Working 12-14 hour days, am burning out.......

Specialties Home Health

Published

I am an RN who went from acute care to HHC in Jan '11 after moving from Tulsa to Phoenix. I needed something less physical after being fused from C2-C6 in 2008. I had no experience so I took what I could get after applying a few places. I had no idea this company was in such a shamble. I was offered 60,000/year, no mileage but 300.00/month for car allowance???, and 10 PTO days a month. I also have insurance.

In the beginning, I took call at 2.50/hour every Monday-Thursday but now I take call for 10.00/night for the same days because they hired a answering service to route the calls. I should have known this job was going to be crazy when my interview lasted 6 minutes! My training included a ride-a-long with an RN to do one SOC. Yep, that's it. The "DON" hated "teaching" anything and basically answered my questions with "...because that's the way it's done". When I say I was on my own after the one visit, I am not kidding. We have been without a DON for 3 months! The company gets away with this by "using the DON" in their other HHC in another city 2 hours away. The new DON is now training at the other facility; I was so excited to learn that finally we would have resources, at least a nurse in the office to help facilitate orders and assist with questions. Well, I am devasted at this point. The new "DON" has absolutely no HH experience and no OASIS experience. He will be at our office 3 days a week but the rest of the time he will be at the other office 2 hours away. How is this supposed to help me? I have absolutely everything on my own and have put in more hours per week that I can admit. I am more comfortable with OASIS but my fear is that, everything I have learned is crap. JCAHO made their second visit in June after their first visit almost shut the company down. Our auditor was a retired person who was get ready to go on vacation and pretty much flew us through-really??? She did say that my charting was "impeccable" :). Our total staff is 2 full-time RN's, a few PRN nurses, one receptionist, one other person who takes calls, audits charts (she's not a nurse), does pay role, talks with the "corporate" office", and some of the accts payable stuff. Our "marketer", the guy who talked his way into becoming Director of our branch, and then resigned after not being able to deliver on his mission, brings nothing other than a few "dumps". My travel is huge. I can drive up to 3 hours a day and my stuff is scattered everywhere because we "take what we can get". There is not even a nurse in the office to answer questions or send an order for us.

I am so burned out. I am a very good nurse. I have good clinical skills, have great repore with my patients, and am professional. I have learned absolutely everything on my own through many, many, many hours. They actually hired an DON who stayed 5 weeks. This girl knew her stuff and had rescued companies facing really bad things with compliance/OASIS/everything. She knew her stuff the right way but after 5 weeks she couldn't take it anymore and went somewhere where she could actually do what she was hired to do. I am the "primary nurse". I do and do an do. How can I case manage clients I am not familiar with? I work Mon-Fri, the other nurse works Thurs-Monday. There is no continuity in my schedule. Case conferences are a joke. The PT, OT, SW never comes, I don't get report, I don't know what their frequencies are unless I call them and the office mgr says "I can't make them come to the meetings". I am expected to see 5 patients per day but many times I will have 4 or 5 visits and a SOC completely in opposite directions because they don't have enough patients.

When I hear nurses talk about their flexabillity, I'm like "really"? I can't even make and keep a doctor's appointment for myself because I'm all over the place. I did get a 5% wage increase a few months back but I'm pretty sure it's just because they were freaking out that I was wanting to leave. I have asked to go to 32 hours a week because I just can't keep up with the paperwork. I have yet to get that request. I have absolutely no life. On the weekends, I am stressed because I need to do paperwork and my family wants me to spend time with them. I am so passed tired, I'm totally exhausted. I have stayed here because literally I can't schedule interviews because I never know where I am going to be. This weekend I am updating my resume and will definitely make the interviews, so I have a few questions:

1. Do most HHC use paper or computer charting?

2. Is everyone required to attend Case Conferences?

3. What's your distant requirements?

4. Are SOC's the same form, no matter which company you work for?

5. How much training should I expect to receive?

6. Should there be an RN in the office to facilitate orders and assist the RN's in the field. If so, what does a nurse

in the office do to help the nurses in the field?

7. Are you required to keep up with what supplies need to be ordered?

8. How does your DON help you?

9. How many people do you see in a day? (Our starts count as 2 visits)

10. How long do you have to complete paperwork?

11. Does a nurse check your charting or just someone in the office?

Please feel free to comment so I can figure out if this pretty much the norm, if HHC is just hard overall. Also, answering any of the questions will give me an idea of what I can expect from other places.

Up Vote Up Vote ×

I think that you have formulated good questions but you will have to go with trial and error if you can't find any personnel who can clue you in to other agencies. The disaster state that you have described is not to be considered to be par for the course. Hopefully any new job will be an improvement, just by chance. Hope you can get out of there soon and find something more organized and smooth running.

Up Vote Up Vote ×
Specializes in Home Health.

1. Do most HHC use paper or computer charting?

2. Is everyone required to attend Case Conferences?

3. What's your distant requirements?

4. Are SOC's the same form, no matter which company you work for?

5. How much training should I expect to receive?

6. Should there be an RN in the office to facilitate orders and assist the RN's in the field. If so, what does a nurse

in the office do to help the nurses in the field?

7. Are you required to keep up with what supplies need to be ordered?

8. How does your DON help you?

9. How many people do you see in a day? (Our starts count as 2 visits)

10. How long do you have to complete paperwork?

11. Does a nurse check your charting or just someone in the office?

Please feel free to comment so I can figure out if this pretty much the norm, if HHC is just hard overall. Also, answering any of the questions will give me an idea of what I can expect from other places.

I know it's been several days since this thread started, BUT. You poor thing!! Unfortunately, the agency I work with now (which is my first HH experience) gives precious little training, and NOT much more than 1 SOC. It is NOT acceptable, but many get away with it. Sounds like you have tried to work it out for a while, and in my opinion, it is time to move on. Give another company a shot, but stay in home health. Other nurses in the field can learn SO MUCH from you and you from them, as well.

To answer your questions, we use paper charting, they have promised us computer charting for more than one year.

Everyone IS supposed to attend CC, but usually we only get the Case Managers, the DON, and a couple LPNS.

We have had a terrible attendence record from any of the therapies-SW shows up regularly though.

We don't have distance "requirements" but our area is more than 60 miles in one direction.

The Oasis part of the SOC should be the same form, but companies may have difference processes and cover different process measures with different paperwork, i.e. if the patient is PT only and will get no SN, did you teach high risk meds at the SOC? One would think new staff would have to pass an Oasis eval test before they can start to be responsible for paperwork, but that must not be a popular opinion.

Yes, there must/should be an RN in the office to facilitate and follow up for RNs and LPNs in the field. It takes 15-20 minutes to get through just to leave a message for a doc sometimes, and though there are instances where the nurse in the field should report something since she witnessed it, there are definitely times when the RN in the office can help. They can request H&Ps, med lists, contact and follow up with patient complaints about other services. They should really coordinate all the care after the SOC-your task is to do a complete enough job to get he/she all the info they need to run with it.

Our agency orders pt supplies at SOC that are drop shipped, and from then, we only drop ship a week of supplies at a time to a pt, but many times lately, the field RN hasn't even been ordering supplies.

I do NOT have a DON help me. She was hired with supposed HH experience, but she knows precious little. I find that I end up educating her about most everything we interact on.

I will not do more than 2 SOCs in a day, and maybe one other small thing like a SNV or DC.

Paperwork is due within 48 hours. Case Managers should review what you submit, point out areas that need correction, and then you return it to them. We usually suggest that field staff negotiate a set number of hours with the DON for the field nurses to claim as training so they are compensated for the time they spending fixing things that they never learned how to do right in the first place. I know I had to do this when I was a new HH RN because I would get so frustrated every time I went in the office, CM would tell me what I needed to fix, but I already spent so much time on the SOC, I was working for free.

Like I said, it sounds like you are a self-propelled nurse-please try a different agency-we and the patients NEED good nurses who really care and try hard, and next time, take this list of questions with you if they want to offer you a job. Good luck!

Up Vote Up Vote ×

This sure sounds like it was written by ME!! I swear I am in the exact same position... except I have NOT been given an increase... How did I get here??

Up Vote Up Vote ×

Your questions are very right on and I agree, take them with you to your next interview. Stay in Home Health!!! You have already been "Baptized by Fire" and survived. We NEED nurses like you to help turn this thing around. I have been doing this for several years now and I DO NOT feel like ANYONE gives a crap about us or the pts we take care of. Only the NUMBERS get the attention.

Up Vote Up Vote ×

How does a "person in the office" take physicians orders??? Is that legal???

Up Vote Up Vote ×
Specializes in COS-C, Risk Management.

I am a "person in the office" and I take physician orders all the time. :D

Up Vote Up Vote ×

Thank you everyone for your feedback. I gave my 2 wk notice today. My last day is 11/13/11!!!!! I wasn't even mad when I gave notice. Usually I'm so frustrated I'm teary eyed. This morning I was in a "risk management" situation. I had no DON and the Director of the home health refused to answer her phone. She would text but would not answer. That's when I calmly finished my visit, went back to the office and placed my handwritten 2 week notice on her desk. It felt so good. I didnt even care that I didn't have a job already lined up. Thirty minutes after I gave notice, I received a phone call wanting me to schedule an interview. Kinda weird but maybe carma is on my side. :nurse:

Up Vote Up Vote ×
Specializes in telemetry, ICU, cardiac rehab, education.

I had a similar experience with home health, I felt sooo.. relieved when I turned in my two week notice.

Good luck with the interview!!

Up Vote Up Vote ×

Thank you so much Lou12. I'm nervous but not quite sure why lol. I don't yet have the norms for what visits,

SOCs, ROCs, Recerts pay for this area. I live in Phoenix, AZ.

Up Vote Up Vote ×

you know it funny,,,the door swings both ways, i am currently working in the office, have been in the field 25 yrs, so i have not forgotten what it is like! i have a new orientee, no HH experience is is furious after day one that she is not in the field "i know what to do"!!! so we try and give them appropriate orientation, they don't want it, we put them in the field and they can't do it....they get frustrated, complain and quit,,,,when you want to say "i told you so"./...so i have told her she needs to absorb as much as she can, one thing at a time, and still has attitude....so you just can't win!!

Up Vote Up Vote ×
Specializes in telemetry, ICU, cardiac rehab, education.

How great to have orientation with Home Health and someone to back you up! I have many years experience in nursing in ICU, PACU, teaching and so on but not home health. When I interviewed with the agency, I asked about orientation and was told oh yes we want you to feel ready. Huh really...no orientation on how to fill out an Oasis, just another RN who said here you work on this and ask me questions. Two weeks later both she and the branch manager quit leaving me as the only regular staff RN--yeah orientation..

Up Vote Up Vote ×
+ Add a Comment