Words from home health nurses?

happymama · May 23, 2015

I love the one on one care I can give my patients but I am PRN with a hospital based home health facility. I get paid per patient which is horrible. I don't get paid for mileage or travel time so an 8 hour day I make about 10 an hour. per patient I make about 21. Another nurse I work with (LPN) is PRN as well but works full time hours as well with no benefits. Plus I have charting to do at home that I do not get paid for. Looking for another job but might have to stick it out because it is flexible while I am in school. Doing LPN to RN program.

TheCommuter, BSN, RN · May 24, 2015

Your thread has been moved to the Home Health Nursing forum with the ultimate goal of attracting more responses from other nurses who work in home health.

Mom2boysRN · May 24, 2015

On my typical day I start around 8 am at my first patient's home and I end by 2 seeing anywhere from 4-6 patients. I plan my day in advance so that my route makes sense. If I have fasting labs that patient will be first on my list, any other labs are done in the morning also. If I don't have labs I see my patients that don't mind an early time that are closest to my home first, work my way toward my farthest patient, then work my way back toward my home. I work for an agency that is large enough that my farthest patient is only about 15 miles from my home. I get paid per visit, no mileage generally because you only get mileage for the miles you drive over 50 miles for the day. I feel what I get paid is fair. When I get home I work on paperwork and generally I will be doing it after dinner too as when you have children there is no sitting and just doing paperwork uninterrupted as soon as you get home. On a normal smooth moving day I can drop off and pick up my children from school.

There are days when you get slowed down, sometimes a patient is showing s/s of uti and you have to take a u/a to the lab, something else is going on you call the doc and they ask for labs, or your patient just needs psychosocial support. I've had many days that I expected to be a short day because I only have 3 patients but it ends up being a 6-7 hour day in the field. Sometimes you aren't expecting to see a particular patient but family calls you and something is going on so you have to make a prn visit.

Your typical day will vary based on where you are and the type of area you cover. I live in a suburban area and cover the area I live in. If you cover a more rural area you will drive more miles and typically have a longer day due to that. It also varies based on home health agency. If they try to keep you to a certain area you will drive fewer miles, if they schedule everyone everywhere you will obviously drive much more. With smaller agencies you will drive more because there are going to be fewer nurses.

caliotter3 · May 24, 2015

There are many threads in the home health and "private duty" forums that cover this question.

annabanana2 · May 28, 2015

I work out of an office, so my day is 8:30 to 4:30 every day no matter how many patients I have to see. I also do my charting and re-supplying and stuff there too. Usually I arrive around 8:15 to settle in, organize my belongings, change my clothes (we go into a lot of bug-infested buildings so I always do a full change before and after work). At 8:30 we have a quick huddle to go over the assignment and make any changes that are necessary ("I can't see patient x because he needs to be seen at 9:30 and I have to see patient y by 9:45," that kind of thing). Then we all go out and do our visits. Our area is very, very urban and densely-populated so I can actually walk to and from all of my visits. I see lots of wound care, chronic disease management, med management, and a ton of home hospice/palliative care. Sometimes I can finish all of my visits before I need to eat lunch, but not always. I see usually between 4 and 7 people a day (7 is a very, very busy day and very stressful). Then I come back and get all my charting done. If we have meetings they're usually at 3:00-4:00 and then go home at 4:30, hopefully!

JustMeRN · May 29, 2015

I work per diem and get paid hourly,mouth milage reimbursement. I set my hours, and typically give the agency an 8-2 block twice a week. I get my assignment the night before. If I have and admit scheduled I might spend a half hour or so reviewing referrals, otherwise I don't download my assignment until morning.

Some days I have to start in the office, if I need supplies or have a meeting. Most days I start from home. I try to be on the move by 830, having reviewed all my charts, mapped out my day, and called everyone to tell them when to expect me. Since I work per diem I fill in where needed and territory can be pretty large. We have some far out clients whom I will drive 45minutes to an hour each way to see. On those days the number of patients I see is 2-3. If I'm close to home I can see up to 6. For us an admit counts as 2 visits. I'm home by 2 to get my kids off the bus. If I have had an admit I'm looking at another 2 hours of paperwork, if it's been an average done and I have charted on the go I might spend another half hour to an hour charting before I'm done.

I am am paid hourly, and it is expected that I will log my time for every minute I have spent working. This includes my pre and post care, driving time, charting time, time spent making calls or sending emails to coordinate care.

The down side to per diem is I am not gaurenteed visits. When census is low I might be done my day by 11, one day last week they didn't have any visits for me. It's ok for me since my paycheck is not depended on to pay the bills. It would be a problem if I needed that income to live. Full time nurses at the agency case manage, which generally means their days a little more difficult than mine, and over time is a fact of life.