With five years of home care experience, I can tell you how these things work in the agencies in which I have worked and in my state (GA). Of course, these general guidelines are effected often by complications and unexpected changes!
1. First of all, you don't work by appointments. You will create a lot of difficulties for yourself if you do this. Our general rule of thumb is to, through the use of strong organizational skills, organize your day first by a.m. and p.m. visits. These are the visits that are generally going to have to be performed within a pretty tight time frame (your a.m./p.m. insulins, infusions, dressing changes if they're BID). Secondly, when you make your calls to your patients that morning, you can say, "I expect to be there before lunch (or after lunch), is that okay?" These patients are usually homebound and aren't expecting to go anywhere-but sometimes you get difficult ones anyway. That gives you some cushion for you to run early/late. The agency expects you to be pretty independent in planning your day.
2. Directions: If it is an established patient but you're a nurse that hasn't seen them yet--we have direction sheets on the chart or in the handheld computer. If it is a patient that is new, the referral comes with a home phone number. You call and ask directions to the home. A map is useful to have, though, because some of the patients will say, "You take a left at the Old Crossroads Church, they tore that down about ten years ago, you know where that is? Well, then, you take a left by a real big old oak tree-you can't miss it." -- Don't laugh, it really happens! A cell phone
is also useful if you can't find the house after all, so you can call the patient back. I must also mention that you need to be efficient in planning your day according to where the patients live-a map can help if you don't know so you can kind of look according to their address. That way you won't be retracing your steps.
3. Usual visit times are 30 min-1 hr, though there have been many times I go over that. Post-hospitals 1 - 1 1/2 hrs and admissions (RNs only) 1-2 hours. Short/long and early/late: don't make appointments as stated earlier.
4. If you are running early/later than you told patient, yes, you do call the patient and let them know. This should not happen often though, and once you get the hang of it, will be easier than it appears.
5. You should have an office nurse that you can call to back you up/get an opinion from in case you need help, which I have at times. The agencies I have worked at have been very good to send a nurse out with you if it is a new procedure for you and check you off - show you how to do it and get you to return demonstrate. I have been in situations, though, where I have asked for help and the nurse would say, "You know how to do that, it's easy." And I would just have to be firm and say, "No, I have never performed this procedure before and need to be checked off on it first." Your nursing supervisor is held liable for the assignments she/he makes.
6. I have never been fired over this. There is an "Assignment Despite Objection" form available from the ANA listing that you can object to the assignment (not refuse)because you are not trained or experienced in area assigned and the safety of the patient is threatened. That way you've CYA in that you have done everything in your power to be properly trained in the assignment before attempting to perform it.
7. You have orders (a POC or 485) and added orders that you take with you. In some agencies, that packet has already been put together for me, along with the directions to the home. Also, an assignment is given to you (ie a.m. insulin, teach wound care, etc.) Also, sometimes you have a note that you need certain supplies before you make the visit. Other times, you get out there and the right supplies aren't out there. You get a standard trunk supply in case of this. Sometimes, you get caught out there without the right supplies in the home or in your trunk. Then, you would just have to call the MD and ask for an order to substitute or either drive back to the office. It is smart to communicate with the previous nurses who have seen the patient (or case mgr who probably knows the pt well) and review the chart for their history. If you are a floater/PRN you get a list of assigned patients and what to do that visit, along with the patient packet. If you are a case manager, you have a lot of control over what patient you want to see on what day and if you have more than you want, which patient you want to give away to the PRN nurses. Patient frequencies may be Q month, 3 X week, every day, BID, and everything in between. A lot different than hospital work.
8. More about scheduling: The agencies I have worked for allow for 5 8-hour days or 4 10-hour days. If you're paid per visit you may work a little under or a little over that and the pay will be the same. It all balances out, though. You are allowed to work out your hours as you wish. I know nurses that start at 6 am and end at 2 pm and those that start at 10 am and end at 6 pm--as long as the patients do not mind. We generally can't expect the patients to be seen before 8 am or after 5 pm if they don't want to (excluding IVs at odd hours). The schedule you typed in looks more like a PRN nurse's schedule, which I have worked a lot. It works out great with children if you only want to work certain days and you get a higher rate too!
9. No, especially if you are PRN. It may be possible as P/T or F/T depending on the agency; you would just have to ask. Usually there is such a high need for nurses in this area that they will use you whenever they can get you!
Hope this helps!