HELP! New to HHN and sinking....

Traveler · Dec 23, 2004

I have done hh for 4 years and have found my niche like many other on the board have said. The visits do vary. I am paid per visit, but I do what is needed. Some visits can be quick, others take me a long time depending upon what the patient needs. One of the hardest things to do (and it takes time to perfect it) is to focus primarily on the problem, do teaching, skill, etc., be friendly and make some small talk, and then get out. Lots of the patients are people who love to have a visitor and they could just sit all day and chat. It is hard to make a timely and graceful exit, but that is what you have to do. I have found that it works to have my bag in hand and inch my way toward the door when it is time to go. The paperwork takes less time as time goes on, and each day is different. My husband will often ask me what time I think I'm going to be home- who knows. Things can change in hh at the drop of a hat. Some days I make triple of what I do other days, but it all evens out. I prefer to work at home since I can't concentrate at the office. I'm a night owl anyway. I prefer to get home a little earlier to be with my family and then stay up late by myself watching television and doing paperwork. As far as the cell phone, if your agency is not paying you anything for it, don't give them the number. The cell phone is handy, but you can make do without it. Where I work, there is no cell service in about 90% of our coverage area. If I need to call a doctor or the office, I use the patient's phone. When I have to leave a message at the doctor's office, I tell them to call the office. I then let the office know what is going on and let them take it from there. All of that being said, there are some hh agencies that are better to work for than others. At my last job, my base hourly rate (for meetings, etc.) was $10/hour less than at this job. In addition, I would easily drive over 100 miles a day making visits. At my new agency I average 40 miles a day. The patients are closer together which means that I can see more. Mileage rates vary too. At my last job it was a paltry .26 cents/mile (and still is).

My job now pays whatever govt. pays. If you love the job, the people, the work, etc., my best advice would be to give yourself time to settle into a routine and get used to all of the paperwork- six months or so, and then re-assess.

renerian, BSN, RN · Dec 23, 2004

I did it some time ago and my hourly wage was between 8 to 10 per hour. I did it for about a year after leaving the office work to escape politics but it was not a decent wage so I left. Your right the PPS system has strapped alot of agencies. If they manage their case mix it is workable but if no one is watching that and people just take anyone it makes it difficult. It is nice your boss is trying to help you but in the end you will have to make a hard choice.

It is very hard and I felt guilty doing what was right for myself and my family.

renerian

barefootlady, ADN, RN · Dec 24, 2004

Wow! This post hits home. I too loved my patients, I was supposedly working for one of the best companies around here, but between the price of gasoline, wear and tear on my car, the tons of paperwork, not to mention the dumping of certain patients on "more experienced" nurses, I got over the feeling of my boss being understandly rather quickly. I am looking for another position and I will be glad to be off the road and in one spot.

I learned the world of home health is too poorly paid and the regular nurses too overworked. I just could not continue to leave at 07:30 am get home and 19:30 or later, do the paper work, call docs and still have any type of life. I wish you well, but I got out, I learned a lot about how to treat many types of people, in doing so, I learned I had to treat myself good first.

Claver · Dec 24, 2004

I have been in home health for the past 4 1/2 years and next week - 12/31/04 will be my last day. I worked per diem and thought it was great to have free time to myself- but after replacing two transmissions in my car and pushing my mileage close to the 100,000 limit in four years I have made a decision to try something else. However, you need to give your self time to settle in - do not just open cases and pass them on to others. After a while you will get some good cases that will not require a great deal of time - home health aide supervision or weekly prepours. I eventually worked it out that my weekly case load was just the two mentioned above. Also you do not have to acept every case - I once did a case - wound care - bed sores ++- a nurse had asked me to cover for her- 3 hours later I emerged feeling so dirty I did not even want to get into my car - of course I gave it up. Also do not give the agency your personal cell phone - I let them leave messages on my voice mail or answering service and then I retrieve them later. Try to get your cases in the same zip code area and in the same community if possible -this saves on gas, mileage etc. Also try if possible to do cases in the same area on the same days so that you are not going back and forth - Try to schedule your oasis into your weekly visits so that you are not visiting twice in a week - do the same with any home health aide supervisions so that you are not running back to the same are twice in a week - make it work for you and enjoy for as long as possible.

Good luck

renerian, BSN, RN · Dec 27, 2004

Some of what you said hit home for me. Doing home health full time I needed a new car every other year at best. I would put no less than 30,000 miles on my car per year/several pairs of tires, brakes--you know. way more than the tiney mileage check........

renerian

lossforimagination · Dec 27, 2004

I think you should tell them to pay you by the hour and definately charge them for the paperwork you have to do at home. Don't work for them for free! Also, see if they will give you a company cell phone you only use for work purposes.

You area absolutely correct, payday! I am reimbursed for mileage at $0.30/mile after the first appointment of the day. But as far as the homework...yeah, I know! Tons of it! Phone calls, faxes, etc., etc. And the cell phone bill! It's growing by the day. Non-reimbursable, but you can't survive the field without it.
Paperwork...that's what I'm doing right now - yesterdays paperwork because I was on the road all day or in the office. And only saw TWO patients! One early then to the office followed by one late and then home at 5:30. Nothing inbetween other than a stop for gas at $1.80/gallon! Followed by phone calls to arrange visits when I got home last night.

Traveler · Dec 27, 2004

I think we all know exactly what you're talking about. I have 105k on my 4 year old car. Luckily it's a good vehicle (knock on wood) and never has any trouble getting up some 4wd roads and driveways that I encounter frequently in my neck of the woods. I have never done anything to it other than change the oil, filters, etc. I have almost worn out my third set of tires and am getting ready to have the timing belt, etc. changed. One thing that the mileage reimb. does not pay for is the day you have to spend at the shop getting things done. My vehicle is also so disghusting at times that neither my husband nor my kids want to get in it. (That might be a good thing) The kids have gotten used to sitting next to catheters in the backseat. I try to get the trash out at least once a week and it usually fills a bag- I think many of us take our meals (such as they are) in our cars. It's always a pain when someone has to ride in the passenger seat since I have to move notebooks, bags, etc. Knowing all of this and how good my vehicle has been, I have decided to keep it for as long as I can. My goal is to get a new car in two years that is just for family stuff and to use the one I have now for work. It doesn't pay to trade them in since the mileage is so high. But, I get to be out driving on beautiful days (the rainy and icy ones aren't much fun) and actually get paid to go explore new places which is something I love to do. Every policeman in the county waves when I go by since they see me out so much.

renerian, BSN, RN · Dec 27, 2004

I remember that being an issue with my kids.....LOL.

renerian :rotfl:

barefootlady, ADN, RN · Dec 28, 2004

Once I was on call, had a newly released patient with a draining wound, when the call came, I rushed to the office and attempted to get the supplies requested. I literally took every 4x4, abd pad, sterile water, tape, underpads, and so forth that I could think of. I was at the patients home until 1:00 am and back on the road seeing my other patients by 08:30 ama the next morning. At 10:00 am I get a "snooty" call from the clinical supervisor asking why I had not taken enough supplies to the patient I had seen less than 24 hours ago. I attempted to explain in detail what I had taken and just what type of wound we were dealing with. I was shot down by her rudeness and inability to understand that the dressings ordered were not adequate for this patient. When I went into the office, she did say she had spoken to the family and they did confirm the amount of supplies I had taken. She then lit into me about not taking the right supplies, mind you, this was the first time I had any contact with this patient and was doing what was on the order sheet. I looked at her, told her I was not capable of reading the doctor's mind at midnight and if the wound care was wrong or needed changed she could now call the doctor, she blanched, did make the call, needed me to describe what was happening to the best of my feeble knowledge, and when I handed her the phone back to take the orders she just about exploded. I repeat, the world of home health is not for me. Of all of the positions I had ever had, these agencies are the most ungrateful to the employees, most underhanded in dealing with patients, and just uncaring.

letina · Dec 28, 2004

Does anyone have any info about HH nursing - hospital attached rather than agency? I'm relocating to Florida from the UK, have been in HH nursing here working for a hospital and love it, was considering HH in Florida but all these posts are putting me off

lossforimagination · Dec 29, 2004

Does anyone have any info about HH nursing - hospital attached rather than agency? I'm relocating to Florida from the UK, have been in HH nursing here working for a hospital and love it, was considering HH in Florida but all these posts are putting me off

I think the problem is just the people and/or the agency policies. My previous jobs in hospitals have all been pretty much deep hell. My new job in home health is sooo much better than any nursing job I've had before. My bosses and coworkers are very agreeable and my only complaints are: the pay; being on call every other week; and the fact that it's a small agency that can't offer health insurance at this time because the owner can't afford it. I'm not sure I can bear to stick around for too long without benefits, but I'd sure hate to leave for something else..... which would no doubt put me back in hell!

I think you have to check out the policies very thoroughly before you jump in on a job. Tell them you don't have a cell phone and they will have to provide you one. Use it just for on the job. Also, make sure they don't expect you to work for free doing paperwork. I expect to be paid for every fricking minute and every fricking mile I put in and I document it all very well on weekly time sheets. They will definately hear from me if I don't get the correct pay.

RetiredMSN · Dec 29, 2004

I find these stories to be very distressing. I was in home care for 30 years, so am fortunate enough to remember the "good old days," when there was less paper work, less required at a visit, fewer regulations, and we could really enjoy the work. However, we still complained about the paper work because it was all by hand and repetitious. Also, we were expected to make 8-10 visits a day, and we were salaried with no overtime. We did not hire per diems then.

However, time and situations changed all that the last several yrs., especially with the advent of PPS. By the time I retired, I was observing the types of things we are reading in these posts.

Bottom line, you must be super-organized. DO NOT put off documenting until you get home. This will drown you in nothing flat. DO NOT make your patients dependent on you. Tell them when you will return so you will not have to call ahead every time. Teach them what to do in emergencies so you those kinds of calls aren't coming in all the time. Have your supervisor take those physicians' calls after you inform her/him of the problem. You really do not need to use a cell phone all the time if you plan ahead & effectively. Call those physicians from pt.'s homes, or leave a message with the supe to call when he/she is available. Use the office time to catch up on orders and other necessary paperwork. Keep accurate mileage records so you can claim income tax deductions at the end of the yr. Plan your travel routes so you don't waste miles & fuel. And keep routine supplies on hand along with extra dressings so you're not making trips to the office unnecessarily. You have to learn to keep visit time down as noted in a previous post.

That's about the best I can offer. Home care can be very rewarding; but, yes, it is hard work. On-call time can be frustrating, but a lot of those calls really can be avoided with good teaching & planning. A good, experienced Supe is invaluable in helping you do this. And yes, you do put miles on the car.

I hate to see you leave the field; be sure you're getting help with organization over the next few weeks.

Lastly, don't forget to write your congressman about the true picture of home health. Congress created this monster & they need to know how it's affecting the nursing shortage and patient care. RetiredMSN :coollook: