And the survey says? To all home care nurses who switched from hospital.........

camoflower · Mar 18, 2015

I love home health. I am single. I can not see myself in this field with children, nor, if I did not have a very supportive husband. I have seen husbands bring in the equipment, bag, computer and phone verbalizing very sternly "she will not be coming back", that's how that one quit. Large turn over, you either like it or hate it. We see 5-7 patients per day, huge paper workload, get paid 8 hours per day, lots of your home time spent charting. Three years ago I could sit and politely chat to the patient and work too, lately I have my head down typing, like a mad squirrel. I feel rude, in their home, we get where we can't visit, because of all the paper work. Physicians orders are received, doc com made, verbal order made, calendar updated, slow computers ..takes time. Oasis knowledgeably takes time, months to learn. Organizational skills is a must. If it only paid more, if I could have some of my home time back. I'd stay forever. But, I've put 30,000 on my car every year, my salary doesn't reflect what I am worth, my files and supplies overrun the car. If you took my salary I probably make 8.00 per hour. I sleep with my phone, I wake up from dreams thinking...got a "BMP" order, did I put that order in, and order the supplies, and enter the date on the calendar...yes, you did. When we discharge, its call the doc get the order, enter the order, doc com the order, do the discharge, don't forget to document you provided a medication sheet, instructed the follow up ..then do the Agency Discharge. I sigh. We are the paper work charting masters. Car, no Friday nite date night, drive lots, charting never ends... I don't know anymore. I am getting so tired of working 60 hours per week.

babynurse73 · Mar 18, 2015

Wow camoflower! Thank you for the honest assessment! I have been told it takes getting used to, and a good year to get a rhythm going. I've been in the hospital 15 years, my time management and organizational skills are very good. I was told if you are able to chart in the patients home you are at an advantage to getting your charting done in a timely manner. I'm really scared to make the switch. In addition I will be taking a pay cut. But I am so tired of the hospitaldistractions low morale spinning my wheels, don't feel like I am a nurse at all! 75% of my job is sitting at the desk charting and keeping the lid down on a boiling pot! I work in psych at the moment. I did labor and delivery for many years as well. I come home exhausted! i'm so scared to make the switch that I have a lump in my throat but I've been up sussing about this for a couple of years. I think I'm just going to have to make the jump and a leap of faith.....but God I certainly don't want to work 60 hours a week!

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Wendy

KelRN215, BSN, RN · Mar 20, 2015

I never chart at home and I turn my phone off at 4:30pm. People can call me during normal business hours and they can call the on-call nurse afterwards. The ONLY time I sleep with my work phone is when I'm being paid to be on-call. Other than that it's literally never on when I'm home. I make more money than I ever made in the hospital- significantly more. Like $15k a year. Leaving the hospital was the best thing I ever did for my quality of life. I don't understand all these home health nurses who say it's not possible to have a life and do home health. I have a life. I go out almost every night of the week and travel out of town most weekends. My social life is significantly better than it was in the hospital because I don't work nights or weekends anymore. I never thought I wanted a Mon-Fri but, now that I have it, I can't imagine going back. I have the same schedule as my friends and when they ask "what are you doing Friday night?" I don't have to say "working." I work 40 hours/week, period. All my charting is done between the hours of 8am-4:30pm.

babynurse73 · Mar 20, 2015

Thank you for that!!! Yesterday I was offered a position. I took it. 40 hours and a bit of a pay cut but I am very excited! It is nice to hear a positive review:)

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Wendy

daisyRN1, BSN, RN · Mar 20, 2015

I also accepted a home health position! I am excited to have the same schedule as my friends and family, and to leave the stress of the hospital. I am really afraid of this change- but at the same time I feel I will be much happier. Right now my hospital job makes me discouraged and I never feel like I can do all that I want to for my patients. I am told I am good at what I do and I get good feedback from my patients, but I really feel like the patients deserve more. I am also frustrated with coming to work early, leaving late, not taking a lunch and not getting paid for that time! (The hospital I work for doesn't have a time clock to punch in or out, so we have to page our nsg supervisor and fill out paperwork whenever we don't take a lunch or leave late and explain why--too much of an ordeal for me when I just want to get out asap at the end of my shift.) Maybe I will do a per diem hospital job once I am situated, but I am really excited for this opportunity. I shadowed a home health nurse and I loved the patient interaction.

Libby1987 · Mar 20, 2015

You will likely be working long hours in home health as well, especially at first. Sounds like you guys are hourly so there will also be pressure to avoid OT. And with hourly/salary there iare higher productivity expectations to meet.

Most of my career has been HH and I love it. But HH isn't easy, different but not easy. It's a different type of pressure. You will feel like you gave good care because there is time to do it, but the documentation burden is heavy.

I like to see nurses be successful in HH but so many are blindsided when they come (escape) from acute care. Be prepared for it to be rough for awhile, IMO it's worth it to get to the place where you're more efficient but it takes time.

irishgrace · Mar 20, 2015

I thought maybe I would want to do home health one day but I've read so many stories of nurses working 60 plus hours a week and always feeling like they are working that Ive had second thoughts. I own my own business and one of the reasons I want to get into nursing, is to feel like after I clock out, my time is my own. When you have your own business, it feels like your are always and i mean always working. yuck.

babynurse73 · Mar 20, 2015

I appreciate the comments! I'll have to put in the time and effort like anything. I did labor and delivery for 7 years..... I remember coming home crying the first year or so. Now I'm in psych and my unit is unsafe, plain and simple. Mostly due to staffing and unrealistic expectations, not to mention about 75% of my job is charting! I'm very dissatisfied with the hospital environment in general. I will never advance, unless I want to be a floor manager, which I don't. (Poop rolls downhill)....ðŸ˜³

I need a fresh start. Thank you for the dose of realism, I do have high hopes :-)

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Wendy

toomuchbaloney · Mar 20, 2015

I never chart at home and I turn my phone off at 4:30pm. People can call me during normal business hours and they can call the on-call nurse afterwards. The ONLY time I sleep with my work phone is when I'm being paid to be on-call. Other than that it's literally never on when I'm home. I make more money than I ever made in the hospital- significantly more. Like $15k a year. Leaving the hospital was the best thing I ever did for my quality of life. I don't understand all these home health nurses who say it's not possible to have a life and do home health. I have a life. I go out almost every night of the week and travel out of town most weekends. My social life is significantly better than it was in the hospital because I don't work nights or weekends anymore. I never thought I wanted a Mon-Fri but, now that I have it, I can't imagine going back. I have the same schedule as my friends and when they ask "what are you doing Friday night?" I don't have to say "working." I work 40 hours/week, period. All my charting is done between the hours of 8am-4:30pm.

Here is the evidence that charting at POS is THE ONLY WAY to make home care profitable for the nurse.

Well done!

UpTheLadder12 · Mar 21, 2015

I do home health and hospice, and even though I love the nature of the work, I was at first very miserable, broke, and fairly certain that I was going to have a stroke before I was 40. I have learned some valuable things, and here's my Ultimate Guide to Enjoying Home Health:

Work for several agencies at once if you are Per Diem- Donn't give one agency a monopoly on your time. This way you can be a little more picky on accepting patients and you can keep your service area within a reasonable distance of your home, or in less trafficky spots. This also gives you more job security as the patient load fluctuates throughout agencies, you have more control over keeping steady income.

Become super ultra organized. I made myself a huge binder with reference to data like lab values, wound assessment, and common home health and hospice diagnoses and interventions. No matter how much experience you have or how good you are, your brain will be fried after a long day of work and traffic, and it helps to have the data right in front of you so that your mind can go straight to the critical thinking and planning.

*Like previous posters have said, you must to do your charting in real time, otherwise you will be charting when you should be sleeping or spending time with your family. I have learned to put nothing off. I used to try to see several patients in a row and then block out time for charting and giving reports, but something always gets in the way, there is just no way to plan other than to expect the unexpected. So I do spend part of each visit with my face in the computer, or the paper chart, depending on the agency, but I still manage to find some time to visit to listen and engage with the patient and give a thorough assessment, and even though this makes it feel like the visits are longer by charting on site, my days are anywhere from an hour to three hours shorter by forcing this habit of finishing all charts and reporting on the patient before even thinking about the next patient.

*Also regarding organization, the back of my car is literally a mobile supply closet, with everything I might need for visits. My nursing bag is huge and organized as well with everything from my paperwork to paper towels, hand sanitizer, small trash bags etc. so that I don't have to spend a lot of time asking the patient and family for things when it comes to my infection control measures, wound care etc. I pretty much just need to find a workable surface and I have everything that I need in my bag. I went to a lot of trouble to invest in specific plastic bins to organize things in a way that makes sense to me personally in the back of my trunk and my car used to literally look like a trash dump, so I finally got into the habit of always bringing my supplies from the visit and putting them directly into their place in the trunk, and keeping a food trash bin in the car for eating on the road.

*And I also used to do a lot of drive-thrus for coffee and food, BECAUSE IT'S SOOO TEMPTING when you drive past all of your faves all day, and you technically have the time to stop if you want to. and I now save sooooo much money and time by taking a little extra time in the evening or early morning to prepare food for myself, and I bring a couple large thermoses as well as a reusable Starbucks cup with all of the coffee and tea that my heart desires, as well as lots of water and lunch and snacks, because for some reason I just get so hungry out on the road. Any "quick" stops are surprising time suckers. Making my own food has also helped me to stay healthy and lose a little bit of weight and I spend so much less.

if you are a contractor, which you almost always are per diem except for very rare cases, take advantage of this and keep all receipts and write everything off on your taxes. I mean literally anything that you bought that you're using in the course of your workday. You are essentially your own small business, the government is taxing you accordingly, so it is literally giving money away if you do not write off the same expenses that any other small business would write off.

And last but not least is boundary setting- Of course when you are brand-new you don't have a lot of options, you are at the bottom of the food chain, and that's natural in any job. But after almost 3 years in the field, and garnering a good reputation from coworkers and from patients and families, I was able to start demanding more. I now set a bar for what I will accept in pay, including additional mileage for distance or extremely complicated cases with a lot of wound care and/or complicated family dynamics. So it pays to work hard, go the extra mile, but then do not let a company or administrator run you into the ground.

Like previous posters have said, the turnover is very high. These companies are not stupid. Whether they are clearly willing to let people go in order to find new people to abuse, at least half of the companies that I've worked with are smart enough to see that when you have someone who really knows what they're doing and can save everyone's butt in certain situations and/or train other staff , and help them pass survey; often times they will be willing to pay that extra bit, meet your demands, because they are after all saving so much money by being cheap in any way they can, unfortunately. Remember, since they have chosen to go Per Diem in order to be cheap, that also gives them the disadvantage of not having control over their nurses' time. Most of these companies are extremely disorganized and chaotic when it comes to having nurses available for distance cases and after hours cases, or they have a lot of turnover very suddenly. This is why working for several agencies is important, that way you won't feel desperate when one company is asking a lot of you and you know it's because they have a nursing shortage, you can turn the tables and say "sure I'll do these visits for you for X amount of additional pay and mileage, etc." Any visits that go over 1.5 hours, or are so outside of the area that my round trip plus visit is 2.5 hours total time from the next patient or the agency office, I get authorization for increased pay for my time. They'll agree when they know that you are thorough and you won't end up costing them time with QAPI problems or having to send out another nurse because you missed something, or if they simply have no one else to go.

I often am not fond of some of the agencies that I work for and their practices, but I have learned that regardless of Home Health, SNF, Hospital, almost every nurse I know is burnt out and feels that the company they work for is money over people. So instead of trying to take on the whole system myself, I just try to give the patients my absolute best, and take comfort in the fact that regardless of what else they experience in healthcare, that they at least received quality, genuine care while I was assigned to them. And then I make sure to take care of myself as well. I have friends and family who depend on me, so I am not doing anyone any favors by allowing some money hungry company to burn me out and make me a less effective mother, friend,etc.

The $$$ -I've done the math on my current status, and I am making approximately $27 an hour as an LVN in Los Angeles in home health and hospice after my travel and other expenses are figured. This includes factoring in unpaid time at the office, meetings, and the rare occasions that I do have to go back into the chart when I'm not "working". ( RNs can make $50 per hour after expenses, based on their visit rates at my agencies, if they follow the same system. But of course they have a more volatile schedule since the nature of their visits are different and can be harder to anticipate ) This does not include any benefits, so if you did the math on what I'm paying out-of-pocket for my health insurance and considering the lack of vacation, sick time, and other benefits, it would probably be the equivalent of $25 an hour at a salaried position. Another major plus is that I have a lot of flexibility and freedom, even though I don't have paid vacation, I also don't have to miss work to see my son's school performances, attend his field trips, or attend any other important family gatherings or other things in life that matter. Essentially all I have to do is reschedule my patients and I can still get my hours in around my personal life. Also pays big time to make allies at your companies, cover for them if they do need to have you see their patients for a day or week, and it'll get you some extra pay, and then you can rely on them to see your patients at times that you can't or don't want to reschedule if you are going out of town or sick etc.

As much as I want to pull out my hair a lot of the times, I hear the same complaints from my friends who work in hospitals and SNFs about horrible management, unpaid time, and stress, so based on the overall freedoms I enjoy in the field, I can never imagine going to a salaried position again.

Libby1987 · Mar 21, 2015

I do home health and hospice, and even though I love the nature of the work, I was at first very miserable, broke, and fairly certain that I was going to have a stroke before I was 40. I have learned some valuable things, and here's my Ultimate Guide to Enjoying Home Health:
Work for several agencies at once if you are Per Diem- Donn't give one agency a monopoly on your time. This way you can be a little more picky on accepting patients and you can keep your service area within a reasonable distance of your home, or in less trafficky spots. This also gives you more job security as the patient load fluctuates throughout agencies, you have more control over keeping steady income.
Become super ultra organized. I made myself a huge binder with reference to data like lab values, wound assessment, and common home health and hospice diagnoses and interventions. No matter how much experience you have or how good you are, your brain will be fried after a long day of work and traffic, and it helps to have the data right in front of you so that your mind can go straight to the critical thinking and planning.
*Like previous posters have said, you must to do your charting in real time, otherwise you will be charting when you should be sleeping or spending time with your family. I have learned to put nothing off. I used to try to see several patients in a row and then block out time for charting and giving reports, but something always gets in the way, there is just no way to plan other than to expect the unexpected. So I do spend part of each visit with my face in the computer, or the paper chart, depending on the agency, but I still manage to find some time to visit to listen and engage with the patient and give a thorough assessment, and even though this makes it feel like the visits are longer by charting on site, my days are anywhere from an hour to three hours shorter by forcing this habit of finishing all charts and reporting on the patient before even thinking about the next patient.
*Also regarding organization, the back of my car is literally a mobile supply closet, with everything I might need for visits. My nursing bag is huge and organized as well with everything from my paperwork to paper towels, hand sanitizer, small trash bags etc. so that I don't have to spend a lot of time asking the patient and family for things when it comes to my infection control measures, wound care etc. I pretty much just need to find a workable surface and I have everything that I need in my bag. I went to a lot of trouble to invest in specific plastic bins to organize things in a way that makes sense to me personally in the back of my trunk and my car used to literally look like a trash dump, so I finally got into the habit of always bringing my supplies from the visit and putting them directly into their place in the trunk, and keeping a food trash bin in the car for eating on the road.
*And I also used to do a lot of drive-thrus for coffee and food, BECAUSE IT'S SOOO TEMPTING when you drive past all of your faves all day, and you technically have the time to stop if you want to. and I now save sooooo much money and time by taking a little extra time in the evening or early morning to prepare food for myself, and I bring a couple large thermoses as well as a reusable Starbucks cup with all of the coffee and tea that my heart desires, as well as lots of water and lunch and snacks, because for some reason I just get so hungry out on the road. Any "quick" stops are surprising time suckers. Making my own food has also helped me to stay healthy and lose a little bit of weight and I spend so much less.
if you are a contractor, which you almost always are per diem except for very rare cases, take advantage of this and keep all receipts and write everything off on your taxes. I mean literally anything that you bought that you're using in the course of your workday. You are essentially your own small business, the government is taxing you accordingly, so it is literally giving money away if you do not write off the same expenses that any other small business would write off.
And last but not least is boundary setting- Of course when you are brand-new you don't have a lot of options, you are at the bottom of the food chain, and that's natural in any job. But after almost 3 years in the field, and garnering a good reputation from coworkers and from patients and families, I was able to start demanding more. I now set a bar for what I will accept in pay, including additional mileage for distance or extremely complicated cases with a lot of wound care and/or complicated family dynamics. So it pays to work hard, go the extra mile, but then do not let a company or administrator run you into the ground.
Like previous posters have said, the turnover is very high. These companies are not stupid. Whether they are clearly willing to let people go in order to find new people to abuse, at least half of the companies that I've worked with are smart enough to see that when you have someone who really knows what they're doing and can save everyone's butt in certain situations and/or train other staff , and help them pass survey; often times they will be willing to pay that extra bit, meet your demands, because they are after all saving so much money by being cheap in any way they can, unfortunately. Remember, since they have chosen to go Per Diem in order to be cheap, that also gives them the disadvantage of not having control over their nurses' time. Most of these companies are extremely disorganized and chaotic when it comes to having nurses available for distance cases and after hours cases, or they have a lot of turnover very suddenly. This is why working for several agencies is important, that way you won't feel desperate when one company is asking a lot of you and you know it's because they have a nursing shortage, you can turn the tables and say "sure I'll do these visits for you for X amount of additional pay and mileage, etc." Any visits that go over 1.5 hours, or are so outside of the area that my round trip plus visit is 2.5 hours total time from the next patient or the agency office, I get authorization for increased pay for my time. They'll agree when they know that you are thorough and you won't end up costing them time with QAPI problems or having to send out another nurse because you missed something, or if they simply have no one else to go.
I often am not fond of some of the agencies that I work for and their practices, but I have learned that regardless of Home Health, SNF, Hospital, almost every nurse I know is burnt out and feels that the company they work for is money over people. So instead of trying to take on the whole system myself, I just try to give the patients my absolute best, and take comfort in the fact that regardless of what else they experience in healthcare, that they at least received quality, genuine care while I was assigned to them. And then I make sure to take care of myself as well. I have friends and family who depend on me, so I am not doing anyone any favors by allowing some money hungry company to burn me out and make me a less effective mother, friend,etc.
The $$$ -I've done the math on my current status, and I am making approximately $27 an hour as an LVN in Los Angeles in home health and hospice after my travel and other expenses are figured. This includes factoring in unpaid time at the office, meetings, and the rare occasions that I do have to go back into the chart when I'm not "working". ( RNs can make $50 per hour after expenses, based on their visit rates at my agencies, if they follow the same system. But of course they have a more volatile schedule since the nature of their visits are different and can be harder to anticipate ) This does not include any benefits, so if you did the math on what I'm paying out-of-pocket for my health insurance and considering the lack of vacation, sick time, and other benefits, it would probably be the equivalent of $25 an hour at a salaried position. Another major plus is that I have a lot of flexibility and freedom, even though I don't have paid vacation, I also don't have to miss work to see my son's school performances, attend his field trips, or attend any other important family gatherings or other things in life that matter. Essentially all I have to do is reschedule my patients and I can still get my hours in around my personal life. Also pays big time to make allies at your companies, cover for them if they do need to have you see their patients for a day or week, and it'll get you some extra pay, and then you can rely on them to see your patients at times that you can't or don't want to reschedule if you are going out of town or sick etc.
As much as I want to pull out my hair a lot of the times, I hear the same complaints from my friends who work in hospitals and SNFs about horrible management, unpaid time, and stress, so based on the overall freedoms I enjoy in the field, I can never imagine going to a salaried position again.

There is a lot of experience speaking here.