A few questions

[LauraRN13]

This is long, please bear with me. I’ve been doing HH about 9 months now. I did take a 3 month hiatus in there due to my son’s health issues. So 6 months experience. I’ve been a nurse 15 years, was so burnt out from the hospital! Worked labor and delivery, cardiac IMCU, SNF, and then ER for the past 8 years. I’m part time, no benefits (hubs works for the railroad with awesome benefits so don’t really need them) although PTO would be nice. No idea what the standard pay in Indiana is. I get paid per visit, which I’m fine with because one of my days I schedule my easy patients and am done pretty fast and still get paid for a full days work. No mileage reimbursement, which stinks, but my patients are for the most part relatively close. I make 35 per regular visit, 55 for SOC, and negotiated rates for special things like ivs, or if a patient lives further away. I still make more than hospital after not having to pay daycare since I only work on my husbands days off. We are Medicare only, very small company, and chart on kinnser. Now to my questions:

1. I have one LPN I am responsible for supervising, also the only LPN at the company. My company has me doing direct supervisory visits (have to coordinate with LPN schedule) every 4 weeks with her there. I do all her recerts, discharges, SOC, etc. It is so difficult trying to have a consistent schedule for my own patients (which some get upset about) and then trying to fit in her supervisory visits and recerts plus her aide supervisory visits. They make me do 2 direct (Again coordinating with Aide schedule) every 4 weeks also. I do get paid 25 for supervisory visit and don’t have to stay for whole visit or chart except for the quick one page form on how LPN is doing. So, super easy, just hard to fit in. I read in CMS guidelines that LPN and aide supervisory visits only need to be done annually unless there is a problem. Is this true, something I should bring up to my boss? The LPN laughed when I asked her about setting up supervisory visits, said she hasn’t been supervised in years but is fine with setting them up with me.

2. Trouble with supplies. They always seem to be out of stuff and are super stingy with what I get. I have no back up supplies if needed and sometimes don’t have enough wound supplies for my patients with wound orders. What can I do about this? Buy my own?

3. I have a few patients that are insanely inflexible with visit day/time. I have to back track so much just to see them at the time they want. Am I allowed to tell them no to their specified time?

4. I was told when I interviewed that after 3 months my visit rate would go up to 38. Right as we were discussing it, is when I had to take a 3 month leave for my son. Since I’ve been back, it has not been brought up. How do I bring it up again? I am super non confrontational and those conversations are so hard for me!

5.) I do my charting at home at night when my kids go to bed. I would love to be able to do some charting in homes or in my car when I have time between visits. I have my iPhone, a personal tablet, and personal laptop at home. How do u chart in homes without WIFI on your laptop???

6.) would love to get a second part time job doing postpartum/baby visits. What companies do this?

I really do like HH, and I looove the company I work for. Seriously, the nicest people ever to work for. They make sure patients are all well cared for. Some of the above things just really get on my nerves and I don’t want to end up feeling resentful and end up quitting because of it! Since we can’t claim mileage anymore on taxes, (unless you are above the standard deduction), I feel like that screws me a bit! I see anywhere from 14-25 patients a week depending on how many LPN recerts and supervisory visits I do.
Any advice on any of my dilemmas?
Thanks!

[limitless7]

how do you make a post?

[LauraRN13]

Once u make an account, you should be able to post. If u want to make a new post, go to the HH forum home page and click new topic

[chrisjk]

I worked in home health for 10+ years, and I was never asked to do a supervisory visit with an LPN(they are licensed!). Sup visits for CNAs yes, every 2 weeks. As far as being stingy with supplies; if you have to buy any with your own $ you need to then submit a receipt to your company so that you can be reimbursed. They need to provide what is needed for the patient.period. I did have some patients who wanted certain days to be seen but would always be willing to work with me(dialysis patients of course...) For those who are incredibly inflexible I would be asking if they're truly homebound; if not, they need to be discharged. I ended up doing most of my documenting at home as well, but otherwise I would use my phone as a mobile docking site for my laptop(my cell provider charged me $10/mo for that and I had an android phone)---that ensures that your connection is private. Can't help you regarding the other questions; I'm a bit of a "shrinking violet" myself and have always just accepted the pay given....however, since they offered that to you before, I don't know why you couldn't just casually bring it up, especially since it sounds like they're decent people(perhaps they just forgot?). Good luck in your career!

[DallasRN]

I can tether my chromebook to my phone. I have unlimited data/phone/text/etc. with my carrier. Check on that. Also, I'm not so certain your company is so wonderful based on your pay rates (I'm in a metro area so probably much higher), no mileage, running around here and there. $55 for a SOC? That is low IMO. Look at the time involved in a SOC. Figure out the number of hours a day you spend total - visits, driving, charting, add in gas/wear and tear on vehicle cost - what does your true hourly rate come to? Beyond that....

As for buying your own supplies, I had an "experienced" nurse con me into doing that at one time. Huge expense! Don't get caught up in that. When the company gets the order for home health/wound care, they should be obtaining the supplies. And you should always have basic supplies in your "go box". What if you're in a patients home to check cardiac status and they fall in front of you. You need to be able to provide basic wound care/stop the bleeding, etc. Ask some of the more highly experienced HH nurses for a list of supplies for your "go box".

Totally agree with chrisjk. If they are that inflexible they are not homebound and makes me wonder why they are on service. Just like they are going to accept appointment availability at at doctors office, they should accept your availability, too, as long as you're being a bit flexible. However, you will burn yourself out in a hurry if you're having to double back, run around helter-skelter. Nope. Don't do it.

I didn't do LVN sup visits, either. Just CNA's. Have your agency look at the policy.

Money. Square your shoulders up and march into the office with a friendly but confident smile and tell them you need to talk about the raise previously discussed and you were counting on. I would also mention an increase in the SOC rate. You have great value as an experienced nurse but also now as an experience HH nurse who really seems to enjoy the job and eager to learn more. Good luck!!

[caliotter3]

A colleague who did visits told me that she gave the clients a two hour window in her tight daily schedules. If they didn't want to cooperate, that was that. She wasn't going to budge for them. Nor was she going to mess up the schedules of her other clients. Of course, she was backed up by her agency. Most of us have agency supervisors who would make us bend over while the clients call the shots.

[Tats89]

Hey

55$ for a SOC ?!? That’s crazy it takes me anywhere from 2 to 3 hours. Inacceptable! I’m sorry ?

1- I don’t do direct supervisory visit.

2- Don’t buy your own supplies. Please talk to your Clinical manager about this. How can you do your job without supplies ? Most discharging facilities will give patient enough supplies for wound care until you’re able to order more supplies for your patient.I also would not buy my own supplies for exemple : blood draw... especially at that rate ?

3- I cover a vast area and I am really busy so I usually propose a visit time ( always 2 hour window ) and sometimes I can be flexible but most days I can’t. If my time for that day doesn’t work I’ll just reschedule the patient for another day and if by the end of the week I don’t see the patient, Because he’s too “busy”, then patient doesn’t need me. When patients are annoying I just ask straight up “ do you need my help/care?”. You’ll get an honest answer. I understand when patients have appointments but otherwise it’s all about their priorities. I try to use a calendar at SOC and will tell patient : I’ll see you Thursdays Am/pm but will call night before for a more specific window or to reschedule if something comes up on your end or my end.

4- I don’t have any advice sorry.

5- I’m using HCHB on the agency’s Samsung tablet And have internet 3G integrated. I do most of my charting while I am with patient or in my car but I am on the road usually from 8 am to 3-4 pm on a busy day.

6- don’t know sorry, I might start to do IV Infusion on the side ?

Good luck