the notes, be sure you send the whole weeks worth of notes and that no pages are missing. Don’t wait until the end of your shift to document the events of the entire shift. Above all, change your attitude about the importance of clinical notes. Your job depends on it.


Note: First published on American Home Health's news, January 2012.


Nursing Talk
Dear Cassandra,

Several times a week I call the office, or I receive a call from the office. Sometimes the scheduler is offering a case to me or confirming or canceling a shift. Sometimes I need to speak with the supervisor about a clinical issue. Sometimes I have an HR or payroll question. What can I do to make these calls more efficient?

Needs to Talk in Pingree Grove

Dear Needs to Talk,

If you watched Rowan and Martin’s Laugh In on NBC during the 1970’s, you will remember Lily Thomlin’s sketch of Ernestine, the switchboard operator. Ernestine was a nosy, condescending telephone operator who generally treated customers with little sympathy. She wore her hair in a 1940’s hairstyle with a hair net, and she often had on a white blouse. Her most memorable words were “1 Ringy Dingy, 2 Ringy Dingy. Is this the party to whom I am speaking?” (duh)

At American Home Health, those who answer the phones try to provide good customer service. Sometimes this is difficult. Our toll free number, which is (800) 872- 4427, is just one digit different from the phone number of J.R. Cigars in Burlington, North Carolina. We receive many calls from customers wanting to order cigars. Most people apologize when they realize they have dialed the wrong number. Some do not. Recently a woman with a smoker’s voice called. When the staff member answered the phone in the usual way, the woman paused. Then she said, “What the hell!” A few seconds later she called again. Once again she paused. Once again she said, “What the hell!”

What can you do to make your calls more efficient? First, always listen to the message on your answering machine before calling the office. Don’t call and say, “Someone tried to call me.” There are almost twenty people in the main office. Was it a scheduler, a supervisor, payroll, HR? What was the person’s name? What message did the caller leave for you?

Second, identify yourself by your full name when you call the office. Don’t say, “This is Mary.” Mary who? American Home Health has two hundred and thirty employees. Sometimes we don’t recognize your voice. Sometimes the caller ID simply says, “Wireless Call.” Sometimes the connection is bad, and we cannot hear the caller clearly.

Third, don’t wait until the end of the day to call the office. The office is open from 8:00 A.M. until 4:30 P.M. Monday through Friday. The phones get especially busy in late afternoon. If you need to rearrange your schedule or cancel your shift, call early in the day. Give the schedulers time to make adjustments or find a substitute.

Fourth, leave a message if the person you are calling is not available. Sometimes the calls get backed up, or the staff member has stepped away from his desk. Sometimes the person is in a meeting or is out of the office. If you leave a message, we will be sure that the individual gets your message.

Fifth, be sure that you return your monthly availability form by mail each month by the deadline. Do not expect the scheduler to take your availability over the phone.

Above all, be courteous and professional. Do not swear at the schedulers or tell them that you hate them. Remember that their job is to offer cases to you to provide coverage for the clients. They are trying to match nurses to cases within twenty miles from the nurse’s home. They must also consider the shift you want to work, what days you want to work, how much you want to work, and your skills with g-tube, trach, and vent.

Finally, upgrade your skills. The State of Illinois Department of Specialized Care for Children has fewer dollars available. That means the State will approve fewer hours of care and focus on the care for trach and vent dependent children. If you are not vent proficient, get trained. The schedulers will then be able to offer more cases to you.


Note: First published on American Home Health's news, December 2011.


Nursing Talk

Dear Cassandra,

My car was low on gas, and I didn’t have time to go to the gas station on my way to work. I took my purse with the $40.00 of cash with me into the client’s home. At the end of my shift, I discovered that the cash was missing. How can I prevent this from happening again?

—Devastated in Des Plaines


Dear Devastated,

I’m sorry your gas money was stolen. It’s not just the financial loss. It’s the violation of trust and the intrusion into your personal space.

Once I heard a police officer speak to a group of women about ways to avoid being a victim of theft. He stated that women have a relationship with their purses that goes far beyond purses as fashion accessories or mule packs. He described how some practices make purses easy targets.

Have you ever gone into a shoe store or a shoe department and put your purse on the chair while you got up to look at the shoes on display? Your purse is marking your territory, saving that chair for you. It is also an easy target for a thief who can steal your wallet while you are admiring the shoes.

How many times have you seen a woman put her open purse into the basket of the shopping cart at the grocery store? Then she walks halfway down the aisle to pick up a jar of brown mustard. Even if she sees the thief take the wallet or purse, is she going to be able to run fast enough to catch the thief?

Have you ever hung your purse on the hook on the back of the door in the toilet stall in a public restroom? It is no problem for a thief to reach over the door and grab the purse. How quickly could you react when you are otherwise indisposed?

Taking your purse into a client’s home is asking for trouble. You are there to care for the client, not to guard your purse or money. Do not carry your purse into the home. Instead, put your money into your pocket or other concealed place. If you must carry a purse, do not leave it in the client’s living room where neighbors, delivery men, family, or children have easy access to it.


Note: First published on American Home Health's news, October 2011.


Nursing Talk

Dear Cassandra:

Sometimes I think about the awesome duty of being responsible for the life of my client. So many things can go wrong. Private duty nurses face ventilators which malfunction, gang members in the neighborhood, the danger of carbon monoxide build-up in the home, gas leaks, rotting floors, runaway wheelchairs, school bus accidents, and the danger of fire or flame near oxygen. How can I be sure I can keep my client safe?

Worried in Waukegan


Dear Worried,

First, let me say that your fears are perfectly normal. What parent responsible for a baby has not gone in to look at the child just to be sure that he is breathing? In fact, studies have shown that the most important factor in the survival of a child to age three is the loving care of a parent/adult.

Although your client is not your child, you feel the same responsibility to care for the child and keep him safe. Your job is complicated by the fact that you take care of a medically fragile child.

Human beings have an amazing ability to react to emergency when survival is at stake. Exhibiting superhuman physical strength, men are able to lift cars off of accident victims pinned underneath. Others work for days to rescue a child who has fallen down a well. Firefighters dash into a burning building to rescue the inhabitants.

Sometimes having a clever idea is the key to survival. My favorite example of an unusual survival skill is the true story of an attorney who went hunting with his buddies in the swamps of the Deep South. Somehow, he and his dog got separated from the rest of the group. Trying to find the way out, the hunter waded for hours through the murky water filled with snakes, turtles, and alligators. When he was exhausted, he would sit on a fallen log. His dog would swim over to the log and climb out of the water to rest, too. Night came. Still no rescue.

The next morning the hunter heard the sound of a small plane flying over the area, apparently searching for them. The plane even passed overhead, but, since the hunter was dressed in camouflage, the rescuers did not see him. Then he had an idea! He ripped off his white Jockey briefs and tied the underwear to the barrel of his gun. When the plane flew over again, the hunter waved the gun with the white cloth tied to the barrel, and the rescuers saw it. Saved by “tighty whities!”

The honest truth is that you cannot be sure that you can keep your client safe. You can only do your best. Review safety procedures. Try to anticipate dangers. Try to prevent accidents. Have a plan of action in place in case of emergency. Should those fail, keep calm, use your wits, and remember the story of the hunter saved by his underwear.


Note: First published on American Home Health's news, May 2011.



Nursing Talk

Dear Cassandra,

When I went to high school in the 1970’s, I took college prep courses. I excelled in math and science and took algebra, calculus, geometry, and even Fortran (a computer programming language). My career goal was business.

At that time, college prep students did not take typing. Typing was part of the secretarial/clerical track including shorthand.

Instead, I became a nurse. The result is that I am a 48 year old nurse with no keyboarding skills or computer skills. Do you think home health documentation will be done on computers during my working career?

Clueless about Computers


Dear Clueless,

The technological advances made during our lifetime have been phenomenal. Many farm families in Illinois did not even have electricity until 1947. Th at was a result of the Rural Electrification Act of 1936, a federal program aimed at bringing electricity to farms, ranches, and other rural areas across the nation. In the 1950’s, lucky Chicago families sat across their living rooms staring at tiny black and white TVs, and they invited their neighbors and relatives to come watch this wonderful invention. Until the 1970’s, the workers at the Chicago offi ce of the Burlington Northern were calculating tariff s for cross-country freight by hand using pen and paper. Many suburban elementary schools got their first computers in the 1980’s. Your nieces and nephews with their cell phones and iPods cannot comprehend these things.

Today most hospitals and large clinics have medical records on the computer. However, the transfer of electronic medical fi les is not seamless. How many times have you gone for pre-op tests at the hospital and your surgeon tells you he has not received the results? The American Reinvestment and Recovery Act of 2009 (Stimulus Bill) dedicated more than $20 billion to develop a nationwide electronic health records exchange by 2014. On February 12, 2010, former Governor Pat Quinn announced that Illinois was to receive $18.8 million in federal funds to develop a statewide Health Information Exchange, which was to allow Illinois healthcare providers to electronically share health information.

In Greek mythology, Apollo, the god of love, gave Cassandra the gift of prophecy. However, when she did not return his love, he placed a curse on her so that no one would ever believe her predictions. I hope you do believe the prediction of this Cassandra.

Yes, Clueless, I do believe home health documentation will be done on computer during your working career. In fact, I believe it will happen within the next fi ve years. Th e Visiting Nurses Association in Aurora requires their home health nurses to come to the Aurora offi ce to use banks of computers to enter their clinical notes.Another company issues a laptop to each home health nurse for the nurse to use to “do paperwork” in the home.

This transition to computer technology is not going to be cheap. Th e cost of the hardware alone (e.g., a laptop computer for each nurse) will be substantial. Add to that the yearly contract with the on-line fi rm, the training and workforce development costs, added insurance costs, IT (Information Technology) support, replacement hardware, and other expenses.

You need to become computer literate. You don’t need to know how to program a computer. You need to know how to turn it on and use it. Take a basic computer class at your community college. Go to the library to use the computers.
Enlist your nieces and nephews to teach you. Start now. Don’t wait until your job depends on your being computer literate.

If you have little or no keyboarding skills, get the program Mavis Beacon Teaches Typing. Th e program uses games to teach keyboarding skills. No more typing boring paragraphs for three minutes! You have the nursing skills. I know you can master the computer.


Note: First published on American Home Health's news, December 2010.


Nursing Talk

Dear Cassandra:

Two years ago I got my nursing license at Joliet Junior College. I have been working in a home for the visually impaired, and I have experience with trachs, g-tubes, and vents. I am interested in pediatric private duty.

I am tatted out and have a tramp stamp. I have rings in my pierced eyebrow, nose, and navel, and a stud in my tongue. My hair is orange, red, green, and purple. I think I have a great body and badonkadonk. I like to wear tight clothes and show lots of cleavage. My jewelry box is filled with bling. I spend hours each day on my BlackBerry during breaks at work, while driving, while eating. I have to keep in touch with my peeps.

I have orientated on several cases. However, the parents seem reluctant to let me work with the children. They have told the scheduler that they do not feel comfortable with me. Do you think my appearance can be affecting the way the parents are reacting to me? What can I do?

Tatted Out in Tinley Park


Dear Tatted Out,

First, let me try to decode your letter and get a mental picture of you. Your body is covered with tattoos, and you have a special tattoo on your lower back.

When you are wearing low-riding jeans and a short t-shirt, that tattoo can be seen. You like to wear sparkly, gaudy jewelry, and you have multiple piercings.

You wear low cut blouses showing lots of cleavage, and you think you have an attractive derriere. You are constantly sending e-mails, tweets, and text messages on your digital device such as a BlackBerry or phone. You feel you must stay in constant contact with your people, your closest friends or family.

Do I think your appearance can be affecting the way client’s parents react to you? Fo’shizzle (certainly). The parents are entrusting the care of their child to the nurse. Right or wrong, they are not comfortable with you based on what they see. They interpret it as rebellion, not professionalism. You are defying or resisting the established convention and tradition.

Rebellion has been a pattern in the youth of every generation. In the 1950’s, the most outrageous thing a teenage boy could do was to go to school with his shirt hanging out. In the l960’s, college students drove their parents crazy by wearing dirty white tennis shoes with holes in them. In the late l960’s, straight young men started wearing blue, green, orange, even pink dress shirts with their suits. IBM demanded that its male employees continue to wear traditional white dress shirts. In the 1970’s, rebellious young men had long hair, especially dirty, stringy, long hair. In the 1990’s, teenage girls had six or seven piercings going from their ear lobes to the top of their ears. Today’s teens pay good money for new jeans with holes in them.

Image still plays an important role in adult society. Bankers wear dark suits and have conservative hair styles. Lawyers wear suits to court to show respect to the court and judge. Would you trust your money or your life to a dirty, unshaven, unkempt man with greasy hair? What can you do? You have a choice.

You can continue to dress and act the way you do and continue to be rejected, or you can dress and act in a professional way. Wear clothing that covers your tattoos on your arms and back. Take out the rings from the piercings on your eyebrow and nose, and take out the stud from the piercing in your tongue. Wear less revealing clothing. Save the outrageous hair color for the weekend. Leave your BlackBerry/phone at home or in your purse. Focus on the care of the child.

If you think this is unfair, get used to it. If you want to play in the games of the adult world, you have to follow the rules of the game.


Note: First published on American Home Health's news, November 2010.


Nursing Talk

Dear Cassandra,

The Client Service Coordinator told me I cannot work because my CPR card has expired. The local hospital won’t be offering a class for a month. The fire department just had a class, but I missed it. I know how to do CPR. What’s the big deal? The same thing happened when my license needed to be renewed. I knew that my license was going to expire, but I bought a pair of $500 shoes. Then I didn’t have the money to renew the license. American Home Health wouldn’t let me work until I had a current nursing license.

Frustrated in Chicago


Dear Frustrated,

As they say, you are up a creek without a paddle. You are in an awkward position with no easy way out. You cannot work without a valid license and CPR card.

Would you let your driver’s license expire and continue to drive? What would happen if you got stopped? One night you and a friend go to Pizza Hut for the large Supreme pan pizza for $10.00. You are feeling great because the pizza was wonderful and the price was awesome. As you drive along the highway, you are pulled over by a police officer, who noticed your tail light was burned out. He asks for your driver’s license.Yikes! Now you have a ticket and have to go to traffic court. You miss a day of work and lose a day’s pay and, of course, you have to pay to renew your license.

What if you had been in a serious accident, and your passenger was killed? Say the accident was your fault. The liability would be tremendous. You had no valid license. Will your insurance company be happy to have you as a customer? Will they renew your insurance at the same premium? Not a chance. Soon you’ll be spending your free time calling Geico, Travelers, American Family Insurance, State Farm, and every cut rate insurance company in the phone book.

Having a valid nursing license is required by the Nurse Practice Act. The State of Illinois Department of Specialized Care for Children, one of our funders, requires that the personnel file of each nurse contains a copy of the nursing license, the on-line verification of the license at the Illinois Department of Financial and Professional Regulation Website, and copies of the front and back of the CPR card. The back must be signed by the nurse. The State of Illinois will not accept on-line CPR classes.

Think of the financial liability the agency would face if a child died under questionable circumstances, and the nurse had no valid license or had no valid CPR card. The parents would sue. The failure to be properly certified would feature prominently in a trial. The bad publicity and financial loss could destroy the whole company. You would be out of a job, and over two hundred other nurses would need to find another employer.

By the way, why did you need a pair of shoes that cost $500? I don’t know anyone who has shoes like that. Once I heard an exotic dancer say that she had spent $500 for a pair of shoes to wear to work. She was a poor, misguided soul. You can be sure that not one of the patrons of that establishment was looking at her shoes.


Note: First published on American Home Health's news, September 2010.