Visit quotas and safe care

Cattitude · Jun 13, 2007

I would never attempt to do that many visits in an 8 hr day. Our expected amount is 5, sometimes I do 6 and never , ever more than 7. 7 is actually unusual.

Average is 5-6.

sk8rmom · Jun 13, 2007

I'm about ready to go insane! I might be scheduled for 4 visits one day and 12 the next. Even that changes from day to day. If I plan to catch up on paperwork on a "slow" day (less than 7 visits). I am looking for a new job, but I have been doing that for three months and I don't want to jump from the frying pan to another frying pan.

Home Health Columnist / Guide · Jun 14, 2007

There is no maximum# visits per day as dependent on type of pateint care you are doing and service territory. At my last agency, could not believe that RN's visiting 6 pts in 3 hours while I was taking 8 hrs to see that many.

What I failed to realize is that they all had patients in only 2 zip codes--patients often lived on same or next block and could walk from house to house or at most drive 5 minutes between patients. Care provided was minor BP chek, med teach or simple wound care.

I however, covered 3 counties with average 30 min drive between patients drove 100-250 miles/day, got all IV infusion cases, trach/vent and complicated wound care as "homecare expert". Once agency stopped infusion program and accepting vents as I was only one with experience, my travel time dropped way down. Picked up office of aging program patients and could see 3-4 patients in same building in about 2 hours!

NAtional average for expected vists per day is 6patients in 8 hrs per stat I've seen. Those that work our 12hr WE program scheduled for 10 pts.

cookie102 · Jun 14, 2007

i do believe the "national standard" is 6 visits in 8 hrs....on some days i agree it is possible to do 7, but with driving, traffic, paperwork, 5-6 is doable...we had one nurse doing 12 visits/8hrs and come to find out she was only doing vitals, getting her note signed and on to the next one...needless to say she is no longer with us

JentheRN05, RN · Jul 8, 2007

I'm new to home health. Only been doing it through an agency for about 3 weeks. 1st week I followed a nurse, second week they through me to the wolves. Had up to 8 visits in a day already. They are well known for throwing SOC at you at the end of the day. I absolutely HATE SOC at the end of the day, and asked if they could stop it, unless it was before 2pm and if it was after 2pm, it needs to be on my route home, is that unreasonable?

I just can't believe they through me out there like they did (I only been a nurse for 2 years). I'm maxed out on driving. Gave me company card and gas card, and I've logged up to 8.5 driving hours in a day. ONLY Driving for those 8.5 hours. can you believe that? I drive minimum 250 miles/day. And they are expecting me to get all these visits done? AND throw SOC at me sometimes 3 in a day! HELP is this right?

Also - I'm working from 7am to 10pm most days. Actually arriving home around 7pm and taking 3 hours to finish up paperwork (most of it's usually complete) and get the next day ready. I've made a habit of scanning everything I do into the computer (under a locked file of course) so that I always have proof of what I do. I'm just frustrated and need to know if this is normal?

caliotter3 · Jul 9, 2007

It was evident that our last supervisor was very lax with her out of office activities. I got the impression that she spent a good deal of her day at her home. One of the clients got very perturbed that when she did a supervisory visit, she would just show up at the front door without even giving a courtesy call, much less arranging a good time/day to visit. I think she did this sort of thing in order to keep her real acitiviities hard to figure out. But, in general, I didn't care, as long as I was not bothered. I just don't like making any kind of excuse to a client about a coworker or the employer. It's awkward for me.

You are slowly being driven into the ground. You need to find some way to get back down to near what you should be doing. 7am to 10pm does not cut it. You are not the Director of Clinical Services, spending all that time on big projects or worrying about everything or straightening out crises. Are you salaried or by the hour? If you are by the hour, get paid for all your hours. If they give you a hard time then it is time to consider getting the pay that is owed you through the labor board and looking for another employer. Don't let these people put you into the hospital or continue to walk all over you. Good luck.

Quietstorm1234 · Jul 12, 2007

Jen-I think that is way too much esp for a new hire. We try to slowly phase our staff into their new role. We try to spread it out over 90 days, by week 5, the new person may still be seeing 3-4 pts but they get bored and try to see more but we don't want them to get too overwhelmed.

JentheRN05, RN · Jul 12, 2007

I thought so too, when I brought it up, a few times to different people and then finally my nursing supervisor, she said.

I think we need to have a sit down and talk about your job description and our expectations. I'm a little frustrated because I don't know what their expectations are, or if they were testing me or what. This week has been extremely light. Monday I had 8 visits (2 SOC, 1 DC, and supervisory, rest were reg visits). Tues, 1 visit. Wed 1 visit 1 supervisory. I offered to take a veni and the supervisor said, no, let someone else do it. So i'm worried I'm in the process of losing this job, and I really can't afford that. My husband disagrees and says all will be fine if I just keep my mouth shut during the meeting.

Also - how in the world are you supposed to turn in a schedule for the next week, when everything changes. Pt have doctor appointments, and you need the outcome of doctor visits which always appear to be on the same day as the schedule is due in.

I think I need to have a sit down and get this a little more understood on both our sides. I think they've been over doing it myself, however they seem to think it's fine. It may be fine for someone who has worked for an agency before, but it's not for me. I have only been a nurse for just over 2 years.

I love the job, desperately need the money, but I think I'm in over my head. But I do truly love it. I'm starting to get comfortable with it and now they ask me to come into the office for a meeting over my job descrip. *sigh* I don't know what to think.

Hubby tells me this is a good thing, I don't see how. *sigh* Meeting will be next week sometime. Any thoughts?

JentheRN05, RN · Jul 12, 2007

Some of my visits (just regular visits) can take as little as 15 minutes. I'm really good at being kind and compassionate, and at the same time getting things done and keeping on track. So I do a quick head to toe, ask a few specific questions related to their specific health issues, always ask about BM and urinary, and of course get vitals. Unless there's a dsg change or other stuff involved I am fairly quick. Am I doing anything wrong? I found a wonderful book that has alot of helpful tips in it for home care nurses called "Tops & Timesavers for Home Health nurses" by Paula Milone-Nuzzo. Been using some of those hints (just got the book a couple of days ago) in fact I had already incoporated some of the hints into practice to get in and out quicker and not miss anything.

Sorry for posting twice. I'm really just scared about losing my job. Please tell me your thoughts. I'll be at work today - I hope I can pick up more assignments.

caliotter3 · Jul 12, 2007

They should have had that talk with you concerning their expectations when they hired you. Think over how things have been going and be prepared for a little constructive criticism. If they were planning on heaping praise upon you, I think that would have been happening on a day to day basis. Also, in my home health jobs, anything anybody had to say to me was done on a day to day basis when I was in the office. Being called in for a specific meeting meant somebody was in trouble for something. I'm not saying this to discourage you, just giving you a slight warning about how it has always been everywhere I've worked. Your people could be more formal. If they come down on you too hard for the circumstances, then you need to do some serious consideration about this job. You are the one who has to cope with the job. In normal circumstances, it takes time to get used to home health. It takes time to get comfortable with the patients, their families, the paperwork. If you feel your office staff is too much the problem then maybe this agency is not for you. However, leaving may be contingent upon the availability of jobs in your area, so make sure you're giving it enough of a chance. Good luck. Hang in there.

tennesseeRN · Aug 1, 2007

Just a thought---and I feel your pain in busy-ness-Todays schedule consisted of 2 admissions, 3 patients and 1 recert, approx 100 miles, and that is a light day. Now I'm sitting down to do paperwork.

But in terms of quickness, medicare's standard for a regular billable visit is 30 minutes. Just poking my nose in here, but when you said "quick...15 minutes..." I just had to ask!:uhoh21:

Sounds like your agency has some unrealistic expectations concerning any new nurse (both new to home health and nursing in general). Don't let them get to frisky with you--good nursing jobs are easily found. Good luck