Typical day for a Home Health nurse... - page 19

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like... Read More

  1. by   septvirgo03
    RyanSofie,

    thank you for your honesty re: HH. i've been in HH for less than a year and am utterly shocked at how "it never ends". To me, it's equivalent to working in the hospital, arriving on your unit every single day, taking care of 10-12 patients, on your feet for your entire 8 or 12 hours, no break; you're taking a bite of your food in between room-to-room (seeing patients)....go home (with your laptop in hand to document on all 10-12patients), and start all over the next day. No "light days".
    i didn't have a clue. I was told in my interview that my hours would be mon to fri, 8-430, one weekend a month...sweet, right?!!! when i was on orientation, i remember the day when my preceptor said, "Good job! now, go home and finish your documentation, synch, and let me know when u finish it, so that i can look over it" (via laptop). Cool, no problem! after all, it wasn't 430 yet, i was still on the clock; i did what he told me to do, 430pm, done....so i thought. He texted me (via my cell phone) around 9pm, "hey! i checked ur documenting. good job; here's a few changes i need u to make. let me know when you're finished"....Huh????? maybe i misread the text; maybe he meant "TOMORROW, make the changes....". Nope. He meant that night!......that was my first inkling in that most nurses are STILL working/documenting during the evening/night..Why? because 8 hours isn't enough to finish all the "required work" for 5-6patients. Per day. Every day.
    Where i work, majority of nurses have voiced the same concerns to managers, etc...but wonder if the concerns are falling on deaf ears. One of the issues that concerns me is 'what is considered productive?'...To the managers, clinical supervisors and HH directors, 'daily quota/productivity' is defined as seeing 5-6+ patients daily...anything less, or any non-patient time, is not a productive day.....So taking the time to call doctors, explaining to doctors what is going on in the home, taking time to order supplies, taking time to research answers for questions patients/families have, taking time for find some good teaching materials to give to the patients, taking time to fax info to the doctors and mobile lab company, the time it takes to drive between each patient, NEEDING an administrative/office day to do all of this "non-client work", is THAT NOT PART OF THE QUOTA/PRODUCTIVITY????? well if it's not work, then what is it? Play time?
    sorry for venting.....just a lil discouraged....thanks for reading.
  2. by   RyanSofie
    Sept/Virgo: HH is a 24/7 commitment without the compensation to reflect the amount of time consumed from your life. The companies know the time required and the managers,adminstration are appropriately compensated for putting the whip at the field staffs backs to complete the reams of documentation needed for billing purposes. I went to per diem status because I was literally overwhelmed at the 'productivity! requirements of seeing 5-6 patients daily or more if pts cancelled or refused that particular day. In addition to completing documentation which required hours more of (work @ at home). We do not get "administrative office day". We had a turnover of administration as a matter of fact and the "office was rearranged "to make it exceedling difficult for clinicians to work there at all. Charts are under lock n key...there is no desk space for clinicians...no pc to utilize etc. To staple papers together one must ask to get stapler from office manager. my home has therefore become free office space for the company. Complain away because I sincerely understand your frustration. May I add one positive to this? I enjoy my patients and their families. I feel I can make a positive impact in health care management for the patient through teaching. I enjoy getting in my car and traveling away from my city into the countryside here. Those families who so lovingingly care for their loved ones at home face so many challenges in the day to day of life. I know what we do is time consuming and poorly compensated financially for us but my compensation is when a family member takes the time from her busy day to bake me a loaf of homemade bread which she wraps warm from the oven to send with me. To see the parents of two very ill adult children sitting on their front porch waiting for me, lifts me from my fatigue in a way that is incomparable to any day in a hospital. I believe as nurses we give of ourselves beyond what most do in any profession but our rewards are also beyond what most recieve as well.
  3. by   septvirgo03
    RyanSofie, re: the rewards are greater than financial compensation, you are so very right. I had that experience today: woke up early to get started early, went to visit my first patient. He asked me who can he speak to regarding his home health care experience. I told him he would be receiving a survey to answer and write comments on his homecare/rate us nurses, and other disciplines, etc...He told me he can't wait to write a review for me because out of all the care he's received (pre-admission, pre-op, post-op and while in the hospital), no one has ever taken the time to explain things to him, like I have...it humbled me and gave me strength, and placed a smile on my face.....so now, let me get off of the Internet because it's 9pm and i have a slew of documenting to do....
  4. by   ConflictedRN
    Hi,
    You all sound very dedicated and I appreciate that. I have a dilema, I am currently working in a hospital for 10 years now in and work 3 12.5 no holidays no weekends no call. shift is 9:30 -10p takes 1.75 hours to commute in am 45 min at night. There is no shift after mine and sometimes have to wait for a pt to be placed appropriately in step down or critical care bed.
    Recently interviewed for a home care position. It is a full time salaried position. I have a second interview next week. I believe I was told I will be seeing 6 pts daily and every week to 10 days have an office day. There are a total of 6 full time RNs and then perdiem. I am not sure of pay yet but I will not even consider it if it is not close to what I am currently making. If it is a reasonable amount then I really not sure if I should make this jump. I definately want something closer to my home and I am told I would be working independently. What questions should I ask at this interview are there certain things that are deal breakers if so what are they. Thanks for all of your input. I read many of your days and have a better understanding of what hh nursing consists of
  5. by   RyanSofie
    Quote from ConflictedRN
    Hi,
    You all sound very dedicated and I appreciate that. I have a dilema, I am currently working in a hospital for 10 years now in and work 3 12.5 no holidays no weekends no call. shift is 9:30 -10p takes 1.75 hours to commute in am 45 min at night. There is no shift after mine and sometimes have to wait for a pt to be placed appropriately in step down or critical care bed.
    Recently interviewed for a home care position. It is a full time salaried position. I have a second interview next week. I believe I was told I will be seeing 6 pts daily and every week to 10 days have an office day. There are a total of 6 full time RNs and then perdiem. I am not sure of pay yet but I will not even consider it if it is not close to what I am currently making. If it is a reasonable amount then I really not sure if I should make this jump. I definately want something closer to my home and I am told I would be working independently. What questions should I ask at this interview are there certain things that are deal breakers if so what are they. Thanks for all of your input. I read many of your days and have a better understanding of what hh nursing consists of
    Ask if clinicians are allowed contact with physicians if orders are needed. Do physicians see patients if change of status occurs? Commuting/road warrior is the norm for home health. Expect alot of travel time and reams of paperwork unless company has computerized system. Are clinical supervisors involved in field visits ( or are they just administrative and hands off? How often are clinicians required to take on call rotation? How many patients are you expected to carry and does clinician also do case management with assigned patients.
  6. by   Nursecathy123ca
    Ask what are the TOTAL work hours involved in 'full time' position. 6 patients daily is a very full schedule. It is doable, but if there is a lot of paperwork/case management, it will very quickly become 45+ hours weekly. I love my home health patients, and the one-to-one patient care is great. But the paperwork is a huge burden. I am just hanging on until our company gets electronic charting. If that doesn't improve the workload, I will move on to something else.
  7. by   RyanSofie
    The "TOTAL" work hours are as long as it takes to complete visits, open cases,recert cases,discharge cases ( assessments) and make routine visits or prn visits. Then...complete Oasis, med sheets, careplan, orders,Braden scales,pain assessment forms forms and more forms...If patient cancels one day then squeeze him/her into the next or the next. Then there is driving time between patients, to labs, to office etc etc. Time for phone calls to Physical therapists,HHA,OT,Doctor blah blah blah...All for about 65,000/year base pay.Weekends,holidays etc included in hours to be worked. Piles of paperwork that never seem to end. Keeping track of 30 patients recerts, resumptions,discharges...lab dates. No overtime, straight salary...hours worked ENDLESS...Hospital nursing 8-12 hours, complete paperwork (notes on patients) admits ,discharges...labs, surgeries...etc etc..at designated hour punch out and go home. Nursing ahhhhhhhhhhh such an easy profession...anyone can do it. LOLOL
  8. by   yecart1
    i have been in hh for a little over 3 months. i am already burnt out. i haven't done laundry or dishes but maybe once during that time...my family has to do it because my 40 hour week is really 50-60 hours.

    i just put in my 2 week notice. i hate being a quitter. i worked in the hospital for 4 years in med/surg, acu, pacu, and ed. at least when you were done with your shift you could go home and relax. there is no relaxing or a day off in hc.

    in fact, i have a day off today and there are 3-4 charts that i should be working on. but seriously, i not only need a day without work. i'm physically ill! i'm torn between taking some time to myself, cleaning. hell, i don't even put my clothing away, i just pile it up. this is not a life i want.
    good luck and god bless all you home health nurses. you are a tough lot and very much appreciated. you put in way too much work.

    i do love my pts and coworkers. but can't do it anymore.
  9. by   Nursecathy123ca
    I understand completely. And you are NOT a quitter! You realize this is not the life you want, and you are getting out now before you invest more time, effort, and frustration in the field.
    When I started HH nursing, I was part time, so had plenty of time to learn paperwork. Things have changed, and I need a full time job. It is taking over my life. Hoping our agency will get electronic charting. I've heard that helps greatly. If not, I may start looking around at other fields.
    Medicare rules and regs are just too much...and they are getting worse.

    Good luck to you!
  10. by   Isabelle49
    Quote from Hellllllo Nurse
    Very interesting. I have never done HH.

    HH nursing has always been a mystery to me.Thanks for opening a window to your day.
    You might want to consider something other than Home Health.
  11. by   Isabelle49
    Daughter being treated very poorly by Home Health she works for. She was in office Case Manager for 4 months, then her manager left, same day management says they need her expertise in the field full time. First week in the field full time she has 3 patients to see, and she is not salaried, she is paid by visit. This does not include 2 hours to office and 2 hours home. Home Healtah stinks. Am a home health nurse, can't wait to get out of here.
  12. by   Nursecathy123ca
    Before ditching home health, look around at other agencies. Some pay a salary, or have a guaranteed minimum. And some agencies really value their nurses.
  13. by   smartnrse
    Which ones? I'm scared to swap because I don't know if one is better than the other?

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