HELP! New to HHN and sinking....

  1. Hello, everyone, and in advance, let me say any advice offered will be greatly appreciated.

    Brief history...22 years in nursing, with about 12 in ICU/ER, followed by about 10 as a Work Comp Case Manager including supervision. Total burnout. Decided to try HHN. Well!

    The good parts...I absolutely love it and feel like I am really "A Nurse" for the first time ever. I have a wonderful territory, great patients. My manager is fantastic. In 22 years, the one of the two best and kindest people I've ever worked for. And she thinks I'm wonderful, too, for a newbie to the field.

    The problem? I'm going broke doing this and working harder than I recall working in YEARS! I am per diem, and the rate isn't bad, however...no reimbursement for cell phone usage and that adds up - as I'm sure you all know. I get paid "per visit" yet there is tons of paperwork to be done at home - all part of "the visit." Then...the pre-visit phone calls, having to call some docs 3-4 times before getting a response, etc.

    Part of it is my organizational skills, I'm sure. However, I'm just not the type to zip in and zip out. For a routine visit, it takes me at least an hour. And you know...some of these little old people...it takes them 30 minutes to walk from the chair to the bed! For example, today I did one admit OASIS and 2 reg visits. And granted - they were spread out with considerable driving time between #2 and #3, but still, I spent a good 6 hours in the day for just those 3 visits and I STILL have paperwork to do!

    And running back and forth between home and office! Non-reimbursable in terms of time or mileage, but gosh! It really adds up in a flash. So the bottom line...I absolutely love it, love my manager, love the challenges, but I can't keep on doing this if it's going to COST me money.

    Now you know why I need help. Please?
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  2. 40 Comments

  3. by   stbernardclub
    If I were you, I would pretty much tell this company almost your entire post your wrote here. It gets to the heart of the matter, and you could say that your hoping you do not have to make a job change in the near future
  4. by   shammy
    Welcome to HHN. I too am new so can't offer ANY advice. Only been doing HH since Sept 13th.

    I am paid per hour not per visit because of that very thing. But per visit is an option if I ever become a zip in, zip out nurse.

    But I can tell you that visits do get quicker. My repeats use to last an hour. Now they usually don't. But if I have lots of teaching to do they can last that long.

    I will be checking back to see what the more experienced HHN say.
  5. by   DallasRN
    Quote from stbernardclub
    If I were you, I would pretty much tell this company almost your entire post your wrote here. It gets to the heart of the matter, and you could say that your hoping you do not have to make a job change in the near future
    Thanks stbernardclub, but I've already done that. Yesterday, in fact. Another nurse that started at the same time (and also very experienced in hospital nursing) had the same discussion with the manager. She's as helpful as she can be, I think, but basically, we've both been told..."Welcome to the world of home health nursing." I'm having a hard time this is the world of HHN because there sure wouldn't be many of them out there!

    Honestly, I'm more discouraged than I think I've ever been. I've finally found a line of work I love, and I honestly think I could be great at it, but I can't afford to do it. If something doesn't give soon, I'm going to have to go back to comp case management.
  6. by   renerian
    I have seen alot of great nurses leave home health for your posted reasons. Been there myself.

    Let me know if you talk to your manager and how it pans out. Good luck.

    renerian
  7. by   DallasRN
    I have talked to my manager in detail, renerian. First before I posted here and briefly again yesterday. I even told her about this site and this post.

    Basically, her hands are tied in terms of salary, reimbursement, etc. She is as supportive as she can realistically be and is giving me as many cases as she possibly can. Also, she goes out of her way to help - taking supplies and things home to her house (she lives near me) so that I don't have to make unnecessary trips to the office, etc.

    I understand that these agencies are allowed only X amount of dollars to treat patients (Medicare), and those dollars are eaten up quickly leaving the agency losing money in many cases. Therefore, the real problem is with Medicare reimbursement. But still...I have to pay my bills, too, and as a R.N., with years of nursing experience, I just can't see working for what turns out to be about $10.00/hour if I'm lucky.

    My frustration stems from the very fact that after several years, I've found an area of Nursing I absolutely love, feel that I could be really good at HHN (part of the battle in any job), found a wonderful manager...what could be better? Except I can't afford to work this type of job! I keep thinking I have to figure out a way to make this work. I know part of the problem lies with me in terms of newbie organizational skills, taking too much time per visit, but darn! I hate to cut corners but guess I'll have to start if I hope to continue. Seems that this is a universal problem with HHN's.
  8. by   payday
    You need to find an employer that reimburses for mileage. If not. you are working to replace a vehicle. Some HHA's offer $40/visit with no mileage. If you take two hours to open (and don't forget the pre-paper work, post phone calls, follow up) and drive let's say fifty miles, what are you really making an hour. We also had mounds of other paper work associated with the visit besides the OASIS. Clinical pathways, care plans, case conference write ups. I know you figured that out.

    I am saying this for others considering HH. I've seen experienced nurses who have been doing this for years still take their paperwork home to finish the day. I cannot afford to work for free . These issues need addressed my management because nurses have mortgages to pay too.

    Some cases take longer, sometimes you cannot cut corners and do your personal best, particularily when the elderly take so many meds. Doing med reviews with them can take an hour if they are on three pages of meds and cannot even find them in the home.
    Good luck, I'm glad you like it and hope you can resolve this.
  9. by   letina
    To Dallas RN:
    I'm a Home Health Nurse in the UK (here we call it District Nursing) and like you, after 20+ years of nursing I have finally found a job I love and wouldn't do anything else now.
    I sympathise with your predicament re the pay and I just wanted to ask you this - is all HH nursing in the US carried out via agencies? The reason I ask is that maybe you could consider working for a hospital who employs HH nurses, that's what I do here, and that way you get a salary, guaranteed pay no matter how many visits you do. Or does it not work that way in the US?
  10. by   DallasRN
    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.
  11. by   DallasRN
    I really don't know, letina, about the hospital stuff. I think some hospitals do employ HHN's, but I suspect the rate of pay is rather poor for the amount of work required. The other issue I have is that I love working for the person I'm working for. She has 27+ years HHN experience and is a wonderful teacher. I know you can't have everything, but gosh! I really want to keep working for her and be able to pay my bills, too. It's such a catch-22.

    I don't begrudge the extra "homework" too much except when it eats into my entire day and I look back and realize I've worked all those hours for pay at around minimum wage. You know...the issue is so far above the agencies. It really has to do with the value of nursing in general and of course, Medicare. They are screaming and begging for nurses, yet they refuse to pay decently. That's pretty much across the board. And I'm sure most nurses already know what I've discovered. These docs turn the patient lose to HHN and almost forget them! Wash their hands of them, so to speak. That's frustrating, too...having to call a doc 3-4 times to get any type of response.
  12. by   payday
    Hospital based HH dept.'s and county based ones seem to reimburse for mileage and provide use of a cell phone more than privately owned HH agency. They also are more likely to pay per hour which is nice. You are paid for driving time. Down side, may require call.

    Per visit pay really sucks -though the per visit rate may sound fantastic to a new nurse. I worked for an agency for about two weeks before I figured out that they were really making off like bandits and I was screwed. No mileage either. One nurse drove over 100 miles (some time spent lost) just for one client.

    Per visits folks, if they won't pay mileage, request a certain mileage radius, like 15 miles -that will cut down on gas. Also, pack supplies for several days and store in your car to cut down on trips to office.

    I am beginning to believe from reading these boards that nurses are last on the totem pole of respect in the healthcare field yet they are the driving force that holds it all together and makes it possible for the "suits" to stay in their offices.
  13. by   payday
    P.S. ask the billing person how much they are reimbursed for a MEDICARE visit, it may shock you!
  14. by   Traveler
    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.

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