So overwhelmed..any advice?

Well, I also feel overwhelmed, I work for an agency that was mentioned. And I DO see 10 or more in a day. And I travel 100 miles. I work the week-ends and 1 day during the week. When I get home, i am so tired, I usually do my charting at 5:00 in the am on my day off because it has to be in by 9:00 am, and then there are the QCC calls on my supposed day off. I feel like I never have a "day off". I have only been working here for 15 months, but sometimes it feels like only a few months due to the learning incidents that happen. For instance, this week-end I am sent to admit a patient, well, it seems she can't get out of bed, and is left alone from 7:10 until 4:00 pm. When I call the cm to report, she tells me, "that is an unsafe environment, we shouldn't have admitted her", to which I said, "Well, I wish I had known that!" I told her it would be nice if we had a hand-out with situations in which we should not admit the patient. It was the week-end with no way to call anyone, however, I didn't know about the safety issue and the State law saying we can't see a patient in this situation. Well, enough raving! I am getting sooooo burned out, and SICK of working every week-end!

I am fairly new to Home Health nursing. I would like to know how others in the field get paid. For me, it is "per visit" no matter how much paperwork and phone time I spend outside of the patient's home. I am considered the "team leader" and "case manager" to coordinate and communicate with everybody else on the team. Is it just me, or do others feel as if they are earning minimum wage by the time all of this is accomplished? Does anybody ever get a differential for acuity???? And how much help is the office for other nurses, e.g. with sending faxes, following up on orders that have not been signed by doctors, correcting mistakes generated in the office such as incorrect patient addresses, obtaining written orders for orders a receptionist has taken per telephone, etc.?

Very interesting post, thank you! I just would like to know what these mean:

QCC
CM

Also: when you are called to admit a patient on the weekend, what type of prescreening process takes place? In my agency we have office staff to verify the physician order and eligibility with the patient's insurance company. We are not expected to stay with a patient from 7:10 am until 4:00 pm as that is not the purpose of home health nursing, we are there to perform a visit which can take anywhere from 1/2 hour to longer if it is an initial evaluation or a recert.

Concerning getting phone calls on your days off, you need not be obligated to answer your phone if you are off duty. That is what the on call nurse, on call doctor, and Emergency Room are for.

Eager to hear more from you!

I can tell you what goes through my mind when I think of looking for another job. The directors of the various home health agencies in my city all know one another and compare notes. I would not like my agency to know if I am inquiring about other positions and the working environment in those other agencies because I fear it will be held against me, all without my knowledge. But I would really like to work at a place where computers can be used for our charting and where I will be given a laptop to take into the field.

This reminds me of the time one of my DOCS told me that she knew my other DOCS. I picked up on the undertone in her statement quite easily.

Hello all, thanks for letting me rave. In answer to the question, how do we get paid, I get paid by the visit and this is another reason for my frustration, I may be in the home for 45 min and not have done any charting, and I have a laptop but this is time consuming and if the patient and family need teaching, I can't type and teach at the same time, sorry can't concentrate. So.....then I get home and chart on this patient and probably spend 20 more minutes charting, that's IF it's an uncomplicated case. An admission usually takes me an hour if uncomplicated, and then 1 hour doing the OASIS paperwork in the laptop, and then another 10 minutes or so filling out all forms to turn in at office, all for 65.00. And now, the patient's are coming home sicker and sicker. Saturday I admitted a patient with 2 wounds on wound vac system, another wound to sacrum and a picc line with bid iv antibiotics. That admit took me an hour and 10 minutes in the home + over hour doing all of oasis, 3-10 minute phone calls about when iv due and how long to run,wound care report, etc, and then filling out forms at office. Geesh, that one was soooo complicated. And to start off with, the hospital was originally supposed to send home friday night for me to admit at 7:00 am with IV antibiotic due and no one even left me a message to let me know? And then there was the write in patient with directions to the home but no soc date or telephone # to call. She was new, so there was no MR #, so.....I spent 20 minutes at office searching for info on this patient due to fact that we are told we must call first. Well, give me a number please!

In answer to the questions, QCC is the Quality Care Coordinator, I think, anyway these are the nurses who screen our oasis and do all the coding, they have to call us and discuss every Recert, Admit, and Post hospital oasis that we do. CM is the Clinical Manager. They don't work on the week-end when I have a question, and yes we have an on call nurse, she can answer some questions, but again, since I am so new, many times I didn't even realize there was a question about a problem, because I don't realize it's a problem, does that make sense? Our office has over 400 patients. Is that a lot? They make us do all the test runs for any new software, Point of Care, and now Frequency Based Scheduling, try doing new stuff AND seeing 10+ patients in a day, and driving over 60-80 miles in a day. I AM EXHAUSTED. Sorry this is soooo long but I have NO ONE to talk to and I am about to pull my hair out.

The posts above about visits are exactly why I do shift work. I am in the home for eight or 12 hours, do my nursing care, do my charting; then I leave. I don't do extra work at my home that I am not compensated for. Any necessary phone calls are made from the home while I am on shift. My pay pretty much reflects the in home shift time that I put into the case, that's all. I get all my work done while I am on the clock.

I agree, shift work is much better, but they didn't even offer me the choice. And down south, the home health care agencies are few, and with small towns, the DOO all seem to know each other here too. I am really beginning to dislike working as a nurse, I love nursing, just hate working for others. I don't feel like I am appreciated by the staff, and now, a lot of the families and patients are rude, thats not even taking into consideration for the nasty working conditions.

Based upon my present location, I would not do home health if I weren't given the option of shift work. I have already trashed one car because of home health, and refuse to put myself through what others describe so well. I have done uncompensated work before, and refuse to do it on a daily basis. I also will not drive from one address to another in the traffic and go to the neighborhoods that are around here. When there is no longer shift work for me, then I guess that is the end of it.