The exhausting side of home care

  1. [font=book antiqua]wow......the census is picking up on a daily basis and we're getting hit with multiple opens per day. i've been running literally from early morning and working overtime trying to keep up with the paperwork, and i have the lightest case load! i've done overtime all week and this weekend is my first weekend on call, so it will be a while before i get a day off. i've had to pick up pts in areas i normally don't cover because pts have requested a female nurse and the nurse covering those areas is male. last night i realized how tired i am and thought "uh-oh........". i do not want to burn out on this one, i love what i'm doing but i need to learn how to pace myself. we also have lvns i can delegate to but right now a good portion of my case load is ivs, and that's the one thing they're not allowed to do. plus i'm still learning to delegate, i'm not used to that and keep forgetting i have that option.
    [font=book antiqua]
    [font=book antiqua]don't mind me, not complaining, just voicing a concern.
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  2. 28 Comments

  3. by   RN1989
    I feel for you. I was reading an article yesterday that reimbursement for HH is going to get cut even more. That is going to make the strain on everyone worse. Wish there was some magic wand I could wave. Will tell you that the best HH wound care nurse that I've worked with was an old ER nurse.
  4. by   leslymill
    I love Home Health. Lots of paperwork but, your car will burn out before you do.
  5. by   RN1121
    The mountains of paperwork took me away from my family. I'd be charting well into the evening on a consistent basis.

    AND I was salaried, so I didn't get paid for working OT!
    It just wasn't worth it anymore.

    The areas I'd have to go to were dangerous, and looking back, I took a risk every day I worked in home care.

    I know exactly what you mean.
  6. by   leslymill
    Come to think of it, the two times out of three that I worked in Home Health I quit right after Medicare reimbursements where cut.
  7. by   Spidey's mom
    We haven't had home health here in years . . . . . too expensive to run.


    steph
  8. by   steelcityrn
    From what I understand, many smaller home health agencies will not be around after the new changes occur early next year. There are already classes started on the new oasis. If anyone can or would want to, start looking for work with hospital affiliated homecares. Its going to get much worse for these smaller ones to compete.
  9. by   TazziRN
    Quote from steelcityrn
    from what i understand, many smaller home health agencies will not be around after the new changes occur early next year. there are already classes started on the new oasis. if anyone can or would want to, start looking for work with hospital affiliated homecares. its going to get much worse for these smaller ones to compete.
    [font=book antiqua]i doubt that will be an issue in this area, there are only two agencies here. mine is one. we're not going anywhere.
  10. by   steelcityrn
    Where Im from there are probably a dozen smaller ones. A owner of one of them was explaining some of the changes, its not pretty.
  11. by   NurseDawgJess
    I did home health for several years before going back to the hospital. I loved it for a while but I did get burned out on the paperwork aspect. I was always buried and felt like I was in college again with that never ending nag of "homework" aka, paperwork. It was so redundant at times and bored me to tears. Felt like it was busy work.

    I loved the flexibility, the autonomy and the quality time and care I could give to my patients; however, the wear and tear on my vehicle, not to mention the climbing gas prices, just made it another hassle. Our company gave us gas card every month which was a nice perk but it still didn't take the mileage off my car. Seeing peeps in incliment weather was no fun either. And of course, dodging bullets and stray hostile dogs in dangerous neighborhoods became a risk not worth taking. I also felt so isolated at times with no fellow nurses to vent to.

    I love working in the ER now and hopefully I stay happy. It's nice to have coworkers to interact with and I really love just doing my job, clocking out and coming home.

    Good luck to you Taz and try to learn to say "no" to burdensome assignments if you can. I know it's easier said than done. Also try to remember to set aside time each day for phone calls to doctors, labs, pharmacies and your homecare company if needed. That was something I often forgot to consider when taking on extra "New Admits" . Those phone calls can really eat up a lot of your time. Do you have a fax machine at home? If not, that might help save you some time also instead of making extra trips to the agency. Are you full-time and if so, how many patients a week are you seeing? I found that if I saw 30 patients/week and of those visits did about 3 Oasis (including recerts) I was ok. Once I hit the 35 mark and the 5 Oasis mark I started to get fried and buried in paper.

    I briefly worked for a company that did computer charting. It sounds like a blessing but it was even worse- total nightmare. We had these teeny little screens on a hand held computer and I would get horrible neck cramps from looking down all the time. The amount of questions on the assessments was ridiculous and so many questions didn't even apply- yet you couldn't skip sections either. I hated it! It was a sytem through McKesson so beware if that name comes up when you switch to computer charting. I say "when" because eventually all agencies will be required to do computerized charting for billing purposes- at least that was the info I was relayed. On the up side, I heard there are other computer systems that are very user-friendly. Hopefully you'll be blessed with that opportunity once it arrives.

    Contact me anytime for feedback or someone to vent to. Hopefully I can turn to you for ER/Trauma feedback as well. :spin:
  12. by   TazziRN
    Quote from nursedawgjess
    i love working in the er now and hopefully i stay happy. it's nice to have coworkers to interact with and i really love just doing my job, clocking out and coming home.

    do you have a fax machine at home? if not, that might help save you some time also instead of making extra trips to the agency. are you full-time and if so, how many patients a week are you seeing? i found that if i saw 30 patients/week and of those visits did about 3 oasis (including recerts) i was ok. once i hit the 35 mark and the 5 oasis mark i started to get fried and buried in paper.

    contact me anytime for feedback or someone to vent to. hopefully i can turn to you for er/trauma feedback as well. :spin:
    [font=book antiqua]and i loved the years i spent in the er! what i like about home health is spending one on one time with pts, without having to worry about the guy in the next bed trying to crash on me
    [font=book antiqua]
    [font=book antiqua]right now i have about 14 pts; one is a daily dressing change and the other is a daily iv. all of the others are 2-3 times weekly. i'm making anywhere from 4-6 visits daily; what makes it difficult is that two of my pts are about 35 miles away from the rest, so it's a wide circle i go in. i do have a fax at home but since most of my pts are close to the office it doesn't make sense to not go in. my caseload of 14 doesn't sound like a lot, but up till now the acuity of my load wasn't as heavy as it is now.
    [font=book antiqua]
    [font=book antiqua]even though i'm off orientation my preceptor still calls me when she doesn't see me for a day or so, to make sure i'm doing okay and don't need any help. i've got good back-up, i just need to get used to being busy again!
  13. by   Sabby_NC
    Hi Tazzi,

    Do you not have computers in your agency?
    We do for Hospice and I have my notes in before I leave the pts home.
    I hear you on only having 14 patients but gawd that can run you ragged. I have 14 in Hospice at the moment and like you most are 30-65 miles apart so my van is clocking the miles up big time.
    Sounds like you are doing a great job and I am thrilled that your preceptor phones you. I do the same thing for the staff that I train. It is always nice to know you have a back up.
    My LPN has been in Europe the last 2 weeks (yeah the cheek of her LOL) so it has been tough going for this little lady.
    Hmmm evil thought here. Deb comes back I go off hahahahaha I only but WISH.
    Do you have a ceiling on how many patients you can take?
    Ours is 12 for Case Managers but me being greedy like more LOL I love to keep busy but I have to say I am almost stretched at the moment due to the acuity of patients. We seldom do IVI's but my AIDS patient is.
    I wish you well on your first weekend on call and pray it is a kind one for you. Not TOO many call outs.
    Funny thing is I love my call shifts. Yeah I have been told I am sick.
    Take care
  14. by   TazziRN
    thanks, sabby! no, we don't have computers yet, admin is working on getting a system. so far they haven't found a system that everyone can agree on.

    we don't officially have a cap on pt load, although i suppose if one threw a tantrum about being overworked, that might help to keep new opens away. that would also not put that person in a good light with the rest of the staff, however.........our agency's policy is that caseloads can go up to 25, which would be manageable if we delegate out, but at the moment we only have two full time lvns, one in each area of the county. both are being run ragged at the moment, and yesterday when my day was about to explode i felt guilty calling the lvn and asking if she could take one of mine for the day.

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