Calling all HH Nurses, roll call - page 20

Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field. I have been a nurse 20 years, 17 in critical care,... Read More

  1. by   Mijourney
    Quote from hcnurse
    Hi, I joined this group specifically to discuss this problem. I've been an RN for ten years and five years of it has been in home care.
    I have come to the conclusion that the "fee for service" nurses have the best deal, they can pick and choose what they want to take, as much or little. When I was FFS and I was swamped and they called me for a case, I would just say no thanks, I am swamped and that was the end of it.
    Then I made the big mistake of going staff and I regret it. I have an opening every day, sometimes two, and if not two, then an opening, discharge, recert, and a couple of revisits. Its impossible to do it all in a ten hour day.
    I am getting fed up and thinking about taking a shift in a hospital on weekends or per diem just to see if I can do it. Anyway, I just joined and this is the Howdy forum so Howdy and I'm going to see if I can find a thread with this topic. E-mail me if you want, I'm also over 50, and its getting tough.
    When I was out in the field, I worked both FFS and salaried and I liked what the company I worked for was doing a far as salaried employees were concerned. It seemed that when I was FFS, I had to case manage a lot more patients then when I was salaried. The company I worked for enforced a quota on the number of patients salaried staff were expected to see. Perhaps the company you work for is the problem and you should find another HHA. I just don't think I could ever go back to the hospital after experiencing home health unless I was a "corporate nurse" in that environment.
  2. by   rnluann
    Hi there! I'm a 25 year nurse, back in home health again after the gruel of administrative jobs in long term care and hospital floor work..I love the home visits and actually dont mind the paperwork too much, but I would like to have a bit more time for myself/family, etc. I case manage 25 clients and find it hard to get it done, even at 55-60 hours a week most of the time. Is
    this status quo or am I a sloth...Love my job, love my company, burning out quickly, tho

    Quote from hoolahan
    Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field.

    I have been a nurse 20 years, 17 in critical care, mostly cardiac critical care, and the last 2.5 years in HH, or asthma disease management , which I also had to leave because I hated to be in a cube farm all day.

    I still love HH, even though PPS is the pits, even though the OASIS would make good kindling for a massive bonfire, and even with all the rest of the paperwork, it is the most rewarding nursing I have ever done!!

    PS, I went back to my former VNA who is now paying $30/hr, yes, you read that right, to work 3 out of 4 weekends. Since weekends work well for me, it's a good deal.

    Let's hear from all the HH nurses out there. Out of all those registered members, there's got to be plenty of us on this BB!!
  3. by   Mijourney
    Quote from rnluann
    Hi there! I'm a 25 year nurse, back in home health again after the gruel of administrative jobs in long term care and hospital floor work..I love the home visits and actually dont mind the paperwork too much, but I would like to have a bit more time for myself/family, etc. I case manage 25 clients and find it hard to get it done, even at 55-60 hours a week most of the time. Is
    this status quo or am I a sloth...Love my job, love my company, burning out quickly, tho
    Are your patients close in vicinity to one another or are you rural with long drives? Are you able to get your paperwork done on your visits, or do you carry your work home? Do you notice other case managers experiencing the same problem as you? It doesn't sound as though you are a sloth, because you seem concerned about that. Case management is hard work in any form. There is so much to do. When I did case management, I was spending on average 50-60 hours a week. That's the reason I went part time. I wanted more time with the family. Some nurses I know were able to stay the course, because they found their "method". Unfortuately, some methods short change the client. It sounds as though you are being thorough. I say, don't give up on that, but find your "method". I know you'll hear from HH nurses who are currently working in the field with the same problems.
  4. by   blu
    hi i'am new to this it my first time i don't even know how to post a message with replying to one help please i'am also new to home health i have no clue as what to do!! the don that hired me quit the day i was suppose to start and the business is new and i have no one to formally train me i truly want to do a good job but i'am nervous i really need some help with my charting any help or examples would be great please e mail me @clearopp71@yahoo.com
    Quote from hoolahan
    Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field.

    I have been a nurse 20 years, 17 in critical care, mostly cardiac critical care, and the last 2.5 years in HH, or asthma disease management , which I also had to leave because I hated to be in a cube farm all day.

    I still love HH, even though PPS is the pits, even though the OASIS would make good kindling for a massive bonfire, and even with all the rest of the paperwork, it is the most rewarding nursing I have ever done!!

    PS, I went back to my former VNA who is now paying $30/hr, yes, you read that right, to work 3 out of 4 weekends. Since weekends work well for me, it's a good deal.

    Let's hear from all the HH nurses out there. Out of all those registered members, there's got to be plenty of us on this BB!!
  5. by   rosalee1
    I am another home health nurse who loves her job!!! Five years in one small area and now I am thinking of moving on...traveling but not leaving home health. Did wonder if anyone does home health as a traveler and how it works??
    Quote from hoolahan
    Great, thanks for your replies!

    Come you other HH nurses, check in!!
  6. by   akhales
    Quote from hoolahan
    Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field.

    I have been a nurse 20 years, 17 in critical care, mostly cardiac critical care, and the last 2.5 years in HH, or asthma disease management , which I also had to leave because I hated to be in a cube farm all day.

    I still love HH, even though PPS is the pits, even though the OASIS would make good kindling for a massive bonfire, and even with all the rest of the paperwork, it is the most rewarding nursing I have ever done!!

    PS, I went back to my former VNA who is now paying $30/hr, yes, you read that right, to work 3 out of 4 weekends. Since weekends work well for me, it's a good deal.

    Let's hear from all the HH nurses out there. Out of all those registered members, there's got to be plenty of us on this BB!!
    I just joined this board tonight. I have been looking for a forum that includes home health, and was glad to see your post.
    Just started my own blog last week, still kind of learning, but it is about Home Health. Please check it out if you get a chance. If you like, I'll send a link.
    Yes, home health is the absolute most rewarding thing I have found. You can truly get to know your patients and make a meaningful difference.
    I work for a large company also, and am one of those cube rats you talked about. It's difficult not getting to see patients, I just have to live vicariously through my staff. They do share well!
  7. by   lossforimagination
    Quote from akhales
    I just joined this board tonight. I have been looking for a forum that includes home health, and was glad to see your post.
    Just started my own blog last week, still kind of learning, but it is about Home Health. Please check it out if you get a chance. If you like, I'll send a link.
    Yes, home health is the absolute most rewarding thing I have found. You can truly get to know your patients and make a meaningful difference.
    I work for a large company also, and am one of those cube rats you talked about. It's difficult not getting to see patients, I just have to live vicariously through my staff. They do share well!

    Please post the link!!
  8. by   Trailblazer
    Quote from akhales
    I just joined this board tonight. I work for a large company also, and am one of those cube rats you talked about. It's difficult not getting to see patients, I just have to live vicariously through my staff. They do share well!
    Hello akhales!
    Last year I was promoted to a new position as an in office Case Manager. I miss seeing the patients, but speak to them frequently over the phone. I case manage around 60 patients. The Field clinicians are no longer burdened with developing the POC, playing phone tag with the MD's etc. I work M-F, am salried, and sometimes I work long hours, but usually can leave at 4:30. We have 10 agencies in our organization. Hope to hear from you soon!
  9. by   akhales
    Quote from Donna_Beth
    Hello akhales!
    Last year I was promoted to a new position as an in office Case Manager. I miss seeing the patients, but speak to them frequently over the phone. I case manage around 60 patients. The Field clinicians are no longer burdened with developing the POC, playing phone tag with the MD's etc. I work M-F, am salried, and sometimes I work long hours, but usually can leave at 4:30. We have 10 agencies in our organization. Hope to hear from you soon!
    Hi Donna Beth,
    What you do is very similar to what I do, I just have to manage the clinical staff to go with that. What area are you in? I am in New Braunfels, close to San Antonio. We carry about 50-60 patients, pedi-adult, from Medicare/Medicaid to many, many insurances.
    It's kind of nice every once in a while if one of our nurses can't get a venipuncture, I get the chance to go out and see the patient.
    How do you handle the calls to the MD etc, do you have the nurse place the initial call with a message to call you back, or are they just telling you what they need and you call the doc yourself?
    How about insurance authorizations??
    Nice to hear from you, take care!
    Angie
  10. by   Trailblazer
    Quote from akhales
    Hi Donna Beth,
    What you do is very similar to what I do, I just have to manage the clinical staff to go with that. What area are you in? I am in New Braunfels, close to San Antonio. We carry about 50-60 patients, pedi-adult, from Medicare/Medicaid to many, many insurances.
    It's kind of nice every once in a while if one of our nurses can't get a venipuncture, I get the chance to go out and see the patient.
    How do you handle the calls to the MD etc, do you have the nurse place the initial call with a message to call you back, or are they just telling you what they need and you call the doc yourself?
    How about insurance authorizations??
    Nice to hear from you, take care!
    Angie
    Hi Angie!
    I work in Sturgeon Bay, Wisconsin, which is the Door County Peninsula, NE of Green Bay. We carry between 60-70 patients, mostly adults with an occasional peds pt. I have recently noticed an increase in the number of insurance pt's. Some of them are generous with their authorizations, but a few are very stingy- I have to plead my case for each visit! We have just begun having centralized inatke, and it has decreased the time I had to spend for the initial authorization.

    The clinician will call the MD, with a message to call me back, and also call me with an update. The MD's appreciate having a contact in the office. The nurses schedule are on their laptops. They import the patiients in the AM and are expected to export no later than 8 AM the next day.

    I work for a very progressive organization. Our field clinicians are paid hourly, at the same rate as the local hospitals with travel pay at 42.5 cents per mile, and receive a minimum of 2 hours overtime pay when called out. They are expected to attend 6 visits per 8 hours. An admit counts as two visits. They work every 5th weekend. I am salaried and work M-F. Although I am not management, I am responsible for overseeing their OASIS data and that the required Sup visits are done.

    One of our field clinicians has a time share on the River Walk in San Antonio. She loves going there! My nephew recently transferred to Ft Hood.

    I am glad to hear from you! It seems like most agencies do not have in office CM's!

    Donna
  11. by   akhales
    Quote from Donna_Beth
    Hi Angie!
    I work in Sturgeon Bay, Wisconsin, which is the Door County Peninsula, NE of Green Bay. We carry between 60-70 patients, mostly adults with an occasional peds pt. I have recently noticed an increase in the number of insurance pt's. Some of them are generous with their authorizations, but a few are very stingy- I have to plead my case for each visit! We have just begun having centralized inatke, and it has decreased the time I had to spend for the initial authorization.

    The clinician will call the MD, with a message to call me back, and also call me with an update. The MD's appreciate having a contact in the office. The nurses schedule are on their laptops. They import the patiients in the AM and are expected to export no later than 8 AM the next day.

    I work for a very progressive organization. Our field clinicians are paid hourly, at the same rate as the local hospitals with travel pay at 42.5 cents per mile, and receive a minimum of 2 hours overtime pay when called out. They are expected to attend 6 visits per 8 hours. An admit counts as two visits. They work every 5th weekend. I am salaried and work M-F. Although I am not management, I am responsible for overseeing their OASIS data and that the required Sup visits are done.

    One of our field clinicians has a time share on the River Walk in San Antonio. She loves going there! My nephew recently transferred to Ft Hood.

    I am glad to hear from you! It seems like most agencies do not have in office CM's!

    Donna
    Donna,
    Well, our Managers of Clinical Practice (that's me) are expected to do that plus manage the staff, answer the phone (we have only one clerical person), and whatever else comes up. What you are doing is definitely a full time job, and I bet the MD's DO like having someone in the office they can actually reach. That's how we do it also, plus we have the clinicians complete a form to request auth, then I review it and someone does follow up on it for us that's non-clinical.
    We did try centralized intake for a while but it didn't work well for us. We are from a small town, and San Antonio thinks like a small town, so physicians and referral sources did not like speaking to someone that wasn't right there in their town. Try as we might, they still figured out that the intake dept was in Dallas (5 hours away). So we are now back to local intake. Personally, I like it better. There's no substitute for speaking to a referral source yourself.
    I wish we already had laptops. Our company has looked at them again, and we're not there yet. I believe it HAS to improve charting and continuity of care. I think most of our staff would be happy and willing to do it, so I guess it's just a matter fo time.
    Have you attended any Oasis training? I know it's out there. I work for a very large company and we have our own on line training that's pretty good. There's still no substitute for someone on site that can look at them for a while and give helpful suggestions.
    Well, good luck and let me know if there are any specific things I can help you with. I'll be glad to!
    Angie
  12. by   akhales
    Here's the link I promised. It's not much, just starting out. I would love to hear from any of you that would like to comment or if you know of any other good medical blogs let me know and I'll link to them.
    What is everyone out there seeing nowadays for mileage reimbursement for clinicians?
    We recently changed ours to 33 cents per mile from a flat trip fee.
    http://homehealthhangout.blogspot.com/
    Last edit by akhales on Jul 8, '05
  13. by   tracey1968
    Quote from hoolahan
    Great, thanks for your replies!

    Come you other HH nurses, check in!!
    Hello, I am an LPN soon to be RN and I have done HH care for 2 years, been a nurse for 10 years. I have a diverse background that ranges from nursing homes to life support, juvenile corrections etc. I have always enjoyed my profession, but I love my HH gig. I set my own schedule based on the patients needs of course, and I can work 5 hours or 2 hours whatever want.
    And the pay is sooo much better than any wage I have ever received. What I really like is the one on one care that you can deliver, like nursing is supposed to be. I am constantly turning down job offers from consumers because I just haven't figured a way to split myself into several people yet, although my body mass would allow it if only...
    I am working on grant projects to bring nursing and related services to the rural area where I live, it's a long process but one that definitly has a future worth going for.
    In this world you can choose to dream, and act on that dream, or you can wake up day after day and contribute to someone elses dream and make things happen for them, either way you have to do the work. But in my dreams I reap the rewards I deserve. DREAM BIG!!!

close