what is your day like for nursing home/ALF visits?

[gatorxo]

Just wondering what everyone's thoughts are on this position. I've been researching primary care role with a dr that includes making rounds in nursing homes, assisted living facilities, and some home visits that are through a home health company. The position is a 1099 and requires a minimum of 100 patients to be seen per week, with bonus incentives for anything over that. All facilities are within 10-15 min of each other, so not too much driving around. My question for anyone with this experience is what are your typical hours and how much time are you spending with each patient? I was told they are relatively stable and once you are familiar with each of them, you can move throughout your day pretty quickly. Starting out the min is around 60 per week and there is some training provided. Just curious what your thoughts are. Thanks

[TX RN]

I self-contract with a physician that has patients at a several nursing homes.

I'll be happy to answer your question:

1. What are my typical hours?

Start to finish.

Since I am self-contracted I don't have a minimum number of encounters I need to make. This makes my rounds extremely flexible. I can see as many or as few pt's as I want/need.

So with that said, the hours are whatever I choose to make them. I can start early, like say 0600 and be done by noon. For the most part I average about 3.5 pt's per hour. And there have been days where patient condition necessitates an encounter, and there have been 10-14 hour days where I see 25-30 patients. My productivity declines as the work day hours increase, so I try to keep my work day to no more than 8 hours the majority of the time.

2. How much time are you spending with each patient?

New encounters typically are about 30-40 minutes.

F/u's can vary between 10 minutes to 30 minutes. Depends how complex the patient is.

My experience in this line of work has given me some insight on things I know now that I didn't know when I started. I'll share them with you and post them as questions for you.

1. Will you be taking call?

Call can impact your productivity dramatically. If you haven't been told if the position involves call, I would ask how much and how often. Night call blows too.

2. How many patients are in each nursing home?

Driving to a place for less than 5 patients is not ideal. Windshield time can grow long in the tooth with low census facilities.

3. Are these skilled pt's or long term patients?

Skilled pt's can at times be a bit more complex. The trend from hospitals continues to push pt's out earlier and discharge sooner in the course of illness. You will find a very high emphasis on prevention of readmissions and a need to develop high acumen for picking up on subtle changes in condition. It becomes challenging especially when taking into account the disparity of nurse staffing when compared to hospital units.

[gatorxo]

Thanks so much TX RN for your comments and for sharing your experiences! Initially I was hesitant, as it seemed like a lot to accomplish in one day, but I think once I get into the swing of things it will become easier. Your questions bring up some great points that I will have to find out about. I know I will be taking call during the day for the facilities I'm rounding in, but I will not have night or weekend call. Thanks again for your time and advice! I will have to do some more research!