Am I whiny or is this too much?

renerian, BSN, RN · Jan 18, 2004

Unfortunately this is why alot of nurses do not stay in home health? Do you have weekends off? What is your productivity scale? How large is your service area?

renerian

goodywhyte · Jan 18, 2004

Thank you so much for replying! My farthest away patient is about 40 miles from the office...I have 5 patients at that distance to the north, a few about 30 miles west, and to the south probably 20 miles.

Actually I wasn't really told anything about productivity! Just bits and pieces from the scheduler. I just started the job in September and sometime last month I said something to the scheduler about working in the admits around a 6-7 patient recert/sup vist schedule with all the miles to cover and she said she was told to "keep me busy"! That has never settled well with me because I consider myself to be a professional nurse; most of my background is CCRN, Clinician IV, or Supervisory/Charge...what have you. I wanted to stay where the patients were. Anyway, my work ethic is such that I certainly need no one to "keep me busy"!!!

A few weeks later she alluded to a "quota". I had never heard about that either. However, the assistant admin told me her brother was in home health and could do 15 admits with oasis a week and sometimes more! They should have hired *him*!

So, in a nutshell...there is no real guidance there about what I should be able to do.

Last week I did 2 recerts, 4 admits, 2 Primacor hookups in hospital, 3 sup visits, and 2 follow up visits for one of the Primacor patients. Of the 14 visits, 5 of them were at the 40 mile one way distance; 3 of the patients required extra time because of problems that required intervention.

I also made the weekly meeting, and did care coordination for 4 other patients I did not have to visit.

So here I sit...whining...when I still have to write up the 2 recerts, 3 of the admits, and all of the visits.

This week was busier than usual, but not by much.

Appreciate you input!

Goody

renerian, BSN, RN · Jan 18, 2004

I have worked in home health over 10 years. Most places if you are full time have a productivity scale of 25 to 30 but some have more some less. Obviously if your geographically located you can keep up with more work. Did they tag a number to you? I do not know yet if you only work M-F or if you have to do weekends now? Many people who have not actually done case management and OASIS have no clue about how much time it takes or what it is like to drive all over God's green acres. Gas with prices up all factor into things. Do you get mileage or is it included in your visit?

Do you have to be on call? Personally it sounds like they are really overworking you.

Are you salaried or per visit?

renerian

crystalrose · Jan 19, 2004

geez you have to be an RN I am a lpn in home health care and I do have flexiility in my job and do not plan to get my RN anytime soon I see my supervisors worked to death all I have to do is go to my patients and do my nursing note for that patient I work from about 6-12 that is the advantage to being a LPN.

goodywhyte · Jan 19, 2004

I'm full time 8:30 to 5:30 (the hour lunch is total illusion) and do not have to take call or work weekends. I am available to the weekend nurse though if she has a question.

I get mileage or can drive the company car.

Do you all actually do 25 or 30 admit/recert/sup visits a week *plus* the paperwork??

What in the heck am I doing wrong?

CseMgr1, ASN, RN · Jan 19, 2004

Originally posted by goodywhyte
I'm full time 8:30 to 5:30 (the hour lunch is total illusion) and do not have to take call or work weekends. I am available to the weekend nurse though if she has a question.

I get mileage or can drive the company car.

Do you all actually do 25 or 30 admit/recert/sup visits a week *plus* the paperwork??

What in the heck am I doing wrong?

You're not doing anything wrong, honey. You are working 10-12 hour days, because for every visit you do, it means more profits for the agency. I know, because I worked in Home Health for 18 years, and RARELY did I ever get the paperwork done before the end of the day...not when I was expected to drive all over God's Green Acre...then work until 1AM, doing paperwork.

It wasn't bad, when I first started working Home Health back in '82. But, as the cost of doing business went up...and OASIS kicked in, I could no longer keep up with my employers' productivity demands...and my body gave out. I'm not trying to be discouraging, but that's the way it is in home health these days.

Traveler · Jan 19, 2004

You have to remember that you will be able to complete your paperwork much more quickly after you get used to all the newness with the Oasis. It's just becoming accustomed to it. When I first started in hh, it used to take me a good 3 hours to complete it for admission. Now it usually takes about 45 minutes.

That being said, hh is crazy and busy. You never know what the day will bring and what you think will be an easy admission can turn into a nightmare and vice versa. I personally prefer to stay out of the office as much as possible as I find there are too many distractions to be very productive.

I have learned to see my patients, go home, be with my family and wait until they settle in for the night to finish my work. I work per visit prn so I don't have any quotas. But, in my office I believe it's 24 a week. Admission counts as 3, follow up or discharge counts as 2, any travel time over 30 mins between pts. counts as 1 per hour (60 mins from one pt to next= .5). Meetings, etc. are the same.

We have been getting TONS of IV's lately and complicated visits so any visit (not admission- just visit) past the one hour mark count (2 hour visit= 1 plus 1 for extra hour.)

Some days are very hectic indeed and others are a little more manageable. I personally prefer it to being in an institutuion setting but there are drawbacks.

Ann

goodywhyte · Jan 19, 2004

Wow...thanks for that. Now I can compute my visits.

Usually an admit takes me about 2 hours in the home by the time all the paperwork is signed, assessment completed, teaching started, in home chart set up and "skill" done. Then, for me, the entire packet takes about 2 hours. We have the Oasis, with all diagnoses prioritized, dated, and coded, then the 485 with all the frequencies, med sheets written and coded, the start of care case conference narrative, a report sheet to be given to the visiting nurse (ok, I added this...but there was no communication between the admit nurse and the nurse who was doing the visits!),any orders that need to be written, and the referral that goes to the scheduler. I think that's about it. Except for the phone calls. aagh

Also I have to track on a spreadsheet *all* the admissions, who did them, and follow up to make sure contracted therapies were started.

All in all it takes about 5 hours to do an entire admit: visit, travel time, paperwork, care coordination.

I think I'm too slow! Good grief! I like the idea of doing the visits and going home to do the paperwork. If I can do it. I'm supposed to be in the office, too. I may have to speak with the director about that part!

Thanks alot everyone!

Goody

P.S. of course, any more advice, suggestions, critique will be most welcome!

hoolahan, ASN, RN · Jan 19, 2004

The problem, as I see it, is that you are traveling too much. Travel time MUST be taken into consideration. When you fill out a time sheet, is there a section to add up your time traveled?? In my agency, we try desperately to keep nurses geographically clustered, b/c it increases productivity, and decreases cost, AND it keeps the nurses happy.

It sounds like your agency needed another field nurse, but gave you a title to lure you in. In both agencies I work for, we have no "admission" nurse. Weekdays, RN's are expected to do 5 RV (Re Visits) and one admit, LPN's are expected to do 7 RV. There are days I may put on 14 miles, and at most it was 80 in a day, and that is very rare indeed. You can see how I can easily get my work done when my visits are 5-10 minutes from each other.

I would say for you 3 admits a day, and at my agency an admit counts as 2 visits, and the other agency it only counts as 1.5, is enough with all that travel.

I am a weekend sup at one agency which we cover 3 counties. I try very hard to keep nurses clustered, but on occassion, I have to send a nurse traveling extensively, like if she is my only wound vac nurse on duty, and a pt far from where she is needs a visit. They really get upset when that happens, but I hate to say it, that is why I chose to work for an agency that only covers ONE county, as field staff. I know I do not like to travel like that, so I would never work as field staff for the agency that covers that much territory.

I would have a chat with my boss. If you are expected to be an administrator, you should have to do no more than 2 admits a day, and even that is too much for 40 mile trips!!

renerian, BSN, RN · Jan 20, 2004

I am with hoolahan, too much time in the car.

renerian

sphinx, BSN, RN · Jan 24, 2004

Where I work, we don't have admit nurses either. We have a productivity expectation of 5.2 (per day, which is averaged through the week). On any given day our nurses can do 4 RV and an opening, or 5 RV and an opening, or if we have a lot of openings, 2 RV and an opening. Recerts and D/C tend to get lumped right in with the revisists cuz the visits are short, although the paperwork is longer. We tend to have a lot of patients drop off, which can be frustrating, because you start off with a full board......call in per diems to help, then the full time staff have visits drop off and their productivity is low, making it look bad that we used per diem that day. Our problem is that an opening counts the same as a RV in terms of productivity.

The good thing though, is our nurses who travel a lot, like our OB nurse who does the whole county is expected to have a lower productivity, same as our peds nurse who does half a county. Also, our IV nurses do not have as high productivity expectation. I work in the office and part of my (very busy!) job is scheduling, and all our nurses have "areas" the follow, and I always try to keep them in those boundries. Occasionally if they have a slow day I may send them a little further off to help out another nurse who is busy. However, we are not in a rural area, so even that travel is not too horrid. (I worked in the field, so I know.....and I used to do the whole county for OB).....

I agree that a big problem is that you are driving a lot. Also, given time (and it does take a *long* time!), you will become more used to oasis, and both the assessment and the paperwork will go much quicker. I hope things get better for you! Good luck!