New Home Health Nurse with Questions

  1. 0
    Hello everyone,

    New to this website. Fairly new RN, and Fairly new to HH. I actually graudated from Nursing school a year ago. Began working as a RN until August after I took a much needed break. Started working in a horrible oncology/medsurge/offsite telemetry unit with awful staff. I must admit learned alot considering I was solo as a brand new nurse. Only lasted till October, when I got a job offer from a Home Health Agency and began working there first week of October. I LOVE HOME HEALTH!!! I did ever since i was in nursing school and did my orientation with a home health agency. I love the one on one I get with my patients. I really feel more involved with their care and more independent and feel like I could educate them alot more... Anyways, with that being said I love home health. Only thing Im having trouble with is with some of the conflicts im experiencing currently. I dont know if its the norm for Home Health and just the bad side of home health, or if Im literally just being jipped. Let me being with the pay. Currently im getting payed using the point system with Hourly wage. Got started off at $27.50 a hr and getting payed 150$ biweekly for gas, and 50$ a month extra for Cellphone coverage. I love my job, love my bosses, not sure if im getting my legged pulled though. My current point system works this way.

    SOC-2.5
    PH-2.5
    RECERT-2.0
    DC-1.5
    REG Visit-1.0

    That time includes driving time, documentation time, and visit time. I have to complete 37 points a week, 3 points are given to me already for our weekly case conference. So is that a norm?

    In addition on Recerts im incharge of completing Case Conference reports, physician orders, transfers, etc. IDK if that is considered norm for a field nurse.

    Next thing im having trouble with is, sometimes im being sent to do SOC and find that once I get there after driving 50-60 miles to a location they arent home bound, and I have to depart after I spend about 20 minutes assessing them and had spent about 30-45 minutes driving there. I dont get paid for the time devoted.

    Im driving about 600miles a week, having to complete a oil change monthly.

    I love my job, love what I do and I have become so devoted to my patients and trying to help them in all possible ways.

    I just want to take away that feeling that I feel I might be getting jipped or taken advantage of. As I said im a new nurse, the administrators know that, and they are so helpful and all, but just want to be sure things are fair.

    All input and suggestions are appreciated, thank you guys .
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  3. 8 Comments so far...

  4. 0
    Your hourly was is fair for a new nurse. But, here are a few problems that I see. Their productivity EXPECTATION points are high. Most agencies require 26-30. But your daily productivity points are higher too. For example, these are the points that I've worked with SOC-2.0, RECERT/RESUMP-1.5, REG Visit-1.0 AND D/C OASIS 1.0. So you may not be that far off. Secondly, before you leave to do a SOC, you should always call the patient and ask a lot of questions to determine homebound status. Sometimes they fool you but most of the time you can find out on the phone if they drive daily etc. If the agency makes a rule that you have to go out there anyway then you need some sort of reimbursement for it. It should be worth some points. Thirdly, the government standard for mileage reimbursement in my area is about .50 cents per mile. So you can tell if they are paying you enough by doing the math. Remember, mileage to your first patients home (of the day) and from your last patients home (of the day) to your home does not count. If you really like the job, and you think you are doing a good job, then try to negotiate with them. If they are not willing, then stay until you get more experience and then leave for an agency that pays better. Good Luck!
  5. 0
    Hello I am new to home health..In South FLorida..i am also a new nruse..and hospitals are very picky about hiring and they dont want new nurses..anyways..i am getting started and dont have much training by any of the Home HEalth agencies..does any one have some sample forms i can see for like SOC's and any other ..my email is anacerratoyoung@Hotmail.com greatly appreciate it any help or process flow you can provide..
    Ana
  6. 2
    Your agency should have all the forms you need for a SOC. If you are looking for a narrative for the clinical findings, its goes like this...

    PATIENT IS 78 Y/O FEMALE POST HOSPITALIZATION FOR EXAC OF COPD. INDEPENDENT PRIOR TO HOSPITAL PMH: COPD, CAD, HTN, ANEMIA, NIDDM. CURRENTLY, A&OX3, VITALS WNL. USES 2L/NC OXYGEN CONTINUOUSLY. DYSPNEA WITH MINIMAL EXERTION. LUNGS SOUNDS DIMINISHED BILAT. NEW NEBULIZER AND RX FOR ALBUTEROL. ADMITS TO STRESS BLADDER INCONTINENCE. POSITIVE BS X4. SHE HAS A 0.5 X 0.5 X 0.2 CM WOUND (SKIN TEAR) ON HER RIGHT ANTERIOR FOREARM. POSSIBLE TAPE BURN. WOUND BED IS BRIGHT PINK WITH NO DRAINAGE. BANDAID APPLIED. FBS 110 TODAY AND COMPLIANT WITH GLUCOMETER AND 1800 ADA DIET .EDEMA: 2+ PEDAL BILATERAL, LEFT INSTEP 28CM, RIGHT INSTEP 26CM. RATES PAIN 2/10 IN BACK DUE TO ARTHRITIS. UNSTEADY GAIT, USES WALKER. INDEPENDENT WITH ADL'S EXCEPT BATHING. LIVES WITH BROTHER WHO IS MAIN CAREGIVER. PLAN TO TEACH COPD DISEASE PROCESS AND MANAGEMENT; TEACH MEDICATIONS, SAFETY, NEBULIZER, HOW TO DECREASE EDEMA. MONITOR WOUND.

    Basically you need to write the story. What were they in the hospital for? Medical HX? and then go through this list. I usually chart by exception, meaning that if I didn't mention it, it does not pertain or is normal. I added normals to this example so you could see how its done. All of this assessment data is in the OASIS anyway but most agencies want you to write a narrative. I might have missed something but this is the basics. Hope it helps.

    orientation
    vitals
    lungs
    oxygen
    exertion level
    bladder/bowel
    wounds
    pain
    edema
    FBS if diabetic
    diet
    ambulation
    assistive devices
    ADLS
    support system/CG
    new meds (coumadin, insulin)
    any new or changed DME
    Atownshend and bevjohnson like this.
  7. 0
    What state are you in? I've been an LPN for one year at a LTC I am now doing home health and get paid 30/visit but I do not have guaranteed hours, it can be slow in the beginning but everyone tells me (other nurses) that it'll pick up. I think that pay is low for an RN, I'm in Illinois and at my company they pay the Rns forty a visit.
  8. 0
    Quote from aflack41
    What state are you in? I've been an LPN for one year at a LTC I am now doing home health and get paid 30/visit but I do not have guaranteed hours, it can be slow in the beginning but everyone tells me (other nurses) that it'll pick up. I think that pay is low for an RN, I'm in Illinois and at my company they pay the Rns forty a visit.
    Per visit pay is different than hourly pay. OP is being paid hourly.
  9. 0
    I know that's why I put that I get paid 30/visit. My company pays the RN's 45 a visit not forty like I said earlier.
  10. 0
    Here in Ohio, I am paid per visit : 60 for skilled open, 35 for non skilled, 25 HHA check, 30 for reg skilled visit, 45 for oasis and 50 for resumptions...42 cents per mile. I avg approximately 25-30 visits per week, I make my own schedule. For those who are paid per visit, what are your pay scales like... To the OP: That is a confusing pay scale! I would have a hard time following that!!
  11. 1
    Quote from paradiseboundRN
    Your agency should have all the forms you need for a SOC. If you are looking for a narrative for the clinical findings, its goes like this...

    PATIENT IS 78 Y/O FEMALE POST HOSPITALIZATION FOR EXAC OF COPD. INDEPENDENT PRIOR TO HOSPITAL PMH: COPD, CAD, HTN, ANEMIA, NIDDM. CURRENTLY, A&OX3, VITALS WNL. USES 2L/NC OXYGEN CONTINUOUSLY. DYSPNEA WITH MINIMAL EXERTION. LUNGS SOUNDS DIMINISHED BILAT. NEW NEBULIZER AND RX FOR ALBUTEROL. ADMITS TO STRESS BLADDER INCONTINENCE. POSITIVE BS X4. SHE HAS A 0.5 X 0.5 X 0.2 CM WOUND (SKIN TEAR) ON HER RIGHT ANTERIOR FOREARM. POSSIBLE TAPE BURN. WOUND BED IS BRIGHT PINK WITH NO DRAINAGE. BANDAID APPLIED. FBS 110 TODAY AND COMPLIANT WITH GLUCOMETER AND 1800 ADA DIET .EDEMA: 2+ PEDAL BILATERAL, LEFT INSTEP 28CM, RIGHT INSTEP 26CM. RATES PAIN 2/10 IN BACK DUE TO ARTHRITIS. UNSTEADY GAIT, USES WALKER. INDEPENDENT WITH ADL'S EXCEPT BATHING. LIVES WITH BROTHER WHO IS MAIN CAREGIVER. PLAN TO TEACH COPD DISEASE PROCESS AND MANAGEMENT; TEACH MEDICATIONS, SAFETY, NEBULIZER, HOW TO DECREASE EDEMA. MONITOR WOUND.

    Basically you need to write the story. What were they in the hospital for? Medical HX? and then go through this list. I usually chart by exception, meaning that if I didn't mention it, it does not pertain or is normal. I added normals to this example so you could see how its done. All of this assessment data is in the OASIS anyway but most agencies want you to write a narrative. I might have missed something but this is the basics. Hope it helps.

    orientation
    vitals
    lungs
    oxygen
    exertion level
    bladder/bowel
    wounds
    pain
    edema
    FBS if diabetic
    diet
    ambulation
    assistive devices
    ADLS
    support system/CG
    new meds (coumadin, insulin)
    any new or changed DME
    This is a perfect example of a narrative or nurse's note
    Tampa121 likes this.


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