Hoolahan I need advice

  1. Hey there Hoolahan, since you are a pro at this home health stuff I thought I would ask you for your opinion on something.
    My background is ICU, it is all I have ever done. I still work critical care but I just signed up per diem with a HH agency (I like the hours and the fact that it's something different. I also like teaching patients and I don't get to do much of that with my pts).
    Anyhoo, I am getting the feeling that maybe I am being taken advantage of because I am clueless when it comes to HH. I live in Central FL. This agency is paying me $24 per visit for a basic visit, more for IV visits and more for admissions. Plus mileage. I thought I would get at least $30 for a regular visit based on what I have heard from other nurses. Was I given incorrect info? I am just getting the sinking feeling that I am going to be sent to Timbuktu all the time and have mountains of paperwork for piddly pay. Do per diem nurses make more than full-time ones, like in the hospitals? I am making $32 an hour at the hospital now, and even though I don't like the 12 hour shifts, I may have no choice but to pick up more shifts there instead of HH.
    Tomorrow I am going into the field with another nurse so she can "show me the ropes." I saw all the paperwork today and needless to say I was overwhelmed!!!

    Help me Hoolahan (or anyone else who has some advice, especially if you work in FL). Am I just being paranoid?

    Thanks a million :kiss
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  2. 10 Comments

  3. by   CseMgr1
    The pay that you state is about PAR for a routine visit. You could easily knock out a couple of visits in an hour (if your patients live close to each other)...that would equal $48.00 hr

    I worked in home health for 18 years and LOVED per diem pay. I'd take per diem over salaried ANY day. At LEAST you get paid for working

    Good luck!
  4. by   rmprn
    If the visits really go by that quickly then that will be great! We are doing 6 visits tomorrow so I will see how fast we get thru them (of course it will be longer since she has me with her).
    Someone told me that since I am an ICU nurse I will be too meticulous and take too long on the paperwork, and that I won't like HH because it is so "dirty". Wasn't that mean? Or do you think it's true? I don't think that person had ever taken care of a comatose vented patient with C-Diff and copious oral/et secretions! That's pretty dirty to me!
    Anyhow, thanks for the reassurance. I will see how it goes tomorrow.

  5. by   hoolahan
    rmprn,

    I am flattered you think me an expert! I am just a frequent poster here Everyone who posts here gives good advice, trust me!!

    I am/was? a seasoned ICU nurse before doing HH, so I can tell you firsthand that theory is bull...oney! ICU is far dirtier and much harder physical labor than you will ever do in home health!!! OK roaches for me are a serious issue, but I don't have to deal w it every dayI work.

    As for the money, Florida is notorius for lousy pay for HH nurses! I have heard this from many people. Considering what I have heard $24 is not too bad for Florida for a revisit rate. And if your territory is not too far spread, you may be able to get your actual visits done 5-6 visits in 6 hours, and then the rest of the time for paperwork.

    Speaking of the paperwork, it is no worse than the ICU, what with neuro check lists, restraint checklists, code cart checklists, etc.. OK, it's more, and it is rough in the begining. But, it is doable.

    The KEY, IMHO, to getting the paperwork down is that you have to understand 2 things. One, the process of the paperwork in your agency. In other words, where does the form go after you are done with it, and what is that person needing to be on the form. If you do not do the paperwork right the first time, you will be harrassed to no end, and it will make you crazy. Two, you need to learn the insurances. Not each and every HMO per say but you must know what Medicare covers, what Medicaid covers, and what is different about HMO's. Medicare is the real stickler. But, if you understand what criteria are needed for Medicare reimbursement, and you are sure to address it in your documentation, then you won't have a problem. But it takes time to learn.

    In my opinion, critical care nurses make the best HH nurses, because you are used to having to make snap decisions under difficult circumstances. You know how to prioritize. So, when you are at a pt home on the weekend, and they used to take Lasix 40 OD prior to admission, and they were d/c home w no lasix on d/c instructions, and you see they have edema and have crackles, and the doc does not answer the pages, you can feel pretty comfortable telling them to continue the lasix until they can reach the doc on Moday am and instruct them in s&s of CHF and when to call 911. This is not as easy for everyone to do as you would think, but this is the kind of decision making you are used to and you will be fine!! One of my supervisors said I practice "Nursing on the edge." I like that.

    You also mention you get mileage reimbursement, even with per visit rates? That's pretty generous, many agencies who pay per visit don't reimburse for mileage. Will you be case managing? If so, negotiate for an hourly salary, otherwise, that time spent on calls and coordinating things will be on the house, and that is being used as far as I am concerned.

    Good luck to you!!!
  6. by   renerian
    I was getting 25 per visit in Ohio but my visits were sometimes two to three hours apart. Was not worth my while.

    renerian
  7. by   rmprn
    Today was my first day in the field with a preceptor. We did 7 visits but 2pts were in the same home. We left home at 8:30 and did not get home until 7:00 pm! That is almost as many hours as I would put in during a shift at the hospital, but for WAY less money! Granted, the work is not at all labor intensive like ICU and it was soo nice to be one on one. By the end of the day I was doing the assessments and the paperwork (the revisit flowsheet is not bad). Our last patient was really sick. She has a huge neck wound that we are doing dsg changes on. They are having her drink Boost because she can't eat. So on our way to the visit, the nurse precepting me tells me about the pt, and states that the Boost drink is going thru the fistula between somewhere in her espophagus/mouth and into the wound! She said it like it was no big deal! And I was like, wait a minute, we are packing this wound so it will heal and the packing is getting wet with BOOST????? Do you know how much sugar and other stuff that bacteria LOVES is in there???? I said, this lady needs a peg tube! How could they send her home like this? I guess since she is going for reconstructive surgery next week they figured they would just let her go like this??? I dunno. Anyway I guess I got my preceptor thinking and when we unpacked the wound, sure enough there was boost on it. Also the pt is feeling worse and her face is more swollen (HELLO!! Her facial tissue is getting saturated with a milkshake!). So she (the nurse) called the pts doctor. I think if I had not been so alarmed, that we would have just changed the dressing and left. So I felt good about that. I will find out tomorrow if they are going to eval her for a peg (and I told her to make SURE she does not forget to take her antibiotics!)
    I did go to one roach motel today and I thought I was gonna throw up. No air conditioning and the roaches were practically coming up to say hello! Couldn't get out of there fast enough!!
    Our agency does medicare and private insurance, and a combo of the two. No medicaid. Not yet anyway.

    Anyway I am still debating whether or not I will keep the job, mostly for financial reasons. I think I may have to do less HH than I wanted to originally and more ICU, but maybe I will do at least one day a week for the experience. I will not be doing any case management because I won't be working enough for them to be responsible for that. I am going out again with the same RN tomorrow.
    I have another question. This RN does not do IVs, but I am willing to (and they pay more). She says you teach the family how to admin the IV medication. Is that true? Even with central IV access? I would think a nurse would have to do that stuff. I mean, you can kill someone with air thru a central line. I don't think I would be comfy having family do it, but maybe that's how it's done. Just wondering.

    Thanks for all the advice!
  8. by   renerian
    We taught patients all the time to do central line infusions. You just teach them about the air issues. Unfortunately alot of insurance companies do not care about that, they give you so many visits and you work with what you have. That boost thing is sad.

    I left home health after 11 years due to many hours and low reimubursement only because my clients were so far apart I just could not make money. Sometimes I could only see 3 or 4 people in a day and would make 75 to 100 per day for working 8 to 9 hours. We were not paid for drive time, office time or anything. NOt worth my while anymore.

    renerian
  9. by   rmprn
    about the making no money. I figured it up yesterday, and the nurse I followed made $16 an hour for yesterday, plus mileage which will really only cover her gas. That is half of what I make in the hospital setting. Yes the work is different and yes I can see how rewarding it is, but the bottom line is that I have a family to feed and bills to pay. So I don't think I am going to keep this job. I will talk to the supervisor today. I am dissapointed because I really do enjoy the work.
  10. by   renerian
    I made between 8 to 10 dollars per hour most days. Our problem where I worked was our service area was nine counties. None of the nurses had geographic areas so we were all over the place. The managment would not consider areas. Not many nurses stay there for that reason. I don't blame you. It is sad as home health is so neat, you just have to do it right.

    renerian
  11. by   hoolahan
    That is a shame rmprn. Too bad it didn't work out for you. At my agency, I am making very good money right now.

    Maybe you could try a different agency?? With better pay? That is a ridiculously long day, even if she was precepting you. Now if they were smart, they would have only given you both 4 visits, so you could have taken your time, and maybe you wouldn't have been so discouraged right from the get go.

    That is unbelieveable about the boost. Sheesh. Thank God you were in the right place at the right time for that patient!!
  12. by   renerian
    Hoolahan where are you practicing? Anywhere in Ohio?

    renerian

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