I have recently returned to home health after spending most all my 20 years in ICU/CVR. I hired as the admissions/assessments nurse and part of the "management". I'm doing admits, recerts, post hospital, discharges, sup visits in a wide geographical area. Originally it was stated that my work would be 60% field, 40% office. In reality it's 100% field and the few times a week I'm in the office I'm writing like a fiend. This job also entails a good portion of case management/coordination too, until the case gets set up and all things rolling. Unfortunately, the job is killing me. I usually am on the absolute run 9 hours a day, last week there were 2 12 hour days and I am facing about 14 hours of paperwork right now because the entire last week was patients and miles. The DON said that nurses love home health because of the flexibility. What flexibility would that be? Perhaps I'm not working "smart". But, my daughter wants her mom back...Friday night my dog even chimed in by eating my pager! How many admits, recerts, etc should I be able to do in a week...including case set up and paperwork? Any responses, suggestions, advice, will be incredibly welcome. I'm worn out, stressed out, and have gained 10 pounds from sitting on my behind driving...this is totally not a good thing!
This company wanted a nurse to primarily focus on admissions so they would have a comprehensive assessment, complete Oasis, and plan of care. Here an admit consists of the Oasis, 485, med sheets (of course), CNA orders (of course again) SOC conference narrative, referral sheet and completed signature packet. I think there are about 10 or 11 pages requiring patient's signature and 12 spaces requiring their initials.
By the time I have explained everything they are signing, set up the home chart, explained the focus of home health, etc etc, it's about 2 hours in the home...1 1/2 if there is no particular "skill" involved (wound, IV, etc). Then by the time I have completed everything, including calls to physician, ICD and CPT coded, set all the goals and frequencies, written the 485,it's about another 1 1/2 to 2 hours!
Obviously I'm taking way too long! Although, it's not the Oasis...that's not too bad actually. Much of it can be done in the home.
How do you handle discharges? We are supposed to write a discharge Oasis, based on the most recent one, whether we visited or even saw the patient. So far I haven't done this...it doesn't seem quite cricket to me to write an Oasis based on a previous one! Why then, would they be discharged? I was asked to write on up on a patient that died at home. His Oasis reflected a living person for heaven's sake!
I've just come off 2 weeks of straight 9 to 11 hour days and am now brain dead.
The other thing...I also have to problem solve and troubleshoot most of these cases as they go...including anything that comes my way when I'm in the office. That's where I try not to be anymore, though...because it seems to come my way. The DON is not very competent apparently.
That is RIDICULOUS to have the pt sign 12 times!!! My agency has them sign ONCE!!
Also, it seems as though you are only using one OASIS?? We have several OASISES, one for d/c, one if the pt is re-hospitalized...3 pages, and a death at home OASIS 2 pages.
You need some secretarial support. Our field staff does NO coding, but In know another agency does, b/c they use laptops, and have a program to refer to, it is pretty easy to code that way. But, in my agency, the nurses just write the diagnosis and the data entry people code it. As a supervisor though, you would be expected to know the codes I suppose.
If you want, PM me your address, I would be happy to send you samples of the OASISES from my 2 agencies. Not all agencies do things the same way I have learned.
Your company has some process issues for sure. NO way would I do any more than 2 admits a day if that were the case.
Remember you can only be treated like a doormat if you allow it...Ann Landers
The exact count (culled from my 3 admits, 2 recerts and 4 visits I have yet to write, sigh): 9 signature lines (10 if CNA) plus 9 initial lines equals 18 places for "patient participation"!
16 page Oasis for SOC Recert
Discharge: 10 page Oasis plus Discharge narrative, Discharge instructions. We use this Oasis even if thy died! That's nutty to me.
I do have to code everything, prioritize the DX (which I should actually do that) and turn it in so, if all goes well, it gets typed and the DON signs it.
At post hospital I do a SCIC Oasis which I don't have with me, but I assure you we don't have an Oasis under 10 pages. I had no idea there were even options!
I kiss the tiny little toes of all of you...and I will pm you Hoolihan, as soon as I figure out how to do it. I will, though...and thank you so much. BTW, I'm not a supervisor!
I got the PM. I just finished my weekend and won't be back at agency #2 until Friday, so it will likely be a week or so before it even gets mailed, but it will get mailed. (The agency is 45 min from home, so it's not like I will just "ron over there," sorry. I am sure you can relate to not wanting to do any unnecessary driving, haha!
BTW I like the OASIS from agency #2 better, b/c it incorporates the care plan, goals, and orders all in one. It is 25 pages, but it eliminated sooooo many other forms! I'll also send you out admission packets.
Agency 1 uses carepaths, so you would have to select the correct one, and sometimes you can't figure out what you're going out there for by the crummy referrals we sometimes get. For this reason I usually grab 2 or 3 packets that I think may apply, and then I don't have to drive back for paperwork, even tho that office is only 7 miles from home. The admission note is generic, but you have to do goals for the carepath, and a careplan, and a tracking form. The notes are rather nice, b/c literally you just check off little boxes, and the forms are so detailed, that you rarely have to write more than 1 sentence for a Re-Visit.
So, be patient, it will come, if you think I forgot, please PM me, I don't have Alhiemer's, I have Sometimers." Hahaha, a pt of mine told me that one. :)
I have been having a VERY hard time w/ the new point system our agency is using...They expect FT RN to do 30pts/week w/ an admit counting as 2 d/c=1.5 and routine 1...they do not have extra points for driving(we have a 50 mile radius), or IV's, Labs, Extensive wound care/Wound vac. I work P/T 8am-2pm m-f and usually take extra admits QO weekend. I also am the "orientation nurse" training new field staff on the computer system, and in the field...I don't have a piont allowence for that!!! Where can I find some productivity scales??? How do they come up w/ these POINTS???
You have to remember that you will be able to complete your paperwork much more quickly after you get used to all the newness with the Oasis. It's just becoming accustomed to it. When I first started in hh, it used to take me a good 3 hours to complete it for admission. Now it usually takes about 45 minutes.
That being said, hh is crazy and busy. You never know what the day will bring and what you think will be an easy admission can turn into a nightmare and vice versa. I personally prefer to stay out of the office as much as possible as I find there are too many distractions to be very productive.
I have learned to see my patients, go home, be with my family and wait until they settle in for the night to finish my work. I work per visit prn so I don't have any quotas. But, in my office I believe it's 24 a week. Admission counts as 3, follow up or discharge counts as 2, any travel time over 30 mins between pts. counts as 1 per hour (60 mins from one pt to next= .5). Meetings, etc. are the same.
We have been getting TONS of IV's lately and complicated visits so any visit (not admission- just visit) past the one hour mark count (2 hour visit= 1 plus 1 for extra hour.)
Some days are very hectic indeed and others are a little more manageable. I personally prefer it to being in an institutuion setting but there are drawbacks.
Try http://www.housecalls-online.com there are some quality indictaors there, coding assistance, and, maybe you will find something like the point system.
Actually, your point system looks similar to our productivity, except we count a discharge as 1 pt, which stinks, but I am telling you, the reason you are struggling is because of your travel. I rarely put over 25 miles a day on my car, last weekend I did 29 and had 4 admits in 10 hours. Also, our preceptors only had 4-5 visits a day or 1 admit and 2-3 RV. They also got 50 cents more per hour. Speak up, you deserve compensation and a lighter load if you are orienting. It takes a lot of time to teach, and you deserve to be compensated.
I have applied for a job with a home health agency and they are asking me to do 6 sup visits a week plus QA. I can handle the QA part, however, I forgot what the sup visits were. If they consist of actually doing the certs/recerts, forget it. Please pm me with what a sup visit is.
I do about 24-30 visits per week.All types included. Travel involves 5 counties but they try to keep me in my home area. We are REQUIRED to do all documentation "point of care". This means before I drive to the next patient, my charting is done on the patient I just saw. This eliminates the paper work jam up. Recommend you do the same. Are you computerized? We have laptops. Most new home health RN's are overwhelmed at first with the paperwork. It gets easier. Hang in there. :)
I have recently returned to home health after spending most all my 20 years in ICU/CVR. I hired as the admissions/assessments nurse and part of the "management". I'm doing admits, recerts, post hospital, discharges, sup visits in a wide geographical area. Originally it was stated that my work would be 60% field, 40% office. In reality it's 100% field and the few times a week I'm in the office I'm writing like a fiend. This job also entails a good portion of case management/coordination too, until the case gets set up and all things rolling. Unfortunately, the job is killing me. I usually am on the absolute run 9 hours a day, last week there were 2 12 hour days and I am facing about 14 hours of paperwork right now because the entire last week was patients and miles. The DON said that nurses love home health because of the flexibility. What flexibility would that be? Perhaps I'm not working "smart". But, my daughter wants her mom back...Friday night my dog even chimed in by eating my pager! How many admits, recerts, etc should I be able to do in a week...including case set up and paperwork? Any responses, suggestions, advice, will be incredibly welcome. I'm worn out, stressed out, and have gained 10 pounds from sitting on my behind driving...this is totally not a good thing!
Cordially,
Goody
Dear Goody
Your are not whiny. I have been in Home care for 18 months now, And I have yet mastered the paper work. I recently decreased my hrs and My manager talked me into doing 10 hrs day x 4 days, having a day off. The paper work is very over whelming. Recerts, Oasis, Soc, roc, on and on. I Start my day at 8am with 6 patients a day, We do our paper work on computer, people come home very sick a basic visit is about 45 min, documentation 30-45 min. If the patient has several wounds you need to document on each wound. I would work 9-10hrs and getting paid for only 7.5 hrs. I case manage between 27-30 patients over a week. Responsible for all even if another nurse visits for you. Admissions equal three visits and the paper work is about 1-2 hrs. Not to mention travel time, blood draws and dropping off at the lab, all this included in your day besides paper work. I feel that I ready to leave home care. I really love home care, Hate the paper work.
I was in the same job as you. It is totally overwhelming and you never get the paperwork caught up during business hours. I wondered why there hadn't been anyone in that position for 9 months, (so I had 9 months of paperwork to do). I lasted 18 months. Even 10 years later there is an ad for this position every 1-2 years. I did home infusion also and was the liason between community hospices, VNA, and Agency for Aging. Don't let the job destroy your family life. I did and still regret the time I missed with my daughter.
Your are not whiny. I have been in Home care for 18 months now, And I have yet mastered the paper work. I recently decreased my hrs and My manager talked me into doing 10 hrs day x 4 days, having a day off. The paper work is very over whelming. Recerts, Oasis, Soc, roc, on and on. I Start my day at 8am with 6 patients a day, We do our paper work on computer, people come home very sick a basic visit is about 45 min, documentation 30-45 min. If the patient has several wounds you need to document on each wound. I would work 9-10hrs and getting paid for only 7.5 hrs. I case manage between 27-30 patients over a week. Responsible for all even if another nurse visits for you. Admissions equal three visits and the paper work is about 1-2 hrs. Not to mention travel time, blood draws and dropping off at the lab, all this included in your day besides paper work. I feel that I ready to leave home care. I really love home care, Hate the paper work.
You are in a job that has been classified as exempt. Other HHAs classify the same job as hourly. Over time, you will become faster at all your responsibilities, but you could have a geography and caseload that is not possible within a normal work week. If your agency is small, you wear many hats and have a large georgraphy to deal with. A larger more established agency will have confined territories for the purpose of enhancing efficiency and productivity of all staff. Chances are the field nurses are traveling all over creation as well. The director and the marketing person can improve this strategically and work on a densification plan. A business like this needs to grow if at all possible ,in ever larger concentric circles geographically. You focus on accounts nearest where the bulk of staff and the main branch offices are. Ideally, developing relationships with assisted living facilities where one nurse may have several patients in one location. As you grow, you widen the net and hire accordingly.
I was in the same job as you. It is totally overwhelming and you never get the paperwork caught up during business hours. I wondered why there hadn't been anyone in that position for 9 months, (so I had 9 months of paperwork to do). I lasted 18 months. Even 10 years later there is an ad for this position every 1-2 years. I did home infusion also and was the liason between community hospices, VNA, and Agency for Aging. Don't let the job destroy your family life. I did and still regret the time I missed with my daughter.
Thank you for responding, Some weeks I feel like all I do is work, After two days off trying to get family things accomplished, It's time for work again.
Can I ask what are you doing now. I started as a new grad for home health.
I have been with agency for over 20 yrs. I would like to do something else.
goodywhyte
18 Posts
I very much appreciate all your responses.
This company wanted a nurse to primarily focus on admissions so they would have a comprehensive assessment, complete Oasis, and plan of care. Here an admit consists of the Oasis, 485, med sheets (of course), CNA orders (of course again) SOC conference narrative, referral sheet and completed signature packet. I think there are about 10 or 11 pages requiring patient's signature and 12 spaces requiring their initials.
By the time I have explained everything they are signing, set up the home chart, explained the focus of home health, etc etc, it's about 2 hours in the home...1 1/2 if there is no particular "skill" involved (wound, IV, etc). Then by the time I have completed everything, including calls to physician, ICD and CPT coded, set all the goals and frequencies, written the 485,it's about another 1 1/2 to 2 hours!
Obviously I'm taking way too long! Although, it's not the Oasis...that's not too bad actually. Much of it can be done in the home.
How do you handle discharges? We are supposed to write a discharge Oasis, based on the most recent one, whether we visited or even saw the patient. So far I haven't done this...it doesn't seem quite cricket to me to write an Oasis based on a previous one! Why then, would they be discharged? I was asked to write on up on a patient that died at home. His Oasis reflected a living person for heaven's sake!
I've just come off 2 weeks of straight 9 to 11 hour days and am now brain dead.
The other thing...I also have to problem solve and troubleshoot most of these cases as they go...including anything that comes my way when I'm in the office. That's where I try not to be anymore, though...because it seems to come my way. The DON is not very competent apparently.
Sorrry for being so chronically witchy.