Typical day for a HH nurse... - page 12

by hoolahan

182,213 Views | 254 Comments

Hi guys, I thought it would be nice to start an ongoing thread to just post/vent about your usual day. With a lot of entries, it can sort of serve to show nurses who are thinking about getting into HH what it is really like on... Read More


  1. 0
    Quote from danvet
    I am new to home health but have been a nurse for nearly 10 years and have worked in various settings where I am able to manage my time in the most efficient way.

    Since taking this new HH job, I am about 3.5 weeks out in the field and I am taking appx. 4 patients now. I actually started with this company about 4 weeks ago and have been taking patients on my own for about 1 1/2 weeks now. I am all over th place. 48 miles yesterday between three patients (was going to be 4 but one cancelled), and all in-town driving.

    I left out of the office at 0940 and did take a 1 hour lunch. I give up lunch all the time, but did take one yesterday but no breaks. All of my patients had issues such as: seen a week but didn't know anything about their care or meds, and my other patient was only taking a half dose of her prescribed coumadin so her pt/inr was pretty low. I made sure that the problem was taken care of but patient states that she didn't write things down properly.

    I returned to office at 1750. Any suggestions about how to better manage time and moreover, can you tell me exactly what my responosibility is in making sure everything is correct. These were all weekly summaries and nothing had been updated so I made sure that everything was complete. I am finding things that don't get updated, and I wonder if it's because the CM's aren't always seeing the patients. I just couldn't bring myself to leave something done half way or a patient to screw up her coumadin and get a dvt or worse yet PE.

    How do you all manage your time???? They say they give 6mos to 1 year to get this job down, I have been very thorough and wonder if I am doing too much? I just don't see that they expect me to be at the level of a HH nurse that's been with the agency for 2-15 years. I am new to home health altogether and love it, but they keep stressing time management so I want to get better ASAP because I love the job otherwise. Coordinator hung up on me yesterday and left bad taste in my mouth, received page demanding to know when I would be back to office. I sincerely see patients, don't go shopping or sleep in the car. HELP!!!!!!!!!!!!!!!!!!!! I need to get better!!

    Thanks!!!
    3.5 weeks out in the field and expecting you to have a "method" down for seeing clients seems rushy in my opinion. I say protect your clients and your license first. Being thorough in my mind is a good thing. One of the reasons I left the hospital is because I felt extremely rushed. I think as long as you are focusing on quality and documenting such, you have legs to stand on no matter what the supervisor does or says. If you are working for a agency certified by an authority such as JCAHO, they will appreciate what you are doing for the patient and your focus on quality. Maybe I'm wrong. One of the things that you can do the night before you see your patients is to set everything up and document what you can on the progress note if you're not already doing this. Doing this and having a mental picture of how I was going to attempt to perform the visit helped. Be curious to see what others have to write.
  2. 0
    Ok my week this week was from heck.Our little company just went big overnight and we did not have enough CNA's to do it all .I work in Non medical home health.So I have been doing care and my manger is doing care in the home as well
    Over 56 hours in overtime. On friday afternoon I was called by a hospice company and had 1 hr to set up 24hr care for a man who was dying. Then they called me on Sat to set up another.
    Then The phone never stopped ringing over the weekend I picked up 4 more Then 9 more today to start care in about a week.I am so behind on paperwork its unreal this week .Plus I did a 24 and two 12 hr shifts on top of all this. My boss has no clue since he has not worked in nursing at all.I was mad as heck and very stressed out I even told him I need more money and bigger gas allowence I was ready to quit! (I market and direct care.)
    I was dead serious about quiting.!
    Well it worked out $300.00 more for gas and a hefty raise .I guess sometimes it pays to go off on your boss.When there not listening.
  3. 0
    Well, this week isn't better by much. Today I was told I was a "dawdler" and picked up three additional patients in addition to my one scheduled. I arrive at 0800 and my assignment isn't ready and then have unassigned. My first patient looked like a classic dvt, but no way to tell at home. Had to make arrangements to get to MD. Saw two more patients and made up time. Had to get more gas, oh that hurt, but not too bad this time, and proceeded to my 4th pt. Bad situation there, I'll just say neglect issues and was dumped in my lap so had to send to ER but of course, MD line was busy. Work number for me just kept me on hold. I left office at 1025am and returned at 1645. I was told I should've returned at 1500 and that my preceptor wants all my timecards to review. My first line supervisor said that I should't be having overtime and that the load I had was totally doable. I feel like I'm going to be openly ridiculed for time management in the morning.

    Talk about eating their own young!!!! I'm a strong person with excellent clinical skills and good judgement. To subject me to ridicule over time management seems ridiculous but I am only human after all. And, now I will be case managing my preceptors patients while she is out for couple of weeks. I'm feeling dumped upon. I seem to get all the patients that something is wrong with. Is it because I"m being assigned patients that other nurses are looking to pawn off because they are a problem or can one nurse just have that much bad luck? I've never had anyone treat me so juvenile and unprofessionally and have never been made to feel so inadequate and disorganized in my life and just feel so truly disappointed. I really love the job itself, but these attitudes are turning my usually very positive "can do" self into something meek and insecure. I guess I'll head in with my resignation and also a request to transfer to another unit if the supervisor isn't responsive.

    You've given good feeback so far, but would love to hear how experienced H.H. nurses weigh in on this issue and past experiences.
  4. 0
    danvet,
    You need to give yourself time getting used to home health. It's certainly not an area that all nurses like, and other nurses couldn't imagine going back to a facility- I am one. As you have already expereinced, you never know what the day will bring. The days that you think will go smoothly turn into nightmares and vice versa. One of the nurses in my office does all of her paperwork in the home. The only paperwork I do in the home is recording vitals and anything else that is pertinent that I think I might forget. I jot down little notes to myself for documentation later. I am paid per visit and find that I am very distracted in the home to do much documentation. The same holds true for me in the office. I spend as little time in there as necessary. My family got used to me a long time ago spreading my paperwork out on the living room floor. I try to do it after they go to bed since I can concentrate better when the house is quiet.

    I don't work full time and my office and coverage area is 45mins away so, out of choice I take a pretty full load on the days I work. I am scheduled for two days a week but often work more. Last week I worked four days and this week I worked three. There is no way that I could do as many visits in a day as I do now if I worked five days a week.

    You also have to remember that every office is different. The last agency I worked for had a huge coverage area. My area now is smaller with less time between patients. It usually ranges from five minutes to thirty minutes.

    To give you an idea:
    Tuesday- 4 regular visits, one patient not at home, two recerts, an hour staff meeting and 58 miles (not counting my commute) Left my house at 6:30. At the office at 7:15 to get things ready. Made visits until 2:30. Home at 3:15. Did an hour of paperwork

    Wednesday- 2 admissions, 5 visits, 43 miles. Left house at 7am, got to office at 7:45. Made visits until 3pm. Home by 3:45. 43 miles (not counting commute) 3 hours of paperwork

    Thursday- 1 admission, 1 recert, 6 visits, 55 miles, will have about 2 hours of paperwork (I'm not turning it in until otmorrow afternoon) Left my house at 7:45. Saw first patient on the way in at 8:15. Left last patient's house at 2:15. Home by 3:15.

    You will find that the more "regular" patients you have, the visits will go more smoothly (most of the time). It is also less stressful since you know where you are going, which door to go to, etc.

    I have been doing hh about 4.5 years now.

    I hope this helps!

    Ann
  5. 0
    I, too, feel that I am a very organized, put together, and quick worker. I find myself working insane amounts of hours, and don't know what I'm doing wrong. I leave from my house each day to see patients around 8 am, 9 on some days. I often don't get home until 530 or 6, and I still have a couple hours of paperwork left over! This isn't all the time, but it definitely is that way when I have several opens for the week. The thing is, I get paid per visit, so no overtime, and no office time for me. When I mentioned how much time i have been spending on my work, my manager responded to me with questions like "Well, what time do you leave in the morning?" or "Do you know how many patients I had to see?" Since coming to this company a little over a year ago, I have seen FOUR new managers!!!!!!! We have an incredible nursing shortage here, and I am constantly expected to go over and beyond my full # of patients.

    To top it all off, for nurses day, all I got was some crappy ID badge necklace thing that I won't ever use! How cheap!

    I'm not usually so negative, but I just worked 9 staight days of 10-12 hours per day! I do love the work, but hate the office politics.

    Try to hang in there. You will get more organized as time goes on. Home health is truly a wonderful area in nursing...we just need to vent here and there!! State your feelings to your manager, and directly ask his/her advice on time management. It will show that you are trying to address the "problem" and are wanting to be a team player.

    sherri



    Quote from danvet
    Well, this week isn't better by much. Today I was told I was a "dawdler" and picked up three additional patients in addition to my one scheduled. I arrive at 0800 and my assignment isn't ready and then have unassigned. My first patient looked like a classic dvt, but no way to tell at home. Had to make arrangements to get to MD. Saw two more patients and made up time. Had to get more gas, oh that hurt, but not too bad this time, and proceeded to my 4th pt. Bad situation there, I'll just say neglect issues and was dumped in my lap so had to send to ER but of course, MD line was busy. Work number for me just kept me on hold. I left office at 1025am and returned at 1645. I was told I should've returned at 1500 and that my preceptor wants all my timecards to review. My first line supervisor said that I should't be having overtime and that the load I had was totally doable. I feel like I'm going to be openly ridiculed for time management in the morning.

    Talk about eating their own young!!!! I'm a strong person with excellent clinical skills and good judgement. To subject me to ridicule over time management seems ridiculous but I am only human after all. And, now I will be case managing my preceptors patients while she is out for couple of weeks. I'm feeling dumped upon. I seem to get all the patients that something is wrong with. Is it because I"m being assigned patients that other nurses are looking to pawn off because they are a problem or can one nurse just have that much bad luck? I've never had anyone treat me so juvenile and unprofessionally and have never been made to feel so inadequate and disorganized in my life and just feel so truly disappointed. I really love the job itself, but these attitudes are turning my usually very positive "can do" self into something meek and insecure. I guess I'll head in with my resignation and also a request to transfer to another unit if the supervisor isn't responsive.

    You've given good feeback so far, but would love to hear how experienced H.H. nurses weigh in on this issue and past experiences.
  6. 0
    I agree with the previous posters. I would ask for suggestions for time management. But, from what I'm hearing from you, I don't feel like the supervisor is being very supportive. Have you expressed to this person your concern about getting your practice up to snuff and that you want to be an asset to the company? If your supervisor still seems to be resistant to your desire to be good at what you do, I have to wonder about his/her motives. Did this person hire you? If not, maybe you can confide to the person who did and express that you have a desire to learn and grow with the company and you want to be given a chance to do so. Do this after you learn what it is your supervisor wants from you. What does anyone else think?
  7. 0
    :hi i'am new to home health and new to this forum i don't even know how to post a message with just replying to one i hope this works i'am desparate i just start my new job i have never done home health before i was really excited @ first but the DON that hired me quit the day i started this is a new company too i have no one to train me or help me out is there anybody out there that can help !!!!!!!! examples would be great i'am very nervous about this
    blu
    Quote from hoolahan
    Hi guys, I thought it would be nice to start an ongoing thread to just post/vent about your usual day. With a lot of entries, it can sort of serve to show nurses who are thinking about getting into HH what it is really like on the good days and the bad.

    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 I usually try to do.

    8:00am :6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

    First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec streroids), reveiwed her meds, VS stable, edema but no change. Off I go.

    Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is backordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re pls give pt Rx for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

    Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

    Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

    Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently she was on spirolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back thursday for labs. off I go

    Next, funniest LOL, she answers door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, , saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook, and was taking her meds correctly. Then she pulls out five Rx dated 1-21-03, two are new meds, but prn types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relived, she gives me a big hug. Off I go

    Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

    2:15pm. Back to my township, drop wee wee at quest labs, drop off Rx at the pharm, get to my house. Reheat leftover chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

    Worked on paperwork until 4:45, finshed time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

    Pretty routine kind of day today.

    Anyone else want to share??
  8. 0
    Blu- How are you doing? Is anyone orienting you to Home Health? There so many rules and regs that I cannot imagine working in HH with adequate orientation! Please post back soon!
    Donna
  9. 0
    Good for you!!! So, how is home health nursing working with your ankle? I have hip problems. I'm an ortho nurse, and am thinking about transferring to the Home Health department.

    Quote from Scavenger'sWife
    Great thread, Hoolihan.

    I have worked Med-Surg for 4 years and 1-1/2 years with Hospice.

    I just took a Home Health job and will start March 6. I will do some case-manager and some home visits. Altho I did home visits w Hospice, and had done a little cross-training w HH, this will be a real change for me. I am really looking forward to it. I have an ortho prob w my left ankle and really needed to get a job where I didn't pound the floors for 12-14 hours.

    We are going all computer and have lap-tops for our paperwork in the field. Do you have experience w this? I am fairly computer-competent and have no fears of it.

    The thing I have NO experience w is the insurance stuff. With my Med-surg backgraound, the nursing skills and documentation skills are what got me the job. How hard is it to grasp the insurance, OASIS, etc.???

    Any input will be welcomed.
  10. 0
    we are a small rural non-profit and do HH/HOS & HIP-dialed in and updated laptop -tiny thing,4x6x1-love it! about 7AM out the door @8A 10 mi. to first call at 8:15A- 2&1/2 hr. visit-infusion must access port,reconstitute med 5 + bottles,put in bag one bottle at a time,spike and hang bag and run over at least an hour,then add NS to flush the line-infusion costs $10,000-yes-ten thousand dollars/mo. ,line hold at least 20 ml.so I make sure pt. gets every drop. New shipment of supplies so I bag up into kits each weeks supplies,darling grandchild there too,pt. is hooked to pump so I help with
    grandchild as needed-just one of the perks-these people are our neighbors too,another perk.
    then 33 mi. drive to 3 hr. qoweek combined team meeting--as all groups of nursing do we have ours who play power games and c/o simply for something to do. Participating in productive pt. review time 1.5 hr.,
    reviewing schedule and call time 0.5 hr.
    listening to ********/whining and manipualtion 0.5 hr.
    watching manager with no backbone crumble 10 min.
    watching effective manager bring situation under control establish and reinforce boundaries and limits 20 min. We also have some outstanding RN's... takes all kinds..then
    45 mi. drive to HOS pt. draw H&H from port,set up med box,review pain control,BM's,and when they saw their minister last-he came over during the visit(the gold standard of HOS lol,prayer, pain and poop lol) and a proceedure to be done later in week,call in med refills to pharmacy,call MD office for narc script,they will take down the block to pharm in AM,meds will be mailed.,20 mi. drive to lab,drop off H&H,get another blank of lab req. and take upstairs to Care Managers office for copies and to touch base ie,can we help?how ya been? really great you got that newpaper article done on so and so before they died,family has it in a scrap book for grand&great grand kids- 17 mi.to home,export charts and be w/fam at home,no plans I'm on-call till 8:30A Thurs. this is a short-VERY short day visit wise due to meeting. This is a very rural area,big drive time,but I see great people and country. Mis. phone calls to MD's,Aide orientation,ph. calls from peers and office about pt. situations,problem solving etc... thru out day. I love it(except the whining and manipulation,real time wasters and distractions,but I guess thats why it's called work :-)
    Last edit by mebeafrn on Jul 12, '05


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