New to HH need advice

caliotter3 · Jan 24, 2009

You might find yourself doing better if you switched to shift work instead of doing intermittent visits. You complete your one nurse's note during your 8 or 12 hour shift and you are done. Rarely do you ever have to do anything outside of the time frame of your shift. So much easier.

RNRutRO · Jan 25, 2009

Mari96RN

You say you are new to HH. Have you thought about asking if you could possible ride with another nurse and "re-orient"? My first HH job, I had a very lazy office manager that seemed to take FOREVER to get my computer. But, it worked to my advantage. During that time, I got to ride with three of the nurses. Each had their strengths and weaknesses. I learned from each of them.

Also, how many visits are you doing in a day? If it's five "regular" visits (teaching, insulin, wound care) that is totally different than say two admits. When you say "re-visits" are you talking about regular visits? I was told that those should be at least thirty mins. That would also include your charting. Remeber, Medicare doesn't expect you to teach everything the first time around. So, say you have a new diabetic, you will "front load" those visits so you can go over the material more frequently at first. Then you can back off to once a week, or even every other week.

Believe me, I hear you about the paperwork. I hate OASIS forms. Luckily, they get easier and easier each time you do them. There's a website on here about them you might want to watch the video. It helps. Plus, I'm a black and white person, and patients don't always fall into those answers. Sometimes you have to go "grey" See if your agency has some info on them. Then you can read up on what are they asking.

I work PRN for two agencies. One is on computer, the other is on paper. The one on computer is so much easier than the one on paper because you can read everything from the other nurses, PT/OT, LVN's etc. Plus, you can also read the last OASIS answers. Although, I really don't like to do that. I like to make my judgement on the time of visit. But sometimes, it's nice to have another clinical person's note to review. Plus, it helps in answering did they once have wounds, are they getting better, what did they uses, etc.

It's tough getting use to the paperwork, finding houses the first time (GPS isn't always right), the Medicare rules, and the unknowns you find at each house. But, the more and more you see that patient, the more you learn about them and by the next cert, if you don't d/c them, you will fly by the OASIS questions.

This summer I found that I was spending a whole day of my weekend doing charting. When I would go to my pt's homes, I would write myself notes about the visit. Then I would come home and do my offical note, or computer work. I no longer do that. I do as much of that note in the patient's home as possible. Weekends are for me and my family and I find that I am not as crabby about work when I do that too. Sometimes, I will sit in my car and finish up my note before the next.

I know this sounds crazy to people too. But, I try to take a real lunch break during the day. Go somewhere quiet and eat. Sometimes I chart, sometimes I meet a friend. It helps me to not get over stressed.

Are you on a salary? Do you get paid by the visit? Are you trying to do too many visits? I know that some places want you to work so many "units", Maybe they are set too high for you? I interviewed at one place that wanted me to do 35 units a week. That would have been way too much for me in the Houston area.

Well, I've written a book on you question, and could go on and on. Stick with it. HH is a great job. It really does get easier and easier.

jnette, ASN, EMT-I · Jan 25, 2009

I too, would complete my visit notes in the home, as the patient is still chatting with you...either that, or in the car after leaving the home. Do as much "on the road" as you can, to free up your home time.

My agency requires us to only complete the OASIS on SOC and Recertification (follow up). We don't do case management, so we don't have to do all the other time consuming stuff, like writing care plans, etc. That is all done by the office nursing staff. We deliver our labs to the office as well.

We spend about half hour in the patient's home for the average visit. SOC's anwhere from 1-2 hours, depending on what is going on with the patient, and Recerts (follow ups) about 1/2 hour to 45 minutes.

I would average 5-7 pts/day.. I'd be at my first home by 0800 and most often I would be home between 1-2 pm.

If you're not doing case management, you should be able to do this as well. As the previous poster said, don't try to teach everything.. space out your teaching so you will have a little something to teach each visit.

It does get easier, and in time, you will find your own routine. Hang in there... there's nothing like home health !!! Very liberating, and so appreciated by your patients. :up:

Mari96RN · Jan 25, 2009

Thanks for the reply. I'm only seeing 4 to 5 pts per day and almost always have a soc. I always have lots of questions since its so new. I do ask though. I know I can't be expected to do everything on the first visit but just what is expected. Just admitting them takes me at least 2 hrs. And yes, I do have anxiety about findng the home and what I will find once I get there, esp with soc. I don't case manage. We are salary no per visits. I do some charting in the home but mostly write notes and chart at home b/c its more comfortable and I spend too much time in the home as it is. I'm resenting it though so I'm going to try harder to chart in the home. We do our own care plans drop off to the labs. Jnette, I'd love to work where you work. I no longer have a preceptor, never really had one. Wish I had one person I could go to with all my questions. I ask whoever is available. How long before you felt comfortable with all of this? What is the priority with soc as far as care plan orders social work etc? thanks again.

jnette, ASN, EMT-I · Jan 26, 2009

Thanks for the reply. I'm only seeing 4 to 5 pts per day and almost always have a soc. I always have lots of questions since its so new. I do ask though. I know I can't be expected to do everything on the first visit but just what is expected. Just admitting them takes me at least 2 hrs. And yes, I do have anxiety about findng the home and what I will find once I get there, esp with soc. I don't case manage. We are salary no per visits. I do some charting in the home but mostly write notes and chart at home b/c its more comfortable and I spend too much time in the home as it is. I'm resenting it though so I'm going to try harder to chart in the home. We do our own care plans drop off to the labs. Jnette, I'd love to work where you work. I no longer have a preceptor, never really had one. Wish I had one person I could go to with all my questions. I ask whoever is available. How long before you felt comfortable with all of this? What is the priority with soc as far as care plan orders social work etc? thanks again.

You do things quite differently than we do... we jsut go in and do the OASIS with the patient.. and of course vital signs, etc. I make the OASIS as brief as possible for the patient.. they've been through enough already, especially if they've just come home from the hospital. I explain things to them, but don't go on and on. If there's wound care, then of course I do that as well.

As far as "orders".. we already have MD orders when we go out to do the admission/SOC. So we don't have to call for orders.. unless something is really amiss. We already know what we're there to do, and explain to the pt. just what their PCP has ordered for them in terms of care, PT, etc. I save their meds for last.. I always ask them to bring out any and everything they are currently taking, including OTCs, vitamins etc. I write them all down on our med sheet for that patient. Usually, I use this SC as a "bonding, trust forming" time. Our patients are always very receptive and appreciative. I do ask if they have any financial or medical supply needs, and if they do, I bring this to the attention of our MSW. If they have PT ordered, our DON calls PT and makes the referral.. we don't have to fool with any of that. and as for labs, we jsut take them to the office, we have to have them there by noon, when one of the office staff takes all the labs up to the hospital or wherever they are suppose to go. She does a daily lab drop off for us.

And if we are pretty far out, she will meet us at a designated place, so we don't have to drive all the way back to the office to deliver labs.

Our POCs are done at the agency after the OASIS has been coded.. they cover all the basics that are done for every patient, and then individualized for their particular frequencies, care, labs due, PT, HHA, etc. The road nurse doesn't have to do anything with preparing a POC at all.

Actually, this what I do.. I went from road nurse to office nurse a year ago, and am in charge of doing all the POCs.. typing them up and getting them ready to send out to the MDs. I still go to pts homes every now and then, when a nurse call is sick, or we are swamped, and I'll volunteer to help out on weekends from time to time sa well, if the call nurses are swamped. That way I still get to do some hands on, and interact with our patients.. I do miss that sometimes. :)

I'm in a very rural area, and have never really had much trouble finding a home. I always call ahead of time and get directions, then pull up mapquest if I have any questions.

if the patient doesn't have an Adavance Directive but wants to complete one, our MSW goes out to assist them with that. Anything I think the pt might need in the Social Services aspect, I bring to the MSW's attention when I turn in my OASIS. As far as IVs, TPNs, Tube feedings, etc... all that has already been taken care of either by the PCP's office or from our office.. when we go to the home, the pharmacy has already delivered what the pt will be needing, so that's one more thing we don't have to concern ourselves with.

I do like the way we do things.. it sounds like you are pretty much responsible for everything.. more like case management. I wouldn't like that.

I hope I've been able to answer some of your questions.. if you're still not quite comfortable, ask your agency to allow you a little more time to learn the ropes.. especially the SOCs. Ask for another nurse to go with you, and watch and listen. How long were you oriented?

They sent me with other nurses for three weeks, then slowly worked me in.. 2 patients/day the first several days, then 3/wk, then 4, etc. It was a good month before I was asked to do an admission.

And we ALWAYS have the option to call our nursing supervisor at the office with ANY doubts questions, and concerns... any time.

If you're concerned about anything, always call your office for advice, direction !

I sincerely hope you soon feel more comfortable... HH is truly the best. But so much also depends on your agency, and how they are willing to work with you.. what support they offer, etc.

Keep us posted, and wish you the best !!! :icon_hug: