New nurse / new to HH / tons of questions

  1. Hi all, I just graduated and got my license. My first job is home health. My first week is over and I have found that I have a ton of questions if anyone doesn't mind taking the time to give me some input.

    1) Where do you normally get lab supplies? I have been told to get them from the hospital lab, but the lab tech doesn't seem to want to supply me. She did for the patient I have right now, but I am not sure that she will in the future. I don't want to take the cost out of own pocket, and the office isn't giving me any either.

    2) A doctor told my patient that I can take his staples out. I know how to use the staple remover, but, again, don't want to pay for one, especially since they are one-time use. I told him that I can't. Does this sort of thing happen a lot?

    3) How do most agencies pay? I get a flat rate for each visit and that is ALL - no car allowance, not even benefits. Is this normal in home health?

    I really like the work, and could't get a better job right out of school, but what do you guys think of this stuff?

    I will stop with just these for now. Thanks to anyone who is willing to help. Any other suggestions?

    Thank you!
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    About tinyRN72

    Joined: Jun '12; Posts: 25; Likes: 4


  3. by   darkbeauty
    Will you be shadowing an experienced RN for your first few visits, since you are a new grad?
    Do you have an on call RN at the office should you have any questions while at a patient's/client's home?
    Apart from clinical experience (at school), have you really taken out staples on your own?

    *just my 2cent piece* It'd be best if you were experienced and confident in your skillsand capabilities as a Registered nurse before getting into Home Care Nursing. But, if this was the only job that came by after graduation, I don't blame you for getting your foot in the door.
  4. by   paradiseboundRN
    Medicare pays the agency about $48 per patient for the cost of supplies. While a patient is under service, your agency is obligated to pay for all of their supplies. That includes any dressings, ostomy wafer and bags, catheters, suture and staple removers etc. The agency should also have basic supplies to be used by the nurses such as alcohol, band-aids, tape, thermometers, non-sterile dressings, cotton tip applicators, etc. Many agencies stock the basic stuff and drop ship supplies that are specific to a patient. If the patient doesn't have Medicare, they still need to pay for a staple remover and have a DME supply the other stuff. Lab supplies are usually supplied by the lab that you drop off your specimens on a regular basis. They are ordered in bulk. I'm not sure if there is a charge for them. Do not pay for any of these things out of your pocket!

    A flat rate per patient is pretty common but they should be paying you mileage. This should be close to .0.50 per mile. If they don't want to pay mileage than you should be getting a higher per visit rate. In Michigan, the average per visit is $50 for a revisit and $85 for a SOC.

    I recommend that all new home care nurses read this book cover to cover. It explains home care documentation, Medicare regulations, the OASIS and much more! I know I suggest this book a lot but I learned so much about home care after reading it. You can find it on Amazon or the authors web site.
    [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]The Handbook of Home Health Standards: Quality, Documentation and Reimbursement, author: Tina Marelli

    Welcome to Home care!
  5. by   erika.RN
    Uhh lab supplies, staple remover kits, everything should be supplied by your agency /hospital you work for. You are never required to pay for these things out of pocket. Also...don't just take a pt's word on things. Make sure you have a doctors order before you remove those staples.
  6. by   tinyRN72
    Thanks for the input. NO, I had NO training, shadowing of any kind. I did an interview and was seeing patients the next day. I do know how to take staples out. I have never done it without an instructor standing beside me, but I have done it.

    Honestly, I can't believe that I was sent out on my own so fast. I am shocked. I have not been asked to do anything that I am not comfortable with, and I can call the office and speak to an experienced RN any time, so that is good. I don't know why this MD told the pt that I can take the staples out. I have decided not to do it just because I don't want to spend my money on a disposable tool, and because they are abdominal, so I don't want to take any chance of dehiscence.

    I was actually offered another home care position at $15/hr, but decided to take the one with the most pay. I have applied for dozens of hospital jobs with no luck at all.

    Thanks for your response.
  7. by   tinyRN72
    OH, yes, Erika, I do at least know to get orders before doing anything --- but that might be about all I know.

    Thank you
  8. by   tinyRN72
    HI Paradise,

    Thanks. I sort of feel like I'm getting ripped off here now. I wasn't given ANYthing - not even one cotton ball or band-aide. It is very frustrating because I don't feel like I am getting any support, training or guidance. I really have enjoyed what I have been doing so far, but all of this is making me think that I am with the wrong agency. Problem is, I need experience before I can go to another one.

    thank you for the book suggestion, I'm going to get a copy ASAP.
  9. by   erika.RN
    This really just blows my mind. You don't take your own supplies to work with you at the why is this any different. They don't have a supply room of stuff? Dressings, lab supplies, tapes, bandages, etc.?? Have you asked? Sorry you're having such a rough time...home health is nerve wracking enough when you are out there by yourself, especially as a newbie.
  10. by   CrunchRN
    You need to tell them what supplies you need. If not provided than get the heck out of there.
  11. by   tinyRN72
    Here is an example. I was sent to 2 hip replacements on the same day. I was told that they would have supplies from the hospital. The patients told me that they were sent home with nothing. I called my boss. I was told that the patients left the supplies at the hospital and they should go pick them up. I called the floor that they came from to see if they could come get them, the charge nurse ripped me a new behind..... then I was told by my boss that I should order supplies. I found the form that I was given, but I had no list of available supplies and had no idea what this bandage is called. I did the best I could and faxed it over. It was then denied for both patients because the insurance company said they don't need the supplies.

    The MD ordered dressing changes x 5 days.
    PT came in the next day and told them both that they could shower. I called the the MD office and his nurse acted like I was completely stupid because they don't need bandages after showering.

    I was ready to quit that day. However, other than getting lab supplies, so far I haven't needed anything. The lab insists that they do not supply needles and my boss insists that they do.

    Hopefully I just wont need anymore until I can get the heck out of there... but I have to have income, so I can't just quit.

    Thanks to everyone who has responded.
  12. by   tinyRN72
    I have asked and I was told that everything I need would either be at the patient's house, I would order, or the lab would supply. Of course, though, I can't seem to get a supply list to order anything.

  13. by   84RN
    This is ridiculous. You've been given no training at all, sent out and expected to track down your own patient supplies on wild goose chases?

    I know jobs aren't easy to find right now, but if I were you, I'd leave this agency and find one that provides some mentoring. At the very least, you should be taught about OASIS, exactly how to get supplies the patients need, and be able to shadow an experienced nurse for a few weeks. Even that is not nearly enough, imho.
  14. by   tinyRN72
    I am actively looking for a new agency / internship / or just about any job.... and I am studying OASIS on my own - thanks to this site I found out that I really need to know it. It is ridiculous. I just keep thinking that if I can just stick it out for 6 months (if nothing else comes along) then I can change to a better agency. It is really a shame because I greatly enjoy the actual work. I didn't expect to go into HH, but I really like it a lot and I can see that I would love it if I were working for company that isn't such a joke.

    Thanks all --- at least I now know that it isn't just me who thinks this is crazy.