[wenron]

I have a 20 ct. caseload. I usually have an admit every other day. It takes me at least 3 hours to do an admit. I see 4-5 clients/day. I spend 3 hours in the morning before I even start my day, drive 40-70 miles everyday and by the time I get back from the office, I still have to hours of paperwork and my boss wants us to have it all done in 8 hours. I end up taking paperwork home everynight and I feel I am working for free. Do any of you feel the same? I do love my job, but exhausted from the paperwork at times. Would love to hear about your overtime and if you don't have overtime, what are your tips.
Thanks a bunch.

[sjsap]

I hear you! I work per diem for a home care agency and get a per visit rate- so no matter how long it takes me, I only get a set amount. I travel between 50-130 miles per day and get paid $.32/mile. The agency is currently short-staffed, so I am filling a full time position and have 5-9 visits/day. I supervise and LPN who does visits on my patients, so when I give her visits, I lose $, but I don/t make myself crazy about it, because I usually pick up admit visits for other staff. (they pay me a higher rate for admits than they do for regular visits) But fulltime staff have a "productivity" of around 24-30 visits/week. Admits count for 2 visits. I complained that I was the only RN who supervised an LPN, it would make more sense to me to link her up with a full-time staff nurse, but the regular staff is difficult to work with (?burnt-out) and won't take on the extra responsibility of an LPN. There is a disgusting amount of rather redundant paperwork- duplication of "homebound status" on 3 different forms, rewriting orders, SCIC forms, Transfer oasis, D/C oasis, recert oasis- it is enough to drive a sane person crazy. I also do a larger amount of paperwork at home because the office is no place to get anything productive done. I am not paid for office time or charting time at home- in the eyes of the boss, we are "supposed" to get the charting done in the home during the visit (OH YEAH, that really makes the patient comfortable) I guess I never really looked this closely at this before- it is time to go back to a job I can do in 8 hours/day and go home to enjoy my kids......... What keeps me sucked in is the patient- there is nothing more satisfying than making a true difference in the life of your patient, and I have been honored to have met and cared for most of the patients to whom I have been sent.

[caliotter3]

Almost everyone reaches a point at a place of employment where it gets to the point where unemployment is better. You might not be able to recognize that point. So you might want to consider making a plan to confront and assert, as calmly, as possible, remember "no ultimatums", try not to lose self control. Just follow through with what you know you must do to regain or maintain your own sanity and health. Good luck and God bless.

[caliotter3]

Oh, and BTW, my car is getting to the point where it is no longer reliable. Can't buy a new car, can't buy a used car (as if it would last long in home care either). Refuse, for common sense and safety reasons to use public transportation (which is almost non-existent). Just another one of my many nightmares. I see the future, and it don't look good, or something like that.

[renerian]

After 11 years in home health, the last job was pay per visit, no OT, no pay for office, drive or phone time. On call pay was 100 per week. Pay if you went out only per visit. That per visit pay was lower that the rate I used to be paid in 1991. Our service area was 7 counties. I spent between 20 to 30 hours in my car unpaid of course. My hourly wage for all hours suffered to work was between 9 to 13 per hour. I left after almost 2 years there.

renerian

[CWOCN]

I don't know exactly how she did it, but a co-worker started working for an agency who actually got 16 visits in a day...She was paid per visit...probably didn't have to cover much geography. The way I see it, we all like to sit and chat and "be there" for our lonely clients. I have been advised to get down to business, make it very clear what the goals for the visit are, stick to a time limit, and simply indicate that the instruction will be continued at the next visit, and Bye-Bye... Without lowering your standards, I do believe there are some things that can be eliminated in the visit. Don't set yourself or the visiting nurse up for failure by writing things into the treatment plan that aren't necessary at every visit. DO vital signs need to be done at EVERY visit? If we are worried about BP, take that. If a wound, take the temp. Meet the goals, tell the patient where you will pick up at the next visit, stick with the plan, make it simple. Of course there are always things that are new that will be a real time-suck for you, but these things have helped me manage my time a little better. Can't help you on the OASIS time frame--that's always a given for me...

[rnhomeind]

Has your management went out and performed the work that they expect you to complete in a 8 hr period? It AMAZES me, the expectations upper management have for visits? The days I can complete 5 to 6 visits in a day and be completed with call, paperwork, etc. are far and few between....

[wenron]

I agree with rnhomeind...let's see if it's possible to get done by them first...then we'll talk!

[NursieMe]

The larger the organization you work for, the more unpaid overtime you will be bullied into, and the "blinder" your supervisor will be to the fact that everyone is expected to be doing it.

Nurses cook their own soup however. I have spoken up about this and other controversial things at nurse meetings, and NOBODY would speak up to back me. The majority of nurses I have worked with over the years are very easily intimidated by management bullies (who are also bullied by THEIR supervisors!) Every nurse in our office works hours and hours of unpaid overtime and management speaks to the effect that they "don't allow any unpaid /unrecorded overtime," all the while seeing you there many more hours than ever clocked for pay.

Nurse are in demand more than ever right now. It is time to speak up and refuse to work all this "unpaid time." Management is collecting the benefits as they sit at their desks and read the newspaper. I have BEEN management and I got out of it because I couldn't tolerate all the unethical demands I was expected to enforce!

The nurses in the above article are correct. NONE of the managers could get the same amount of work done any sooner--EVEN the ones with no compassion or dead consciences. Let's decide to command the money we really earn! Patient care cannot be "produced" like inanimate furniture on a factory conveyor belt. BE GONE! with unrealistic "PRODUCTIVITY" expectations! People need CARING!

[sjsap]

Bravo, NursieMe! Hear hear! It is too bad there aren't more like you around, brave enough to tell it like it is![color=blue]