Hi,

I'm being asked to take on a client who needs many many nursing skills to be performed each visit. The visits would take over an hour (I'm guessing 2 hours for me). The pay would be the same as a client I go in to see for 20 minutes. Frankly, I don't think this visit is worth the money. In addition, the times the client needs to be seen do not mesh with the rest of my visits. Work is begging me to do it and I'm getting afraid to say no. I am a part time worker and a flexible schedule is pretty much the only benefit I get from this job.

Is it okay to refuse a client? What should I say?

Your only reason for refusing the client is the visit would take too long? I don't know how long you'll last at an agency with that attitude. Not passing judgment....just saying.

I used to work for an agency. I called them once and said "Find someone else for this client." His wife was extraordinarily rude, the guy weighed close to 300 pounds, and he tried to choke me. Other than that, I went where I was sent.

My nurses who always say no to cases find themselves asked less and less to take on new patients...

In extended care hh, there is more latitude in refusing patients, but only to a point. Due to the more limited interaction with visit clients, it is more critical that nurses are more open to "get in there, get it done, and get out". The staffers don't have the resources to try to match personalities or other, but the most basic, of, criteria. If they have to go to another nurse or even hire another nurse to get the visits done, they will soon drop you by the wayside.

Is it safe to say you are new to home health and new to this agency?

To tell this agency the truth, as you have told us, "Frankly, I don't think this visit is worth the money" is silly - - - they already know that. That's why they sent you! They new staff always get the cases no one wants. Otherwise they wouldn't have hired you in the first place.

And the experienced staff will always tell you, as we have told you, refusing cases is not the way to get more cases or build part-time hours. You have to take the 2 hour visits with the 20 minute visits.

So you've pretty much seen the average workday already: seventy minute visits for which you will be paid for an hour. (120 minutes + 20 minutes)/2 visits = 70

Welcome to home health!

Just ask for more money , most of the time the agency already know how long the visit take, if not , go see that patient last .

"Worth the money"????

In the for profit Home Health world the only entity that is allowed to schedule with the goal of financial gain is the agency. The visits are worth the money to the agency.

You are paid to provide nursing care.

If you skimp on the amount of care or hours of care to protect your financial interests you will be professionally liable.

I agree with Nursep225, I recently applied for a home health agency and the person who hired me told me they would pay me a bit more if I would take patients that where a little bit further than my area. I believe you can negotiate a bit in your pay, and since they are "begging" you then I think they will be willing to talk about your pay for that case. But be reasonable.

I was told once, by a privately owned home health agency that they would pay me a "bonus" when I agreed to accept a certain type of patient. After accepting those patient types a couple of times it became a really really big deal when I refused one. A big deal to the point that I received several calls about it, each one higher up the food chain.

They really did not want me to say no. Tried to make it really difficult for me to say no. Tried to coerce me into saying yes. Tried to intimidate me into saying yes.

I submitted my resignation less than 3 months after starting with them. Their priorities were unbearable.

I am paid like you: same pay for a short or extended visit. In the end, it should even out. Consider taking the patient just to help out and to get experience if you don't have it with the skills the patient needs. I would decline a two hour visit knowing the regular staff gets paid by the hour. That is too much of a discrepancy in pay to make it reasonable. Rarely make it about the money though. If you also have a scheduling issue, make it about that for now.

I am paid like you: same pay for a short or extended visit. In the end, it should even out. Consider taking the patient just to help out and to get experience if you don't have it with the skills the patient needs. I would decline a two hour visit knowing the regular staff gets paid by the hour. That is too much of a discrepancy in pay to make it reasonable. Rarely make it about the money though. If you also have a scheduling issue, make it about that for now. BTW, I feel I can do this because I have taken many hour plus cases and have helped out in other ways that wasn't crazy about.